Implementation of Trauma Systems ... - Field Center: Home · 22/07/2017 · • TST-FC can be...
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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
11
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: [email protected]
Thank you!