Federal Efforts to Address the ACE Epidemic: Two Examples from Child Welfare

Clare Anderson, Deputy Director Administration on Children, Youth, and Families

Adverse Childhood Experiences

December 11, 2011 Clare Anderson 2

Brain Development Patterns

Traumatic Stress BRAIN

Hormones, chemicals, and cellular systems prepare for a tough life in an evil world

INDIVIDUAL

> Edgy > Hot temper > Hyper vigilant > “Brawn over brains”

OUTCOME

Individual and species survive the worst conditions

NEUTRAL START

Adapted from: Family Policy Council. (2007). The High Cost of Adverse Childhood Experiences (PPT). Olympia, WA: Author.

BRAIN

Hormones, chemicals, and cellular systems prepare for life in a benevolent world

INDIVIDUAL

> Laid back > Relationship oriented > Think things through > “Process over power”

OUTCOME

Individual and species live peacefully in good times; vulnerable in poor conditions

Effective screening and assessment help identify children who have trauma symptoms; evidence based interventions and strategies help restore developmentally appropriate functioning.

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The Overlap of Trauma and Mental Health Symptoms

Trauma and Mental Health Systems by Age for Children Entering Care, IL

100%

13,12%

90% 80% 70% 60% 50%

7,11% 11,76% 39,18% 13,56% 54,13% 62,00%

BOTH Trauma and Mental Health Symptoms Mental Health Symptoms Only 40% 30%

68,02% 13,81% 21,92% 15,75%

Trauma Symptoms Only

6,93%

20%

33,45% 6,00%

10% 0% December 11, 2011 0 – 6 Year Olds

17,03%

7 – 12 Year Olds 13 – 16 Year Olds

Age Range

Clare Anderson

16,25%

17 + Year Olds NO Symptoms (Griffin, McClelland, Holzberg, Stolbach, Maj, & Kisiel , 2012) 4

Able to manage emotions and regain equilibrium when upset Able to sustain positive interpersonal relationships December 11, 2011 Feeling safe and stable in the living environment

WELL BEING

Has a positive self image Belonging and social connectedness (permanency) Self-efficacy based on developing competencies

Children’s Well-Being Has Multiple Domains That Are Impacted by Trauma

Adapted from Impact Youth Services, 2011; http://impactyouthservices.com/goals.htm

ACYF-CB-IM-12-04: http://www.acf.hhs.gov/programs/cb/laws_p olicies/policy/im/2012/im1204.pdf

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Aligning Discretionary Funding to Address Trauma

• • • • • $28 million in FY 2012 43 grantees Promoting social and emotional well being by increasing access to

screening, assessment, and treatment of trauma

Significant investments in building capacity of State and local systems to deliver evidence-based interventions to children who are in or at risk of entering child welfare.

Leveraging existing policies, such as EPSDT

Partnerships to Demonstrate the Effectiveness of Supportive Housing for Families in the Child Welfare System Initiative to Improve Access to Needs Driven, Evidence-Based/Evidence Informed Mental and Behavioral Health Services in Child Welfare Comprehensive Support Services for Families Affected by Substance Abuse or HIV/AIDS Regional Partnership Grants to Increase the Well-Being of and to Improve Permanency Outcomes for Children Affected by Substance Abuse

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New Title IV-E Child Welfare Demonstration Projects

• • • • • On September 30, HHS approved nine new child welfare demonstration projects for FY 2012 Prioritized social/emotional

well-being trauma

and addressing Each demonstration project has identified at least one well-being outcome to target for improvement Collaborations with Medicaid and behavioral health authority were prioritized; six of the nine demonstration projects have collaborations in place or will pursue them Accepting applications

now

projects for FY13 demonstration – Information Memorandum: https://www.acf.hhs.gov/sites/default/files/cb/im1205.pdf

Arkansas Colorado Illinois Massachusetts Michigan Pennsylvania Utah Washington Wisconsin Proposals are posted online: https://www.acf.hhs.gov/pr ograms/cb/programs/child welfare-waivers November 15, 2012 NRCOI Webinar - Clare Anderson 7

December 11, 2011

SUPPORTIVE HOUSING & CHILD WELFARE

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Supportive Housing and Child Welfare

• • • Public-private partnership to test a collaborative model of intensive service delivery for high-need families $35 million over 5 years; 5 grantees Funded projects must secure affordable housing for at least 50 families as the platform for which the services will be provided for the target population December 11, 2011 Clare Anderson 9

Target Population for the Supportive Housing-Child Welfare Demonstration

• • • • • • “Characteristics of appropriate target populations under this FOA include, but are not limited to: Reports to child protective services related to abuse and neglect Exposure to prior traumas, including child abuse and domestic violence Lack of financial resources and receiving or eligibility for public assistance Children who exhibit severe emotional and/or behavioral problems Repeated episodes of homelessness over time and/or long stays in shelters Parents with serious and chronic substance abuse, mental health, or physical health problems.

…This points to the need for the collaboration between project partners to focus on identifying those families who are

most in need

and who would derive the

most tangible benefit

from receiving assistance provided by this pilot project (i.e., those families that present with

multiple characteristics

).” HHS-2012-ACF-ACYF-CA-0538: Funding Opportunity Announcement: Partnerships to Demonstrate the Effectiveness of Supportive Housing for Families in the Child Welfare System. U.S. Department of Health and Human Services November 28, 2012 SH-CW Grantees Kickoff 10

• • • • •

Program Components: Interdisciplinary Teams for Case Management

Establish trusting relationship with families to promote child well being and family stability while improving capacity of caregivers to provide safe and permanent home for children Work with family to develop integrated case plan including housing needs and other services needed Ensure housing retention and improve housing stability as platform for ongoing engagement and family stability

Build a network of support among tenants that focuses on trust, well-being, and social/community integration

Advocate on behalf of parents and children to ensure that they understand requirements of social services in which they are engaged.

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• • •

Program Components: Services for Parents and Children that Address Family Functioning

Parenting skills training to provide evidence-based strategies to promote parenting abilities (e.g., NPP, PAT, Triple P) and access to programs that address relational problems (e.g., PCIT, BSFT, CPP, FFT)

Services and interventions to improve family functioning and assist with reunification of families (e.g., MSFT) Ancillary services for families to provide assistance in securing needed services such as safe and drug-free housing, transportation, and child care December 11, 2011 Clare Anderson 12

Program Components: Services and Activities for Children and Youth that Address Child Well-Being and Trauma

• Screening and assessment of child well-being across domains •

Evidence-based, developmentally appropriate approaches to promoting child well-being, tailored to the specific needs of each child

• Access to appropriate mental health services for children involved in the child welfare system, including services to address experiences of trauma December 11, 2011 Clare Anderson 13

Services to address family functioning Services to address child well-being and trauma

Program Components Collectively Promote Well-Being

Interdisciplinary case management teams

In Supportive Housing Context

Child and Family Well-Being

Clare Anderson December 11, 2011 14

December 11, 2011

TITLE IV-E CHILD WELFARE DEMONSTRATION PROJECTS

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HHS may waive title IV-E requirements for States with approved projects, allowing them to use funds flexibly and reinvest savings.

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Goals for Demonstration Projects

• • • Increase permanency for all infants, children, and youth by reducing the time in foster placements when possible and promoting a successful transition to adulthood for older youth. Increase positive outcomes for infants, children, youth, and families in their homes and communities, including tribal communities, and improve the safety and well-being of infants, children, and youth. Prevent child abuse and neglect and the re-entry of infants, children, and youth into foster care. December 11, 2011 Clare Anderson 17

Promoting Well-Being and Addressing Trauma in Demonstration Projects

• • • Demonstrations that explicitly support social and emotional well-being and address trauma are prioritized for approval.

Each demonstration project has identified at least one well-being outcome to target for improvement.

States are encouraged to align screening, assessment, and evidence-based interventions with the needs and characteristics of the target population in order to achieve improved well-being.

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Matching Populations, Outcomes, and Approaches

Target Population

Children, 8-17 Children, 13-17 Children, 2-7 December 11, 2011

Screening & Assessment

- UCLA PTSD Index - Strengths & Difficulties Questionnaire - Child & Adolescent Needs & Strengths - Strengths & Difficulties Questionnaire - Child & Adolescent Needs & Strengths - Trauma Symptoms Checklist for Young Children - Infant Toddler Emotional Assessment - Child Behavior Checklist

EBIs

Trauma-Focused Cognitive Behavioral Therapy (ages 0-21) Multisystemic Therapy (ages 6-17) Parent-Child Interaction Therapy (ages 0-12) Clare Anderson

Outcomes

- Behavior problems - PTS symptoms - Depression - Delinquency/Drugs - Peer problems - Family cohesion - Conduct disorders - Parent distress - Parent-child interaction 19

• • • •

Pennsylvania

Target population

services : Children in or at-risk of entering placement, discharged from placement, or receiving in-home

Geographic scope

: 5 counties initially

Key outcomes

: Improved parent behavioral health and functioning; increased parenting skills; improved child and youth functioning in home, school and community; reduced use of congregate care and other restrictive placement settings; increased placement in most appropriate and least restrictive settings

Evidence-based or promising programs considered

Years; Why Try?

: PCIT; MST; MTFC; TF-CBT; Triple P; NFP; SFP; Incredible November 30, 2011 NC Waiver Meeting 20