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Overview of Evidencebased Practices for Youth in Connecticut

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Title: Overview of Evidencebased Practices for Youth in Connecticut


1
Overview of Evidence-based Practices for Youth in
Connecticut
  • Robert P. Franks, Ph.D.
  • Director
  • Connecticut Center for Effective Practice (CCEP)
  • Child Health Development Institute

2
Outline
  • History Description of the Connecticut Center
    for Effective Practice
  • Context for Best Practices Positive Youth
    Development
  • Rationale for Using Evidence-based Practices
  • History of Adoption and Implementation of
    Evidence-based Practices in Connecticut
  • V. Current EBPs Being Utilized Numbers of
    Youth Served
  • VI. Lessons Learned from MST Implementation
    Ongoing MST Progress Report

3
History Description of the Connecticut Center
for Effective Practice
4
History Description of the Connecticut Center
for Effective Practice
  • Founded five years ago in response to identified
    need in the State to have a mechanism for
    providing information on best practices in child
    mental health and to implement evidence-based
    practice on a large scale.
  • First major project was working with DCF to
    implement Multisystemic Therapy (MST) across the
    state.

5
Connecticut Center for Effective Practice (CCEP)
  • Five active partners
  • Department of Children and Families (DCF)
  • Court Support Services Divisions (CSSD)
  • University of Connecticut Health Services (UCHC),
    Department of Psychiatry
  • Yale University School of Medicine
  • Child Study Center
  • The Consultation Center
  • Child Health Development Institute (CHDI)
  • Funding sources
  • State agencies, private foundations, grants

6
CCEP Vision and Mission
  • The purpose of the Connecticut Center for
    Effective Practice (CCEP) is to enhance
    Connecticut's capacity to improve the
    effectiveness of treatment provided to all
    children with serious and complex emotional,
    behavioral and addictive disorders through
    development, training, dissemination, evaluation
    and expansion of effective models of practice.

7
CCEP
  • A place to connect the dots

8
Achieving Vision Engaging Stakeholders
  • Engage stakeholders in activities that promote
    systemic change or act as catalyst for change
    across Connecticut at multiple levels
  • Through work with state agencies who serve
    children and families
  • Through work with major academic institutions
  • Through work with policy makers and legislators
  • Through work with providers of services
  • Through work with consumers (parents, caregivers
    and children)

9
Achieving Vision Four Overarching Strategic
Goals of CCEP
  • Identification, adoption, and implementation of
    evidence-based and best practices
  • Research, evaluation and quality assurance of new
    and existing services
  • Education and raising public awareness about
    evidence-based and best practices
  • Development of infrastructure, systems and
    mechanisms for implementation and sustainability

10
Context for Best Practices Positive Youth
Development
11
Context for Best Practices Positive Youth
Development (Commission on Positive Youth
Development, 2004)
  • Focuses on youths talents, strengths, interests
    and future potential
  • Traditional models focus on deficits
  • Criminal justice models focus on punishment over
    prevention and rehabilitation
  • Positive youth development recognizes adversities
  • Builds on strengths and resiliencies
  • Emphasizes ecological approach

12
Core Ideas of Positive Youth Development
  • Adolescents can overcome adversity and thrive by
    building on resiliencies and strengths
  • Resiliency alone is not enough Adolescents are
    not impervious to unrelenting adversity
  • Youth that thrive must have both positive
    individual characteristics and positive
    characteristics of their families, schools and
    communities

13
What are the characteristicsof programs that
supportpositive youth development?(From
meta-analysis published in 2005)
  • Comprehensive, time-intensive
  • Earliest possible intervention
  • Timing is important
  • High structure is better
  • Fidelity to model is key to effectiveness

14
Characteristics of programs that support
positive youth development
  • 6. Need adult involvement
  • 7. Active, skills-oriented programs
  • 8. Programs that target multiple systems
  • 9. Programs that are sensitive to the
    individuals community and culture
  • 10. Programs based on strong theoretical
    constructs and proven effective by evidence

15
Rationale for Using Evidence-based Practices
  • Evidence-based practices are arguably our best
    approach to provide consistent, reliable,
    effective interventions that result in promoting
    positive youth development.

16
Rationale for Using Evidence-based Practices
  • Changing landscape of practice in mental
    health, juvenile justice, social work
  • Push for Accountabilitywhere is the data?
  • Increased quality and relevance of research
  • Emergence of the concept Best Practices
  • What is a best practice?
  • More thanwhat we already do
  • More than a theoretical approach

17
Rationale for Using Evidence-based Practices
  • Systematic clinical intervention programs that
    are
  • integrative in nature (practice, research,
    theory)
  • And use systematic clinical protocols clinical
    maps
  • Manual driven
  • Model congruent assessment procedures
  • Focus on adherence and treatment fidelity
  • Models that have strong science/research support
  • Clinically responsive and individualized
  • to unique outcome needs of the client/family
  • to the unique process needs of the family
  • Are able to guide practice with high expectation
    of success
  • with specific client problems
  • within specific community settings

18
Biases against Evidence-based Practices
  • They are too rigid and cookbook
  • Doesnt apply to real world kids with real
    world, multi-problem histories
  • Developed in some lab
  • Overly simplistic
  • Too difficult to implement in community setting
  • Just a band-aid and doesnt address underlying
    issues and concerns
  • Another passing fad
  • My training and expertise are not valued

19
Barriers to Implementation of Evidence-based
Practices in Connecticut
  • Economic barriers
  • Community-based and independent providers
  • barely getting by
  • No mechanism for supporting supervision and
    training necessary for implementing EBPs in a
    fee-for-service environment
  • Providers do not see that up front investment
    will yield longer term gains
  • Turnover is high
  • Medicaid and managed care do not routinely
    reimburse or create incentives to deliver EBPs

20
Barriers to Implementation of Evidence-based
Practices in Connecticut
  • Workforce Issues
  • Older clinicians may not share theoretical
    perspective and see EBPs as incompatible with
    their worldview
  • Current clinicians may not receive adequate
    training and not sufficiently prepared exiting
    graduate programs
  • Turnover is high and clinicians are underpaid
  • For some types of EBPs work can be intensive and
    not traditional
  • Difficulty finding appropriate supervision

21
Types of Evidence-based Practices in Child
Mental Health Juvenile Justice
  • Outpatient Services/Community-based Services
  • E.g., treatments for anxiety disorders, conduct
    disorders, child abuse and trauma related
    disorders such as CBT and TF-CBT
  • School-based services
  • E.g., Postive Action (PA) and Cognitive
    Behavioral Intervention for Trauma in Schools
    (CBITS)
  • In-home Family-focused Services
  • E.g., treatments for conduct and substance abuse
    problems such as Multisystemic Therapy (MST),
    Functional Family Therapy (FFT) and others
  • Foster Care Programs
  • E.g., Multidimensional Treatment Foster Care
    (MTFC)
  • Residential or Inpatient Services
  • E.g., Sanctuary Model

22
History of Adoption and Implementation of
Evidence-based Practices in Connecticut
23
Factors contributing to implementation
of EBPs in Connecticut
  • Identification of need
  • Acknowledgement that existing services were not
    working well
  • Negative media attention
  • Available resources through grant funding
  • Champions within state government
  • Legislative and policy changes
  • Economic factors
  • Ease of implementation of model
  • Success of pilot programs

24
  • Connecticuts History
  • of EBP Development
  • Legislative Program Review 1997
  • DSS/DCF Memorandum of Understanding 1999
  • Report on Financing/Delivering Childrens Mental
    Health Services 1999
  • DCF developed first Multisystemic Therapy team
    1999
  • Connecticut Community KidCare Legislation 2000
  • Blue Ribbon Mental Health Commission Report 2000
  • Development of the Connecticut Center fro
    Effective Practice 2001
  • Connecticut Policy and Economic Council (CPEC)
    Report 2002
  • Statewide Implementation of MST and other EBPs
    2002 - present

25
CTs Community KidCares Legislation New and
Expanded Service Continuum Enhancing the
Traditional Service Model
  • Emergency Mobile Psychiatric Services
  • Care Coordination
  • Extended Day Treatment
  • Crisis Stabilization Beds
  • Therapeutic Mentors
  • Short-term Residential Treatment
  • Individualized Support Services
  • Intensive In-Home Services

26
Other Contextual Factors Leading
to Systems Change
  • Legal action Two major consent decrees for the
    Department of Children and Families impacting
    child protection and juvenile justice (Juan F and
    Emily J)
  • Data Statewide evaluation of juvenile justice
    programs that called for systems change (CPEC
    Report, 2002)
  • Media Ongoing media coverage of problems at
    states Department of Children Families

27
Implementation of Evidence-based Practice
in Connecticut
  • 1999 - Pilot Multisystemic Therapy (MST) Team in
    Department of Children and Families
  • 2001 - CT Center for Effective Practice formed to
    disseminate MST across the state
  • 2001 to Present - Dissemination of MST and other
    in-home evidence-based practices for juvenile
    justice youth

28
Implementation of Multisystemic Therapy WHY
MST???
  • Identified need to target deep end children who
    were accounting for most of resources
  • Acknowledgment that existing business as usual
    was not working
  • Much emphasis on juvenile justice population
  • Policy focus on keeping children in their
    communities and providing intensive in-home
    services through KidCare legislation
  • Strong evidence-base
  • Well-defined implementation and delivery system
    for MST
  • Champions within the State

29
MST Growth in CT
30
Growth of MST led to implementation
of a range of other evidence-based practices
for juvenile justice youth in
Connecticut
31
Current Evidence-based Practices
Being Utilized in Connecticut Numbers of Youth
Served(2007)
32
Evidence-based Practices for Youth in the JJ
System in Connecticut
  • Multisystemic Therapy (MST)
  • Multidimensional Family Therapy (MDFT)
  • Functional Family Therapy (FFT)
  • Brief Strategic Family Therapy (BSFT)
  • Multidimensional Treatment Foster Care (MTFC)
  • Intensive In-home Child and Adolescent
    Psychiatric Services (IICAPS)

33
Multisystemic Therapy (MST)
  • Program Overview
  • Multisystemic Therapy (MST) is an intensive
    family- and community-based treatment that
    addresses the multiple determinants of serious
    antisocial behavior in juvenile offenders. The
    multisystemic approach views individuals as being
    nested within a complex network of interconnected
    systems that encompass individual, family, and
    extrafamilial (peer, school, neighborhood)
    factors. Intervention may be necessary in any one
    or a combination of these systems.
  • Program Targets
  • MST targets chronic, violent, or substance
    abusing juvenile offenders at high risk of
    out-of-home placement and their families.

34
Multisystemic Therapy (MST)
  • Current Number of MST programs in Connecticut
  • 10 (DCF)
  • 15 (CSSD)
  • Current Number of MST Specialty Teams
  • 3 (DCF)
  • Current Capacity for Children Served
  • 350 (DCF)
  • 625 (CSSD)
  • 975 Total Capacity

35
Multidimensional Family Therapy (MDFT)
  • Program Overview
  • Multidimensional Family Therapy is an intensive
    in-home program. MDFT focuses on several core
    areas of the teen's life simultaneously -
    parents, schools, other family members and the
    community. The program also helps the family
    understand the connections between drug use,
    criminal behavior and mental health.
  • During treatment, skills are learned which
    enhance
  • Positive peer relations Healthy self-esteem
    Connection to school and community activities
    Increased autonomy Emotional connection to
    family members
  • Parents and family members are also involved by
    learning and applying skills which
  • Improve the relationship with their child or
    sibling Increase their knowledge of successful
    parenting practices Improve day-to-day and
    intimate communication
  • Program Targets
  • Adolescents ages 11-18 at risk for drug
    addiction.

36
Multidimensional Family Therapy (MDFT)
  • Current Number of MDFT Teams in Connecticut
  • 9 (DCF)
  • Current Number of MDFT Specialty Teams
  • 5 (DCF)
  • Current Capacity for Children Served
  • 395 (DCF)
  • 395 Total Capacity

37
Functional Family Therapy (FFT)
  • Program Overview
  • The FFT clinical model is identifies specific
    phases which organize intervention in a coherent
    manner, thereby allowing clinicians to maintain
    focus in the context of considerable family and
    individual disruption. Each phase includes
    specific goals, assessment foci, specific
    techniques of intervention, and therapist skills
    necessary for success. Interventions focus on
    engagement/motivation, behavior change and
    generalization of new behaviors and skills.
  • Program Targets
  • Youth ages 10-18, and their families, whose
    problems range from acting out to conduct
    disorder to alcohol/substance abuse.

38
Functional Family Therapy (FFT)
  • Current Number of FFT Teams in Connecticut
  • 4 (DCF)
  • Current Capacity for Children Served
  • 432 (DCF)
  • 432 Total Capacity

39
Brief Strategic Family Therapy (BSFT)
  • Program Overview
  • Brief Strategic Family Therapy (BSFT) is a
    problem-focused, and practical approach to the
    elimination of substance abuse risk factors. It
    successfully reduces problem behaviors in
    children and adolescents and strengthens their
    families. BSFT provides families with tools to
    decrease individual and family risk factors
    through focused interventions that improve
    problematic family relations and skill building
    strategies that strengthen families.
  • BSFT fosters parental leadership, appropriate
    parental involvement, mutual support among
    parenting figures, family communication, problem
    solving, clear rules and consequences, nurturing,
    and shared responsibility for family problems. In
    addition, the program provides specialized
    outreach strategies to bring families into
    therapy.
  • Program Targets
  • Children and adolescents, 6 to 17 years with
    conduct problems associations with anti-social
    peers substance use
  • and problematic family relations.

40
Brief Strategic Family Therapy (BSFT)
  • Current Number of BSFT Slots in Connecticut
  • 180 (CSSD)
  • Current Capacity for Children Served
  • 450 (CSSD)
  • 450 Total Capacity

41
Multidimensional Treatment Foster Care (MTFC)
  • Program Overview
  • The goal of the MTFC program is to decrease
    problem behavior and to increase developmentally
    appropriate normative and pro-social behavior in
    children and adolescents who are in need of
    out-of-home placement. Youth come to MTFC via
    referrals from the juvenile justice, foster care,
    and mental health systems.
  • MTFC treatment goals are accomplished by
    providing
  • Close supervision fair and consistent limits
    predictable consequences for rule breaking a
    supportive relationship with at least one
    mentoring adult and reduced exposure to peers
    with similar problems.
  • The intervention is multifaceted and occurs in
    multiple settings. The intervention components
    include
  • Behavioral parent training and support for MTFC
    foster parents family therapy for biological
    parents (or other aftercare resources) skills
    training for youth supportive therapy for youth
    school-based behavioral interventions and
    academic support and psychiatric consultation
    and medication management, when needed.

42
Multidimensional Treatment Foster Care (MTFC)
-continued
  • Program Targets
  • Children in the foster care system with multiple
    familial and behavioral concerns.
  • Three forms of MTFC
  • MTFC-P For preschool-aged children (3-5 years)
  • MTFC-L For latency-aged children (6-11 years)
  • MTFC-A For adolescents (12-18 years)

43
Multidimensional Treatment Foster Care (MTFC)
  • Current Number of MTFC Teams in Connecticut
  • 3 (DCF)
  • Current Capacity for Children Served
  • 30 (DCF)
  • 30 Total Capacity

44
Intensive In-home Child and Adolescent
Psychiatric Services (IICAPS)
  • Program Overview
  • IICAPS is a Yale University model created to meet
    the comprehensive needs of children with severe
    psychiatric disorders.  The program makes use of
    a consistent treatment team to provide
    comprehensive assessments, case management,
    individual and family treatment, and crisis
    intervention. Intervention is informed by a
    synthesis of the medical model, development
    psychopathology, systems theory, and wraparound
    concepts.  
  • Program Targets
  • Children appropriate for IICAPS intervention may
    be returning home from psychiatric
    hospitalization, at-risk for institutionalization
    or hospitalization, or unable to benefit from
    traditional outpatient treatment. 

45
Intensive In-home Child and Adolescent
Psychiatric Services (IICAPS)
  • Current Number of IICAPS programs in Connecticut
  • 14 (DCF)
  • 5 (CSSD)
  • Current Capacity for Children Served
  • 598 (DCF)
  • 90 (CSSD)
  • 688 Total Capacity

46
(No Transcript)
47
Bottom LineAlmost 2,900 children and
adolescents currently receive evidence-based
practices through DCF and CSSD annually in
Connecticut.
48
Lessons learned from
MST Implementation
49
Connecticut Evidence-Based Practices System of
Care Development
  • Systems Changes
  • Economic Changes
  • Consumer Changes
  • Practice Changes
  • Quality Improvement

50
Lessons learned from
MST Implementation
  • Ongoing Progress Report being conducted by
    Connecticut Center for Effective Practice
  • Examining quantitative outcomes of over 1,000
    youth receiving MST services through DCF and CSSD
  • Examining qualitative outcomes and implementation
    factors for families, providers, agency staff,
    probation officers, judges and others (over 30
    focus groups).
  • Report with lessons learned available in July
    2007.

51
Lessons learned from
MST Implementation
  • Preliminary results show positive outcomes and
    reduction in recidivism
  • Ultimate Outcomes N 1,000
  • Living at Home 73.5
  • Attending School 76.1
  • Not Arrested 73.1

52
Lessons Learned
  • Must invest in Quality Assurance and Quality
    Improvement of services
  • Must build capacity, invest in ongoing training
    of workforce, and provide ongoing technical
    assistance to providers
  • Fidelity to treatment models is key to successful
    outcomes
  • Outcomes data should be shared with parents and
    stakeholders

53
Summary
  • Evidence-based practices are best means of
    helping juvenile justice youth.
  • A range of evidence-base practices exist as
    alternatives to detention/incarceration of youth
    in the justice system.
  • These practices have demonstrated positive
    results nationally (including in youth ages
    16-18)
  • Connecticut already has a range of excellent
    juvenile justice services in place that can be
    expanded
  • Ongoing need for training and technical support
    of providers, attention to implementation and
    fidelity and ongoing evaluation and quality
    assurance of programs.

54
QUESTIONS?
  • Bob Franks, Ph.D.
  • Director
  • Connecticut Center for Effective Practice (CCEP)
  • rfranks_at_uchc.edu
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