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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
Recommended