Federal Efforts to Address the ACE Epidemic: Two Examples from Child Welfare

1. Federal Efforts to Address the ACE Epidemic: Two Examples from Child Welfare Clare Anderson, Deputy DirectorAdministration on Children, Youth, and Families

2. Adverse Childhood Experiences Clare Anderson

3. Brain Development Patterns Traumatic Stress NEUTRAL START Adapted from: Family Policy Council. (2007). The High Cost of Adverse Childhood Experiences (PPT). Olympia, WA: Author. Effective screening and assessment help identify children who have trauma symptoms; evidence-based interventions and strategies help restore developmentally appropriate functioning. Clare Anderson

4. The Overlap of Trauma and Mental Health Symptoms (Griffin, McClelland, Holzberg, Stolbach, Maj, & Kisiel , 2012) Clare Anderson

5. Children’s Well-Being Has Multiple Domains That Are Impacted by Trauma Adapted from Impact Youth Services, 2011; http://impactyouthservices.com/goals.htm ACYF-CB-IM-12-04: http://www.acf.hhs.gov/programs/cb/laws_policies/policy/im/2012/im1204.pdf Clare Anderson

6. Aligning Discretionary Funding to Address Trauma • $28 million in FY 2012 • 43 grantees • Promoting social and emotional well-being by increasing access to screening, assessment, and treatment of trauma • Significant investments in building capacity of State and local systems to deliver evidence-based interventions to children who are in or at risk of entering child welfare. • Leveraging existing policies, such as EPSDT Partnerships to Demonstrate the Effectiveness of Supportive Housing for Families in the Child Welfare System Initiative to Improve Access to Needs-Driven, Evidence-Based/Evidence-Informed Mental and Behavioral Health Services in Child Welfare Comprehensive Support Services for Families Affected by Substance Abuse or HIV/AIDS Regional Partnership Grants to Increase the Well-Being of and to Improve Permanency Outcomes for Children Affected by Substance Abuse Clare Anderson

7. New Title IV-E Child Welfare Demonstration Projects • On September 30, HHS approved nine new child welfare demonstration projects for FY 2012 • Prioritized social/emotional well-being and addressing trauma • Each demonstration project has identified at least one well-being outcome to target for improvement • Collaborations with Medicaid and behavioral health authority were prioritized; six of the nine demonstration projects have collaborations in place or will pursue them • Accepting applications nowfor FY13 demonstration projects • Information Memorandum:https://www.acf.hhs.gov/sites/default/files/cb/im1205.pdf Arkansas Colorado Illinois Massachusetts Michigan Pennsylvania Utah Washington WisconsinProposals are posted online: https://www.acf.hhs.gov/programs/cb/programs/child-welfare-waivers NRCOI Webinar - Clare Anderson

8. Supportive Housing & Child Welfare Clare Anderson

9. Supportive Housing and Child Welfare • Public-private partnership to test a collaborative model of intensive service delivery for high-need families • $35 million over 5 years; 5 grantees • Funded projects must secure affordable housing for at least 50 families as the platform for which the services will be provided for the target population Clare Anderson

10. Target Population for the Supportive Housing-Child Welfare Demonstration “Characteristics of appropriate target populations under this FOA include, but are not limited to: • Reports to child protective services related to abuse and neglect • Exposure to prior traumas, including child abuse and domestic violence • Lack of financial resources and receiving or eligibility for public assistance • Children who exhibit severe emotional and/or behavioral problems • Repeated episodes of homelessness over time and/or long stays in shelters • Parents with serious and chronic substance abuse, mental health, or physical health problems. …This points to the need for the collaboration between project partners to focus on identifying those families who are most in needand who would derive the most tangible benefitfrom receiving assistance provided by this pilot project (i.e., those families that present with multiple characteristics).” HHS-2012-ACF-ACYF-CA-0538: Funding Opportunity Announcement: Partnerships to Demonstrate the Effectiveness of Supportive Housing for Families in the Child Welfare System. U.S. Department of Health and Human Services SH-CW Grantees Kickoff

11. Program Components: Interdisciplinary Teams for Case Management • Establish trusting relationship with families to promote child well-being and family stability while improving capacity of caregivers to provide safe and permanent home for children • Work with family to develop integrated case plan including housing needs and other services needed • Ensure housing retention and improve housing stability as platform for ongoing engagement and family stability • Build a network of support among tenants that focuses on trust, well-being, and social/community integration • Advocate on behalf of parents and children to ensure that they understand requirements of social services in which they are engaged. Clare Anderson

12. Program Components: Services for Parents and Children that Address Family Functioning • Parenting skills training to provide evidence-based strategies to promote parenting abilities (e.g., NPP, PAT, Triple P) and access to programs that address relational problems (e.g., PCIT, BSFT, CPP, FFT) • Services and interventions to improve family functioning and assist with reunification of families (e.g., MSFT) • Ancillary services for families to provide assistance in securing needed services such as safe and drug-free housing, transportation, and child care Clare Anderson

13. Program Components: Services and Activities for Children and Youth that Address Child Well-Being and Trauma • Screening and assessment of child well-being across domains • Evidence-based, developmentally appropriate approaches to promoting child well-being, tailored to the specific needs of each child • Access to appropriate mental health services for children involved in the child welfare system, including services to address experiences of trauma Clare Anderson

14. Program Components Collectively Promote Well-Being SUPPORTIVE HOUSING In Supportive Housing Context Clare Anderson

15. Title IV-E Child Welfare Demonstration Projects Clare Anderson

16. HHS may waive title IV-E requirements for States with approved projects, allowing them to use funds flexibly and reinvest savings. Clare Anderson

17. Goals for Demonstration Projects • Increase permanency for all infants, children, and youth by reducing the time in foster placements when possible and promoting a successful transition to adulthood for older youth. • Increase positive outcomes for infants, children, youth, and families in their homes and communities, including tribal communities, and improve the safety and well-being of infants, children, and youth. • Prevent child abuse and neglect and the re-entry of infants, children, and youth into foster care. Clare Anderson

18. Promoting Well-Being and Addressing Trauma in Demonstration Projects • Demonstrations that explicitly support social and emotional well-being and address trauma are prioritized for approval. • Each demonstration project has identified at least one well-being outcome to target for improvement. • States are encouraged to align screening, assessment, and evidence-based interventions with the needs and characteristics of the target population in order to achieve improved well-being. Clare Anderson

19. Matching Populations, Outcomes, and Approaches • Target Population • Screening& Assessment • EBIs • Outcomes • Children, 8-17 • - UCLA PTSD Index • - Strengths & Difficulties Questionnaire • - Child & Adolescent Needs & Strengths • Trauma-Focused Cognitive Behavioral Therapy • (ages 0-21) • - Behavior problems • - PTS symptoms • - Depression • - Delinquency/Drugs- Peer problems- Family cohesion • Children, 13-17 • - Strengths & Difficulties Questionnaire • - Child & Adolescent Needs & Strengths • Multisystemic Therapy • (ages 6-17) • Children, 2-7 • - Trauma Symptoms Checklist for Young Children- Infant Toddler Emotional Assessment • - Child Behavior Checklist • Parent-Child Interaction Therapy • (ages 0-12) • - Conduct disorders • - Parent distress • - Parent-child interaction Clare Anderson

20. Pennsylvania • Target population: Children in or at-risk of entering placement, discharged from placement, or receiving in-home services • Geographic scope: 5 counties initially • Key outcomes: Improved parent behavioral health and functioning; increased parenting skills; improved child and youth functioning in home, school and community; reduced use of congregate care and other restrictive placement settings; increased placement in most appropriate and least restrictive settings • Evidence-based or promising programs considered: PCIT; MST; MTFC; TF-CBT; Triple P; NFP; SFP; Incredible Years; Why Try? NC Waiver Meeting