ENSURING FIDELITY OF VTC: FAMILY-CENTERED FOCUS IN EVALUATIONS COLLEEN M. KILLIAN, PHDRESEARCH ASSOCIATE

HOLLY CHILD, PHD ABDRESEARCH ASSOCIATE

CHILDREN AND FAMILY FUTURES

Children and Family Futures

Track 9: Veteran Families - All presentations are available for download at www.cffutures.org

Today’s Presentation

Introduction Infancy of the VTC field Monitor implementation of VTCs Inclusion of the family-focused model

Session Objectives Explain why a family-focused VTC is important Discuss the current “best practices” of VTCs including

family-focused program activities Measuring team understanding of shared program goals Identify program strengths and challenges for program

improvement

Why Families?

Military Families and Deployment

Deployment rates (Clay, 2010): Four million parents have had a child deployed Two million children have had a parent

deployed One million spouses are coping with

deployment

Average deployment lasting 12-15 months Two or more deployments common

Effects of Deployment

Deployment and reintegration Associated with an array of transition-related

stressors relationship challenges mental health difficulties 30-35% of deployed parents have trauma and

substance abuse issues

Compounded by a lack of centralized services

VTC perfect venue to address the needs of these families

Connecting to Services*

Low rates of service utilization among veterans returning from Iraq and Afghanistan persist

~50 percent of veterans in need do not initiate mental health services  

Veterans are reluctant to seek help due to lack of interest, stigma, concerns about confidentiality and logistical/geographical barriers

*a: Milliken et al., 2007; Stecker, Fortney, Hamilton, Sherbourne, & Ajzen, 2010;b: (Hoge, Terhakopian, Castro, Messer, & Engel, 2007; Tanielian & Jaycox, 2008; c Dickstein, Vogt, Handa, & Litz, 2010; D.A. Gibbs, Olmsted, Brown, & Clinton- Sherrod, 2011; Gould et al., 2010;; Kim, Britt, Klocko, Riviere, & Adler, 2011; Kim, Thomas, Wilk, Castro, & Hoge, 2010; McFarling, et al, 2011; Pietrzak, Johnson, Goldstein, Malley, & Southwick, 2009; Stecker et al., 2010; Vogt, 2011

Federal Focus on Military Families In 2010- coordinated government-wide

approach to supporting our military families.

In response to this directive, the Interagency Policy Committee (IPC) has identified four priority areas that included:

ENHANCE THE WELL-BEING AND PSYCHOLOGICAL

HEALTH OF THE MILITARY FAMILY

Why Focus on Families?

Number of military children receiving outpatient mental health care doubled, and during that period inpatient visits by military children increased by 50 percent (Park, 2011)

Long parental deployments affect*: academic performance cause depression and anxiety physical health problems behavior problems

*Jensen, Grogan, Xenakis, & Bain, 1989; Chartrand, Frank, White, & Shope, 2008; Chandra et al., 2010; Richardson et al., 2011

Family Factors and Crime

Family issues are one of most commonly identified criminogenic factors (Bonta et al., 2008)

Attachment to children reduces violations (Visher, 2013)

Meta-analyses show that family interventions reduce recidivism (Farrington & Welsh, 2003; Woodfenden, Williams & Peat, 2002)

Family involvement results in better employment and reduced drug use (Visher, La Vigne & Travis, 2002; Lipsey et al., 2010)

Offenders with more family contact are less likely to be arrested again or re-incarcerated (LaVigne, Visher, & Castro, 2004; Martinez and Christian, 2009)

Family-focused approach

Looking at program fidelity

“Best practices” of VTCs

Family-Focused

What is “family focused”?

A. Identifying family

B. Screening of the family unit

C. Connecting to services

D. Family focused interventions

Identifying “Family”

Data Capture Sheet

Kitsap County example

Kitsap VTC Family Snapshot

INSTRUCTIONS: This form was developed to capture demographic and service need information on the participant’s children. The purpose is to identify preliminary service needs and areas that need more comprehensive assessment and case planning. Please note for each child whether the following services are: NEEDED but the child is not currently receiving that service (mark N), needed and the child is currently RECEIVING service (mark R), OR this is NOT A NEED for this child (mark X). Family Name/ID: _______________________ How many children do you have? _____

What is your relationship status? _____ Single _____ Significant Other _____ Married _____ Separated _____ Divorced _____Widowed

Child One N R X Child Two N R X Child Three N R X Child Four N R X Child Five N R X Child’s Gender

□ Female □ Male

□ Female □ Male

□ Female □ Male

□ Female □ Male

□ Female □ Male

Child’s DOB Does your child currently live with you?

□ Yes, % ____ □ No

□ Yes, % ____ □ No

□ Yes, % ____ □ No

□ Yes, % ____ □ No

□ Yes, % ____ □ No

Do you feel that this child needs or is currently receiving counseling, educational, health or any other type of supportive service?

Behavioral Issues Behavioral Issues Behavioral Issues Behavioral Issues Behavioral Issues

Child Care Child Care Child Care Child Care Child Care

Criminal Behavior

Criminal Behavior

Criminal Behavior

Criminal Behavior

Criminal Behavior

Educational/ Learning Issues

Educational/ Learning Issues

Educational/ Learning Issues

Educational/ Learning Issues

Educational/ Learning Issues

Food/nutrition Food/nutrition Food/nutrition Food/nutrition Food/nutrition

Housing Housing Housing Housing Housing

Mental health Mental health Mental health Mental health Mental health

Physical Health Physical Health Physical Health Physical Health Physical Health

Substance Abuse Substance Abuse Substance Abuse Substance Abuse Substance Abuse

Trauma Trauma Trauma Trauma Trauma

Other: Other: Other: Other: Other:

Is your family currently: Yes No receiving services through the VA? receiving services through a Community Based Vet Center receiving child welfare services? receiving on SSI, SSDI or other public assistance to support yourself and/or your family?

Screening

Family Strengths and Needs Survey (FSN) Physical Health Mental Health Substance Use

Specific assessment based on screening of needs Substance Abuse Mental Health Trauma Physical Health Parenting

FAMILY STRENGTHS AND NEEDS SURVEY

Pilot Test Findings

87.3% had a child

65.5% lived with one or more of their children

42.7% had parental rights for one or more children did not live with them

Pilot Test Findings: Impact of Use

To what extent… Children ParentsSpouse/

Significant Other

Do you feel your alcohol and/or drug use is affecting your…

53.7% 41.8% 33.3%

Have others expressed concern about the effect your alcohol and/or drug use is having on your…

54.7% 30.8% 30.8%

Have you experienced serious conflict with your…

17.3% 38.9% 47.8%

Pilot Test Findings: Family Issues

52.7% children’s social and emotional well-being

47.2% children’s medical problems 40.0% children’s behavior 17.8% significant concerns SO mental

health 9.1% significant concerns about their own

parenting skills, but 25.7% “Other community members” had

expressed such concerns

Examples of Assessments

Family-Focused North Carolina Family Assessment Scale

(NCFAS) Family Environment Scale (FES)

Child-Focused Ages and Stages Questionnaire (ASQ-3) and

Ages and Stages Questionnaire: Social-Emotional ASE:SE

Child Behavior Checklist (CBCL) Denver

Connecting “Families” to Services

VTCs Don’t Have To Do It Alone Maternal and child health Mental health Child development Youth services Special education Delinquency prevention

The task is not diverting funds from VTCs; it is accessing funds already available for children's services

Family-Focused Interventions

Strong Families Strong Forces Program

Parent-Child Interaction Therapy (PCIT)

Age-based parenting tool kits for OEF/OIF veterans and their partners:www.ouhsc.edu/VetParenting

Free online parenting course for veterans: www.veteranparenting.org  

Operation Enduring Familieshttp://www.ouhsc.edu/OEF/

Looking at Program Fidelity

How to Ensure Program Fidelity

Fidelity – early tool

Examine collaborative partners’ knowledge

Examine implementation and goals

Examine evolving context of program

Where to Start?

Defining who should be part of your collaboration

Identify collaboration’s experience and knowledge

Identify mission and goals

10 key components

10 Key Components

1. Veterans Treatment Court integrate alcohol, drug treatment, and mental health services with justice system case processing

2. Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants' due process rights

3. Eligible participants are identified early and promptly placed in the Veterans Treatment Court program

4. Veterans Treatment Court provide access to a continuum of alcohol, drug, mental health services

10 Key Components

5. Abstinence is monitored by frequent alcohol and other drug testing

6. A coordinated strategy governs Veterans Treatment Court responses to participants' compliance

7. Ongoing judicial interaction with each Veteran is essential

10 Key Components

8. Monitoring and evaluation measure the achievement of program goals and gauge effectiveness

9. Continuing interdisciplinary education promotes effective Veterans Treatment Court planning, implementation, and operations

10. Forging partnerships among Veterans Treatment Court, Veterans Administration, public agencies, and community-based organizations generates local support and enhances Veteran Treatment Court effectiveness

Identify Program Strengths & Challenges

Obtain information from multiple sources

Obtain information utilizing multiple methods

Process and Outcome Evaluation

How to Use for Program Improvement

Present findings to strategic partners

Develop an action plan

Monitor progress

VTCs and Accountability

VTCs hold parents responsible for their recovery and their parenting

But to function effectively, VTCs must also hold the system accountable for responding to the needs of families and children

Q & A

• Conference presentations• Workshop trainings• Online tutorials• Toolkits• Publications• Video

National Center on Substance Abuse and Child WelfareResources

Please visit: www.ncsacw.samhsa.gov/

Visit our exhibit

table!

Children and Family Futures

CONTACT INFORMATION:

Colleen M. Killian, PhDResearch Associate

Holly Child, PhD ABDResearch Associate

Children and Family Futures25371 Commercentre Drive, Suite 140Lake Forest, CA 92630(714) 505-3525www.cffutures.org www.ncsacw.samhsa.gov