Authors: Jenny Cooper
Event: 2016 TheMHS Conference
Subject: Supporting Recovery from Trauma, communities, innovation, quality, mental health service reform, research & evaluation informing practice, service delivery, implementation, service systems and programs, trauma-informed care, usa, north carolina, america,
Type of resource: Conference Presentations and Papers
Abstract: Partnering for Excellence (PFE) is an initiative, funded by a private grantor, to improve the behavioural health and well-being outcomes for children served by the child welfare system. Through a partnership between the local child protective agency (Department of Social Services or DSS) and public healthcare funding oversight agency (Managed Care Organization or MCO), the PFE model ensures that children between the ages of 5 – 18 who are being monitored while they remain in their parents’ home or have come into custody of the state:
- Are screened for exposure to and symptoms of psychological trauma
- Receive timely, trauma-informed comprehensive clinical assessments (TiCCA) from qualified behavioural health practitioners
- Receive trauma-focused, evidence-based behavioural health treatment such as Trauma-Focused Cognitive Behavioural Therapy to reduce trauma symptoms and support recovery
- Live in a community which is dedicated to an increased understanding of the impact of trauma
To achieve these goals, the DSS and the MCO are instituting practice, policy and funding changes within their respective organizations. In addition, DSS and the MCO partner with a select group of behavioural health providers to ensure that the target population of children are able to receive these outlined services in a timely and coordinated manner. These select providers demonstrate a commitment to high quality services, fidelity to identified models of care, and effective communication and care management with DSS, MCO, and other System of Care stakeholders.
PFE was implemented in a mid-sized North Carolina county in February 2014. To date, more than 250 kids have entered the PFE pipeline. 100% of the youth who were in the custody of the State screened positive for trauma. PFE uses a trauma screening which looks at potentially traumatic events as well as trauma symptoms and is completed by the DSS caseworker.
Youth who screen positive are referred for a Trauma-Informed Comprehensive Clinical Assessment (TiCCA). The TiCCA requires three hours of face to face contact with the family, child, and social worker. The TiCCA includes a standardized battery of measures, multiple collateral contacts, and holistic recommendations for the child and family which includes various life domains. The TiCCA is very focused on offering not only the type of service that should be delivered (mental health outpatient, therapeutic school), but also the model of care that should be used (TFCBT, SPARCS, PCIT, etc.).
Once the TiCCA is completed, it is reviewed by the Child and Family Team and the recommendations are put in to the Family Services Agreement, the plan that the family follows while DSS is providing oversight. Typically, Family Services Agreements focus on what is needed for the parents to be healthy enough to provide a safe environment for the children in the home. Now, however, DSS is focusing more on child wellbeing in addition to safety in their homes.
DSS is also focusing on the availability of evidence-based practices for children and families. They have worked with local private practices to request more services as well as reaching out to other areas which have more services. DSS case workers have learned how to assess the quality of the mental health services that are being offered to ensure that their youth get the best quality of care.
DSS and MCO have worked together through a series of training. They have cross-trained to better understand one another’s processes. They also co-train DSS staff on the impact of trauma. This training has been so popular that it has been opened up to the community. This has afforded personnel from the school system, child advocacy, juvenile justice, and others to learn about trauma. Resource parents are also now trained in trauma and how to parent children who have been impacted by trauma in their home.
Other initiatives in the community have begun focusing on trauma as well. The local System of Care has decided to focus on trauma informed care. The local Youth Substance Use Prevention Task Force is considering how their policies should also focus on trauma and its impact on substance use. PFE is also instituting quarterly meetings for the community to address trauma.
While quantitative data is not yet available, preliminary data will be available in April with final data shortly to follow.
This workshop will focus on the components of PFE and how they could be translated for the local area. PFE data will be introduced at the beginning of the session. Then, a short amount of time will be spent on each component followed by small group work and reporting the various brainstorming. Participants will be grouped regionally as cultures and services vary. The areas that will be focused on for the small group work are:
- Screening for trauma
- Trauma informed assessments
- Increasing evidence-based practices
- Trauma informed workforce
- Trauma informed communities
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