Overview of the Arkansas Building Effective Services for Trauma (AR BEST) Project

Transcription

1 Overview of the Arkansas Building Effective Services for Trauma (AR BEST) Project 4 th Annual Arkansas Association for the Treatment of Sexual Abusers Fayetteville, AR (T-7) Thursday, 12/2/10, 3:40-5:10 p.m.

2 AR-BEST: Coordinated Projects to Improve the Services Provided to Abused Children and Their Families Karen Worley Ph.D., Janice Church Ph.D., & Nicholas Mitrani, M.S. UAMS Department of Pediatrics

3 Many slides courtesy of Psychiatric Research Institute and the AR BEST Annual Report Teresa L. Kramer, Ph.D., Adam H. Benton, Ph.D., Nicola Burrow, Ph.D., Benjamin A. Sigel, Ph.D., & Christian E. Lynch, M.P.H. Funding made available by the Arkansas Building Effective Services for Trauma (AR BEST) Program, University of Arkansas for Medical Sciences

4 Arkansas Building Effective Services for Trauma (AR BEST) The mission of AR BEST is to improve outcomes for traumatized children and their families in Arkansas through excellence in clinical care, training, advocacy and research/evaluation.

5 AR-BEST Objectives Clinical Care Implement evidence-based assessment and treatment practices throughout the state to create a comforting and safe environment for children and adolescents who are traumatized and optimize their physical and mental health outcomes. Training Provide state-of-the-art training, supervision and learning environments that will maximize the adoption of quality interventions for traumatized children and adolescents. Advocacy Enhance awareness, expand knowledge and promote collaboration among all individuals working with traumatized children and adolescents and their families. Research/Evaluation Consistently monitor, assess the effectiveness of, and develop and test new models of interventions for traumatized children and adolescents to provide the safest and most effective care available.

6 Resources Senator Percy Malone District 26 Funding Source Legislative funding from the increase in beer tax So do it for the kids, please drink responsibly Available Funds Psychiatric Research Institute $800,000 per year for 5 years Department of Pediatrics $500,000, with $176,000 going to support CSC mental health providers Also fund training for private and local community mental health center therapists

7 UAMS Pediatrics and Psychiatric Research Institute Development of mental health screening tool Development of standardized assessment protocols Development of pre- and post- evaluation process Establish database for 3, 6, and 12 month followup of child abuse treatment

8 Child Safety Center Therapists Training and monitoring of mental health screening of all children presenting to CSCs Continuing education, consultation, supervision, and technical assistance of mental health professionals Cooperative agreements with CSCs Trauma-focused cognitive-behavioral therapy Development, dissemination, and linkage to resources for CSC professionals

9 Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Created and developed by Judith A. Cohen, M.D. & Anthony P. Mannarino, Ph.D. Allegheny General Hospital, Pittsburgh, PA Center for Traumatic Stress in Children and Adolescents Esther Deblinger Ph.D. New Jersey Child Abuse Research Education and Services Institute For more information on TF-CBT, please visit

10 Why TF-CBT? TF-CBT is the most rigorously tested treatment for traumatized children 8 randomized trials as of April 2010 For Children: Improved PTSD, depression, anxiety, shame and behavior problems compared to supportive treatments For Parents: Improved parental distress, parental support, and parental depression compared to supportive treatment Successful with diverse ethnic and racial populations

11 TF-CBT Treatment Structure Average sessions 1 to 1 ½ hour weekly sessions Each session is divided into individual child and parent sessions The length of the child and parent portions may vary by topic Similar topics in most parent and child sessions Same therapist for both child and parent(s) Combined parent-child time in some to many sessions

12 Treatment Using TF-CBT Components Psychoeducation and Parenting Skills Relaxation Affect Modulation Cognitive Coping Trauma Narrative and Processing In Vivo Mastery of Trauma Reminders Conjoint Child-Parent Sessions Enhancing Future Safety and Development

13 Training and Consultation Masters and doctoral level professionals Community Mental Health Practitioners, private practice and CSCs Trainees tracked in a program database Training and consultation provided by 8 nationally recognized experts in TF-CBT

14 Training and Consultation Free on-line assessments and feedback reports on AR BEST web site Assessments used include the Strengths and Difficulties Questionnaire (SDQ) and the UCLA PTSD Index for DSM-IV Revision 1; both measures have child and parent versions (for kids >12 y/o and kids <12 y/o respectively) List serve and technical support Certificate of completion Identification of local champions AR Level Certified TF-CBT Trainers

15 TF-CBT Training Sequence for Arkansas Online training Providers Since August 2009, 257 mental health providers across Arkansas have completed this web-based training and received 10 hours of continuing education credit TF-CBT Conference A free two day TF-CBT Training Workshop was held on April 15-16, 2010, at UAMS for those who completed the Online TF-CBT Training Presented by Dr. Anthony Mannarino, co-developer of TF-CBT and director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh.

16 TF-CBT Training Sequence for Arkansas Providers TF-CBT Conference Continued Attended by 134 treatment providers who have completed the web-based training. A second TF-CBT Conference scheduled for March 30 - April 1 st 2011, with Dr. Mannarino presenting. The Arkansas State map on the next slide breaks down attendance by county for the 2010 TF-CBT Conference

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18 TF-CBT Training Sequence for Arkansas Consultation Calls Providers Ongoing consultation via teleconferences is conducted with Dr. Mannarino and other nationally recognized TF-CBT experts. These occur twice a month for 7 months. 70 mental health professionals who attended the TF-CBT conference have participated in the calls. Mental health professionals can use the AR BEST web system to complete on-line assessments of their clients, plan their treatment, and document their use of TF-CBT elements in the treatment process. This system can be used during the teleconference sessions to monitor clinician progress in TF-CBT implementation. Registration of TF-CBT certified providers

19 What s Been Going On Since the TF- CBT Training The TF-CBT trained therapists could begin entering client information starting on May 1 st, Since that time, 219 clients (thru Sept. 1 st ) have been registered by clinicians into the system. The following slide shows various information from the AR- BEST Quarterly Clinician Data Report Summary: 219 clients from 37 Arkansas counties have been registered in the AR BEST system by a mental health professional. The majority are Caucasian females with a history of sexual abuse. At intake, the majority of children are experiencing serious behavior problems or significant symptoms of Post-Traumatic Stress Disorder.

20 Type of Trauma for Children Receiving Mental Health Treatment Time Frame of Trauma for Children Receiving Mental Health Treatment 80% Type of Trauma 70% 70% 60% 50% 40% 50% 45% 40% 35% 30% 25% 44% Time Frame of Trauma 28% 30% 20% 10% 23% 11% 21% 8% 12% 20% 15% 10% 5% 11% 16% 0% 0% 1 Year Ago or Less 1-3 Years Ago 3-5 Years Ago More than 5 Years ago

21 Information on Client Symptomology from the SDQ and UCLA PTSD Measures Percent with Mild, Moderate and Significant Symptoms on UCLA PTSD INDEX Significant Moderate Child Report (n = 84) Parent Report (n = 61) Mild

22 Strengths and Difficulties Questionnaires - Results from Child Self Report (n = 76) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Abnormal Borderline Normal 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Emotional Symptoms Figure 10: Strengths and Difficulties Questionnaires - Results from Parent Report (n = 59) Conduct Problems Hyperactivity Peer Problems Prosocial Behavior Total Difficulties Abnormal Borderline Normal

23 What Does This All Mean? Results suggest that at the baseline evaluation, about half to three-quarters of the children meet criteria for partial or full PTSD, with about half experiencing serious symptoms at the time of the assessment. Results from the SDQ suggest that about half of children are exhibiting behaviors that fall in the abnormal /clinically significant range. In addition, another 25-30% are exhibiting behaviors in the borderline range. Problems with peers, conduct problems and emotional symptoms were the most common problem areas.

24 AR-BEST, TF-CBT and the Near Future Scheduled from March 30 th April 1 st 2011, Dr. Mannarino will be hosting another TF-CBT training conference at UAMS. Two day training for new providers (3/30-3/31), and a one-day advanced training for returning clinicians (4/1). Again, the ultimate goal of the project is to enhance the statewide availability of this empiricallysupported treatment for children who have experienced trauma. So tell your friends

25 AR-BEST and Supporting Child Advocates Some CSCs don t have advocates Advocates rarely have formal training There are no standards of practice for advocates to follow like in other professions CSC Advocates play a critical role in family support and often this role is overlooked.

26 The Role of the Advocate at the CSCs and With AR What does an advocate do? Where do they get their training? What is being done to support the important role of the advocate? The Role of the Advocate in the AR-BEST Project

27 Roles and Responsibilities of Advocates provided by NCAC s focus group on child advocates Pre-Interview Greet child at the door First Contact Build rapport with the family Complete intake forms with parent/guardian and ensure parent signs all necessary release forms Provide and review information packet with parent Conduct a needs assessment for both the child and the parent and make referrals as necessary Communicate with the Forensic Interview regarding any alarming behavior, information or coaching that may be taking place Interview/Medical Sit with parent during interview/exam Observe the forensic interview Observe parental interactions Educate/inform parents about the nature of the interview/medical exam Follow Up Refer child and parent to mental health and other services Maintain consistent communication with the family on a regularly scheduled basis (~1x/week for 6 weeks, then ~1x/month as needed) Maintain contact with the MDT to solicit system information to pass along to the family and to enter into the databases Serve as a liaison between investigative agencies and family Make reports to DHS as necessary MDT Case Review Attend case reviews Report to MDT how the family is responding to case management plan, along with relevant interaction between child and parent, include family dynamics, and any outside information that could help with the case

28 Roles and Responsibilities of Advocates Court/Judicial Services Help prepare, educate, and possibly accompany the child/family to the judicial process and courthouse Closed Cases Review/reinforce safety plan Provide ongoing support as necessary through referrals or on-site at the center Ongoing/Continuous Services Crisis Intervention Case tracking/documentation Maintain accurate records/databases on the families served

29 Wow that s a lot, how many years of training/schooling does the job require? Rarely, there is no formal school, license, degree for this line of work Some Arkansas Advocates have degrees in the following backgrounds: Psychology, Business, Theatre, Global Studies, Elem. Ed, Social Work, and Spanish Most advocates have on-the-job training and learn as they go.

30 Supporting the Advocates Every CSC in Arkansas has been visited by the Family Treatment Program/AR-BEST in the past year. Those meetings, as well as surveys regarding advocate training needs, have led to a number of exciting additions to supporting our advocates. The first annual meeting of Arkansas CSC Advocates took place on 9/30/10 in Little Rock. Topics discussed were the professional role of an advocate in Arkansas, engendering networking and communication between advocates and attending agencies, and the facilitation of support and training endeavors in 2011

31 Supporting the Advocates Support/training programs will be in place starting in 2011 An NCAC provided 3-day victim advocacy training will be held in Little Rock in February 2011 for all advocates to attend. The ultimate goal is to have this provided to the advocates every 1-2 years. Quarterly case discussions will be held where a few advocates will volunteer to present cases that would facilitate learning, discussion, and growth. In addition, each meeting will have a speaker present a specific topic to promote further learning and growth among the advocates (e.g. updates on Arkansas law, crisis intervention, working with children/families with disabilities, etc.) Current Arkansas CSC advocates have expressed support to mentor newly hired advocates via phone calls or s on the various aspects of the job as necessary

32 Advocates and AR-BEST Every CSC Advocate has been registering the children they see into the online AR- BEST website, in addition to making follow up calls to the families at 1 week, 1 month and 3 months. Since the implementation of the program to Sept. 1 st 2010, 526 children have been seen at the CSCs. Majority are Caucasian females referred from Arkansas State Police for sexual abuse investigation More than two-thirds are referred to mental health counseling Approximately one fourth report at least one mental health concern By the 1 week follow-up, 65.6% of children had been referred for counseling 74% Gender 26% Male Female 9% 5% 9% Race Caucasian 77% African American Bi-racial Hispanic/Other Age Group Under 5 14% 32% 36% 18% years 5 thru 9 years 10 thru 14 years 15 years and older

33 Advocates and AR-BEST 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 19.4% 5% 85% Type of Trauma 1% 7% Physical Abuse Sexual Abuse Neglect Witnessed Violence 7.4% 24.9% Type of Offender 6.5% Parent Stepparent Other Relative Parents' Boyfriend/ Girlfriend 28.1% Other Known Offender 1% Drug Endangered 11% Other 4.0% 2.9% Multiple Offenders Other 5.9% Unknown

34 Advocates and AR-BEST Responses to Follow-Up Screening Items Percent Responding "Somewhat" or "Certainly True" 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 9% 11% 26% 28% 32% 30% 40% 36% 29% 27% 25% 22% 23% 22% 32% 30% 1 Week 1 Month

35 Getting By With A Little Help From Our Friends Thanks to Senator Malone for his hard and diligent work in securing funding for these worthwhile projects Thanks to others at PRI and the AR-BEST steering committee for their hard work, dedication, and support on helping traumatized children and their families, including: Teresa Kramer, Ph.D. Nicola Burrow, Ph.D. Adam Benton, Ph.D. Ben Sigel, Ph.D. John Clemmons, Ph.D. Christian Lynch, M.P.H. Kathy Helpenstill, LCSW Once again, most of the slides presented today were courtesy of AR-BEST staff and the AR-BEST annual report.

36 Karen Worley, Ph.D Janice Church, Ph.D Nicholas Mitrani, M.S Contact Information