bryan samuels, executive director the intersection of safety, permanency and child well-being bryan...
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Bryan Samuels, Executive Director
The Intersection of Safety, Permanency and Child Well-Being
Bryan Samuels, Executive Director
CHILDREN IN FOSTER CARE ON 9/30
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 -
100,000
200,000
300,000
400,000
500,000
600,000
23.3% decline
STATE CHANGES IN CASELOADS: 2002-2011
-80.0%
-60.0%
-40.0%
-20.0%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Mai
ne
Haw
aii
Mar
ylan
d Pu
erto
Ric
o DC
New
Jer
sey
Ohi
o N
ew H
amps
hire
G
eorg
ia
Cal
ifor
nia
New
Yor
k Fl
orid
a M
inne
sota
V
erm
ont
Penn
sylv
ania
V
irgi
nia
Mas
sach
uset
ts
Col
orad
o M
ichi
gan
Illi
nois
W
isco
nsin
R
hode
Isla
nd
Sout
h C
arol
ina
Mis
sour
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enne
ssee
C
onne
ctic
ut
Ala
ska
Nor
th D
akot
a N
ebra
ska
Ala
bam
aN
orth
Car
olin
a M
onta
na
Lou
isia
na
Okl
ahom
a K
ansa
s D
elaw
are
Wyo
min
g O
rego
n K
entu
cky
Was
hing
ton
New
Mex
ico
Sout
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akot
a Id
aho
Iow
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rkan
sas
Indi
ana
Uta
h M
issi
ssip
pi
Wes
t Vir
gini
a T
exas
Nev
ada
Ari
zona
Data Source: Adoption and Foster Care Analysis and Reporting System, U.S. Department of Health and Human Services
WELL-BEING CHALLENGES AMONG CHILDREN KNOWN TO CHILD WELFARE
Developmental Prob-lems
(0-5 years-old)
Cognitive Problems (4-17 years-old)
Emotional/Behavioral Problems
(1.5-17 years-old)
Substance Use Disorder (11-17 years-old)
0%
10%
20%
30%
40%
50%
In-Home, Connected to Services In-Home, Not Connected to ServicesOut-of-Home
Dolan, M., Casanueva, C., Smith, K., & Ringeisen, H. (2011). NSCAW Child Well-Being Spotlight: Children Placed Outside the Home and Children Who Remain In-Home after a Maltreatment Investigation Have Similar and Extensive Service Needs. OPRE Report #2012-32, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services .
EMOTIONAL AND SOCIAL CAPACITIES ARE INEXTRICABLY INTERTWINED WITHIN THE ARCHITECTURE OF THE BRAIN
TRAUMA’S IMPACT ON SOCIAL AND EMOTIONAL FUNCTIONING AND
RESULTS IN POOR OUTCOMES
Toxic Stress, Trauma, Community Violence, Abusive or Neglectful
Parenting
Insecure Attachments, Emotional
Dysregulation, Negative Internal Working Models
Maladaptive Coping Strategies
Poor Social Functioning, Disturbed
Peer RelationshipsPsychological Distress
Poor Outcomes for Children and
Families
PERMANENCY IS INSUFFICIENT FOR ACHIEVING LONG-TERM POSITIVE OUTCOMES
REUNIFICATION OUTCOMES
• Following reunification, children are more likely to have increases in both externalizing problems, such as aggression and delinquency, and internalizing problems, such as depression and acting withdrawn.
• This is likely the result of increased exposure to risk factors and decreased system supports.
KINSHIP CARE OUTCOMES
• Children who spent all of their time in foster care living with relatives have almost identical rates of mental health diagnoses later in life as children in foster care who never lived with relatives.
• For both groups, the rates of diagnoses are much higher than the general population.
ADOPTION OUTCOMES
• Following adoption, children have high levels of mental health problems.
• 2, 4, and 6 years following adoption, anxiety, depression, and ADHD increase steadily.
• Rates of difficulty among children adopted from public child welfare are similar to those among children adopted from private agencies.
Bellamy, 2008. Roller White et all, 2007. Simmel et al, 2007.
RESEARCH IS FRAGMENTED…
EducationMedicine
Child Welfare
Mental Health
Juvenile Justice
Neuroscience
…AND NOT ALIGNED
A SHARED FRAMEWORK ALIGNS THE BEST KNOWLEDGE AND MOVES US IN A COMMON DIRECTION
Child Welfare
Neuroscience
Medicine
Education
Juvenile Justice
Mental Health SOCIAL & EMOTIONAL WELL-BEING
FOR CHILDREN AND YOUTH EXPOSED TO
ABUSE, NEGLECT, and
VIOLENCE
INTEGRATING WELL-BEING WITH SAFETY AND PERMANENCY
WELL-BEING
PERMANENCYSAFETY
A FRAMEWORK FOR WELL-BEING
Environmental Supports
Personal Characteristics
Developmental Stage (e.g., early childhood, latency)
Within each domain, the characteristics of healthy functioning relate directly to how children and youth navigate their daily lives: how they engage in
relationships, cope with challenges, and handle responsibilities.
Cognitive Functioning
Physical Health and
Development
Emotional/ Behavioral Functioning
Social Functioning
THE FRAMEWORK IN PRACTICE: OUTCOME DOMAINS BEYOND SAFETY AND PERMANENCE
Intermediate Outcome Domains Well-Being Outcome DomainsEnvironmental Supports Personal Characteristics Cognitive Functioning Physical Health and
DevelopmentEmotional/Behavioral
FunctioningSocial Functioning
Infancy(0-2)
Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES)
Temperament, cognitive ability
Language development Normative standards for growth and development, gross motor and fine motor skills, overall health, BMI
Self-control, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms
Social competencies, attachment and caregiver relationships, adaptive behavior
Early
Childhood (3-5)
Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES)
Temperament, cognitive ability
Language development, pre-academic skills (e.g., numeracy), approaches to learning, problem-solving skills
Normative standards for growth and development, gross motor and fine motor skills, overall health, BMI
Self-control, self-esteem, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms
Social competencies, attachment and caregiver relationships, adaptive behavior
Middle Childhood (6-12)
Family income, family social capital, social support, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES)
Identity development, self-concept, self-esteem, self-efficacy, cognitive ability
Academic achievement, school engagement, school attachment, problem-solving skills, decision-making
Normative standards for growth and development, overall health, BMI, risk-avoidance behavior related to health
Emotional intelligence, self-efficacy, motivation, self-control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms
Social competencies, social connections and relationships, social skills, adaptive behavior
Adolescence
(13-18)
Family income, family social capital, social support, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES)
Identity development, self-concept, self-esteem, self-efficacy, cognitive ability
Academic achievement, school engagement, school attachment, problem solving skills, decision-making
Overall health, BMI, risk-avoidance behavior related to health
Emotional intelligence, self-efficacy, motivation, self-control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms
Social competence, social connections and relationships, social skills, adaptive behavior
Social and Emotional Well-Being Domains
ESTABLISHING THE RIGHT EVIDENCE-BASED SERVICE ARRAY TO SUPPORT WELL BEING
Functional Assessment
Evidence-Based Trauma, Mental Health &
Parenting Interventions
Trauma Screening
Generic Counseling
Anger Management
Parenting Classes
RESEARCH- AND EVIDENCE BASED
APPROACHES
INEFFECTIVE APPROACHES
De-scaling what doesn’t
work
Investing in what does
De-scaling what doesn’t work, scaling up what does
USING MEDICAID TO INTEGRATING SAFETY, PERMANENCY AND WELL-BEING
• Early Periodic Screening Diagnosis and Treatment• State Plan Services, including preventive services,
described in section 1905(b) of SSA• Alternative Benefit Plans• Home and Community-Based Services• Health Home – central coordination for health services• Managed Care• Integrated Care Models• Section 1115 Research and Demonstration Programs
Multiple Medicaid vehicles allow for identification and treatment of complex trauma:
Well Being
Focus on child & family level
outcomes
Monitor progress for
improved child/youth functioning
Change Child Welfare
practice to address
impact of trauma
Take developmental
specific approach
Actively promote healthy
relationships
Build capacity to deliver Evidence
Based Practices
PRACTICES BEYOND SAFETY AND PERMANENCE TO IMPROVE OUTCOMES
“Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the
negative impacts of early fear learning.”
National Scientific Council on the Developing Child (2010)
Questions?