Evolution of a Trauma-Informed, Adoption Competent Child Welfare System

Transcription

1 Evolution of a Trauma-Informed, Adoption Competent Child Welfare System 2016 SAN DIEGO INTERNATIONAL CONFERENCE ON CHILD AND FAMILY MALTREATMENT DARLENE ALLEN, MS CANDACE JOHNDROW, BS SARAH KELLY- PALMER, MSW, LICSW

2 2012: ARI & FSRI come together Evolution of a Trauma-Informed, Adoption Competent Child Welfare System 2012-Present and Beyond 2013: ACF Grant Proposal 2015: Change is happening 2016: The Future 2014: We are a Supercommunity!

3 What is a Trauma-Informed/Adoption Competent System? Trauma-Informed child welfare system: A trauma-informed child welfare system is one in which all parties involved recognize and respond to the varying impact of traumatic stress on children, caregivers, families, and those who have contact with the system. Programs and organizations within the system infuse this knowledge, awareness, and skills into their organizational cultures, policies, and practices. They act in collaboration, using the best available science, to facilitate and support resiliency and recovery. Chadwick Trauma-Informed System Project. (2013) Creating trauma-informed child welfare systems: A guide for administrators(2 nd ed.) San Diego, CA: Chadwick Center for Children and Families Adoption-competent mental health practitioner has: The requisite professional education and professional licensure; A family based, strengths based, and evidence based approach to working with adoptive families and birth families; A developmental and systemic approach to understanding and working with adoptive and birth families; Knowledge, clinical skills and experience in treating individuals with a history of abuse, neglect and/or trauma; and Knowledge, skills and experience in working with adoptive families and birth families. The Center for Adoption Support and Education

4 Darlene Allen, MS Executive Director/CEO ADOPTION RHODE ISLAND IS A PRIVATE NON- PROFIT ORGANIZATION. OUR MISSION IS TO FACILITATE, PROMOTE AND SUPPORT THE PERMANENT PLACEMENT OF CHILDREN WAITING FOR ADOPTION AND TO IMPROVE THE WELL- BEING OF FOSTER AND ADOPTED CHILDREN AND THEIR FAMILIES. WE PROVIDE SERVICES TO CHILDREN AND FAMILIES, EDUCATE AND ADVOCATE FOR A CHILD S RIGHT TO A SAFE ENVIRONMENT AND INCREASE PUBLIC AWARENESS OF THE UNMET NEEDS OF CHILDREN AND FAMILIES IMPACTED BY FOSTER CARE AND ADOPTION.

5 History of Adoption Adoption became an official legal process in the 1850 s Up until the 1970 s adoption was primarily Babies married adoptive couples/infertility single unmarried women placed children closed/secretive parents tried to adopt children that looked similar to them The last 40 years- changes in adoption

6 Adoption today One out of every 25 U.S. families with children have an adopted child 81.5 million Americans have considered adoption The number of children that found new homes through an international adoption placement fell to 8,668 in 2012 from 22,884 in 2004 The number of domestic infant adoptions has decreased from 49,000 per year in the 1970 s to approximately 18,000 per year. In 2012, 110,000 children live with LGBTQ parents, up from 65,000 in Roughly 40% of adoptions are from the U.S. foster care system There are 107,918 foster children eligible for and waiting to be adopted In 2014, approximately 50,644 foster kids were adopted Every year, about 23,000 children age out of foster care without finding a permanent family.

7 Adoption today Single parents make up approximately 1/3 of foster care adoptions. 40% of adopted children are of a different race, culture or ethnicity than one or both their adoptive parents. In 2012, 110,000 children live with LGBTQ parents, up from 65,000 in On National Adoption Day, November 21, 2015, approximately 5,000 children were adopted creating extensive awareness and media coverage of adoption.

8 In Rhode Island Of the 216,506 children under the age of 18 in Rhode Island, approximately 5,054 are adopted and 2,953 are foster children. Additionally more than 17,000 children are being cared for by a grandparent or other relative. 18% of children exiting foster care are adopted-14% age out. In FY2014, 212 children in the care of DCYF were adopted and 205 were waiting for adoption. Adopted Waiting 64% white 41% white 67% under age 6 32% under age 6 5% 14 and older 11% 16 and older At Adoption Rhode Island- significant recruitment efforts to single and LGBTQ prospective families. Fewer licensed private agencies-families more open to consider foster care adoption.

9 Rhode Island Children waiting for adoption

10 Rhode Island Adoptions 300 Adoptions over time

11 Myths About Adoption and Trauma This child just moved to a new foster home. Starting trauma work now would be disruptive. Trauma treatment can wait until the adoption is legalized. When treating child trauma, I use the same therapeutic components for children living with their birth families as well as for children living with their adoptive families. She is not ready for adoption preparation work because she has been acting out in her group home. When she behaves, she can begin with her adoption specialist.

12 Myths About Adoption and Trauma He is only 5, he doesn t need counseling. He will adjust to his new family in no time. He has adjusted just fine to his last three placements. He never asks about previous families after he moves. Let s not rock the boat. She has never lived with her brother since entering foster care so she does not need a family that will consider parenting them together. Don t tell him his birth mother passed away because he is behaving in his foster home and I don t want to disrupt his placement.

13 Myths About Adoption and Trauma Her parents flew half way around the world to adopt her from an orphanage and she was given everything a child could ever want. I don t understand where this oppositional behavior is coming from. Even though my child has a Facebook page, he does not know who his birth family is and would never connect with them on line. We shouldn t talk about the sexual abuse now, wait until he is adopted.

14 Building Partnerships ARI & FSRI Come Together AT ADOPTION RHODE ISLAND WE WERE CONCERNED ABOUT A NUMBER OF TRENDS WE WERE SEEING IN THE CHILDREN, YOUTH AND FAMILIES WE WERE SERVING: ADOPTION DISRUPTIONS AND DISSOLUTIONS PARENTING CHALLENGES YOUTH WITH TRAUMA HISTORIES AGING OUT OF FOSTER CARE INEFFECTIVE CLINICAL INTERVENTIONS INCREASE IN PSYCHIATRIC HOSPITALIZATIONS PSYCHOTROPIC MEDICATION AGENCY WORKFORCE HAD LITTLE KNOWLEDGE ABOUT EVIDENCED - BASED TRAUMA TREATMENTS

15 Sarah Kelly Palmer, LICSW

16 A Focus on Trauma NCTSN Category III site: Trauma System Therapy Trauma-Focused Cognitive Behavioral Therapy Alternatives for Families Cognitive Behavioral Therapy Child-Development Community Policing Identified the need to have the agency be trauma-informed Focus was on what we could do inside our organization

17 Building Partnerships ARI & FSRI come together Children in foster care and group homes needed adoption preparation and support Parenting challenges Agency workforce had little knowledge about adoption policy, practice and clinical issues Youth aging out of foster care Increasing permanency focus across agency child welfare programs

18 We are a Supercommunity! In the beginning.. Getting to know you meetings Cross-Training Case Consultations Solidifying partnership with child welfare Began to look for funding and ways to formalize partnership We became a Supercommunity!

19 Building Momentum ACF Grant Proposal Adopt Well-Being Rhode Island Diligent Recruitment- A Family for Every Child! Joint meetings, shared processes Assessing system needs-screening,assessment, available evidenced based treatments, foster care evaluation, training and support Data and evaluation position funded, data analysis, data dissemination Creating a comprehensive plan

20 Where it all came together. Children s Bureau, Administration for Children and Families Trauma 3 Grantee: Promoting Well-Being & Adoption After Trauma- 6 sites funded Adopt Well-Being Rhode Island Universal Screening and Assessment System for Trauma Guidelines for Providers and Families around Trauma-Informed, Adoption-Competent Practice On-going Functional Assessment of Child Well-Being Data-Driven Case Planning that is Trauma-Informed and Adoption- Competent Alignment of Service Array to Include Evidence-Based or Evidence- Informed Treatments that match the needs of the target population Training & Support for Youth, Professionals, Resource and Adoptive Parents

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22 Trauma System Readiness Tool Created by the Chadwick Trauma-Informed Systems Project - Distributed to Child Welfare Staff & Community Providers - Added questions to get at Adoption Competence - Conducted Focus Groups with: - Youth Alumni - Foster/Adoptive Parents - Birth Parents - Child Welfare Line staff - Child Welfare Supervisors - Community Agencies - Implementation Plan

23 Adoption Surveillance Report Children waiting for adoption Disruption rates Characteristics of youth who experienced disruption Dissolution rates Characteristics of youth who experienced a dissolution

24 NCTSN Child Welfare Trauma Training Toolkit Foundational training on trauma-informed child welfare practice Delivered to over 100 child welfare professionals to date Pre and post test data being collected

25 Screening Pilot Change is happening! Two Units Identified to implement screening pilot Tools being piloted: Connecticut Trauma Screening Child and Caregiver Versions Pediatric Symptom Checklist-17 Caregiver Version CRAFFT Youth Report

26 Candace Johndrow, BS Director

27 Overview Funded by a 17 month Administration for Children and Families, Children s Bureau Intensive, Child- Focused Adoptive Parent Recruitment grant Project partners:

28 Overview The Project targets children and youth waiting two years or more for an adoptive home, with a special focus on older youth in congregate care settings, sibling groups, and those with serious behavioral issues. Leadership Team advises on all Project activities.

29 Goals Children will spend less time waiting for adoption. A greater number of older adolescents will leave the child welfare system with a permanent adoptive family. Participating children will be fully prepared for adoption. Participating children will be successfully matched with a potential adoptive parent.

30 Goals new prospective adoptive parents will be recruited. New prospective adoptive parents will be fully prepared to adopt. Resource parents/caretakers will show improved attitudes toward adoptive children. Improved emotional and behavioral functioning of participating children.

31 Components Adoption preparation: Model : Preparing Children for Permanency Comprehensive trauma-informed recruitment planning Child-focused adoptive parent recruitment: Wendy s Wonderful Kids Resource parent training: National Child Traumatic Stress Network s Caring for Children Who Have Experienced Trauma: A Workshop for Resource Parents (A.K.A. Resource Parent Curriculum)

32 Components Trauma-informed, adoption competent liaison to Rhode Island Family Court Trauma Systems Therapy Ongoing post-adoption services Public Awareness Dissemination of best practices

33 Henry s birth All adopted by sister s paternal grandmother Foster placement with aunt and 1 sister Foster placement with new family foster placement with new family - foster mom is a behavioral health professional Mother struggles with addiction & mental illness - Henry & his 4 siblings experienc e neglect All children removed from mother s custody 1 mo Grandmother dies 2 mo 4 mo Decompensates in response to discussions about adoption; 2 weeks before finalization, aunt changes her mind - only adopts sister Discharged to residential placement. 1 mo 2nd residential Placement Decompensates in response to discussions about adoption foster family changes their mind

34 3-5-7 Model Evidence-informed relational practice developed by Darla L. Henry, PhD, MSW, MRS. Separations from important, intimate caregivers, and being in relationships that are abusive, rejecting, or abandoning, contribute to beliefs of being unlovable and unwanted. Strengths-based process for grieving losses and empowering individuals to engage in relationships that are secure and sustainable.

35 Trauma-Informed Adoption Recruitment Intake & Assessment Tool Incorporates best practice approaches to child-focused, strengths-based and adoption competent parent matching and recruitment. Tool is updated on-going with each participant. Adoption Rhode Island piloting the tool for agency-wide use to the expected benefit of over 150 child welfare involved children and youth annually waiting for adoption.

36 Intake & Assessment Tool Below is a list of behaviors that describe reactions that children may have following a frightening event. Please rate the child s presentation within the past 30 days, applying the following rating scale*: 0= Not True (as far as you know) 1 = Somewhat true or Sometimes True 2 = Very True or Often True Child reports more physical complaints when reminded of the event, such as headaches, stomachaches, nausea, difficulty breathing Child avoids doing things that remind him or her of the event Child startles easily. For example, he or she jumps when hears sudden or loud noises Child gets very upset if reminded of the event. *Used, with permission, from the Child Stress Disorders Checklist Short Form (CSDC-SF) (v /10) by Glenn N. Saxe, M.D. & Michelle Bosquet Enlow, Ph.D. of the National Child Traumatic Stress Network, New York University, and Children s Hospital, Boston

37 Child Focused Adoptive Parent Recruitment Maintains a small caseload of 15 children Wendy s Wonderful Kids Diligent search strategies Family Finding techniques Model Initial evaluation surveys Part of the child s provider team Meets with the child face-toface every week

38 Wendy s Wonderful Kids Evidence-based, nationally evaluated adoptive parent recruitment model Designed to increase adoptions of children for whom it has traditionally been difficult to find adoptive families primarily older children and children with mental health disorders, sibling groups, those with previously failed adoption efforts, special needs, and/or who have lingered in foster care

39 National Child Traumatic Stress Network s Caring for Children Who Have Experienced Trauma: A Workshop for Resource Parents Participants learn how trauma-informed parenting can support children s safety, permanency, and well-being, and engage in skill-building exercises that help them apply this knowledge to the children in their care Designed to be taught by a mental health professional and a foster parent as co-facilitators

40 Resource Parent Curriculum The workshop is divided into 8 modules: 1. Introductions 2. Trauma Understanding Trauma s Effects 4. Building a Safe Place 5. Dealing With Feelings and Behavior 6. Connections and Healing 7. Becoming an Advocate 8. Taking Care of Yourself

41 Family Court Liaison Promotes continuity of care, seamless sharing of information, and coordination of services for youth awaiting permanency On site trauma-informed, adoption competent consultation ongoing and during Rhode Island Family Court proceedings associated with the child/youth s case

42 Trauma Systems Therapy (TST) Developed by the New York University s Child Study Center and the Department of Child and Adolescent Psychiatry at NYU's School of Medicine, overseen by Dr. Glenn Saxe Evidence-informed model of care for traumatized children addressing both the child s emotional needs and the social environment in which he or she lives

43 TST TST helps a child with dysregulation gain control over emotions and behavior by enhancing the child's capacity to regulate emotion and diminish ongoing stresses and threats in the social environment. TST also builds the capacity of significant others within the child's social environment to help regulate emotional and behavioral responses. An FSRI TST clinician and TST case manager are assigned to each participating child to assist with this work follow the child

44 TST TST provides a framework for organizing traumainformed services. Phase-based approach spanning: home- and community-based care services advocacy emotion regulation skills training psychopharmacology

45 Public Awareness

46 Evaluation Independent Evaluation Consultant, Dr. Roberta S. Pearlmutter, PhD, dean and professor at the School of Social Work, Rhode Island College Mixed method evaluation examining the process and short-term outcomes of the set of interventions proposed and of the individual components Cost analysis

47 What if? Henry s birth All adopted by sister s paternal grandmother Foster placement with aunt and 1 sister Foster placement with new family foster placement with new family - foster mom is a behavioral health professional Mother struggles with addiction & mental illness - Henry & his 4 siblings experienc e neglect All children removed from mother s custody 1 mo Grandmother dies 2 mo 4 mo Decompensates in response to discussions about adoption; 2 weeks before finalization, aunt changes her mind - only adopts sister Discharged to residential placement. 1 mo 2nd residential Placement Decompensates in response to discussions about adoption foster family changes their mind

48 Lessons Learned Thus Far Individual Level Mutual respect, commitment to expand, open communication Value difference Organizational Level leadership, culture of collaboration, commitment to best practice, managing models, team-based approach System Level Working through changes in leadership ( state and federal) Working across public and private organizations and with courts Data and Outcome Trauma screening data Toolkit Training data

49 Integration, Innovation and Momentum Create trauma informed recruitment assessment tool Create permanency update reports /judicial case consultation Adoption competence curriculum development Expanded partnership-mou: Bridges of Hope Planning Statewide Conference The Future

50 Moving Forward Testing theories of change Child-focused recruitment + TST Adoption recruitment+ court liaison WWK compared to non-wwk child -focused recruitment APPLA Embedding practices within public child welfare co-location piloting trauma screening Embedding practices within judiciary judges meeting CASA training Adoption attorneys training Continue training and education RPC Child Welfare Training Toolkit conference presentations Media

51 Sustainability Diversify Funding Develop and Leverage Partnerships Grant and Contract Funding Awareness Building