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16th National Conference on Child Abuse and NeglectApril 19, 2007
Child Protection and Systems of Care: Assessing Barriers and Opportunities for Collaboration Between Systems
Ilene BersonLouis de la Parte Florida Mental Health Institute, University of South Florida
Frank RiderTA Partnership for Children’s Mental Health
John Fluke
Walter R. McDonald & Associates, Inc.
David Sanders
Casey Family Programs
16th National Conference on Child Abuse and NeglectApril 19, 2007
Overview of Roundtable Issues
John Fluke
Vice President Research
Walter R. McDonald & Associates, Inc.
April 19 16th National Conference on Child Abuse and Neglect
Key Issues
Enumerating Needs
Barriers to Implementation
Opportunities
April 19 16th National Conference on Child Abuse and Neglect
Rationale for the Roundtable
Assumption Children’s mental health services for child welfare
populations are not adequate to meet needs.
Questions Are both children’s mental health and child
welfare serving the same kids? What are the leverage points to improve services? Are there models for addressing leverage points?
April 19 16th National Conference on Child Abuse and Neglect
Populations of Focus
Child Protection and Child Welfare – Neglected and Abused Children (NCANDS CM 2005)
3.6 million investigated 899 thousand victimizations
Key Demographic for Victims Average Child Age: 7 African American (25%) Hispanic (17%) White (54%)
Services Investigations/Assessments (100%) Post-investigation Services (35%) Placement (7.5%)
April 19 16th National Conference on Child Abuse and Neglect
Populations of Focus
Child Protection and Child Welfare (cont.) – Children Served in Foster Care and Adoption
(AFCARS 2005) 799 thousand children served
Key Demographic for Children Placed (entries) Average Child Age : 8.2 African American (26%) Hispanic (18%) White (47%)
April 19 16th National Conference on Child Abuse and Neglect
Figure 3-3 Victimization Rates by Maltreatment Type, 2000-2005
Victimization Rates per Thousand by Maltreatment Type, 2000-2005
2.4
7.3
0.5
1.21.0
2.8
2.3
7.1
0.3
1.20.9
3.2
2.3
7.2
0.3
1.20.8
3.3
2.3
7.5
0.3
1.20.8
3.0
2.1
7.4
0.3
1.20.9
3.2
2.0
7.6
0.3
1.10.9
3.1
0
1
2
3
4
5
6
7
8
Physical Abuse Neglect Medical Neglect Sexual Abuse PsychologicalMaltreatment
Other Abuse
Year
Rate
per
1,0
00 C
hild
ren
2000 2001 2002 2003 2004 2005
April 19 16th National Conference on Child Abuse and Neglect
Profiles of CPS Neglect Populations Victims Based on 35 States Average Age: 6.7 (n = 429,757) Median Age: 6 Male: 50.5% Race/Ethnicity (n= 431,180)
African American: 21.5% Asian/Pacific Islander: 1.0% Hispanic: 18.4% Native American: 1.4% White: 49.9%
April 19 16th National Conference on Child Abuse and Neglect
Populations of Focus
Systems of Care – National Evaluation Report to Congress 2002 - 2003 Children with Serious Emotional Disturbance Key Demographic Average Child Age:
Average Child Age 12.3 African American (26.4%) Hispanic (11.3%) White (57%)
Services - National Evaluation Report to Congress 2001 5.8 different services in the first 6 months 10% hospitalized
April 19 16th National Conference on Child Abuse and Neglect
Characteristics of Children Under 6: System of Care Grantees Funded 2002 - 2004 Data for 912 Children under 6
522: Child Welfare Involved 390: No Identifiable Involvement in Child Welfare
Both Populations 69% At or Below Poverty Biological Family Member Substance Abuse (n=
210) 76%: Child Welfare Involved 58%: No Identifiable Involvement in Child Welfare
Number of Family Risk Factors (n = 215) 2.1: Child Welfare Involved 1.7: No Identifiable Involvement in Child Welfare
April 19 16th National Conference on Child Abuse and Neglect
Children Under 6 Enrolled in Systems of Care: Phase IV Grantees
April 19 16th National Conference on Child Abuse and Neglect
Some Barriers* Children’s Mental Health Service Availability
Challenges to Collaboration
Family Involvement and Participation
Service Array
Funding (particularly Medicaid)
*Highlights From McCarthy, J., Marshall, A., Irvine, M., and Jay, B., (2004), An Analysis of Mental Health Issues in States’ Child and Family Service Reviews and Program Improvement Plans: Wash, DC: Georgetown
April 19 16th National Conference on Child Abuse and Neglect
Some Barriers (cont.)* Among children in child welfare (NSCAW - in-home and placed)
42% of children with significant mental health needs (CBCL) Much more use of mental health services for children placed
compared to in-home Limited use of specialty mental health services “Controlling for level of clinical need, younger children were
much less likely to receive specialty mental health services than older children.”
African American and Hispanic children are less likely get mental health services
Service provider availability doesn’t improve service availability to child welfare populations
*Hurlburt, M., Leslie, L., Landsverk, J., Barth,R., Burns, B., Gibbons, R., Slymen, D., Zhang, J. (2004). Contextual Predictors of Mental Health Service Use Among Children Open to Child Welfare. Arch Gen Psychiatry. 61:1217-1224.
April 19 16th National Conference on Child Abuse and Neglect
Some Barriers (cont.)
CPS and Child Welfare Population of Focus is Young Children Coercive Interventions Emphasis on Child Safety
Systems of Care Emphasis on SED Diagnostic Criteria Focus on Older Children
April 19 16th National Conference on Child Abuse and Neglect
Some Opportunities CPS and Child Welfare
Family Group Decision Making Processes Alternative Response Systems Comprehensive Community Service Orientation IVe Waivers Linkages between child welfare and mental health
agencies improved likelihood of services*
Systems of Care Underlying Philosophy of Services Increased Emphasis on Young Children Implementation of Flexible Diagnosis (DC: 0 to 3R) and
Medicaid Funding Emphasis on Community Collaboration Emphasis on Family Driven Services
*Hurlburt, M., et. al. (2004).
April 19 16th National Conference on Child Abuse and Neglect
Some Opportunities
CPS and Child Welfare Family Group Decision Making Processes Alternative Response Systems Comprehensive Community Service Orientation IVe Waivers
Systems of Care Increased Emphasis on Young Children Implementation of Flexible Diagnosis (DC: 0 to 3R)
and Medicaid Funding Emphasis on Community Collaboration Emphasis on Family Driven Services
16th National Conference on Child Abuse and NeglectApril 19, 2007
A Statewide Integration Effort – the Case of Arizona
Frank Rider
TA Partnership for Children’s Mental Health
April 19 16th National Conference on Child Abuse and Neglect
Arizona Behavioral Health (BH) and Child Welfare (CW) Systems Were
Misaligned Different expectations Different mandates and external requirements Different funding streams and approaches Different pace of work with family No common outcomes
April 19 16th National Conference on Child Abuse and Neglect
Terrible outcomes for children: Behavioral health needs going unmet Limited permanency Poor academic achievement by children Extremely high juvenile delinquency among
foster children Family instability damaging children Poor outcomes evident among former foster
children
Consequences of Misalignment of BH and CW Systems
April 19 16th National Conference on Child Abuse and Neglect
Huge Costs to Families: “Mending the Damage”
Trust (“abandonment”) Triggering traumatic memories Guilt Etc.
Consequences of Misalignment of BH and CW Systems
April 19 16th National Conference on Child Abuse and Neglect
Enormous Costs to Both Systems: Inadequately prepared, poorly supported clinical staff Insufficient effort to heal families, which might prevent or
shorten removals of children to foster care Lack of appropriate front loaded behavioral health services
exacerbates family separations Resentment, lack of understanding & mistrust between
systems’ personnel Lack of “shared care” evident Trauma-induced, situational and substance-abuse related BH
needs challenge both systems Overworked personnel discouraged by poor results equates to
high turnover and low morale
Consequences of Misalignment of BH and CW Systems
April 19 16th National Conference on Child Abuse and Neglect
Example: CW Focus on Safety Applied at Odds with Permanancy and Well-Being
Arizona: 100 CPS youth placed in out-of-state RTCs (2002)
BH System: Interventions and Supports not Timely; No “Ownership” of Child Welfare Mandates
CW: No evidentiary basis supported effectiveness of residential treatment.
Conclusive evidentiary base supports effectiveness of: Wraparound/Child and Family Teams Therapeutic Foster Care
Bob Friedman, USF (Katie A. Declarations, 10/05)
April 19 16th National Conference on Child Abuse and Neglect
What Is Effective?
Therapeutic Foster Care (TFC)
Intensive outpatient programs
Maintaining strong ties to the community
Interventions that target change in peer associations
Case managers with smaller caseloads using a “wraparound” model of care
From: U.S. Surgeon General’s Report (1999)
April 19 16th National Conference on Child Abuse and Neglect
Build A Collaborative Foundation among Child-Serving Systems
Arizona’s Journey: JK Litigation, Discovery (1993-2000) Governor’s Task Force on Behavioral Health Services for
Child Welfare (2000) JK Settlement Agreement (ADHS and AHCCCS, 2001) State-Level Memorandum of Understanding (April 2002). Gov. Janet Napolitano Executive Order (January 2003):
Established a Children’s Cabinet Ordered CPS Reform Federal Revenue Maximization task order
Building Practice, Capacity, Embedding, CQI (2003 to ?)
April 19 16th National Conference on Child Abuse and Neglect
Building A Common, Collaborative Vision
“In collaboration with the child and family and others, Arizona will provide accessible behavioral health services designed to aid children to:
achieve success in school live with their families avoid delinquency become stable and productive adults.
Services will be tailored to the child and family and provided in the most appropriate setting, in a timely fashion, and in accordance with best practices, while respecting the child’s and family’s cultural heritage.”
J.K. vs. Eden et al. No. CIV 91-261 TUC JMR, Paragraph 18
April 19 16th National Conference on Child Abuse and Neglect
“Construction Materials” for Integration in Arizona
Common Vision: Outcomes, Values, Language Structural Components:
Funding Covered BH Services Array
Common Processes: An integrated/unified planning process – AZ Child and
Family Teams Assessment – e.g. Urgent BH Response, 0-5 y.o./CAPTA Protocols – e.g. Unique BH Needs of Children and Families
Involved with CPS Targetted Programming
April 19 16th National Conference on Child Abuse and Neglect
Example: Arizona’s Urgent BH Response Process
“Urgent responses must be initiated upon notification by DES/CPS that a child has been, or will be, removed from their home.”
ADHS Policy 3.2: Appointment Standards and Timeliness of Services[Effective August 15, 2003]
1. Identify immediate safety needs and presenting problems
2. Provide direct therapeutic support to each child3. Provide direct support to each child’s new caregiver4. Initiate development of a Child and Family Team5. Provide CPS caseworker and Court with findings and
recommendations to inform the caseplan
April 19 16th National Conference on Child Abuse and Neglect
From August 15, 2003 to February 28, 2007, more than 12,000 Arizona children received an urgent behavioral health response beginning within 24 hours of removal by CPS for placement in protective foster care.
582
256
678
301
697
432
595
442
552
382
0
100
200
300
400
500
600
700
Aug 2004~39% Feb 2005~44% Aug 2005~62% Feb 2006~74% 8/1/2006~75%
Children removed
Urgent BH responses
April 19 16th National Conference on Child Abuse and Neglect
Child and Family Team Process
Services planning is family-centered, strength-based, individually tailored, culturally informed, and collaborative across systems
Families report feeling hopeful, more willing to positively engage their own strengths as respected member of team
Service plans identify and promote reliance on informal and natural supports in combination with formal services
April 19 16th National Conference on Child Abuse and Neglect
“Wraparound” Works
“Building on family strengths is essential if we are to prevent and control juvenile delinquency behavior. The process that embraces this concept is more formally known as Wraparound. This process can help prevent families from becoming abuse, neglect and delinquency statistics. It works well as an intervention model even for the most severe cases of abuse, neglect or delinquency.”
Hon. David C. Bonfiglio, Superior Court Judge, 6/01 Testimony before Indiana Legislature
April 19 16th National Conference on Child Abuse and Neglect
Comparing Outcomes for Arizona Children with and without Child and Family Teams (Ages 5-11)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
CFT
No CFT
CFT 74.6% 69.2% 77.9% 62.9% 77.9% 88.8%
No CFT 59.5% 55.5% 65.1% 52.3% 65.1% 83.3%
Increased Stability
Increased Safety
Avoids Deliquency
Prep for Adulthood
Success in School
Lives with Family
April 19 16th National Conference on Child Abuse and Neglect
Comparing Outcomes for Arizona Youth with and without Child and Family Teams (Ages 12-17)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
CFT
No CFT
CFT 71.1% 67.3% 70.9% 58.7% 65.1% 75.8%
No CFT 51.3% 51.3% 55.4% 43.4% 49.6% 68.8%
Increased Stability
Increased Safety
Avoids Deliquency
Prep for Adulthood
Success in School
Lives with Family
April 19 16th National Conference on Child Abuse and Neglect
Coming Home to Arizona:Successful Outcomes
100
38
15 1325
0
20
40
60
80
100
120
Jun-02 Jun-03 Jun-04 Jun-05 Jun-06
Jun-02Jun-03Jun-04Jun-05Jun-06
April 19 16th National Conference on Child Abuse and Neglect
Implications for Child Welfare, Legal Processes
Use Child and Family Teams to develop and present to the Court “options” leading to a single, unified plan across multiple agencies, intended to respect the mandates of each involved system.
Creative, individualized plans will be based on “discovered” strengths and needs of each child and family, reflecting not only the input of professionals, but of the families and youth themselves.
Advocate that the Court offer flexibility for a child and family team to develop a timely plan to meet defined requirements for safety and well-being. Use this as an alternative to ordering specific placements and treatments for children.
16th National Conference on Child Abuse and NeglectApril 19, 2007
Ilene R. Berson, Ph.D.Associate ProfessorLouis de la Parte Florida Mental Health InstituteUniversity of South Florida
Sarasota Early Childhood Mental Health Partnership
April 19 16th National Conference on Child Abuse and Neglect
Brief History of Early Childhood Mental Health in Florida
September, 2000 Florida’s Strategic Plan for Infant Mental Health finalized and published [http://www.cpeip.fsu.edu/faimh/IMHPlan.pdf]. This document laid the groundwork for services, training, research and policy changes.
Task force worked on policy changes specific to Community Mental Health services for children ages birth through five and their families.
May, 2002 Policy approved and published by AHCA (Agency for Health Care Administration)-Florida’s Medicaid agency
April 19 16th National Conference on Child Abuse and Neglect
Development of the Crosswalk Impetus –Change in Medicaid Community Mental
Health Policy to specifically address children ages birth through five and their families with mental health problems.
Context –Policy recommended use of DC: 0-3 for assessment/diagnostic purposes, but still required use of ICD-9-CM for reimbursement
April 19 16th National Conference on Child Abuse and Neglect
Comprehensive Systems Approach to Early Childhood MH Services
State-level Coordination, Collaboration, Planning, Funding and Advocacy
Local-level Coordination, Collaboration, Planning, Funding and Advocacy
Universal/Preventive Services
Focused Services for At-Risk Children & Families
Tertiary Intervention ServicesEducation
Intervention
Referral
Risk-specific Assessment
Health & Developmental Screening & Assessment
Parenting Education
Referral
Provision of Care
Case Management
Diagnostic Assessment
Treatment for Parent & Child
Direct Infant Mental Health ServicesConsultation
& Referral
Promotion
Promotion
Promotion
Zeanah, Stafford & Nagle, 2005
April 19 16th National Conference on Child Abuse and Neglect
Why focus on early childhood? Early environments matter, and nurturing
relationships are critical Patterns of attachment between a young child and
caregiver are the most robust predictors of subsequent development
April 19 16th National Conference on Child Abuse and Neglect
But do babies really need psychologists?
April 19 16th National Conference on Child Abuse and Neglect
Estimated Prevalence
No national epidemiological data In studies of health care visits, rates of psychosocial
problems=10-21%; externalizing problems=7-17% In Head Start, externalizing problems=10-23% 10-15% typical preschoolers have chronic
mild/moderate behavior problems No data for children under age of 2
Center for Evidence-Based Practice: Young Children with Challenging Behavior
April 19 16th National Conference on Child Abuse and Neglect
Prior Findings Based on Young Children’s Behavioral Health Services in the State of Florida (Berson et al., 2002, 2003, 2004) Speech and language impairments are the most
prevalent diagnosis across all age groups. Identification of emotional and behavioral
disorders increases in frequency during the preschool years.
Data emphasize the complexity of differential diagnosis and the dilemma of determining the severity of behaviors among young children.
April 19 16th National Conference on Child Abuse and Neglect
Age at Which Behavioral Health Services Peak for Young Children
29.3%
44.7%
26.1%
45.3%
30.7%
24.0%
0%
10%
20%
30%
40%
50%
Birth to 1 Year 1 Year to 2 Years 2 Years to 3 Years
Age
Per
cen
t o
f C
hild
ren
Ser
ved
2000
2001
April 19 16th National Conference on Child Abuse and Neglect
Age by Gender
53.5%
60.2%
67.2%
46.5%
39.8%
32.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
0 Years Old 1 Year Old 2 Years OldAge
Per
cen
t
MaleFemale
April 19 16th National Conference on Child Abuse and Neglect
Young Children at Imminent Risk(Berson, 2006)
Very young children are the largest subgroup among confirmed cases of physical abuse and medical neglect. One-third of infants discharged from foster care re-enter the
child welfare system. Over four-fifths (81%) of victims of fatal child maltreatment in
the U.S. are less than four years of age, with 45% of all victims being under one year of age.
Compared to older children in foster care, young children face far greater risks to their healthy development and future adult well-being. Nearly 80% of young children in foster care are prenatally
exposed to substance abuse. Nearly 40% are born low birthweight and/or premature. More than half have developmental delays or disabilities.
Many young children in foster care experience multiple placements that can inhibit their capacity to form emotional attachments.
April 19 16th National Conference on Child Abuse and Neglect
Consequences of Aggression: Preschool Expulsion
Gilliam (2005): Pre-K students expelled at a rate 3x higher than K-12 peers (6.67 v. 2.09)
0
5
10
15
20
25
30
Expulsion
PrivateStateK-12
April 19 16th National Conference on Child Abuse and Neglect
The Sarasota Early Childhood System of Care: Demographics Population ages 0-9 in Sarasota County
30.1% of the population ages 0-5 years are below poverty in Sarasota County.
3,463 children live in high-poverty neighborhoods (where 20% or more of the population is below poverty).
35% of infants and children under age 9 in Sarasota County qualify for free/reduced lunch.
11% of infants and children under age 9 in Sarasota County live in homes in which the primary language is other than English.
Non-Hispanic Hispanic Total White 23,121 3,220 26,341 Black 2,626 142 2,768 Other 62 753 815
April 19 16th National Conference on Child Abuse and Neglect
Child Welfare Involvement of Young Children Number of Reports of Abuse or Neglect of Children
Ages 0-9 years: 1,960 Children ages 0-8 years placed in out of home care:
4,006 Receiving in-home services: 106 Receiving out-of-home services: 335 Source: Florida Department of Children and Families, Reports During FY 2004-2005
Sarasota is the 2nd highest city in the Suncoast Region for babies born substance exposed.
April 19 16th National Conference on Child Abuse and Neglect
Prevalence Rates for Behavioral Health Disorders Among Young Children For children under age 9 in Sarasota County:
1,886 children are identified as Severely Emotional Disturbed (SED)
2,514 children are identified with mild to moderate ED
4,400 with a diagnosable psychiatric disorder
April 19 16th National Conference on Child Abuse and Neglect
Preschool Expulsion in Sarasota County Early Learning and Care Centers in Sarasota County were surveyed regarding expulsion or exclusion of children in the past 12 months due to a child’s behavioral problems. 39 respondents 48 children were terminated. In 87% of these cases the center
requested assistance with the child prior to recommending removal from the program. In most of the cases where assistance was not requested, it was due to the fact that the children were already receiving care.
Out of these early learning and care centers, 108 children with challenging behaviors were able to continue in the programs because support and/or assistance were received.
April 19 16th National Conference on Child Abuse and Neglect
child
community investment
Sarasota Early Childhood Mental Health Partnership
MISSIONTo strengthen Sarasota’s system of care that supports early childhood mental health & well-being
VISIONAll young children & their families are healthy, happy & thriving in Sarasota County communities
…so what do we mean by early childhood mental health?
• Experiencing & expressing emotions• Forming close, secure relationships• Exploring the environment & learning
• With primary caregivers • In a family• In a cultural context• In a community
emotions learning
relationships
chil
d
family
culture
caregiver
April 19 16th National Conference on Child Abuse and Neglect
child
linkage / connection
service expansion / enhancement
training / education
feedback / evaluation
Sarasota Early Childhood Mental Health Partnership
Embracing family voices, cultures, strengths & choices
Championing care & safety for all children
Prioritizing the role of caregivers
Valuing relationships & a sense of belonging
Promoting awareness & acceptance of mental health
System of Care Values:Child centered and family focused, with the needs of the child and family dictating the
types and mix of services provided.Community based, with the locus of services as well as management and decision
making responsibility resting at the community level.Culturally Competent, with agencies, programs, and services that are responsive to the
cultural, racial and ethnic differences of the populations they serve.
April 19 16th National Conference on Child Abuse and Neglect
Challenges Professionalization of Staff
Limited pool of professionals trained in early childhood behavioral health
Increasing Awareness Lack of awareness as to what services for young
children are available within local communities Challenge of changing people’s opinion that one
can simply apply a model that works for older children to this younger age group
Misperception that children should not be treated for a specific disorder until they reach the age of five
April 19 16th National Conference on Child Abuse and Neglect
Challenges Challenge of distinguishing mental health issues
from other developmental areas (i.e. speech and language, motor, cognitive) in young children Limited capacity of providers with developmentally
specific training Stigma associated with early childhood mental
health and the taboo against diagnosing behavior problems in an early childhood population
Shifting the focus of interventions to the relationship between the child and his/her caregiver(s)
Transformation to a public health approach that seeks to promote, safeguard, and restore mental health for young children and their families.
April 19 16th National Conference on Child Abuse and Neglect
Ilene R. Berson, Ph.D.Associate ProfessorDirector, Consortium for Child Welfare StudiesDepartment of Child and Family StudiesLouis de la Parte Florida Mental Health InstituteUniversity of South Florida13301 Bruce B. Downs Blvd., MHC2402Tampa, Florida [email protected]
16th National Conference on Child Abuse and NeglectApril 19, 2007
The Mental Health Needs of America’s Most Vulnerable Children
Dr. David Sanders, Executive Vice President, System ImprovementCasey Family Programs
April 19 16th National Conference on Child Abuse and Neglect
Casey’s 2020 Strategy
Safely reduce the number of children in foster care in America by half – by the year 2020.
Enhance the long-term well-being of children in care by improving outcomes in three areas:
Education Employment Mental Health
April 19 16th National Conference on Child Abuse and Neglect
2020 Goals, Initiatives, Strategies and Solutions
reduct
ion em
ployment
educa
tion
mental health
prevention at entry
per
man
ency
sa
fety
pre
par
atio
n
get job, keep & advance career
post secondary
assessment & intervention
earlychildhood
2020
rein
vest
men
t
highschool
April 19 16th National Conference on Child Abuse and Neglect
A Two-County Snapshot Hennepin County, MN
Los Angeles County, CA
April 19 16th National Conference on Child Abuse and Neglect
Federal CFSR Findings
Requirement of a mental health screening or assessment: 10 states (26%) – Yes; 26 states (68%) -- No
Do foster children receive initial formal mental health screenings/assessments?
The vast majority of states report that screenings and assessments are, at best, done inconsistently (32 states – 84%).
11 states -- even when mental health needs were assessed, needed services were not provided, were ended prematurely, or no follow-up monitoring was provided.
Are services provided to meet the mental health needs of children: 38 states (100%) – Inconsistent practice.
Is there a scarcity or lack of mental health services to meet system needs? 37 states (97%) – Yes.
April 19 16th National Conference on Child Abuse and Neglect
Federal CFSR Recommended Solutions Assessment and Services (improving assessment of child and family
mental health needs and building/expanding the array and accessibility of mental health services).
Training (child welfare, mental health clinicians and foster parents).
Collaboration (cross-system strategies to address problems, rather than having the child welfare system attempt solutions on its own).
Comprehensive strategies (taking a comprehensive approach – three or more statewide strategies or actions -- to strengthening mental health services for children and families in the child welfare system.
April 19 16th National Conference on Child Abuse and Neglect
Casey Research
Northwest Alumni Study Mental Health Findings: Compared to the general population, a disproportionate number of alumni had
mental health disorders. Within the 12 months prior to being interviewed, their diagnoses included:
One or more disorders: 54.4% Post-traumatic stress disorder (PTSD): 25.2% (a rate nearly double that
of U.S. war veterans) Major depression: 20.1% Social phobia: 17.1%
Recommendations: Federal and state governments should eliminate barriers to valid assessment
of mental health conditions and evidence-based mental health treatment. Barriers include:
Restrictive eligibility requirements for funding and inadequate worker capacity for identifying and treating mental health problems.
Maintain placement stability.
April 19 16th National Conference on Child Abuse and Neglect
Casey Research Mental Health Care for Children and Adolescents in Foster Care: Review
of Research Literature
Recommendations: Increase access to care Move beyond the usual institutional and outpatient care Increase the use of evidence-Based interventions in child welfare Use evidence to improve practice and policies in child welfare