1. Federal Efforts to Address the ACE Epidemic: Two Examples from Child Welfare Clare Anderson, Deputy Director Administration on Children, Youth, and Families

2. Adverse Childhood Experiences December 11, 2011Clare Anderson 2

3. Brain Development Patterns BRAIN Hormones, chemicals, and cellular systems prepare for a tough life in an evil world INDIVIDUAL > Edgy > Hot temper > Hyper vigilant > “Brawn over brains” OUTCOME Individual and species survive the worst conditions BRAIN Hormones, chemicals, and cellular systems prepare for life in a benevolent world INDIVIDUAL > Laid back > Relationship- oriented > Think things through > “Process over power” OUTCOME Individual and species live peacefully in good times; vulnerable in poor conditions Traumatic Stress Adapted from: Family Policy Council. (2007). The High Cost of Adverse Childhood Experiences (PPT). Olympia, WA: Author. December 11, 2012 3 Clare Anderson Effective screening and assessment help identify children who have trauma symptoms; evidence- based interventions and strategies help restore developmentally appropriate functioning. NEUTRAL START

4. The Overlap of Trauma and Mental Health Symptoms December 11, 2011Clare Anderson 4 (Griffin, McClelland, Holzberg, Stolbach, Maj, & Kisiel, 2012)

5. Children’s Well-Being Has Multiple Domains That Are Impacted by Trauma Adapted from Impact Youth Services, 2011; http://impactyouthservices.com/goals.htm http://impactyouthservices.com/goals.htm ACYF-CB-IM-12-04: http://www.acf.hhs.gov/programs/cb/laws_p olicies/policy/im/2012/im1204.pdf http://www.acf.hhs.gov/programs/cb/laws_p olicies/policy/im/2012/im1204.pdf December 11, 2011 5 Clare Anderson

6. Aligning Discretionary Funding to Address Trauma $28 million in FY 2012 43 grantees Promoting social and emotional well- being by increasing access to screening, assessment, and treatment of trauma Significant investments in building capacity of State and local systems to deliver evidence-based interventions to children who are in or at risk of entering child welfare. Leveraging existing policies, such as EPSDT Partnerships to Demonstrate the Effectiveness of Supportive Housing for Families in the Child Welfare System Initiative to Improve Access to Needs- Driven, Evidence-Based/Evidence- Informed Mental and Behavioral Health Services in Child Welfare Comprehensive Support Services for Families Affected by Substance Abuse or HIV/AIDS Regional Partnership Grants to Increase the Well-Being of and to Improve Permanency Outcomes for Children Affected by Substance Abuse December 11, 2012 6 Clare Anderson

7. New Title IV-E Child Welfare Demonstration Projects On September 30, HHS approved nine new child welfare demonstration projects for FY 2012 Prioritized social/emotional well-being and addressing trauma Each demonstration project has identified at least one well-being outcome to target for improvement Collaborations with Medicaid and behavioral health authority were prioritized; six of the nine demonstration projects have collaborations in place or will pursue them Accepting applications now for FY13 demonstration projects – Information Memorandum: https://www.acf.hhs.gov/sites/default/files/cb/im1205.pdf https://www.acf.hhs.gov/sites/default/files/cb/im1205.pdf 7 Arkansas Colorado Illinois Massachusetts Michigan Pennsylvania Utah Washington Wisconsin Proposals are posted online: https://www.acf.hhs.gov/pr ograms/cb/programs/child- welfare-waivers https://www.acf.hhs.gov/pr ograms/cb/programs/child- welfare-waivers Arkansas Colorado Illinois Massachusetts Michigan Pennsylvania Utah Washington Wisconsin Proposals are posted online: https://www.acf.hhs.gov/pr ograms/cb/programs/child- welfare-waivers https://www.acf.hhs.gov/pr ograms/cb/programs/child- welfare-waivers November 15, 2012NRCOI Webinar - Clare Anderson

8. SUPPORTIVE HOUSING & CHILD WELFARE December 11, 2011 8 Clare Anderson

9. Supportive Housing and Child Welfare Public-private partnership to test a collaborative model of intensive service delivery for high-need families $35 million over 5 years; 5 grantees Funded projects must secure affordable housing for at least 50 families as the platform for which the services will be provided for the target population December 11, 2011 9 Clare Anderson

10. Target Population for the Supportive Housing-Child Welfare Demonstration “Characteristics of appropriate target populations under this FOA include, but are not limited to: Reports to child protective services related to abuse and neglect Exposure to prior traumas, including child abuse and domestic violence Lack of financial resources and receiving or eligibility for public assistance Children who exhibit severe emotional and/or behavioral problems Repeated episodes of homelessness over time and/or long stays in shelters Parents with serious and chronic substance abuse, mental health, or physical health problems. …This points to the need for the collaboration between project partners to focus on identifying those families who are most in need and who would derive the most tangible benefit from receiving assistance provided by this pilot project (i.e., those families that present with multiple characteristics).” November 28, 2012 10 SH-CW Grantees Kickoff HHS-2012-ACF-ACYF-CA-0538: Funding Opportunity Announcement: Partnerships to Demonstrate the Effectiveness of Supportive Housing for Families in the Child Welfare System. U.S. Department of Health and Human Services

11. Program Components: Interdisciplinary Teams for Case Management Establish trusting relationship with families to promote child well- being and family stability while improving capacity of caregivers to provide safe and permanent home for children Work with family to develop integrated case plan including housing needs and other services needed Ensure housing retention and improve housing stability as platform for ongoing engagement and family stability Build a network of support among tenants that focuses on trust, well-being, and social/community integration Advocate on behalf of parents and children to ensure that they understand requirements of social services in which they are engaged. December 11, 2011 11 Clare Anderson

12. Program Components: Services for Parents and Children that Address Family Functioning Parenting skills training to provide evidence-based strategies to promote parenting abilities (e.g., NPP, PAT, Triple P) and access to programs that address relational problems (e.g., PCIT, BSFT, CPP, FFT) Services and interventions to improve family functioning and assist with reunification of families (e.g., MSFT) Ancillary services for families to provide assistance in securing needed services such as safe and drug-free housing, transportation, and child care December 11, 2011 12 Clare Anderson

13. Program Components: Services and Activities for Children and Youth that Address Child Well-Being and Trauma Screening and assessment of child well-being across domains Evidence-based, developmentally appropriate approaches to promoting child well-being, tailored to the specific needs of each child Access to appropriate mental health services for children involved in the child welfare system, including services to address experiences of trauma December 11, 2011 13 Clare Anderson

14. Child and Family Well-Being Interdisciplinary case management teams Services to address family functioning Services to address child well-being and trauma Program Components Collectively Promote Well-Being December 11, 2011 14 Clare Anderson In Supportive Housing Context

15. TITLE IV-E CHILD WELFARE DEMONSTRATION PROJECTS December 11, 2011 15 Clare Anderson

16. HHS may waive title IV-E requirements for States with approved projects, allowing them to use funds flexibly and reinvest savings. December 11, 2011Clare Anderson 16

17. Goals for Demonstration Projects Increase permanency for all infants, children, and youth by reducing the time in foster placements when possible and promoting a successful transition to adulthood for older youth. Increase positive outcomes for infants, children, youth, and families in their homes and communities, including tribal communities, and improve the safety and well-being of infants, children, and youth. Prevent child abuse and neglect and the re-entry of infants, children, and youth into foster care. December 11, 2011 17 Clare Anderson

18. Promoting Well-Being and Addressing Trauma in Demonstration Projects Demonstrations that explicitly support social and emotional well-being and address trauma are prioritized for approval. Each demonstration project has identified at least one well-being outcome to target for improvement. States are encouraged to align screening, assessment, and evidence-based interventions with the needs and characteristics of the target population in order to achieve improved well-being. December 11, 2011 18 Clare Anderson

19. Matching Populations, Outcomes, and Approaches Target Population Children, 8-17 Children, 13-17 Children, 2-7 Screening & Assessment - UCLA PTSD Index - Strengths & Difficulties Questionnaire - Child & Adolescent Needs & Strengths - UCLA PTSD Index - Strengths & Difficulties Questionnaire - Child & Adolescent Needs & Strengths - Strengths & Difficulties Questionnaire - Child & Adolescent Needs & Strengths - Strengths & Difficulties Questionnaire - Child & Adolescent Needs & Strengths - Trauma Symptoms Checklist for Young Children - Infant Toddler Emotional Assessment - Child Behavior Checklist - Trauma Symptoms Checklist for Young Children - Infant Toddler Emotional Assessment - Child Behavior Checklist EBIs Trauma-Focused Cognitive Behavioral Therapy (ages 0-21) Trauma-Focused Cognitive Behavioral Therapy (ages 0-21) Multisystemic Therapy (ages 6-17) Multisystemic Therapy (ages 6-17) Parent-Child Interaction Therapy (ages 0-12) Parent-Child Interaction Therapy (ages 0-12) Outcomes - Behavior problems - PTS symptoms - Depression - Behavior problems - PTS symptoms - Depression - Delinquency/Drugs - Peer problems - Family cohesion - Conduct disorders - Parent distress - Parent-child interaction - Conduct disorders - Parent distress - Parent-child interaction December 11, 2011 19 Clare Anderson

20. Pennsylvania Target population: Children in or at-risk of entering placement, discharged from placement, or receiving in-home services Geographic scope: 5 counties initially Key outcomes: Improved parent behavioral health and functioning; increased parenting skills; improved child and youth functioning in home, school and community; reduced use of congregate care and other restrictive placement settings; increased placement in most appropriate and least restrictive settings Evidence-based or promising programs considered: PCIT; MST; MTFC; TF-CBT; Triple P; NFP; SFP; Incredible Years; Why Try? November 30, 2011 20 NC Waiver Meeting