June 2021 – December 2021
The Wisconsin Public Child Welfare and Home Visiting Data Project was a rapid cycle analysis conducted to help inform Wisconsin’s IV-E service planning process. Using eight years of administrative records, we examined the risk profiles of families who received a screened-in CPS report during their time...
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Children thrive when they have regular interactions with responsive, caring adults. Families experiencing significant stressors related to financial insecurity, housing instability, or the impact of systemic and interpersonal trauma can be overloaded with stress, interrupting those interactions. Families that are experiencing this overload of stress are at greater risk for having neglect identified as a threat to their child(ren)’s safety. If we ensure that communities are equipped to ease the burden on overloaded families, we make resilience a real possibility.
Neglect is cited as the primary or contributing reason for 73% of family separations into foster care nationally and 68% here in Wisconsin. Neglect is frequently defined as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being are threatened with harm[1]. Children who experience the trauma of family separation for reasons of neglect are more likely than not to return home. Overloaded families are left vulnerable by systems that are misaligned to meeting their basic necessities. Poverty, trauma, and systemic racism are some of the deep seeded root causes to this inequity. We believe that there are pathways forward to preventing a significant portion of these separations from happening.
The conditions that lead to family separations for reasons of neglect are complex, extending beyond any single system or solution. The goal of the Strong Families, Thriving Children, Connected Communities (SFTCCC) initiative is to reduce the number of family separations for reasons of neglect by building a community focused on collaboratively pursuing policies and practices that support overloaded families and address systemic failings. SFTCCC is a developmental strategy at its core, recognizing that more can be accomplished through shared learning and action to address the drivers of systems change that either hold the conditions that contribute to neglect in place or provide scaffolding for progress.
Children’s ICFW team will strive to support programs, organizations, and communities to collaborate on solutions and generate knowledge to address these complex challenges families overloaded by stress face before safety threats emerge. By elevating the latest thinking and resources we hope to foster a community of changemakers, support shared learning, expand their networks, and inspire innovation and collaboration.
To learn more and sign up to get involved, please visit the SFTCCC project page.
[1] For a further discussion about what constitutes child neglect, see Child Welfare Information Gateway’s Acts of omission: An Overview of Child Neglect.
The mission of the Institute for Child and Family Well-Being is to improve the lives of children and families with complex challenges by implementing effective programs, conducting cutting-edge research, engaging communities, and promoting systems change.
The Institute for Child and Family Well-Being is a collaboration between Children’s Wisconsin and the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The shared values and strengths of this academic-community partnership are reflected in the Institute’s three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
Meet Our Translational Design Coordinator – Megan Frederick-Usoh
The ICFW recently created a new position, Translational Design Coordinator, to support both a strategic and operational evolution within our design and capacity-building projects. We are excited to announce that Megan Frederick-Usoh has recently joined our team in this new role.
Megan has over 16 years of experience in public health and child welfare. She has worked in both the for-profit and non-profit sectors in foster care, injury prevention and with adults with intellectual and developmental disabilities. Megan began her tenure with Children’s Wisconsin in 2019 as a Treatment Foster Care Recruiter and Educator, with an additional focus on program evaluation. She earned a Bachelor of Arts degree in Psychology, Political Science and Criminal Justice from the University of Tennessee, Honors College-Knoxville.
Meet Our Predoctoral Fellows
The ICFW recently launched a predoctoral fellowship training program that will provide mentorship and funding to doctoral students whose research can be applied to promote better and more equitable outcomes for children and families. We are proud to announce the selection of two predoctoral fellows for 2022: Darejan Dvalishvili and Anthony Gómez.
Darejan Dvalishvili is a predoctoral fellow at the Institute for Child and Family Well-Being. She is completing her Ph.D. in social work at Washington University in St. Louis. Her research focuses on intersections of poverty, child maltreatment, and adverse childhood experiences. Following her work with UNICEF and other international and local non-profit organizations, her interests include exploring the impact of various economic interventions on children’s wellbeing both in the US and globally. Darejan earned an MSW from Columbia University (New York, US) and an MD from Tbilisi State Medical University (Tbilisi, Republic of Georgia).
Anthony Gómez is a predoctoral fellow at the Institute for Child and Family Well-Being. Anthony’s research broadly focuses on child and family well-being, and its relationship to the child welfare system. Driven by professional experience working in early education and child welfare, he is interested in understanding how service systems can better fulfill the material and emotional needs of parents and caregivers, and in turn, how such support can improve parenting, mental health, and child development outcomes. Anthony holds a master’s degree in social welfare from UCLA and is currently a doctoral student at the UC Berkeley School of Social Welfare.
Meet our Parent Child Interaction Therapy (PCIT) Trainer Team
During the past month, our Parent Child Interaction Therapy Trainer Team of Dimitri Topitzes and Leah Cerwin has begun delivering the PCIT International Within Agency Trainer (WATer) training to our team member, Meghan Christian. Dimitri became a in 2020, a distinction held by less than fifty PCIT therapists globally, and Leah became a in 2019. We are excited to add Meghan to our training team, so that we may train more clinicians within Children’s and across the state in order to provide greater access to this effective therapy for children and their caregivers.
The Institute accelerates the process of translating knowledge into direct practices, programs and policies that promote health and well-being, and provides analytic, data management and grant-writing support.
Recent ICFW Publications
Effects of COVID-19 on Home Visiting Services for Vulnerable Families
ICFW faculty published a multi-state study that documented the toll of the pandemic on home visiting programs that offer services and support to new and expectant parents. Compared to pre-pandemic levels, post-COVID enrollments decreased by 33–36% and total visits fell by 15–24%. These findings are especially concerning given the vital role that these programs play in supporting children and families from more vulnerable and marginalized populations.
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
Strong Families, Thriving Children, Connected Communities Initiative
Children thrive when they have regular interactions with responsive, caring adults. Families experiencing significant stressors related to financial insecurity, housing instability, or the impact of systemic and interpersonal trauma can be overloaded with stress, interrupting those interactions. Families that are experiencing this overload of stress are at greater risk for having neglect identified as a threat to their child(ren)’s safety. If we ensure that communities are equipped to ease the burden on overloaded families, we make resilience a real possibility.
Neglect is cited as the primary or contributing reason for 73% of family separations into foster care nationally and 68% here in Wisconsin. Neglect is frequently defined as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child’s health, safety, and well-being are threatened with harm[1]. Children who experience the trauma of family separation for reasons of neglect are more likely than not to return home. Overloaded families are left vulnerable by systems that are misaligned to meeting their basic necessities. Poverty, trauma, and systemic racism are some of the deep seeded root causes to this inequity. We believe that there are pathways forward to preventing a significant portion of these separations from happening.
The conditions that lead to family separations for reasons of neglect are complex, extending beyond any single system or solution. The goal of the Strong Families, Thriving Children, Connected Communities (SFTCCC) initiative is to reduce the number of family separations for reasons of neglect by building a community focused on collaboratively pursuing policies and practices that support overloaded families and address systemic failings. SFTCCC is a developmental strategy at its core, recognizing that more can be accomplished through shared learning and action to address the drivers of systems change that either hold the conditions that contribute to neglect in place or provide scaffolding for progress.
Children’s ICFW team will strive to support programs, organizations, and communities to collaborate on solutions and generate knowledge to address these complex challenges families overloaded by stress face before safety threats emerge. By elevating the latest thinking and resources we hope to foster a community of changemakers, support shared learning, expand their networks, and inspire innovation and collaboration.
To learn more and sign up to get involved, please visit the SFTCCC project page.
[1] For a further discussion about what constitutes child neglect, see Child Welfare Information Gateway’s Acts of omission: An Overview of Child Neglect.
Voice of Lived Experience in Program Design and Improvement
By Luke Waldo
COVID-19 has created enormous stress on families, staff, and communities, and exposed existing and new challenges that families face when it comes to accessing and benefiting from supportive services. In response to these new challenges, we conducted our strategic learning process with the COVID Resilience Plan (PDF) through which we learned that we could better meet the needs of our clients if we increased the voice of lived experience in our program design, implementation and improvement efforts. “…Lived experience brings value, particularly in contexts with rich histories, cultural nuances, and generations of communal knowledge. These are the things we can’t bottle up in a diagram or find best practices for in a textbook” (Ali, 2019).
When we elevate the voice of lived experience and create authentic engagement and accountability between our program staff and clients, we “prioritize relationships, increase trust across all stakeholders, and use participatory approaches to ensure the work is guided by those most affected” (Hayden et al). So, how might we bring the voice of lived experience to our programs’ training, use of evidence-based models, and “content expertise” to ultimately deliver more positive outcomes for the children and families that we serve?
Many programs already include the voice of lived experience in their program design and improvement efforts in the form of:
Through the use of these approaches, programs can better understand our clients’ needs, barriers, priorities, and strengths. Empowered with this knowledge, we are better positioned to design, implement, and adapt programs that more effectively meet our clients where they are, build trust, and lead to better engagement. Additionally, these approaches can provide feedback on what works and what doesn’t work for our clients, so that we may make program improvements that demonstrate authentic engagement and accountability to those we serve.
Children’s Child Well-being Programs’ Voice of Lived Experience Journey
Prior to COVID-19, Children’s Child Well-being leadership was polled on its priorities, and the overwhelming majority chose “client voice” in program activities and improvement as its top priority. In 2020, through the COVID Resilience Plan we conducted 19 After Action Reviews, in which it became clear that there were three core areas that we needed to prioritize:
Consequently, we developed a Community Engagement in Program Design and Improvement Community of Practice, which met over four months and developed three core recommendations, which were then presented as the primary design objectives of the Champions team that represented each program area of the Child Well-being department.
Framing the Challenge
Upon recruiting Champions from each program area across the Child Well-being department, we focused our design project on the following question, so that we could effectively design program and department-wide policy and practice recommendations.
As our service environment has changed due to families’ complex situations and needs – COVID-19, access and technology issues, cultural needs, etc. – how might we increase and/or center family/client voice in our program design, implementation, and improvement processes?
Our Translational Design Process
Over the course of 8 working 90-minute meetings, we centered the Champions team activities on the three COVID Resilience Plan Community Engagement recommendations.
Our Translational Design process centers the principle that the lived experience of the professional and client should be present in all activities while also elevating the best available evidence from our fields. As a result, each phase of the process incorporated reflective practices, client and colleague feedback, and tools that centered the client’s experience, relationships and needs.
As the Champions completed their Storyboards, Prototype Workflows, and Theories of Change, they worked closely with their sub-committee partners to review and reflect on their ideas before sharing them with their colleagues and clients for further feedback. They then reworked their ideas and updated the tools to reflect what they had learned. Lastly, they shared their tools on our Basecamp page where all Champions could review them and share their lessons learned. Additionally, throughout the process, the Champions could attend Office Hours with me to work individually on their tools, reflect on what they had learned, and make final updates before submitting to Basecamp.
In our final phase of the design process, we reviewed best practices and evidence by reading literature from national and local partners that have been strong examples of incorporating lived experience into their organizational practices and culture. We then made final additions to our design projects or cited those ideas that we had already developed that are supported by evidence.
In the coming weeks, we will present our final policy and practice recommendations along with a number of the design projects to the Child Well-being leadership team to determine how we might implement them.
References:
Ali, Kareeshma. (2019, February 8) There is an imbalance between lived and learned experience. Retrieved from:
Hayden, Justin, Kalra, Surbhi, Rudd, Christopher, Walker, Justin. How can organizations assess their readiness to co-design? Casey Family Programs, Questions from the Field. Retrieved from:
Learn More:
Translational Design Workshops – If you are interested in learning more about our Translational Design workshops, contact Luke Waldo at lwaldo@chw.org.
Storyboarding – IDEO
– Center on the Developing Child at Harvard University
Trauma and Recovery Project Training
As the final year of Trauma and Recovery Project 5-year SAMHSA grant comes to a close, the final cohort of 21 Trauma-Focused Cognitive Behavioral Therapy trainees from around the state of Wisconsin completed their last synchronous training days. Already this cohort has begun treating 55 child and families affected by post-traumatic stress. During these training days, topics included developing and processing a trauma narrative, identifying supportive caregivers to serve as a witness to the narrative, in-vivo exposure, developing future resilience and safety and creating resilience and longevity in clinicians using the Components for Effecting Clinician Experience and Reducing Trauma (CE-CERT) model by Dr. Brian Miller. Cohort trainees will continue to develop their practice through literature review and consultation with the trainer, Jennifer Wilgocki, LCSW and ICFW team member, Meghan Christian.
If you would like to refer a family to a Children’s provider for trauma therapy, please call 414-266-3339. You can also search for certified clinicians by visiting .
Learn More
More information on Trauma-Focused Cognitive Behavioral Therapy can be found at .
The Institute provides training, consultation and technical assistance to help human service agencies implement and replicate best practices. If you are interested in training or technical assistance, please complete our speaker request form.
Presentations, Trainings and Workshops:
January 2022
February 2022
Frontiers of Innovation and Children’s Home Society of America Webinar
with Children’s Wisconsin’s Community Services Programs
Strong Families, Thriving Children, Connected Communities (SFTCCC) is a statewide initiative that empowers changemakers to reimagine how we strengthen families and prevent child neglect. It moves beyond crisis response to build conditions where families can truly thrive—addressing root causes of neglect such as poverty, social isolation, and community underinvestment. Powered by lived experience, cross-sector collaboration, and continuous learning, SFTCCC brings people together to lead change from the ground up.
Coming soon!
Live welcome for changemakers new to Strong Families, Thriving Children, Connected Communities. May 5th at 12pm CDT
The Challenge
Children thrive when they have regular interactions with responsive, caring adults. Families experiencing significant stressors related to financial insecurity, housing instability, or the impact of systemic and interpersonal trauma can be overloaded with stress, interrupting those interactions. Families that are experiencing this overload of stress are at greater risk for having neglect identified as a threat to their child’s safety.
Child neglect represents a critical social justice issue, with 37% of all children in the US experiencing a Child Protective Services (CPS) investigation before age 18. In Wisconsin, neglect accounts for 54% of all CPS reports and is a primary or contributing factor in 65% of family separations into foster care. These statistics reveal a system that struggles to distinguish between neglect and poverty, with systemic issues like housing instability, underemployment, racial inequities, social isolation, and inadequate access to community resources creating conditions where overloaded families become vulnerable to adverse experiences and family separation. We believe that there are pathways forward to preventing many of these separations from happening.
SFTCCC’s Vision
The conditions that lead to neglect are complex, extending beyond any single system or solution. SFTCCC envisions a Wisconsin where every child and family thrives, free from the threat of neglect and separation. Our goal is to reduce family separations for reasons of neglect by building a community focused on collaboratively pursuing policies and practices that support overloaded families and address systemic failings.
What We’ve Built Together
SFTCCC is not a program; it’s a growing ecosystem of people and places advancing shared goals through diverse approaches. As a field catalyst, the Institute for Child and Family Well-Being (ICFW) strategically connects fragmented stakeholders, builds local capacity, and facilitates conversations that challenge existing paradigms. Through roundtables, collaborative workshops, data walks, storytelling, podcasting, and continuous learning, ICFW builds shared understanding while remaining adaptive and responsive to community needs.
Together, SFTCCC has:
SFTCCC’s strength lies in its people—parents, social workers, educators, and system leaders and changemakers—who are constructively dissatisfied with the status quo. To join the conversation and action:
Want to Build Something Like This?
If you are interested in building dynamic local ecosystems to prevent neglect, SFTCCC offers tailored support. Learn more about how ICFW can support your efforts through technical assistance and coaching.
Contact us to start a conversation – Gabe McGaughey at gmcgaughey@childrenswi.org or Luke Waldo at lwaldo@childrenswi.org
Gabe McGaughey
Luke Waldo
Leah Cerwin
Meghan Christian
Megan Frederick-Usoh
Colleen Janczewski
Peter Power
Children’s Wisconsin
Children’s Wisconsin’s Child Well-being Programs
Join the initiative and receive updates regarding upcoming roundtables and events.
Learn more about Critical Pathways
Children thrive when they have regular interactions with responsive, caring adults. Families experiencing significant stressors related to financial insecurity, housing instability, or the impact of systemic and interpersonal trauma can be overwhelmed with stress, interrupting those interactions. To better support families overloaded by stress, Children’s...
This past year marked the fifth anniversary of the Institute for Child and Family Well-being. As we reflect on the past five years, we are humbled by the opportunities we have had to join many others who are dedicated to strengthening families and nurturing children. Our community-university partnership emerged from a shared commitment to promoting the well-being of all children and families and to addressing barriers that result in unequal access to the best available care. We do so by translating the science of what works into prevention and intervention strategies that are effective in the real world. Central to this process is the relationships that are present in communities, organizations, and systems with whom we work to integrate effective, culturally responsive, and sustainable solutions. The list of agencies and stakeholders who deserve our gratitude is too long to acknowledge here, but we invite you to check out our project pages where you will find many of our key partners.
As we look to the future, our aim is to strengthen these alliances and forge new community connections that are necessary to disseminate effective strategies and produce lasting systems change. So take a moment to review what we learned and accomplished in 2021, and keep an eye on our newsletter, social media, and webpage that will celebrate our five years of partnership as the Institute for Child and Family Well-being.
As Community Engagement and Systems Change are a core service area of the ICFW, collaboration with our community and systems partners is critical to fulfilling our mission. In recognition of those that value collaboration and whose mission seeks to improve child and family well-being, we have invited those partners to join us as ICFW Affiliates. We were honored to introduce eight ICFW Affiliates in 2021, and are looking forward to expanding our affiliates in 2022.
Jennifer Jones, Dr. John Meurer, & Carmen Pitre
Dr. Julian Ford, Clarence Johnson, & Dr. Christy Warner-Metzger
Leah Jepson & Jennifer Winkler
We are excited to announce that Children’s Wisconsin was presented with the Key Innovator award from . Over the past few years, our ICFW team has worked closely with Jen Winkler, an ICFW Affiliate, to adapt and implement Mobility Mentoring® into Children’s Wisconsin’s child welfare program in Milwaukee. We are honored to be recognized for the collaboration and innovation that have contributed to the implementation of this promising model. Please read the award statement from the EMPath Annual Report below.
Mersky, J. P., McKelvey, L. M., Janczewski, C. E., & Fitzgerald, S. (2021). Effects of COVID-19 on home visiting services for vulnerable families: A multi-state analysis of enrollment, engagement, and attrition patterns. Families, Systems, & Health.
Abstract
Introduction: COVID-19 has resulted in massive health and economic consequences, with effects felt most acutely by populations that were disadvantaged prior to the pandemic. For families with young children, the effects have been compounded by service interruptions, though there is a lack of empirical evidence that demonstrates how COVID-19 has affected home visiting programs. This cross-state study is the first to examine the effects of the pandemic on home visiting enrollment, engagement, and retention patterns.
Method: Program implementation records gathered from 2017–2020 in Arkansas and Wisconsin were analyzed. Both states operate a large network of home visiting programs that serve predominantly low-income families and that are supported by the federal Maternal, Infant, and Early Childhood Home Visiting program. Trends prior to COVID were compared to post-COVID trends (March 12 to December 31, 2020) in program enrollments, service capacity, visitation frequency, service modalities, attrition rates, and service duration.
Results: Compared to average pre-pandemic enrollments from 2017–2019, post-COVID enrollments decreased by 33–36%. Total visits fell by 15–24%; the percentage of completed visits relative to expected visits declined more modestly. However, the average duration of services increased post-COVID while rates of early program dropout decreased.
Discussion: The findings suggest that enrollment and engagement in home visiting decreased during the COVID-19 pandemic, which is unfortunate given the large number of vulnerable families served nationwide. Further research is needed to examine how COVID affected both consumer and program behaviors.
A new Institute paper highlights how T-SBIRT was successfully integrated into a universal home visiting program called Family Connects. Findings showed that it was feasible for Family Connects providers to identify trauma-related postpartum mental health challenges and provide referrals to community mental health providers. The results suggest that implementing T-SBIRT on a large scale within an active system of care may help to reduce disparities in access to mental health care.
For more information, see the publication here.
Strong and Stable Families is a mixed-methods study that aims to (1) identify protective factors that reduce the risk of child abuse and neglect in Wisconsin households; (2) examine the impact of Wisconsin’s Family Resource Centers. (FRCs) are universal,...
The mission of the Institute for Child and Family Well-Being is to improve the lives of children and families with complex challenges by implementing effective programs, conducting cutting-edge research, engaging communities, and promoting systems change.
The Institute for Child and Family Well-Being is a collaboration between Children’s Wisconsin and the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The shared values and strengths of this academic-community partnership are reflected in the Institute’s three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
We are excited to announce that Children’s Wisconsin was presented with the Key Innovator award from . Over the past few years, our ICFW team has worked closely with Jen Winkler, an ICFW Affiliate, to adapt and implement Mobility Mentoring® into Children’s Wisconsin’s child welfare program in Milwaukee. We are honored to be recognized for the collaboration and innovation that have contributed to the implementation of this promising model. Please read the award statement from the EMPath Annual Report below.
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Mobility Mentoring® in Family Support and Preservation Programs
Children thrive when they have regular interactions with responsive, caring adults. Families experiencing significant stressors related to financial insecurity, housing instability, or the impact of systemic and interpersonal trauma can be overwhelmed with stress, interrupting those interactions. To better support families overloaded by stress, Children’s Wisconsin is proud to announce a partnership through to bring intervention into our Family Preservation and Support programs around the state for implementation starting in January 2022. Mobility Mentoring® focuses on using a science-based approach to support family-led goal attainment with a primary goal of economic mobility out of poverty. Children’s ICFW team members will be supporting this implementation, evaluation, and shared learning moving forward.
Learn More:
ICFW Practice Brief: Mobility Mentoring (PDF)
Executive Function and Mobility Mentoring®: Using Brain Science to Promote Mobility Out of Poverty
By Meghan Majors
Early adversity can derail the development and use of the core capabilities for success in adulthood. Childhood stress and trauma can have a negative impact on the developing brain. The prefrontal cortex, which controls executive functioning, and the limbic system, which controls the assessment of threats, are the most affected. When exposed to enough stress, this leads to brains that lack skills in planning and impulse control and are hypervigilant of threats. Chronic stress can also lead to a dysfunctional stress response over the lifespan. When experiencing a threat, the brain activates the “fight-or-flight” response to deal with the threat, limiting one’s ability to utilize self-regulation skills. Therefore, living in an environment of frequent fear and anxiety leads to brains that are continuously in “fight-or-flight”, affecting one’s ability to both develop and use executive function skills.
Executive function refers to the capacity to plan ahead and meet goals, control impulses, prioritize tasks, and stay focused despite distractions. These skills are developed through practice. Early childhood is an important period for developing executive function. Children who do not have the opportunity to use and strengthen these skills are less proficient and may have a difficult time managing routine tasks of life. In adulthood, executive functioning and self-regulation are the key skills necessary to get and keep a job, develop healthy relationships, and manage finances.
Growing up in poverty, even without the addition of trauma, can have a negative impact on the developing brain and executive function. Poverty is associated with chronic stress and fewer opportunities to practice executive functioning skills. Chronic scarcity, such as that experienced when living in poverty, can be viewed as a series of frequent, stressful events that can result in an overloaded brain. Constantly needing to direct attention to crises takes a toll and requires an incredible amount of energy and time. This bandwidth tax leads to poor decision making and difficulty setting realistic goals. Additionally, it can be difficult for people experiencing chronic scarcity to plan and set goals for the future because needing to frequently handle short-term crises can consume a lot of bandwidth. Executive functions, like impulse control, working memory, and mental flexibility, are important for success in work and school. This contributes to the cycle of poverty, as living in poverty itself limits one’s ability to have mobility out of poverty.
Poverty itself can impact executive functioning but considering the large overlap between living in poverty and experiencing early trauma, the cumulative impact on executive functioning is greater. This intersection of trauma and poverty is frequently seen in the populations involved in home visiting and the child welfare system. The impact can span across the life course. Childhood poverty and adversity can lead to increased parenting stress as an adult and reduce the ability to provide effective care to children. This can be associated with poor emotional regulation in children and neglect, contributing to intergenerational effects. Therefore, to implement programs that will improve the lives of child and families in this population, it is necessary to consider the impact of trauma, stress, and poverty on executive functioning.
Mobility Mentoring® is an executive functioning and trauma informed intervention that focuses on partnering with clients to build the skills, resources, and behavior to achieve financial independence. Mobility Mentoring® engages clients through a coaching model to develop decision-making and goal-setting skills in five key pillars: family stability, health and well-being, financial management, education and training, and employment and career. The intervention includes the use of external incentives to build intrinsic motivation in participants. Children’s Wisconsin is expanding the Mobility Mentoring® program to five programs in six regions in Wisconsin: Family Support (Black River Falls, Northwoods), Home Visiting (Black River Falls, Northwoods, Stevens Point, Milwaukee, Rock County), Early Head Start (Northwoods), and Education and Employment (Madison).
T-SBIRT Training and Development
T-SBIRT, or trauma screening, brief intervention and referral to treatment, is a one-session interview protocol that has been integrated into health and human service programs across Wisconsin. Implementing T-SBIRT in such settings recognizes two interrelated truths: a) most people experience significant adversity and trauma across the life course, an assertion that is all-the-more salient during this time of pandemic and collective trauma, and b) cumulative trauma exposure undermines functioning across many domains and limits engagement in various service systems.
Derived from screening, brief intervention, and referral to treatment for substance use, T-SBIRT has several distinct goals for participants. Namely, it was designed to:
Thus far, T-SBIRT has been delivered by direct service providers from a variety of settings, including community-based primary care clinics, nurse home visiting programs, and employment service programs. Typically, providers conduct T-SBIRT sessions early in the course of services to strengthen rapport with service recipients, generate insight into root causes of presenting problems, and develop well-informed service and referral plans. T-SBIRT sessions extend over approximately 10 to 45 minutes, dependent on context, and evaluators have published three studies to date indicating that it is feasible to implement T-SBIRT across these diverse settings.
The primary author of T-SBIRT, Dimitri Topitzes, has led multiple T-SBIRT training initiatives in southeastern Wisconsin and other parts of the state. Typically, trainings involve one or two day intensive workshops followed by ongoing technical assistance. The workshops cover topics such as the rate and consequences of trauma exposure. He also presents the trauma service frameworks on which T-SBIRT is based, such as trauma-informed care and trauma-responsive practices. Subsequently, training participants observe T-SBIRT demonstration role-plays and complete T-SBIRT practice role-plays.
The gatherings generally end with discussions about implementation drivers and barriers along with agency-specific plans for integrating T-SBIRT within service workflows. Dr. Topitzes provides monthly T-SBIRT technical assistance or consultation during initial phases of integration to support ongoing practice. During these consultation sessions, usually held remotely, participants present T-SBIRT case examples, discuss T-SBIRT practice themes, and raise T-SBIRT-related questions.
In September of 2021, Dr. Topitzes delivered a two-day T-SBIRT training workshop to health and human service prevention specialists in Dayton, Ohio. Thirty-five direct service or administrative professionals from six area agencies attended the event, sponsored by Montgomery County Alcohol, Drug Addiction, and Mental Health Services (ADAMHS). All agencies represented at the training received grant funding from ADAMHS, and many were planning to combine T-SBIRT with SBIRT services, a relatively common practice. According to evaluations completed by participants at the conclusion of the training workshop, participants found T-SBIRT to be very useful for their practice and were very satisfied with the training event. The participating agencies are currently completing the initial stages of implementation with the help of monthly consultation. If interested in learning more about T-SBIRT, please see the T-SBIRT Issue Brief or contact the Institute for Child and Family Well-Being.
Learn More:
ICFW Webinar – T-SBIRT: An Introduction
ICFW T-SBIRT Demonstration Video
The Institute accelerates the process of translating knowledge into direct practices, programs and policies that promote health and well-being, and provides analytic, data management and grant-writing support.
Recent ICFW Publications
Romain Dagenhardt, D., Mersky, J.P., Topitzes, J., Schubert, E., & Krushas, A. (2021). Assessing polyvictimization in a family justice center: Lessons learned from a demonstration project. Journal of Interpersonal Violence.
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
Evaluating Systems Change at the Organizational Level
By and Luke Waldo
“Real and equitable progress requires exceptional attention to the detailed and often mundane work of noticing what is invisible to many.” – The Water of Systems Change.
Introduction
As demand for mental and behavioral health services has grown over the past decade and is projected to outpace growth of most sectors in the coming decade, mental and behavioral health organizations face complex challenges as to how to meet the needs of children and families. At Children’s Wisconsin, we have been implementing evidence-based therapies as one potential strategy and evaluating their impact over the past four years as part of a five-year Substance Abuse and Mental Health Services Administration (SAMHSA) grant.
The Trauma and Recovery Project (TARP) is a 5-year SAMHSA-funded initiative that aims to increase the availability and accessibility of trauma-responsive treatments for children and families in southeastern Wisconsin. Children’s Wisconsin’s Child and Family Counseling programs in southeastern Wisconsin form part of the project’s Center of Excellence (CoE), which consists of clinicians who have been trained in trauma-informed and evidence-based therapies and deliver these models to children and families. In order to demonstrate the impacts of the CoE to SAMHSA, clinicians must complete a National Outcomes Measures (NOMs) assessment at baseline, every six months, and discharge.
Presenting Challenge
During the third year of TARP, NOMs completion rates fell below 10% and the project was notified by SAMHSA that completion rates needed to improve to a benchmark of 80% or better. Clinicians face increasing and, at times, conflicting demands on their time and ability to focus on the care of their clients. By adding new assessments to their workflow, there may be a perception that their limited time with their client is being infringed upon even further. Consequently, an intense effort was made by leadership and CoE clinicians to increase completion rates. After a variety of systemic interventions, NOMs completion rates eventually reached a high of 82.1% in year four of the grant.
In order to learn how we addressed this challenge and improved our outcomes, we conducted interviews and surveys with grant managers, administrative staff, clinical supervisors, and CoE clinicians. We explored the six drivers of systems change to evaluate the factors involved in this process.
Six Drivers of System Change
Policies ˦ Resource Flow ˦ Relationships & Connections
According to Kania et al, policies include the “rules, regulations, and priorities that guide actions”. Resource flow is “how money, people, knowledge, information, and other assets such as infrastructure are allocated and distributed.” Relationships and connections are the “quality of connections and communication occurring among actors in the system, especially among those with differing histories and viewpoints.” Based on these conditions and feedback from clinicians, supervisors, and administrative support staff, the most significant impact on NOMs compliance was the addition of an administrative support staff member to manage the NOMs process across offices. Having an administrative staff member assigned to track compliance and offer support to clinicians centralized the process. The administrative support staff emailed the clinicians and their supervisors each month with upcoming NOMs due dates so they knew in advance what their NOMs workload would be. Each week, emails were sent to the clinicians individually reminding them what they needed to complete. The information including specific clinician, child, caregiver, and due dates made next steps very clear. The administrative support staff also entered all the NOMs into the SAMHSA database within one week of them being completed further reducing clinician burden. The policies, resource flow, and relationships and connections impacted by this change helped to improve NOMs completion by guiding actions, distributing information, centralizing core responsibilities, and ensuring quality communication.
Policies ˦ Practices
A second area that contributed to improved NOMs completion was the adaptation of tools to increase accessibility and use. This involved the organizational policies that guide actions, and practice or the “activities targeted to improving social and environmental progress; and the procedures, guidelines, or informal shared habits that comprise their work.” NOMs was initially a long, printed assessment that was filled out by hand. When COVID-19 hit, SAMHSA converted it into a six-page word document that could be completed electronically. The electronic format caused issues with clinicians not being able to type in responses and check boxes, which created another barrier to timely completion. Consequently, our team modified the assessment to make it more user friendly. This included dividing the assessment into three separate measures to use at baseline, reassessment, and discharge. Finally, clinicians were not required to enter NOMs into a database and instead were able to email them directly to the administrative support staff upon completion. These tools and increased accessibility worked to simplify processes for all staff.
Relationships & Connections ˦ Power Dynamics
Another contribution to improved NOMs completion was increasing the accountability between clinicians and their supervisors. The relationships and connections involved in this process, and the power dynamics or “the distribution of decision-making power, authority, and both formal and informal influence among individuals and organizations” were central to creating change. Regular meetings were set up with supervisors to discuss NOMs completion. These meetings were designed to support the sites with their individual issues, empower supervisors to enhance their clinicians’ NOMs completion rates, and build a community of practice to meet SAMHSA requirements.
Mental Models
Mental models are deeply held beliefs that influence our behavior and are instrumental in making transformational change. In this case study, we asked the CoE clinicians about their attitude towards assessment-based interventions to learn more about barriers to completing NOMs. All thirteen clinicians who completed the survey reported that assessment-based interventions were important in their clinical practice. Working with clinicians who value assessment-based interventions likely contributed in a positive way to the increase in NOMs completion because the clinicians understood and valued the importance of the measure.
Conclusion
Organizational and system change can be tremendously complex. We believe that we must strive for ongoing improvement, but improvement without understanding what, how and why we improved is simply not enough. Through the evaluation of our small internal system change, we were able to engage clinicians, supervisors, and administrative support staff to determine that the most influential drivers of change were new policies, resource flows, and relationships and connections. By using the six conditions of systems change, we are able to identify the many factors that impact our ability to accomplish our objectives and, ideally, replicate similar efforts in the future for sustained improvements and success.
References
Kania, J., Kramer, M., & Senge, P. (2018). . FSG, pp. 1-18.
Learn More:
National Outcomes Measure (for children)
The Institute provides training, consultation and technical assistance to help human service agencies implement and replicate best practices. If you are interested in training or technical assistance, please complete our speaker request form.
Presentations, Trainings and Workshops:
August 2021
PCIT National Biennial Convention – ICFW presented the following panels, symposia, papers and posters:
September 2021
September 15th: Brain Science and Self-Esteem Workshop for Foster Parents
December 2021
December 1st: Mindfulness for the Family – Workshop for 51’s Children’s Learning Center
Mersky, J. P., Topitzes, J., Langlieb, J., & Dodge, K. A. (2021). Increasing mental health treatment access and equity through trauma-responsive care. American Journal of Orthopsychiatry.
Abstract
Adverse childhood experiences and other potentially traumatic events have lasting implications for mental health. Evidence-based treatments are available to address trauma-related symptoms, but their impact is hindered because access is limited and unequal. In the U.S., adverse experiences and mental disorders disproportionately affect socioeconomically disadvantaged groups that face treatment access barriers—disparities that are compounded by passive systems of care that wait for clients to seek treatment. This article presents a conceptual argument, backed by empirical evidence, that population health can be improved by implementing trauma-responsive practices, and that greater mental health equity can be achieved if these strategies are used to engage underserved clients. A description is provided of the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT), a promising protocol that can be used by nonclinical providers to detect trauma-related mental health concerns in adults and help them access therapeutic services. The T-SBIRT protocol has been successfully implemented in diverse settings, and it is currently being piloted in a universal postpartum home visiting program called Family Connects. Prior results from three trials of Family Connects are summarized, including evidence of program impact on maternal mental health. New results are also presented indicating that T-SBIRT is feasible to implement within Family Connects, as denoted by indicators of suitability, tolerability, provider adherence, and referral acceptance. Closing recommendations are offered for reducing mental health disparities by testing and disseminating T-SBIRT through Family Connects and other large-scale programs and systems of care.
Romain Dagenhardt, D., Mersky, J.P., Topitzes, J., Schubert, E., & Krushas, A. (2021). Assessing polyvictimization in a family justice center: Lessons learned from a demonstration project. Journal of Interpersonal Violence.
Abstract
There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.
The mission of the Institute for Child and Family Well-Being is to improve the lives of children and families with complex challenges by implementing effective programs, conducting cutting-edge research, engaging communities, and promoting systems change.
The Institute for Child and Family Well-Being is a collaboration between Children’s Wisconsin and the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The shared values and strengths of this academic-community partnership are reflected in the Institute’s three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
As Community Engagement and Systems Change are a core pillar of the ICFW, collaboration with our community and systems partners is critical to fulfilling our mission. In recognition of those that value collaboration and whose mission seeks to improve child and family well-being, we have invited those partners to join us as ICFW Affiliates. We are honored to introduce our three newest ICFW Affiliates with whom we look forward to partnering with now and into the future.
Leah Jepson is the Project Director of the Milwaukee Coalition for Children’s Mental Health (CCMH) at Mental Health America of Wisconsin, an initiative to improve the mental health of children 0 – 8 in the City of Milwaukee through systems change and authentic engagement of people with lived experience. She is also the co-founder and Executive Co-Director at the Next Step Clinic, a community-based collaboration to address disparities in Autism Spectrum Disorder and children’s mental health identification and treatment. Leah has nearly 25 years’ experience as a social worker that includes home visitation, research, community-based program development and implementation, advocacy, and coalition-building. Her current focus is on young children’s mental health and social-emotional development, authentic engagement of those with lived experience, social justice and health equity.
Leah holds a Master’s of Science degree in Social Work and a Bachelor of Arts degree in Psychology, both from the University of Wisconsin-Milwaukee.
Leah has collaborated with ICFW through the Milwaukee Coalition for Children’s Mental Health to align action and values around children’s mental health, bringing in ICFW staff to provide presentations for coalition members. Leah served on an expert panel for the ICFW webinar, Authentic Community Engagement: Made in Milwaukee. Most recently, we collaborated with ICFW through the Next Step Clinic. When the clinic was first opening, Dr. Topitzes joined the team to advise clinic leadership on the manifestations of childhood trauma in the children that are served by the clinic. The ICFW team has also trained Next Step Clinic clinicians in Parent-Child Interaction Therapy through the Trauma and Recovery Project.
Jennifer Winkler is currently the Family Case Management Well-Being & Family Support Manager at Children’s Wisconsin, where she has worked for the last 12 years in various direct practice and leadership positions within the agency. Throughout her career, Jennifer has demonstrated passion around staff and program development, continuous quality improvement efforts, and building an organizational culture that is rich in innovation.
Jennifer received a Bachelor of Arts degree from Carthage College in 2006, with a major in Social Work, and a Master’s of Social Work from the University of Wisconsin-Madison in 2007, with a specialization in child and family welfare.
The ICFW team has worked collaboratively with Jen to conduct a human-centered design process that led to the adaptation and implementation of Mobility Mentoring® (MM) into Milwaukee’s Family Support Program. Jen has continued to collaborate with the ICFW to engage and interview her staff and the families that they serve to evaluate the effectiveness of and opportunities to improve MM. Additionally, Jen has co-presented with ICFW at regional and national conferences, and advocated for MM and strategic adaptation which has inspired other Children’s programs to begin implementation of the model.
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Minecraft® to Build Our Children’s Social Skills
A virtual game-based, social skills group recently completed its first prototype iteration. The group planned to improve social and emotional skills such as social communication, cooperation, problem solving, and self-control. For 6 weeks, children ranging from 6.5 to 13 years old gathered on Zoom with a Mental Health Consultant for a brief didactic lesson on a specific social skill, and then the group played the video game Minecraft® to practice and develop the skill.
There was initially a group of 9, with 8 finishing the group. A few participants missed 2 groups meetings in the middle weeks. Although technical problems were frustrating to the facilitator and the participants in the beginning, the participants did not note this as a barrier on a post-group survey. Weekly email touch points with caregivers were provided by the facilitator and the use of the Manatee app was expected, however, low enrollment in the app and lack of engagement with this app by parents and staff found this not to be a useful tool in tracking progress. Of those who responded to a feedback request, all (children and parents alike) agreed the group was a useful way to spend their time and felt the group helped them improve their social skills. One child respondent and the facilitator shared they hope the group can run longer each week in the future. In fact, as the weeks went by, the children often preferred to continue interacting with each other in the game world after group time had ended. Some lessons learned garnered through the use of an After Action Review completed by staff suggested that a mixed level of familiarity with Minecraft® actually facilitated more opportunities to practice adaptive social skills and strongly indicated the need for a facilitator workflow to be documented so another facilitator could recreate or step in, if necessary. Also suggested by staff was splitting the age groups up, although the children respondents did not mention this.
In future iterations, ICFW will continue to work on supply chain issues brought on by COVID-19 to make a standardized pre and post assessment a part of the intake and discharge process in order to gather data on efficacy, likely implement a 90 minute group instead of 60 minutes, have a written workflow for the facilitator, and expand the referral opportunity to all children in the state.
For more context, see the original briefing in the Spring 2021 newsletter. If you are interested in referring a child to a future group, please email mchristian@chw.org.
Learn More:
ICFW Practice Brief – After Action Review (PDF)
ICFW Practice Brief – Strategic Learning (PDF)
Utilizing Technology for Continued Evidence-Based Clinical Training
By Kate C. Bennett, LCSW
With support from the Trauma & Recovery Project, a 5-year SAMHSA-funded initiative that aims to increase the availability and accessibility of trauma-responsive treatments in southeastern Wisconsin, the ICFW has continued to collaborating with partner agencies to disseminate Parent-Child Interaction Therapy (PCIT) to families Milwaukee, Racine, and surrounding southeastern Wisconsin counties.
This summer, certified trainers from Children’s Wisconsin/ICFW and Washington County Health and Human Services facilitated the second annual virtual Wisconsin Regional PCIT Initial Therapist Training for 9 newly trained clinicians. Each clinician participated in 40 total hours of didactic evidence-based workshops over Zoom videoconferencing during learning sessions held in May and July 2021. All trained clinicians will be providing the evidence-based intervention to families under consultation with our trainers through May 2022.
Please help us in welcoming each clinician to our Wisconsin Regional PCIT community!
Beth Strickland, LCSW – PSG (Washington County)
Stacey Davison, LCSW – PSG (Washington County)
Amber Stroud, LPC – Pediatric Psychology Associates (Milwaukee County)
Cathy Brown, LPC – Children’s Wisconsin (Milwaukee County)
Lauren Miller, LPC – Children’s Wisconsin (Milwaukee County)
Leann Vice-Reshel, PsyD, LPC – Children’s Wisconsin (Milwaukee County)
McKenzie Rehm, LPC – Children’s Wisconsin (Milwaukee County)
Michelle Jerard, LPC – Children’s Wisconsin (Milwaukee County)
Kelah Hatcher, MSW Student – University of Wisconsin Milwaukee / Children’s Wisconsin (Milwaukee County)
Learn More
PCIT at ICFW
The Institute accelerates the process of translating knowledge into direct practices, programs and policies that promote health and well-being, and provides analytic, data management and grant-writing support.
A Brief Measure of Work Environment for Human Service Organizations
The Measure of Work Environment (MWE) is a new, brief instrument developed to assess work environment in human service agencies. The MWE demonstrated good internal consistency when tested with staff from child welfare and home visiting agencies. With an administration time of less than five minutes, the MWE offers applied researchers and evaluators an efficient method to assess and compare organizational functioning. It may also provide program administrators insight into specific areas of improvement.
Learn More:
Publication – Human Service Organizations: Management, Leadership & Governance.
Tool – Measure of Work Environment
The Institute provides training, consultation and technical assistance to help human service agencies implement and replicate best practices. If you are interested in training or technical assistance, please complete our speaker request form.
Presentations, Trainings and Workshops:
May and July 2021:
August 2021:
PCIT National Biennial Convention
Jennifer Winkler is currently the Family Case Management Well-Being & Family Support Manager at Children’s Wisconsin, where she has worked for the last 12 years in various direct practice and leadership positions within the agency. Throughout her career, Jennifer has demonstrated passion around staff and program development, continuous quality improvement efforts, and building an organizational culture that is rich in innovation.
Jennifer received a Bachelor of Arts degree from Carthage College in 2006, with a major in Social Work, and a Master’s of Social Work from the University of Wisconsin-Madison in 2007, with a specialization in child and family welfare.
Leah Jepson is the Project Director of the Milwaukee Coalition for Children’s Mental Health (CCMH) at Mental Health America of Wisconsin, an initiative to improve the mental health of children 0 – 8 in the City of Milwaukee through systems change and authentic engagement of people with lived experience. She is also the co-founder and Executive Co-Director at the Next Step Clinic, a community-based collaboration to address disparities in Autism Spectrum Disorder and children’s mental health identification and treatment. Leah has nearly 25 years’ experience as a social worker that includes home visitation, research, community-based program development and implementation, advocacy, and coalition-building. Her current focus is on young children’s mental health and social-emotional development, authentic engagement of those with lived experience, social justice and health equity.
Leah holds a Master’s of Science degree in Social Work and a Bachelor of Arts degree in Psychology, both from the University of Wisconsin-Milwaukee.
Janczewski, C. E., Mersky, J. P., & Plummer Lee, C. (2021). A brief measure of workplace environment for health and human service professionals. Human Service Organizations: Management, Leadership & Governance.
Abstract
Organizational characteristics are important predictors of workplace outcomes, but the length and complexity of validated instruments restrict their use in research and practice. This study tested a brief Measure of Work Environment (MWE) using data from 718 child welfare and 349 home visiting professionals. Results confirmed a three-factor structure: group cohesion, leadership support, and organizational justice. The MWE demonstrated acceptable internal consistency (α = .87) and was significantly associated with job satisfaction, burnout, and intent to leave. The MWE is a promising, pragmatic measure of organizational environment for implementation research and program improvement.
The mission of the Institute for Child and Family Well-Being is to improve the lives of children and families with complex challenges by implementing effective programs, conducting cutting-edge research, engaging communities, and promoting systems change.
The Institute for Child and Family Well-Being is a collaboration between Children’s Wisconsin and the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The shared values and strengths of this academic-community partnership are reflected in the Institute’s three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
A Message from Our Co-Directors, Gabe McGaughey and Josh Mersky
This newsletter marks the fifth anniversary of the Institute for Child and Family Well-being. As we reflect on the past five years, we are humbled by the opportunities we have had to join many others who are dedicated to strengthening families and nurturing children. Our community-university partnership emerged from a shared commitment to promoting the well-being of all children and families and to addressing barriers that result in unequal access to the best available care. We do so by translating the science of what works into prevention and intervention strategies that are effective in the real world. Central to this process is the relationships that are present in communities, organizations, and systems with whom we work with to integrate effective, culturally responsive, and sustainable solutions. The list of agencies and stakeholders who deserve our gratitude is too long to acknowledge here, but we invite you to check out our project pages where you will find many of our key partners.
As we look to the future, our aim is to strengthen these alliances and forge new community connections that are necessary to disseminate effective strategies and produce lasting systems change. In that spirit, we will be organizing a series of events over the next year to support the exchanging of information, building relationships, and translating knowledge into action. We hosted our first event in April to highlight our Program Design and Implementation efforts with group-based, telehealth therapy. To learn more about upcoming events, follow us on social media, visit our website, and .
We hope that you will join us!
As Community Engagement and Systems Change are a core pillar of the ICFW, collaboration with our community and systems partners is critical to fulfilling our mission. In recognition of those that value collaboration and whose mission seeks to improve child and family well-being, we have invited those partners to join us as ICFW Affiliates. We are honored to introduce our three newest ICFW Affiliates with whom we look forward to partnering with now and into the future.
Dr. Julian Ford, Ph.D., A.B.P.P.
Dr. Ford is a board certified clinical psychologist and Professor of Psychiatry and Law at the University of Connecticut where he directs two Treatment and Services Adaptation Centers in the National Child Traumatic Stress Network: the Center for Trauma Recovery and Juvenile Justice and the Center for the Treatment of Developmental Trauma Disorders. Dr. Ford is past President of the International Society for Traumatic Stress Studies, and a Fellow of the American Psychological Association. He has published more than 250 articles and book chapters and is the author or editor of 10 books, including Posttraumatic Stress Disorder, 2nd Edition, Treating Complex Trauma: A Sequenced, Relationship-Based Approach, 2nd Edition, Treating Complex Traumatic Stress Disorders in Children and Adolescents: Scientific Foundations and Therapeutic Models, and Critical Moments: Transforming Crises into Turning Points in Psychotherapy. Dr. Ford is the Principal Investigator for the national Developmental Trauma Disorder Field trial research study, and developed and has conducted randomized clinical trial and effectiveness studies with the Trauma Affect Regulation: Guide for Education and Therapy (TARGET©) model for youths and adults with developmental trauma histories and complex PTSD.
ICFW leaders have collaborated with Dr. Julian Ford, an international leader in traumatic stress studies, on several occasions. First, Dr. Ford served as an expert consultant during initial implementation of the trauma screening, brief intervention, and referral to treatment (T-SBIRT) protocol. Subsequently, he co-authored the initial T-SBIRT feasibility study that Dr. Topitzes published in 2017 along with Dr. Mersky (Topitzes et al., 2017). Second, Dr. Ford presented his trauma counseling model for youth, TARGET, in a symposium led by Dr. Mersky at the Society for Social Work and Research 2018 annual conference. Dedicated to exploring new frontiers in trauma research, the symposium included presentations delivered by Drs. Mersky and Topitzes. Future collaborations might center on the continued development of the T-SBIRT and TARGET models.
Mr. Clarence Johnson is currently serving as the Executive Director of Wisconsin Community Services. The mission of WCS is to advocate for justice and community safety, providing innovative opportunities for individuals to overcome adversity. Mr. Johnson was instrumental in leading the effort that resulted in the WCS Center for Driver’s License Recovery being named as one of Mutual of America’s three national 2019 Community Partnership Award winners. Clarence also brought Community Building Milwaukee to WCS, which involves numerous agencies, institutions and organizations across the Milwaukee community serving, youth and adults.
Mr. Johnson believes the key ingredients to effective and successful leadership include holding yourself accountable to the highest standards of performance and empowering and supporting others to reach for their highest level of effectiveness. As one of the most experienced African American nonprofit leaders in the Milwaukee area, he has helped shape the future of several nonprofit organizations in the Milwaukee Community and is held in high regard in many circles. During his long and distinguished career, Mr. Johnson has served on over 20 nonprofit boards and remains an active member of the Milwaukee area community. He was recently elected to the board of directors of the Wisconsin Association of Family and Children’s agencies and also serves as a board member for NAMI Southeast Wisconsin.
Mr. Johnson is a lifelong resident of city of Milwaukee and earned both his undergraduate and graduate degree from the University of Wisconsin-Milwaukee. He has worked on several research projects during his career and began a program to reduce the incidence of obesity and chronic disease among central youth. Working for over 35 years in Social Services, Mr. Johnson has served as Executive Director of Neighborhood House of Milwaukee, Chief Operating Officer for YW Works, and as a high level manager for Milwaukee County Department of Health and Social Services.
ICFW leaders have worked directly with Mr. Johnson in several capacities. Dr. Topitzes, for instance, serves on the WCS board of directors and on several project-based work groups overseen by WCS and Mr. Johnson, including the Community Building Milwaukee Steering Committee.
Christina Warner-Metzger, Ph.D., hails from Oklahoma State University with a doctorate in Clinical Psychology. True to her organization’s motto of Doing good and doing it wellTM, Dr. Warner-Metzger founded Evidence-based Practices and International Consulting (EPIC), LLC, to promote increased accessibility and excellence in professional training, consultation, and program development within the mental health and wellness sector. With a focus on training culturally humble and socially responsible professionals, she also directs the Parent-Child Interaction Therapy (PCIT) Program and Early Assessment and Recommendations for Learning in Young Children (EARLY) Clinic at DePaul University’s Family and Community Services. She is 1 of 21 PCIT International Certified Global Trainers worldwide and a Child-Adult Relationship Enhancement (CARE) co-developer, which provides her with clinical expertise in PCIT and CARE training and dissemination. Dr. Warner-Metzger is also the co-developer of a project piloting Trauma-Directed Interaction (TDI) with young children. She has served as a trainer and consultant for dissemination efforts across the United States, as well as Indonesia and Australia. Her contributions as an expert trainer and consultant on institutional, regional, federal, and international grant-funded projects has spanned the greater part of the past decade.
She is also experienced using the National Child Traumatic Stress Network (NCTSN) Learning Collaborative model. Dr. Warner-Metzger’s clinical and research interests include Autism Spectrum Disorders (ASD), developmental disabilities, disruptive behavior disorders, trauma-informed systems, underserved populations, barriers to treatment participation, and dissemination efforts. She has contributed to these topics through numerous peer-reviewed and invited presentations at national and international conferences, as well as authored peer-reviewed journal articles, government publications, and edited book chapters. Her previous clinical work in Memphis and current work in Chicago has focused on serving urban populations experiencing economic and racial marginalization.
ICFW leaders and clinicians, Dimitri Topitzes, Kate Bennett, and Leah Cerwin have worked closely with Dr. Warner-Metzger in their continuing development as certified PCIT International Within-Agency and Regional Trainers as part of the Trauma & Recovery Project. Dr. Warner-Metzger has also co-facilitated PCIT Therapist Trainings with our team in Milwaukee and as part of a statewide dissemination project in Utah.
Congratulations to Ross Gilbert on matching for his residency in Internal Medicine and Pediatrics at Johns Hopkins Medicine-Pediatrics Urban Health Residency Program in Baltimore, Maryland. Ross has worked with the ICFW as a fellow through the while completing medical school at UW-Madison.
Congratulations to Mary Kusch on her acceptance to the . She will be placed with the Wisconsin Division of Public Health, Bureau of Environmental and Occupational Health. Mary has worked with the ICFW as a research assistant while completing her master’s degree at the 51 Zilber School of Public Health.
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Minecraft® to Build Our Children’s Social Skills
The Institute for Child and Family Well-Being consulted with Children’s Wisconsin professionals across the state to develop Community Services’ COVID Resilience Plan. During this process, a collaboration between Black River Falls Family Support Prevention Program and the ICFW resulted in a virtual, game-based social skill building group opening up to children statewide. This program is designed to help youth acquire social and communication skills to help them interact with others more successfully.
Minecraft® and the work of Australian psychologist Raelene Dundon are used by a Family Support Specialist in secure video teleconferencing software currently in a 1:1 format. This will be the first iteration of using groups and inviting children from all over Wisconsin. The program will target the improvement of social and emotional skills such as social communication, cooperation, problem solving, and self-control. Weekly touch points with caregivers and the use of the Manatee app will help monitor goals and foster communication between the provider and caregivers. Our Before Action Review was used to help create workflows, determine how to collect data and set goals. An After Action Review will be used to log design learning, propose improvements and assess for possible scalability. In future iterations, data will be gathered on executive functioning pre and post completion to examine possible correlations between participation in group and improved functioning.
If you would like more information on referring a child, please email mchristian@chw.org.
Learn More:
ICFW Practice Brief – After Action Reviews (PDF)
ICFW Practice Brief – Strategic Learning (PDF)
Parenting with P.R.I.D.E. and Web-based Assessments
By Kate Bennett
As the ICFW clinical team continues to work toward improved iterations of group-based intervention modifications, we are reminded that successful program design and implementation relies on collecting and analyzing quality data. While data is critical for program analysis, it is also one of the cornerstones of Parent-Child Interaction Therapy (PCIT) treatment and the multifamily Parenting with P.R.I.D.E. intervention.
The screening and assessment tools typically applied in PCIT are accessible for use at Children’s Wisconsin and include the following:
Because the ongoing administration and analysis of each of these assessments results are critical to individual patient/family treatment and the overall program evaluation, our clinicians have been piloting the use of web-based assessment forms. Our purpose in moving to electronic administration and scoring is to enhance convenience for both clinicians and families as we continue forward with telehealth delivery of Parenting with P.R.I.D.E. and other trauma-based treatment groups. For example, web-based administration of the ECBI through allows a parent/caregiver to report on child behavioral observations on a weekly basis from their phone or laptop throughout the duration of treatment. Form completion takes approximately 5 minutes for a respondent and is entered within 24 hours prior to the family checking into a therapy session. The assigned clinician receives the assessment results in real-time. This allows for more focused time in treatment, and additionally contributes to the fidelity of goal-directed services for families.
Our intention is to continue to pilot the use of web-based screening and assessment tools for ease of caregiver completion, immediate scoring, and automatic skill progress tracking throughout treatment for PCIT and other evidence-based treatments. We look forward to sharing our findings and feedback from families in coming newsletters and reports.
References:
The Institute accelerates the process of translating knowledge into direct practices, programs and policies that promote health and well-being, and provides analytic, data management and grant-writing support.
Milwaukee Equity Action Plan
Leaders at the Institute for Child and Family Well-Being at 51 are collaborating with the Wisconsin Department of Workforce Development, Division of Vocational Rehabilitation (DVR) to develop, implement and test a consumer quality improvement plan at the Milwaukee central city location. This initiative builds on an extensive consumer service review that DVR conducted in 2019. Stakeholder interviews revealed that Milwaukee-area DVR consumers, the majority of whom are Black Americans, face multiple barriers to effective service engagement and completion. These include extreme poverty resulting from structural racism, significant distress due to current and historical trauma, and poor service access owing to organizational policies and procedures. Titled the Milwaukee Equity Action Plan, the consumer quality improvement plan aims to enhance the culturally responsive and trauma-informed nature of DVR consumer services.
Members of the Institute’s team for the Milwaukee Equity Action Plan project will help translate insights from the field and results from DVR’s consumer service review into a viable quality improvement plan. The Institute team will also develop and execute an evaluation plan to help DVR gauge progress toward consumer service goals and adjust the quality improvement plan as needed. In addition, the team will help DVR develop a sustainable, high quality consumer service model that reflects its values.
Learn More:
Recent ICFW Publications
Practice Brief: COVID Resilience Plan for Nonprofits (PDF)
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
By Luke Waldo
In November 2020, Children’s Wisconsin’s and collaborating partners, Wisconsin Department of Children and Families and Bay Area Workforce Development Board, began working on a planning grant to facilitate a community assessment to determine the causes of poor outcomes for youth between the ages of 18-24 who are aging out of foster care and to propose targeted solutions. The assessment surveyed the region’s strengths, resources, needs and gaps as they relate to the population of youth transitioning to adulthood in Northeastern Wisconsin.
Through these collective efforts, the long-term goal is to provide a pathway to independence by strengthening youths’ resiliency and equipping them with the knowledge and skills necessary to become self-sufficient, build a strong support network, achieve educational and/or job training goals to earn a living wage, and maintain safe and stable housing.
Over four months, insights were gathered from leaders, staff and administrators working within the region’s Independent Living systems, as well as from youth and young adults who have received services through those systems. We used a human-centered design approach in the development of the assessment. A core planning team consisting of representatives from the following organizations and groups developed the assessment:
Data were collected through surveys, focus groups and literature review.
Surveys
Between the youth/young adult and provider surveys, there were areas of strong consensus and divergence in the responses noted in Table 1. Consensus occurred when youth and provider responses had strong consensus within and across groups. Divergence occurred when strong consensus was present in one of the surveyed groups but not the other.
Table 1:
Focus Groups
Focus Groups were conducted over 90 minutes on Zoom due to COVID-19 safety and health requirements. Participants were asked a series of questions and were provided between 1-3 minutes to individually reply in the Chat box. Upon completing individual brainstorming, the facilitators identified themes and asked participants to elaborate on those themes and ideas. Between the youth/young adult and provider focus groups, there were areas of strong consensus and divergence noted in Table 2.
Table 2:
Lessons Learned: The Importance of Mental Health and Supportive Relationships
During our assessment, we came back to a number of key questions for youth and providers in response to the prioritization of mental health. Do youth today have more mental health needs, or are we just more aware of those needs? Are housing and financial stability less important to youth today, or do youth prioritize them lower than mental health in recognition that they are much more difficult to obtain and maintain when they are struggling with mental health issues?
While elaborating on why mental health is a bigger concern than it may have been in the past, one of our youth team members said that managing overwhelming feelings and stress is harder to manage than the initial cause of the stress (i.e. relationship or financial issues). She expressed that there might be a generation gap as it was not previously “acceptable” to talk about mental health.
Throughout this assessment, we have heard how having a trusted, supportive person to talk to, even if they aren’t a mental health professional, can be beneficial in strengthening youth’s executive functioning (i.e. enhancing coping and organizational skills). Ultimately, we see potential for meaningful impact by training service providers in trauma, mental health and strengths-based engagement so that they may support youth’s mental well-being and executive functioning, while not expecting them to serve as mental health professionals for youth.
During the final phase of this planning grant, we will develop and identify solutions that align with the lessons learned from the regional assessment. Our final analysis and proposed solutions will be delivered to the regional funder, Oshkosh Area Community Foundation, and the grant partners for future funding and implementation consideration.
Children’s Mental Health in Times of COVID: Interviews with ICFW Clinicians
By ICFW Interns – Paige Bintz, Kelah Hatcher, and Johanna Nelson (photos in order)
While the ICFW clinicians were adapting their therapy to virtual platforms in response to the COVID crisis, the need for Parent-Child Interaction Therapy (PCIT) was growing. From the end of in-person visits until the start of virtual therapy in May, a significant waitlist had developed. The stress related to COVID-19 seemed to have created and exacerbated mental health issues for children and their families.
Early on in virtual therapy, clinicians noticed an increase in externalizing behaviors for both caregivers and children. Irritability, animosity, and jealousy towards siblings were some of the commonly reported behaviors that clinicians saw in response to children adjusting to COVID-19. Family relationships also were impacted due to increased time spent together while kids were doing school virtually and caregivers worked from home or had lost their jobs. Consequently, caregivers reported more conflicts with their children and between siblings.
Several months into the pandemic, the clinicians began hearing caregivers attributing their children’s challenges directly to the impact of COVID-19. Our clinicians noted an increase in internalizing behavior such as fatigue, anxiety, and depression in children. Symptoms of social anxiety or anxiety around getting sick were also reported more often than previously.
The effect of the pandemic on children’s school experience has varied based on numerous factors. Younger children have struggled more with remaining attentive during virtual learning, while older children have suffered from the lack of social interaction with their peers. For families with multiple children, a lack of consistency between virtual and in-person learning for different age groups has also presented a challenge. However, children are more resilient than we often realize, and the support provided by their families and teachers can make a big difference.
Children of all ages had to adjust to virtual learning and then back to hybrid or fully in-person learning. Virtual learning is unfortunately less cooperative, and older students have shared that they have been stressed by an increase in assignments. More students than usual are “behind”, and while eager to see their friends and teachers, they may not want to return to in-person school if it’s not the same as before. It’s difficult to predict if there will be a long-term impact on social skills, especially for younger children, but so far there is no indication of that. Conversely, a lack of closure for older students, especially seniors, has been disappointing, but again their experience was often dependent on how their school supported them.
The clinicians are noticing that the grief process has been intense for children and families who have experienced loss (i.e. death of a family member, employment, normalcy with school, social life, etc.). They are having to identify loss and know what it looks like, which can be difficult without social interaction. Without social situations due to the pandemic, children are having a harder time developing empathy and different point of views which is strengthened through interaction. Children are being siloed into basic emotional words but grief is a continuous cycle that is more complex than “sad” or “mad”. Caregivers can have difficulty with this too. With a noticeable increase in parental stress, there may be “shorter fuses”. Caregivers are going into survival mode, trying to keep their children safe from disease as well as maintain the mental and economic well-being of their family. Clinicians are noticing that parental response to children’s grief along with their own is key to process the past year and build emotional awareness.
All of this stress and grief seems to have reached an equilibrium due to telehealth, according to the clinicians. Mental health services have become more accessible with the push to virtual formats. Clients do not need to worry about childcare, transportation, or other barriers when seeing their care provider from the comfort of their own home. Families are more willing to reach out for help online. Because of this, clinicians push for more agency leaders, insurance companies, and other services to keep telehealth options and increase accessibility for families in need post pandemic. This way caregivers can focus on the relationships they build with their children, managing emotions and behaviors, responding to uncertainty, and building resilience.
The ICFW Clinicians’ Tips to Building Resilience:
Encouraging emotional labeling with children is key to helping them understand what the pandemic is and how it has impacted them. Then focus on validation. Let the children know that this has an impact on everyone and they are not alone.
Come together as a family and determine what boundaries need to be implemented in order to maintain emotional and physical well-being. Saying “no” can be difficult, but caregivers should emphasize self-care and what is best for the family. An example of a boundary could include electronic use because of the increased need for virtual access during the pandemic. Now may be a good time to develop a plan to return to basics or having conversations about healthy electronic use with children.
At this point of the pandemic, people are exhausted and social interaction can be overwhelming. To minimize the stress of this, set up a hierarchy of social stimulation and work your way upwards with the child. For example, this means starting with a walk around the block and working your way up to sitting in a classroom surrounded by other children. Overall, be proactive about creating a safe place and work in short bursts to make the transition smoother.
Caregivers should be mindful of preparing children for possible unknowns, but having a daily routine is key to dealing with tough situations like a pandemic. Caregivers could plan out the day and create visual charts, that way the children can tangibly see and check off accomplishments during the day. Make sure to praise for any adaptation that the child is going through and say that you are proud they are dealing with difficulty. Also, building the routine may be a great opportunity to set new and healthier habits that get back to family time.
The Institute provides training, consultation and technical assistance to help human service agencies implement and replicate best practices. If you are interested in training or technical assistance, please complete our speaker request form.
ICFW 5th Anniversary – May 2021
Schedule of events to celebrate our anniversary year and highlight our efforts to achieve our mission will be announced soon on our website and social media.
ICFW Webinars:
April:
Presentations, Trainings and Workshops:
April:
Together for Children Conference: Vicarious Trauma: Honoring the Weight of our Work – Meghan Christian and Luke Waldo
Together for Children Conference: Asking Sensitive Questions: Effectively Assessing for Exposure to Trauma and Adversity – Kate Bennett and Dimitri Topitzes
May and July 2021:
Christina Warner-Metzger, Ph.D., hails from Oklahoma State University with a doctorate in Clinical Psychology. True to her organization’s motto of Doing good and doing it wellTM, Dr. Warner-Metzger founded Evidence-based Practices and International Consulting (EPIC), LLC, to promote increased accessibility and excellence in professional training, consultation, and program development within the mental health and wellness sector. With a focus on training culturally humble and socially responsible professionals, she also directs the Parent-Child Interaction Therapy (PCIT) Program and Early Assessment and Recommendations for Learning in Young Children (EARLY) Clinic at DePaul University’s Family and Community Services. She is 1 of 21 PCIT International Certified Global Trainers worldwide and a Child-Adult Relationship Enhancement (CARE) co-developer, which provides her with clinical expertise in PCIT and CARE training and dissemination. Dr. Warner-Metzger is also the co-developer of a project piloting Trauma-Directed Interaction (TDI) with young children. She has served as a trainer and consultant for dissemination efforts across the United States, as well as Indonesia and Australia. Her contributions as an expert trainer and consultant on institutional, regional, federal, and international grant-funded projects has spanned the greater part of the past decade.
She is also experienced using the National Child Traumatic Stress Network (NCTSN) Learning Collaborative model. Dr. Warner-Metzger’s clinical and research interests include Autism Spectrum Disorders (ASD), developmental disabilities, disruptive behavior disorders, trauma-informed systems, underserved populations, barriers to treatment participation, and dissemination efforts. She has contributed to these topics through numerous peer-reviewed and invited presentations at national and international conferences, as well as authored peer-reviewed journal articles, government publications, and edited book chapters. Her previous clinical work in Memphis and current work in Chicago has focused on serving urban populations experiencing economic and racial marginalization.
Julian D. Ford, Ph.D., A.B.P.P. is a board certified clinical psychologist and Professor of Psychiatry and Law at the University of Connecticut where he directs two Treatment and Services Adaptation Centers in the National Child Traumatic Stress Network: the Center for Trauma Recovery and Juvenile Justice and the Center for the Treatment of Developmental Trauma Disorders. Dr. Ford is past President of the International Society for Traumatic Stress Studies, and a Fellow of the American Psychological Association. He has published more than 250 articles and book chapters and is the author or editor of 10 books, including Posttraumatic Stress Disorder, 2nd Edition, Treating Complex Trauma: A Sequenced, Relationship-Based Approach, 2nd Edition, Treating Complex Traumatic Stress Disorders in Children and Adolescents: Scientific Foundations and Therapeutic Models, and Critical Moments: Transforming Crises into Turning Points in Psychotherapy. Dr. Ford is the Principal Investigator for the national Developmental Trauma Disorder Field trial research study, and developed and has conducted randomized clinical trial and effectiveness studies with the Trauma Affect Regulation: Guide for Education and Therapy (TARGET©) model for youths and adults with developmental trauma histories and complex PTSD.
Fueled by a lifelong commitment to leadership excellence in Human Services, Clarence Johnson has held many high-level positions since beginning his career decades ago. Clarence believes the key ingredients to effective and successful leadership include holding yourself accountable to the highest standards of performance and empowering and supporting others to reach for their highest level of effectiveness. As one of the most experienced African American nonprofit leaders in the Milwaukee area, Clarence has helped to shape the future of several nonprofit organizations in the Milwaukee Community and is held in high regard in many circles. During his long and distinguished career, Clarence has also served on over 20 nonprofit boards and remains an active member of the Milwaukee area community. Clarence was recently elected to the board of directors of the Wisconsin Association of Family and Children’s agencies and is also serving as a board member for NAMI Southeast Wisconsin.
Mr. Clarence Johnson is currently serving as the Executive Director of Wisconsin Community Services, a position he has held since January of 2017. Established in 1912, Wisconsin Community Services, Inc. (WCS) is a non-profit organization respected throughout the Milwaukee region and state of Wisconsin for its steadfast commitment to bettering the lives of individuals involved in, or at risk of becoming involved in, the criminal justice system. WCS provides services to more than 15,000 individuals each year through 40+ programs in southeastern Wisconsin. The mission of WCS is to advocate for justice and community safety, providing innovative opportunities for individuals to overcome adversity. Since assuming top leadership role at WCS, Clarence has led the organization to a 62% increase in revenue (from 24 million to 40 million dollars), and significantly expanded the number of programs offered by the agency. Johnson was also instrumental in leading the effort that which resulted in the WCS Center for Driver’s License Recovery being named as one of Mutual of America’s three national 2019 Community Partnership Award winners. A national award that honors the outstanding contributions that nonprofit organizations, in partnership with public, private, and other social sector organizations, make to society.
Johnson joined Wisconsin Community Services in 2010 as the Associate Executive Director. In addition to providing high-level leadership, Johnson was then responsible for various programs and divisions, which helped to expand the work of WCS, and cultivate partnerships with community organizations and stakeholders. Clarence also brought Community Building Milwaukee to WCS, which involves numerous agencies, institutions and organizations across the Milwaukee community serving, youth and adults. Johnson is a lifelong resident of city of Milwaukee and earned both his undergraduate and graduate degree from the University of Wisconsin-Milwaukee. Has worked on several research projects during his career and began a program to reduce the incidence of obesity and chronic disease among central youth. A program that is now offered city-wide. Working for over 35 years in Social Services, Johnson has extensive experience working in and leading nonprofit, government, and human/social services agencies in the Milwaukee area. Prior to his time at WCS, he served as Executive Director of Neighborhood House of Milwaukee, Chief Operating Officer for YW Works (then subsidiary of the YWCA), and spent several years as a high level manager for Milwaukee County Department of Health and Social Services.
In partnership with the Wisconsin Department of Workforce Development, Division of Vocational Rehabilitation (DVR), ICFW will work to develop, implement and test a consumer quality improvement plan at the Milwaukee central city location. This initiative builds on an extensive consumer service review that DVR conducted in 2019. Stakeholder interviews...
The Institute for Child and Family Well-Being was proud to host the webinar “Parenting with PRIDE – Designing Group-based, Telehealth Solutions with PCIT in Times of COVID” with Haley Challoner Miller, Child and Family Therapist II, and Kate Bennett, Well-Being Lead Clinician, on April 14, 2021 from 12:30-1:30PM CST.
One of the most profound and noticeable effects of the COVID-19 pandemic, aside from the toll on the physical health of individuals and families, is the impact on the mental health of individuals, specifically in children. Inconsistency in school models, pressures put upon caregivers due to loss of or changes in employment, illness or death of family members, and the stress of family isolation and lack of support led to a rush of referrals and a building waitlist of families looking for mental health treatment for their children at Children’s Wisconsin.
Parent Child Interaction Therapy (PCIT) has been referred to by experts as the “gold standard” treatment for children with disruptive behaviors, and is a well-known, well-researched evidence-based treatment for children with behavioral difficulties and adjustment disorders. In order to meet the growing need for PCIT services, Institute for Child and Family Well-being clinicians at Children’s Wisconsin designed and implemented a program that administers core components of PCIT in a group setting by way of telehealth, to reach larger numbers of families in a safe and effective way.
In this webinar, Leah Cerwin discussed the following with Ms. Bennett and Ms. Miller:
Related Resources from the ICFW
ICFW Newsletter – Winter 2021: Parenting with PRIDE
Practice Brief: Internet-based PCIT: Beyond the Pandemic (PDF)
Integrating PCIT into Child Welfare Programs
Webinar PowerPoint Presentation (PDF)
Related Resources from PCIT International
A new study by the Institute found alarming rates of childhood vaccine hesitancy among low-income women in Wisconsin who received home visiting services. Results showed that vaccine hesitancy was especially prevalent among Black and American Indian women. Mothers who reported greater trust in their medical providers and in their home visitors had more positive attitudes toward vaccines.
For more information, see the publication here.
Mersky, J. P., Choi, C., Plummer Lee, C, & Janczewski, C. E. (2021). Disparities in adverse childhood experiences by race/ethnicity, gender, and economic status: Intersectional analysis of a nationally representative sample. Child Abuse & Neglect.
Abstract
Background
Adverse childhood experiences (ACEs) are disturbingly common and consequential. Priority should be given to identifying populations that bear a disproportionate share of the burden of ACEs, but such disparities have received limited attention to date.
Objective
This study analyzes data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample in the U.S., to explore variation in ACEs by race/ethnicity, economic status, and gender.
Methods
In addition to using conventional statistical methods to generate unadjusted and adjusted estimates, we conduct an intercategorical intersectional analysis of variation in ACEs using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA).
Results
Descriptively, we find that ACEs are more prevalent overall among the poor than the non-poor, among most racial/ethnic minority groups than non-Hispanic Whites, and among females than males. However, multivariate regression results indicate that gender is not a robust correlate of cumulative adversity and that economic status moderates racial/ethnic differences. MAIHDA models further expose heterogeneity in aggregate ACE scores between intersectional strata representing unique combinations of gender, race/ethnicity, and economic status.
Conclusions
The MAIHDA results confirm that conclusions based on unadjusted group differences may be spurious. While most variance in ACE scores is explained by additive main effects, accounting for intersections among social categories generates a more complex portrait of inequality. We compare our work to prior studies and discuss potential explanations for and implications of these findings for research on disparities.
Mueller, D., Bacalso, E., Ortega‐Williams, A., Pate Jr, D. J., & Topitzes, J. (2021). A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity, and trauma among diverse residents of a midwestern city. Journal of Community Psychology.
Abstract
Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community‐based resources, and addressed structural and systemic barriers. The data generated a theory of “a mutual process of healing self and healing the community” through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer‐led, community‐engaged initiatives and holistic, trauma‐informed, healing‐centered practices.
The mission of the Institute for Child and Family Well-Being is to improve the lives of children and families with complex challenges by implementing effective programs, conducting cutting-edge research, engaging communities, and promoting systems change.
The Institute for Child and Family Well-Being is a collaboration between Children’s Wisconsin and the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The shared values and strengths of this academic-community partnership are reflected in the Institute’s three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
As Community Engagement and Systems Change are a core pillar of the ICFW, collaboration with our community and systems partners is critical to fulfilling our mission. In recognition of those that value collaboration and whose mission seeks to improve child and family well-being, we have invited those partners to join us as ICFW Affiliates. We are honored to introduce our three newest ICFW Affiliates with whom we look forward to partnering with now and into the future.
Jennifer A. Jones, MSW
Chief Strategy Officer, Prevent Child Abuse America
Jennifer Jones currently serves as the Chief Strategy Officer at Prevent Child Abuse America (PCAA) where she develops, implements and advocates for an integrated strategic framework to help grow PCAA’s leadership role consistent with national prevention priorities, and serves as the lead on regional and national strategic partnerships. Prior to her role with PCAA, Jones was the Director of the Change in Mind Institute and the Co-Director of the Safety and Resilience Impact Area at the Alliance for Strong Families and Communities. As the Director of the , she worked closely with ICFW Co-Director Gabe McGaughey as Children’s Wisconsin was one of the organizations that participated in the inaugural Change in Mind class. Since then, Jennifer has partnered with Gabe and Luke Waldo to present the impact of and findings from the Change in Mind experience at conferences across the country.
Jones led all aspects of the Institute, including raising $1.7 million for the Texas Change in Mind Learning Collaborative and National Impact Study. Jones also served as the Project Director of the Child Safety Forward Initiative, a three-year Department of Justice cooperative agreement working with 5 jurisdictions to develop community-led, systematic solutions to reduce child fatalities caused by child maltreatment. Jones worked closely with the Alliance policy team, other national organizations and congressional representatives to advance brain science infused policy and trauma-informed care legislation.
Preceding her role at the Alliance, Jones served as the Associate Director of the Wisconsin Children’s Trust Fund (CTF). In her last two years at the agency, Jones served as Interim Executive Director, at the Board’s request, and coordinated all activities related to the Governor-appointed Child Abuse and Neglect Prevention Board, including managing all operations, and overseeing the agency’s budget and grantmaking functions. Before her positions with the Children’s Trust Fund, Jennifer served as the communications specialist in the Secretary’s Office at the Wisconsin Department of Children and Families and as a child welfare policy advisor in the Wisconsin Division of Children and Family Services. Jones is also a member of the National HOPE (Healthy Outcomes from Positive Experiences) Advisory Board and serves on the Board of Directors of the Hunger Task Force.
Jennifer received her master’s in social work from the University of Wisconsin-Madison and bachelor’s in social work from Marquette University.
Dr. John Meurer
Professor and Institute for Health & Equity Director, Medical College of Wisconsin
John Meurer, MD, MBA is Professor and Director of the Medical College of Wisconsin Institute for Health & Equity. The mission of the Institute is to improve health and advance equity through research, education, and shared expertise by working collaboratively with local, national and global communities.
Dr. Meurer is a general pediatric clinician-educator and is academically recognized for his achievements in community-engaged research. He has a national reputation for research to improve childhood asthma and advance early childhood development and community-engaged health systems research. He has been a collaborative and transformative steward and leader of 25 Advancing a Healthier Wisconsin projects including 5 recently focused on improving early childhood developmental care systems.
Dr. Meurer worked closely with ICFW Co-Directors Gabe McGaughey and Josh Mersky on his that aimed to improve early childhood developmental screening and assessment along with improved practices in data monitoring and integration. More recently, he co-led the Scaling Wellness in Milwaukee (SWIM) Policy Action Team with Gabe.
He holds a medical degree from the University of Wisconsin-Madison, completed his residency at Baylor College of Medicine, Houston, Texas, attained a master of business degree from Northwestern University, and was a fellow with the David Winston Program, Washington DC.
Carmen Pitre
President & CEO, Sojourner
Carmen Pitre is the President and Chief Executive Officer of Sojourner, Wisconsin’s largest service provider for families dealing with domestic violence. Under Pitre’s leadership, Sojourner provides crisis housing, system advocacy and individual support to thousands of women, children and families.
Carmen and her team at Sojourner worked closely with ICFW Co-Director Josh Mersky and Clinical Director Dimitri Topitzes to develop and administer a polyvictimization screening tool with clients that receive services from the Sojourner Family Peace Center. Subsequently, Carmen and her team have remained strong partners with the ICFW in the pursuit of collaborative community efforts through initiatives like Scaling Wellness in Milwaukee.
Pitre draws on decades of work and personal experience to improve the way the community supports families impacted by domestic violence. Pitre believes – and data proves – a holistic approach of co-locating services and coordinating resources is effective, efficient and yields better outcomes for families. In 2016, Pitre rallied key community leaders to create the Sojourner Family Peace Center where people impacted by domestic violence can access emergency shelter, domestic violence services, physical and mental health services, law enforcement and legal assistance, counseling, employment services, financial literacy, community education and professional training – all under one roof.
Pitre was integral in the 2009 merger of Sojourner Truth House and the Task Force on Family Violence when she became Co-Executive Director of the new agency, Sojourner Family Peace Center. Before the merger, Pitre was the Executive Director of the Task Force on Family Violence from 2002 to 2009. Pitre served as the Director of the First Judicial District Judicial Oversight Demonstration Initiative and the Coordinator of the Milwaukee Commission on Domestic Violence and Sexual Assault from 1997 to 2000.
Pitre graduated from the University of Southwestern Louisiana – Bachelor of Arts program in 1984.
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Parenting with P.R.I.D.E. – Group-based, Virtual Parent-Child Interaction TherapyBy Kate Bennett and Haley Challoner Miller
Due to the COVID-19 pandemic, we recognize that it is imperative to meet the mental and behavioral health needs of families through safe, convenient and swift approaches. Providing telehealth services in the context of Parent-Child Interaction Therapy (PCIT) allows for evidence-based treatments to reach more families in a shorter period of time. As a result, waitlist times decrease for families seeking treatment. As many children and families are socially isolated during these times, virtual group-based therapy offers a sense of connection and community that otherwise would not be available right now.
As a result of earlier prototype designs and testing conducted by the Institute for Child and Family Well-being (ICFW), Children’s Wisconsin is currently providing an 8-week virtual therapy group for parents/caregivers and a child in their care: Parenting with P.R.I.D.E. This group is being facilitated by licensed mental and behavioral health clinicians and masters-level student interns, and includes components from the evidence-based intervention PCIT. Providing this group-based service through telehealth offers caregivers and children the opportunity to learn with and from one another in a supportive online environment from the comfort and safety of their own homes.
Parenting with P.R.I.D.E. helps caregivers of young children manage challenging behaviors including not listening, difficulty with transitions, acting out, and handling big emotions. Each family is able to learn tangible strategies that promote positive behaviors, enhance the caregiver-child relationship, and decrease undesired behaviors through engaging activities and live coaching with a PCIT-trained therapist. Additionally, this group benefits parents who may identify as overwhelmed, depressed, stressed, feeling guilty, or are confused about how to best meet the needs of their children who might be struggling with focus on tasks or changes in daily life. Parents who have previously participated in the ICFW’s PCIT-based groups have provided feedback that they feel less isolated and have experienced a reduction in parenting stress.
Specifically, the group format of the Parenting with P.R.I.D.E. program allows for virtual service delivery to a maximum of six caregiver/child dyads (families) through telehealth. Dyads include children between the ages of 2.5-5 years who were screened for inclusion criteria prior to intake. Caregivers access weekly therapy appointments through Zoom on Children’s Wisconsin MyChart, the web-based portal for their child’s electronic medical record. Services are provided in the following format:
Children’s Wisconsin plans to continue to utilize group-based therapy approaches for children and families beyond the pandemic and will begin to share new offerings in coming weeks.
By Luke Waldo
Youth aging out of foster care do not fare as well as their same-aged peers. Frequent exposure to trauma and adversity stresses executive functioning skills most needed to perform essential life skills that set the foundation for self-sufficiency and independence. According to the National Center for Children in Poverty, youth who are aging out of care are at increased risk for a variety of adverse outcomes, including homelessness/unstable housing, unemployment, low educational attainment, higher prevalence of poor health status, sexual and physical victimization, and incarceration.
Children’s Wisconsin’s Institute for Child and Family Well-being (ICFW) and its collaborative partners were awarded a planning grant from the Oshkosh Area Community Fund to facilitate a community assessment to delineate the causes of poor outcomes for youth 18-24 years of age who are aging out of foster care and to identify solutions. The assessment will help us gain a greater understanding of the risk factors and future difficulties that young adults in the region face when leaving the foster care system. These youth are often left on their own to navigate the transition to adulthood, and in the absence of strong, stable connections with parents or extended family members, there is no safety net to support them.
The ICFW will convene key stakeholders, including but not limited to the Wisconsin Department of Children and Families, Bay Area Workforce Development Board and the region’s Youth Advisory Council to collect and assess information about the extent of the challenges facing this population. The assessment will include surveying the region’s strengths, resources, needs, and gaps as they relate to the population of youth transitioning to adulthood. The assessment findings will provide a foundational framework that we will use for exploring existing service delivery models, such as Youth Villages LifeSet and/or developing a tailored intervention(s) to meet the unique needs of the target population. Through these collective efforts, our long-term goal is to provide a pathway to independence by strengthening youths’ resiliency and equipping them with the knowledge and skills necessary to become self-sufficient, build a strong support network, achieve educational and/or job training goals to earn a living wage, and maintain safe and stable housing.
Learn More:
The Institute accelerates the process of translating knowledge into direct practices, programs and policies that promote health and well-being, and provides analytic, data management and grant-writing support.
We are pleased to announce a new partnership with the Wisconsin Department of Health Services (DHS) to support the evaluation of innovation grants awarded to 15 Birth to 3 programs across the state to pilot new and innovative efforts to improve social-emotional outcomes for participating children.
The ICFW team is conducting a cross-site evaluation of the 15 projects with 3 central aims:
Learn More:
Birth to Three Social-Emotional Innovation Project
Mueller, D., Bacalso, E., Ortega-Williams, A., Pate, D. J., & Topitzes, J. (in press). A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity and trauma among diverse residents of a midwestern city.” Journal of Community Psychology.
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
COVID-19 placed unique and unprecedented stress on families, staff, and communities while also exacerbating already existing health and economic disparities. On March 18, 2020, Wisconsin’s governor issued a ‘Safer-at-Home’ order to mitigate the impact of COVID-19 that dramatically impacted nonprofit service delivery, a $14.6 billion sector in Wisconsin, accounting for 1 in 12 employees in the state. In one survey, 27.6% of nonprofits reported widespread conversion to virtual programming.
System disruption can lead to one of three types of outcomes for families and service providers to navigate; a return to the old equilibrium, finding a new equilibrium, or managing a new disequilibrium. The scale of the innovation required to adapt to the challenges associated with COVID-19 have been staggering, from rapid expansion of virtual therapy to radical shifts in group-based parent support programs. At no time in our profession’s history has innovation occurred on this scale so rapidly. How might organizations move quickly, but also identify what has value that will be useful to carry into the ‘new normal’ of a post-COVID social service delivery system?
COVID-19 has forced nonprofit human services providers to rapidly adapt to new restrictions on how they might engage families made more vulnerable because of either disparities or the inability of systems to support their well-being. Coming out of this unprecedented level of disruption, nonprofits have an opportunity to reflect on what of their innovative responses can support their objectives moving forward. Children’s Wisconsin’s Well-Being programs developed a COVID Resilience Plan to identify and elevate innovative practices that have surfaced since the start of the COVID-19 crisis that supports the well-being of families, are adaptable to our current limitations, and may enhance future practice. This process leveraged strategic learning to highlight lessons learned to carry forward in the future state, including:
The ongoing work of the COVID Resilience Plan is now focused on facilitating Communities of Practice focused on these three prioritized findings to deliver recommendations on concrete next steps for activities that will carry forward beyond the restriction associated with social distancing. While these findings reflect a specific set of experiences, the role of virtual service provision in what was almost exclusively in-person supportive services is inescapable. Different organizations may be able to yield relevant insights for their own work from these lessons, or adapt the strategic learning process to identify their own specific lessons learned to carry into the ‘new normal’ of a post-COVID world.
Learn More:
Practice Brief: Strategic Learning (PDF)
Practice Brief: After Action Reviews (PDF)
The Institute provides training, consultation and technical assistance to help human service agencies implement and replicate best practices. If you are interested in training or technical assistance, please complete our speaker request form.
ICFW 5th Anniversary – May 2021
Schedule of events to celebrate our anniversary year and highlight our efforts to achieve our mission will be announced soon on our website and social media.
ICFW Webinars:
April 14th:
Parenting with PRIDE – Designing Group-based, Telehealth Solutions with PCIT in Times of COVID
Presentations, Trainings and Workshops:
January 21st-22nd:
Janczewski, C.E., Nitkowski, J. (2021). Parental Mental Health and Substance-Related Services Among CPS-Involved Families, Society for Social Work Research, January 22. Virtual Event
February 22nd:
April 15th:
Together for Children Conference: Vicarious Trauma: Honoring the Weight of our Work – Meghan Christian and Luke Waldo
May and July 2021:
Youth aging out of foster care do not fare as well as their same-aged peers. Frequent exposure to trauma and adversity stresses executive functioning skills most needed to perform essential life skills that set the foundation for self-sufficiency and independence. According to the National Center for Children in Poverty, youth who are aging out of...
John Meurer, MD, MBA is Professor and Director of the Medical College of Wisconsin Institute for Health & Equity. The mission of the Institute is to improve health and advance equity through research, education, and shared expertise by working collaboratively with local, national and global communities.
Dr. Meurer is a general pediatric clinician-educator and is academically recognized for his achievements in community-engaged research. He has a national reputation for research to improve childhood asthma and advance early childhood development and community-engaged health systems research. He has been a collaborative and transformative steward and leader of 25 Advancing a Healthier Wisconsin projects including 5 recently focused on improving early childhood developmental care systems.
He holds a medical degree from the University of Wisconsin-Madison, completed his residency at Baylor College of Medicine, Houston Texas, attained a master of business degree from Northwestern University, and was a fellow with the David Winston Program, Washington DC.
Lixia Zhang’s research interests focus on child maltreatment and other negative circumstances that undermine individuals’ health and well-being across the life span. She is also interested in prevention and intervention strategies to avert childhood trauma or mitigate its effects, especially among disadvantaged children and families. Zhang has been involved in a variety of international, national and state research projects. As an ICFW affiliated scholar, she is currently collaborating with Dr. Joshua Mersky on two adverse childhood experiences (ACEs) studies. The first study is a cross-cultural ACEs Study. Dr. Zhang and Dr. Mersky collected original data from more than 1,200 recent high school graduates in China to test the effects of ACEs on psychosocial well-being in emerging adulthood. The second study is an intergenerational ACEs study. Dr. Zhang and Dr. Mersky are working with families and schools to determine how parents’ exposure to ACEs can affect the emotional and behavioral development of their school children.
Lixia holds a master’s and PhD in social work from the University of Wisconsin-Milwaukee.
Penelope is the Shelter Manger at the Milwaukee Women’s Center, a division of Community Advocates. In her role as the shelter manager, she oversees the 68 bed shelter for families experiencing homelessness and domestic violence. She is committed to providing a trauma-informed approach to enhance housing stability for the families served.
Prior to her role as a shelter manager, Penelope spent eight years with Children’s Wisconsin and the Institute for Child and Family Well-Being as a Child and Family Therapist and Foster Parent Educator. In both roles she worked directly with families involved in child welfare. Earlier in her career, she worked in special education in Milwaukee Public Schools.
Penelope is a licensed professional counselor. She earned her bachelor’s degree in educational policy and community studies from the University of Wisconsin-Milwaukee, and later a master’s degree in professional counseling from Grand Canyon University. She is a Milwaukee native with a passion for caring for Milwaukee’s most vulnerable populations.
Stemming from her macro and direct practice work with domestic violence and sexual assault services, Dr. Voith focuses on violence prevention and intervention, particularly violence against women and children, and implementation science on the delivery of violence prevention programs. Her research on social inequalities contributing to the risk of violence exposure, subsequent health disparities resulting from violence exposure, and the prevention of such violence is carried out through two lines of research. (1) Dr. Voith examines the effects of individual- and neighborhood-level cumulative risk and protective factors on the relation between violence exposure and risky outcomes with children and adolescents. (2) Dr. Voith examines how men’s exposure to trauma, violence, and adversities contribute to violent perpetration and victimization, and how individual factors, such as men’s social networks, interact with neighborhood-level characteristics to enhance or diminish the risk of men’s use of violence in intimate relationships. These two lines of research will inform the development and evaluation of violence prevention programs with at-risk children and adolescents, and the improvement of batterer intervention programming with men.
Jennifer Jones currently serves as the Chief Strategy Officer at Prevent Child Abuse America (PCAA) where she develops, implements and advocates for an integrated strategic framework to help grow PCAA’s leadership role consistent with national prevention priorities, and serves as the lead on regional and national strategic partnerships.
Prior to her role with PCAA, Jones was the Director of the Change in Mind Institute and the Co-Director of the Safety and Resilience Impact Area at the Alliance for Strong Families and Communities. Jones led all aspects of the Institute, including raising $1.7 million for the Texas Change in Mind Learning Collaborative and National Impact Study. Jones also served as the Project Director of the Child Safety Forward Initiative, a three-year Department of Justice cooperative agreement working with 5 jurisdictions to develop community-led, systematic solutions to reduce child fatalities caused by child maltreatment. Jones worked closely with the Alliance policy team, other national organizations and congressional representatives to advance brain science infused policy and trauma-informed care legislation.
Preceding her role at the Alliance, Jones served as the Associate Director of the Wisconsin Children’s Trust Fund (CTF). In her last two years at the agency, Jones served as Interim Executive Director, at the Board’s request, and coordinated all activities related to the Governor-appointed Child Abuse and Neglect Prevention Board, including managing all operations, and overseeing the agency’s budget and grantmaking functions. Before her positions with the Children’s Trust Fund, Jennifer served as the communications specialist in the Secretary’s Office at the Wisconsin Department of Children and Families and as a child welfare policy advisor in the Wisconsin Division of Children and Family Services.
Jones is an affiliate of the Institute for Child and Family Well-Being, a joint project of Children’s Wisconsin and the University of Wisconsin-Milwaukee. Jones is also a member of the National HOPE (Healthy Outcomes from Positive Experiences) Advisory Board and serves on the Board of Directors of the Hunger Task Force. Jennifer received her master’s in social work from the University of Wisconsin-Madison and bachelor’s in social work from Marquette University.
Katelyn Blair, MSW, Ph.D., is a Senior Researcher in Child Welfare at JBS International, Inc. She is responsible for the analysis of Child and Family Services Review data on child and family outcomes, yielding results on national and State performance and best practices in child welfare. Dr. Blair also contributes to the analysis of calculating Statewide Data Indicator Profiles for the Children’s Bureau. She provides support in the analysis of estimates of improper payments and state and national error rates for the IV-E Foster Care Program. Previously, Dr. Blair worked at the University of Wisconsin-Milwaukee and Children’s Wisconsin as a research assistant and clinician where she designed and implemented studies that aided in the translation of evidence-based interventions into child welfare. She led efforts to examine distal system-level intervention outcomes, developed and validated a measure of early childhood resilience, and evaluated child welfare practice. She also delivered evidence-based interventions (Parent-Child Interaction Therapy and Trauma-Focused Cognitive Behavioral Therapy) to children and families within the context of child welfare services to improve well-being and facilitate resilience. As a researcher-practitioner, Dr. Blair married her clinical work with data collection, analysis and management to help develop an applied, translational research and evaluation agenda that contributed to the implementation and dissemination of trauma-informed services to underserved families.
As an ICFW affiliate, Dr. Blair continues to collaborate with team members to promote the use of evidence-based interventions and resilience in child welfare research and practice.
Dr. Blair holds a master’s degree in social work and a doctoral degree in social work from the University of Wisconsin-Milwaukee.
November 2020- April 2022
The Wisconsin Birth to 3 Program is a federally-mandated Early Intervention program to support families of children with developmental delays or disabilities under the age of three. The Wisconsin Department of Health Services (DHS) awarded innovation grants to 15 Birth to 3 programs across the state to pilot new and...
Gilbert, R., Mersky, J. P., & Plummer Lee, C. (2021). Prevalence and correlates of vaccine hesitancy in a sample of low-income mothers. Preventive Medicine Reports, 21, 101292.
Abstract
The US is facing a rise in vaccine hesitancy, delay, and refusal, though little is known about these outcomes in socio-economically disadvantaged populations. This study examines the prevalence and correlates of vaccine attitudes and behaviors in a diverse cohort of low-income mothers receiving home visiting services. Survey data were collected from 813 recipients of evidence-based home visiting services in Wisconsin from 2013 to 2018. Analyses were performed to describe outcome measures of vaccine attitudes and self-reported completion, and multivariate regressions were used to test associations between vaccine-related outcomes and hypothesized correlates. Most women (94%) reported their children were up to date on vaccines; 14.3% reported having ever delayed vaccination. A small minority disagreed that vaccines are important (5.0%), effective (5.4%), and safe (6.2%), though a larger proportion responded ambivalently (10.9%–21.9%). Participants with greater trust in health care providers reported more positive overall vaccine attitudes (B = 0.24; 95% CI = 0.17, 0.31), a lower likelihood of vaccine delay (OR = 0.57; 95% CI = 0.46, 0.73), and a greater likelihood of being up to date on vaccines (OR = 1.79, 95% CI = 1.30, 2.44). Women with greater trust in a home visitor also rated vaccines more positively (B = 0.09; 95% CI = 0.02, 0.15), and women who reported better mental health were more likely to report their children were up to date (OR = 1.05; 95% CI = 1.02, 1.09). Compared to non-Hispanic whites, American Indians and non-Hispanic blacks had poorer vaccine-related outcomes. More research on vaccine attitudes and behaviors among higher-risk populations is needed to develop tailored strategies aimed at addressing vaccine hesitancy and underimmunization.
Reggie Moore serves as the Injury and Violence Prevention Director of the Office of Violence Prevention (OVP) located within the City of Milwaukee’s Health Department. Appointed in 2016, Reggie leads the city’s efforts to assess, prevent, and decrease incidents of structural and community violence. OVP’s mission is to prevent and reduce violence through partnerships that strengthen youth, families, and neighborhoods. On November 11, 2017, the Office of Violence Prevention released Milwaukee’s first comprehensive plan to address violence from a public health perspective.
Prior to joining the city, Reggie has led local and national organizations including the Center for Youth Engagement, Urban Underground, and the national Youth Activism programs for the Truth Initiative in Washington, DC. He has volunteered his time with several local and national organizations including the Milwaukee Public Schools Foundation, the Funders Collaborative on Youth Organizing, and Scaling Wellness In Milwaukee. An organizer at his core, Reggie has dedicated his life to being a catalyst for social change.
Tim Grove is a senior consultant at Wellpoint Care Network, a human services agency whose mission is to facilitate equity, learning, healing and wellness for all. He has 25 years of professional experience in a variety of direct care and administrative positions including, in-home services, foster care, treatment foster care, residential treatment, child welfare, community based services, quality improvement and staff development.
Grove’s work at Wellpoint includes being the senior leader of trauma informed care (TIC) initiatives across all agency programs and as such was responsible for implementing Wellpoint’s TIC philosophy and practices, including Dr. Bruce Perry’s Neurosequential Model of Therapeutics (NMT). He also created a TIC training curriculum centered around the Seven Essential Ingredients, or 7ei, of understanding and practicing TIC. Grove and the training team at Wellpoint have used the 7ei framework to train more than 50,000 people across the country over the past 12 years. Groups that are currently using the 7ei curriculum include judges, law enforcement/first responders, schools, child welfare agencies, social service agencies, health centers, community agencies, post secondary academic institutions and many others.
He is a Mentor with the ChildTrauma Academy and a Master Trainer in Dr. Rob Anda and Laura Porter’s ACE Interface curriculum. Grove and the SaintA team’s work has been highlighted in various radio and television projects, including a 2018 60 Minutes segment with special correspondent Oprah Winfrey. Their work has also been showcased in a number of magazines, journals and newspapers, including a three-year research study on the effectiveness of 7ei in child welfare published by the Journal of Child Custody in 2019.
Carmen Pitre is the President and Chief Executive Officer of Sojourner, Wisconsin’s largest service provider for families dealing with domestic violence. Under Pitre’s leadership, Sojourner provides crisis housing, system advocacy and individual support to thousands of women, children and families.
Pitre draws on decades of work and personal experience to improve the way the community supports families impacted by domestic violence. Pitre believes – and data proves – a holistic approach of co-locating services and coordinating resources is effective, efficient and yields better outcomes for families. In 2016, Pitre rallied key community leaders to create the Sojourner Family Peace Center where people impacted by domestic violence can access emergency shelter, domestic violence services, physical and mental health services, law enforcement and legal assistance, counseling, employment services, financial literacy, community education and professional training – all under one roof.
Pitre was integral in the 2009 merger of Sojourner Truth House and the Task Force on Family Violence when she became Co-Executive Director of the new agency, Sojourner Family Peace Center. Before the merger, Pitre was the Executive Director of the Task Force on Family Violence from 2002 to 2009. Pitre served as the Director of the First Judicial District Judicial Oversight Demonstration Initiative and the Coordinator of the Milwaukee Commission on Domestic Violence and Sexual Assault from 1997 to 2000.
Pitre graduated from the University of Southwestern Louisiana – Bachelor of Arts program in 1984.
At the Institute for Child and Family Well-being, we recognize that COVID-19 has created challenges during this past year that require innovative practices and policies that draw on established evidence to provide the best possible care to our community, and opportunities to learn from those practices and policies that may lead to more resilient and supportive communities in the future. As we reflect on this past year, we have deepened our commitment to strong community and systems partnerships, research and evaluation, and adaptation and innovation to meet the needs of our clients and community, so that we may ultimately improve child and family well-being.
We are excited to remain steadfast in these commitments and to continue this journey as we celebrate our 5th anniversary later this year. So take a moment to review what we learned and accomplished in 2020, and keep an eye out for upcoming announcements for our events that will celebrate our five years of partnership as the Institute for Child and Family Well-being.
As Community Engagement and Systems Change are a core service area of the ICFW, collaboration with our community and systems partners is critical to fulfilling our mission. In recognition of those that value collaboration and whose mission seeks to improve child and family well-being, we have invited those partners to join us as ICFW Affiliates. We were honored to introduce three ICFW Affiliates in 2020 and are looking forward to expanding our affiliates in 2021.
COVID-19 placed unique and unprecedented stress on families, staff, and communities while also exacerbating already existing health and economic disparities. Read some of our articles that illustrate how we responded to COVID-19 and its challenges this past year.
From Trauma Screening to Authentic Community Engagement, Housing as a Pathway to Prevent Maltreatment and Executive Functioning for Child and Family Well-being, check out our conversations with the ICFW team and community and national experts on these important issues.
To learn more, explore the webinars here.
Mersky, J. P., Plummer Lee, C., & Janczewski, C. E. (2020). Toward the Assessment of Adverse Adult Experiences: An Initial Validation Study of the Adult Experiences Survey. Psychological Trauma: Theory, Research, Practice, and Policy.
Objective: The current investigation is a validation study of the Adult Experiences Survey, a seminal assessment of adverse adult experiences.
Method: Data were collected between July 2015 and June 2019 from a sample of 1,747 low-income women as part of a longitudinal study in Wisconsin, United States. Analyses of 10 adversities were conducted to assess item prevalence and internal consistency in the full sample and test-retest reliability in a subsample of 90 participants. Exploratory and confirmatory factor analyses were performed to examine the factor structure of the measure, and multivariate regressions were conducted to estimate the effects of adult adversity on 3 health-related outcomes: poor physical health, depression, and posttraumatic stress disorder.
Results: Most participants (86%) endorsed at least 1 adversity. Each item demonstrated good test-retest reliability except crime victimization, and the full measure had sound internal consistency. Each adversity was associated with all health-related outcomes at the bivariate level, and most were linked to 1 or more outcomes in multivariate analyses. Exploratory and confirmatory factor analyses validated 1- and 2-factor solutions with good fit. A cumulative adult adversity score was associated with all study outcomes controlling for adverse childhood experiences, and effects associated with a latent adversity score were even larger in magnitude.
Conclusions: Extending research on adverse childhood experiences, the findings indicate that adverse adult experiences can be measured reliably and validly using a brief assessment. Implications are discussed, including opportunities to advance the study of trauma and resilience over the life course.
