Promoting EBPs and Systems Integration in Community Settings Targeting the needs of Parents & Young Children Strengthening Society through Stronger Parenting: Integrating Evidence-Based Parenting Programs into Public Health Systems September 28, 2018 Margo Candelaria, PhD & Kate Wasserman, MSW, LCSW-C Co-Directors Parent, Infant, Early Childhood (PIEC) Program University of Maryland School of Social Work Institute for Innovation & Implementation

Objectives – Within 20 Minutes  Describe University of Maryland SSW efforts to support community-based systems implementation of best practices to address the needs of pregnant folks, parenting folks, and folks that are 0 – 5. Understand the considerations, facilitators and barriers supporting in integrated systemic approach to EBPs in the community.

SAMHSA’s Behavioral Health Continuum of Care Model Based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes the following components: Promotion — Strategies designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. Prevention — Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem. Treatment — Services for people diagnosed with a mental health condition or disorder. Recovery — Services to support individuals’ abilities to live productive lives in the community following treatment.

As a collaborative initiative, BRIDGE is led by the Charles County LMB with the University of Maryland SSW and is set out to achieve the following: Create a tiered model of early childhood services delivered within community and natural settings as well as clinic based services Fund evidence-based direct services to address mental health concerns in children birth to 5 and their families, Create a replicable early childhood training and workforce development model, Create a social marketing campaign to engage families in services, Create a replicable and sustainable financing model for delivering services.

BRIDGE Partnerships & Service Array

BRIDGE Tiered Targeted Services COS-P & Parent Cafes ABC & PCIT CPP 1 2 3 In addition to the targeted tiers of EBPs offered, BRIDGE funds support Care Coordination (COMAR – Targeted Case Management) for the birth – 5 population in the tri-county area as well as the development and implementation of an “Enhanced ECMH Consultation” model, adding clinical assessment an in-home supports to families of children served by the model in childcare settings. Both CCO & E-ECMHC are intended to serve the needs of children and families across the three tiers of service intensity.

What does an integrated service array look like? Services + Infrastructure = Integrated System

BRIDGE SOC Workforce Impact 93 members of the workforce trained in EBPs Training and technical assistance in ECSII, DC 0-5, competencies in IECMH 5 state and local agencies infused with IECMH EBPs 4 different setting types that the work is delivered [MH Clinics, home-based, childcare centered, community setting anchored (CCO)]

100 Families Served in 2 years

To create good outcomes for children we need to support adults. Two-generation approaches recognize that the child is experiencing ACEs now and the caregiver likely experienced ACEs in their own early years.

Benefits of integrated services Workforce competencies increase Increased communication, cross pollination of disciplines = greater understanding of the child & family needs. Leads to less confusion on parent’s part Provider A and B giving differing sometime conflictual advice! Reduces stigma Reduces family burden of multiple visits, locations, appointments, etc.

Peer Support & Family Navigation

Parent Infant Early Childhood System of Care Workforce Competencies Considerations for PIEC SOCs: KNOWLEDGE BASE: Knowledge and experience across the PIEC landscape: including attachment, trauma, parenting, development, dyadic interactions, lifespan mental health. ASSESSMENT AND DIAGNOSIS: Specialized clinical skills required to support competence in data-based assessment, treatment & diagnosis of children 0-8. DIADIC + MULTIGENERATIONAL SKILLS: PIEC SOC workforce needs skills in both adult and child assessment, treatment options and systems. Potential Outcomes: KNOWLEDGE BASE: Increased dissemination of information including basic science, developmental trajectories, interventions and treatment models, and systems infused in undergraduate and graduate curriculum as well as post-graduate training. ASSESSMENT AND DIAGNOSIS: Specialized, targeted training needed to promote competence and increase earlier identification, increased access, and adequate skilled workforce across adult and child settings. DIADIC + MULTIGENERATIONAL SKILLS: PIEC SOC workforce has competence and presence in both adult and child assessment and treatment settings. COMMUNITIES OF PRACTICE & ONGOING TA to facilitate best practices in EBPS and reflective supervision and promote the integration of community partnerships.

Parent Infant Early Childhood System of Care Access Point Considerations for PIEC SOCs: Unique focus on prevention, promotion, and early identification. Unique challenges of caregivers often needing help formulating a question about what help they need due to variable early development. Very young children typically not yet linked to formal services or systems, so engagement focused on parent. Multiple opportunities for service entry, yet family is often unclear of what is available, where to go and who to ask. Potential Outcomes: Many, coordinated access points: Coordinated screening starting prenatally thorough school entry for both children and caregivers that facilitates proper referral and system engagement. Multiple points of entry should be made available, anchored in a range of community and natural settings within both adult and child agencies across the PIEC landscape. Service teams and service planning that is regularly coordinated and considers dyadic multigenerational needs. Community partnership that facilitate coordination of care and services across the PIEC landscape. Coordinated financing that allows for integrated partnerships through systems. Family navigation and care coordination to help facilitate sustained engagement in supports.

Parent Infant Early Childhood System of Care Intergenerational Approach Family Driven Individualized Strengths-Based Approach Least Restrictive Environment Co-located Services Culturally Responsive Evidence-Informed Promising Practices Data & Accountability Coordinated Service Array Braided Financing Across Adult & Child Systems, Un-Siloing Behavioral & Physical Health Principles: Access and address needs of entire family unit (defined family) Interventions focus on caregiver competence & confidence Trauma Responsive Data-Informed decision making & care planning Family Peer Support Integration of Services & Service Teams Services Anchored in Community Settings and Across Developmental Lifespan Universal -------- Promotion ------- Prevention --------- Intervention ------ Recovery/Maintenance Prenatal -------- Postpartum ------- Infancy -------- Toddler ------ Preschool ------- Early Elementary

Parent Infant Early Childhood System of Care Behavioral Health Physical Health Adult Services Early Childhood Services Target

Discussion & Questions mcandaleria@ssw. umaryland. edu kate Discussion & Questions mcandaleria@ssw.umaryland.edu kate.wasserman@ssw.umaryland.edu