The document discusses promoting social and emotional well-being for children and families through an integrated approach. It presents a developmental framework for well-being that identifies four domains: cognitive functioning, physical health and development, behavioral/emotional functioning, and social functioning. It also discusses using screening, assessment, evidence-based interventions, case planning, and progress monitoring to achieve outcomes of safety, permanency and well-being. Key strategies discussed include addressing trauma, building workforce capacity, and collaborating across agencies and systems.

1. Promoting Well-being:
An Integrated Approach
CLARE ANDERSON, DEPUTY COMMISSIONER
ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES

2. Policy: Social and Emotional Well-Being
http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf

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. 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. 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. 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. 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. 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. District of Columbia
Child and Family Services
Agency
September 12, 2013
9

10. 10

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
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
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
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. 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. 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

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. 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. 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. 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. 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. 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. 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. 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