mcstart: history & overview monterey county screening team for assessment, referral, and...
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MCSTART: MCSTART: History & OverviewHistory & Overview
Monterey County Screening Team for Assessment, Referral, and
Treatment of Substance-Exposed Children
Chris Shannon, MCCDP, Ex. Dir.
Pre-Natal Exposure in Pre-Natal Exposure in Monterey CountyMonterey County
• 800 pregnancies exposed annually
• Combination exposure
• Meth & alcohol most prevalent
• Prevent/modify effects thru early intervention
Diagnostic Considerations Diagnostic Considerations for Substance-Exposed for Substance-Exposed Children Children
• Attention disorders• Anxiety and mood disorders• Developmental disorders• Language based disorders• Attachment disorders• Learning disabilities• Post traumatic stress disorder
Without early interventionWithout early intervention
Streissguth, et
al., 1996
It doesn’t take a village—It doesn’t take a village—but it takes a well-but it takes a well-coordinated team!coordinated team!
• Trans-disciplinary (parents/caregivers are most important members of the team)
• Targeted, flexible interventions, based on• Comprehensive assessment
MCSTART Early MCSTART Early Intervention:Intervention:the difference of a lifetime the difference of a lifetime . . .. . .• Inter-Disciplinary Clinic
• Located 130 Church St, Salinas• County-wide accessibility and
outreach• Pre-Natal Prevention and intervention• Assessment and early intervention of
developmental, social/emotional, and neurobehavioral disorders
• Policy Component
Public/Private Partnership Public/Private Partnership and Collaborationand Collaboration
• Door to Hope, lead agency• DSES, Family and Children’s Services• Monterey County Children’s Behavioral
Health• Monterey County Community Health• The Parent Center, Salinas Adult
School
MCSTARTMCSTART Multi-disciplinary Multi-disciplinary StaffStaff• Physician
• Child Psychiatrist• Physician’s
assistant• 3 Clinical Ph.D• PhD intern• 2 Psychiatric
Social Workers• 2 Occupational
Therapists
• Speech Therapist• PHNs• Parent Educators• 3 Case Managers• Mentor Coord.• 15 – 20 mentor
parents• Supervisory &
Support staff
Capacity DevelopmentCapacity Development
• 450 - 500 young children annually
• 30 – 50 high risk pregnant women
• 140 dependency court families
• 24 – 30 training events annually
• 800 participants annually
MCSTART FISCAL NEEDS & MCSTART FISCAL NEEDS & STRATEGIESSTRATEGIES
• $2 million annual budget• Difficulties w/ capital funding• Blended & braided funding streams
• First 5 (primary developmental source)
• SA/HIV, formerly OFR• TCM• Title IV E• EPSDT (primary long-term source)
History of DevelopmentHistory of Development
• 1994 & 1998 Dr. Chasnoff addressed DSES, families and community
• 1997 used OFR funds to develop SPARK parent training program for foster/adoptive parents of drug-exposed children
• 2000-01 explored options for reunified families
Development (cont.)Development (cont.)
• Feb. 2002 Dr. Ira Chasnoff and Sid Gardner, Children & Family’s Futures, chaired a Community Summit to address the needs of substance exposed children
• June 2002 team attended Clinical Institute at Children’s Research Triangle, Chicago
• August 2002 developed First 5 grant proposal for MCSTART
Development (cont.)Development (cont.)
• MOU’s developed: Door to Hope↔CBH↔CH↔SAS↔First 5
• Clinic opened 2003• Leadership Institute w/ Children’s
Research Triangle June 2003 w/ over 20 leaders from Board of Supervisors, Health Dept., DSES, MCOE, MD’s, SARC, foundations, & parent educators
Best & Evidence-Based Best & Evidence-Based PracticesPractices
• Chasnoff’s SART• Theraplay®• Circle of Security• Sensory Integration• Therapeutic Listening• FASCETS• How Does My Engine Run?• PCIT• Consultation from Child Trauma Center
MCSTART OUTCOMESMCSTART OUTCOMES
DemographicsDemographicsn= 570 children; 110 pregnant n= 570 children; 110 pregnant womenwomen
Ethnicity
• 61% Hispanic• 28% Caucasian• 9% African-Am• 2% Asian/Pacific Islander
Geographical LocationGeographical Location
• 49% Salinas• 35% Monterey Peninsula• 5% North County• 9% South County• 2% Watsonville
Family StructureFamily Structure
• 60% biological parent(s)
• 14% adoptive parents• 20% relative
caregivers• 15% foster parentsNote: Placements of
children change (79% of caseload involved w/ CPS)
Photo Digital Analysis Photo Digital Analysis for FASfor FASMCSTART ResultsMCSTART Results
• 55% absent any facial features
• 35% mild FAS• 8%
moderate FAS• 2% severe
FAS
ScreeningScreening
Instruments:• Ages & Stages Questionnaire
(ASQ)• ASQ:SE• Parental Stress Index (PSI)• Life Stages Progression (LSP)
ASQ/ASQ:SE ResultsASQ/ASQ:SE Results
• 62% below cut-off levels 1st year of operation
• 54% below cut-off levels 2nd year of operation
• Social Emotional & Communication delays most prevalent (38% & 19%)
• Personal Social (15%) & Problem Solving (13%)
• Gross & Fine Motor (13% & 10%)
OutcomeOutcomere-screen @ 6 months 0-3 yrs. & re-screen @ 6 months 0-3 yrs. & annually @ > 3 yrs.annually @ > 3 yrs.
• 100% improved Personal Social• 75% improved Gross Motor• 64% improved Social Emotional• 60% improved Fine Motor• 58% improved Problem Solving• 44% improved CommunicationChange in placement dramatically affects outcome
Parental Stress IndexParental Stress Index• 1/3 of bio moms
high • 1/5 relative high• 1/10 foster/adoptive
high• > 3 children in
home high• 94% of these
scores decreased after intervention
Life Stages Progression Life Stages Progression IndexIndex
• Nurturing Scale: 79% target enrollment, 93% after 12 months
• Discipline Scale: 80% target enrollment, 100% after 12 months
• Support of Development Scale: 68% target enrollment, 79% after 12 months
• Safety Scale: 85% target enrollment, 100% after 12 months
Occupational Therapy Occupational Therapy ServicesServices
• OT capacity maximized• Clinic & staff currently being expanded• Sensory Profile & Peabody
Developmental Scales• Improvements noted in motor skills,
self-soothing, self-regulation, problem solving, motor planning, sensory defensiveness, attention, behavior
ChallengesChallenges• Accessing services for moderately
delayed children• Engagement & retention of biological
substance-abusing mothers • Parenting skill-building• Capacity maximized• Intensive case management• Inter-team & inter-agency
communication