Where the Rubber Hits the Road: Strategies for Implementing and Sustaining Trauma-Informed Child Welfare Practice Erika Tullberg, MPA, MPH Bonnie Kerker, PhD NYU Child Study Center Georgia Boothe, LMSW Children’s Aid Society June 7, 2017
Today’s Agenda • Trauma-informed child welfare practice • The Atlas Project • Starting the work • Measuring the impact • Sustainability
Trauma-Informed Child Welfare Practice Presentation Title Goes Here 3
Why Trauma-Informed Child Welfare Practice? • High incidence of trauma among children and families in the child welfare system • >19% of youth in foster care have clinically significant post-traumatic stress symptoms (Kolko et al., 2010) • Foster care alumni have higher rates of PTSD compared to the general population (21% vs. 4.5%) (Pecora et al., 2006) • Impact of trauma on child health and development, adult health • Impact of trauma on child welfare outcomes 4
Essential Elements of Trauma-Informed Child Welfare Practice 1. Maximize physical and psychological safety for children and families 2. Identify trauma-related needs of children and families 3. Enhance child well-being and resilience 4. Enhance family well-being and resilience 5. Enhance the well-being and resilience of those working in the system 6. Partner with youth and families 7. Partner with agencies and systems that interact with children and families National Child Traumatic Stress Network
Using Trauma-Informed Child Welfare Practice to Improve Placement Stability Breakthrough Series Collaborative 1. Trauma-informed mental health assessment (including screening) 2. Case planning and management 3. Trauma-informed services 4. Knowledge-building and developing practice 5. Cross-system partnerships and system collaboration National Child Traumatic Stress Network
Child Welfare Traumameter 1. Recruitment and Training 2. Trauma Screening 3. Decision-making/Services Planning 4. Clinical Services 5. Support and Supervision 6. Working with Children and Families 7. Cultural Responsiveness
ACYF “Trauma” Projects To meet the complex special needs of children and youth in foster care, child welfare systems must: • Have universal screening for the early identification of children and youth with behavioral and mental health needs; • Provide universal and periodic functional assessment of the social- emotional strengths and difficulties of a child and parenting capabilities using; and • Ensure access to effective treatments and services that are aligned with the assessed behavioral and mental health needs of children and youth with behavioral and mental health needs. Administration on Children, Youth and Families
Atlas Project Elements Foster care-mental health provider partnerships Organizational planning Staff and foster parent consultation and training mental mental mental treatment health health health decision- screening assessment making treatment
Mental Health Screening and Assessment • Pediatric Symptom Checklist • Looks at attention, internalizing and externalizing behavior • Child Stress Disorders Checklist • Looks at trauma exposure and symptoms Both tools: Have shorter • versions Have youth and • observer versions Are available in • Spanish
Child Ecology Check-In Looks at child’s emotional and behavioral dysregulation, the stability of caretakers, foster care agency and larger service system Intervention for Environmental Risk highest score for ANY environmental item Low need (1 or 2) Moderate need (3) High need (4 or 5) No intervention Social intervention Low need Intervention (1 or 2) (bucket 6) (bucket 5) for Child’s Symptoms Regular trauma intervention Moderate highest score for need (3) (bucket 2) ANY symptom item Safety-focused trauma intervention High need (4 or 5) (bucket 1)
Trauma Systems Therapy Child Social Environment Assess the social Assess child’s environment’s tendency to shift capacity to help & into SIM states protect the child Increase child’s Increase the social capacity to stay environment’s regulated even capacity to support when confronted by the child’s cat hair regulation
Trauma Systems Therapy • Team-based model • Grounded in foster care and mental health program partnership • “Therapy” includes what child welfare staff and foster parents do
Trauma Systems Therapy… Moving from speculation to KNOWING Survival in the Moments pattern Moment
Trauma Systems Therapy… Moving from speculation to KNOWING Safe & healthy relationships pattern
Addressing Secondary Trauma • Looking at secondary trauma experienced by Our supervisors and administrators identify when their staff are suffering from STS and provide effective staff across the agency support and guidance to them • 18 Collecting data on 16 people’s perceptions of: 14 • Supervisors’ trauma -related 12 practice 10 • Secondary trauma-related 8 skills 6 • Secondary trauma 4 identification and support 2 0 Mostly Sometimes Rarely
Starting the Work Presentation Title Goes Here 17
Can our agency take this on? • Financial and time-related resources • Staff strengths and weaknesses • Organizational capacity Impact on scope of project and ramping up schedule
Potential Barriers and Facilitators • Integrate tools/processes into existing practice • Replace activities when possible, instead of adding on • Flexibility re scope, timing • Staff turnover • Time limitations • Initiative fatigue
Staff Attrition: October 2016-March 2017 # positions that Position # of Staff # who left were vacant 1+ % Attrition month Social 6 5 2 83% worker Socio- 7 2 0 29% Therapist Supervisor 2 0 - 0%
Potential Barriers and Facilitators Acknowledge the impact of trauma on children, families, staff • Increases engagement, success of interventions • Increases trauma exposure, related stress may make staff more rigid, fall back into old patterns
Planning Process • Plan BEFORE implementation • Involve all levels of staff • Identify how new processes will be integrated into existing processes • Balancing existing demands while shifting practice • Account for billable time • Create infrastructure for sustainability from the beginning • Training • Day-to-day leadership
Culture Change • How does an agency’s existing culture facilitate or get in the way of trauma-informed practice? • How can this be effectively be harnessed and/or addressed during the implementation process? • How can the adoption of trauma-informed practices help drive positive culture change?
Measuring the Impact Presentation Title Goes Here 24
Why is this important? • Important to know if w e’re doing what we wanted to do • Important to know how we can do it more effectively • Important to know if we are achieving our goals • Important to know what would help us achieve our goals • Important to show funders that this work is worth their continued support • Important to show us that this work is worth our effort!!
Align with Agency Priorities • Helps to increase staff and leadership buy-in • Reduces burden of data collection • Helps people see the outcomes of the work
Data Collection • Use administrative data whenever possible • Lateral moves, step-ups, time in care, hospitalizations • For symptom-level data, primary collection is often necessary • Comparison Groups • Benefits of collecting qualitative data • Can inform the implementation process • Can capture more subtle changes in practice • IRB approvals
Atlas Implementation Study: Foster Parent Focus Groups • Implemented annually with foster parents at each Atlas agency • Aimed at informing Atlas development and monitoring the relationship between foster staff and parents over time • Used a semi-structured guide to conduct the groups, and qualitative methods were used to identify themes in the data
Foster Parent Focus Group Domains • Relationships and communication with foster care agency staff • Tools and training • Clinical care
Foster Parent Focus Group Results: An Example • In one follow-up focus group, foster parents were less critical than the first about individual staff members and were more likely to attribute the problems they faced to structural issues in the agency . • Lack of communication with foster care staff was a concern among most agencies’ foster parents – highly dependent on the individual worker
Atlas Implementation Study: Agency Leadership Interviews • Conducted with 2-3 leaders per agency • Conducted towards the end of the first year of implementation, and annually when possible • Aimed at understanding the main barriers and challenges to successfully implementing Atlas • An interview guide was used
Agency Leadership Interview Guide • Expectations (are they being met?) • Challenges in implementation • Helpful parts of planning • Training • Weekly consultations
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