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 33-48
Severe 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 Description
Intensive 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)
Percentage
Female 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)
Percentage
Physical 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 Type
Table 5: Group Custody Type (Known at Intake) ,
Beech Brook Level 4 Foster Care, Fiscal Years
2010 and 2011 (N = 126)
Custody Type Percentage
Permanent
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 5
4 5 9 Small study with baseline group differences.
Compare MTFC to Group Care. Focus on recidivism, delinquency.
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 Solomon
216-831-2255, ext. 2300
Mark R. Groner
216-831-2255, ext. 2402
Beech Brook
3737 Lander Road
Cleveland, OH 44124