Measuring Well Being in Child Welfare. Three Branch Institute July 2013

Transcription

1 Measuring Well Being in Child Welfare Three Branch Institute July 2013

2 Most agency specific outcomes are actually process measures Outcomes limited to the mandate or activities of a single agency and/or external service providers To truly measure an outcome (such as family well-being, or child s health status) we need to take a multi-systems approach

3 Getting to Well-Being Assessment of Need Access to Services Quality of Services Effectiveness of Services Different data for different purposes: Child level vs. systems level

4 Getting to Well-Being Descriptive: how many children have diagnosed disabilities? (By age, gender, race, type of disabilities) Agency Specific Outcome: Do children receive assessment and treatment? Are children with disabilities achieving permanency? Integrated Functional Outcome: Are children experiencing limitations as a result of their medical condition? Is status improving?

5 Getting to Well Being What screening tools are already in place? Many can be used over time to identify service needs, assess improvement and determine the need for changes in service delivery. Consider reporting capabilities before scaling up What outcomes are already being measured by a partner agency? Can child welfare children be identified in the data?

6 And How Are the Children? National Health Care Access Measures: Insurance coverage Having a Usual Source of healthcare Immunizations Oral Health Dental Visits Federal Interagency Forum on Child and Family Statistics. America s Children: Key National Indicators of Well-Being, 2013.

7 And How Are the Children? Additional Data Needed Adequacy of healthcare coverage Quality and content of health care In Child Welfare, physical health is monitored through qualitative case reviews. Some jurisdictions employ foster care health nurses and use Medicaid claims or other healthcare data to assess health care utilization

8 Getting to Well Being: Access to Healthcare

9 Getting to Well Being: Access to Healthcare

10 And How Are the Children? National Measures of Health Status Preterm Birth and Low Birth weight Infant Mortality Emotional and Behavioral Difficulties Adolescent Depression Activity Limitation (due to chronic condition) Diet Quality (Healthy Eating Index), Obesity Asthma Federal Interagency Forum on Child and Family Statistics. America s Children: Key National Indicators of Well-Being, 2013.

11 And How Are the Children? Health Data Needs Improved measure of child disability based on functional difficulties In Child Welfare: we know very little about the health status of children and have traditionally focused on healthcare processes. Increased use of functional assessments and linkages to other data systems are key to improvement in this area

12 And How Are the Children?

13 Getting to Well Being: Descriptive Data/Assessing Need

14 Begin where you are: start small, show value, build relationships Cluster Analysis Trauma Assessment and Treatment collaborations with behavioral health Access to Educational Data Connections to Medicaid data Primary prevention connections to public health and early learning

15 Resources for Action Planning Data sharing resources America s Children: Key National Indicators of Well-Being, 2013 High level child welfare data state fact sheets Descriptive Data Who s In Care Ongoing peer learning Additional support and TA

16 There can be no keener revelation of a society's soul than the way in which it treats its children. Nelson Mandela

17 Key Questions: Well-Being Processes Are children and caregivers assessed for appropriate service needs? What interventions are currently in place to address trauma and improve functioning and well-being? Are they achieving the desired results? How is program fidelity being assessed? Are there services/interventions available in all areas? Are they culturally sensitive? Targeted for the population? Evaluate capacity for data sharing and interagency collaboration (Medicaid, substance abuse, public health, early learning )

18 Key Questions: Well-Being Outcomes Are children and caregivers assessed for appropriate service needs? Do children and youth have a positive relationship with a caring adult? Have children reached normative standards for growth and development? Are children and youth succeeding in school? Are children and youth exhibiting a reduction in trauma symptoms and/or improved social and emotional development? 18

19 Guidance from ACF: Well-Being Explains ACYF s priority to promote social and emotional well-being for children and youth receiving child welfare services, Encourages child welfare agencies to focus on improving the behavioral and social-emotional outcomes for children who have experienced abuse and/or neglect. im/2012/im1204.pdf

20 Guidance from ACF: Trauma Defines the issues surrounding psychotropic medication use by children in foster care, highlights available resources encourages increasing access to clinically appropriate screening, assessment, and evidence-based interventions for foster children with mental health and trauma-related needs. im/2012/im1203.pdf

21 Guidance from ACF: Early Learning Provides information to State and local child welfare agencies to reinforce the Children's Bureau commitment to supporting child welfare agencies' investment in partnerships with Head Start and Early Head Start agencies in order to improve young children's access to and continuity of comprehensive, high quality early care and education services.

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23 February 26, 2012 CWLA Pre-Conference Institute: Trauma

24 February 26, 2012 CWLA Pre-Conference Institute: Trauma

25 February 26, 2012 CWLA Pre-Conference Institute: Trauma

26 Common Outcomes National Indicator State Level (all children) County or Agency Level Child level special populations Child level special populations Child level special populations

27 And How Are the Children? Family and Social environment Child care: access and quality Adolescent births In Child Welfare: Child maltreatment/victimization rates; Living situation, Placement stability, Maltreatment in foster care, achievement of permanency

28 Family and Social environment: Data Needs Social Connections and Engagement The formation of close attachments to family, peers, school and community have been linked to healthy youth development In child welfare, connections are measured through the Child and Family Services Review additional measures include placement with siblings, relative placement, and relational and legal permanency.

29 And How Are the Children? Economic Circumstances Child poverty, income distribution, parental employment Food insecurity Data needs: Economic Well Being: Standard of Living Long Term Poverty In child welfare: National Youth in Transition Database (NYTD) for older youth Family poverty as risk factor

30 And How Are the Children? Physical Environment and Safety Outdoor Air and Drinking Water Quality Environmental Tobacco Smoke Lead in the Blood declining, but higher in African American and Latino children, higher for children living in poverty Housing and Homelessness Victims of violent crimes Injury and mortality

31 And How Are the Children? Physical Environment and Safety Data Needs Exposure to violence Improved accuracy for measuring homelessness In Child Welfare: Child Fatalities/near fatalities Homelessness as removal condition/risk factor National Youth in Transition Database (NYTD) for older youth

32 And How Are the Children? Behavior Cigarette, Alcohol, and Illicit Drug Use Sexual Activity Youth Perpetrators of Violent Crime Data Needed: Activities promoting health and development In Child Welfare: Overlap with the Juvenile Justice System

33 And How Are the Children? Education Family reading to young children Mathematics and Reading Achievement High School Academic Coursetaking High School completion College Enrollment Youth Neither Enrolled in School nor Working

34 And How Are the Children? Education Data Needs Early child development; cognitive, emotional, social skills of preschoolers (will be a special forum available at Childstats.gov) In Child Welfare: Educational needs are monitored though the CFSR and NYTD (older youth). Some Jurisdictions employ educational specialists and have access to educational data.

35 Well Being is a Shared Responsibility Courts Public Agencies Legislature

36 Three Branches: Different processes Child welfare process: Court process Policy/Statute Policy Practice Oversight Outcome

37 Different processes, Common Outcomes Behavioral Health Child Welfare Child and Family well being Education Public Health