Amelia Franck Meyer, MS, MSW, LISW, APSW CEO, Anu Family Services

1. Outcomes in Treatment Foster Care Amelia Franck Meyer, MS, MSW, LISW, APSW CEO, Anu Family Services

2. Agenda • Introductions and History • Brief Framework for Treatment Foster Care • State and National perspective on TFC outcomes and research • Anu’s TFC outcomes and research • Challenges to Providing TFC outcomes and research • The Bottom Line/Summary • Final Questions

3. I. Introductions and History

4. Perspective and Experience • 20 years of experience in child welfare in Illinois, Minnesota and Wisconsin with some experience in North Dakota and Colorado • 8 years as CEO of Anu Family Services • Past President, former Research Committee Co-Chair and Public Policy Committee Chair, 6-year Board member of the Foster Family-based Treatment Association (FFTA); an international association of over 400 Treatment Foster Care agencies

5. History: Anu Family Services • Operating as a Wisconsin non-profit agency for 17 years (formerly known as PATH Wisconsin) • Former parent company was PATH, Inc. which operated in WI, MN, ND and CO • Began services in Western Wisconsin and moved over the years to the Eastern part of the state.

6. Mission-driven: Anu Family Services • Our Mission: “We create permanent connections to loving and stable families.” • We are passionate about the idea that everyone deserves a permanent family and a place to call “home”.

7. Operations: Anu Family Services • Main offices in Hudson, Madison and Eau Claire. • Services include a continuum of care including: • Family Preservation/Prevention • Family Reunification/Family Search and Engagement • Treatment Foster Care to children ages 0-18 yrs • Adult Treatment Homes • DeafBlind and Medically Fragile Services • Approximately 8-10 program areas

8. Scope: Anu Family Services • Serving 45 Counties and 5 Tribes annually • Providing service to 170-250 children annually • $4-5 million annual operating budget • Ranging from 25-50 employees

9. National & State Leadership in TFC • Council On Accreditation (COA) accredited since opening in 1992. (National gold standard in care for child welfare agencies) • History as founding agency of national Foster Family-Based Treatment Association (FFTA); including initial co-authorship of FFTA (now also COA) standards for Treatment Foster Care. • A founding member of the Wisconsin Chapter of the FFTA and the Western Region TFC Collaborative. • Other Affiliations: • Child Welfare League of America (CWLA) • Wisconsin Association of Family & Children’s Agencies (WAFCA) • United Way Agency

10. II. Brief Framework For Treatment Foster Care

11. “Treatment” Foster Care vs. “Regular” Foster Care • “Regular” Foster Care (HFS 56): • 24-hour care provided by licensed foster parents • Intended for children who cannot live with their parents. • County human service agencies license and oversee these placements. • Treatment Foster Care (HFS 38): • Same as “regular” foster care and • Children have complex and/or severe mental health, chemical addiction, behavioral, emotional, medical or physical needs requiring specialized care and training from both the Treatment Foster Parents and the Treatment Social Workers. • County human services typically contract with private agencies to provide this level of foster care; although some counties license their own treatment homes.

12. Treatment Foster Care (TFC) • There is not “one” universally used or agreed upon model of Treatment Foster Care in Wisconsin, or across the United States. • Many states call TFC “Specialized” Foster Care or other related names. • Makes comparing “apples to apples” challenging.

13. Common elements among TFC programs include: • Children with higher levels of need/severity • Need for specially trained foster parents and social workers • Use of treatment through therapy, day treatment, etc. • Lower social worker caseloads and more frequent child and family visits than in “regular” foster care.

14. Common elements of excellence inTFC programs include: • Use of research-informed and promising practices and clinical interventions. • Use of standardized assessment instruments to inform treatment planning. • Measurements of outcomes tied to a continuous quality improvement process. • National Accreditation and adherence to FFTA program standards.

15. III. State and National perspective on TFC outcomes and research

16. Treatment Foster Care Model and History • Anu has roots as an early founder of the Treatment Foster Care model in the United States (and internationally) dating back to the early 1970’s. • Until about a decade ago: • There were no benchmarks established in TFC • There was no multi-agency, multi-state comparison of treatment foster care outcomes

17. National comparison studies ofTFC benchmarks and outcomes Anu’s roots are as a co-founding agency member of the following national TFC outcomes and benchmarks projects: • QOLA (Quality Outcomes Leadership Alliance)/10,000 Kids Project* (approx. 2000-2003) • 4 agencies • 27 states • 2,500 kids • Benchmark TFC! Project* (2005-2009) • 45 agencies • 20 states • 5,677 admissions/2,151 discharges *Both Projects were terminated due to lack of funding.

18. Federal Child and Family Service Reviews (CFSR) • Federal attempt at setting and collecting benchmark data • Because agencies define and measure differently, have different program models and interventions, still challenging to compare “apples to apples”.

19. National Project Results on Permanence Number of children who were adopted or reunified: • 39%=Minnesota Homecoming Project (4-year, 1.5 million dollar project) • 45%=National average of agencies participating in Benchmark TFC! Project • 57%=Anu’s Family Service’s average

20. IV. Anu’s Treatment Foster Care outcomes and research

21. Anu’s Outcome Measures… • Customer Satisfaction • Youth • Treatment Foster Parents • Referents • Biological family • Staff • Continuous Quality Improvement (CQI) Metrics • 12 metrics monitored monthly and reviewed in two specialized monthly (CQI) meetings • Discharge Outcomes

22. FY 2009 Outcome HIGHLIGHTS  79% of children were discharged to less restrictive settings.  57% of children were reunified with their family or adopted.  95% of children remained with the same family during care.  The number of children experiencing social worker transfers was cut by more than half.  Therapeutic Crisis Intervention Strategies have reduced the number of child restraints to ZERO.

23. Ages of Children Served

24. FY09 Discharge Data

25. What the children are Saying about their treatment foster parents 36 Anu foster youth 10 yrs. – 18 yrs. completed foster home report cards while in care during 2009. • Treatment Foster Youth Placed with Anu Family Services consider themselves well-served by Anu Treatment Foster Parents.

26. FY08 Referent Survey Data

27. Anu’s On-call Satisfaction Survey

28. From Good to Great… • In 2006, decided that although we had achieved very good outcomes, they were not good enough. • We did not want to be “one in a line of many” placements for our youth. • We did not want to “give it a try” or “do our best; we wanted to get it right the first time. • We narrowly define “permanence” as being discharged to adoption or returned home.

29. Anu wants to be a child’s last placement • In 2006, we established our goal to be “The last placement prior to permanence for 90% of the children we serve.” • We increased our outcomes by nearly 10% per year in the first two years of our goal. • We are currently among the highest in the nation for our discharges to permanence.

30. Anu’ Progress to Permanence for Children in out-of-home care

31. Reunification and Adoption Outcomes

32. How did we do it? • History of agency change based on review of current evidence base • 2004-2006 Behavior Supports and Intervention Initiative • $60,000 grant from the Otto Bremer Foundation; distributed over 3 years. • IV-E Partnership with the University of Minnesota Center for Advanced Studies in Child Welfare. • Changes in organizational culture

33. Advancing our goal… • 3-year project: • Year I: literature review and review of national best practices in preventing placement disruptions • Year II: aligning our practices with current evidence-informed practices • Year III: pilot project in Family Search and Engagement

34. What’s next? • Family Search and Engagement (FSE) • 3-5-7 Model of preparing youth for permanence • Complete review of organizational culture, training, procedures, systems, policies to adapt to a framework of finding and supporting connections for youth • Continuing to find additional funding to support our mission-driven initiatives

35. V. Challenges to Providing TFC outcomes and research

36. Research in Treatment Foster Care • TFC research is rarely funded—privately or publicly—nationally or in Wisconsin (hence the ending of the national “Benchmark TFC!” project as of 2009) • Although there are common elements to TFC (locally and nationally), there are many variations in programs that make comparing outcomes challenging. • Databases and systems are not uniform (nationally or locally) which makes sharing and comparing data sets challenging or impossible.

37. Accreditation and Quality • National Accreditation is not required, rewarded, funded, or encouraged. • State CPA license renewal still required if accredited (even though COA standards, in most cases, far exceed State standards) • CQI (continuous quality improvement) practices are not required, rewarded, funded, or encouraged.

38. Quality & Outcomes The following elements which impact youth permanence and quality of care are often not required, rewarded, or funded for Wisconsin TFC providers: • National Accreditation & adherence to national standards • Outcomes measurement and benchmarks • Use of evidence or research informed practices • Use of standardized assessment tools to inform treatment planning • Attempts to identify permanent resources and/or families for youth

39. VI. The Bottom Line

40. Operating on a thin margin • Wisconsin non-profit TFC agencies are challenged to survive on existing margins (0%-5%) that do not • Ensure sustainability in challenging times • Fund innovation • Support accreditation and quality assurances • Fund use of research-informed practices such as family finding and Family Search and Engagement (FSE) which are known to improve outcomes and reduce long-term costs • A lack of continued investment will result in a reduction in the quality of care provided, and therefore, in the outcomes children achieve.

41. Investment in TFC: Experiences in other states • Social Worker Caseload size increases which leads to: • Decreased treatment foster parent contact and support • Decreases in treatment foster parent retention • High staff turn-over/low morale • Decreased in frequency and duration of visits with children • Lack of continuity in relationships for children in care • Decreased child safety, permanence and well-being • Decreased successes in child outcomes at discharge • Inability to perform clinical interventions or make substantial clinical progress.

42. Without continued investment in TFC… • Wisconsin loses the ability to: • achieve nationally-recognized outcomes in stability and permanence • obtain national accreditation ensuring best practices in child welfare are met • use research-informed practices • hire master’s-level, highly trained and experienced social workers to manage complex treatment needs in community-based settings • Provide quality training to treatment parents and staff • obtain and measure outcomes

43. Without continued investment in TFC… • Wisconsin loses the ability to: • have sound clinical consultation and interventions for children in care which meet national standards • to do what is right for each child and meet children’s basic needs clinically, medically, socially, etc. • e.g., pay for the glasses, medication, dental work, etc. that MA won’t cover • Nurture each child’s strengths • e.g., pay for art supplies, music lessons, sports equipment above and beyond what is “covered” or expected in a foster parent per diem

44. Summary • We are achieving better stability and permanency outcomes for children in out-of-home care in Wisconsin than almost anywhere else in the nation. • We cannot continue to deliver these outstanding outcomes, nor improve those outcomes, without continued investment and re-investment in Wisconsin’s children. • Reductions in reimbursement will directly relate to a reduction in permanence for Wisconsin’s children.

45. VII. Final Questions Amelia Franck Meyer, MS, MSW, LISW, APSW CEO, Anu Family Services 516 Second Street, Suite 209 Hudson, WI 54016 715.386.1547 ext. 302 afranckmeyer@anufs.org