Because Mind Matters Screening and Assessment Panel Discussion August 27-28 , 2012

1. Because Mind MattersScreening and Assessment Panel Discussion August 27-28, 2012 Denise Revels Robinson, MSW, Assistant Secretary, Children’s Administration Department of Social and Health Services Barb Putnam MSW, Supervisor, Well-Being Unit Children’s Administration The Mission of DSHS The Department of Social and Health Services will improve the safety and health of individuals, families and communities by providing leadership and establishing and participating in partnerships.

2. Children’s Administration Service Structure State administered public child welfare system. Children’s Administration serves children and families in their communities through three regional offices and 45 field offices and by partnering with 26 federally recognized American Indian tribes.

3. Service Delivery Activities In Fiscal Year 2011 There are approximately 1.55 million children in Washington1 1.55 million children1 in Washington Children’s Administration received 77,882 reports alleging possible child abuse in State Fiscal Year 20112 Of those referrals, 37,992 were screened in for investigation. (35,772 did not meet the legal criteria for abuse, neglect, or abandonment or were referred to Alternative Services) 2 • Children • exiting care2 • 2,658 children (51%) went home • 1,514 children (29%) were adopted • 513 children (10%) placed in guardianships • 414 (8%) reached age of majority. On June 30, 2011, there were 9,987 children in the care of Children’s Administration2 Of those, 8,966 were in out-of-home care such as foster care or group homes. (1,021 were state dependent but living at home.)2 Of those children placed in out-of home care, 3,147 lived with relatives. (Approximately 10% of relative caregivers are licensed.)2 6,507 children exited care2 www.Census.Gov ; 2.FamLink

4. Safety is at the forefront of every aspect of our work We endeavor to safely: • Maintain children in their own homes preventing out-of-home placement • Serve and support children with relatives or in temporary licensed out-of-home placement • Return children home as quickly as possible • Secure permanent homes for children who cannot return home • Decrease over-representation of children of color in the public child welfare system

5. Values, Guiding Principles and Priorities • Safety, permanency, and well-being are sought for all children and families regardless of race, ethnicity, or place of residence. • Child safety, permanency, and well-being are the shared responsibility of parents and foster parents, caregivers, tribes, service providers, and community members. • Practice improvement is data driven and outcomes are communicated transparently both within the Administration and publically. • Efforts to reduce racial disproportionality are embedded into all aspects of our work. • Supervisors are supported toward competency, accountability, and professional development.

6. Children’s Administration Programs and Services Public child welfare for Washington state • Child abuse intake and investigation • Services to support children and families • Foster care and relative placement • Adoption and post-adoptive services • Adolescent Services • Foster family home and facility licensing

7. Specialized Services and Programs • Fostering Well Being • Care Coordination services for complex health, dental and mental health concerns including psychotropic medications. • Regional Medical Consultants • Six part time Pediatricians out-stationed in regional offices are available to support case worker needs in the field. • Foster Care Assessment Program assessment for children/youth languishing in care and have behavioral difficulties.

8. Screening • Initial Health Screens • Child Health and Education Track

9. Initial Health Screens Purpose: • Intent is to help identify and manage a child’s urgent medical problems that may be overlooked in the transition from their home into out of home placement with a caregiver. • Physician physical screening that occurs within the first 72 hours to five days of a child or youth initially coming into care.

10. Activities of the Initial Health Screen Health Screen is a well child exam that consists of a quick review of the child’s current health status that includes: • Height, weight and growth • Blood pressure and other vital signs • Immunizations • Health status • Complete physical exam • Referrals to other specialists if needed

11. Capacity Building • State Medicaid partners created a billing code a specialized form and protocols for the physician use. • Initially physicians needed extensive communication and training regarding the purpose and billing procedures. • Worked extensively at the regional level to identify local qualified medical providers. • Currently physicians are fully engaged in the process.

12. Child Health and Education Tracking (CHET) • Legislatively mandated in 2000 to develop comprehensive screening capability in child welfare. • Approximately 80 trained staff and supervisors deployed throughout the regions who screen all children and youth. • CA’s role is to comprehensively screen and when identified, refer to the experts for a comprehensive assessment.

13. CHET Program Goals • Identifies the long term well-being needs of children and youth in care. • Solicits information from people who have known the child/youth for 30 days or longer. • Is a “snapshot” of the child/youth at the beginning of the child’s placement. • Provides a baseline for on-going monitoring. • CHET screens are completed within the first 30 days of placement.

14. Who are the Screeners? • Dedicated social workers who are and trained to administer screening tools. • Not case carrying, except in small offices. • Have an interest in the wellbeing needs of children coming into care. • Have an understanding of child welfare and the movement /responsibilities within the system. • Have an understanding of resources in their local communities.

15. Domains AREAS OF FOCUS: CHET screens children in five domains: • Physical Health • Social/Emotional • Education • Developmental • Connection to family, community, peers, and other significant relationships

16. Tools The Screener administers the following standardized validated tools: • Denver (birth to one month) • Ages and Stages Questionnaire (ASQ) (1 month – 5 years) • ASQ – Social Emotional (3 months – 5 ½ years) • Mental Health: Pediatric Symptom Checklist – 17 (PSC-17) (ages 5 ½ -18) • Global Assessment of Individual Needs – SS (13 – 18 years)

17. Pediatric Symptoms Checklist(PSC – 17) • Developed as brief screen to identify possible psychosocial problems in pediatric settings for children 4-17 years. • based on original 35-item PSC -- Leiner et al. 2007 • Includes 17 items that fall into 3 domains • Externalizing problems (7 items) • Attention problems (5 items) • Internalizing problems (5 items) • Has clinical cutoff scores for each scale

18. PSC-17 Sample Questions INSTRUCTIONS: Please read each question carefully and check off the box for the response that you believe is most true for your child during the past 6 MONTHS.

19. PSC – 17 Results • In Washington State fiscal year 2011, CHET Screeners administered the tool for 5,143 children and/or youth. • Based on scores: • 54% had “No Apparent Concerns”, and • 46% had “Possible Mental Health Concerns” which resulted a referral for a comprehensive mental health assessment.

20. Post Implementation: What We Know

21. Assessment: Mental Health Service Referrals • If the child/youth scores are at the cut-off point, the child is referred to the Regional Support Network (RSN) for a comprehensive mental health evaluation. • Additionally, at any point while the child is in out-of-home care if there is an identified mental health concern, he or she is referred to mental health services.

22. Additional Resources • Evidenced Based Programs: • Intensive Family Preservation Services – Homebuilders • Project SafeCare • Functional Family Therapy • Incredible Years • Parent Child Interactive Therapy • Multidimensional Treatment Foster Care • Promoting First Relations • Wraparound

23. Challenges • We continue to need: • A full array of Evidenced Based treatments that address the specialized trauma and other mental health needs of foster children and youth in the publicly funded mental health system, especially for 0-5 children. • Barrier free access to mental health services. • Training and better understanding in mental health of the unique needs of children and youth in foster care.

24. Next Steps • Currently examining tools that are trauma screens. • Anticipate implementing a trauma screen in the next year within the CHET process for those children and youth entering care.