Children without Placement: Facilitating Safe Alternatives Erica Balderrama, MSW, Dr. Candyce Berger, PhD, MSW, and Virginia Martinez, LCSW The University of Texas at El Paso Child Welfare Training Collaborative (CWTC)

Nature of the Problem: National Perspective Nationally, seen an increase from 397,000 (2012) to 415,000 (2014) = 4.5% increase The declining availability of foster homes has created a crisis in available foster care placements Possible causes: Increase in foster children while available foster beds declining Difficulty recruiting and training potential families Difficulty of recruiting young generation of foster parents Retirement of older foster parents (Baby Boomers) In one state, experienced a drop in the number of foster beds of unrelated foster parents from 22,000 – 9,000 Nature of the Problem: National Perspective

Nature of the Problem: Texas CPS reported an increase in the number of kids without foster placement Steady decline in the number of approved foster homes The lack of foster homes resulted in children being placed in alternative locations Placed in CPS offices Placed in hotels 178 CPS staff were required to provide 24-hour supervision 7 days a week CPS staff not sufficiently prepared to provide the level of care or manage behavioral issues Conservatorship (CVS) personnel qualified but only represented x% of those provided care Nature of the Problem: Texas

Nature of the Problem: Texas Behavioral and medical challenges surfaced that created concern for compliance and safety: Runaways Children with special needs (e.g., autism, mental health diagnoses, and trauma) Children requiring medications (e.g., psychotropic medications, medical conditions such as asthma and allergies) Medical appointment schedules Dietary requirements Demographics of the CWOP population: Age range = 4-17 yrs. Length of stay in alternative setting = 7-10 days Average occupancy = 9 children Nature of the Problem: Texas

In a Title IV-E Steering Committee (Region 10 CPS and UTEP) meeting the problem of CWOP was identified A decision was made to provide mandatory training to ALL staff designated to provide supervision for CWOP Crisis Intervention and De-Escalation chosen as the theoretical underpinning of the training Contracted with El Paso Child Guidance Center for training: Social worker (LCSW), Psychiatrist, and Licensed Professional Counselor (LPC) Design of the Project

Prior to the training, CPS addressed systemic and some educational issues that created challenges for staff providing CWOP supervision (e.g., communication, creating a medication log, and self-care strategies to decrease burnout) Outsourcing of Family Based Safety Services (FBSS) decreased available staff Design of Project

As a result of the planning sessions, the following decisions were made: Title: “Crisis Intervention & De-Escalation: Working with Children without Placement (CWOP)” Objectives: Learn the impact of exposure to trauma in children & adolescents Learn trauma-informed care principles & how to apply them to working with children & adolescents without placement Learn methods for working with children & adolescents to prevent escalation Learn de-escalation techniques in working with children without placement Design of Project

Organization of Training The training was held in a local CPS office to accommodate all regional staff (214) Venue accommodated up to 70 with 8 per table Was provided in 4 half-day sessions within a one week period Separated into 2-hour blocks: First 2 hours = LCSW/LPC presented Last 2 hours = Psychiatrist presented Training focused on Crisis Intervention & De-Escalation Interactive (group work) Video illustrations of case scenarios and discussion A folder with handouts provided information on: PowerPoint Pointers on therapeutic techniques Policies Referral links Organization of Training

Training was provided to a total of 209 Department of Family and Protective Services (DFPS) Child Protective Services (CPS) staff out of a total of 214 staff (98%) members Of those 209, 178 staff (85%) were designated to provide child watch duties 28 staff (16%) management level 150 staff (84%) caseworkers Implementation:

Evaluation Methodology Each of the 4 half-day sessions were provided with the satisfaction survey from UTEP An additional satisfaction evaluation was provided by the El Paso Child Guidance Center An overall satisfaction evaluation report was developed from all 4 sessions from the responses from UTEP’s evaluation Evaluation Methodology

Content of Evaluation Forms: State mandated satisfaction survey (Likert-Scale responses: Strongly Agree to Strongly Disagree excluding “Neutral”) UTEP is contracted to provide trainings that will yield at least a 90% satisfaction rating Divided into 5 categories ranging from 1-6 questions per category Course Material & Presentation Trainer Application of Course Content Overall Satisfaction Comments Content of Evaluation Forms:

Evaluation Findings: “Course Material & Presentation” Overall satisfaction rating of course materials & presentation 98%

Evaluation Findings: “Trainer” Overall satisfaction of trainer = 99%

Evaluation Findings: “Application of Course Content” Overall satisfaction of application of course content = 96%

Evaluation Findings: “Overall Satisfaction” Overall satisfaction rating = 98%

Evaluation Findings: “Comments” Comments by the staff provided feedback that was both positive and negative, suggesting ways in which to better improve the training for the future and suggestions for others who might benefit from attending this training Examples of Comments: “This training was very helpful. I learned so much. I will use this material for my next CWOP. Thank you.” “This should have been a whole day training” “Great training! The material was very informative although it was based on trauma and I wanted more understanding about CWOP rules & regs. Loved the training” “I think the training is directed more to children that are acute and in need of hospitalization and not a child who needs basic needs” Evaluation Findings: “Comments”

Evaluation Findings: “Comments” Comments Continued “Excellent exercises. I texted my daughter to show her about right/wrong consequences” “Foster parents should be given the training on de- escalation” “Should be offered to teachers as well” “Really enjoyed the training provided. I feel that the training has improved my skills & knowledge of working with children who are under our care” “We were already aware of what was trained today and practice this. More examples of children in our care de- escalation needed in lieu of Dr.’s patients. His examples of child on CWOP getting up would not work with CWOP kids” Evaluation Findings: “Comments”

The CWOP Training Program is only a band aid to the real crisis As long as there are children without available foster beds, those providing the temporary supervision need the skills necessary to provide a safe and caring environment for these children The real challenge is how to expand the number of available foster beds to meet the growth in the number of foster children – suggestions from the literature Strategies focused on recruitment and retention Streamlining the approval of kinship foster placements Improving the relationship between foster parents and CPS staff Conclusion: