SAMPLE Project Narrative Texas CASA Proposal to the Hogg Foundation for Mental Health Texas Mental Health Policy Projects October 2012

Transcription

1 A. Project Summary SAMPLE Project Narrative Texas CASA Proposal to the Hogg Foundation for Mental Health Texas Mental Health Policy Projects October 2012 The need to improve mental health outcomes for children in foster care in Texas is clear. Our aim is to clarify and advocate for policy changes that will reduce the system-induced trauma that children in foster care suffer and provide better mental health care for foster children. Texas CASA s strength lies in our firsthand knowledge of and passion about children in foster care, our success in advocating for policy change, and the respect we garner in communities across Texas. This proposal is designed to enhance our advocacy capacity by 1) increasing our expertise in mental health, 2) developing evidence-based policy recommendations regarding mental health issues for children in foster care, and 3) advocating more effectively for those changes. We will: Implement a strong leadership task force with mental health expertise to develop a well informed and researched mental health public policy agenda. Hire a Mental Health Policy Coordinator (Coordinator) with mental health and advocacy experience who will work with mental health and foster care stakeholders, and lead and guide the Task Force and CASA Policy Advocates in mental health policy development and advocacy. Increase our grassroots public policy efforts by training new CASA Policy Advocates and providing training related to mental health issues. B. Statement of Need The Texas child protection system is overburdened, under-resourced, and, for too many children, broken. Unfortunately, the foster care system can often end up re-traumatizing the very children it was meant to protect. CASA volunteers and others have become increasingly frustrated with the foster care system s inability to meet the needs of children. In the 82 nd legislative session, the Texas Legislature authorized a redesign of the foster care system to provide better outcomes for children. Texas CASA is a member of the Public Private Partnership that is helping to develop the redesign. Unfortunately, the redesign has been stalled and Texas CASA will need to engage more strenuously in the implementation of the redesign to ensure that children s mental health and other needs are not compromised even further. Sunset Review of the Department of Family and Protective Services is scheduled in 2015 and the 84 th legislative session. In addition to being a resource to the Sunset Commission and the legislature as part of this process, Texas CASA needs to be able to thoroughly research mental health issues, collaborate with experts and stakeholders, including Star Health (the health and mental health care provider for foster children), and educate legislators on the issues. As a best interest advocate for children, Texas CASA needs to be part of this and other mental health agendas, but currently, we simply do not have the staff and expertise to be effective at this Texas CASA Proposal to the Hogg Foundation for Mental Health: Public Policy October 2012 page 1

2 critical juncture. Though we have some clarity about the problems, we especially need expertise to propose and advocate for evidence-based solutions. Here are just a few of the mental health implications for foster children: During the last ten years, the number of children who are the legal responsibility of the State of Texas grew from 27,865 1 in 2001 to 45,929 2 in 2011 a 65% increase in ten years! As the foster child population grows in Texas and resources are strained, the Texas Department of Family and Protective Services (DFPS) is struggling to provide the caseworkers needed to coordinate quality placements and services for children. And, there are fewer and fewer mental health, substance abuse, foster parent training, and other services available for children. Because of a lack of quality foster homes where they are needed most, children are routinely placed in foster care placements that are outside of their home counties, and too often separated from their siblings and bounced around from foster home to foster home. Research over the last two decades has demonstrated strong association between frequent placement moves and poor mental health outcomes. 3,4,5,6 With each move, children do not have consistent clinical mental health providers or caregivers. This disruption in attachment relationships may lead to Reactive Attachment Disorder, 7,8 a disorder in which the child exhibits severe disturbances in relationships with caregivers, and which can result in their being placed in a more restrictive placement, such as a group home, residential treatment center, or psychiatric hospital. Instability of placement, placement in an institutional setting, and case worker changes are also aspects of case practice that are likely to interfere with achieving permanence through adoption or placement with a relative. 9 The system s limitations are also evident in the mental health services for foster children that favor the quick fix of psychotropic medication over a more holistic response that begins with other therapeutic interventions. There is no doubt that children in foster care exhibit more numerous and serious medical conditions, including mental health conditions, than do other children. 10 But there is evidence of overmedication. In an analysis of Medicaid fee for service 1 Texas Department of Family and Protective Services, 2001 Annual Report and Data Book. 2 Texas Department of Family and Protective Services, 2011 Annual Report and Data Book. 3 Pecora P, Kessler R, Williams J, et al. Improving Family Foster Care: Findings From the Northwest Foster Care Alumni Study. Seattle, WA: Casey Family Programs; Available at: Accessed July 1, Taussig HN. Children who return home from foster care: a 6-year prospective study of behavioral health outcomes in adolescence. Pediatrics.2001;108 (1). Available at: 5 Jonson-Reid M, Barth R. From maltreatment to juvenile incarceration: uncovering the role of child welfare services. Child Abuse Neglect.2000;24 : Barth RP, Jonson-Reid M. Outcomes after child welfare services: Implications for the design of performance measures. Child Youth Serv Rev.2000;22 : American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, DSM-IV. Washington, DC: American Psychiatry Association. 8 Gean, M., Gillmore, J., & Dowler, J. (1985). Infants and toddlers in supervised custody: A pilot study for visitation. Journal of the American Academy of Child Psychiatry, 24, 5, Gretta Cushing, Sarah B. Greenblatt, Casey Family Services. Vulnerability to Foster Care Drift after the Termination of Parental Rights Research on Social Work Practice. OnlineFirst, published on February 23, 2009 as doi: / GAO, Foster Care: State Practices for Assessing Health Needs, Facilitating Service Delivery and Monitoring Children s Care. GAO-09-26, (Washington, DC: February 6, 2009). Texas CASA Proposal to the Hogg Foundation for Mental Health: Public Policy October 2012 page 2

3 data across five states (including Texas), foster children were prescribed psychotropic drugs at rates two to over four times higher than non-foster children, and thousands of foster children were prescribed psychotropic medications exceeding maximum recommended levels. 11 CPS caseworkers carry caseloads of 32 children statewide (2011), 12 double the Child Welfare League s recommendation of 15 to 17 cases. 13 They are often overwhelmed and many are inexperienced with a turnover rate of 25% annually statewide (2011). 14 It is not surprising that they are unable to coordinate the services that children and families need in a timely manner or even at all. It is common for a child to have several changes in caseworkers, which results in inefficient and disjointed casework and services for children. Mental health issues are especially acute for African American children. African American children experience differences in the quality of services received; less access to drug treatment services, mental health services, family preservation services; and fewer contacts by caseworkers. 15,16 C. Project Plan Policy Issue to be Addressed: Improved Mental Health Outcomes for Children In Foster Care. We are already focusing some of our efforts toward improving mental health outcomes. In September 2012, Texas CASA s Board of Directors voted to focus on improving the quality of foster care for children by ensuring that children are not re-traumatized by the system that is charged with protecting them, and improving mental health services for children in DFPS legal custody by ensuring appropriate medication and therapeutic mental health services. However, we are dissatisfied with the depth of our understanding and are concerned that we advocate for more specific, evidence-based solutions. During year one of the Project we will focus our efforts on advocating and gathering information about mental health issues, while developing a twelve member Mental Health Task Force with specific expertise: Academic, practical, and policy knowledge of psychotropic medications and therapeutic interventions for children in foster care In depth, practical knowledge of the Foster Care System including DFPS and child placing agencies CASA volunteers and advocates with mental health expertise 11 GAO, Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions (Draft). GAO , (Washington, DC: 2011) 12 Texas Department of Family and Protective Services, 2011 Annual Report and Data Book. p Child Welfare League website on October 12, Available at Accessed October 17, Texas Department of Family and Protective Services, 2011 Annual Report and Data Book. 15 Courtney, M., Barth, R. Berrick, J., Brooks, D., Needell, B. & Park, L. (1996). Race and child welfare services: Past research and future directions. Child Welfare, 75 (2): Garland, A., Hough, R., Landsverk, J., McCabe, K., Yeh, M., Ganger, W. & Reynolds, B. (2000). Racial/ethnic differences in mental health care utilization among children in foster care. Children s services: Social policy, research and practice 3, Texas CASA Proposal to the Hogg Foundation for Mental Health: Public Policy October 2012 page 3

4 We are working with our constituents to identify expert membership and have already begun to approach potential members. NAMI Texas Executive Director has agreed to serve as well as a several others. The Task Force will: 1. Identify issues and needed policy changes and make recommendations to the Texas CASA Board of Directors; 2. Develop action plans for 2014 and 2015; 3. Approve training and advocacy materials; and 4. Participate in advocacy activities. The Task Force will likely examine: Descriptions of new laws and policies and their implications; Trauma informed care for foster children; Abandonment of children to state care because parents cannot pay for adequate mental health services; System induced trauma caused by the foster care system; Therapeutic and nontherapeutic interventions available in the foster care system; Barriers to improved mental health including lack of truly therapeutic foster homes; Instability of children s placements and mental health services; Children s ability to have a voice in their own care; Disparities in mental health; and Benefits/problems with prescription of psychotropic medications. During the first six months, the Coordinator will be gathering further information about mental health issues and research evidence-based best practice solutions to inform the work of the Task Force. The Task Force will hold its first meeting at a two day retreat and then meet by conference call or in person quarterly. We also consult with individual members related to their expertise. Enhanced Public Policy Advocacy Efforts CASA s extensive network of volunteers, staff, members of the judiciary, child placing agencies, and community based organizations form a grassroots learning community with an extensive capacity to advocate on behalf of children in foster care. Throughout the year the Coordinator will receive ground-level, direct input and anecdotal information from children and CASA volunteers which has been critical to our success as public policy advocates. The Task Force will access this community through enhanced and expanded programming: CASA Capital Day 2013 (and planning for 2015). We will increase attendance and refocus on mental health issues. CASA Capital Beat. This tool will be used to educate on the issues and alert advocates to upcoming legislation, committee meetings, etc. We will focus on mental health issues and grow our current contact list. Legislative Advocacy Teams. Texas CASA has developed ten Legislative Advocacy Teams within local CASA programs throughout the state to achieve effective grassroots advocacy for system improvements. We will strategically develop eight new teams. Public Policy Primer. In November or December of 2013 and 2014 we will hold a one day training for volunteers interested in advocating on behalf of Texas foster children. We will Texas CASA Proposal to the Hogg Foundation for Mental Health: Public Policy October 2012 page 4

5 increase attendance at this event and will focus on teaching CASA volunteers to tell the stories of the children who they have met in the context of our Mental Health Agenda. The addition of a Mental Health Public Policy Coordinator will enable us to expand and enhance our public policy advocacy efforts over the next two years. The Coordinator will work to influence decision-making by advocating for improvements and serving as a resource and resource broker to policy makers in the judicial, executive and legislative branches. The Coordinator will provide technical assistance to CASA Advocates and host legislators and their staff at CPS court observations. The project will allow us to provide additional and expanded direct advocacy efforts on behalf of CASA and the children we serve in legislative districts, at the state and U.S. Capitols, the Texas Association of Psychiatrists, and with DFPS, Health and Human Services Commission, Star Health (a foster care Medicaid Provider), Mental Health America, Disability Rights, Texans Care for Children, child placing Agencies, CASA volunteers, legislators, and judges. (See Timeline for detailed list of activities and agencies.) D. Organizational Capacity This project directly connects with our mission to be a voice for abused and neglected children through the power of volunteer advocacy and change in the child protection system. As the statewide non-profit association of all independent local CASA programs, Texas CASA is in the best position to carry out a mental health policy project focused on one of the most vulnerable populations in our state children in foster care. We represent 7,246 CASA volunteers and 69 local CASA programs. We have grown the number of CASA volunteers in Texas by 2,700 since 2006, and have substantially increased the resources and funding available for CASA programs since Texas CASA is led by CEO Vicki Spriggs who has more than 37 years of experience working with and for children in the child welfare and juvenile justice systems. She served for 16 years as Executive Director of the Texas Juvenile Probation Commission. The Coordinator will work under the direction of Public Policy Director Andrea Sparks. Ms. Sparks has worked in management positions for Texas CASA for five years. She is a graduate of The University of Texas School of Law. We have an extensive and strong financial and administrative management history. Since 2004, the Texas Legislature and federal officials have entrusted Texas CASA to be the grant manager of funding that includes current state funding of 8.5 million and federal funding of $4 million annually. We have built strong relationships with many state and national officials, who understand the importance of CASA advocates in ensuring positive mental health outcomes for foster children. Additionally, our network of CASA program staff and volunteers look to Texas CASA to mobilize and lead policy change efforts. In the past three legislative sessions, Texas CASA s efforts have resulted in enactment of several laws that improve the child protection system and outcomes for children, including: Texas CASA Proposal to the Hogg Foundation for Mental Health: Public Policy October 2012 page 5

6 1. Increased services to allow extended family members to care for children instead of resorting to the more expensive, more damaging last resort of foster care; 2. Improved processes and services to encourage timely adoptions so that children can begin healing in a safe, permanent home that allows them to thrive; 3. Services for foster youth who are forced to leave foster care without a family, so that they have a better chance of becoming healthy, responsible adults; 4. Legislation and CPS policies strengthening CASA s effectiveness, increasing CASA s access to information and records, participation in CPS and court processes, and resources to support additional CASA volunteers. During this past year we were invited to participate in the: Public private partnership that is redesigning the foster care system (ongoing); Senate Bill 434 Task Force to Address the Relationship between Domestic Violence and Child Abuse and Neglect; Texas Appleseed s Policy Development Team for Improving the Lives of Children in Longterm Foster Care which developed a final report to improve court systems to achieve permanency; Texas Supreme Court s Children s Commission Workgroup on Psychotropic Medications for Foster Youth; and Texas Supreme Court s Children s Commission s Workgroup on Improving Legal Representation in Child Protective Services Cases. E. Project Evaluation Coordinator and Director refocus efforts on mental health and increase the number of educational contacts with policy makers annually via telephone, , or in person. Preliminary advocacy work plan for 2014 developed by December 2013 and advocacy activities continue. Mental health public policy agenda and materials researched, vetted and finalized by October Task Force of 12 formed by July At least 5 meetings and one retreat during 2 years. 90% indicate that the Task Force has been effective. Training provided at the Public Policy Primer in 2014 for 250 (100 in 2012) CASA network members. 95% indicate that the training was good or excellent. 400 (300 in 2012) CASA Advocates will attend CASA Capital Day in 2013 and educate legislators about the Mental Health Agenda. Increase the CASA Capital Beat mailing list from 1,000 to 1,500 by the end of the grant period. At least 24 issues will be sent during the grant period. Increase the number of active Legislative Advocacy Teams from 10 (2012) to 16 by the end of the grant period. Evaluative measures will be tracked using a Project Tracking Spreadsheet. Participants at events will complete evaluations. Task Force Members will complete evaluations in December 2013 and December Improvements will be made in subsequent years based on evaluations. Texas CASA Proposal to the Hogg Foundation for Mental Health: Public Policy October 2012 page 6