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Coming Together to Improve Outcomes for Vulnerable Children and Youth

Coming Together to Improve Outcomes for Vulnerable Children and Youth. BRYAN SAMUELS, COMMISSIONER ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES. CHILDREN IN FOSTER CARE ON 9/30. STATE CHANGES IN CASELOADS: 2002-2011.

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Coming Together to Improve Outcomes for Vulnerable Children and Youth

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  1. Coming Together to Improve Outcomes for Vulnerable Children and Youth BRYAN SAMUELS, COMMISSIONERADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES

  2. CHILDREN IN FOSTER CARE ON 9/30

  3. STATE CHANGES IN CASELOADS: 2002-2011 Data Source: Adoption and Foster Care Analysis and Reporting System, U.S. Department of Health and Human Services

  4. ACYF’s Priority:INTEGRATING WELL-BEING WITH SAFETY AND PERMANENCY TO ACHIEVE BETTER OUTCOMES FOR CHILDREN, YOUTH, AND FAMILIES

  5. Healing and Recovery SOCIAL AND EMOTIONAL WELL-BEING FOR CHILDREN, YOUTH, AND FAMILIES Assessment drives individualized treatment plan with evidence-based interventions Systematic approaches to teaching coping skills and social skills Nurturing environments provide security and promote positive outcomes Supportive, responsive relationships promote healing and recovery and reinforce growing social and emotional skills Systems and policies promote and sustain screening, assessment, the use of evidence-based interventions, progress monitoring, and continuous quality improvement Adapted from the Technical Assistance Center on Social Emotional Intervention for Children and the Center on the Social and Emotional Foundations for Early Learning

  6. ACHIEVING BETTER OUTCOMES context: therapeutic, responsive & supportive settings & relationships Validated Screening Case Planning for Safety, Permanency, and Well-being Outcomes: Safety, Permanency, Well-Being Evidence-based Intervention(s) Clinical Assessment Functional Assessment Progress Monitoring social-emotional functioning

  7. INTEGRATING A FOCUS ON WELL-BEING THROUGHOUT CHILD WELFARE Many child welfare requirements and activities already taking place could be reconceived to support children’s well-being:

  8. ESTABLISHING THE RIGHT SERVICES ARRAY: DE-SCALING WHAT DOESN’T WORK, SCALING UP WHAT DOES De-scaling what doesn’t work Investing in what does INEFFECTIVE APPROACHES RESEARCH-BASED APPROACHES

  9. A TRAUMA-FIRST APPROACH CAN IMPROVE OUTCOMES FOR CHILDREN WITH COMPLEX NEEDS Number of symptoms pre- and post-treatment with CBT among children 3-6 years-old with PTSD • Children who have experienced trauma have significant behavioral health needs, which drive their health care costs • The Academy of Child and Adolescent Psychiatrists recommends psychotherapy as the first-line treatment for PTSD; yet many children receive medication first and in the absence of evidence-based psychosocial intervention. • A trial of Cognitive Behavioral Therapy (CBT) with 3-6 year-old children with PTSD demonstrated improvement across symptom categories: Scheeringa, 2013

  10. EXAMPLE: PERMANENCY INNOVATIONS INITIATIVE

  11. EXAMPLE FROM PII: KANSAS INTENSIVE PERMANENCY PROJECT (KIPP) • Part of the Permanency Innovations Initiative (PII), KIPP is conducting a five-year demonstration to reduce long-term foster care, targeting children ages 3-8 with severe emotional disturbances (SED) • During the planning year, KIPP engaged in an intensive, intentional process to understand their population and design an effective intervention strategy

  12. DEFINING THE TARGET POPULATION • Research indicates that children with SED are more likely than their peers to experience long-term foster care. KIPP had to identify these children and understand who they are in order to design an intervention strategy. • SED status is determined by the presence of any two of the following criteria: • A mental health diagnosis • A CBCL t-score of 70 on any of the 3 subscales or a CAFAS total score of 100, or 30 on any two subscales • Psychiatric hospitalization

  13. CONDUCTING EXTENSIVE DATA ANALYSIS • Bivariate and multivariate analysis of child and case characteristics associated with long-term foster care • Case record review of family risk factors in 30 long-term foster care cases • Electronic survey of systemic barriers to permanency for children with SED Findings • Children with SED are more than 3 times more likely than their peers to experience long-term foster care • Children with SED who experience long-term foster care are more likely than children in every other comparison group to have both internalizing and externalizing diagnoses. They are also more likely to present with co-occurring developmental disorders.

  14. REVIEWING AVAILABLE EVIDENCE-BASED INTERVENTIONS • Began exploring models of Intensive Family Reunification Services (IFRS). Consultation with child welfare researchers shifted focus to evidence-based parent training models to supplement IFRS. • Worked to line up potential interventions with expected child- and system-level outcomes. • Considered implementation science, including adaptability and sustainability

  15. SELECTING AN INTERVENTION AND PLANNING FOR IMPLEMENTATION • Narrowed down to two options, and selected Parent Management Training-Oregon Model (PMTO) • Factors impacting selection of evidence-based parent training model: • Fit with needs of target population • Ability of intervention to reduce long-term foster care • Long-term sustainability and anticipated systems changes • Consulted with EBP purveyors and some of its implementers with specific focus on tailoring it to the needs of the foster care population with SED.

  16. KIPP SERVICE MODEL OVERVIEW

  17. AN EVIDENCE-BASED INTERVENTION THAT INTEGRATES SAFETY, PERMANENCY, AND WELL-BEING: KEEP

  18. KEEPING FOSTER & KIN PARENTS SUPPORTED AND TRAINED (KEEP) • Group intervention for foster and kin families with children who have demonstrated externalizing problems, mental health problems, problems in school, or problems with peer groups. • KEEP is a form of Multi-dimensional Treatment Foster Care for regular foster and kinship families. • Essential components include: Weekly parent support and training group sessions Supervision for parents in behavior management methods Parent Daily Report Checklist Calls • Reduces changes in placement, increases reunification, increases positive parenting skills for foster parents.

  19. OVERVIEW OF KEEP COMPONENTS

  20. OUTCOMES FROM KEEP IMPLEMENTATION KEEP was effective in reducing behavioral problems among children with mild to severe behavior problems at baseline. Price, JM; Roesch, SC; & Walsh, NE. (2012). Effectiveness of the KEEP foster parent intervention during an implementation trial. Children and Youth Services Review. 34:2487.

  21. EXAMPLE OF STATEWIDE KEEP IMPLEMENTATION • According to an evaluation of KEEP results, if the intervention were implemented in a large State, the following outcomes could be expected: Results derived from in: Price, JM; Chamberlain, P; Landsverk, J; Reid, J; Leve, L; & Laurent, H. (2008). Effects of a foster parent training intervention on placement changes of children in foster care. Child Maltreatment. 13(1):64.; model and analyses by F. Wulczyn, Chapin Hall, University of Chicago, and Jeremy Goldhaber-Fiebert, Stanford University Medical School.

  22. OPPORTUNITIES TO MOVE FORWARD TOGETHER

  23. HELPING VICTIMS OF TRAUMA HEAL AND RECOVER • Guidance to State child welfare, mental health, and Medicaid directors released on June 11, 2013 encourages comprehensive approaches to addressing trauma among children and youth known to child welfare • Describes mechanisms in each system to finance better trauma screening, assessments, and evidence-based interventions • http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-13-004.pdf

  24. ONE WAY TO INTEGRATE SAFETY, PERMANENCY AND WELL-BEING: LEGISLATIVE ACTION • Connecticut2013 Conn. Acts, SB 972, P.A. 178: Requires the Department of Children and Families to develop a comprehensive implementation plan for meeting the emotional and behavioral health needs of all children in the state. The plan, must: (1) strengthen families through home visitation and parenting education programs; (2) increase mental, emotional, or behavioral health issue awareness within elementary and secondary schools; (3) improve the current system of addressing such issues in youths; and (4) provide public and private reimbursement for some mental, emotional, or behavioral health services. • West Virginia 2010 W.V. Acts, HB 4164, Chap. 20: Establishes a pilot program (to be known as Jacob’s Law) for the placement of children ages 4 to 10 in foster care to provide children in crisis with early intervention, assistance with emotional needs, medical evaluations, independent advocates, and foster family training and education. The law also requires immediate evaluation and testing following removal from a home. • Wisconsin2010 Wis. Laws, AB 823, Act 336: Requires that all foster parents complete training regarding the care and support needs of children who are placed in foster care or treatment foster care. The training shall be completed on an ongoing basis and include parenting skills, the teaching and encouragement of independent living skills, and issues that may confront foster parents of children with special needs.

  25. ONE WAY TO INTEGRATE SAFETY, PERMANENCY AND WELL-BEING: USE MEDICAID TO ADDRESS TRAUMA • Multiple Medicaid vehicles allow for identification and treatment of complex trauma: • EPSDT • State Plan Services, including preventive services, described in section 1905(b) of SSA • Alternative Benefit Plans • Home and Community-Based Services • Health Homes • Managed Care • Integrated Care Models • Section 1115 Research and Demonstration Programs

  26. ONE WAY TO INTEGRATE SAFETY, PERMANENCY AND WELL-BEING: SAFE BABIES COURT TEAMS • Major findings from ZERO TO THREE’s Safe Babies Court Teams evaluations: • 99.05% of the 186 infant and toddler cases examined were protected from further maltreatment while under court supervision. (JBA, 2009) • 97% of the 186 children received needed services. (JBA, 2009) • Children monitored by the Safe Babies Court Teams Project reached permanency 2.67 times faster than the national comparison group (p=.000). (McCombs-Thornton, 2011) 10 Core Components: Judicial Leadership Local Community Coordinator Active Court Teams Focus on the Big Picture Targeting Infants and Toddlers in Out-of-Home Care Placement and Concurrent Planning Family Team Meetings Monthly to Review All Open Cases Parent-Child Contact Continuum of Mental Health Services Training and Technical Assistance Evaluation

  27. ELEMENTS OF SYSTEMS THAT FOCUS ON CHILD AND FAMILY WELL-BEING

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