collaborating with stakeholders to improve …...collaborating with stakeholders to improve outcomes...

Collaborating with Stakeholders to Improve Outcomes for Families

of Infants and Young Children

Michelle Rupe, MSW, Division of Family and Community PartnershipsSunday Gustin, RN, MPH, Division of Family and Community PartnershipsGerard Costa, Ph.D., Center for Autism and Early Childhood Mental Health,

Montclair State University

Participants will gain a better understanding of:

The characteristics of families with infants and young children who come to the attention of the Division of Child Protection and Permanency (DCPP)

The Strengthening Families / Protective Factors Framework Strategies for collaborating with community partners, laying the

groundwork for a Prevention System of Care What infants and young children need for healthy development Strategies to enhance the core competencies of child protective

services workers and prevention partners Strategies for implementing a Supervisory Structure that brings

together system partners Considerations for evaluation

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Our story began in 2011 in Cape May County, New Jersey

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36%

25%

39%

31% 29%

40%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

New Open Re‐open

When a group of DCF Fellows learned that more than 1/3 of referrals were Frequently Encountered Families

July-December 2010Source: NJ Spirit

Avg. State n = 5,596 , Cape May County n = 93

New Jersey

Cape May County

4Source: Analysis of Multiple Referrals and Avenues for Resolution, 2012

To better understand Frequently Encountered Families, DCF Fellows conducted an analysis of

cases closed 4/1/2009 -3/31/2010

There were 591 cases closed in Cape May County during this period and 195 re-opened as of 5/10/11

5Source: Analysis of Multiple Referrals & Avenues for Resolution, 2012

We learned that half the Frequently Encountered Families had at least one child under the age of four

Source: NJ Spirit n = 195


We also learned that Frequently Encountered Families shared the following characteristics:

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Multiple prior referrals to the Division of Child Protection & Permanency (DCPP), most unfounded and closed without services

No immediate safety concerns or evidence for court involvement

Risk factors for poverty, substance abuse, domestic violence, andpoor parenting

Distrust of DCP&P And they kept DCP&P workers awake at night!

The 2 am Agenda!Source: Analysis of Multiple Referrals & Avenues for Resolution, 2012

We conducted a qualitative review, identifying strengths in our case practice

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Timely response & investigation completion Reviewers agreed with safety and risk scores There were interviews with children, caregivers,

alleged perpetrators & others in home Reporters were contacted There was communication

with families and reporters about disposition of investigation

Source: Analysis of Multiple Referrals & Avenues for Resolution, 2012

We also found significant challenges

We had room for improvement in:

Integrating history

Conducting and/or documenting supervisory conferences

Collaborating with systems partners

Linking families with resources, services and support that may have reduced risk for child maltreatment before we closed our investigations


These findings lead us to believe that we needed to integrate a Prevention Framework into our Child Protection and Permanency practice.

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What is at stake?

According to Harvard University: Children exposed to

6 risk factors face a 90-100% likelihood of having delays in cognitive, language or emotional development.

Adversity in childhood is also linked to increased risk for adult health problems.

The ACE (Adverse Childhood Experiences) Studies

11Source: Center on the Developing Child, Harvard University

Almost 23,000 infants and young children were served by DCPP in March 2013

Safe Measures n=59,985

22684

26102

11199

0

5000

10000

15000

20000

25000

30000

0-5 years 6-13 years 14-17 years

38 %43 %

19 %

National Data on Child MaltreatmentVictim Percentages by Age Groups

Source: DHHS Publication, Child Maltreatment

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0

5

10

15

20

25

under1

Age 2 Age4-7

Age12-15

Rate per 1000

What does the research tell us?

Child maltreatment can be reduced if the following protective factors are enhanced: Nurturing & Attachment Knowledge of Parenting & Child Development Parental Resilience Social Connections Concrete Supports for Parents Social and Emotional Competence

of Children

14Source: Preventing Child Maltreatment & Promoting Well-Being: A Network for Action

According to the Center for the Study of Social Policy, it will take collaboration among system partners and a team approach.

15Source: Center for the Study of Social Policy’s A protective Factor Framework

Outcomes we hope to accomplish

Increased collaboration among child protection and prevention partners to:

Decrease risk

Increase protective factors

Decrease frequency of referral for protective service investigation

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Where do we begin?

In Burlington, Cape May and Ocean Counties, we are attempting to make changes at the Local Office and Community levels by developing:

A Prevention System of Care

Well-equipped staff

A Supervisory Structure

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We began by engaging a core group of community partners in roundtable discussions: Home visiting: Healthy Families, Parents as Teachers,

Nurse Family Partnership Early Head Start and Head Start Early Intervention Early Childhood Mental Health Child Care Family Success Center School-based Parents

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Prevention partners meet monthly for 2 hours Group is co-facilitated by DCPP and DFCP Agendas are focused; A Prevention System

of Care, Well-Equipped Staff, and A Supervisory Structure

Relationships are developing New agenda items are being identified

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Ultimately, our goal is to collaboratively develop: A continuum of accessible,

affordable, culturally anddevelopmentally appropriateresources, high quality services & informal supports

With Centralized Intake for prevention services To support the success of every family with an infant or

young child

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New Jersey’s Prevention System of Care

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2. Screeninga) Prenatal/Newborns: Coordinate w/ prenatal providers and birthing hospitals (use PRA).Prenatal Clinics / FQHCsHospitals / Private OB/GYNsWIC / Local Health AgenciesSchool-Based ProgramsSocial Service AgenciesExpectant Parents / Families----------------------------------------

b) Children: Birth to Age 5(Developmental Screening Points) Parents / Families•FQHC, Clinic, Medical Home

Pediatric / Family Practice WIC / Local Health AgenciesEarly Head Start/Head StartChildcare / PreschoolSocial Service AgenciesElementary SchoolsChild Welfare Agencies

Access to Care - Outreach Workers Grassroots Outreach Programs Health/Social Services Pregnancy Testing Points

1. Community Outreach (Community Referral)

5. Community-Based Services

Essential medical & social support services: Medical Home/PCP Depression and Mental

Health Treatment Addiction Treatment Domestic Violence Service WIC Nutrition Program Family Success Centers Fatherhood Support Parent Education Early Intervention/SCHS Child Lead Poisoning Local Health Agency SCHIP/Health Insurance Public Assistance thru

County Welfare Agencies Emergency Assistance Housing/Transportation Food/SNAP Immigrant Services Infant & Childcare Centers Head Start / Early HS Pre-K programs Strengthening Families

Protective Factors Parent Linking Program/

School-Linked services Child Protective Services And more…

4. Home Visiting Services

Healthy Families / TANF Initiative for Parents (HF/TIP): Pregnancy to age 3. Enroll pregnancy or infancy by 3 months.

Nurse-Family Partnership (NFP): Low income, 1st time moms, prenatal to age 2. Enroll by 2nd trimester (28 weeks).

Parents As Teachers (PAT): Pregnant and/or children up to age 3-5. Family can enroll at any point in time.

Early Head Start (EHS)-Home based: Pregnancy to age 3. Enroll during pregnancy or after birth.

3. Central Intake (CI)Referral is reviewed by CI coordinator and family is referred to an appropriate partner agency for initial assessment, prevention education and/or linkage to needed services. Children referred for development screening

a) Assigned for an Initial Home Visit and Assessment (voluntary)

Universal Screening Perinatal Screening & Risk Assessment

To screen for physical, psychosocial, & behavioral health risk factors

Screen includes NJDOH 4 P’s Plus – alcohol, tobacco, other drugs, domestic violence, and depression

Facilitates initial referral for prevention education, information and linkage

Family Risk Factors include: Teen pregnancy (< age 19) Language & culture barriers First-time pregnancy Low income/poverty/homeless Domestic violence Addiction or substance abuse Mental health issues *Infant/Child Developmental Screening Use of a standard screening tool to

identify infant and early childhood developmental / social-emotional delays

b) Referred directly to Community-Based Provider(s)

Agenda for Local Collaboration Determine appropriate central point of intake Use of standard screening/ risk assessment tools (prenatal / infant-child) Develop interagency agreements for referral and data sharing Establish a local referral flow chart and hold regular meetings w/ community partners Provide opportunities for cross-training and shared in-service Use of a uniform client/family data set and data system for tracking & analysis

HIPPY Program (Bergen County only) Parents with young children–ages 3 to 5

Other Local Programs (vary by county)– e.g. Parent Linking Program, Project TEACH, Public

Health Nurses, Doula, Parent Child Home

Systems Integration in NJ–Central Intake• Simplify & streamline referrals for providers & parents• Lead CI Coordinating Agency (local level) – to work with

providers/families to determine needs & make linkages • Increase prenatal / infant / early childhood referrals to

reach families earlier (for voluntary services & supports)• Coordination among providers—links to home visiting (HV)

models & other needed services (interagency agreements)• Help local programs reach service capacity—HV & others• Eliminate duplication of services• Community Advisory Board (providers & participants)• Universal Prenatal Screening & Risk Assessment (PRA)• Developmental Screening (ASQ / ASQ-SE)

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Well-equipped Staff

Our objective is for systems partners, at all levels, to undergo a “transformational process” and: Intervene earlier See the world through the eyes of a child and a

beleaguered parent Use reflective practice Promote protective factors and teaming Use developmentally and relationship-based

interventions Minimize unintended consequences in foster care Take care of themselves

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Well-equipped Staff

Training is offered in: A central location Once per month for seven months 3 hours / session Uses lecture, videos, interactive exercises,

and group discussion Participants volunteer one family / session for

a 1 hour consultation

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We began with these promises

1) You will learn something that will change you and the way you work.

2) This will challenge you, stir you up, make you think about your own growing up and your life as a parent or caregiver.

3) This is not “dumbed down” – BUT you will understand everything!

4) You will develop more empathy for parents who have failed in some way.

5) Read Number 1 again.

2/22/13

Gerard Costa, Ph.D. 2013

And provided “Starting Points”, including

Parenting with the “brain” in mind!

Early Experience Matters!

“Lived Moments”

2/22/13

Gerard Costa, Ph.D. 2013

And we illustrated the amazing abilities of the newborn and infant to take the “world in” and to both influence

and be affected by what happens !

The “Still-Faced” ParadigmEd Tronick

2/22/13

And we focused on:Areas of Professional Development

7 Core Domains and Competencies Infant and Early Childhood Mental Health Interpersonal neurobiology – how relationships

“sculpt” mind, brain and character Relationship-based intervention Parenting as a RELATIONSHIP not a skill

Seeing the world “through the eyes of the child” “Front end” foundational experiences The “case for empathy”

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Areas of Professional Development (Con’t)

Engagement and Reflective Practice How affect and gesture TRUMP

words Three domains of “reflective” practice

Protective Factors and Teaming with System Partners Five “protective factors” and the

Strengthening Families Initiative The notion of “Respectful Pursuit” “Warm” hand-offs

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Developmentally-based Interventions Developmental/Parental Guidance and

“systems’ advocacy” Speaking “on behalf of the child” Emotional and social development as a guide

for interventions

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Minimizing Unintended Consequences in Placement and Visitation The “violence” of intervention and removal Recognizing shame and humiliation Practicing “courageous” conversations Infants and children in two homes Visitation practices and development, duration

and frequency

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The Critical Importance of Self-Care Secondary trauma Reflective mindfulness and mindsight”-

regular, ongoing, required Strategies for self care

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A Supervisory StructureProtective Service and Prevention Partners meet each week and discuss 1-3 families with at least one child under the age of five with multiple prior referrals and closed at moderate to high risk in the last investigation. The process:

Builds on DCP&P foundations for “Focus for Supervision” and the Case Practice Model

Includes a Domestic Violence Liaison, Clinical Consultant and others

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A Supervisory Structure

During the conference, the group discusses: Family structure and history Current status Safety and risk concerns Strengths, needs and protective

factors Goals, objectives and next steps Monitoring, accountability and trouble-shooting

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Informally, we are already seeing signs of success

There are new, collaborative relationships among system partners!

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Our transformation IS beginning!

We have a greater sense of urgency and a clearer purpose as we better understand the world as seen through the eyes of a child.

We have more empathya patience with parents.

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We are more effectively addressing risk and protective factors by:

Intervening earlier Integrating history in a supervisory process Working harder to engage parents Building teams that include families, child

protection and prevention partners Connecting families

with resources, services and supports

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How will we measure theimpact of our process?

A Prevention System of Care: Wilder Collaborative Survey

Well-Equipped Staff: Training Evaluations

Supervisory Structure: Focus Groups

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How will we measure impact on children and families?

Decrease Risk: Risk Assessment

Increased Protective Factors:Protective Factors Survey

Decreased Referrals for Investigation: Qualitative Review

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We’ve made a good start, and our story continues as we integrate a Prevention Framework into our Child

Protection and Permanency practice.

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References

Center for the Study of Social Policy’s. Strengthening families – The Protective Factors framework. Retrieved from www.strengtheningfamilies.net

Cornell University, The Wilder Collaborative Factors Survey. Retrieved from www.librarycornell.edu

Friends National Center for Community-Based Child Abuse Prevention. Chapel Hill, NC. Retrieved from friendsnrc.org/protective-factors survey (2012)

Rupe, M., Rzemyk, B., Brantley, D., Racine, F., & Olabinjo, O., (2012). Analysis of multiple referrals and avenues for resolution cape may county. Department of Children and Families, Fellows Program, Trenton, NJ.

Shonkoff, J.P., (2008). The science of child development and the future of early childhood policy. Presented at the National Symposium on Early Childhood Science and Policy, Cambridge, Massachusetts. Retrieved at www.developingchild.harvard.edu

Stephleton, K., Mcintosh, J., and Corrington, B., Center for the Study of Social Policy, Strengthening Families, “Allied for Better Outcomes Child Welfare and Early Childhood”, 2010.

U.S. Department of Health and Human Services, Administration for Children and Families, Child Welfare Information Gateway, Preventing child maltreatment and promoting well-being: a network for action (2012).

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