Children's Bureau ExpressJuly/August 2018 | Vol. 19, No. 6

Table of Contents
 

Spotlight on Mental Health and Children and Youth in Foster Care
In this month's CBX, read a message from Jerry Milner, Associate Commissioner of the Children's Bureau, about the importance of emotional and psychological well-being for children in foster care, as well as articles focusing on the mental health challenges and promising interventions for children and youth in foster care.

  • Let's Commit to Ensuring Emotional and Psychological Well-Being for Children in Foster Care
  • Mental Health Interventions for Children in Foster Care
  • Predictors of Admission to Psychiatric Residential Treatment Facilities
  • Resource Center Aims to Improve the Appropriate Use of Psychotropic Medication for Children in Foster Care
  • Youth Mental Health First Aid Course

News From the Children's Bureau
Read about two conceptual frameworks that seek to improve outcomes and increase child well-being for low-income families, a recent podcast from the Children's Bureau, and a list of the latest updates to the Children's Bureau website.

  • Conceptual Frameworks for Improving Outcomes for Both Parents and Their Children
  • 'Prevention: Connections Matter' Podcast
  • CB Website Updates

Child Welfare Research
We highlight an evidence-based intervention that seeks to enhance a parent's or caregiver's ability to nurture and respond to an infant or child in their care as well as the importance of positive, transformational relationships for youth.

  • Intervention Promotes Caregiver Responsiveness, Child Well-Being in Vulnerable Families
  • New Study Explores the Role of Relationships in Transforming Youth

Strategies and Tools for Practice
This section of CBX offers publications, articles, reports, toolkits, and other resources that provide either evidence-based strategies or other concrete help to child welfare and related professionals.

  • Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
  • ZERO TO THREE Safe Babies Court Team Project Seeks to Raise Awareness
  • Look Before You Leap: How a Data Plan Can Help You Dig Deeper Into Your Agency’s Needs

Resources
This section of CBX provides a quick list of interesting resources, such as websites, videos, journals, funding or scholarship opportunities, or other materials that can be used in the field or with families.

  • Connect: An Attachment-Based Program for Parents and Caregivers
  • Talking to Children About Violence: Tips for Parents and Teachers

Training and Conferences

  • Attachment, Regulation, and Competency (ARC) Reflections Training Program
  • Conferences

Spotlight on Mental Health and Children and Youth in Foster Care

Let's Commit to Ensuring Emotional and Psychological Well-Being for Children in Foster Care

Written by Jerry Milner.

All too often in child welfare we focus on the physical safety of children and youth to the exclusion of their psychological and emotional well-being. Law makes clear that safety is paramount, and it is absolutely critical, but ensuring safety should not impede seeing that children in foster care have their other health and well-being needs met. It is a "yes-and" situation. We must ensure both.

A letter I recently received made this point more eloquently than I ever can. The letter was written by an 8th-grade student. Her insight and words are quite moving. The young author wrote to express her concerns about the mental health of teens in foster care. She articulated that while there are benefits to foster care, such as a place to stay and food to eat, there are many conditions that leave foster youth quite vulnerable to mental health challenges. She spoke to feelings of aloneness that come with multiple placements and school moves, disconnection from birth parents, the struggle and conflict youth feel when living with a foster parent while still loving and worrying about their birth parents, difficulty learning how to make and maintain healthy relationships, and loss of independence. She cautions that all of these factors leave foster youth susceptible to bullying, and worse.

She continues by drawing a very powerful analogy comparing youth in foster care to "broken crayons" but pointing out that even broken crayons can still color. She warns that when not properly attended to, crayons can become dull or dusty, but that when properly maintained they are capable of brining great brightness and creativity in the world. She asks which type of crayon we prefer to see in the world. The letter ends with a simple, poignant statement: The choice, Mr. Milner, is yours.

I've made my choice and urge all who may read this article to do the same. At the federal level we will do everything we can to ensure that well-being is regarded as essential in our work with children and their families. These efforts of course include making sure all clinical services a child or youth may need are properly identified and addressed in an ongoing fashion. In addition to that, we must not lose sight of the fact that parent-child separation is in and of itself very traumatic, even in situations where it is the only way to keep children safe. This trauma can be very serious and last a lifetime.

Experiences in foster care can also add more trauma. Each move within foster care adds to the losses a child has experienced. We must not forget that, even when essential, removing children from their families can be incredibly disruptive, difficult, and confusing to all children and youth. In fact, there is no normality in those situations for children.

Yet, there are ways to make such removals and placements less traumatic, such as helping children maintain connections to family, friends, their schools, and other events. There are ways to help promote healthy development, ensure that children and youth feel cared for and supported, meet social and emotional needs, and provide as close to a "normal" childhood experience as possible under the circumstances. In many situations, I believe that we have the know-how to do these things, and taking these types of approaches need not cost systems more money. The investment should come from our vision, our commitment to practice, and an expectation that our work will support the well-being of children and families.
 

Issue Date: July/August 2018
Section: Spotlight on Mental Health and Children and Youth in Foster Care
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5179


Mental Health Interventions for Children in Foster Care

Children placed in out-of-home care usually have suffered adverse childhood experiences or situations that can lead to high rates of mental health problems, such as disruptive behavior disorders, attention deficit/hyperactivity disorder, posttraumatic stress disorder and other anxiety disorders, and mood disorders. Between 50 and 80 percent of children in foster care meet the criteria for at least one mental health disorder, and 23 percent meet the criteria for more than one. These children, however, are difficult to treat because of the transitory nature of out-of-home care. For example, some interventions meant for birth parents and their children are inappropriate in a foster home setting, or the child may have experienced two or more placements within a couple of years, making the continuity of treatment difficult. Additionally, some families may prefer to avoid the stigma of seeking out mental health care.

An article in Children and Youth Services Review aimed to evaluate intervention research in order to identify promising solutions to help children in foster care who are in need of mental health care. The study focused on research involving children who were between the ages of birth and 12 years.

Researchers selected interventions based on the following inclusion criteria:

Researchers identified 10 interventions that fit the above criteria—Attachment and Biobehavioral Catchup, child-parent psychotherapy, Fostering Healthy Futures, Incredible Years, Keeping Foster Parents Trained and Supported, Kids in Transition to School, parent-child interaction therapy, short enhanced cognitive-behavioral therapy, trauma-focused cognitive-behavioral therapy, and Treatment Foster Care Oregon for Preschoolers. Most of these interventions were developed for foster care situations, but 4 of 10 interventions were not developed specifically for use in the foster care setting; however, they proved to be applicable to this population. Further, the diversity among these interventions in terms of characteristics, frameworks, and delivery sites indicates that it may be possible to tailor interventions to specific needs and patient preferences.

"Mental health interventions for children in foster care: A systematic review," by Erin P. Hambrick, Shani Oppenheim-Weller, Amanda M. N'zi, and Heather N. Taussig (Children and Youth Services Review, 70), is available at https://www.sciencedirect.com/science/article/pii/S0190740916302717.
 

Issue Date: July/August 2018
Section: Spotlight on Mental Health and Children and Youth in Foster Care
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5162


Predictors of Admission to Psychiatric Residential Treatment Facilities

Children who have adverse experiences, such as abuse, neglect, and other forms of maltreatment, have a greater risk of developing behavioral and mental health problems compared with children who do not. For many of these children, the child welfare system may open the door to the mental health services they need, including admittance to psychiatric residential treatment facilities (PRTFs), which are the most expensive and restrictive settings for children in need of extensive, long-term mental health care. Given the costly and restrictive nature of PRTFs, a recent study in the International Journal of Environmental Research and Public Health sought to determine the factors that contribute to a child investigated for maltreatment being admitted into a PRTF—after taking into account clinical need based on the behavioral and mental characteristics of the child—with the goal of informing policy discussions regarding the best strategies to ensure children receive appropriate care in the appropriate setting as well as prevent unnecessary placements in PRTFs.

For the study, there were three determining factors for PRTF use—predisposing factors, enabling factors, and need, and research was guided by questions such as the following:

After data analysis, the researchers found that receiving a trauma-associated behavioral health diagnosis, having received care in a less restrictive service setting, and being prescribed one or more antipsychotic drugs were associated with a greater risk for PRTF admission. However, a history of substantiated maltreatment was not associated with admission to a PRTF. Taken together, the findings suggest that the strongest determining factor for being placed in a PRTF was mental health need, although other social service factors, and particularly child welfare-related factors, were independently associated with admission after accounting for this need.

"A longitudinal study of child maltreatment and mental health predictors of admission to psychiatric residential treatment facilities," by Roderick A. Rose and Paul Lanier (International Journal of Environmental Research and Public Health, 14), is available at http://www.mdpi.com/1660-4601/14/10/1141/htm.
 

Issue Date: July/August 2018
Section: Spotlight on Mental Health and Children and Youth in Foster Care
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5163


Resource Center Aims to Improve the Appropriate Use of Psychotropic Medication for Children in Foster Care

Children in out-of-home care are more likely to receive psychotropic medications than children who are not. As a result, the Center for Health Care Strategies, Inc., and the the Annie E. Casey Foundation created an online resource center that provides publications, tools, and webinars to help states improve the oversight and monitoring of psychotropic medication use for children in foster care.

The following resources are included:

Improving the Appropriate Use of Psychotropic Medication for Children in Foster Care: A Resource Center is available at https://www.chcs.org/resource/improving-appropriate-use-psychotropic-medication-children-foster-care-resource-center/.
 

Issue Date: July/August 2018
Section: Spotlight on Mental Health and Children and Youth in Foster Care
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5164


Youth Mental Health First Aid Course

The Youth Mental Health First Aid course, produced by the National Council for Behavioral Health, is intended for adults (e.g., parents, family members, other caregivers, educators, peers, neighbors, health and human services workers) who regularly interact with young people between the ages of 12 and 18 experiencing mental health and substance use challenges or who are in crisis.

The course describes common mental health challenges for youth, reviews typical adolescent development, and provides a five-step action plan for helping young people in both crisis and noncrisis situations. The course covers topics such as anxiety, depression, substance use, psychosis, disruptive behavior disorders, and eating disorders.

For more information on how to participate in the Youth Mental Health First Aid course, go to https://www.mentalhealthfirstaid.org/take-a-course/course-types/youth/.
 

Issue Date: July/August 2018
Section: Spotlight on Mental Health and Children and Youth in Foster Care
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5165


News From the Children's Bureau

Conceptual Frameworks for Improving Outcomes for Both Parents and Their Children

A brief from the Office of Planning, Research & Evaluation, within the Administration for Children and Families within the U.S. Department of Health and Human Services, offers two conceptual and complementary frameworks for simultaneously improving parental economic security and child well-being. The frameworks offer insight to researchers and program administrators interested in understanding how programs that seek to boost both overall family economic security and well-being may do so through intentionally combined activities and approaches.

The first framework considers the services and outcomes for children and their caregivers. It draws from developmental science and economics to gauge potential impacts on both parents and their children as well as the overall home environment. 

The first framework identifies the populations served; describes the service model for both parents (or other caregivers) and children within the same family; explains the important role of intentionality, quality, and mutual parent and child motivation in determining the delivery of services and ultimate outcomes; and offers potential shorter and longer-term outcomes for children, parents, and the home environment. Services for parents include those related to employment, education, the development of specific skills, supporting and promoting family well-being, and home visiting and/or parenting classes. Services for children include those that promote healthy development or academic success. The framework shows how the content, delivery, and schedule of services for both parents and children complement each other and potentially influence outcomes.

The second framework explores the impact of varying degrees of service collaboration on parents and their children. It builds on the first framework by offering strategies for achieving the desired parent and child outcomes through partnerships that occur at varying levels (e.g., communication, joint missions, resource sharing). For example, the brief points to child development and job training programs that could increase the degree to which they collaborate when delivering services designed to benefit the whole family.

Conceptual Frameworks for Intentional Approaches to Improving Economic Security and Child Well-Being is available at https://www.acf.hhs.gov/opre/resource/conceptual-frameworks-intentional-approaches-improving-economic-security-child-well-being.
 

Issue Date: July/August 2018
Section: News From the Children's Bureau
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5166


'Prevention: Connections Matter' Podcast

Protective factors are vital to alleviating the negative effects of trauma and contributing to positive outcomes for children, families, and communities.

The Children's Bureau has released a new podcast, "Prevention: Connections Matter," which highlights a community-based effort to build understanding, trauma-informed communities. The "Connections Matter" podcast, which is based on a training developed by Prevent Child Abuse Iowa, utilizes evidence-based training that is tailored to specific community sectors, such as education, health care, workforce, and more. This podcast covers how the training was developed, the value of delivering it to the community, and the statewide needs assessment that helped shape the training.

The podcast and other related resources are available on the Children's Bureau website at https://www.acf.hhs.gov/cb/resource/child-welfare-podcast-prevention-connections.
 

Issue Date: July/August 2018
Section: News From the Children's Bureau
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5167


CB Website Updates

The Children's Bureau website hosts information on child welfare programs, funding, monitoring, training and technical assistance, laws, statistics, research, federal reporting, and much more.

Recent additions to the site include the following:

Visit the Children's Bureau website often to see what's new.

Issue Date: July/August 2018
Section: News From the Children's Bureau
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5169


Child Welfare Research

Intervention Promotes Caregiver Responsiveness, Child Well-Being in Vulnerable Families

Attachment and Biobehavioral Catch-up (ABC) is an evidence-based intervention, developed by Mary Dozier, Ph.D., Amy E. du Pont Chair of Child Development at the University of Delaware, and colleagues over a 20-year period, that seeks to enhance a parent's or caregiver's ability to nurture and respond to an infant or child in their care. ABC has proven useful in improving both the attachment security and neurobiology of young children who have experienced early abuse or neglect.

The article, Attachment and Biobehavioral Catch-up: An Evidence-Based Intervention for Vulnerable Infants and Their Families, looks at the following research findings and implications for clinical practice:

The article also highlights the issues to consider when developing interventions for the families of young children who have experienced early adversity, advice to researchers, and future directions for research.

The paper is available at http://www.abcintervention.org/wp-content/uploads/2017/11/2016-Dozier-et-al.pdf (366 KB).
 

Issue Date: July/August 2018
Section: Child Welfare Research
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5170


New Study Explores the Role of Relationships in Transforming Youth

Transformational relationships help young people see that they matter and that they can change the way they think, feel, and act. Transformational Relationships for Youth Success, a recent report from the Center for the Study of Social Policy in partnership with the Dartington Social Research Unit in the United Kingdom, describes a study that looked at a the role of transformational relationships in the lives of youth and how to promote them. The report describes what makes relationships transformational, the attributes of workers who are most successful at creating such relationships, and what organizations need to do to promote them. It also probes the larger question of how complex public systems can avoid getting in the way of relationships and actually promote them. The study comprised over 80 interviews in both the United States and the United Kingdom with youth, social workers, and organizational leaders.

The study found the following to be important for workers in achieving transformational relationships with children:

Youth identified the following challenges to affecting positive change:

The study noted youth experienced the following positive effects as the transformational relationships were developed:

The study outlined the following attributes of organizational cultures that promote transformational relationships:

Finally, the study makes the following recommendations for organizational and system leaders:

Transformational Relationships for Youth Success is available at https://www.cssp.org/pages/body/Transformational-Relationships-for-Youth-Success-Report.pdf (6,480 KB).
 

Issue Date: July/August 2018
Section: Child Welfare Research
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5171


Strategies and Tools for Practice

Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants

Opioid misuse continues to negatively affect the health and well-being of individuals, families, and communities across the nation. The number of women of childbearing age who reported past-month heroin use increased by 31 percent in 2013–2014 compared with 2011–2012, and the same population who reported past-month misuse of prescription pain relievers increased by 5.3 percent during the same time period. This has led to an increase in infants diagnosed with neonatal abstinence syndrome, from 3.4 per 1,000 births in 2009 to 5.8 per 1,000 hospital births in 2012—with higher rates in rural areas. In addition, barriers to treatment, such as stigma and fear of legal consequences, prevent women with opioid use disorder and their infants from receiving care.

The U.S. Substance Abuse and Mental Health Services Administration has published a free clinical resource that provides guidance on treating pregnant and parenting women with opioid use disorder and their infants. It is meant to help health-care professionals and patients decide appropriate actions for their unique situations and inform treatment decisions.

The guide is split into three sections, each containing several factsheets pertaining to the section topic:

Each factsheet illustrates a clinical scenario to help the health-care professional understand the situation under consideration; clinical action steps that describe recommendations for what can or might be done, as well as what should not be done when caring for women and their infants; supporting evidence and clinical considerations that describe how to tailor recommended actions to unique patient situations and preferences, the necessary clinical experience of the provider, and available community resources; and web resources that provide additional online information.

This free, online guide can be found at https://store.samhsa.gov/product/SMA18-5054.
 

Issue Date: July/August 2018
Section: Strategies and Tools for Practice
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5172


ZERO TO THREE Safe Babies Court Team Project Seeks to Raise Awareness

ZERO TO THREE's Safe Babies Court Teams (SBCT) project offers resources to raise awareness about  child maltreatment and the importance of permanence for infants and toddlers. The project includes a webpage featuring resources designed to connect child welfare-involved families with the support and services they need to encourage healthy child development, shorten involvement with the child welfare system, and avoid future court involvement.

The SBCT project focuses on improving how the courts, child welfare agencies, and other child-serving organizations work together to improve services for the youngest children in foster care and shorten the amount of time they are involved with the system. With SBCT, a team of professionals support child welfare-involved families with targeted services to help them learn how to promote safe parenting practices and healthy development and, hopefully, avoid further contact with the child welfare or court systems.

While families involved with the foster care system typically have formal hearings every 3 to 6 months, ZERO TO THREE points out that families and teams involved in SBCT hold hearings or family team meetings at least once a month and notes that they reach permanency faster than infants and toddlers in the foster care population.

The ZERO TO THREE resource page offers several tools, articles, and reports to promote SBCT, including the following:

The resource page can be found on the ZERO TO THREE website at https://www.zerotothree.org/resources/services/safe-babies-court-teams.
 

Issue Date: July/August 2018
Section: Strategies and Tools for Practice
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5173


Look Before You Leap: How a Data Plan Can Help You Dig Deeper Into Your Agency’s Needs

Written by the Children's Bureau's Capacity Building Center for States.

Much like in their work with families, agencies must understand their own underlying needs to develop solutions that will effectively address them. Six basic tasks can guide agencies as they dig deeper into their organizational needs and identify reasons for their performance on key outcomes. One task is creating a comprehensive data plan developed in collaboration with program leadership, stakeholders, and data/information technology staff to guide data collection and analysis. Once a problem or need is identified, a data plan helps organize existing data and identify new sources to understand the problem and get to the root cause(s).

A comprehensive data plan includes the following:

A good data plan will guide the problem-exploration process and help ensure that an agency has a solid understanding of the problem it wants to address and what kind of solution is needed. Investing time and energy into this phase of the improvement process will pay off later, as the agency is able to pinpoint the best intervention and clearly communicate with its stakeholders why change is needed.

Look for the Change and Implementation in Practice series, which offers user-friendly resources to walk agencies through a research-based process (including developing a data plan) for effectively making changes to improve outcomes. In addition, the following resources provide more information on data analysis and quality to support development of a strong data plan:  

 


 

 

Issue Date: July/August 2018
Section: Strategies and Tools for Practice
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5174


Resources

Connect: An Attachment-Based Program for Parents and Caregivers

Connect: An Attachment-Based Program for Parents and Caregivers is a 10-week group program for parents and caregivers of youth aged 8 to 19 who have serious behavioral problems. It seeks to reduce externalizing (e.g., acting out) and internalizing (e.g., anxiety/depression) problems and increase parenting and familial satisfaction, as well as parent-child attachment security, by promoting parenting sensitivity and introducing attachment principles.

The essential components of the training include the following:

This strengths-based program also has an adaptation for foster parents that focuses on trauma, attachment, and caregiving.

Two certified Connect group facilitators are needed to run this program. Training to become certified is available through a 3-day workshop and 10 to 12 hours of subsequent clinical supervision.

More information on the program, certification, and additional resources are available through the California Evidence-Based Clearinghouse for Child Welfare website at http://www.cebc4cw.org/program/connect-an-attachment-based-program-for-parents-and-caregivers/detailed.


 

Issue Date: July/August 2018
Section: Resources
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5175


Talking to Children About Violence: Tips for Parents and Teachers

It can be difficult to talk to children about violence—especially about violent events that happen at schools. Children may become confused about what has happened, frightened, or worried that they and their friends are at risk. Often, children will turn to parents, teachers, and other school personnel for guidance. The National Association of School Psychologists created a tip sheet and infographic to help parents and educators learn how to talk to children about violence. The resource offers the following suggestions:

The tip sheet also includes suggested points to highlight when having these discussions with children. It is available in multiple languages, including Spanish.

Talking to Children About Violence: Tips for Parents and Teachers is available at https://www.nasponline.org/resources-and-publications/resources/school-safety-and-crisis/talking-to-children-about-violence-tips-for-parents-and-teachers.


 

Issue Date: July/August 2018
Section: Resources
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5176


Training and Conferences

Attachment, Regulation, and Competency (ARC) Reflections Training Program

Foster parents, kin, and other caregivers play an important role in supporting children and youth who have been exposed to complex trauma. Therefore, it is important for them to learn how trauma can affect children in foster care and develop the skills to give these children the support they need.

The Annie E. Casey Foundation created a resilience-based training program that child welfare agencies can use to train foster parents so they may better care for children who have experienced trauma. Attachment, Regulation, and Competency (ARC) Reflections is a nine-session program that covers the following:

ARC Reflections provides PowerPoint slides and a guide for facilitators for each session. There are accompanying resources for facilitators, such as an implementation guide that acts as a primer for child welfare agencies, an orientation document that provides handouts and implementation tips, and a guide for case managers to support staff as they learn ARC concepts.

All materials for the training program can be found at http://www.aecf.org/work/child-welfare/child-welfare-strategy-group/arc-reflections-training-program/.
 

Issue Date: July/August 2018
Section: Training and Conferences
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5177


Conferences

Upcoming conferences and events on child welfare and adoption include the following:

July

August

September

 

Issue Date: July/August 2018
Section: Training and Conferences
URL: https://cbexpress.acf.hhs.gov/index.cfm?event=website.viewArticles&issueid=198&articleid=5178



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Children's Bureau Express does not disclose, give, sell, or transfer any personal information, including email addresses, unless required for law enforcement by statute.


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