Promoting Well-being:
An Integrated Approach
CLARE ANDERSON, DEPUTY COMMISSIONER
ADMINISTRATION ON CHILDREN, YOUTH AND FAM...
Policy: Social and Emotional Well-Being
http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf
A DEVELOPMENTAL FRAMEWORK
FOR WELL-BEING
Environmental
Supports
Personal
Characteristics
Developmental Stage (e.g., early ...
A DEVELOPMENTAL FRAMEWORK FOR WELL-BEING
Intermediate Outcome Domains Well-Being Outcome Domains
Environmental
Supports
Pe...
Functional
Assessment
Validated
Screening
Clinical
Assessment
Evidence-
based
Intervention(s)
Case
Planning for
Safety,
Pe...
Policy
Promoting Safe and
Stable Families – Trauma
Screening and Treatment
Information Memoranda:
Well-Being,
Psychotropic...
BLOG: Helping victims of childhood trauma heal and recover
July 11, 2013
Dear State Director Letter – HHS: CMS, SAMHSA and...
A Commitment to Promoting Well-Being
for Children and Families Means:
1. Proactive approach to social and emotional needs
...
District of Columbia
Child and Family Services
Agency
September 12, 2013
9
10
Four Pillar Strategic Agenda
Front Door – Children should be removed from their families
only when necessary to keep them ...
Collaborate with other systems to:
• Improve Academic Achievement from
Early Childhood through Adolescence
• Address Traum...
Office of Well Being
Mayor’s Services Liaison Office
 Coordinating entity between D.C. Superior Court and the Executive O...
Well Being Support Services
 Domestic Violence
Provide services and supports that address the immediate and long-term
nee...
Well Being Support
Services
 Education
• Child Care and Developmental
Screenings: Preparation of children and
families to...
Raise DC
Cradle-to-Career Approach
16
Goals
Every child is
prepared for
school
Every child
succeeds in
school
Every youth ...
Initiative to Improve Access to Needs-Driven,
Evidence-Based/informed Mental and Behavioral
Health Services in Child Welfa...
Initiative to Improve Access to Needs-Driven,
Evidence-Based/informed Mental and Behavioral
Health Services in Child Welfa...
Initiative to Improve Access to Needs-Driven,
Evidence-Based/informed Mental and Behavioral
Health Services in Child Welfa...
Phase I Planning and Assessment
Early Lesson Learned
 Develop a knowledgeable and effective workforce and
lay the system-...
Examples of Expected Outcomes
 Improve emotional/behavioral functioning
 Improve social functioning
 Improve academic a...
Title IV-E Waiver Demonstration Project:
DC CFSA’s Proposal
 Implement two evidence-based family preservation models
 Pr...
Title IV-E Waiver Demonstration Project:
CFSA’s Proposed Well-Being Outcomes
CFSA’s proposed well-being outcomes include t...
Contact Information
Amy Templeman, Well Being Supervisor, amy.templeman@dc.gov
Carla Perkins, Well Being Education Supervi...
Illinois Birth through Three
IV-E Waiver
Presentation for First Focus Webinar
September 12, 2013
Cynthia L. Tate, Ph.D.
De...
26
Illinois Registers One of the Lowest
Foster Care Entry Rates in the US
Rate per 1,000
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8...
27
Kids Stay Too Long
Leads to One of the Longest Median
Lengths of Stay in the US
0
5
10
15
20
25
30
35
40
45
50
Tennesse...
28
Average Permanency Rates
Children Birth through Three
Cook vs. Outside Cook County
Source: DCFS administrative data; da...
Birth Thru Three
Waiver Question
Will children aged birth thru three years old, who are
initially placed in foster care, e...
Theory of Change
 Traumatic events that led to out-of-home placement and can
hinder children’s development into healthy, ...
31
Randomized Controlled Trial
(RCT)
32
TAU Group
Population is split into
2 groups by random lot
3,000 children
aged birth t...
TREATMENT AS USUAL [CONTROL] WAIVER/ DEMONSTRATION CASES
Case is assigned to waiver or control agency Case is assigned to ...
Interventions to Be Used
 Moderate Risk Families
 The Nurturing Parent Program (Dr. Stephen
Bavolek)
 The Nurturing Par...
The specific goals of the
model are to:
 Increase parents' sense of self-worth,
personal empowerment, empathy, bonding,
a...
2 Versions: PV & CV
 The demonstration will adapt a version of the
Nurturing Skills for Families version of NPP
for careg...
High Risk Families
 Child-Parent Psychotherapy
 Developed in the early 2000’s and widely distributed in 2005,
CPP is bas...
CPP Continued
 The average length of treatment is 12-18 mos.
 Expected Target Population: High Risk infants,
toddlers, c...
Waiver Demonstration
Timeline
39
DevelopmentPeriod
Date
10/9/12 Term & Conditions Signed
11/15/12 LADI Survey Administered...
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Raising the Bar: Child Welfare’s Shift Towards Well-Being

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Raising the Bar: Child Welfare’s Shift Towards Well-Being

  1. 1. Promoting Well-being: An Integrated Approach CLARE ANDERSON, DEPUTY COMMISSIONER ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES
  2. 2. Policy: Social and Emotional Well-Being http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf
  3. 3. A DEVELOPMENTAL FRAMEWORK FOR WELL-BEING Environmental Supports Personal Characteristics Developmental Stage (e.g., early childhood, latency) Cognitive Functioning Physical Health and Development Emotional/ Behavioral Functioning Social Functioning The framework identifies four basic domains of well being: (a) cognitive functioning, (b) physical health and development, (c) behavioral/emotional functioning, and (d) social functioning. Within each domain, the characteristics of healthy functioning related directly to how children and youth navigate their daily lives: how they engage in relationships, cope with challenges, and handle responsibilities.
  4. 4. A DEVELOPMENTAL FRAMEWORK FOR WELL-BEING Intermediate Outcome Domains Well-Being Outcome Domains Environmental Supports Personal Characteristics Cognitive Functioning Physical Health and Development Emotional/Behavioral Functioning Social Functioning Infancy (0-2) Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Temperament, cognitive ability Language development Normative standards for growth and development, gross motor and fine motor skills, overall health, BMI Self-control, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms Social competencies, attachment and caregiver relationships, adaptive behavior EarlyChildhood (3-5) Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Temperament, cognitive ability Language development, pre-academic skills (e.g., numeracy), approaches to learning, problem- solving skills Normative standards for growth and development, gross motor and fine motor skills, overall health, BMI Self-control, self-esteem, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms Social competencies, attachment and caregiver relationships, adaptive behavior MiddleChildhood (6-12) Family income, family social capital, social support, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Identity development, self-concept, self-esteem, self-efficacy, cognitive ability Academic achievement, school engagement, school attachment, problem-solving skills, decision-making Normative standards for growth and development, overall health, BMI, risk- avoidance behavior related to health Emotional intelligence, self-efficacy, motivation, self-control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms Social competencies, social connections and relationships, social skills, adaptive behavior Adolescence (13-18) Family income, family social capital, social support, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Identity development, self-concept, self-esteem, self-efficacy, cognitive ability Academic achievement, school engagement, school attachment, problem solving skills, decision-making Overall health, BMI, risk- avoidance behavior related to health Emotional intelligence, self-efficacy, motivation, self-control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms Social competence, social connections and relationships, social skills, adaptive behavior Social and Emotional Well-Being Domains
  5. 5. Functional Assessment Validated Screening Clinical Assessment Evidence- based Intervention(s) Case Planning for Safety, Permanency, and Well- being Progress Monitoring social-emotional functioning ACHIEVING BETTER OUTCOMES context: therapeutic, responsive & supportive settings & relationships Outcomes: Safety, Permanency, Well-Being
  6. 6. Policy Promoting Safe and Stable Families – Trauma Screening and Treatment Information Memoranda: Well-Being, Psychotropics, CQI IM: Title IV-E Child Welfare Waiver Authority and Well-being Priority CMS: Early and Periodic Screening, Diagnosis, and Treatment Workforce Program Screening, Assessment, and Services Array Grants Regional Partnership Grants Protective Factors across Populations Ending Youth Homelessness Rethinking Services and Supports for Youth Aging Out of Care Practice Permanency Innovations Initiative – Illinois & Kansas Collaboration with SAMHSA and CMS Waiver Demonstrations in 6 States Integrating Trauma into Child Welfare Services Supportive Housing and Child Welfare ADDRESSING SOCIAL & EMOTIONAL WELL-BEING
  7. 7. BLOG: Helping victims of childhood trauma heal and recover July 11, 2013 Dear State Director Letter – HHS: CMS, SAMHSA and ACF The impact of complex trauma for children who have experienced maltreatment can be profound, derailing them from healthy development, impairing social and emotional functioning, and compromising health. These effects can be addressed, however, and children can heal and recover. CMS, SAMHSA, and ACF are committed to improving the life outcomes for children who have experienced the complex trauma associated with child abuse and neglect and exposure to violence and are prepared to offer technical assistance as needed. This guidance letter is intended to encourage the integrated use of trauma-focused screening, functional assessments and evidence-based practices (EBPs) in child- serving settings for the purpose of improving child well-being. http://www.hhs.gov/secretary/about/blogs/childhood-trauma-recover.html http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-13-07-11.pdf
  8. 8. A Commitment to Promoting Well-Being for Children and Families Means: 1. Proactive approach to social and emotional needs 2. Promotion of healthy relationships 3. Developmentally specific approach 4. Focus on child & family level outcomes 5. Build capacity to use screening, assessment & EBPs 6. Monitor progress for reduced symptoms and improved child/youth functioning
  9. 9. District of Columbia Child and Family Services Agency September 12, 2013 9
  10. 10. 10
  11. 11. Four Pillar Strategic Agenda Front Door – Children should be removed from their families only when necessary to keep them safe. Temporary Safe Haven – Foster care should be a temporary safe haven, with permanency planning beginning the day a child enters care. Well Being – Every child is entitled to have a nurturing environment that supports healthy growth and development. Exit to Permanence – Every child and youth will exit care to a well-supported family or lifelong connection and will be prepared for self-sufficiency. 11
  12. 12. Collaborate with other systems to: • Improve Academic Achievement from Early Childhood through Adolescence • Address Trauma and Mental Health • Assess and Treat Substance Abuse • Support Physical Health • Reduce Teen Pregnancy and Support Teen Parents 12 Well Being
  13. 13. Office of Well Being Mayor’s Services Liaison Office  Coordinating entity between D.C. Superior Court and the Executive Office of the District of Columbia to address family need with housing, substance use, education, employment, mental health, and disabilities. Partners for Kids in Care  Partners for Kids in Care engages community and business stakeholders to develop strategic partnerships to generate private resources, services and monetary donations to benefit children and families served by CFSA. Well Being Support Services  Domestic Violence  Substance Use Disorders  Education 13 Office of Well Being
  14. 14. Well Being Support Services  Domestic Violence Provide services and supports that address the immediate and long-term needs of non-offending partners and their children when dealing with issues of domestic violence, while also ensuring that supports are available to the offending partner.  Substance Use Disorders Technical assistance from National Center on Substance Abuse and Child Welfare (NCSACW) within Substance Abuse and Mental Health Services Administration (SAMHSA). Five goals of technical assistance: 1. Screening and assessment 2. Engagement and retention 3. Data and information-sharing 4. Joint accountability and shared outcomes 5. Services for youth and parents/families 14 Well Being Support Services
  15. 15. Well Being Support Services  Education • Child Care and Developmental Screenings: Preparation of children and families to start school • Transportation: To help child remain connected to school of origin • Tutoring and Mentoring: Promotion of academic and social development • Aligning CFSA strategy with citywide initiatives to develop a “cradle-to-career” approach to education 15 Well Being Support Services
  16. 16. Raise DC Cradle-to-Career Approach 16 Goals Every child is prepared for school Every child succeeds in school Every youth who has dropped out is reconnected to education/training Every youth attains a postsecondary credential Every youth is prepared for a career
  17. 17. Initiative to Improve Access to Needs-Driven, Evidence-Based/informed Mental and Behavioral Health Services in Child Welfare  Most children, teens, and families we serve have had many traumatic experiences, and many have significant mental and behavioral health needs. Helping them heal is our greatest challenge.  Through the Four Pillars strategic agenda, District child welfare is seeking measurable improvement in outcomes for the children, youth, and families we serve  Impressed by the best practices and outcomes of private sector child welfare organizations; interested in applying techniques in public system  Through a $3.2M grant and five year partnership with the Children’s Bureau, CFSA will transform the way the District approaches and treats child mental and behavioral health, including trauma 17
  18. 18. Initiative to Improve Access to Needs-Driven, Evidence-Based/informed Mental and Behavioral Health Services in Child Welfare We are one of nine grantees partnered with the Children’s Bureau: 1. New York University School of Medicine 2. University of Western Michigan 3. Dartmouth College in New Hampshire 4. Rady’s Children’s Hospital in San Diego 5. University of Washington in Seattle 6. Tulane University in Louisiana 7. Franklin County, Ohio Children’s Services 8. Oklahoma Department of Human Services 9. DC Child and Family Services Agency 18
  19. 19. Initiative to Improve Access to Needs-Driven, Evidence-Based/informed Mental and Behavioral Health Services in Child Welfare Five primary activities in this demonstration project: 1. Screening 2. Functional assessment 3. Data driven case planning 4. Ongoing progress monitoring 5. Data driven service array reconfiguration 19
  20. 20. Phase I Planning and Assessment Early Lesson Learned  Develop a knowledgeable and effective workforce and lay the system-level foundation to support and sustain the five activities  Nearly 1,400 trained in Trauma Systems Therapy  233 direct practitioners (social workers, therapists)  599 resource parents (foster, kin, adoptive)  558 stakeholders (support staff, mental health, human services, school system, police dept., family court judges, legal community, etc.) 20
  21. 21. Examples of Expected Outcomes  Improve emotional/behavioral functioning  Improve social functioning  Improve academic achievement  Decrease use of psychotropic medication  Decrease length of stay in foster care  Improve placement stability  Increase exits to positive permanence 21
  22. 22. Title IV-E Waiver Demonstration Project: DC CFSA’s Proposal  Implement two evidence-based family preservation models  Project Connect—intensive, in-home services to families affected by substance abuse, mental illness, and/or domestic violence and involved with the child welfare system.  Homebuilders—intensive, in-home crisis intervention, counseling, and life-skills education for families who have children at imminent risk of placement in foster care.  Expand evidence-based prevention programs  Home Visitation  Parent Education and Support  Father-Childhood Attachment  Parent and Adolescent Support Services (PASS) http://www.cfsri.org/projectconnect.html http://www.institutefamily.org/programs_IFPS.asp 22
  23. 23. Title IV-E Waiver Demonstration Project: CFSA’s Proposed Well-Being Outcomes CFSA’s proposed well-being outcomes include the following:  Improved family functioning, including elements such as:  patterns of social interaction, including the nature of contact and involvement with others, and the presence or absence of social support networks and relationships;  parenting practices, including methods of discipline, patterns of supervision, understanding of child development and of the emotional needs of children;  access to basic necessities such as income, employment, adequate housing, child care, transportation, and other needed services and supports.  Improved educational achievement  Improved social and emotional functioning 23
  24. 24. Contact Information Amy Templeman, Well Being Supervisor, amy.templeman@dc.gov Carla Perkins, Well Being Education Supervisor, carla.perkins@dc.gov Aisha Hunter, Trauma Grant Specialist, aisha.hunter@dc.gov Julie Fliss, Supervisory Planning Advisor, julie.fliss@dc.gov 24
  25. 25. Illinois Birth through Three IV-E Waiver Presentation for First Focus Webinar September 12, 2013 Cynthia L. Tate, Ph.D. Deputy Director, Office of Child Well Being IDCFS 25
  26. 26. 26 Illinois Registers One of the Lowest Foster Care Entry Rates in the US Rate per 1,000 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 PuertoRico Virginia Illinois NewHampshire Maine Maryland NewJersey NorthCarolina Utah Texas Georgia NewYork Delaware SouthCarolina Connecticut Alabama Idaho Mississippi Michigan Louisiana Wisconsin California NewMexico Hawaii Washington Pennsylvania Ohio Massachusetts Florida Nevada Missouri Colorado Tennessee Minnesota Indiana Montana Kansas Arizona DistrictofColumbia Kentucky Alaska Oregon Oklahoma Vermont RhodeIsland Arkansas NorthDakota Iowa Nebraska SouthDakota Wyoming WestVirginia Rate:Per1,000Children Data Source: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau, www.acf.hhs.gov/programs/cb Data current as of July 2012 Illinois: 1.5 per 1,000 National: 3.3 per 1,000
  27. 27. 27 Kids Stay Too Long Leads to One of the Longest Median Lengths of Stay in the US 0 5 10 15 20 25 30 35 40 45 50 Tennessee Idaho Florida Utah Wyoming Arkansas Minnesota Iowa Arizona WestVirginia Indiana Mississippi Nebraska Texas Kansas Kentucky Colorado Georgia Ohio NewMexico Louisiana NorthDakota SouthDakota Missouri Wisconsin RhodeIsland Pennsylvania Maine NewJersey Nevada NorthCarolina Michigan Oregon Alaska Hawaii NewHampshire Oklahoma Montana Massachusetts Connecticut California Vermont SouthCarolina Washington Virginia Delaware Alabama Maryland NewYork Illinois DistrictofColumbia PuertoRico MedianmonthsinCare National: 13.5 months Data Source: U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau, http://cwoutcomes.acf.hhs.gov/data/overview 2010 Data Highlights, Children in care on 9/30/10 Illinois: 28.6 months
  28. 28. 28 Average Permanency Rates Children Birth through Three Cook vs. Outside Cook County Source: DCFS administrative data; data current as of June, 2011. Data reflect average outcomes for children who entered custody during the most recent 4 year period.
  29. 29. Birth Thru Three Waiver Question Will children aged birth thru three years old, who are initially placed in foster care, experience reduced trauma symptoms, increased permanency, reduced re- entry and improved child well-being if they are provided child-parent therapy or other trauma- informed parent support programs compared to similar children who are provided IV-E services as usual? 29 Source: Illinois Department of Children and Family Services (2012). Title IV-E Child Waiver Demonstration Project, last accessed August 22, 2012 www.acf.hhs.gov/programs/cb/programs_fund/il_waiver_proposal.pdf.
  30. 30. Theory of Change  Traumatic events that led to out-of-home placement and can hinder children’s development into healthy, caring, and productive adults .  If providers can provide immediate access to EBIs to alleviate the distress experienced by children, they will be better supported to recover from adverse childhood experiences.  If caregivers of children exposed to adverse childhood events were specifically equipped with knowledge and strategies to manage traumatic reactions, the opportunity to intervene in a supportive, therapeutic relationship would add an essential element to achieving permanency and improving the well being of children.
  31. 31. 31
  32. 32. Randomized Controlled Trial (RCT) 32 TAU Group Population is split into 2 groups by random lot 3,000 children aged birth through three Waiver Group = Reunification
  33. 33. TREATMENT AS USUAL [CONTROL] WAIVER/ DEMONSTRATION CASES Case is assigned to waiver or control agency Case is assigned to waiver or control agency IA completes initial assessment using existing tools:  Denver II  Ages & Stages  Ages & Stage Social Emotional IA completes initial assessment using existing tools: 1. Denver II 2. Ages & Stages And the following enhancements: 3. Devereux Early Childhood Assessment for Infants and Toddlers [DECA] 4. Infant Toddler Symptom Checklist [ITSC]; 5. The Parenting Stress Inventory (These 5 instruments comprise the enhanced IA). Note: Trauma experiences are identified using the CANS [2/3]. Traditional Recommendations are rendered IA w/ ECH consult determines appropriateness of demonstration interventions& traditional recommendations as required. ECH follows up with children that pass the screening to age 3-0. ECH follows up with all waiver children & families with ongoing screenings @ intervals TBD. ECH follows up on referrals to providers and determines if treatment needs change during the life of case to age 3-11mons.
  34. 34. Interventions to Be Used  Moderate Risk Families  The Nurturing Parent Program (Dr. Stephen Bavolek)  The Nurturing Parent Program was developed in the early 1980’s and distributed nationally by 1985, NPP is a psycho-education and cognitive-behavioral group intervention when targeted to biological parents, is aimed at modifying maladaptive beliefs that led to abusive parenting behaviors and to enhance the parents’ skills in supporting attachments, nurturing and general parenting.
  35. 35. The specific goals of the model are to:  Increase parents' sense of self-worth, personal empowerment, empathy, bonding, and attachment;  Increase the use of alternative strategies to harsh and abusive disciplinary practices;  Increase parents' knowledge of age- appropriate developmental expectations;  Reduce abuse and neglect rates.
  36. 36. 2 Versions: PV & CV  The demonstration will adapt a version of the Nurturing Skills for Families version of NPP for caregivers which will be considered our caregiver version (CV)  Goal 6-8 Sessions  60-90 Mins.  Parent Version targeted to the developmental needs of children 0-5  16 Group Sessions
  37. 37. High Risk Families  Child-Parent Psychotherapy  Developed in the early 2000’s and widely distributed in 2005, CPP is based on attachment theory, but combines and integrates principles from multiples theories (developmental, trauma, social- learning, psychodynamic and cognitive-behavioral therapies). CPP is a dyadic (caregiver and child) intervention for children from birth through age 5 who have experienced at least one traumatic event such as the sudden or traumatic death of someone close, a serious accident, sexual abuse, exposure to domestic violence, and as a result, are experiencing behavior, attachment, and/or other mental health problems. The primary goal of CPP is to support and strengthen the relationship between a child and his or her parent (caregiver) as a vehicle for restoring the child’s sense of safety, attachment, and appropriate affect.  Purveyors: Dr. Alicia Lieberman & Dr. Patricia Van Horn
  38. 38. CPP Continued  The average length of treatment is 12-18 mos.  Expected Target Population: High Risk infants, toddlers, caregivers and biological parents  Proximal outcomes include a decrease in trauma symptoms and increases in regulatory capacity.  Distal outcomes include changes in attachment categories and improved mental health of the caregiver.
  39. 39. Waiver Demonstration Timeline 39 DevelopmentPeriod Date 10/9/12 Term & Conditions Signed 11/15/12 LADI Survey Administered 12/5/12 Evaluation Plan Submitted 12/15/12 Design and Implementation Plan Submitted 1/15/13 Usability Testing Starts 3/15/13 Formative Evaluation Starts 7/1/13 Demonstration Starts

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