July/August 2018Vol. 19, No. 6Spotlight 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.
- Youth Mental Health First Aid Course
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/.
- Resource Center Aims to Improve the Appropriate Use of Psychotropic Medication for Children in Foste
Resource Center Aims to Improve the Appropriate Use of Psychotropic Medication for Children in Foste
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:
- Common Measures and Outliers—This section provides recommendations on using data for ongoing oversight as well as indicators that call for the immediate review of a child's psychotropic medication regimen.
- Agency Consent for Psychotropic Medication Use—Agency consent refers to the oversight model that requires child welfare agencies to conduct a review of psychotropic medications prescribed to children and youth to help prevent inappropriate prescribing. This section describes three state agency consent models (New Jersey, Connecticut, and Illinois).
- Stakeholder Engagement—This section highlights websites and tools to educate the public and professionals about psychotropic medications. It also looks at states that have engaged stakeholders in their work to reduce the inappropriate use of psychotropic medications.
- Assessment Practices—This section provides child well-being assessments and highlights the role of trauma-informed care in behavioral health care for children involved in child welfare.
- Psychiatric Consultation—This section provides information on psychiatric consultation models as well as explores alternatives to psychotropic medication.
- State and Federal Guidance—This section compiles state and federal guidance on psychotropic medication use in children and includes letters, memos, and reports.
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/.
- Predictors of Admission to Psychiatric Residential Treatment Facilities
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:
- What behavioral health characteristics, behavioral health services utilization (e.g., family, group, and individual therapy; care in residential service settings; psychiatric services; and substance use treatment services), and psychotropic and antipsychotic drug prescriptions were associated with PRTF admission?
- What types of child maltreatment findings are associated with subsequent PRTF admission?
- Are patterns of foster care placement, permanency, and return to care associated with subsequent PRTF admission?
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.
- Let's Commit to Ensuring Emotional and Psychological Well-Being for Children 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.
- Mental Health Interventions for Children in Foster Care
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:
- The intervention showed at least one positive child mental health outcome for children in foster care.
- The intervention could be delivered at home or in an outpatient/community setting.
- The intervention contained at least one specific and unique therapeutic component rather than only enhanced foster care or wraparound services.
- Outcome and engagement rates were measured after the completion of the intervention.
- There was an evaluation of the intervention's effectiveness.
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.
Spotlight on Incorporating Youth Engagement and Lived Experience Into Child Welfare Practice
Spotlight on the Title IV-E Prevention Program and the Family First Prevention Services Act
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.
- CB Website Updates
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:
- List of Adoption and Foster Care Analysis and Reporting System Out-of-Home Care and Adoption and Guardianship Assistance Elements With Response Options: https://www.acf.hhs.gov/cb/resource/afcars-list-data-elements-options
- Child and Family Services Reviews Aggregate Report: https://www.acf.hhs.gov/cb/resource/cfsr-aggregate-report
- National Youth in Transition Database Review Planning Call Series and Guidelines: https://www.acf.hhs.gov/cb/resource/nytd-review-planning-call-series-guidelines
- Child and Family Services Reviews Update, Volume 12, Issue 1, April 2018: https://www.acf.hhs.gov/cb/resource/cfsr-update-volume-12-issue-1
- PI-18-05: Fiscal Year 2018 Funding Available for Developing, Enhancing, or Evaluating Kinship Navigator Programs: https://www.acf.hhs.gov/cb/resource/pi1805
- PI-18-06: Additional information and instructions for the Annual Progress and Services Report: https://www.acf.hhs.gov/cb/resource/pi1806
- State Checklist for the Child and Family Service Plan (CFSP)/Annual Progress and Services Report (APSR): https://www.acf.hhs.gov/cb/resource/cfsp-apsr-state-checklist-2019
- "Prevention: Delivering Services Through Education" [podcast]: https://www.acf.hhs.gov/cb/resource/child-welfare-podcast-prevention-education
Visit the Children's Bureau website often to see what's new.
- 'Prevention: Connections Matter' Podcast
'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.
- Conceptual Frameworks for Improving Outcomes for Both Parents and Their Children
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.
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
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:
- Child attachment quality—A randomized trial with 120 children found that children formed organized attachments more frequently if their parents or caregivers had received the ABC intervention (52 percent of the children in the ABC group formed secure attachments compared with 33 percent in the control group).
- Child stress hormones—The ABC intervention proved effective in normalizing the production of cortisol, the hormone associated with stress. The improvements from the intervention were maintained for approximately 3 years after the intervention ended.
- Child emotion regulation—Children whose parents participated in the ABC intervention were less reactive than those in the control group when confronted with a challenging task.
- Child executive functioning—Children whose parents or caregivers participated in ABC showed greater executive functioning than those in the control group.
- Parent report of child behavior problems—Parents and other caregivers who participated in the ABC intervention reported similar levels of problem behaviors in children as those in the control group. The authors assert that observations of children's self-control in both groups suggest a strong endorsement of the intervention's ability to positively affect behavior.
- Parent sensitivity—The ability of a parent or primary caregiver to follow a child's lead was assessed through play interactions. Parents who participated in ABC showed greater sensitivity than those in the control group.
- Parent brain activity—Participants' brain activity was examined 3 years postintervention. Parents who participated in ABC showed greater neural activity than those in the control group in response to an infant's or child's facial expressions and related cues, as well as the ability to differentiate between crying, laughing, and more neutral moods.
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).
- New Study Explores the Role of Relationships in Transforming Youth
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:
- The ability to listen without judgment
- Persistence over time
- The ability to "be real"
- The ability to challenge youth
- Showing up in crises
- Demonstrating love
Youth identified the following challenges to affecting positive change:
- Difficulty experiencing and recognizing emotions
- Negative self-perception and shame
- Sense of powerlessness and lack of agency
The study noted youth experienced the following positive effects as the transformational relationships were developed:
- Feeling that they matter
- The ability to imagine a better future
- An emerging sense of power and agency
- A developing capacity to self-regulate
The study outlined the following attributes of organizational cultures that promote transformational relationships:
- An understanding that relationships are at the heart of healing
- The ability to meet the critical needs of youth in transition (e.g., housing, help with education and employment)
- Adoption of a practice model that considers relationships as essential elements
- Hiring and supervision practices that are responsive to youth needs (e.g., valuing a job candidate that has the potential and personal skills to work well with youth over one with past work experience)
- A culture that values youth through a supportive environment and a spirit of camaraderie
- Smart use of data to track youth well-being and interaction with social workers
Finally, the study makes the following recommendations for organizational and system leaders:
- Put relationships at the heart of the work
- Move beyond a strengths-based practice to one that is grounded in relationships and that empowers young people to become actively engaged in affecting change in their lives
- Understand the role of love and boundaries in affecting change
- Make relating the priority ("First, relate")
- Consider budding relationships as progress (i.e., importance of being patient with progress)
- Pursue equity (i.e., recognize that workers might find some youth more appealing and ignore the needs of others)
- Build relational organizations via a practice model and a set of organizational supports
Transformational Relationships for Youth Success is available at https://www.cssp.org/pages/body/Transformational-Relationships-for-Youth-Success-Report.pdf (6,480 KB).
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
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:
- Section I: Prenatal Care—This section contains the factsheets "Prenatal Screenings and Assessments," "Initiating Pharmacotherapy for Opioid Use Disorder," "Managing Pharmacotherapy Over the Course of Pregnancy," and more
- Section II: Infant Care—This section contains the factsheets "Screening and Assessment for Neonatal Abstinence Syndrome," "Breastfeeding Considerations for Infants at Risk for Neonatal Abstinence Syndrome," "Early Interventions Strategies and Developmental Assessments," and more
- Section III: Maternal Postnatal Care—This section contains the factsheets "Adjusting Pharmacotherapy Dose Postpartum," "Maternal Discharge Planning," and "Maternal Return to Substance Use"
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.
- Look Before You Leap: How a Data Plan Can Help You Dig Deeper Into Your Agency's Needs
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:
- Research questions aimed at the problem's scope and characteristics—A good data plan starts with asking key questions to better understand the problem the agency is tackling. For example, an agency looking into why children are not achieving timely permanency might ask questions like: Does time to permanency vary by population group (by age, race, reason for entry)? Are there differences across regions within our state? How do placement history (e.g., number of placements) and placement type affect time to permanency?
- Data sources that are reliable, timely, and valid—The agency should use multiple sources of both quantitative (numerical) and qualitative (narrative) data to answer its research questions. Quantitative data often provide a big picture of a broad population. Examples of quantitative data sources include administrative data, state or federal data, and agency partner data. Qualitative data usually explore a smaller sample, offering valuable insight into quality of services. Examples of qualitative data sources include case reviews, focus groups, interviews, and child welfare case study results. For timely permanency, quantitative data would include statistics on children's length of time in care and patterns by county. Qualitative data might focus on children's relationships with their caregivers or quality of visits with their caseworkers. In addition to using multiple data sources, agencies should consider data quality and appropriate analysis methods. Data quality includes data reliability (data entry is consistent, and analysis yields the same results), timeliness (data are current), and validity (data measure intended target and represent the population being served by the agency).
- Data analysis that helps tell the story—Analyzing data involves looking at patterns, trends, and relationships to verify and clarify the problem. Analysis helps shed light on the whole story. There are many types of analyses, including those that help summarize data in meaningful ways and those that test relationships between variables for a sample of the population. When exploring factors that prevent timely permanency, the agency may analyze the differences in timely permanency across age groups and then further analyze the relationship between age at removal and length of time in care.
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:
- Focused CQI Services Indepth Skill Building, "Module 5: Data Analysis for CQI: Identifying and Understanding the Problem," "Handout 2: Types of Data Analyses" (Capacity Building Center for States, 2017)
- Focused CQI Services, "Module 4: Overview Curriculum" (Capacity Building Center for States, 2017)
- ZERO TO THREE Safe Babies Court Team Project Seeks to Raise Awareness
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:
- ZERO TO THREE Guide to Implementing the Safe Babies Court Team Approach
- The Safe Babies Court Team Approach: Informing Quality Improvement Center for Research-Based Infant-Toddler Court Teams
- A list of SBCT staff and project sites
- Program evaluation
- Cross Sites 2018 meeting information
- SBCT DVD for professionals (for purchase)
The resource page can be found on the ZERO TO THREE website at https://www.zerotothree.org/resources/services/safe-babies-court-teams.
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.
- Talking to Children About Violence: Tips for Parents and Teachers
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:
- Reassure children that they are safe—Assure children that schools are safe yet validate their feelings and listen to their concerns.
- Make time to talk—Children do not always talk about their concerns readily. Be patient with children and let their questions guide any explanations.
- Keep your explanations developmentally appropriate—Make sure explanations are appropriate for the age and maturity level of the child.
- Review safety procedures—Make sure the child can identify a trusted adult they can turn to at home and at school should an emergency arise.
- Observe children's emotional state—Observe a child's behavior, appetite, and sleep patterns, which can indicate a child's level of anxiety or discomfort. Enlist the help of a mental health professional, if needed.
- Limit television viewing of these events—Developmentally inappropriate information can cause anxiety or confusion, particularly in young children.
- Maintain a normal routine—Keeping a normal schedule can be reassuring for children who are stressed.
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.
- Connect: An Attachment-Based Program for Parents and Caregivers
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:
- A structured interview based on motivational interviewing with each caregiver that welcomes them to the program and addresses barriers to attendance
- A discussion of developmental and trauma-informed attachment principle as it relates to preadolescent and adolescent development and caregiving
- Role-play scenarios to illustrate the application of each principle and lead parents through a set of reflective questions designed to promote parental sensitivity and mutual respect during conflicts
- Role-play scenarios for parents that allow them to take on the role of the child and reflect with the group on their feelings, thoughts, and behaviors in this role
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.
Training and Conferences
Find trainings, workshops, webinars, and other opportunities for professionals and families to learn about how to improve the lives of children and youth as well as a listing of upcoming events and conferences.
Upcoming conferences and events on child welfare and adoption include the following:
- Family Focused Treatment Association 32nd Annual Conference
Family Focused Treatment Association
July 8-11, Atlanta, GA
- National Council of Juvenile and Family Court Judges 81st Annual Conference
National Council of Juvenile and Family Court Judges
July 22-25, Denver, CO
- Pact Family Camp East 2018
August 5-10, Stowe, VT
- NACAC's 2018 Conference
North American Council on Adoptable Children
August 7-10, St. Paul, MN
- 30th Annual Crimes Against Children Conference
Dallas Children's Advocacy and Dallas Police Department
August 13-16, Dallas, TX
- 2018 Families Learning Conference
National Center for Families Learning
September 24-26, Ft. Lauderdale, FL
- Partners in Prevention Conference
Texas Department of Family and Protective Services, Prevention and Early Intervention Division
September 25-27, Arlington, TX
- Family Focused Treatment Association 32nd Annual Conference
- Attachment, Regulation, and Competency (ARC) Reflections Training Program
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:
- Understanding trauma
- Understanding and addressing behavior
- Identifying and managing feelings
- Cultivating connections
- Learning to identify body language
- Practicing and teaching self-regulation
- Responding to behavior appropriately
- Supporting identify development
- Supporting transitions
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/.