Shamra Boel-Studt, Ph.D , MSW Florida State University, College of Social Work

1. The Group Care Quality Standards Assessment: Preliminary Findings from the Statewide Pilot and Next Steps Florida Coalition For Children Annual Conference July 9, 2019 Shamra Boel-Studt, Ph.D, MSW Florida State University, College of Social Work ZandraOdum, M.Ed. Florida Department of Children and Families, Office of Child Welfare

2. Objectives • Discuss the background, purpose, and goals of the group care quality standards initiative and the alignment with the Family First Prevention Services Act • Describe preliminary results from the statewide pilot • Learn about the next phases of the project • Discuss preliminary implications for providers based on findings from the statewide pilot

3. Group Care Quality Standards Project Background • Collaboration between Florida Department of Children and Families, Florida Institute for Child Welfare, Florida Coalition for Children, and network of providers, researchers, former foster youth, and child advocates aimed at improving the quality and effectiveness of residential care. • Objectives: • Establish research-based quality performance standards • Develop and validate assessment tool designed to measure quality standards and facilitate continuous quality improvement • Establish a statewide group care accountability system as defined in Section 409.996(22), Florida Statutes

4. Group Care Quality Standards Eight Quality Domains • Assessment, Admission, & Service Planning • Positive, Safe Living Environment • Monitor & Report Problems • Family, Culture, & Spirituality • Professional & Competent Staff • Program Elements • Education, Skills, & Positive Outcomes • Pre-Discharge/Post-Discharge Processes Link to Quality Standards for Group Care Booklet: http://www.dcf.state.fl.us/programs/foster-care/group-care/docs/1507-255%20Quality%20Standards%20for%20Residential%20Group%20Care%20Booklet.pdf

5. Project Phases Exploration & Development Instillation Initial Implementation

6. Statewide Pilot • Purpose: Implement GCQSA across all six regions of Florida • Orientation/training, technical support, baseline • Methods: Full population of RGC facilities and shelters • GCQSA implementation coordinated with annual re-licensure • Measures: • GCQSA • Monthly technical assistance calls/on-going TA • Site observation • Data collection April 2, 2018 – April 30, 2019 • Pilot debriefing session

7. Preliminary Findings from the Statewide Pilot: RGC Models & Services

8. Distribution of Residential Programs & Licensed Facilities

9. Completion Rates for Programs & Respondents (N = 151)

10. GCQSA Forms Competed by Type & Region (N = 1,516)

11. Types of Group Care Programs • Maternity + Traditional (1) • BHOS (1) • Emergency Shelter (runaway, CINS/FINS) (2) • Enhanced Group Care (Trauma-informed, Therapeutic) (1) • DJJ/Severe Behavioral Issues (1) • Shelter + Group Home (1) • Brain Injury (1) • Traditional + CSEC (1) • Wilderness Camp (1) • Wilderness + Transitional Group Home (1)

12. Shift-Care and Family-Style Residential Programs (N = 151)

13. Residential Care Services (N = 146)

14. Residential Care Services (N = 146)

15. Other Residential Services (N = 29) • 30/60 day check-ins with parents (2) • Civic/volunteerism • Conflict resolution • Driver’s license permit • Equine therapy • Extended foster care • Family vacations • Kicking boxing • Mentoring • Neuropsychological evaluation • Nutrition training • Psychiatric services • Psychoeducation groups • Service referrals (2) • Spiritual guidance • Substance abuse counseling • Therapy • Volunteer training • Anger management/A&D groups • Assessment and service plans • Career/college planning • Dance • Discovery science club • Game & movie night • Hair care • IL skills • Neuropsychiatric monitoring • Research • Transportation

16. Preliminary Findings from the Statewide Pilot: GCQSA

17. Group Care Quality Standards Assessment (GCQSA) – Hypothesized Structure D1 = Assessment, Admission, and Service Planning D2 = Positive, Safe Living Environment D3 = Monitor and Report Problems D4 = Family, Culture, and Spirituality D5 = Professional, Competent Staff D6 = Program Elements D7 = Education, Skills, and Positive Outcomes D8 = Pre-Discharge/Post Discharge Processes.

18. Reliability (Internal Consistency)

19. Confirmatory Factor Analysis (Dimensionality)

20. Domain Means by Respondent Type

21. E D7. Education, Skills, & Positive Outcomes

22. E D8. Pre/Post Discharge Processes

23. Group Care Quality & Family First Prevention Services Act

24. Family First Prevention Services Act • The Family First Prevention Services Act was passed into law on February 9, 2018 as part of the Bipartisan Budget Act of 2018. • The law expands the use of federal Title IV-E child welfare entitlement dollars to prevent entry into foster care, and it restricts funds for out-of-home care that is not a foster family home. Delay…Delay…Delay… September 29, 2021 is Florida’s effective date to implement FFPSA evidence-based prevention services and group care changes

25. Family First Prevention Services Act Not Specified Specified Settings Prenatal Postpartum or Parenting Supports Licensed Residential Family- Based Treatment Facility Qualified Residential Treatment Program (QRTP) Victims of or At Risk of Sex Trafficking Supervised Independent Living(age 18+) Beginning with the third week of placement, no federal funds are to be made for maintenance in a setting that is not a specified setting or a licensed residential family-based treatment program for substance abuse

26. Family First Prevention Services Act Identifies elements of quality residential care • Settings for youth at risk of or victim of sex trafficking • High-quality residential care and support services (S1) • Qualified Residential Treatment Programs (QRTP) • Evidence-based, validated functional assessment tool (D1) • Discharge planning services and aftercare (D8) • Promotes family involvement (D4) • Use of trauma-informed treatment approaches (D6) • Accreditation (S1) • Access to clinical/nursing services (S1) Quality care is essential in all placement settings

27. National Accreditation Status (N = 150)

28. Accreditation Organization (N = 65)

29. D6.19. The program uses a trauma-informed approach (N = 146) Mean = 3.12, SD = 1.51

30. Trauma-Informed Care Checklist (N = 150)

31. D1.3. Evidence-based assessments are used to inform service planning (N = 146)

32. VV Validated Assessment Tools Validated Functional Assessments • Child and Adolescent Needs and Strengths (CANS) • Ages and Stages Questionnaire (ASQ-3 or ASQ:SE) • Behavioral Assessment System for Children (BASC) • Child and Adolescent Functional Assessment Scale (CAFAS) • Child Behavior Checklist (CBCL) • Child Functional Assessment Rating Scale (CFARS) • Emotional Quotient Inventory – Youth Version (EQ-i: YV) • Pediatric Symptom Checklist – 17 (PSC – 17) • Social Skills Rating System (SSRS) Validated Trauma Screeners & Assessments • Child and Adolescent Needs and Strengths Trauma Comprehensive (CANS-Trauma) • Childhood Trauma Questionnaire (CTQ) • Clinician-Administered PTSD Scale (CAPS) • Impact of Event Scale – Revised (IES-R) • Life Events Checklist (LEC) • Pediatric Emotional Distress Scale (PEDS) • Posttraumatic Stress Diagnostic Scale (PDS) • PTSD Checklist (PCL) • Strengths and Difficulties Questionnaire (SDQ) • Traumatic Events Scoring Inventory (TESI) • Trauma Symptom Checklist for Children (TSCC) • Trauma Symptom Checklist for Young Children (TSCYC) • Trauma Symptom Inventory (TSI)

33. Next Steps

34. Timeline – Current Project Phase • Statewide pilot, March 2018-April 2019, (previous project phase) • Data Analysis, May-August 2019, (current activities) • Preliminary Recommendations, September 2019, (next steps) • Tool and Manual Revisions, October-November 2019 • Refresher Training, December 2019

35. Timeline – Next Project Phase • One Year Validation, January-December 2020 (next project phase) • Interrater Reliability (with DCF licensing staff), January-March 2020 • Outcomes Development Pilot, July-December 2020 • Data Analysis and Draft Outcomes, January-June 2021 • Final Recommendations and Draft Accountability System, July-December 2021 • Launch Statewide Accountability System, January-July 2022

36. Outcomes Development Pilot • Purpose: Identify and test outcomes measures to be used in conjunction with the GCQSA • Outcomes should be measurable and, ideally, correlated with quality standards • Outcomes measures can be used test hypotheses that quality care produces positive program & youth outcomes • (Proposed) Youth Outcomes Measures: • Domains: Emotional/Behavorial, Social/Relational, Life/IL Skills, Education • Measures: Youth demographics, CANS, Other indicators TBD… • Sample: 25-50 residential homes; 150-300 youth • Data collection: • Youth data collected by RGC providers (July – Dec 2020) • De-identified data collected by evaluation team via Qualtrics

37. Questions???

38. Contacts Shamra Boel-Studt Phone: (850) 644-9712 Email: sboelstudt@fsu.edu ZandraOdum Phone: (850) 717-4759 Email: Zandra.Odum@myflfamilies.com