BRIEF UPDATE:

NORTH CAROLINA CHILD TREATMENT PROGRAM

December 2015

Dana Hagele, MD, MPH

Co-Director

CONTEXT Population Need: Children and Families

10 year old boy

Lives with parents and 8 year old sister

Witnessed father strike, push and choke mother multiple times

Teacher reports:

• Struggling to stay seated in class

• Needs reminders to pay attention in class

• Irritable and fatigued

• Episodes of aggression toward peers

4 year old boy

Lives with maternal

grandmother and attends

daycare

Disclosure of several

incidents sexual contact by a

16 year step-brother

Day Care Reports

• Enuresis (wetting himself)

• Hyperactivity

• Impulsivity

• Temper tantrums

• One incident whereby he

forcibly touched a peer’s

genitals

9 year old girl

Lives with mother, step-

father, and two younger

brothers.

Witnessed youngest brother

fall to death from second

floor balcony at home 6

months ago.

Parents report:

• Nightmares

• Difficulty sleeping

• Avoidance of second floor

• Withdrawal

• Disengagement from

family activities

24 year old mother

Lives with boyfriend and two

children (2.5 year old son

and 4 month old daughter)

CPS investigation initiated

due report of harsh discipline

and inadequate supervision

CPS investigation reveals

concerns for:

• Prescription medication

misuse

• Maternal depression

The Bad News

Prevalence: trauma and adverse childhood experiences

Associated with poor short- and long-term outcomes

Associated with high-costs across an individual’s lifetime

The Good News

Effective (and cost-effective) treatment exists

More Bad News

Extremely limited access in communities

North Carolina 2005

North Carolina Child Treatment Program

Established 2006

Rigorous training and coaching

platform in an evidence-based,

child trauma treatment model

North Carolina Child Treatment Program

250 licensed clinicians trained (weak clinicians excused)

Hundreds of children served across 80+ counties

90% of children achieved targeted clinical outcomes

Public roster of trained clinician

An implementation platform for other models

Approached the NC General Assembly (2012)

NC Child Treatment Program funded to:

Develop and support an evidence-based MH service array

Assure workforce capacity and accountability: deliver high-quality, cost-

effective EBTs

Offer cost-effective treatment in the least restrictive setting

Monitor implementation benchmarks and outcomes

Achieve targeted clinical outcomes

Achieve targeted systems outcomes

Realize cost-savings

NC General Assembly Funding (2013)

• Program expansion and dissemination

($1.8 million annually-recurring funds)

• Web-based clinical support tool (with performance

and outcomes monitoring capacity)

($500K one-time allocation)

The North Carolina Child Treatment Program

Platform to

implement, disseminate and sustain

evidence-based, child mental health treatment

in multiple settings

across North Carolina

Established 2006

NCGA Funded 2013

NC Child Treatment Program

NC CTP Oversight Agency and Partner

NC Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

Administrative Home

Center for Child and Family Health (501c3)

NC CTP Faculty and Staff

• Center for Child and Family Health

• Duke Evidence-Based Practices Implementation Center

• School of Public Health, UNC-Chapel Hill

• UCLA-Duke National Center for Child Traumatic Stress

NC CTP Cornerstones:

• Provider competence-based training in EBT models

• Support treatment in the community and restricted settings

• Develop a web-based clinical tool that supports monitoring

of: workforce performance, clinical outcomes, service

utilization and cost (NC POP)

• Offer a public roster of NC CTP-trained clinicians

• Collaborate with professionals and state entities

Cornerstone: Expanded Service Array

• Trauma-Focused Cognitive Behavioral Therapy

(TF-CBT)

• Parent and Child Interaction Therapy (PCIT)

• Child-Parent Psychotherapy (CPP)

• Structured Psychotherapy for Adolescents

Responding to Chronic Stress (SPARCS)

Cornerstone: NC CTP Performance and

Outcomes Platform

• Clinicians/Agencies

• Independent Monitors

Data Input

• Case-level data

• Population-level data

NC POP 2.0 • Clinicians/Agencies

• State agencies and NC FAST

• Third Party Payers

Data Access

Analytics

PROGRAM ACHIEVEMENT

Program Performance: Training Workforce

• Clinicians Trained Since 2013

• > 430 licensed clinicians trained

• Clinician-Trainee Retention

• > 90% retention

• (Clinicians excused from training program)

• Outcomes Monitored

• Clinical-trainee competence model fidelity

• Improved organizational capacity

• Client outcomes

• Service utilization

Program

Performance:

Client Outcomes

Children served since 2013

> 1500 children

Outcomes

Improved symptom profile across

all treatment models

Example

o Children 7 – 18 years of age)

with PTSD symptoms

o > 90% with significant

reduction in by the end of TF-

CBT treatment

48.7

20.5

0

5

10

15

20

25

30

35

40

45

50

55

UCLA - Total Severity***

Pre-TreatmentAssessment

Post-TreatmentAssessment

NEW DIRECTIONS North Carolina Child Treatment Program

Potential for Expanded NC CTP Collaboration

Expand EBP training and treatment capacity

Expand EBT service array: o Trauma/attachment (children < 3 years of age)

o Problematic sexual behaviors (children <13)

o Problematic sexual behaviors (children ≥ 13)

Embed EBTs in alternative treatment platforms o PRTF

o Intensive In-Home Services

Engage in cost-effectiveness and cost-benefit modeling

Develop caregiver treatment platform

Others

QUESTIONS AND DISCUSSION

Dana Hagele, MD, MPH,

Co-Director

Dana_Hagele@med.unc.ed