Bryan Samuels, Executive Director The Intersection of Safety, Permanency and Child Well-Being Bryan Samuels, Executive Director

CHILDREN IN FOSTER CARE ON 9/30

STATE CHANGES IN CASELOADS: Data Source: Adoption and Foster Care Analysis and Reporting System, U.S. Department of Health and Human Services

WELL-BEING CHALLENGES AMONG CHILDREN KNOWN TO CHILD WELFARE Dolan, M., Casanueva, C., Smith, K., & Ringeisen, H. (2011). NSCAW Child Well-Being Spotlight: Children Placed Outside the Home and Children Who Remain In-Home after a Maltreatment Investigation Have Similar and Extensive Service Needs. OPRE Report # , Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

EMOTIONAL AND SOCIAL CAPACITIES ARE INEXTRICABLY INTERTWINED WITHIN THE ARCHITECTURE OF THE BRAIN

TRAUMA’S IMPACT ON SOCIAL AND EMOTIONAL FUNCTIONING AND RESULTS IN POOR OUTCOMES Toxic Stress, Trauma, Community Violence, Abusive or Neglectful Parenting Insecure Attachments, Emotional Dysregulation, Negative Internal Working Models Maladaptive Coping Strategies Poor Social Functioning, Disturbed Peer Relationships Psychological Distress Poor Outcomes for Children and Families

PERMANENCY IS INSUFFICIENT FOR ACHIEVING LONG-TERM POSITIVE OUTCOMES REUNIFICATION OUTCOMES Following reunification, children are more likely to have increases in both externalizing problems, such as aggression and delinquency, and internalizing problems, such as depression and acting withdrawn. This is likely the result of increased exposure to risk factors and decreased system supports. KINSHIP CARE OUTCOMES Children who spent all of their time in foster care living with relatives have almost identical rates of mental health diagnoses later in life as children in foster care who never lived with relatives. For both groups, the rates of diagnoses are much higher than the general population. ADOPTION OUTCOMES Following adoption, children have high levels of mental health problems. 2, 4, and 6 years following adoption, anxiety, depression, and ADHD increase steadily. Rates of difficulty among children adopted from public child welfare are similar to those among children adopted from private agencies. Bellamy, 2008.Roller White et all, 2007.Simmel et al, 2007.

RESEARCH IS FRAGMENTED… Education Medicine Child Welfare Mental Health Juvenile Justice Neuroscience …AND NOT ALIGNED

A SHARED FRAMEWORK ALIGNS THE BEST KNOWLEDGE AND MOVES US IN A COMMON DIRECTION Child Welfare Neuroscience Medicine Education Juvenile Justice Mental Health SOCIAL & EMOTIONAL WELL-BEING FOR CHILDREN AND YOUTH EXPOSED TO ABUSE, NEGLECT, and VIOLENCE

INTEGRATING WELL-BEING WITH SAFETY AND PERMANENCY WELL-BEING PERMANENCYSAFETY

A FRAMEWORK FOR WELL-BEING Environmental Supports Personal Characteristics Developmental Stage (e.g., early childhood, latency) Within each domain, the characteristics of healthy functioning relate directly to how children and youth navigate their daily lives: how they engage in relationships, cope with challenges, and handle responsibilities. Cognitive Functioning Physical Health and Development Emotional/ Behavioral Functioning Social Functioning

THE FRAMEWORK IN PRACTICE: OUTCOME DOMAINS BEYOND SAFETY AND PERMANENCE Intermediate Outcome DomainsWell-Being Outcome Domains Environmental SupportsPersonal CharacteristicsCognitive FunctioningPhysical Health and Development Emotional/Behavioral Functioning Social Functioning Infancy (0-2) Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Temperament, cognitive ability Language developmentNormative standards for growth and development, gross motor and fine motor skills, overall health, BMI Self-control, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms Social competencies, attachment and caregiver relationships, adaptive behavior Early Childhood (3-5) Family income, family social capital, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Temperament, cognitive ability Language development, pre- academic skills (e.g., numeracy), approaches to learning, problem-solving skills Normative standards for growth and development, gross motor and fine motor skills, overall health, BMI Self-control, self-esteem, emotional management and expression, internalizing and externalizing behaviors, trauma symptoms Social competencies, attachment and caregiver relationships, adaptive behavior Middle Childhood (6-12) Family income, family social capital, social support, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Identity development, self- concept, self-esteem, self- efficacy, cognitive ability Academic achievement, school engagement, school attachment, problem-solving skills, decision-making Normative standards for growth and development, overall health, BMI, risk- avoidance behavior related to health Emotional intelligence, self- efficacy, motivation, self- control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms Social competencies, social connections and relationships, social skills, adaptive behavior Adolescence (13-18) Family income, family social capital, social support, community factors (e.g., institutional resources, collective socialization, community organization, neighborhood SES) Identity development, self- concept, self-esteem, self- efficacy, cognitive ability Academic achievement, school engagement, school attachment, problem solving skills, decision-making Overall health, BMI, risk- avoidance behavior related to health Emotional intelligence, self- efficacy, motivation, self- control, prosocial behavior, positive outlook, coping, internalizing and externalizing behaviors, trauma symptoms Social competence, social connections and relationships, social skills, adaptive behavior Social and Emotional Well-Being Domains

ESTABLISHING THE RIGHT EVIDENCE-BASED SERVICE ARRAY TO SUPPORT WELL BEING Functional Assessment Evidence-Based Trauma, Mental Health & Parenting Interventions Trauma Screening Generic Counseling Anger Management Parenting Classes RESEARCH- AND EVIDENCE BASED APPROACHES INEFFECTIVE APPROACHES De-scaling what doesn’t work Investing in what does De-scaling what doesn’t work, scaling up what does

USING MEDICAID TO INTEGRATING SAFETY, PERMANENCY AND WELL-BEING Early Periodic Screening Diagnosis and Treatment State Plan Services, including preventive services, described in section 1905(b) of SSA Alternative Benefit Plans Home and Community-Based Services Health Home – central coordination for health services Managed Care Integrated Care Models Section 1115 Research and Demonstration Programs Multiple Medicaid vehicles allow for identification and treatment of complex trauma:

Well Being Focus on child & family level outcomes Monitor progress for improved child/youth functioning Change Child Welfare practice to address impact of trauma Take developmental specific approach Actively promote healthy relationships Build capacity to deliver Evidence Based Practices PRACTICES BEYOND SAFETY AND PERMANENCE TO IMPROVE OUTCOMES “Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the negative impacts of early fear learning.” National Scientific Council on the Developing Child (2010)

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