Serving Our Most Vulnerable Children SHIRLEY PITTZ, M.S.

ALASKA AGE: 0-3 = = = = = = 411 RACE: African/America = 20 AI/Alaska Native = 1275 Asian = 16 Hispanic = 77 Multi-Race = 236 Pacific Islander = 24 White = 442 Unknown = 358 Total = 2448 TYPES OF MALTREATMENT: Medical Neglect = 59 Neglect = 2,295 Physical Abuse = 385 Psychologic Abuse = 583 Sexual Abuse = 583 Child Maltreatment 2013, ACF, Children’s Bureau

Source: AMHB/ABADA staff prepared this slidehttp://dhss.alaska.gov/ocs/Pages/statistics/gender.aspx

Source: AMHB/ABADA staff prepared this slidehttp://dhss.alaska.gov/ocs/Pages/statistics/gender.aspx

Division of Behavioral Health Data Total Served Ages 0-8 (AKAIMS+EDI) SFY 2011 SFY 2012 SFY 2013 SFY 2014 SFY years years ,040 1,096 1,042 Total 1,173 1,210 1,315 1,363 1,288 Source from Kathleen Carls, DBH, Research Analyst IV

National Survey of Child and Adolescent Well-Being (NSCAW) Children with Substantiated and Unsubstantiated Reports of Child Maltreatment are at Similar Risk for Poor Outcomes (NSCAW II) Children Placed Outside the Home and Children Who Remain In-Home after a Maltreatment Investigation Have Similar and Extensive Service Needs (NSCAW II) Children in Out-of-Home Placements Receive More Psychotropic Medications and Other Mental Health Services than Children Who Remain In-Home Following a Maltreatment Investigation (NSCAW II) More than One Quarter of Children Placed Out of Home Experience Placement Disruption in the First 18 Months After a Maltreatment Investigation (NSCAW II) Caregivers of Children Who Remain In home After a Maltreatment Investigation Need Services (NSCAW II) Parents Reported for Maltreatment Experience High Rates of Domestic Violence (NSCAW II) Published April 24, 2013

Impacts of Maltreatment Neurological Impact Traumatic Impact Behavioral Impact Relational Competence Mental Health Psychotropics

Transformation in Child Welfare How can we develop a more integrated and developmentally specific approach in child welfare to improve both child and system level outcomes? How can we effectively integrate an emphasis on well-being into the goal of achieving safety, permanency and well-being for every child? What can we do to build children’s capacity to function in a complex world and negotiate the challenges of life? Safety + Permanency + Well-Being

A Well-Being Framework Four Basic Domains of Well Being: 1)Cognitive Functioning 2)Physical Health and Development 3)Behavioral/emotional Functioning 4)Social Functioning Varies according to age or developmental status of child Takes into account contextual factors, internal and external to the child – family income, community organization, personal characteristics Lou, Anthony, Stone, Vu, & Austin (2008)

DISTAL INFLUENCES PROXIMAL INFLUENCES BIOLOGICAL MEDIATORS PRIMARY OUTCOMES Income & Resources Family Influences Neurological Development Academic Performance Social Cohesion School Influences Stress Reactivity Social & Emotional Competence Physical Environment Peer Influences Absence of Psychological & Behavioral Problems Physical Health Promise Neighborhoods Research Consortium (2011)

Developmental PhaseSocial & Emotional CompetencePsychological & Behavioral Development Prenatal- infancy (birth to age 2) Social/emotional development; attachment Self awareness develops; behavioral development Early childhood (3-5) Self-regulation; emotional symptoms; social relations; prosocial behavior, skills, attitudes Self-concept develops; behavioral development; attentional and hyperactivity difficulties; conduct problems Childhood (6-11) Plus: gradual shift in control from parents to child; peers assume more central role Plus: Self-concept becomes more complex; disruptive and aggressive behavior; depressive symptoms Early adolescence (12-14) Plus: central role of peer group, identity formation Plus: violent behaviors; drug use; risky sexual behaviors Adolescence (15-19) Plus: moral development; intimacy development Same as above

How children make sense of what happens to them; develop perceptions of fairness and opportunity; and create concepts of normalcy. Understanding Experiences Development can be impacted by adverse experiences that cause delays, distortions, or regressions in acquiring regular competencies. Developmental Tasks The array of strategies available to a child to respond to adverse experiences both in the short-term and the long- term. Coping Strategies Environmental Buffers Social and familial contexts that alter how adverse experience will impact children.

Federal Efforts to Elevate Well-Being Ensure educational stability for children and youth in foster care Place siblings together whenever appropriate Improve health care access and coordination Increase incentives to promote adoption and extend support for older youth aging out (including continuing foster care to age 21 for certain youth) Address developmental needs of children in their child welfare plans Focus on improving the behavioral and social-emotional outcomes of maltreated children and youth

A Well-Being Agenda: 1.Responding to the needs of trauma exposed children 2.Promoting expectations and opportunities for positive development for children and youth in foster care 3.Adopting strategies to integrate knowledge of and approaches to building protective and promotive factors into services and supports for children and families Raising the Bar: Child Welfare’s Shift Toward Well-Being, Center for Study of Social Policy, July 2013

Responding to the Needs of Trauma Exposed Children o Provide training in trauma-informed care o Connect families to appropriate mental health service providers o Minimize further traumatization of children in the child welfare system o Consider parents’ trauma histories Raising the Bar: Child Welfare’s Shift Toward Well-Being, Center for Study of Social Policy, July 2013

Promoting Positive Development for Children and Youth Receiving Child Welfare Services o Identify and address developmental needs o Promote improved health outcomes for children in foster care o Provide supplemental developmental supports when needed o Promote positive educational outcomes for children in foster care o Support bonding and attachment during out-of-home placement Raising the Bar: Child Welfare’s Shift Toward Well-Being, Center for Study of Social Policy, July 2013

o Tailor supports to meet each child’s particular needs o Ensure that children are also getting access to “normal” developmental opportunities o Develop plans, backed by data for promoting the well-being of children, including subpopulations that are the greatest risk for poor outcomes o Advocate for multi-agency responses to meeting children’s needs o Support opportunities for court personnel training Raising the Bar: Child Welfare’s Shift Toward Well-Being, Center for the Study of Social Policy, July 2013

Working From a Protective & Promotive Factors Framework o Integrate a protective factors approach into case practice models o Use protective factors as a framework for guiding, contracted providers o Use protective factors framework for developing new partnerships between child welfare and other child, youth and family servicing systems Raising the Bar: Child Welfare’s Shift Toward Well-Being, Center for Study of Social Policy, July 2013

Caregiver Needs & Intervention Areas Intergenerational Trauma Most Common Issues: Alcohol Abuse Drug Abuse Domestic Violence Mental Health Problems Building a Nurturing Environment

the protective factors framework parental resilience social connections knowledge of parenting and child development concrete support in times of need social and emotional competence

Secondary Traumatic Stress “Studies show that from 6% to 26% of therapists working with traumatized populations, and up to 50% of child welfare workers, are at high risk of secondary traumatic stress or the related conditions of PTSD and vicarious trauma. “ Secondary Traumatic Stress: A Fact Sheet for Child-Serving Professionals, The National Child Traumatic Stress Network

Shifts in Thinking  A “trauma lens”  Shift in goals– Safety, Permanency, and Well-Being  Importance of collaboration  Focus on early intervention  Approach to families  Awareness of intergenerational trauma  Awareness of secondary traumatic stress

Understanding Experiences Developmental Tasks Environmental Buffers Coping Strategies Healing and Recovery When adverse experiences do occur, child and family-serving systems can facilitate health and recovery with approaches that build protective mechanisms with children and their families to get children back on track.