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Who Are the Level IV Treatment Foster Care Kids and What Do They Need?. Jean Solomon , M.A., M.S.N. Mark R. Groner , M.S.S.A., L.I.S.W.-S. Attendees’ Goals for Today?. Established in 1852, now serving NE Ohio and beyond $25 million annual budget Staff of 450

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Who are the level iv treatment foster care kids and what do they need

Who Are the Level IV Treatment Foster Care Kids and What Do They Need?

Jean Solomon, M.A., M.S.N.

Mark R. Groner, M.S.S.A., L.I.S.W.-S.

  • Established in 1852, now serving NE Ohio and beyond They Need?

  • $25 million annual budget

  • Staff of 450

  • Prevention, early intervention and treatment programs ranging from sex education in schools to a secure Intensive Treatment Unit for SED children and teens

Learning organization principles
Learning Organization They Need? Principles

  • Systems Thinking

  • Mental Models

  • Shared Vision

  • Team Learning

  • Personal Mastery

Learning They Need?and Performance Improvement Cycle

  • Reflect

  • Define and Analyze Problem

  • Develop Shared Vision

  • Identify Outcome Criteria

  • Map Current Processes


*Look For Similarities

*Identify/Gather Source Data


*Implement Solution/Design

*Monitor and Evaluate Impact and Quality

*Ask if Information Can Be Used Elsewhere

  • Decide

  • Identify Possible Solutions

  • Decide on Best Solution

  • Create New Process Maps/Design

Outcome measurement using the ohio scales
Outcome Measurement Using the Ohio Scales They Need?

  • Quarterly Monitored Performance Improvement Outcomes using Youth Ohio Scales Standardized Outcomes Measure

    Problem Severity: lower scores are desirable.

    Functioning: higher scores are desirable.

Agency foster care
Agency Foster Care They Need?

  • “Waystation”

  • Family Foster Care

  • Treatment Foster Care

  • The 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 care

How 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?

Level IV Foster Care

Liv program description
kids?LIV” Program Description

  • Intensive staff ratio’s

  • Robust foster parent training/mentoring

  • Daily phone contact

  • Wrap around services

  • Access to full care continuum MH services

  • Semi-weekly team meetings

  • Flexible FA dollars

  • Liberal respite

  • Geographic FP support groups

  • FP steering group

  • A lot of celebrations


Define the problem
Define the Problem kids?

  • Ohio 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
Define the Problem (continued) kids?

  • Placement Stability: the mean number of placements while in Beech Brook Treatment Foster Care per level of care

    • Level I = 1.6

    • Level II = 1.8

    • Level III = 2.4

    • Level IV = 2.9

How do we answer the question
How do we answer the Question? levels and within levels?

  • 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 levels and within levels?

Sources of data
Sources of Data levels and within levels?

Disclaimer there are no silver bullets
Disclaimer: levels and within levels?There are no silver bullets……

Research team discussions
Research Team Discussions levels and within levels?

Quantitative data traumatic experiences
Quantitative Data: Traumatic Experiences levels and within levels?

Quantitative data education
Quantitative Data: Education levels and within levels?

Quantitative data placement information
Quantitative Data: Placement Information levels and within levels?

Quantitative data custody type
Quantitative Data: Custody Type levels and within levels?

Quantitative data outcomes comparisons by key variables
Quantitative Data: Outcomes Comparisons by Key Variables levels and within levels?

  • On 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

Qualitative Case Study levels and within levels?: 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)

12/12/08-3/12/09 Level 2 (JH & MH Foster Home)

3/12/09-4/12/09 ITU

4/13/09-11/10/10 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 ITU

12/13/10-1/6/11 Level 4 (RG Foster Home)

1/6/11-1/27/11 ITU

1/27/11-5/6/11 Res

5/6/11-5/16/11 ITU

5/16/11 Res

Literature review
Literature Review levels and within levels?

Small study with baseline group differences.

Compare TFC to treatment as usual. Focus on placement stability and behavior problems.

Compare MTFC to Group Care. Focus on recidivism, delinquency.

DECIDE levels and within levels?

Small group discussion
Small Group Discussion levels and within levels?

Given these data, decide what you believe are the key components of a successful program redesign?

Contact information
Contact Information levels and within levels?

Jean Solomon

[email protected]

216-831-2255, ext. 2300

Mark R. Groner

[email protected]

216-831-2255, ext. 2402

Beech Brook

3737 Lander Road

Cleveland, OH 44124