Expanding the Reach of EBT's Through Brokers: Lessons from Project BEST & PATS

Prof. Benjamin E. Saunders, PhDProf. Rochelle F. Hanson, PhD

Angela D. Moreland, PhDNational Crime Victims Research and

Treatment CenterDepartment of Psychiatry and Behavioral

SciencesMedical University of South Carolina

Charleston, SC USAPresentation at the 9th BASPCAN Congress, April 14, 2015, University of Edinburgh, Edinburgh, Scotland.

Expanding the Reach of EBTs Through Brokers: Lessons from

Project BEST & PATS

Benjamin E. Saunders, Ph.D., 2015

I have no commercial relationships to disclose.

Disclosures

Benjamin E. Saunders, Ph.D., 2015

1U79SM061269 Substance Abuse and Mental Health Services Administration

Benjamin E. Saunders, Ph.D., 2015

Colleagues

Elizabeth Ralston, PhDElizabeth Hinson,

MSWRachael Garrett, MSWCarole Swiecicki, PhD

Kim Reese, MSWDee Norton Lowcountry

Children’s Center

Monica Fitzgerald, PhD

University of Colorado

Michael de Arellano, PhDDan Smith, PhD

Carla Danielson, PhDDean Kilpatrick, PhD

Jan Koenig, MEdEmily FanguyCarrie JacksonNicole Fortune

Medical University of South Carolina

Benjamin E. Saunders, Ph.D., 2015

Need for Trauma Services Exposure to violence and other traumatic events

is highly prevalent among children and youth. Significant portion of youth exposed to potentially

traumatic events will develop trauma-related mental health problems.

Effective treatments (EBTs) exist for many of these problems.

Relatively few children that need these effective interventions receive them.

Benjamin E. Saunders, Ph.D., 2015

Why do victimized children not receive effective trauma

treatment? Lack of service capacity.

Not enough therapists trained in ESIs.Lack of use of the ESI by those trained.Limited service delivery systems.

Children and families not identified and referred to trained therapists.Brokers of mental health services unaware

of ESIs.Generic service plans.Lack of case management skills related to

ESIs. Lack of collaboration between service

providers.Poor initial engagement in treatment.Sporadic attendance.High premature dropout rates.Lack of focus on treatment outcomes.

Benjamin E. Saunders, Ph.D., 2015

Solution: Train Therapists!

Mental Health

ChildWelfare

JuvenileJustice

CACs

PrivatePractitioners

Medical

Schools

LawEnforcement

FamilyCourt

RapeCrisis

DomesticViolence

Drug &Alcohol

MentorPrograms

Probation

GALs

CriminalCourt

Medicaid

Drug &Alcohol

MCOs

Victim’sCompensation

AlternativeCare

ParentingPrograms

Sex OffenderTreatment

pRTFs

GroupHomes

VictimAdvocates

No one agency can make it happen.

FosterHomes

Let’s All Get Trauma-Informed!

Benjamin E. Saunders, Ph.D., 2015

Training within Practice Silos

Child

W

elfa

re

Men

tal

Heal

th

Juve

nile

Ju

stice

Sub

Abus

e

Community as the Target

Community-Based Learning Collaborative

Saunders & Hanson, 2014

Referral

Relevant Service Systems

Child Welfare

Juvenile Justice

VictimAdvocates Guardian

Ad Litem

Rape Crisis Center

Bro

kers

MH

Providers

PublicMentalHealth

NonprofitMH

Services

UniversityMH Services

Private Practitioners

National Survey of Child and Adolescent Well-Being N=1,613 children within 75 child welfare agencies over 36 months Examined Interorganizational Relationships (IORs)

• Number of coordination approaches between each child welfare agency and mental health service providers

Tested relationships between IORs, Service Use, and Outcomes Greater intensity of IORs greater likelihood of service use and

mental health improvement. Conclusions: Greater number of ties with mental health providers may help child

welfare agencies improve children’s mental health service access and outcomes

Encourage different types of organizational ties between child welfare and mental health systems

Bai, Y., Wells, R., Hillemeier, M.M. (2009). Coordination between child welfare agencies and mental health service providers, children’s service use, and outcomes. Child Abuse & Neglect, 33, 372-381.

Community Coordination Improves Outcomes for

Children

• Brokers• Consumers• Payers• Broker Service Systems

• Clinical Practitioners• Clinical Service Systems

Social Economic Model

Benjamin E. Saunders, Ph.D., 2015

5 9

Pre-Work LS1 LS2Action Period

Action Period

4+

Community-Based Learning Collaborative Timeline

12

Supervisors1-day

Orient.SL Train.

Comm.Prep

1CBLC Month

Benjamin E. Saunders, Ph.D., 2015

Senior Leader Track

LeadershipSupport

CBLC Curriculum Areas

Clinical Track

TF-CBT

Broker Track

EBTPCMTS

Common Material and ActivitiesClinicians, Brokers, Senior Leaders

Team Building

JointCommunity

Responsibility

Benjamin E. Saunders, Ph.D., 2015

Broker CBCL Completion

Learning Collaborative LS1 All LS

All Calls Rostered

Pee Dee 18 12 1 1Coastal 29 18 3 3Midlands 14 7 2 2Upstate 13 9 3 2North Central 18 9 9 9Edisto 26 17 9 9Total 127 63 27 26

Benjamin E. Saunders, Ph.D., 2015

Edisto and North Central CBLCsBroker Monthly Metrics

Average N=23

Ave

rage

mon

thly

cas

es

Benjamin E. Saunders, Ph.D., 2015

Lessons Learned -- Brokers Half-life of a child welfare worker – staff turnover. Training and practice culture of child welfare.

Directive about specific procedures to follow.Low reliance on independent choices by front-line

caseworkers. Intensive, advance training of frontline case workers is

rare. Time is precious.

Essential tasks take priority.Crises take priority.More advanced case management procedures often left

behind Procedures that are not mandated will be low

priority. Many of the procedures and skills taught were not

supported adequately by policy, senior leaders and supervisors.

Benjamin E. Saunders, Ph.D., 2015

Lessons Learned – Brokers Lack of clarity about broker responsibilities for:

Coordinating treatment planning with other community professionals

Assessing clinical provider qualificationsScreening for trauma history and trauma-related

problems with toolsReferring for a particular treatment approachQuestioning the clinical provider regarding initial

assessment and treatment, approachesMonitoring treatment delivery and client progress.Monitoring treatment progress. Monitoring specific, measurable treatment outcomes

Benjamin E. Saunders, Ph.D., 2015

Lessons Learned – Brokers Brokers can learn and apply these skills. Brokers will shift task to another part of the

treatment system if possible, e.g., screening. Therapists like working with trained brokers A trained broker will fill up a trained therapist

quickly.

Benjamin E. Saunders, Ph.D., 2015

Partnership:• South Carolina Department of Social Services• South Carolina Department of Mental Health• Project BEST