Fostering Healthy Futures Kempe Center for the Prevention and Treatment of Child Abuse and Neglect

Fostering Healthy Futures Program Design 1) Assessments of Children’s Functioning 2) Therapeutic Skills Groups 3) Mentoring

It Takes a Village Denver Department of Human Services Adams County Social Services Department Jefferson County Human Services Arapahoe County Department of Human Services Broomfield County Health and Human Services Colorado Department of Human Services Graduate schools: DU, Newman, CSU, UCD, Metro School districts and schools Mental health centers and therapists Multiple non-profit organizations Children and families David Olds Sara Culhane Ann Petrila Daniel Hettleman Volunteers Kempe Center Kempe Foundation Youth Mentoring Collaborative Department of Pediatrics, University of Colorado Developmental Psychobiology Research Group Sue

FHF Core Staff 2002-2013 Sara Culhane, Ph.D. Ann Petrila, LCSW Daniel Hettleman, Ph.D. Becky Gennerman-Schroeder, LPC Patrick Nickoletti, PhD Jill Gjerde, MA Michel Holien, LCSW Dana Morgan, LCSW Robyn Wertheimer, LCSW Jennifer Koch-Zapfel, MSW Tracy Rudhe Dongmei Pan, MA Liz Goetter, BA Julie Bemski, BA Tabitha Webster, BA Laura Mann, BA Melody Combs, Ph.D. Tali Raviv, PhD Chris Kelman, LCSW Leslie Fitzpatrick, LCSW Orah Fireman, LCSW, M.Ed Edward Garrido, Ph.D. Christie Petrenko, PhD. Leigh Clasby, BA Michael Knudtson, MA Wendy Gehring, BA John Holmberg, Psy.D. Tara Rhodes, MA Lindsey Weiler, Ph.D. Heather Taussig, Ph.D.

Research Assistants and Group Leaders FHF Graduate Student Research Assistants and Group Leaders Brendan Close Erika Joye Nicole Lariviere Amy Franke Mia Kim Jessi Wheatley Melani Dawson-Lear Melanie Rodriguez Riley Spuhler Walter Heidenreich David Roberts Alexis Karris Marisa Duran Patrick Nickoletti Dena Miller Thea Wessel Jennifer Sackett Amy Percosky Tisha Bean Emily Macdonald Jill Gjerde Rachel Lund Ann Chu Yael Chatav Tiffany Conway Tracy Rudhe Brian Wolff Jenn Winkelmann Pam Freeman Danielle Smith Amanda Brown Heather Frey Vyga Kaufmann Neta Bargai Julie Bemski Jenell Ribble Martine Lopez Alana Henken Kathryn Jargo Liz Hooks Tara Buckley Jordan Pock Andrea Reece Sara Rosenau Natalie Tolejko Kristen Simpson Shari Watters Michelle Brunner Lindsay Heath Kristin Nelson Kate Slivka Lindsay Smart Susan Whittle Elizabeth Goetter Julie Lyons Courtney Fiedler Edyta Biegunajtys Claire Heppner Clara Paynter Kelsey McNeill Jenell Ribble Dena Miller Martine Lopez Thea Wessel Alana Henken Julie Bemski Amy Percosky Andrea Temple Allison Glover Sarah Morehouse Jennifer DeVault Debra Boeldt Christine Kelley Denise Onofrey Jennell Ribble Alanna Gangemi Jenny Doft Jenea Jones Kristin Allen Maddie Philley Rachel Shulman Leigh Clasby Sarah Perzow Emily Rotbart Laurel Story Mayla Yang Tish Wer Claire Stephenson Allison Glover Melissa Toppel Jasmine Crane Christina Hack Olga Leonova Leah Chelist Katie Lange Melena Postolowski Kristen Mackiewicz Allison Bratsch Kristen Vescera Leah Scandurra Emily Laux Caroline Oppenheimer Tara Rhodes Leah Harrigan Cory Reid-Vanas Erica Ragan Jessica Schnittka Shelby Scott Maria Davidsmeier Shawna Henry-Lange Anne Eden Rachel Stonecipher Michelle Turner Liz Healy Lucia Lapaz Rachel Levine Aleja Parsons Meagan Rohde Laura Sullivan

*Over 80,000 hours of training provided to 130 interns FHF Graduate Student Interns 2006-2007 Lorendia Schmidt Phoung Phan Beth Lipschutz Jacquelyn Eisenberg Angela Bierle Lisa Harrison Nicole Henkins Erin Hoglund 2007-2008 Kerrie Earley Ashley Moore Justine Stewart Lauren Goldberg Marissa Nasca Amber Wolfe Jennifer Reynolds Krystal Caduff Miranda Learmonth Molly Jenkins Rebekah Koenigbauer Sarah Oakley Lauren Timkovich Sam Murillo Elizabeth Berling Kristin Krietemeyer 2008-2009 Rachel Alpert Katherine Belcher Taylor Collins Renata Heberton Alyse Keilson Blake Konner Emily Lyons Melissa Maurer Regan Linton Nina Modern Jennifer Pitcavage Meredith Schaffer Holly Selepouchin Heidi VanEpps Katherine Ware 2002-2003 Melani Dawson-Lear Kristine Wilson Brenna Ellington Lanette Ambers Carrie Oliver 2003-2004 Amy Bruner Liz Dinsdale Vashawn Banks Josh Goldman Marisa Duran Amber Cross Thomas Melanie Rodriguez Clover Bone 2004-2005 Tiffany Conway Katie Ferguson Katie Melstrom Lisa Meyers Kendra Sasa Carla Scarpone Lewis Smirl Kelsey Wennesland Regina Richards 2005-2006 Michelle Brunner Jocelyn Gray Jon Phillips Jennifer Stucka Christina Haskins Tina Francis Sarah Kane Mark Spehn Jennifer Nelsen 2010-2011 Mele Cabral Jon Florida Sibyl Graham Beth Hilligoss Tighe Kaysar Alexandria Lewis Sarah Romero Stacy Walsh Jessica Devore Jacquelyn Gabel Jeffrey Hatcher Ryan Holmes Emily Laux Megan Lovingier Sapphire Rosier Cami Wangaard 2011-2012 Jessica Barry Rachel Berns Maria Davidsmeier Diana Gonzalez Brandon Hester Nadine Leonard Julia McKinnon Amy Muetterties Heather Price Kristen Schmidt Rachel Stonecipher Ashley Wiggins 2012-2013 Jessica Henritze- Hoye Jenna Kelley Diane Kleinschnitz Linda Ladago Rachel Sacco Ani Sttele 2013-2014 Rachel Bennett Emily Bruce Stephanie Cichocki Emily Frank Senite Sahezghi Ashley Stewart Elizabeth Stitzel Nancy Vargas 2009-2010 Lissa Miller Jenna Brown Jane Simon Allison Harris Shane Spears Jolie Rinebarger Diane Bouhall Kelly Fries Erica Brown Shavon Perkins Jess Valsechi Katie Kaser Britta Johnson Renea Nilsson Laura Merten Kyle Steinke *Over 80,000 hours of training provided to 130 interns

Federally-Funded Research Risk Behaviors in Maltreated Adolescents National Institute of Mental Health Dissertation Award, 1 R03 MH56781-01, $25,000. Preventive Interventions for Foster Care Youth National Institute of Mental Health, 1 K01 MH01972, $590,166. Intervention Development and Pilot for Foster Care Youth National Institute of Mental Health, 1 R21 MH067618, $472,500. Fostering Healthy Futures Efficacy Trial for Preadolescent Youth in Foster Care National Institute of Mental Health, 1 R01 MH076919, $2,655,734. Research Supplement to Promote Diversity in Health Related Research National Institute of Mental Health, 3 R01 MH0876919-02S1, $283,706. Recovery Act Administrative Supplement Providing Summer Research Experience for Student and Science Educators National Institute of Mental Health, 3 R01 MH0876919-03S1, $18,670. Long-Term Impact of a Positive Youth Development Program on Dating Violence Outcomes During the Transition to Adulthood National Institute of Justice, 2013-VA-CX0002, $440,642.

State, University, and Hospital Funding Edward Byrne Memorial Justice Assistance Grants Colorado Division of Criminal Justice, U.S. Department of Justice Tony Grampsas Youth Services State of Colorado CAPTA Contract Colorado Department of Human Services The Children’s Hospital Research Institute Bridge Funding Colorado Clinical and Translational Sciences Institute Grants University of Colorado ` Academic Enrichment Fund

Kempe Foundation Funding for FHF 2002 Daniels Fund ($20,000) 2003 The Janus Foundation ($5,000) 2003 Bonfils Stanton Foundation ($10,000) 2003 PacifiCare ($10,000) 2003 U.S. Bank ($5,000) 2004 Daniels Fund ($50,000) 2004-present Pioneer Fund ($1,500,000 endowment for Fostering Healthy Futures) 2005 Bonfils Stanton Foundation ($20,000) 2005 Daniels Fund ($50,000) 2006 Gannett Foundation ($3,000) 2006 First Data/Western Union ($5,000) 2006 Donor Advised Fund, Denver Foundation ($30,000) 2006 Anschutz Family Foundation ($3,333) 2006 Colorado Rockies Charity Fund ($10,000) 2006 Denver Foundation ($15,000) 2006 Daniels Fund ($60,000) 2007 Anschutz Family Foundation ($4,167) 2008 TJX Foundation ($3,000) 2008 Rockies/McCormick Foundation ($20,000) 2008 El Pomar Youth in Community Service - Arvada West High School ($500) 2008 El Pomar Youth in Community Service - Northglenn High School ($1,500) 2008 McGowan Foundation ($15,000) 2008 Daniels Fund ($60,000) 2008 MaggieGeorge Foundation ($16,000)

Kempe Foundation Funding for FHF 2008 Xcel Energy Foundation ($5,000) 2009 Rockies/McCormick Foundation ($20,000) 2009 Larrk Foundation ($30,000) 2009 Verdoorn Foundation ($15,000) 2009 Whispering Fox ($5,000) 2009 Daniels Fund ($60,000) 2010 Rockies/McCormick Foundation ($10,000) 2010 Verdoorn Foundation ($11,000) 2010 El Pomar Award of Excellence ($7,500) 2010 Colorado Rapids ($4,000) 2010 IP 5280 ($28,506) 2010 Jay and Rose Phillips Family Foundation ($20,000) 2011 Daniels Fund ($60,000) 2011 Rockies/McCormick Foundation ($10,000) 2012 Rockies/McCormick Foundation ($5,000) 2102 Verdoorn Foundation ($10,000) 2012 Jay and Rose Phillips Family Foundation ($20,000) 2012 Lubert Family Foundation ($7,500) 2012 LARRK Foundation ($35,000) 2012 Daniels Fund ($60,000) 2012 Morgridge Family Foundation ($4,500) 2013 Daniels Fund ($60,000) 2013 Lubert Family Foundation ($5,000) 2013 Verdoorn Foundation ($20,000) 2013 Mile High United Way (30,000)

Inclusion Criteria All 9-11-year-old children in any type of out-of-home placement in participating counties, including those placed in foster homes, kinship care, group homes, and residential treatment centers Placed in court-ordered out-of-home care (over prior 12 months) as result of maltreatment, and were in out-of-home care at the onset of the intervention Cognitive functioning at a level able to comprehend group material Did not exclude youth with significant mental health or behavioral problems (including children with sexual perpetration histories) Youth continued to participate in the 9-month program even if they changed placements or reunified

FOSTERING HEALTHY FUTURES PREVENTIVE INTERVENTION SHORT-TERM OUTCOMES Cognitions Self-Esteem and Efficacy Attitudes and Appraisals Future Orientation Social Functioning Social Support Competence & Acceptance Peer Associations Behavioral Functioning Behavioral Regulation Coping Strategies Extracurricular Activities LONG-TERM AND LIFE-COURSE OUTCOMES Fewer Adverse Life-Course Outcomes Arrests and Incarceration Pregnancy and STDs School Failure and Dropout Emergency Mental Health Treatment Multiple and Restrictive Placements Associated Costs Better Distal Outcomes Mental Health Problem Behaviors Competencies Quality of Life

Fostering Healthy Futures (FHF) Program Design 1) Evaluations of Children’s Functioning 2) Therapeutic Skills Groups 3) Mentoring

Screening Evaluations We assess functioning in the following domains: Cognitive Academic achievement Mental health, including trauma symptoms Social Behavioral

Therapeutic Skills Groups 30 weeks; manualized program 8 children per group, equal females and males Mental health clinicians and graduate trainees facilitate 1 hour group and then dinner with mentors Improve skills, process feelings related to the foster care experience, and reduce stigma

Session Content Basic Social Skills Healthy Coping Change and Loss Feelings Perspective Taking Problem Solving Healthy Communication Healthy Coping Anger Management Positive Self-Talk Dealing with Worry Active Coping Strategies Change and Loss Mixed Emotions Abuse and Neglect Healthy Relationships Panel Night Adolescent Issues Anatomy and Puberty Dealing with Peer Pressure Resisting Drug/Alcohol Use Healthy Dating Relationships Program Ending Future Orientation Career Shadows Healthy Goodbyes GRADUATION!

Mentoring Graduate students spend 3-4 hours per week of individual time with each child they mentor They work on child’s lifebook, engage in extracurricular activities, help find other adult role models, shadow adults in professions of interest, work on homework, take them to libraries, recreational activities, etc. Focus on engaging them in their communities and teaching them advocacy skills Mentors interface with other adults in child’s life Role of mentor - create a web of support for children, improve social skills, and provide staunch advocacy

Lifebooks

Panel Night

Cultural Presentations

Cultural Engagement All project materials translated into Spanish Multicultural stories in group; materials visually and linguisitically sensitive Mentor training in multicultural issues, personal exploration of culture, community exploration project Children and mentors do cultural presentations Embrace and explore differences; engage in culturally-meaningful activities

Career Shadows

Mental Health Outcomes Lower Mental Health Composite Score Fewer Trauma Symptoms Fewer Symptoms of Dissociation Less Anxiety Less Current Mental Health Treatment Fewer Psychotropic Medications (trend) Greater Perceived Social Support Higher Quality of Life

Placement and Permanency Outcomes WHOLE SAMPLE 71% less likely to be placed in residential treatment Threefold increase in adoption for children with TPR (8% vs. 26%; non-significant) FOSTER CARE SAMPLE 44% fewer placement changes (findings strongest for those with high baseline behavior problems) 5 times more likely to have achieved permanency Twice as likely to have reunified with their biological parents

Key Features of FHF Homegrown Program High Rates of Program Engagement 590 youth involved 230 youth received the 9-month program New grant to follow 250 youth into young adulthood High Rates of Program Engagement 92% recruitment rate for voluntary program 92% retention rate Over 90% follow-up at each post-intervention timepoint Similar Level of Evidence with other Evidence-Based Programs (e.g. TF-CBT, PCIT) Reduces both mental health problems and negative permanency outcomes Received recognition

Colorado Practice Model Best Practice Compendium! In the Colorado Practice Model Best Practice Compendium!

Colorado’s Title IV-E Waiver Application Innovative practice Advancing knowledge Trauma-informed child assessments Consistent with Colorado Practice Model Integration of behavioral health and child welfare Addresses mental health needs of children in foster care Piloting teen program Increases permanency Reduces use of congregate care Reduces psychotropic medication use Increases positive outcomes for children Culturally-sensitive, de-stigmatizing and acceptable

Dissemination Phase Widespread Inquiries Implementation Plan Replication Adaptation Implementation Plan Community-Based Agencies Implement Rural Adaptation CAPTA Funding to Provide Training Challenges to Implementation Funding Prevention Program; No diagnoses CORE funding when cases close Grants end Opportunities with Waiver or PA3?

First-Year Implementation Aurora Mental Health Center 2 groups; 16 children Adams, Denver, Arapahoe and Douglas Counties Using Core Service Dollars $5,600 for 9 month program (for 5 hours of programming/week) First-Quarter Progress Developed training materials and training schedule All 16 children continuing participation, despite placement changes Anonymous program evaluations with children: FHF is helpful for learning how to deal with feelings (87% - “A Lot”) I like how we get a chance to know other kids who are in out-of-home care (93% - “A Lot”) I am glad I chose to do FHF this year (93% - “A Lot”) Phone calls with caregivers: Reflect high satisfaction with program Report behavioral and academic changes