Delivering Behavior Support in the Foster Care System:

Transcription

1 Delivering Behavior Support in the Foster Care System: Some Data and Perspectives from a Statewide Initiative Presented by: Glen Dunlap, Ph.D. University of South Florida 1

2 NOTE: All data in this presentation are preliminary. They have not been fully validated or peer reviewed. Please do not disseminate. 2

3 Purpose To describe challenges associated with supports for children in foster care; To describe a state wide initiative (program) providing training and technical assistance for caregivers in the foster care system the Behavior Analysis Services Program To share data illustrating some effects of this program. 3

4 Main Points Children in foster care (and the child protection system) have immense vulnerability for socialemotional and behavioral disruption. The child protection system presents tremendous needs and challenges. One area where we can do a much better job is in the quality of care (parenting) that is provided; and in the supports and interventions that are available. 4

5 Acknowledgments Creation/Development and operation of Florida s BASP Mike Stoutimore Cathy Williams, FL Dept. of Children and Families Tim Vollmer and team, University of Florida Our Team at University of South Florida Bryon Neff; Kim Crosland; Rusty Clark and others 5

6 Foster Care and Child Protection National Issues and Challenges 6

7 Well over 500,000 children are in child protection in the foster care system (estimates vary; some exceed 600,000) This compares to about 250,000 in 1995 Foster Care is widely regarded as a national disgrace 7

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9 Children in Foster Care Foster care children are among the most vulnerable for social emotional and behavior problems They end up in foster care for a variety of reasons (none of which can be considered good ) Risk factors are numerous: Abuse and neglect Poverty Violence Lack of parent figures Etc., etc., etc. 9

10 Placements A range but largely with foster parents in homes with 1 8 foster children Placement disruptions are very high (sometimes horrifyingly high) Placement disruptions are especially high for children with behavior problems (and may exacerbate behavior problems) Studies indicate that between 33 85% of children in foster care display emotional and behavioral problems 10

11 Challenges Unwieldy systems Multiple agencies have responsibility and they are notoriously uncoordinated Unreliable and unreliable tracking systems Massive case loads for caseworkers High turnover of caseworkers Insufficient numbers of foster parents (and adoptions) Inadequate training and assistance for foster parents Great needs for behavioral services 11

12 A Role for Systematic Behavior Support Technology and Perspectives from Applied Behavior Analysis and Positive Behavior Support 12

13 Traditionally, fields of child welfare and social work have not been behavioral, nor have they been very data based Yet there is an obvious role for systematic behavior support and intervention Parent training Systematic intervention Assessment based intervention There have been behavioral precedents, but not on a very large scale 13

14 Some Barriers Disciplinary (conceptual, methodological) differences Need to collaborate, build bridges, work toward same goals, etc. Scope of the problem Need to work broadly but also focus on deep end and high profile problems and cases Extreme need for confidentiality and anonymity Impediments to informed consent, etc. 14

15 Behavior Analysis Services Program Florida s Statewide Initiative 15

16 Background Pilot program established in Tampa Bay area in midlate 1990s Purpose of pilot program: 1) Provide protections and services similar in concept to services in developmental disabilities 2) Improve caregiver competence and confidence 3) Increase stability of placements for children 4) Reduce the need for highly restrictive placements (and save money) 16

17 Pilot program was deemed successful Statewide initiative developed in 2000 by FL Department of Children and Families Services to be established in all 15 DCF districts Coordinating centers established for northern districts at University of Florida; and for southern districts at University of South Florida Contracts initiated in 2001; hiring began in Summer and Fall of

18 Escambia Santa Okaloosa Rosa Walton University of Florida (1, 2, 3, 4, 7, 12, 13, 14) University of South Florida (5, 6, 8, 9, 10, 11, 15) 1 Holmes Washington Bay Jackson Gadsden Calhoun Leon Gulf Liberty Franklin Wakulla 2 Madison Hamilton Suwannee Taylor Lafayette Jefferson 3 Columbia Citrus Baker Dixie Gilchrist Alachua Levy 13 5 Pinellas 6 Union Marion Sumter Hernando Pasco Bradford Hillsborough Sarasota Manatee 8 Nassau Duval Clay Putnam Lake De Soto 14 Charlotte Lee St. Johns Polk Glades Collier Flagler Volusia Orange Hardee Highlands Hendry 4 Seminole Osceola Brevard Indian River Okeechobee 12 7 St.Lucie Martin W Palm Broward Monroe Dade 11

19 The Behavior Analysis Services Program About 60 Behavior Analysts working for BASP statewide We place the equivalent of 1 Senior Behavior Analyst and 3 Behavior Analysts in each district Coordinating Centers at UF and USF provide: PIs and full time Program Coordinators Recruitment and employment of staff Overall supervision Program evaluation and Research Curriculum development Funding for BASP increasingly stable and secure 19

20 Caregiver Training BASP Services A variety of curricula focused on parenting tools Technical Assistance for Foster Parents Special Projects As requested and mandated by districts and/or by FL DCF Evaluation and Research 20

21 Caregiver Training Rationale Caregivers spend the most time with children and can effect the biggest change Enhanced caregiver skills are foundation for improved child behavior Improved child behavior leads to increased placement stability Current and future children benefit from trained caregivers This approach is cost efficient 21

22 Fundamental Behavior Management Skills Don t be mean, Be NICE Shift focus from punishing unwanted behavior to INCREASING desirable behavior Increase rates of EXISTING APPROPRIATE behaviors of children AND caregivers Teach NEW ALTERNATIVE behaviors 22

23 Tools For Positive Behavior Change Curricula Based initially on Latham s The Power of Positive Parenting Various curricula have been developed and field tested e.g., 15 hour and 30 hour courses Courses are performance based with roleplay demonstrations, practice, and feedback Including pre/post tests and in home support 23

24 Content of Tools Curriculum Stay Close Proximity; rapport Give Positive Consequences Specific praise w/ appropriate nonverbals and back ups Ignore Junk Behavior and Pivot Extinction, and focus on positive consequences for desirable behavior of target child and/or another child 24

25 Content (continued) Stop Redirect Give Positive Consequences For behaviors more serious than junk Set Expectations Make expectations and consequences clear Use a Contract More formalized and explicit statement of expectations and consequences Consequences for Serious Problems 25

26 Some Data Scheduled for a special issue of Research in Social Work Practice 1. Use of Invasive/Aversive Procedures 2. Nocturnal Enuresis 3. The Challenge of Runaways 26

27 Invasive and Aversive Procedures Crosland, Cigales, Dunlap, Neff, Clark, Giddings, & Blanco 27

28 The Problem Child Protection system includes restrictive facilities (short and long term) for children with severe emotional behavioral problems and for whom alternatives are unavailable These facilities have large staffs that are usually poorly trained, and most of their training focuses on how to handle crises E.g., with restraint, seclusion, time out and take downs, etc. 28

29 Due to high levels of coercive procedures (etc.), BASP was asked to provide training in two of these facilities Highly unusual for training to be provided on positive and preventive strategies Two Facilities Children s Shelter Locked Residential Facility 29

30 Procedures Training provided with 15 hour curriculum Tools: Stay Close; Use Positive Reinforcement; Set Expectations; Use Contracts; Redirect Use Reinforcement Some on site coaching also provided in Locked Facility Data collected with procedures already in place (e.g., incident reports) 30

31 Total Frequency Pre Training Post Training Locked Residential Facility Children's Shelter Restrictive Procedures

32 Frequency Pre Training Post Training Seclusion Mechanical Restraint PRN Meds Physical Hold Procedure 0

33 Frequency Baseline Post Training Take Down Time out Take Down and Time out 3 0 Elbow control 5 Other hands on intervention Injury 5 Procedure Children's Shelter Restrictive Procedures

34 Frequency Pre Training Post Training Aggression 7 Verbal Junk/Non Harmful Property Destruction Threats Self Injury Other Behaviors Resulting in Restrictive Procedure Use 1

35 Nocturnal Enuresis (Stover, Dunlap, & Neff) 35

36 The Problem Bedwetting is a relatively common problem for 5 year olds (roughly 15%), but less common for 10 year olds (5%) and year olds (3%) It is probably higher for children in foster care (as are emotional behavioral problems in general), but hard data are not available Bedwetting can be a source of placement disruption 36

37 Participants Jimmy 12 years old, in foster care Multiple diagnoses; IQ = 50 Paul 6 years old, in foster care Victim of abuse; placement at risk due to behavior problems Susie 5 years old not in foster care Child of a caseworker 37

38 Procedures Baseline: Data collection (dry/wet nights); children wore pull ups; no systematic consequences. Intervention: (1) removal of pull ups; (2) contingency contract, with schedule thinning; (3) clean up for wet nights Design: Non concurrent multiple baseline across participants 38

39 7 BL Contingency Contracting 3 Month Follow Up Jimmy Number of Dry Nights Susie Paul Weeks

40 Runaways (Clark, Crosland, Geller, Cripe, Kenney, Neff, & Dunlap) An examination of assessment based program interventions for habitual runaways in foster care 40

41 The Problem Children leaving foster care placements without permission A common and serious problem associated with placement disruption and elevated risk Highest rates of running: Children between years old Girls > Boys Children with MH or SA problems and histories of placement instability 41

42 When children are running, or missing, they are at higher risk for perpetrating crimes, contacting drugs/alcohol, or being victims. Many of the tragic, horror stories occur when foster children are on the run. The reasons for children running are numerous 42

43 BASP Approach Functional Assessment What is function of running? What are positive and/or negative reinforcers? What are triggers for running? Assessments conducted with caregivers and with children themselves Interventions highly individualized and based on function 43

44 Case of J Hispanic teenager; removed from home due to physical/sexual abuse Multiple placements shelter, group home, foster care, etc. Functional Assessment Intervention change caregiver behavior; allow visits with sibling; placement with trained foster family to independent living 44

45 500 Jasmine Placement History Approximate point of BASP intervention Number of Days Runaw ay Foster shelter Group Home Ind. Living Successive Placem ents

46 Case of R Caucasian boy 12 years old Abused in home of relatives and placed in emergency children s shelter Multiple placements (and runs) Functional assessment Intervention: Contingency contracts (+ BASP technical assistance) 46

47 Randy Placement History (Including all runs) Number of Days Run Fos She Successive Placements

48 Analysis of BASP Involvement with Habitual Runners Habitual runners = huge priority Focused priority of Florida s Department of Children and Families BASP was involved with referred children/youth in the general Tampa Bay area Data available from state data base on 13 of most frequent runners with BASP involvement 48

49 General Procedures Functional Assessment Interviews; record reviews Interventions Individualized on basis of assessment information and dependent upon context, case workers, and circumstances (we did not have full control) Could include: Preference assessments, Contingency contracts, Living arrangements, Training and consultation for foster parents, Guidance and coaching for caregivers, Enriched activities, etc. 49

50 Analysis Data from state data base on children in foster care 13 BASP participants and 13 matched controls from same data base Matching based on (1) gender, (2) age at first run; (3) ethnicity, (4) lack of extended incarceration and availability of data Principal dependent variable = % days on the run 50

51 0.5 Comparison of Mean % Days for Intervention and Control Groups Mean % Days pre %Days post %Days 1yr post Intervention Matched Controls

52 Summary 52

53 We view these data as. Some initial demonstrations of the value of systematic and functional behavior support in the foster care system An important step in gaining further entry and credibility in the system Pilot data for: (a) larger scale and more rigorous evaluations of BASP effectiveness and (b) analyses of challenges and solutions in the way we approach care for children in child protection 53

54 We appreciate that The foster care system is immense and fraught with tremendous difficulties formidable challenges are faced by advocates, administrators and policy makers as they address these challenges We must approach the challenges with a clear focus on what we can contribute, and also with appropriate comprehension of our limitations 54

55 We are encouraged that We ve been around for almost 6 years, and have been accepted and even respected for the services we ve provided; Despite astonishing turnover in state agencies (DCF), we are more stable and secure than ever; We ve learned a great deal and are well positioned to improve and expand our services, and to obtain more information (data) regarding our effectiveness, our failures, and the future of systematic behavior support in the world of foster care. 55

56 (picture) I m done THANKS 56