Jean Solomon, M.A., M.S.N. Mark R. Groner, M.S.S.A., L.I.S.W.-S.

Who Are the Level IV Treatment Foster Care Kids and What Do They Need?

Attendees’ Goals for Today?

Established in 1852, now serving NE Ohio and beyond

$25 million annual budgetStaff of 450Prevention, early intervention

and treatment programs ranging from sex education in schools to a secure Intensive Treatment Unit for SED children and teens

Learning Organization PrinciplesSystems ThinkingMental ModelsShared VisionTeam LearningPersonal Mastery

Learning and Performance Improvement Cycle

Decide•Identify Possible Solutions•Decide on Best Solution•Create New Process Maps/Design

Connect*Look For Similarities*Identify/Gather Source Data

Reflect•Define and Analyze Problem•Develop Shared Vision•Identify Outcome Criteria•Map Current Processes

*Do*Implement Solution/Design*Monitor and Evaluate Impact and Quality*Ask if Information Can Be Used Elsewhere

Outcome Measurement Using the Ohio Scales Quarterly Monitored Performance Improvement Outcomes

using Youth Ohio Scales Standardized Outcomes Measure

Problem Severity: lower scores are desirable.Functioning: higher scores are desirable.

Interpretation of Ohio Scales Scores – (Ogles)

Level of Impairment

Problem Severity

Functioning

None 0-9 64-80Mild 10-19 49-64Moderate 20-36 33-48Severe 37-52 17-32Extreme 53-100 0-16

Agency Foster Care“Waystation”Family Foster CareTreatment Foster CareThe 90’s and Permanency

Growth of the community – based organizational arm

Transformation of Residential Treatment to stabilization and family identification/reunification

Shortened LOS’s“Virtual RT” or Level IV Foster Care

Level IV Foster CareHow do we help families

accept increasingly challenging kids?

How do we safely support the youth and families?

What type of training do the parentss need?

How do we change the culture and mental models to embrace the care of teens?

How do we recruit?How do we manage risk?

“LIV” Program DescriptionIntensive staff ratio’sRobust foster parent

training/mentoringDaily phone contactWrap around servicesAccess to full care

continuum MH servicesSemi-weekly team

meetings

Flexible FA dollarsLiberal respiteGeographic FP support

groupsFP steering groupA lot of celebrations

REFLECT

Define the ProblemOhio Scales: Aggregate rate of clinically reliable

improvement in the agency’s foster care program was below the agency’s and statewide benchmarks

Symptoms Functioning

Define the Problem (continued)Placement Stability: the mean number of

placements while in Beech Brook Treatment Foster Care per level of careLevel I = 1.6Level II = 1.8Level III = 2.4Level IV = 2.9

Are there different trajectories among foster care youth by levels and within levels?

How do we answer the Question? Focus on LIV youth Compare the youth who

remain the same/stable or get better, to those who appear to get worse on the Ohio Scales.

How are these subgroups the same or different?

What does the sub group that is faring poorly need that may be different from what BB normally provides?

CONNECT

Sources of Data

Disclaimer: There are no silver bullets……

Research Team Discussions

Quantitative Data: Race/Ethnicity and Gender

Table 1: Basic Demographics, Beech Brook Level 4 Foster Care, Fiscal Years 2010 and 2011 (N = 126)  PercentageFemale 48.4%African American 65.1%Caucasian 26.9%Biracial/Hispanic/Unknown

8.0%

Age M = 13.6 (S.D. = 3.0)

Quantitative Data: Traumatic Experiences

Table 2: Trauma Experiences (Known at Intake) , Beech Brook Level 4 Foster Care, Fiscal Years 2010 and 2011 (N = 126)

PercentagePhysical Abuse 42.9%Sexual Abuse 38.9%Domestic Violence 29.4%Parent Alcohol/Drug Abuse 43.7%≥ 1 Traumatic Experience 82.7% Number of TE’s Mean=1.55; SD=1.14

Quantitative Data: Education

Table 3: Education-Related Variables (known at intake), Beech Brook Level 4: Foster Care, Fiscal Years 2010 and 2011 (N = 126)

Percentage

Day Treatment 61.1%Individual Education Plan 50.0%

Quantitative Data: Placement Information

Table 4: Placement Data, Beech Brook Level 4 Foster Care, Fiscal Years 2010 and 2011 (N = 126)

Percentage Mean (S.D.)

Number of Placements before BB FC Admission

  5.29 (3.95)

Transferred from Residential 57.9%  

Number of Placements while in BB Foster Care

2.75 (2.09)

# Residential Placements while in BBTFC    

0 27.8%

1 23.0%

2 24.6%

3 or more 24.6%

Quantitative Data: Custody TypeTable 5: Group Custody Type (Known at Intake) , Beech Brook Level 4 Foster Care, Fiscal Years 2010 and 2011 (N = 126)Custody Type PercentagePermanent Custody

59%

Temporary Custody

43%

Emergency Custody

15%

PPLA 9%

Quantitative Data: Outcomes Comparisons by Key VariablesOn average, females make more progress than

males in the program but they are also more symptomatic than their male counterparts

In general, special assistance around educational needs is associated with better outcomes

African American youth tend to make less functional progress

Level IV clients with 3 or more residential treatment admissions in their course of treatment struggle especially hard to make progress

In general, the presence of high levels of trauma is associated with poor outcomes

12/12/08-3/12/09 Level 2 (JH & MH Foster Home)3/12/09-4/12/09 ITU4/13/09-11/10/10 Level 4 (04/13/09-06/03/09, JH & MH Foster Home -06/03/09-11/10/10, VT Foster Home)11/10/10-12/13/10 ITU12/13/10-1/6/11 Level 4 (RG Foster Home)1/6/11-1/27/11 ITU1/27/11-5/6/11 Res5/6/11-5/16/11 ITU5/16/11 Res

Qualitative Case Study: The general pattern is that these complex clients have trajectories that reflect many ups an downs over time in their functioning and symptoms (as measured by the OS’s)

Literature ReviewRandomized Control Trial Studies on Treatment Foster Care

Juvenile Justice population

Child Welfare/SED Population

Total

Multidimensional Treatment Foster Care (MTFC)

4 1 5

Other TFC Interventions* 0 5 54 5 9 Small study

with baseline group differences.

Compare MTFC to Group Care. Focus on recidivism, delinquency.

Compare TFC to treatment as usual. Focus on placement stability and behavior problems.

DECIDE

Small Group DiscussionGiven these data, decide what you believe are the key components of a successful program redesign?

Contact InformationJean Solomonjsolomon@beechbrook.org216-831-2255, ext. 2300

Mark R. Gronermgroner@beechbrook.org216-831-2255, ext. 2402

Beech Brook3737 Lander RoadCleveland, OH 44124