Bryan Samuels, Executive Director

The Intersection of Safety, Permanency and Child Well-Being

Bryan Samuels, Executive Director

CHILDREN IN FOSTER CARE ON 9/30

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 -

100,000

200,000

300,000

400,000

500,000

600,000

23.3% decline

STATE CHANGES IN CASELOADS: 2002-2011

-80.0%

-60.0%

-40.0%

-20.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

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New

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Illin

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Data Source: Adoption and Foster Care Analysis and Reporting System, U.S. Department of Health and Human Services

WELL-BEING CHALLENGES AMONG CHILDREN KNOWN TO CHILD WELFARE

Developmental Prob-lems

(0-5 years-old)

Cognitive Problems (4-17 years-old)

Emotional/Behavioral Problems

(1.5-17 years-old)

Substance Use Disorder (11-17 years-old)

0%

10%

20%

30%

40%

50%

In-Home, Connected to Services In-Home, Not Connected to ServicesOut-of-Home

Dolan, M., Casanueva, C., Smith, K., & Ringeisen, H. (2011). NSCAW Child Well-Being Spotlight: Children Placed Outside the Home and Children Who Remain In-Home after a Maltreatment Investigation Have Similar and Extensive Service Needs. OPRE Report #2012-32, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services .

EMOTIONAL AND SOCIAL CAPACITIES ARE INEXTRICABLY INTERTWINED WITHIN THE ARCHITECTURE OF THE BRAIN

TRAUMA’S IMPACT ON SOCIAL AND EMOTIONAL FUNCTIONING AND

RESULTS IN POOR OUTCOMES

Toxic Stress, Trauma, Community Violence, Abusive or Neglectful

Parenting

Insecure Attachments, Emotional

Dysregulation, Negative Internal Working Models

Maladaptive Coping Strategies

Poor Social Functioning, Disturbed

Peer RelationshipsPsychological Distress

Poor Outcomes for Children and

Families

PERMANENCY IS INSUFFICIENT FOR ACHIEVING LONG-TERM POSITIVE OUTCOMES

REUNIFICATION OUTCOMES

• Following reunification, children are more likely to have increases in both externalizing problems, such as aggression and delinquency, and internalizing problems, such as depression and acting withdrawn.

• This is likely the result of increased exposure to risk factors and decreased system supports.

KINSHIP CARE OUTCOMES

• Children who spent all of their time in foster care living with relatives have almost identical rates of mental health diagnoses later in life as children in foster care who never lived with relatives.

• For both groups, the rates of diagnoses are much higher than the general population.

ADOPTION OUTCOMES

• Following adoption, children have high levels of mental health problems.

• 2, 4, and 6 years following adoption, anxiety, depression, and ADHD increase steadily.

• Rates of difficulty among children adopted from public child welfare are similar to those among children adopted from private agencies.

Bellamy, 2008. Roller White et all, 2007. Simmel et al, 2007.

RESEARCH IS FRAGMENTED…

EducationMedicine

Child WelfareMental Health

Juvenile Justice

Neuroscience

…AND NOT ALIGNED

A SHARED FRAMEWORK ALIGNS THE BEST KNOWLEDGE AND MOVES US IN A COMMON DIRECTION

Child Welfare

Neuroscience

Medicine

Education

Juvenile Justice

Mental Health SOCIAL & EMOTIONAL WELL-BEING

FOR CHILDREN AND YOUTH EXPOSED TO

ABUSE, NEGLECT, and

VIOLENCE

INTEGRATING WELL-BEING WITH SAFETY AND PERMANENCY

WELL-BEING

PERMANENCYSAFETY

A FRAMEWORK FOR WELL-BEING

Environmental Supports

Personal Characteristics

Developmental Stage (e.g., early childhood, latency)

Within each domain, the characteristics of healthy functioning relate directly to how children and youth navigate their daily lives: how they engage in

relationships, cope with challenges, and handle responsibilities.

Cognitive Functioning

Physical Health and

Development

Emotional/ Behavioral Functioning

Social Functioning

THE FRAMEWORK IN PRACTICE: OUTCOME DOMAINS BEYOND SAFETY AND PERMANENCE

Intermediate Outcome Domains Well-Being Outcome DomainsEnvironmental Supports Personal Characteristics Cognitive Functioning Physical Health and

DevelopmentEmotional/Behavioral

FunctioningSocial 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

Early

Childhood (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

Middle Childhood (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

ESTABLISHING THE RIGHT EVIDENCE-BASED SERVICE ARRAY TO SUPPORT WELL BEING

Functional Assessment

Evidence-Based Trauma, Mental Health &

Parenting Interventions

Trauma Screening

Generic Counseling

Anger Management

Parenting Classes

RESEARCH- AND EVIDENCE BASED

APPROACHES

INEFFECTIVE APPROACHES

De-scaling what doesn’t

work

Investing in what does

De-scaling what doesn’t work, scaling up what does

USING MEDICAID TO INTEGRATING SAFETY, PERMANENCY AND WELL-BEING

• Early Periodic Screening Diagnosis and Treatment• State Plan Services, including preventive services,

described in section 1905(b) of SSA• Alternative Benefit Plans• Home and Community-Based Services• Health Home – central coordination for health services• Managed Care• Integrated Care Models• Section 1115 Research and Demonstration Programs

Multiple Medicaid vehicles allow for identification and treatment of complex trauma:

Well Being

Focus on child & family level

outcomes

Monitor progress for

improved child/youth functioning

Change Child Welfare

practice to address

impact of trauma

Take developmental

specific approach

Actively promote healthy

relationships

Build capacity to deliver Evidence

Based Practices

PRACTICES BEYOND SAFETY AND PERMANENCE TO IMPROVE OUTCOMES

“Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the

negative impacts of early fear learning.”

National Scientific Council on the Developing Child (2010)

Questions?

bsamuels@chapinhall.org