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Implementation of Trauma Systems Therapy-Foster Care in a Public Child

Welfare Setting

June 9, 2017

Berenice Rushovich, MSW, Research Scientist

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Child TrendsJessica Dym Bartlett, MSW, PhD (Principal Investigator)

The Annie E. Casey FoundationDoreen Chapman, MSW, LCSW Senior Associate, Child Welfare Strategy Group

Acknowledgments

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Trauma Systems Therapy –Foster Care

Comparison to TST

Similarities• 10 principles and 4 essential elements• Tools and measures• Team-based treatment approach

Differences • Engage outside partners to provide mental health services• Foster parent training adapted

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Partnership

Annie E. Casey

TST Developers –NYU and KVC

Public Child Welfare Agencies

Child Trends

Community Mental Health

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Maryland:Washington County

Ohio:Richland County

Implementation Settings

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Implementation Process

Implementation Activities/BenchmarksFirst Contact with TST-FC June/ July 2015Kick off Call July/August 2015In-Person Kick-off Meeting August 2015Organizational Planning Form (OPF) complete

February 2016

Number of Meetings to complete OPF Eighteen per countyTST Staff Training December/January 2016TST Train the Trainer January/February 2016 Number of TST Foster Parent Trainings Four per county

Implementation Team Meetings Leadership Team Once a monthTreatment Team WeeklySupervisor Team Bi-weekly

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Target Audience

Format Trainer Content

CW Staff and MH providers

Two full days

KVC trainers

• Introduction to TST concepts• Foundations of child traumatic stress• How to do TST

o Assessmento Treatment Planningo Engagemento Intervention

• How TST is going to work in your settingCW Staff and MH providers providing TST-FC clinical services

One half-day

KVC trainers

• Role on the team• Phase based treatment• Use of TST tools and forms

TST-FC Training Format - Staff

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Target Audience

Format Trainer Content

TST-FC Trainers

Two full days KVC trainers using a train-the-trainer model

• Review of the Foster Parent Resource Guide

• Tips on how to convey the material

Foster Parents and Kinship Caregivers

Four two-hour modules, either: • one full day; • two half

days; or • four

evenings

Site staff • Understanding trauma and my child

• Preparing for success with my child

• Handling challenging behaviors in the moment

• Finding energy and hope

TST-FC Training Format – Foster Parents/Kinship Caregivers

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Evaluation Questions

How is the TST-FC clinical intervention and curriculum implemented?

After training, do foster parents, kinship caregivers, child welfare staff, and mental health clinicians know more about:

The impact of trauma on child behavior and functioning? Trauma-informed approaches?

How, if at all, are foster parents and staff using TST specific tools and approaches to working and caring for trauma impacted children?

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Evaluation Design: Data Collection

Pre-, Post- Follow-up Surveys for

Parents

Pre-, Post- Follow-up Surveys for

Staff

Observation of Training Attendance

Interviews & Focus Groups

AECF Team Meetings

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Staff Demographics

NGender Female 106Male 16

RaceBlack 13White 105Other 5

RoleCase Manager 75Therapist 7Supervisor 25Psychopharmacologist 3Other 14

2 6

5063

2

Staff Education

Number of years working with children M (SD) = 11.9 (7.7), Range = 0-35 years

Number of years working at the agencyM (SD) = 9.6 (7.7), Range = 0-27 years

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Result: Significant Increases in Trauma-Informed Policies and Practices

49.7

65.4

50.6

64.3

57.6

75.1

40

45

50

55

60

65

70

75

80

Pre-training Follow-up

Mea

n TI

SCI s

core

s

Agency Policy

Agency Practice

Individual Practice

Adapted from Richardson, M. M., Coryn, C. L. S., Henry, J., Black-Pond, C., & Unrau, Y. (2010). Trauma Informed System Change Instrument (TISCI, 2nd Ed.). Kalamazoo, MI: Southwest Michigan’s Children’s Trauma Assessment Center (CTAC).

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Foster Parent/Kinship Caregiver Demographics

NGender

Female 69Male 42

RaceBlack 7Hispanic 4White 96Other 7

Age21-25 126-30 131-40 2541-50 3650+ 48

Years of experience as a foster parentM = 5; SD = 5; Range = 0-21 years

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25

35

1916

3

Education

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Results: Foster Parent/Kinship Caregiver Perceptions of Training

Training sessions interesting, presenters clear, activities

helpful, and training implemented with fidelity

Good balance of presentations, discussion, activities; favorite activities: role plays, coping

skills and strategies

Communication among the staff & foster parents improved

due to “shared language”

Knowledge gained helpful to children in their care, and TST-

FC can benefit all children

More confidence and more equipped to care for

children exposed to trauma

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Results: Significant Increases in Trauma Knowledge & Beliefs

3.8

4.34.1

3.5

3.73.63.8

4.14.0

2.5

3.0

3.5

4.0

4.5

Pre-Training (n = 78)Post-Training (n = 55) Follow-up (n = 19)Mea

n RP

KBS

Scor

es fo

r Cou

ntie

s Co

mbi

ned

TIPTOMEFF

Adapted from Sullivan, K., Murray, K., Kane, N., & Ake, G. (2014). Resource Parents Knowledge and Beliefs Survey. Durham, NC: Center for Child & Family Health.

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Implementation Facilitators

Prior relationships with mental health

providers Flexibility of the model

Ongoing support and technical assistance

from both the developers and AECF

consultants

High quality and level of experience of the

trainers

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Implementation Challenges

Staff workload was high and capacity

for innovation was limited

Trainers did not feel fully prepared

to offer TST-FC training

Identifying a psychiatrist willing to treat CW clients

was challenging

Time commitment required of staff was burdensome

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TST-FC Child Welfare Outcomes

• The rate of children exiting foster care from TST-FC homes was lower than foster homes overall in both counties

o Suggests greater placement stability for children in TST-FC foster homes compared to children in non-trained foster homes

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Overall Implications and Conclusions:

• TST-FC can be implemented effectively in public child welfare settings

• TST-FC improved trauma knowledge & beliefs among parents

• TST-FC improved agency trauma-informed policies and practices

• TA (planning, support with training, coaching) is very helpful

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Overall Implications and Conclusions:

• Support for implementation beyond the initial year may help optimize the impact of implementation

• More rigorous research is needed to investigate the impact of training on child outcomes

• Full systems integration (staff, foster parents, mental health providers) is likely optimal for positive child outcomes

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Contact Information:Berenice Rushovich, MSWResearch Scientist, Child TrendsE-mail: brushovich@childtrends.org

Thank you!