Fostering Healthy Futures Kempe Center for the Prevention

and Treatment of Child Abuse and Neglect

Fostering Healthy Futures Program Design

1) Assessments of Children’s

Functioning

2) Therapeutic Skills Groups

3) Mentoring

It Takes a Village

David Olds Sara Culhane Ann Petrila Daniel Hettleman Volunteers Kempe Center Kempe Foundation Youth Mentoring Collaborative Department of Pediatrics, University of

Colorado Developmental Psychobiology Research Group

Denver Department of Human Services Adams County Social Services Department Jefferson County Human Services Arapahoe County Department of Human

Services Broomfield County Health and Human

Services Colorado Department of Human Services Graduate schools: DU, Newman, CSU, UCD,

Metro School districts and schools Mental health centers and therapists Multiple non-profit organizations Children and families

FHF Core Staff 2002-2013 Sara Culhane, Ph.D. Ann Petrila, LCSW Daniel Hettleman, Ph.D. Becky Gennerman-Schroeder,

LPC Patrick Nickoletti, PhD Jill Gjerde, MA Michel Holien, LCSW Dana Morgan, LCSW Robyn Wertheimer, LCSW Jennifer Koch-Zapfel, MSW Tracy Rudhe Dongmei Pan, MA Liz Goetter, BA Julie Bemski, BA Tabitha Webster, BA

Laura Mann, BA Melody Combs, Ph.D. Tali Raviv, PhD Chris Kelman, LCSW Leslie Fitzpatrick, LCSW Orah Fireman, LCSW, M.Ed Edward Garrido, Ph.D. Christie Petrenko, PhD. Leigh Clasby, BA Michael Knudtson, MA Wendy Gehring, BA John Holmberg, Psy.D. Tara Rhodes, MA Lindsey Weiler, Ph.D. Heather Taussig, Ph.D.

FHF Graduate Student

• Tiffany Conway• Tracy Rudhe• Brian Wolff• Jenn Winkelmann• Pam Freeman• Danielle Smith • Amanda Brown• Heather Frey• Vyga Kaufmann• Neta Bargai• Julie Bemski• Jenell Ribble• Martine Lopez• Alana Henken• Kathryn Jargo• Liz Hooks• Tara Buckley• Jordan Pock• Andrea Reece• Sara Rosenau• Natalie Tolejko• Kristen Simpson • Shari Watters • Michelle Brunner

Research Assistants and Group Leaders

• Lindsay Heath• Kristin Nelson• Kate Slivka• Lindsay Smart• Susan Whittle• Elizabeth Goetter• Julie Lyons• Courtney Fiedler• Edyta Biegunajtys• Claire Heppner• Clara Paynter• Kelsey McNeill• Jenell Ribble• Dena Miller• Martine Lopez • Thea Wessel• Alana Henken• Julie Bemski• Claire Heppner• Amy Percosky• Andrea Temple• Allison Glover• Sarah Morehouse• Jennifer DeVault

• Brendan Close• Erika Joye• Nicole Lariviere• Amy Franke• Mia Kim• Jessi Wheatley• Melani Dawson-Lear• Melanie Rodriguez• Riley Spuhler• Walter Heidenreich• David Roberts• Alexis Karris• Marisa Duran• Patrick Nickoletti• Dena Miller• Thea Wessel• Jennifer Sackett• Amy Percosky• Tisha Bean• Emily Macdonald• Jill Gjerde• Rachel Lund• Ann Chu• Yael Chatav

• Debra Boeldt• Christine Kelley• Denise Onofrey• Jennell Ribble• Alanna Gangemi• Jenny Doft• Jenea Jones• Kristin Allen• Maddie Philley• Rachel Shulman• Leigh Clasby• Sarah Perzow• Emily Rotbart• Laurel Story• Mayla Yang• Tish Wer• Claire

Stephenson• Allison Glover• Melissa Toppel• Jasmine Crane• Christina Hack• Olga Leonova• Leah Chelist• Katie Lange

• Melena Postolowski

• Kristen Mackiewicz

• Allison Bratsch• Kristen Vescera• Leah Scandurra • Emily Laux• Caroline

Oppenheimer• Tara Rhodes• Leah Harrigan• Cory Reid-Vanas• Erica Ragan• Jessica Schnittka• Shelby Scott• Maria Davidsmeier• Shawna Henry-

Lange• Anne Eden• Rachel

Stonecipher• Michelle Turner• Liz Healy• Lucia Lapaz• Rachel Levine• Aleja Parsons• Meagan Rohde• Laura Sullivan

•

FHF Graduate Student Interns2002-2003• Melani Dawson-

Lear• Kristine Wilson• Brenna Ellington• Lanette Ambers• Carrie Oliver

2003-2004• Amy Bruner• Liz Dinsdale• Vashawn Banks• Josh Goldman• Marisa Duran• Amber Cross

Thomas• Melanie Rodriguez• Clover Bone

2004-2005• Tiffany Conway• Katie Ferguson• Katie Melstrom• Lisa Meyers• Kendra Sasa• Carla Scarpone• Lewis Smirl• Kelsey Wennesland• Regina Richards

2005-2006• Michelle Brunner• Jocelyn Gray• Jon Phillips• Jennifer Stucka• Christina Haskins• Tina Francis• Sarah Kane• Mark Spehn• Jennifer Nelsen

*Over 80,000

hours of training

provided to 130 interns

2006-2007• Lorendia Schmidt• Phoung Phan• Beth Lipschutz• Jacquelyn Eisenberg• Angela Bierle• Lisa Harrison• Nicole Henkins• Erin Hoglund

2007-2008• Kerrie Earley• Ashley Moore• Justine Stewart• Lauren Goldberg• Marissa Nasca • Amber Wolfe• Jennifer Reynolds• Krystal Caduff • Miranda Learmonth• Molly Jenkins• Rebekah

Koenigbauer• Sarah Oakley• Lauren Timkovich• Sam Murillo• Elizabeth Berling• Kristin Krietemeyer

2008-2009• Rachel Alpert• Katherine Belcher• Taylor Collins• Renata Heberton• Alyse Keilson• Blake Konner• Emily Lyons• Melissa Maurer• Regan Linton• Nina Modern• Jennifer Pitcavage• Meredith Schaffer• Holly Selepouchin• Heidi VanEpps• Katherine Ware

2010-2011• Mele Cabral• Jon Florida• Sibyl Graham• Beth Hilligoss• Tighe Kaysar• Alexandria Lewis• Sarah Romero• Stacy Walsh• Jessica Devore• Jacquelyn Gabel• Jeffrey Hatcher• Ryan Holmes• Emily Laux• Megan Lovingier• Sapphire Rosier• Cami Wangaard

2011-2012• Jessica Barry• Rachel Berns• Maria

Davidsmeier• Diana Gonzalez• Brandon Hester• Nadine Leonard• Julia McKinnon• Amy Muetterties• Heather Price• Kristen Schmidt• Rachel

Stonecipher• Ashley Wiggins

2009-2010• Lissa Miller• Jenna Brown• Jane Simon• Allison Harris• Shane Spears• Jolie

Rinebarger• Diane Bouhall• Kelly Fries• Erica Brown• Shavon Perkins• Jess Valsechi• Katie Kaser• Britta Johnson• Renea Nilsson• Laura Merten• Kyle Steinke

2012-2013• Jessica

Henritze- Hoye• Jenna Kelley• Diane

Kleinschnitz• Linda Ladago• Rachel Sacco• Ani Sttele

2013-2014• Rachel Bennett• Emily Bruce• Stephanie

Cichocki• Emily Frank• Senite Sahezghi• Ashley Stewart• Elizabeth Stitzel• Nancy Vargas

Federally-Funded ResearchRisk Behaviors in Maltreated Adolescents National Institute of Mental Health Dissertation Award, 1 R03 MH56781-01,

$25,000.

Preventive Interventions for Foster Care Youth National Institute of Mental Health, 1 K01 MH01972, $590,166.

Intervention Development and Pilot for Foster Care YouthNational Institute of Mental Health, 1 R21 MH067618, $472,500.

Fostering Healthy Futures Efficacy Trial for Preadolescent Youth in Foster Care

National Institute of Mental Health, 1 R01 MH076919, $2,655,734.

Research Supplement to Promote Diversity in Health Related ResearchNational Institute of Mental Health, 3 R01 MH0876919-02S1, $283,706.

Recovery Act Administrative Supplement Providing Summer Research Experience for Student and Science EducatorsNational Institute of Mental Health, 3 R01 MH0876919-03S1, $18,670.

Long-Term Impact of a Positive Youth Development Program on Dating Violence Outcomes During the Transition to AdulthoodNational Institute of Justice, 2013-VA-CX0002, $440,642.

State, University, and Hospital Funding

Edward Byrne Memorial Justice Assistance GrantsColorado Division of Criminal Justice, U.S. Department of Justice

Tony Grampsas Youth ServicesState of Colorado

CAPTA Contract Colorado Department of Human Services

The Children’s Hospital Research Institute Bridge Funding

Colorado Clinical and Translational Sciences Institute GrantsUniversity of Colorado

` Academic Enrichment Fund

University of Colorado

Kempe Foundation Funding for FHF 2002 Daniels Fund ($20,000) 2003 The Janus Foundation ($5,000) 2003 Bonfils Stanton Foundation ($10,000) 2003 PacifiCare ($10,000) 2003 U.S. Bank ($5,000) 2004 Daniels Fund ($50,000) 2004-present Pioneer Fund ($1,500,000 endowment for Fostering Healthy Futures) 2005 Bonfils Stanton Foundation ($20,000) 2005 Daniels Fund ($50,000) 2006 Gannett Foundation ($3,000) 2006 First Data/Western Union ($5,000) 2006 Donor Advised Fund, Denver Foundation ($30,000) 2006 Anschutz Family Foundation ($3,333) 2006 Colorado Rockies Charity Fund ($10,000) 2006 Denver Foundation ($15,000) 2006 Daniels Fund ($60,000) 2007 Anschutz Family Foundation ($4,167) 2008 TJX Foundation ($3,000) 2008 Rockies/McCormick Foundation ($20,000) 2008 El Pomar Youth in Community Service - Arvada West High School

($500) 2008 El Pomar Youth in Community Service - Northglenn High School

($1,500) 2008 McGowan Foundation ($15,000) 2008 Daniels Fund ($60,000) 2008 MaggieGeorge Foundation ($16,000)

Kempe Foundation Funding for FHF 2008 Xcel Energy Foundation ($5,000) 2009 Rockies/McCormick Foundation ($20,000) 2009 Larrk Foundation ($30,000) 2009 Verdoorn Foundation ($15,000) 2009 Whispering Fox ($5,000) 2009 Daniels Fund ($60,000) 2010 Rockies/McCormick Foundation ($10,000) 2010 Verdoorn Foundation ($11,000) 2010 El Pomar Award of Excellence ($7,500) 2010 Colorado Rapids ($4,000) 2010 IP 5280 ($28,506) 2010 Jay and Rose Phillips Family Foundation ($20,000) 2011 Daniels Fund ($60,000) 2011 Rockies/McCormick Foundation ($10,000) 2012 Rockies/McCormick Foundation ($5,000) 2102 Verdoorn Foundation ($10,000) 2012 Jay and Rose Phillips Family Foundation ($20,000) 2012 Lubert Family Foundation ($7,500) 2012 LARRK Foundation ($35,000) 2012 Daniels Fund ($60,000) 2012 Morgridge Family Foundation ($4,500) 2013 Daniels Fund ($60,000) 2013 Lubert Family Foundation ($5,000) 2013 Verdoorn Foundation ($20,000) 2013 Mile High United Way (30,000)

Inclusion Criteria All 9-11-year-old children in any type of out-of-home

placement in participating counties, including those placed in foster homes, kinship care, group homes, and residential treatment centers

Placed in court-ordered out-of-home care (over prior 12 months) as result of maltreatment, and were in out-of-home care at the onset of the intervention

Cognitive functioning at a level able to comprehend group material

Did not exclude youth with significant mental health or behavioral problems (including children with sexual perpetration histories)

Youth continued to participate in the 9-month program even if they changed placements or reunified

FOSTERING HEALTHY FUTURES PREVENTIVE INTERVENTION

Better Distal Outcomes

• Mental Health • Problem Behaviors• Competencies• Quality of Life

LONG-TERM AND LIFE-COURSE OUTCOMES

Fewer Adverse Life-Course Outcomes

• Arrests and Incarceration• Pregnancy and STDs• School Failure and Dropout• Emergency Mental Health Treatment• Multiple and Restrictive Placements• Associated Costs

SHORT-TERM OUTCOMES

Cognitions

• Self-Esteem and Efficacy

• Attitudes and Appraisals

• Future Orientation

Social Functioning

• Social Support• Competence &

Acceptance• Peer Associations

Behavioral Functioning

• Behavioral Regulation• Coping Strategies• Extracurricular

Activities

Fostering Healthy Futures (FHF)

Program Design

1) Evaluations of Children’s

Functioning

2) Therapeutic Skills Groups

3) Mentoring

Screening Evaluations

We assess functioning in the following domains:

Cognitive

Academic achievement

Mental health, including trauma symptoms

Social

Behavioral

Therapeutic Skills Groups

30 weeks; manualized program

8 children per group, equal females and males

Mental health clinicians and graduate trainees facilitate

1 hour group and then dinner with mentors

Improve skills, process feelings related to the foster care experience, and reduce stigma

Session ContentBasic Social Skills• Feelings• Perspective Taking• Problem Solving• Healthy

Communication

Healthy Coping• Anger Management• Positive Self-Talk• Dealing with Worry• Active Coping

Strategies

Change and Loss• Mixed Emotions• Abuse and Neglect• Healthy Relationships• Panel Night

Adolescent Issues• Anatomy and Puberty• Dealing with Peer Pressure • Resisting Drug/Alcohol Use• Healthy Dating

Relationships

Program Ending• Future Orientation• Career Shadows• Healthy Goodbyes• GRADUATION!

Mentoring Graduate students spend 3-4 hours per week of

individual time with each child they mentor

They work on child’s lifebook, engage in extracurricular activities, help find other adult role models, shadow adults in professions of interest, work on homework, take them to libraries, recreational activities, etc.

Focus on engaging them in their communities and teaching them advocacy skills

Mentors interface with other adults in child’s life

Role of mentor - create a web of support for children, improve social skills, and provide staunch advocacy

Lifebooks

Panel Night

Cultural Presentations

Cultural Engagement

All project materials translated into Spanish

Multicultural stories in group; materials visually and linguisitically sensitive

Mentor training in multicultural issues, personal exploration of culture, community exploration project

Children and mentors do cultural presentations

Embrace and explore differences; engage in culturally-meaningful activities

Career Shadows

Mental Health Outcomes Lower Mental Health Composite Score

Fewer Trauma Symptoms

Fewer Symptoms of Dissociation

Less Anxiety

Less Current Mental Health Treatment

Fewer Psychotropic Medications (trend)

Greater Perceived Social Support

Higher Quality of Life

Placement and Permanency Outcomes

WHOLE SAMPLE 71% less likely to be placed in residential treatment

Threefold increase in adoption for children with TPR (8% vs. 26%; non-significant)

FOSTER CARE SAMPLE 44% fewer placement changes (findings strongest

for those with high baseline behavior problems)

5 times more likely to have achieved permanency

Twice as likely to have reunified with their biological parents

Key Features of FHF Homegrown Program

590 youth involved 230 youth received the 9-month program New grant to follow 250 youth into young adulthood

High Rates of Program Engagement 92% recruitment rate for voluntary program 92% retention rate Over 90% follow-up at each post-intervention timepoint

Similar Level of Evidence with other Evidence-Based Programs (e.g. TF-CBT, PCIT)

Reduces both mental health problems and negative permanency outcomes

Received recognition

In theColorado Practice Model

Best Practice Compendium!

Colorado’s Title IV-E Waiver Application

Innovative practice

Advancing knowledge

Trauma-informed child assessments

Consistent with Colorado Practice Model

Integration of behavioral health and child welfare

Addresses mental health needs of children in foster care

Piloting teen program

Increases permanency

Reduces use of congregate care

Reduces psychotropic medication use

Increases positive outcomes for children

Culturally-sensitive, de-stigmatizing and acceptable

Dissemination PhaseWidespread Inquiries

Replication Adaptation

Implementation Plan Community-Based Agencies Implement Rural Adaptation CAPTA Funding to Provide Training

Challenges to Implementation Funding Prevention Program; No diagnoses CORE funding when cases close Grants end Opportunities with Waiver or PA3?

First-Year ImplementationAurora Mental Health Center

2 groups; 16 children Adams, Denver, Arapahoe and Douglas Counties Using Core Service Dollars $5,600 for 9 month program (for 5 hours of

programming/week)

First-Quarter Progress Developed training materials and training schedule All 16 children continuing participation, despite placement

changes Anonymous program evaluations with children:

FHF is helpful for learning how to deal with feelings (87% - “A Lot”) I like how we get a chance to know other kids who are in out-of-home care (93% - “A Lot”) I am glad I chose to do FHF this year (93% - “A Lot”)

Phone calls with caregivers: Reflect high satisfaction with program Report behavioral and academic changes