partnering for success: a cross-systems model to enhance

Partnering for Success: A cross-systems model to enhance evidence-based service

delivery to children and youth involved with child welfare services

31st Annual Research and Policy Conference

on Child, Adolescent and Young Adult Behavioral Health

Tampa, FL

2018

Presentation Contributors

Jane Gehring, MSW, Assistant Director for

Family Services Division Baltimore County Department of Social Services

Suzanne Kerns, PhD, Research Associate Professor and Executive Director Center for Effective InterventionsUniversity of Denver, Graduate School of Social Work

Disclaimers:The National Center for Evidence Based Practice in Child Welfare under grant number 90CT7001-01-02 is funded by the Children's Bureau, Administration on Children, Youth and Families, Administration for Children and Families, U.S. Department of Health and Human Services. The contents of this workshop are solely the responsibility of the authors and do not necessarily represent the official views of the Children’s Bureau.

5 year cooperative agreement with the CBGrant number 90CT7001-01-02

Goal – to increase local jurisdictions’ capacity to implement and sustain quality, accessible evidence-based treatment for children, youth and families served by the child welfare system.

Partnering for Success (PfS)

Our Model:

Partnering

for success

• A cross-systems workforce competency model to improve

mental health outcomes for child welfare-involved children

and youth.A cross-systems workforce

competency model to improve

mental health outcomes for child welfare-

involved children and youth.

Formula for Success

Effective

Intervention

Effective

Implementation

Enabling

Contexts

Positive

Outcomes

National Implementation Research Network (www.nirn.fpg.unc.edu/)

So what

are they

learning to

implement?

ChildWelfareProfessionals

Build knowledge and skills in

identifying children and youth in

need of mental health services,

types and importance of screening

tools to ID mental health service

needs, referring C/Y and families

to appropriate services, engaging

them in these services, and

monitoring C/Y and family

treatment outcomes.

MentalHealth Professionals

Build knowledge and skills in the

delivery of CBT+, a model

integrating evidence based

approaches to treating anxiety,

depression, conduct problems

and trauma; enhance collaboration

Leadership Learning Track

Build knowledge in core components

of the CW and MH Professional

Learning Tracks to support

application of Partnering for

Success implementation strategies

and practice innovations.

PFS Training Model

Joint training with CW and MH partners

Core elements of CBT to address symptoms of anxiety, depression, behavior problems, and trauma (CBT+)

Shared expectations, streamlined referral/response process, and communication plan throughout treatment

Baltimore County FC Drivers

0%

10%

20%

30%

40%

50%

60%

FY 13 FY 14 FY 15 FY 16 FY 17

Reason upon Entry to Foster Care

Neglect

Physical Abuse

Sexual Abuse

Behavior/Needs

Abandonment

PFS Training Outcomes

Shared assessment tool – PSC 17 + Trauma Instrument

Improved family engagement strategies

Improved referrals and communication between CW and MH

Systematic tracking of symptom reduction throughout treatment

Strategies for mutual support of families

PSC 17 + Trauma Instrument

Open source assessment tool

Quick and easy for youth and families to complete with CW worker

Psychosocial screen with 20 question, 3 point Likert scale to assess children’s behaviors

Simple scoring with cutoff indicating the need for clinical intervention in one or more of the four targeted areas

PFS Transfer of LearningFollowing the 3 day training

CW and MH cohorts are provided with separate ongoing transfer of learning activities through:

Practicums and consultation calls to support to staff and supervisors over several months

Supervision focusing on assessment, referral, communication, and symptom reduction

Agency focus on integration of PFS practice

Impact of Training/Partnership

Family engagement in assessment and referral

Staff empowerment

Caregiver participation in treatment and change

Successful outcomes for children

How We Changed Our Agency’s Practice and Enhanced Partnerships with the Child Welfare Department

Presentation Contributors

Carl Fornoff, MS, LCPCAssistant Director Community Resources

Catholic Charities of Baltimore

Suzie Templeton, MA, LCSW-CProgram Manager, Villa Maria Outpatient Clinic

Catholic Charities of Baltimore

Villa Maria

Advanced Behavioral

Health

THRIVE Behavioral

Health

Better Tomorrow

Starts Today

Participating Community Mental Health Partners

The Three “P’s

Preparation

Partnership

Practice

Preparation

Readiness

Leadership Buy-In

Why CBT+?

Overcoming

resistance

Partnership

Implementation Team

Shared language

Communication Protocol

Practice

Initial Training

Twicemonthly consults

Clinical Supervision

Manager training

Capstone credentialed

Supervision consultations

FidelityFidelity Chart

ReviewsMonitoring

Results

Cost—It is less expensive to deliver CBT+ with fidelity as the clinician gets more practiced and skilled

Kids get better, faster too!

Other agencies have followed suit

Retention of clinicians/supervisors

Findings from the Partnering for Success Implementation in Baltimore

County

Presentation Contributors

Suzanne Kerns, PhD, Research Associate Professor and Executive Director Center for Effective InterventionsUniversity of Denver, Graduate School of Social Work

Leslie Rozeff, MSSW, Director NCEBPCW

Pamela Clarkson Freeman, PhD, Research Assistant Professor

University of Maryland School of Social Work

Evaluation Context

Multiple levels of

intervention

Outcomes across

multiple perspectives

Multiple Intervention

Strategies

High Fidelity Performance

Indicators (HFPI) Framework

Readiness: Is the organization ready for a new model?

Adherence: Are practitioners adhering to model?

Quality: How well do practitioners implement PfS?

Reach: Is the intervention serving the intended target population?

Dosage: Are participants completing treatment?

Participant Responsiveness: Are participants engaged in and satisfied with treatment?

Delivery System

Partnership & Leadership

Performance

Child Welfare & Mental Health

Workforce

Performance

Readiness

Delivery system Partnership and

Leadership Performance

Do Partnering agencies have

appropriate factors in place to facilitate implementation?

Child Welfare & Mental Health

Workforce Performance

Are CW and MH participants prepared

to facilitate PfSintervention?

Adherence

Delivery system Partnership and

Leadership Performance

Are best management practices being

followed by leaders and champions from partnering agencies?

Child Welfare & Mental Health

Workforce Performance

Are best practices and skills associated with the PfS model being acquired by CW and

MH staff?

Reach

Delivery system Partnership and

Leadership Performance

Is there an appropriate mix of CW and MH staff

participating on the Leadership and

Implementation Teams?

Child Welfare & Mental Health

Workforce Performance

Are the appropriate children and youth

being served with CBT+?

Quality

Child Welfare and Mental Health

Workforce Performance

Do CW and MH staff demonstrate appropriate

knowledge and skills?

Dosage and Participant Responsiveness

What is the extent of child and youth

engagement in CBT+?

What are the initial CBT treatment outcomes

for children and youth receiving CBT+?

Results

Adherence – Child Welfare Participation

Attended in-

person

training

Participated

in required

number of

practicum

calls

Completed

required

practicums

Completed

capstone

145 73.2% 47.3% n=41 (28%)

Of those who

completed required

practicum: 92.4%

Adherence – Mental health Participation

Attended in-person

training

Participated in

required number

of consultation

calls

Completed

capstone

134 76.4% 36.6%

(51% of those still at the

agency)

Reach • All therapists required to use model with at least two clients– Many used with more

• Thus far: Participant demographics largely matched overall CW demographics per site

• Race and ethnicity varied by location

• Somewhat greater number of females

– Majority involved in the child welfare system

Documenting:

• Number of participants

• Participant characteristics

• Links between CW and MH

• Treatment targets

• Treatment participation

• Clinical outcomes

Participation requirements

• Two case minimum– One case had to be trauma

– Once case either anxiety, depression or behavior problems

• For many sites, behavior was the least common

Treatment targets for participants

17.53%

18.55%

51.13%

11.55% 1.25%

CBT Clinical Targets

CBT for Anxiety CBT for Depression

CBT for Trauma BPT

Unknown

Quality - Knowledge

63.5%

78.9%

72.3%83.2%

Pre Post

Change in Average Knowledge Assessment Scores

Child Welfare Mental Health

Project Challenges

1. EBP Toolkit designed as clinical and learning tool vs. research

2. Site preferences and research continuity

3. Recruitment and subsequent selection of agencies

4. Installation timeframes took longer than originally anticipated

Summary

Successful implementation requires time, commitment, and flexibility from all parties

Processes are not linear

Constant communication and effective feedback loops from field to leadership and back is essential

Sustainability planning starts at the beginning

Scaling up- goes back to readiness and capacity