The Institute for Child and Family Well-Being was proud to host the webinar 鈥淓xecutive Functioning for Child and Family Well-being鈥� with John Till, Senior Vice President of Strategy and Innovation at The Family Partnership, and Jennifer Winkler, Family Case Management Well-Being and Family Support Manager at Children鈥檚 Wisconsin, on December 7th from 11:00-12:00 CST.
Executive function skills are like an air traffic control system in the brain that helps us manage information, make decisions, and plan ahead. Stress and the lingering impact of Adverse Childhood Experiences (ACEs) can negatively impact executive functioning, making it difficult to effectively navigate challenging and uncertain circumstances.
This webinar explored how executive functioning is impacted by Adverse Childhood Experiences (ACEs) and toxic stress, why it is critical to our child and family well-being systems, and how our presenters鈥� organizations have developed and implemented executive functioning programming into their core service delivery through robust conversation with an experienced panel through their work with the Executive Functioning Across Generations and Mobility Mentoring models.
(EF) skills are like an air traffic control system in the brain that helps us manage information, set and work towards goals, and make decisions that help us reach those goals. EF Skills, which can be developed throughout the life-course, are central to navigating distractions, unexpected challenges, and stressful situations while making decisions that contribute to long-term goal attainment.
Resilience, or the , is a central concept operationalized, in part, through EF Skills. Building resilience helps children and adults navigate stressful situations and the lingering impact of trauma.Childhood experiences are the foundation for healthy development into adulthood. Adverse Childhood Experiences (ACEs) can cause cracks in that foundation, potentially impairing EF Skills and contributing to less intentional self-regulation. ICFW team members Drs. Mersky and Janczewski co-authored a study finding that parents in home visiting programs reported the same level of ACEs as parents with children involved in the child welfare system.
Parents participating in home visiting program face a myriad of complex challenges beyond the legacy of ACEs. 77% of caregivers in that program have reported an alcohol or other drug abuse, mental health, or domestic violence issue. 48% of caregivers screened positive for postnatal depression. Through those challenges, 56% of parents are receiving services and 90% demonstrate positive parent-child interactions, a core component to child health, well-being, and resilience.
How might programs that already reach families further address enhancing executive functioning of parents and children in their programs to promote long-term stability and success?
Children鈥檚 Wisconsin, along with two other partner organizations, is participating in a collaborative feasibility study of the 鈥淓xecutive Functioning Across Generations鈩⑩�� program, funded by , the R&D platform of the Center on the Developing Child at Harvard University. Developed in 2017 by (TFP) in Minneapolis, Minnesota, the organizations are working together to adapt the intervention for virtual use in a Healthy Families America home visiting program.
Over the course of 10 virtual sessions, parents learn about brain science and familiarize themselves with the types of activities that help foster brain development and self-regulation in their children through a language-based curriculum. Specifically, there will be an increase in knowledge of brain science, internal state words, theory of mind, serve and return, and personal narratives (BITSN鈥檚). These are all key functions of brain development in children. Parents will learn how to recognize, model and respond to Internal State Words (ISWs) as part of a supportive relationship with their child. ISWs are important because they are used by children in order to express themselves by describing thoughts, feelings and perceptions. This helps them to tell stories about events that have affected them emotionally (see chart).
Home visitors coach families, encourage further learning, and provide teaching tools, like storybooks that use ISW-based language. There will also be activities and handouts for the parents to practice skills with their children in between the sessions. This project has a greater impact with the implementation of a two-generation approach because it allows for more alignment with the goals and more stability in the family unit. The skills learned and the impacts made can continue to affect more generations and create a 鈥渄omino effect鈥� of positive development.
In order to measure the impact of the curriculum, Minnesota Executive Functioning Scale (MEFS), developed at the University of Minnesota by Dr. Stephanie M. Carlson and Dr. Philip Zelazo, will be used. The app is a quick, 鈥済ame-like鈥� measure of executive functioning for anyone over the age of 2 that features audio and picture-based prompts. This administration should only take 15 minutes to complete virtually. Overall, the MEFS provides a direct behavioral measure of executive functioning skills which are vital for the development of a child鈥檚 social and emotional wellbeing.
By increasing the use of internal state words and a personal narrative, Executive Functioning Across Generations鈩� helps to foster better parent/child relationships, which is central to child resiliency and being able to adapt to challenges. The ICFW is looking forward to collaborating with The Family Partnership, Nebraska Children鈥檚 Home Society, Children and Families First of Delaware, and the Frontiers of Innovation at the Center on the Developing Child at Harvard University to share our lessons learned as we go through this process.
Learn More:
: An R&D platform designed to accelerate the development and adoption of science-based innovations that achieve breakthrough impact at scale.
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鈥檚 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鈥檚 three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
Meghan Christian is a Child and Family Therapist with the Institute for Child and Family Well-Being and a Licensed Clinical Social Worker.
Meghan has spent most of her career in the nonprofit sector, working with people who have experienced acute or ongoing trauma including abused children and adults, refugees and families living in poverty. Meghan鈥檚 interests lie in translating research on the effects of trauma on the developing brain into practical ways of using evidence-based interventions with her clients. She鈥檚 particularly interested in the role resilience plays in protecting against and transforming negative neurophysiological changes.
Along with her direct practice, Meghan enjoys exchanging perspectives and knowledge with fellow helping professionals by way of communities of practice, case consultation and facilitating workshops relating to neurodevelopment, responsive relationships and resilience.
Meghan received her master鈥檚 degree in social work in 2009 from the University of Wisconsin-Milwaukee. She earned her bachelor鈥檚 degree in social work from the same institution in 2006.
Dr. Colleen Janczewski is a policy and practice analyst at ICFW and an assistant professor at the University of Wisconsin-Milwaukee鈥檚 Helen Bader School of Social Welfare. Her research interests include child maltreatment and improving public systems that serve children and families. She has expertise in applying advanced statistical techniques to inform policy decisions and practice innovations in social service systems.
In terms of ICFW projects, Dr. Janczewski is currently the lead evaluator of the Alternative Response in Wisconsin evaluation, for the Wisconsin Department of Children and Families. She is also on the evaluation team for the FACT Study, the Healthy Families Study, Family Foundations Home Visiting Program, and the Trauma and Recovery Project. Dr. Janczewski holds a Ph.D. in social welfare from the University of Wisconsin-Milwaukee and a master鈥檚 degree in social work from Virginia Commonwealth University.
Program Design & Implementation
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Innovation and Executive Functioning: A new feasibility study
(EF) skills are like an air traffic control system in the brain that helps us manage information, set and work towards goals, and make decisions that help us reach those goals. EF Skills, which can be developed throughout the life-course, are central to navigating distractions, unexpected challenges, and stressful situations while making decisions that contribute to long-term goal attainment.
Executive Functioning Skills support intentional self-regulation that is central to success in school, work, and parenting. Source: Center on the Developing Child at Harvard University
Childhood experiences are the foundation for healthy development into adulthood. Adverse Childhood Experiences (ACEs) can cause cracks in that foundation, potentially impairing EF Skills and contributing to less intentional self-regulation. ICFW team members Drs. Mersky and Janczewski co-authored a study finding that parents in home visiting programs reported the same level of ACEs as parents with children involved in the child welfare system.
Resilience, or the , is a central concept operationalized, in part, through EF Skills. Building resilience helps children and adults navigate stressful situations and the lingering impact of trauma.
Parents participating in home visiting program face a myriad of complex challenges beyond the legacy of ACEs. 77% of caregivers in that program have reported an alcohol or other drug abuse, mental health, or domestic violence issue. 48% of caregivers screened positive for postnatal depression. Through those challenges, 56% of parents are receiving services and 90% demonstrate positive parent-child interactions, a core component to child health, well-being, and resilience.
How might programs that already reach families further address enhancing executive functioning of parents and children in their programs to promote long-term stability and success?
Children’s Wisconsin, along with two other partner organizations, is participating in a collaborative feasibility study of the 鈥淓xecutive Functioning Across Generations鈩⑩�� program, funded by , the R&D platform of the Center on the Developing Child at Harvard University. Developed in 2017 by (TFP) in Minneapolis, Minnesota, the organizations are working together to adapt the intervention for virtual use in a Healthy Families America home visiting program.
Over the course of 10 virtual sessions, parents learn about brain science and familiarize themselves with the types of activities that help foster brain development and self-regulation in their children through a language-based curriculum. Specifically, there will be an increase in knowledge of brain science, internal state words, theory of mind, serve and return, and personal narratives (BITSN鈥檚). These are all key functions of brain development in children. Parents will learn how to recognize, model and respond to Internal State Words (ISWs) as part of a supportive relationship with their child. ISWs are important because they are used by children in order to express themselves by describing thoughts, feelings and perceptions. This helps them to tell stories about events that have affected them emotionally (see chart).
Home visitors coach families, encourage further learning, and provide teaching tools, like storybooks that use ISW-based language. There will also be activities and handouts for the parents to practice skills with their children in between the sessions. This project has a greater impact with the implementation of a two-generation approach because it allows for more alignment with the goals and more stability in the family unit. The skills learned and the impacts made can continue to affect more generations and create a 鈥渄omino effect鈥� of positive development.
In order to measure the impact of the curriculum, Minnesota Executive Functioning Scale (MEFS), developed at the University of Minnesota by Dr. Stephanie M. Carlson and Dr. Philip Zelazo, will be used. The app is a quick, 鈥済ame-like鈥� measure of executive functioning for anyone over the age of 2 that features audio and picture-based prompts. This administration should only take 15 minutes to complete virtually. Overall, the MEFS provides a direct behavioral measure of executive functioning skills which are vital for the development of a child鈥檚 social and emotional wellbeing.
By increasing the use of internal state words and a personal narrative, Executive Functioning Across Generations鈩� helps to foster better parent/child relationships, which is central to child resiliency and being able to adapt to challenges. The ICFW is looking forward to collaborating with The Family Partnership, Nebraska Children鈥檚 Home Society, Children and Families First of Delaware, and the Frontiers of Innovation at the Center on the Developing Child at Harvard University to share our lessons learned as we go through this process.
Learn More:
: An R&D platform designed to accelerate the development and adoption of science-based innovations that achieve breakthrough impact at scale.
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 on their Boys and Men of Color Initiative, which aims to support career advancement, self-sufficiency, and leadership development among youth and young men in Milwaukee. An Institute team headed by James 鈥淒imitri鈥� Topitzes, Josh Mersky, and Allison Amphlett are working with Goodwill to design and evaluate an innovative workforce development program to address barriers to economic prosperity, including generational poverty and trauma, incarceration, and health disparities. The program鈥檚 immediate goal is to help participants establish a foothold in the labor force. In the long run, the program aims to help young men of color forge a path toward career success and community leadership.
The Boys and Men of Color Initiative builds on the Institute鈥檚 ongoing commitment to workforce development efforts that promote the dignity of work. We continue to collaborate with the on the Healthy Workers, Healthy Wisconsin project. This job enhancement project aims to strengthen employment services for low-income job seekers by increasing client access to trauma-responsive health and mental health care. The Institute also is partnering with on its Rise Up initiative, which is supporting underemployed mothers with young children by increasing access to an enhanced workforce training program. Taken together, these workforce development projects draw on the Institute鈥檚 academic expertise and reflects our mission 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.
Recent ICFW Publications
Choi, C., Mersky, J. P., Janczewski, C. E., Plummer Lee, C., Davies, W. H., & Lang, A. C. (in press). . Children and Youth Services Review.
Mersky, J. P., Janczewski, C. E., & Plummer Lee, C., Gilbert, R. M., McAtee, C., & Yasin, T. (in press). . Journal of Health Education and Behavior.
Plummer Lee, C., Mersky, J. P., Marsee, I., & Fuemmeler, B. (in press). . Development and Psychopathology.
Zhang, L., & Mersky, J. P. . (in press). Child and Adolescent Social Work Journal.
Zhang, L., Mersky, J. P., & Topitzes, J. (in press). . Child Abuse & Neglect.
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
Trauma and Recovery Project (TARP) 2020: Implications of COVID-19 on Training, Service Delivery, and Trauma Screening
ICFW PCIT Trainers Dimitri Topitzes, Kate Bennett and Leah Cerwin training with PCIT Global Trainer Dr. Christy Warner-Metzger earlier this year.
As the ICFW set out to adapt to the unprecedented changes brought about by COVID-19, many services provided by the Trauma and Recovery Project moved to virtual delivery. This year, our trainers were abruptly asked to shift all training of evidence-based interventions to a virtual setting. This necessitated hand delivery of printed materials to trainees鈥� homes, the need to learn and use novel tools and apps to complete activities virtually, and changes to training structure and processes due to both the trainees鈥� and trainers鈥� new realities; often including lack of their own home office space, supplies, and even childcare. During our third year of the Trauma and Recovery Project, even with this enormous shift, there were a total of 43 new clinicians in Milwaukee & Racine Counties trained in the target interventions (Parent Child Interaction Therapy, and Trauma-Focused Cognitive Behavioral Therapy). Hitting this number during such an unprecedented time required enormous adaptability from our trainers and was an enormous success for the project.
Evidence-Based Treatments as Virtual Services
Similar to our trainers, Center of Excellence (CoE) clinicians at Children鈥檚 Wisconsin quickly and effectively shifted their services to . This was most evidenced by the number of children provided services during the months when COVID-19 hit. During this time, even as clinicians made the immediate move to telehealth services from their homes, only six fewer children were provided services by CoE clinicians, as compared to the previous quarter (136 => 130).
In addition to finding ways to successfully serve their kiddos, clinicians reported high levels of success in adapting PCIT to virtual visits with clients. This, in part, is attributed to the model of PCIT, where clinicians conceal themselves behind a one-way mirror and the parent wears an earpiece to hear the clinician鈥檚 instructions. When using PCIT in a virtual format, clinicians could turn off their cameras, simulating the 鈥渂ehind the scenes鈥� nature of in-person PCIT. This also speaks to the skill, passion, and dedication of the clinicians in administering PCIT to clients鈥攚ithout their knowledge and energy, PCIT would fall flat in a virtual setting. Clinicians could maintain the most fidelity to the PCIT model when meeting virtually with families, especially families they had previously seen in-person.
Of course, there is always a learning curve to new things: the new reality of virtual meetings created the most change for clinicians administering PCIT. Logistically, no access to a printer, variability of internet connections, an increased demand in time required to do simple tasks, and limitations of a webcam were some of the challenges brought on by administering PCIT virtually. Additionally, in a virtual visit, clinicians are now responsible for filling out paperwork that would normally be completed by the parent, creating additional work for the clinician, and delaying the amount of time spent in PCIT.
With the clinician experience aside, parents and children overall have adapted well to the changes and liked the changes to service delivery. Many parents like the video sessions, noting how easy and convenient the virtual format was for them and their family; additionally, when only one parent was previously able to participate in PCIT, now both could, due to the convenience of virtual service delivery. And, many children were more likely to engage in play during the virtual visits. This can be attributed to children feeling more comfortable in their own environment, feeling more familiar in their home versus the office setting.
Trauma Screening and Assessment
In addition to maintaining our service delivery throughout COVID-19, the number of children screened for trauma during this time was actually higher than its preceding quarter (186 => 296).
As clinicians moved to providing assessments from home via telehealth, they experienced the same challenges mentioned above in regards to service delivery. However, our clinicians were able to screen and assess 1,134 children, exceeding our goal of 750 by adapting to web-based screening and assessments to children receiving virtual care.
Overall, our third year of this grant has been unprecedented: a world ravaged by the COVID-19 pandemic and a nation swept by a social movement against racial injustice have changed us. In an effort to maintain normalcy, life moved online: work was largely conducted from home, social gatherings were moved to virtual happy hours, school shifted to virtual classrooms, and so many other changes were made to hold on to life as we knew it. In order to adapt to the rapid changes of reality, clinicians worked tirelessly to continue service delivery for their clients in virtual spaces while finding a new urgency and purpose to increase humility towards race and culture within service delivery.
Parent-Child Interaction Therapy (PCIT) is an internationally-recognized, evidence-based parent management program for families who have young children with internalizing and/or externalizing behavior problems. PCIT was developed in the early 1970s by Dr. Sheila Eyberg, and involves live coaching of parents and caregivers as they interact with their child. Historically, PCIT and the training of new clinicians in this treatment modality have been done in person, however, internet-based PCIT (iPCIT) has been utilized within certain clinics prior to the COVID-19 pandemic. Comer, et al. (2017) showed increased parent-reports of improvement in child behaviors with the provision of iPCIT. With approval from PCIT International and support from the Trauma and Recovery Project, ICFW clinicians Kate Bennett, Leah Cerwin and Dr. Dimitri Topitzes were some of the first in the nation to train new PCIT clinicians and new Level 1 PCIT trainers through virtual platforms.
Traditionally delivered in a clinic setting, PCIT uses a one-way mirror and an earpiece listening device while the clinician is in another room coaching the caregiver during dyadic sessions on how to manage certain behaviors (PCIT International, 2018). In order to establish similar observation and communication capabilities for iPCIT, a webcam on laptop, tablet or phone is set up by the parent with the help of the clinician allowing for sessions to occur in the home. Several benefits have been identified through qualitative and quantitative data. Comer, et al. (2017) have found that families are more likely to stay engaged in treatment and attend services if they do not have to travel to a provider. Some contributing factors to this may be flexibility in scheduling, especially when children have appointments with several specialists, parents who work 1st shift jobs and/or have limited access to childcare, and the ability to physically distance. ICFW works with many families with complex circumstances that made attending appointments regularly difficult. Because of this, ICFW clinicians were some of the first within Children鈥檚 Wisconsin to begin completing virtual PCIT sessions.
The ICFW team of clinicians receives frequent feedback from caregivers about the benefits of iPCIT, which is in line with their findings on doing in-home PCIT years before. Clinicians are now able to be in the home environment while being invisible to the child, which results in clinicians being able to see behaviors that caregivers report only occur at home. At the start of one coaching session, a parent asked if the clinician 鈥渃ould be here all the time鈥� after successfully navigating a particularly lengthy instance of defiance using PCIT skills. Within two sessions, the same parent said they have 鈥渟tarted to see [them] transform into a new child鈥� and the clinician noticed significantly improved concentration, self-regulation, social skills, and joy in the child.
Training new PCIT clinicians and trainers using the internet to maintain safe distances is new to PCIT International, but is likely not going anywhere due to the successes that have been seen thus far. Facilitating sessions with a trainer can now also be done with ease and safety through the use of iPCIT. This keeps clinicians growing in their expertise of the model, and families receiving the best possible service to address treatment goals. Our experience in providing web-based training, consultation, and mentorship for clinicians in 2020 has shown us that PCIT is well-served to fidelity in this context. Clinicians trained in PCIT under the ICFW have reported that they are confident in use of the evidence-based protocol and have learned effective ways to manage telehealth sessions.
To help support trained PCIT clinicians, ICFW has long used virtual case consultations and a Community of Practice through Zoom for live discussions and Basecamp, a project management website, for ongoing shared learning. In Basecamp, digital materials and discussion between clinicians are shared in order to provide clinicians quick access to materials and answers needed, ultimately optimizing family experience with the model. The ability to quickly connect with other clinicians has been helpful in minimizing the isolation felt by clinicians working from home during the pandemic.
PCIT is not a widely practiced modality but has demonstrated high success rates for families. We are excited to be able to work with families who may not have otherwise had access to PCIT due to transportation and scheduling barriers or lack of access to PCIT practitioners around the state. Parity of access from insurance companies now must be matched with clinician availability so all families in Wisconsin have access to iPCIT. ICFW is dedicated to expanding access through training new clinicians, implementing new web-based strategies and sharing information about PCIT throughout the state and nation.
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 Webinars
November 16th:
Executive Functioning for Child and Family Well-being
Presentations
October 26th:
T-SBIRT 鈥� National Association of Social Workers National Virtual Conference 2020
October 28th:
Trainings and Workshops:
August
Home Visiting T-SBIRT Training (Northwest Region) – La Courte Oreilles (HFA); Indianhead Community Action Agency (HFA); Burnett County (HFA)
September
Brain Architecture and Relational Skills Workshops 鈥� Children鈥檚 Wisconsin Family Support and Preservation Program
Choi, C., Mersky, J. P., Janczewski, C. E., Plummer Lee, C., Davies, W. H., & Lang, A. C. (2020). The Childhood Experiences Survey: Replication study of an expanded assessment of adverse childhood experiences. Children and Youth Services Review.
Research has shown unequivocally that adverse childhood experiences (ACEs) are prevalent and consequential, but the field lacks consensus around how they should be measured. This replication study reexamined the construct and concurrent validity of the Childhood Experiences Survey (CES), an expanded assessment of 10 conventional ACEs and seven novel childhood adversities. The CES was administered to three samples of adults with children in a Midwest state: (1) caregivers whose children were the subject of a screened-in child protective services report (n = 1,087), (2) low-income women who voluntarily enrolled in a home visiting program (n = 659), and (3) a convenience sample from general population (n = 667). The prevalence of childhood adversities and their intercorrelations were assessed. Extending a previous exploratory analysis, a confirmatory factor analysis was conducted to examine the underlying structure of the CES, and tests of association were performed between the factors and adult mental health outcomes. Results confirmed that all 17 adversities were common and interrelated. For each sample, the 10 conventional ACEs fit a two-factor structure: child maltreatment and household dysfunction. The expanded assessment of 17 adversities fit a four-factor solution: direct victimization/household dysfunction, neglect, poverty, and family separation/loss. All factors were significantly associated (p < .05) with depressive symptoms and anxiety symptoms in all three samples. Implications for further measurement development aimed at advancing ACE research are discussed.
Zhang, L., Mersky, J. P., & Topitzes, J. (2020). Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults. Child Abuse & Neglect.
Background
International interest in adverse childhood experiences (ACE) is on the rise. In China, recent research has explored the effects of ACEs on health-related outcomes, but little is known about how ACEs impact the psychological functioning of rural Chinese youth as they make transition to adulthood.
Objective
This study is aimed to assess the prevalence and psychological consequences of ACEs among a group of rural Chinese young adults.
Participants and settings
1019 rural high school graduates from three different provinces of China participated in this study.
Methods
A web-based survey was used to assess ten conventional ACEs and seven other novel ACEs using the Childhood Experiences Survey. Using validated brief measures, six indicators of psychological functioning were assessed: anxiety, depression, perceived stress, posttraumatic stress, loneliness, and suicidality. Descriptive and correlational analyses of all ACEs were performed, and multivariate regressions were conducted to test associations between ACEs and study outcomes.
Results
Three-fourths of Chinese youth endorsed at least one of ten conventional ACEs. The most prevalent ACEs were physical abuse (52.3 %) and domestic violence (43.2 %). Among seven new adversities, prolonged parental absence (37.4 %) and parental gambling problems (19.7 %) were most prevalent. Higher conventional ACEs scores were significantly associated with poorer psychological functioning, and each type of new adversity was associated with one or more psychological problems.
Conclusion
ACEs were prevalent among rural Chinese young adults and had deleterious effects on their psychological well-being. Further work is needed to address ACEs by developing culturally appropriate assessment practices, interventions, and policy responses.
Zhang, L., & Mersky, J. P. Bidirectional relations between adverse childhood experiences and children鈥檚 behavioral problems. (2020). Child and Adolescent Social Work Journal.
Research has shown that adverse childhood experiences (ACEs) increase the risk of poor health and well-being, yet less is known about the pathways through which these life outcomes emerge. For instance, prospective, longitudinal research into the link between ACEs and the trajectories of children鈥檚 behavioral problems is limited. Moreover, no longitudinal study has investigated whether children鈥檚 behavioral problems also increase their risk of adverse experiences over time. Therefore, the main purpose of this study is to explore bidirectional relations between adverse childhood experiences (ACEs) and children鈥檚 behavioral problems in a sample of low-income children. This study uses the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children followed from birth through 15 years of age. A random intercept cross-lagged panel model was fit to examine the bidirectional relations between ACEs and child behavioral problems. Study findings indicated that age 5 ACEs score significantly predicted age 9 anxious or depressed problems and age 9 aggressive problems. Age 5 anxious or depressed problems also significantly predicted age 9 ACEs exposure. From age 3 to age 9, ACEs also played a dominant role in the bidirectional relations with behavioral problems. There were certain bidirectional relations between ACEs and child behavioral problems. The findings have implications for understanding the etiology and consequences of adversities as well as the design of prevention and intervention strategies.
Plummer Lee, C., Mersky, J. P., Marsee, I., & Fuemmeler, B. (2020). Child maltreatment and marijuana use trajectories. Development and Psychopathology.
Despite public sentiment to the contrary, recreational marijuana use is deleterious to adolescent health and development. Prospective studies of marijuana use trajectories and their predictors are needed to differentiate risk profiles and inform intervention strategies. Using data on 15,960 participants in the National Longitudinal Study of Adolescent to Adult Health, variable-centered approaches were used to examine the impact of childhood polyvictimization on marijuana onset, marijuana use from age 15 to 24 years, and marijuana dependence symptoms. Zero-Inflated Poisson latent class growth analysis (ZIP-LCGA) was used to identify marijuana use subgroups, and their associations with childhood polyvictimization were tested via multinomial logit regression within ZIP-LCGA. Results showed that the overall probability and frequency of marijuana use increased throughout adolescence, peaked in early adulthood, and diminished gradually thereafter. Polyvictimization was associated with earlier onset and greater overall use, frequency of use, and dependence symptoms. ZIP-LCGA uncovered four subgroups, including non-users and three classes of users: adolescence-limited users, escalators, and chronic users. Polyvictimization distinguished non-users from all classes of marijuana users. The findings underscore the lasting developmental implications of significant childhood trauma. Children who experience polyvictimization represent a group that may benefit from selective interventions aimed at preventing early, frequent, chronic, and dependent marijuana use.
The Goodwill Boys & Men of Color Initiative aimed to support unemployed or underemployed young men of color in Milwaukee, by offering intentional and aligned access to career training programs and holistic supportive services. During the pilot of this initiative, youth and men participated in a training program...
Mersky, J. P., Janczewski, C.E., Plummer Lee, C., Gilbert, R.M., McAtee, C., and Yasin, T. (2020). Home Visiting Effects on Breastfeeding and Bedsharing in a Low-Income Sample. Health Education & Behavior. 1-8.
Background Research suggests that home visiting interventions can promote breastfeeding initiation, though their effects on breastfeeding continuation are unclear. No known studies have assessed the impact of home visiting on bedsharing.
Aims To test the effects of home visiting on breastfeeding and bedsharing in a low-income, urban sample in the United States.
Methods During a field trial conducted in Milwaukee, Wisconsin, from April 2014 to March 2017, referrals to a public health department were randomized to a Healthy Families America (HFA) program or a prenatal care and coordination (PNCC) program. Of the 204 women who accepted services, 139 consented to the study and were allocated to the two treatment groups, which were compared with each other and a third quasi-experimental group of 100 women who did not accept services. Data were collected at four time points up to 12 months postpartum.
Results Breastfeeding initiation was higher among 72 HFA participants (88.4%; odds ratio [OR] = 2.7) and 67 PNCC participants (88.5%; OR = 2.2) than 100 comparison participants (76.5%). Similar results emerged for breastfeeding duration, though group differences were not statistically significant. Unexpectedly, bedsharing prevalence was higher among HFA participants (56.5%) than PNCC participants (31.1%; OR = 2.9) and comparison group participants (38.8%; OR = 2.0).
Discussion Home visiting was linked to increased breastfeeding, while effects on bedsharing varied by program. Progress toward precision home visiting will be advanced by identifying program components that promote breastfeeding and safe sleep.
Conclusion Further research is needed to examine whether home visiting reduces disparities in breastfeeding and safe sleep practices.
Executive function skills are like an air traffic control system in the brain that helps us manage information, make decisions, and plan ahead. Stress and the lingering impact of Adverse Childhood Experiences (ACEs) can negatively impact executive functioning, making it difficult to effectively navigate challenging and uncertain circumstances. Home...
Social innovation within our complex systems, such as child welfare, housing and mental health, demands a difficult balance between trial and error, responsiveness to those directly impacted, and actively sharing learning to build on our progress and failures. Being a learning organization serves multiple purposes: creating institutional memory, supporting just-in-time iteration, and clarifying our hypotheses about our work. Engaging every staff member in these learning practices allows us to make our thinking visible to each other, strengthening our hypotheses and uncovering hidden assumptions. By keeping insights, assumptions, and hypotheses at the forefront of organizational consciousness, our learning practices ensure that the design of any future work is informed by the learning of prior endeavors.
As the ICFW serves as a translational organization, it is essential that our decision-making, planning, learning and dissemination function fluidly and efficiently. While there is no shortage of new innovative approaches to improve child and family well-being, our team must be strategic in identifying, selecting, implementing and testing in order to be effective in each phase of this process within our organizational capacity.
During this webinar on August 20th, ICFW team members Luke Waldo and Gabe McGaughey discussed the following:
Why Strategic Learning is critical to effective Social Innovation;
How the ICFW has implemented its Strategic Learning process and the tools that it uses;
How the ICFW has used Strategic Learning tools to support the Children鈥檚 Wisconsin Community Services鈥� COVID Resilience Plan.
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鈥檚 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鈥檚 three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
Kate Bennett, LCSW, is a Well-Being Lead Clinician and serves as a lead mental and behavioral practitioner at Children鈥檚 Wisconsin and the Institute for Child and Family Well-Being. She has recently shifted to providing direct clinical services primarily via telehealth in response to the COVID-19 pandemic. In her role, Kate routinely delivers community-based and therapist training workshops rooted in evidence-based interventions such as Parent-Child Interaction Therapy (PCIT). As a PCIT International Level 2 Trainer candidate under the Trauma and Recovery Project (TARP), a Category III SAMHSA grant, she is continuing to co-facilitate some of the very first virtual trainings for new PCIT therapist and PCIT Level 1 trainer cohorts statewide throughout the summer.
Kate is passionate about leveraging technology to promote equitable access for families receiving prevention and treatment services. In June, she began pursuing her doctorate in social work at the University of Kentucky and is focusing her capstone on PCIT training and dissemination.
Leah Cerwin, LCSW, is a Well-Being Lead Clinician with Children’s Wisconsin and the Institute for Child and Family Well-Being. Leah is a Parent Child Interaction Therapy Certified Level 1 Trainer and has worked to provide a PCIT virtual training to clinicians across the state this summer. Along with providing services to families herself, Leah also conducts co-therapy over telehealth with PCIT trainees who she co-trained in the fall of 2019 and assisted in transitioning their cases to telehealth services. Leah provides consultation video calls for PCIT clinicians, and works closely with PCIT Level 2 and global trainers to help develop new PCIT training processes. Leah also co-trained a cohort of PCIT clinicians in a virtual Level 1 training this summer and provides consultation for these Level 1 trainer candidates as they begin training clinicians within their own agencies. Leah participated in a virtual PCIT Toddlers training this past spring. Leah also manages a Category 3 SAMHSA grant, in which she promotes the development of strategies to improve assessment processes for evidence-based treatments PCIT, TF-CBT, and CPP.
While in graduate school, Leah interned with the Institute for Child and Family Well-Being directors and University of Wisconsin-Milwaukee faculty, Drs. Dimitri Topitzes and Joshua Mersky, to develop Project Connect, a group-based pilot of PCIT. Leah then helped pioneer PCIT and Project Connect at Children鈥檚 Wisconsin.
Research and Evaluation
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.
Strategic Learning inspires and guides future direction from the failed attempts and successful outcomes of past efforts. The use of a strategic learning process supports an organizational culture committed to continuous quality improvement and collective growth and knowledge. Being a learning organization serves multiple purposes: creating institutional memory, supporting just-in-time iteration, and clarifying our hypotheses about our work. Engaging every staff member in these learning practices allows us to make our thinking visible to each other, strengthening our hypotheses and uncovering hidden assumptions.
The Institute鈥檚 Children鈥檚 Wisconsin team developed a Strategic Learning process and set of tools in early 2019. While many of those tools serve a formal decision-making, planning or evaluation function, Learning Logs are our platform where we share insights and reflections on work that we鈥檙e doing – from the clinic to meetings to thoughts that arise in the course of writing, reading, or meeting new people. Learning Logs serve a knowledge management function, and allow us to share and track how our thinking and work with others and within our systems evolve over time.
Our Learning Log process is rather simple and can be replicated easily by other groups and organizations. We start with two questions that we are asked to answer each week:
What did you learn this week?
How might it inform our work?
These questions land in our inboxes each week through an Automatic Check-in through Basecamp. We then proceed to Basecamp and post our answers with the following basic expectations:
Header 鈥� Topic of Learning (i.e. Systems Change, Clinical Services, Social Innovation, etc.);
Brief synopsis of what was learned and how it relates to/informs our work;
Link to the source material(s) (i.e. Article, Podcast, Speaker, etc.)
Once the posts are submitted, they are shared with all team members for review and are archived on our Basecamp page as institutional memory. We can interact with one another鈥檚 Learning Logs by adding comments, questions, recognition or engaging in further learning by exploring the source material links.
Since we started this process last year, our small team of ten has completed more than 500 Learning Logs on topics ranging from integrating clinical services into the child welfare system to the importance of lived experience in social innovation to systems drivers and evaluation. The content of the Learning Logs has served as a consultative space for the team, a catalyst for deeper, more targeted conversations in supervision, and the development of a virtual learning resource center on Basecamp that our team can refer to for future use.
While the Learning Logs are intended to be driven by each individual鈥檚 learning and relevant areas of interest, we have developed Focused Learning Logs that have a specific topic that is currently relevant and urgent in our practice and culture. In 2019, we focused on our practice, use of tools and strategies around Trauma Focused Cognitive Behavioral Therapy (TF-CBT) to develop a toolkit for fellow practitioners and families that receive TF-CBT. This year, we are focusing on Anti-Racist and Inclusion, Diversity and Equity issues and efforts that impact our clinical practices, systems, policies, and organizational culture. In addition to providing a sharper focus on our own education and reflection in these critical areas, it also serves as an opportunity to understand where everyone on the team is in their learning, which leads to increased empathy, support and constructive conversation on the team.
We believe that ongoing learning is happening daily throughout our organizations, but often occurs without sufficient reflection or documentation that lend themselves to growth 鈥� both personal and organizational 鈥� and future reference and use. Learning Logs have served as a powerful tool that help us capture and enhance our learning, growth, and potential for continuous improvement.
In the previous ICFW newsletter, our team shared a few of the ways that our work has changed in response to the COVID-19 pandemic. One area of focus for our mental and behavioral health practitioners has been the implementation of virtual training. In March, clinicians at Children鈥檚 Wisconsin and the ICFW were recipients of Parent-Child Interaction Therapy 鈥揟oddlers (PCIT-T) training facilitated by Dr. Emma Girard. In July, we were able to flip the script and provide one of the very first web-based PCIT Level 1 Trainer and PCIT Therapist trainings in the country alongside PCIT Global Trainer, .
Traditionally, the standard for PCIT training facilitation has been in-person workshops; however, physical distancing is an important step the ICFW is taking to slow the spread of COVID-19. Attending to the , Dr. Warner-Metzger, Dr. Dimitri Topitzes, Kate Bennett, and Leah Cerwin strategically planned and facilitated an 8-hour web-based Level 1 PCIT training and the first half of a web-based 40-hour PCIT therapist training supported by the Trauma & Recovery Project.
As agencies continue the provision of telehealth services that allow clinicians to engage with families remotely, internet-PCIT (I-PCIT) delivery was included as a highlighted didactic skill. Recommendations for safe implementations of in-person PCIT services for agencies who cannot provide telehealth were also discussed.
Along with adapting to telehealth strategies for PCIT Clinicians, PCIT trainers made space during virtual training for rich discussion of anti-oppressive strategies for delivering PCIT. This was done both by providing information and updates on how PCIT International as an organization is taking steps to create a more inclusive and for therapists, trainers, and families, and also by allowing the trainees themselves the opportunity to discuss the cultural sensitivity and tailoring necessary to make PCIT an approach better suited to meet the needs of their families of color.
PCIT trainers discussed how PCIT as an organization utilizes The Equity Approach, to ensure that everyone has the opportunity to participate and prosper when building strategies to improve community health. By understanding and acknowledging disparities and privilege, the PCIT organization is creating a more inclusive and anti-racist model.
Additionally, the Trauma and Recovery Project, a grant managed by ICFW PCIT Trainers, seeks to recruit and train clinicians of color to build a more diverse clinician pool, and PCIT trainers encouraged trainees to voice how PCIT practices could be tailored to meet the needs of the diverse families in the Milwaukee community that are served by Children鈥檚 Wisconsin.
The ICFW team is truly passionate about expanding evidence-based treatments like PCIT for kids and families throughout Wisconsin. We are excited to welcome our newest PCIT Level 1 Trainer and PCIT Therapist candidates:
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.
Choi, C., Mersky, J. P., Janczewski, C. E., Plummer Lee, C., Davies, W. H., & Lang, A. C. (in press). The Childhood Experiences Survey: Replication study of an expanded assessment of adverse childhood experiences. Children and Youth Services Review.
Beckert, T. E., Plummer Lee, C., Albiero, P. (in press). Reaching Adult Status Among Emerging Adults in United States, Italy, and Taiwan. Journal of Cross-Cultural Psychology.
Plummer Lee, C., Mersky, J. P., Marsee, I., & Fuemmeler, B. (in press). Child maltreatment and marijuana use in adolescence and early adulthood. Development and Psychopathology.
Zhang, L., Mersky, J. P., & Topitzes, J. (in press). Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults. Child Abuse & Neglect.
Stable housing provides a foundation for health, well-being, and prosperity for children, families, and communities. Stable housing can positively affect a broad spectrum of outcomes for children and families, including academic performance, employment, physical, and mental health. Threats to stable and healthy housing are complex and intertwined with systemic and interpersonal factors.
Families experiencing housing instability face increased risk of their children being involved in the child welfare system . 81% of families with children entering care identified recent histories of housing instability, including crowding, homelessness, and evictions. Housing instability is also linked to delays in reunification, while placement in foster care is also connected to youth homelessness. Housing Opportunities Made to Enhance Stability (HOMES) is a systemic intervention focused on building new relationships, sharing ideas and knowledge, and starting new collaborations between housing and child welfare partners in the community.
In this webinar from July 30, 2020, ICFW team members Gabe McGaughey and Luke Waldo reviewed:
The link between housing and child maltreatment
The impact of stress and adverse childhood experiences (ACEs) have on executive functioning,
The increased risk of housing instability in the age of COVID
Systems change framework to inform strategy development and evaluation.
Lessons learned from HOMES that can be applied to other system change efforts
Blair, K. H., Topitzes, J., Winkler, E. N., McNeil, C. B. (2020). Parent鈥揅hild Interaction Therapy: Findings from an exploratory qualitative study with practitioners and foster parents. Qualitative Social Work.
Abstract: This exploratory study examines practitioners鈥� and foster parents鈥� perceptions on use of Parent鈥揅hild Interaction Therapy in child welfare. Focus groups were completed with Parent鈥揅hild Interaction Therapy practitioners and foster parents. Thematic analysis was employed, and four main themes were analyzed. First, practitioners and foster parents identified implementation barriers. Second, practitioners and foster parents identified factors that facilitate implementation. While practitioners perceived benefits from on-going consultation, foster parents favored treatment flexibility and a strong therapeutic alliance with practitioners. Third, practitioners and foster parents found that the integration of trauma principles into Parent鈥揅hild Interaction Therapy helped to meet the needs of the child welfare population. Finally, the translation of Parent鈥揅hild Interaction Therapy into child welfare may be facilitated by model adaptations, such as brief treatments, and integrating Parent鈥揅hild Interaction Therapy into pre-service foster parent trainings. Findings are discussed within the context of the relevant literature, and recommendations for future areas of study are proposed.
The Institute for Child and Family Well-Being was proud to host the webinar 鈥淭rauma screening, brief intervention and referral to treatment (T-SBIRT): Introduction to a promising, brief protocol for social service and healthcare settings.鈥� Led by Dr. Dimitri Topitzes, Clinical Director of the Institute for Child and Family Well-Being, and Lisa Ortiz, UMOS, the webinar took place on June 17th at 11:00 CST.
This webinar introduced participants to a discrete trauma responsive protocol 鈥� trauma screening, brief intervention and referral to treatment or T-SBIRT 鈥� which has been implemented in various healthcare and social services settings in southeastern Wisconsin. Integrating T-SBIRT within such programs recognizes two interrelated truths: 1) most people experience significant adversity and trauma across the life course, an assertion that is all-the-more salient during this time of pandemic, stay-at-home orders, and collective trauma, and 2) frequent exposure to adversity and trauma undermines functioning across myriad domains including physical, mental, and behavioral health.
Delivered by psychotherapists, case managers, nurses, or other professional service providers, T-SBIRT helps programs address the effects of trauma exposure among clients or patients. More often than not, trauma is at the root of client and patient presenting problems. The protocol therefore contributes to effective and efficient trauma-responsive care and overall service delivery.
During the webinar, we described the T-SBIRT protocol, which is based on SBIRT for substance misuse and requires anywhere from 10 to 30 minutes to complete. In addition, we reviewed results from several studies that we recently published, indicating that it is feasible to implement T-SBIRT within healthcare and social service programs and that T-SBIRT may be associated with improved mental health and employment outcomes.
Dr. Topitzes, designed and tests T-SBIRT, and Lisa Ortiz is a supervisor who oversees implementation of T-SBIRT in her TANF program. While Dr. Topitzes provided details about the protocol and feasibility studies, Ms. Ortiz discussed her experience with T-SBIRT, highlighting obstacles to implementation along with perceived staff and client benefits.
Children who have experienced maltreatment and are involved in the child welfare system often exhibit behavioral difficulties, and their parents often struggle to provide effective discipline, may unintentionally engage in coercive parenting practices, or may appear to lack sensitivity towards their children due to their own history of trauma.
Parent Child Interaction Therapy (PCIT) has been referred to by experts as the 鈥済old standard鈥� treatment for children with disruptive behaviors, and it is a well-known, well-researched evidence-based treatment for children with behavioral difficulties, and has gained significant evidence particularly in the last ten years that suggests its efficacious for parents who have engaged in child maltreatment.
The Institute for Child and Family Well-Being was proud to host the webinar 鈥淧arent Child Interaction Therapy (PCIT) & Child Welfare鈥� with , PCIT Master Trainer, and Kate Bennett, Children鈥檚 Wisconsin Well-Being Lead Clinician.
In this webinar, Leah Cerwin discussed the following with Dr. Girard and Kate:
Why it is so important to offer and administer PCIT within the child welfare system;
How PCIT has been adapted and provided to meet the needs of these clients with complex lives, including challenges and potential solutions;
The positive outcomes that have been seen providing this service to these families;
All within the context of the Milwaukee area families.
Mersky, J. P., Lee, C. P., Gilbert, R. M., and Goyal, D. (2020). Prevalence and Correlates of Maternal and Infant Sleep Problems in a Low-Income US Sample. Matern Child Health J. 24(2):196鈥�203.
翱产箩别肠迟颈惫别蝉:听This study examined the prevalence and correlates of maternal and infant sleep problems among low-income families receiving home visiting services.
惭别迟丑辞诲蝉:听The study sample includes 1142 mother-infant dyads in Wisconsin, United States. Women completed a survey when their infants were between two weeks and one year old. Outcome data were collected using the PROMIS庐 sleep disturbance short form-4a and the Brief Infant Sleep Questionnaire. Correlates of sleep problems were assessed in two domains: maternal health and home environment quality. Descriptive analyses produced prevalence estimates, and multivariate regressions were performed to test hypothesized correlates of maternal and infant sleep problems. Subgroup analyses were conducted to examine the prevalence and correlates of sleep problems across different infant age groups.
搁别蝉耻濒迟蝉:听Approximately 24.5% of women reported poor or very poor sleep in the past week; 13% reported an infant sleep problem and 11% reported more than three infant wakings per night. Reported night wakings were more prevalent among younger infants but maternal and infant sleep problems were not. Multivariate results showed that poor maternal physical and mental health and low social support were associated with maternal sleep disturbance but not infant sleep problems. Bed sharing and smoking were associated with infant sleep outcomes but not maternal sleep. There was limited evidence that the correlates of maternal and infant sleep varied by infant age.
Conclusions for practice:聽The findings point to alterable factors that home visiting programs and other interventions may target to enhance maternal and infant sleep.
We are in unprecedented times. COVID-19 is ravaging our health and economic infrastructure, with untold losses still to come. Globally and nationally the pain of the pandemic is widespread, and it is a particularly dire situation for those among us who are most vulnerable. These include individuals and families who struggle with extreme poverty, housing insecurity, substance use, health and mental health problems, and chronic stress. Even in good times, these challenges are difficult to bear. But now they are compounded by social distancing from the connections that protect us in times of stress鈥攐ur families, friends, schools, places of worship, and communities.
These tragic conditions will have a profound impact on children, especially those who need protection. At a point when they are most developmentally sensitive, many are being exposed to adverse experiences that will have lasting neurobiological, cognitive, social and emotional consequences.听 It is a stark reality that, as our lives are being upended, some children are being abused and neglected. Worse still, these children are being dislocated from the social institutions and connections that are in place to protect them.
To illustrate the magnitude of the problem, consider that child protective service (CPS) agencies in the U.S. received over 4.3 million abuse and neglect reports in 2018, representing approximately 7.8 million children. Although most reports are not investigated or substantiated, CPS records indicate that hundreds of thousands of children are abused or neglected each year. Of course, many more children experience trauma that goes unseen or unheard.
Now consider that, at a time when our most vulnerable children are at even greater risk, rates of CPS reporting and detection are plummeting. Here in Wisconsin, in the four weeks following the stay-at-home order which went into effect on March 15, there was a 48% decrease in CPS reports in Wisconsin as compared to the same time period last year.
It is unlikely that this trend reflects a true decrease in abuse and neglect, but rather the social isolation of children from mandated reporters. Roughly two-thirds of CPS reports come from professionals such as teachers and doctors. Yet, as shown in the figure below, their reporting has dropped significantly, because they cannot report what they cannot see or hear.
The Child Protection System
If children do come to the attention of CPS, they are now entering a system that is experiencing a period of instability due to COVID-19. Core functions of the child welfare system have been compromised because of the crisis, not unlike other systems. For example, child welfare agencies have been forced to move away from in-person visits where parent-child interactions can be observed directly. Access to substance use and mental health treatment has been reduced significantly. Staffing shortages and court closures have caused delays in removals and permanency decisions.
Disruptions in regular activities are producing a growing backlog of demand for services inside and outside the system. As stay-at-home policies are relaxed, CPS workers who already carry substantial workloads may face even greater job strain, which could lead to high rates of staff turnover. Worse still, assuming the current rate of abuse and neglect reporting is artificially low, the CPS system should be prepared for the coming spike in referrals, substantiations, and out-of-home placements. These impacts are most likely to affect low-income communities of color that are already overrepresented in the CPS system. Disparities in CPS involvement seen before COVID-19 may be compounded by the disproportionate health and economic burdens that these groups are bearing during the crisis.听 People around the CPS system have been quickly finding new ways of adapting to the social distancing restrictions and accompanying financial hardships, developing clear聽for planning, as the current economic and public health crisis threatens to take a heavy toll on our nation鈥檚 most vulnerable population of children and youth.
The Time for Prevention
With state and local governments facing acute budget shortfalls, and with the loss of revenue due to massive increases in unemployment, the need to focus on the most urgent child welfare challenges is clear. And it may seem untimely to increase funding for prevention services that may not pay off immediately, even if these investments tend to yield greater returns in the long run. Although Wisconsin allocates less than 5% of total child welfare funding to prevention services, it may be difficult to justify increased support for anything other than essential responses to known child safety concerns.
On the other hand, the COVID-19 crisis has exposed frailties in the child welfare system, and it is this kind of shock that could force us to reexamine our priorities and rebuild a system that simultaneously ensures the safety, stability, and well-being of children and families. Before this crisis emerged, there were positive signs of movement in this direction with the passage of the聽Families First Prevention Services Act聽(FFPSA). Signed into law in 2018, the FFPSA reforms federal child welfare financing by increasing the scope of evidence-based prevention and intervention services that are reimbursable. This includes proven approaches that already have strong roots in Wisconsin such as聽parent-child interaction therapy,听聽(TF-CBT), and聽.
We believe that our recovery efforts can include plans for increased public investment in prevention services that support families without compromising the vital mission of protecting vulnerable children. It can be difficult to prepare for the future during times of uncertainty and crisis, but bold visions can set in motion lasting change. Let us rebuild our neglected service systems to provide universal, equitable, and accessible services for families and communities.
Trauma-informed care has increasingly become common nomenclature to social service providers, therapists, researchers, school staff and the general public. To become trauma-responsive, it is essential to conduct trauma screening and assessment so as not to make assumptions, miss vital information, reinforce shame through silence and avoidance, set inappropriate goals and lose rapport with clients. This practice creates many questions for professionals and clients such as why these topics are being explored, how the information will be used and how the process is used as a change maker for families and, at a community-level, policies. Through the process of gradual exposure and developing relationships, authentic client engagement around trauma yields real partnership and voice from those most affected by trauma. Meaningful trauma screening and assessment between interviewer and interviewee is a reciprocal process of empowerment and education that constructs a foundation of frank openness. This foundation then allows for co-creation of informed service goals and treatment design, resilience-building experiences and, ultimately, produces sustainable changes that actually benefits the individual, family, and community.
The Institute for Child and Family Well-Being hosted the webinar 鈥淢aking the Unspeakable, Speakable: Making a Case for Trauma Screening and Assessment鈥� with Dr. James 鈥淒imitri鈥� Topitzes of UW-Milwaukee鈥檚 Helen Bader School of Social Welfare and the Institute for Child and Family Well-being, and Cynthia Franzolin of Sixteenth Street Community Health Centers and Franzolin Consulting Services, LLC.
In this webinar, Meghan Christian discussed with Dimitri and Cynthia:
How trauma screening and assessment is crucial to service goal setting, diagnostics and treatment;
The benefits and challenges on the therapeutic relationship;
Some of the available tools and resources for trauma screening and assessment;
Guidelines to follow when asking sensitive questions.
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鈥檚 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鈥檚 three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.
As both Children鈥檚 Wisconsin and the University of Wisconsin-Milwaukee implemented 鈥渟afer-at-home鈥� policies in mid-March in alignment with the best practice and safety guidelines provided to protect our health, 鈥渇latten the curve鈥�, and support our essential workers and frontline healthcare providers during these times of COVID-19, we have leaned heavily on Zoom and other technologies to continue to do our work and meet as a team.
The Institute for Child and Family Well-being recently celebrated its 4th anniversary during this first week of May! We will be celebrating with one another from a safe distance via Zoom and phone calls.
Children鈥檚 Wisconsin鈥檚 ICFW Team (not pictured: Jenni Scott)
ICFW Leadership Team (not pictured: Jenni Scott)
Community Engagement & Systems Change
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
Non-profit and Systems Innovation in Times of COVID-19
At the Institute for Child and Family Well-being, our mission is to improve child and family well-being through the design and implementation of effective practices that reflect the best and latest research, so that we may promote systems change that engages and serves our community. We recognize that COVID-19 poses challenges today 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.
Source: Milwaukee Independent
In order to effectively meet this challenge, we must first acknowledge that the need to maintain physical distance (or ) and have the potential to have more adverse impacts on our most vulnerable and historically oppressed families and communities. Within the communities where our most vulnerable families live, our systems are often disjointed or insufficient to meet their challenges around access to quality health care, job and housing insecurity, and under-resourced schools, particularly in times like this. These same children and families are also more likely living in high concentration neighborhoods with multiple generations or families in the same home and higher concentration of apartment complexes, which increases risk of infection. In the absence of responsive social connections, these challenges can create high levels of toxic stress and, consequently, greater likelihood of substance abuse, untreated mental health symptoms, violence, and involvement with the child welfare and criminal justice systems.
Since the beginning of the COVID crisis, our ICFW Children鈥檚 Wisconsin team has asked 鈥淗ow might we develop innovative practices to meet these challenges today?鈥� The following is our current set of answers and commitment to our community:
We developed and will facilitate a Community of Practice across our Children鈥檚 Wisconsin Community Services and Community Health programs that will promote shared strategic learning and planning around the following:
Innovative practices that address COVID-19 challenges through family and community engagement, collaboration, program adaptation, etc;
Positive stories about how a COVID-19 challenge was met, and children and families benefitted;
Tips for working remotely to improve how we meet these demands under new and challenging working conditions.
Highlight community efforts and positive stories; and share supportive resources to enhance access to social connections and basic needs, and the latest research and science to reduce the likelihood of infection.
We will work closely with our community, academic and health partners to seek innovative and compassionate solutions to these complex challenges through human-centered design, prototyping and strategic learning, so that children and families may remain healthy while also remaining connected to those that they need and trust for their well-being.
More recently, our team began asking 鈥淗ow might we learn from the conditions that led to today鈥檚 challenges and how we respond to imagine more resilient, supportive and prosperous communities and systems in the future?鈥� When we consider the role that social determinants of health play in one鈥檚 ability to overcome the challenges created by COVID-19, we must propose and develop transcendent solutions much like the did at the height of the Second World War. Formally known as the Social Insurance and Allied Services, the report noted the social and economic devastation that was looming in post-war Britain if a social safety net and national healthcare system weren鈥檛 created. The Report, which drew on surveys of British citizens, existing evidence, and policy proposals that were previously considered politically impossible, would serve as the blueprint for Britain鈥檚 National Health Service, Maternity and Pension Plan, and major labor and housing reforms. As you will see in some of our articles throughout this newsletter, we have tremendous challenges and, therefore, great potential for change within our child welfare, mental and behavioral health, and housing systems, to name just a few. So, let鈥檚 ask ourselves, 鈥淗ow might we understand this unprecedented challenge from a community and systems perspective, so that we may propose and develop solutions that build more resilient, healthy and prosperous communities for all?鈥�
We are in unprecedented times. COVID-19 is ravaging our health and economic infrastructure, with untold losses still to come. Globally and nationally the pain of the pandemic is widespread, and it is a particularly dire situation for those among us who are most vulnerable. These include individuals and families who struggle with extreme poverty, housing insecurity, substance use, health and mental health problems, and chronic stress. Even in good times, these challenges are difficult to bear. But now they are compounded by social distancing from the connections that protect us in times of stress鈥攐ur families, friends, schools, places of worship, and communities.
These tragic conditions will have a profound impact on children, especially those who need protection. At a point when they are most developmentally sensitive, many are being exposed to adverse experiences that will have lasting neurobiological, cognitive, social and emotional consequences. It is a stark reality that, as our lives are being upended, some children are being abused and neglected. Worse still, these children are being dislocated from the social institutions and connections that are in place to protect them.
To illustrate the magnitude of the problem, consider that child protective service (CPS) agencies in the U.S. received over 4.3 million abuse and neglect reports in 2018, representing approximately 7.8 million children. Although most reports are not investigated or substantiated, CPS records indicate that hundreds of thousands of children are abused or neglected each year. Of course, many more children experience trauma that goes unseen or unheard.
Now consider that, at a time when our most vulnerable children are at even greater risk, rates of CPS reporting and detection are plummeting. Here in Wisconsin, in the four weeks following the stay-at-home order which went into effect on March 15, there was a 48% decrease in CPS reports in Wisconsin as compared to the same time period last year.
It is unlikely that this trend reflects a true decrease in abuse and neglect, but rather the social isolation of children from mandated reporters. Roughly two-thirds of CPS reports come from professionals such as teachers and doctors. Yet, as shown in the figure below, their reporting has dropped significantly, because they cannot report what they cannot see or hear.
The Child Protection System
If children do come to the attention of CPS, they are now entering a system that is experiencing a period of instability due to COVID-19. Core functions of the child welfare system have been compromised because of the crisis, not unlike other systems. For example, child welfare agencies have been forced to move away from in-person visits where parent-child interactions can be observed directly. Access to substance use and mental health treatment has been reduced significantly. Staffing shortages and court closures have caused delays in removals and permanency decisions.
Disruptions in regular activities are producing a growing backlog of demand for services inside and outside the system. As stay-at-home policies are relaxed, CPS workers who already carry substantial workloads may face even greater job strain, which could lead to high rates of staff turnover. Worse still, assuming the current rate of abuse and neglect reporting is artificially low, the CPS system should be prepared for the coming spike in referrals, substantiations, and out-of-home placements. These impacts are most likely to affect low-income communities of color that are already overrepresented in the CPS system. Disparities in CPS involvement seen before COVID-19 may be compounded by the disproportionate health and economic burdens that these groups are bearing during the crisis. People around the CPS system have been quickly finding new ways of adapting to the social distancing restrictions and accompanying financial hardships, developing clear for planning, as the current economic and public health crisis threatens to take a heavy toll on our nation鈥檚 most vulnerable population of children and youth.
The Time for Prevention
With state and local governments facing acute budget shortfalls, and with the loss of revenue due to massive increases in unemployment, the need to focus on the most urgent child welfare challenges is clear. And it may seem untimely to increase funding for prevention services that may not pay off immediately, even if these investments tend to yield greater returns in the long run. Although Wisconsin allocates less than 5% of total child welfare funding to prevention services, it may be difficult to justify increased support for anything other than essential responses to known child safety concerns.
On the other hand, the COVID-19 crisis has exposed frailties in the child welfare system, and it is this kind of shock that could force us to reexamine our priorities and rebuild a system that simultaneously ensures the safety, stability, and well-being of children and families. Before this crisis emerged, there were positive signs of movement in this direction with the passage of the Families First Prevention Services Act (FFPSA). Signed into law in 2018, the FFPSA reforms federal child welfare financing by increasing the scope of evidence-based prevention and intervention services that are reimbursable. This includes proven approaches that already have strong roots in Wisconsin such as parent-child interaction therapy, (TF-CBT), and .
We believe that our recovery efforts can include plans for increased public investment in prevention services that support families without compromising the vital mission of protecting vulnerable children. It can be difficult to prepare for the future during times of uncertainty and crisis, but bold visions can set in motion lasting change. Let us rebuild our neglected service systems to provide universal, equitable, and accessible services for families and communities.
While the health and economic consequences of the coronavirus pandemic are readily apparent, its effects on our collective mental health are less recognizable. Many pundits speculate that a mental health crisis is brewing because stressors accompanying the pandemic reflect the very conditions that impair mental health. These include:
Environmental catastrophe and community disruption
Economic insecurity and unemployment
Social isolation and stressed social relationships
Since the emergence of the COVID-19 crisis in the U.S., Americans everywhere have been exposed to the above-mentioned determinants of poor mental health. Add to the list sickness or death of a loved one during quarantine, and it鈥檚 fair to suspect that the population is enduring a collective challenge to its mental well-being unlike any in recent memory. Moreover, families of low-income or racial/ethnic minority status are disproportionately affected by these risk factors, suggesting that they are experiencing extraordinary pressures on their mental health.
Recently released information offers preliminary support for the conclusion that our collective mental health is wavering. For example, calls to crisis hotlines nationwide have jumped nearly nine-fold since the beginning of the crisis, and surveys indicate that nearly half of Americans report negative mental health effects of the pandemic. Low income respondents report mental health effects at even higher rates.
There is also reason to believe that the stress associated with the pandemic is overwhelming Milwaukee area residents. Calls to the local 211 crisis helpline have jumped significantly since the coronavirus outbreak in March. Additionally, Children鈥檚 Wisconsin is reporting an unexpected rise in psychiatric emergency visits.
Milwaukee County Mental Health Requests 鈥� April 2020 Source: https://wi.211counts.org/
Relative to other Milwaukee enclaves, Milwaukee鈥檚 communities of color may be experiencing even higher prevalence of mental health problems. African Americans account for around 65% of the deaths in Milwaukee County due to complications from COVID-19, but only make up about 40% of County residents. Latinx Milwaukee neighborhoods have also seen a recent surge of coronavirus infections and deaths. Both Milwaukee communities, Black and Latinx, tend toward lower income and experience disparities in social and health outcomes. Unfortunately, it is not surprising that families in these communities are bearing a heavy disease burden; nonetheless, it鈥檚 important to recognize that the persistent threat to their collective physical health coupled with the secondary consequences of the pandemic could be undermining their mental health in unprecedented ways.
Worse yet, while mental health needs are likely rising exponentially, access to services is probably dropping precipitously. Families of color in Milwaukee with low annual household incomes already face multiple barriers to quality mental health care, including inadequate health insurance coverage, limited availability of care providers, and stigma associated with treatment. Add to these obstacles the current environment of social distancing, and it would seem that many families will go without needed mental health treatment. This is a big problem that warrants a multi-pronged response.
Two solutions rise to the top of our priority list. We at the Institute for Child and Family Well-Being have a history of exploring and providing telemental health services to families with low annual incomes enrolled in public services such as child welfare. For these families, the Institute plans to expand telemental health provision of evidence-based, trauma-informed treatments. These include Parent-Child Interaction Therapy and Trauma-Focused Cognitive Behavioral Therapy. Using a well-established tracking and supervision system, we will ensure high quality service delivery. Recent changes in patient privacy protections allowing for more liberal use of telehealth treatment during the pandemic, along with greater access to online technologies among lower income families, should help facilitate this plan.
In addition, the Institute will continue to train local providers in the delivery of these treatment services.听 Graduate students from the University of Wisconsin-Milwaukee join the Institute as clinical interns and complete a one-year training apprenticeship.听 A federally-funded grant also enables the Institute to train over 100 area professionals in the aforementioned intervention types.听 Institute trainings will now include support for telemental health, and Institute trainers will recruit students and clinicians committed to serving Milwaukee families eligible for public services.听 Mental health care for these families, who typically experience disorders such as depression and anxiety at astronomically high rates, is critical now more than ever.
Research and Evaluation
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.
The Institute for Child and Family Well-Being was proud to host the webinar 鈥淓valuating Systems Change: An Inquiry Framework鈥� with evaluation innovator Mark Cabaj, President of . In this webinar, Mark and ICFW Co-Director Gabe McGaughey discussed why we need to focus on systems change, measuring system change results in uncertain times, with a focus on how strategic learning can be used in times of uncertainty using Developmental Evaluation. Developmental Evaluation combines the rigor of evaluation, being evidence-based and objective, with the creative and adaptive thinking needed to support innovative and rapidly evolving strategies that are typical in systems change efforts. Will the system environment be returning to 鈥榥ormal鈥� quickly, or are we entering a phase of extended uncertainty? What are some questions to ask in applying an Inquiry Framework lens to the child protection system in this uncertain era of COVID-19?
What are the boundaries of the 鈥楥PS System鈥� and why change it?
The first step of an Inquiry framework, or any system change effort, is to define the boundaries of the systems and the actors within it. Almost 21% of all CPS reports in Wisconsin made in 2019 came from education personnel. Another 19% from legal/law enforcement. How might those actors be included in improving a system challenged by COVID-19? Minority communities are both disproportionately represented in foster care and the negative health and economic impacts of COVID-19. Can families with lived/living experience in the CPS system contribute to new solutions?
What do system change results look like?
The Inquiry framework outlined three types of results that could be applied to child protection systems.
Systems Change: The extent to which efforts change the systems鈥� underlying complex issues, including changes in drivers of system behavior, such as policy, mental models, or resource flows.
Mission Outcomes: The extent to which efforts help make lives better for individuals, targeted geography/groups, or populations.
Strategic Learning: The extent of efforts to uncover insights about what we are doing, how we are thinking, and how we are being that are key to future progress.
Recognizing that we鈥檙e operating in a crisis context, with rapid change and an uncertain future, focusing on Strategic Learning may elevate insights central not only to the current COVID crisis, but emergent solutions that could be carried forward into future practice.
Strategic Learning
Strategic Learning is the intentional practice of collecting information, reflecting on it, and sharing the findings to improve the performance of an organization or system and inform its direction. With the rapid development of solutions in response to the crisis across the industry, how might we surface solutions that were developed? Adding structure to this process can cut through noise and add efficiency to adapting to an uncertain, and potentially chaotic, environment.
Systems often look for the right tool at the right time to collect information to move forward. Using the correct clinical assessment tool can help separate out trauma from mental health symptoms, leading to more efficient and effective treatment of individuals. Systems are no different. The COVID crisis has already challenged CPS and other systems that support families in unforeseen ways, which are likely to continue for the foreseeable future. Using the right tools at the right time that can evaluate adaptive efforts, can support improving systems and their ongoing efforts to meet the complex needs of families.
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Program Design & Implementation
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Clinical Training Adaptations: PCIT-Toddlers
By Kate Bennett
Reflecting upon the many impacts of the COVID-19 pandemic over the previous few weeks, it鈥檚 likely true that each of us have witnessed extraordinary examples of both strengths and challenges affecting individuals, families, and communities. ICFW relies on strategic learning as a way of framing such challenges, with a goal of informing quick adjustments in what we do in our day-to-day work. With shelter-at-home orders in place, the mental and behavioral health needs of families with young children in our community is elevated now more than ever before. For this reason, rapid adaptation has been a standout theme for our team over the last seven weeks.
As we all were pressed to quickly adjust our work and home lives in March, our agency was faced with a question as to whether Children鈥檚 Wisconsin would be able to move forward with a previously scheduled in-person Parent-Child Interaction Therapy with Toddlers (PCIT-T) training for mental and behavioral health clinicians. PCIT-T is an adaptation of Parent-Child Interaction Therapy (PCIT) that focuses on meeting developmental needs of children ages 12-24 months through live coaching of a parent or caregiver.1 The 2-day PCIT-T workshop was to take place on March 19-20, just within a week of our team鈥檚 transition to home-based work.
Expanding access to early childhood mental health services is a top priority at Children鈥檚, so it was imperative to make sure this workshop could still be offered to clinical staff. ICFW was able to collaborate closely with our PCIT-T trainer, Emma Girard, Psy.D., to determine how we might be able to move forward with this training opportunity knowing that our clinics were physically closing, and an in-person workshop was no longer an option. With a focus on how to continue the dissemination of evidence-based prevention and clinical practices to the many families in need in Milwaukee and beyond, Dr. Girard graciously agreed to adapt PCIT-T training to a web-based format for the very first time with our ICFW and Children鈥檚 clinicians as her test group. She worked with our team to create an engaging transition to two 8-hour days of training over Zoom Video Conferencing2, providing well-being baskets filled with PCIT-T themed treats to each clinician participant. ICFW assisted Dr. Girard in ensuring delivery of all training materials to our Milwaukee-based clinicians, and we teamed to provide supplemental training materials to participants through the Basecamp project management and team communication tool.3
From California, Dr. Girard logged onto Zoom shortly after 6am Pacific Standard Time in order to meet clinician need for virtual connection for two full days. Each of the 13 participants joined PCIT-T training from separate locations and remain engaged while Dr. Girard incorporated games, activities, and props into the 16 hours of skills-learning and practice. Reflecting on the experience of training from afar, Dr. Girard indicated that although the process of large-scale distance presentations requires a great deal of energy and planning, she was grateful to be able to offer the physically-distanced workshop to our group of clinicians and was pleased the outcome will provide nurturing and sensitive caregiving practices by brining PCIT-T into the homes of families. We are grateful for her dedication, flexibility, and the thoughtful learning atmosphere she provided.
Additionally, we are nothing short of impressed that Dr. Girard was able to deliver this same training over Zoom for a second PCIT-T clinical cohort grounded in New York the following week. Taking her lead from this web-based experience, Children鈥檚 Wisconsin and other Milwaukee-based agencies are now rolling out extensive telehealth services that allow clinicians to engage with families remotely. Utilizing the same HIPAA-compliant technology, clinicians are providing PCIT-T and other evidence-based interventions through video visits with young children and their caregivers. This platform allows continued connections through a child鈥檚 MyChart account and is simply accessed by a parent from a mobile device.5 Our mental and behavioral health teams at Children鈥檚 and ICFW look forward to continuing the expansion of treatment for kids and families in their natural home environment.
1 Girard, E.I., Wallace, N.M, Kohlhoff, J.R., Morgan, S.S.J., and McNeil, C.B. (2018). Parent-Child Interaction Therapy with Toddlers: Improving Attachment and Emotion Regulation. New York: Springer.
2 Zoom Video Conferencing, Web Conferencing, Webinars, Screen Sharing. (2020). Retrieved April 27, 2020, from
3 Basecamp Project Management and Team Communication Software. (2020). Retrieved April 27, 2020, from
4 Girard, E. I., Wallace, N. M., Kohlkoff, J. R., Morgan, S. S. J., & McNeil, C. B. (2020). Parent-Child Interaction Therapy with Toddlers (PCIT-T): Improving Attachment and Emotion Regulation. Retrieved April 27, 2020, from
5 Children’s Wisconsin: MyChart. (2020). Retrieved April 27, 2020, from
Building Brains with CARE is an experiential knowledge and skill-building platform. ICFW clinicians have been presenting Brain Architecture: ACE鈥檚, Trauma and Resilience for several years which include the Brain Architecture Game. The Brain Architecture Game is a kinesthetic game experience that helps participants understand the powerful role experiences play in early childhood brain development, those that contribute to strong brain function and those that threaten or hinder it. The entire presentation provided foundational knowledge of Adverse Childhood Experiences (ACE鈥檚), the associated physical and neurological changes to the brain and bolstering resilience in youth, but also was useful those with prior exposure to these concepts. Many of past participants had some base knowledge (i.e. had heard of ACE鈥檚 and Trauma-Informed Care) and found the experiential nature of the presentation provided more concrete and eye-opening understanding of their prior knowledge. However, the presentation often left the audience, and presenter, wanting more by way of strategies and tools to help children struggling with effects of toxic stress.
This is where Child-Adult Relationship Enhancement (CARE) comes in. Clinicians were formally trained in the Parent-Child Interaction Therapy adaption by master trainer Christina Warner-Metzger, PhD. After a lot of hard work by Lead Clinician Kate Bennett, and with the support of the iCARE Collaborative, Building Brains with CARE was born and became one of only two applications of CARE outside its initial designed scope granted by the iCARE Collaborative in the nation. Building Brains with CARE is a combination of in-person concept introductions and virtual learning and practice. This format is used to celebrate learning and gaining mastery in concepts and new skills.
After an initial in-person session, each cohort gains access to a Building Brains with CARE Community of Practice. ICFW clinicians and participants utilize Zoom Web Conferencing to virtually engage with each other to revisit and complement in-person information. Additional resources can be provided by ICFW clinician participants, everyone practices skills and shares how they鈥檝e tested the implementation of knowledge through the Plan-Do-Study-Act cycle. The Community of Practice topics are flexible as different avenues of discussion are based on participants鈥� interests, findings and sharing. Basecamp, which is an easily accessible project management platform, is also used to share resources, enable interaction and act as a living archive of discussions and learning objectives.
During the in-person and virtual Community of Practice, participants practice identifying situations that may indicate common trauma reactions and skills they can use within their relationships that support resilience and healthy communication. They have the opportunity for family consultations, skill-building and access to bibliographic resources. Participants learn which evidence-based interventions may be useful to families who are experiencing significant impairment in functioning due to trauma exposure.
While content is traditionally introduced over the course of one day with participants then gaining access to virtual resources including live Community of Practice sessions, there have been a few adaptions made to accommodate audience. Prior to COVID-19 changed so many things, 51猎奇 Children鈥檚 Learning Center approached ICFW to inquire about schedule flexibility in order to be worked into their pre-established professional development time. ICFW set off on adapting the Building Brains with CARE in-person format from a one-day session to five 2-hour sessions. After social distancing expectations were put in place, ICFW clinicians worked to adapt session three from in-person to Zoom-based in order to carry on with our collaboration with 51猎奇 Children鈥檚 Learning Center. Building Brains with CARE will soon be available through the Professional Development System at the 51猎奇 Partnership. If you鈥檇 like to learn more about how to get involved, please contact Luke Waldo at lwaldo@chw.org.
Learn More:
Building Brains with CARE
Recent and Upcoming Events
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.
Trauma screening, brief intervention and referral to treatment (T-SBIRT): Introduction to a promising, brief protocol for social service and healthcare settings Trainings:
May 11-13 (Postponed)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Learning Collaborative 鈥� South Milwaukee
May 14-15 (Postponed)
Sustaining Advanced Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Practice Session – Madison
Community engagement, or 鈥渢he intentional process of co-creating solutions in partnership with people who know best, through their own experiences,鈥�[1] requires the creation of authentic, collaborative relationships between context and content experts. Complex social problems such as gun violence, children鈥檚 mental health, and living through a global pandemic require solutions that are developed in collaboration with the children, families and communities that are most impacted by them. Through meaningful collaboration between service providers, government agencies and our community members with lived experience, we build reciprocal empowerment and education that may lead to co-creation of solutions that will more directly benefit the community and be sustained over time. The greatest challenges to authentic community engagement stem from forced or indifferent collaboration that often results in fraudulent inclusivity and tokenism. In a time of uncertainty and COVID-19, it becomes even more critical that we turn to the people that have lived through these challenges to learn how we might overcome them as a broader community.
The Institute for Child and Family Well-Being was proud to host the webinar 鈥淎uthentic Community Engagement: Made in Milwaukee鈥� with Leah Jepson and Blake Tierney, Project Director and Manager of the聽, and聽Reggie Moore, Director of the聽City of Milwaukee鈥檚 Office of Violence Prevention.
In this webinar, Luke Waldo discussed the following with Leah, Reggie and Blake:
Why community engagement is critical to social change;
How it impacts social change;
The challenges and benefits associated with collaboration;
All within the context of the Milwaukee Coalition for Children鈥檚 Mental Health and the Office for Violence Prevention鈥檚 Blueprint for Peace and .
“Stable housing is a foundation for family stability, not merely a reflection of it.”
聽 聽 聽 聽 聽 聽 聽 聽 -Mary Cunningham
Stable housing provides a foundation for health, well-being, and prosperity for children, families, and communities. Stable housing can positively affect a broad spectrum of outcomes for children and families, including academic performance, employment, physical, and mental health. Threats to stable and healthy housing are complex and intertwined with systemic and interpersonal factors.
Families experiencing housing instability face increased risk of聽 their children being involved in the . with children entering care identified recent histories of housing instability, including crowding, homelessness, and evictions. Housing instability is also linked ; and foster care placement is also connected to
If families experiencing housing instability are at greater risk of child maltreatment and placement into foster care, how can we take a systems approach to support families coping with housing instability, before getting involved in the child welfare system? (HOMES) is a systems change initiative focused on building new relationships, sharing ideas and knowledge, and starting new collaborations between housing and child welfare partners in the community. Housing as a Pathway to Prevent Child Maltreatment is a training ICFW Co-Director Gabriel McGaughey has delivered where participants learn about how brain science, strategic communication, systems change approaches, and design thinking have been used to connect child welfare, health, and housing in efforts to support child well-being.
A nurturing environment promotes resilience, reduces toxic stress, supports healing and is the foundation of child, family, and community well-being. The COVID-19 crisis has presented our communities with unprecedented health and economic challenges, while also accelerating pre-existing disparities. Tools for evaluating system change efforts in an uncertainty context can be a critical tool to inform strategy and direction. Developmental Evaluation combines the rigor of evaluation, being evidence-based and objective, with the creative and adaptive thinking needed to support innovative and rapidly evolving strategies that are typical in systems change efforts.
The Institute for Child and Family Well-Being was proud to host the webinar “Evaluating Systems Change: An Inquiry Framework ” with Mark Cabaj, President of Here 2 There Consulting. Mark is an evaluation innovator, one of North America’s leading developmental evaluation experts who has been supporting system change efforts in eastern Europe, the Untied States, New Zealand, Australia, and Canada.
In this webinar, Mark and ICFW Co-Director Gabe McGaughey discussed:
Evaluation principles and purpose
Why systems change
System change outcomes
The importance of strategic learning to inform adaptive strategies in uncertain times
And different frameworks for navigating learning.
Systems make people vulnerable. The COVID-19 crisis has amplified the disparities and inequities in our community, but also represents an opportunity to address these wicked problems.
鈥淎 revolutionary moment in the world’s history is a time for revolutions, not for patching.” – The Beveridge Report
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 are honored to introduce our three newest ICFW Affiliates with whom we look forward to partnering with now and into the future.
Penny Dixon
Penny Dixon is the Shelter Manager at the Milwaukee Women鈥檚 Center, a division of Community Advocates.
Penny joined the Well-Being Team and the Institute for Child and Family Well-Being in 2015 as a licensed professional counselor with extensive experience training foster parents in the greater Milwaukee area. In her role as a clinician and trainer for the Institute, she quickly mastered and provided several well-validated child mental health treatment models 鈥撀�Parent-Child Interaction Therapy听补苍诲听Trauma-Focused Cognitive Behavioral Therapy聽鈥� to families involved in the child welfare systems.
Penny also utilized Human-Centered Design to develop a psycho-social education group focused on trauma and resilience at the Community Advocates鈥� Milwaukee Women鈥檚 Center shelter. In 2019, Penny assumed the manager role of Community Advocates鈥� Milwaukee Women鈥檚 Center shelter, an emergency facility for families affected by homelessness and/or domestic violence.听In this new role, Penny continues to collaborate with the ICFW on bringing trauma-responsive practices to the Women鈥檚 Center shelter through the聽HOMES听颈苍颈迟颈补迟颈惫别.
Tim Grove
Tim Grove is a senior consultant at SaintA, a human services agency whose mission is to facilitate equity, learning, healing and wellness for all.
Tim鈥檚 partnership with the ICFW team has a long and deep history. Both Tim and ICFW Co-Director Gabe McGaughey led child welfare case management programs at their respective organizations during a time of significant transition. ICFW Co-Director Josh Mersky and Clinical Director Dimitri Topitzes worked closely with Tim when evaluating an implementation project at SaintA funded by the Greater Milwaukee Foundation. Led by Tim, the initiative integrated a comprehensive trauma-informed case management system within several child welfare service units. Results of the evaluation were published in the聽. In 2011, Drs. Mersky and Topitzes also partnered with SaintA to test an innovative training model with foster parents and children, Project Connect. Funded by the National Institutes of Health, this successful initiative helped launch the Institute for Child and Family Well-Being.
Tim鈥檚 dedication and advocacy around advancing trauma-informed care has been the foundation for transformation change at a wide range of organizations and in our community. His willingness to authentically collaborate and thoughtfully pursue improvements in practice, policy, and systems highlight just a few of the reasons we鈥檙e excited about Tim joining the ICFW as an Affiliate.
Reggie Moore
Reggie Moore serves as the Injury and Violence Prevention Director of the Office of Violence Prevention (OVP) located within the City of Milwaukee鈥檚 Health Department.
In that role, Reggie led the effort to develop the聽, Milwaukee鈥檚 first comprehensive plan to address violence prevention from a public health perspective. The Blueprint includes six goals and 30 strategies. It was developed through merging extensive community input and the best available evidence, providing a scaffolding to support cross-system collaboration and change efforts. Other OVP programs such as Trauma Response Initiative, ReCAST MKE, and 414Life view addressing trauma as vital to violence prevention and community resilience.
Reggie also serves on the Scaling Wellness in Milwaukee (SWIM) steering committee and leads the group鈥檚 Policy Action Team. In that role, he鈥檚 worked with ICFW Co-Director Gabe McGaughey around the opportunity to align SWIM鈥檚 policy work with the Blueprint for Peace.听Reggie鈥檚 commitment to social justice and willingness to collaborate across silos is an asset to advancing systems change in our community.
According to the 2019 annual report by the Office of Children鈥檚 Mental Health (OCMH), Wisconsin continues to see trends such as increasing rates of diagnosed mental illness in young children and adolescents1,2, increasing rates of untreated depression and anxiety in youth3, and a significant lack of mental health providers available to the community.4聽In our state, a common concern shared by families and clinicians alike is the accessibility of early intervention and quality mental health services.
The Trauma and Recovery Project is a five-year initiative that aims to increase access to evidence-based mental health services in southeast Wisconsin by leveraging partnerships between the Institute for Child and Family Well-being (ICFW) and Wisconsin鈥檚 Department of Children and Families (DCF), OCMH, and the Milwaukee Child Welfare Partnership (MCWP). Funded by the Substance Abuse and Mental Health Services Administration, one of the project鈥檚 primary foci has been on growing the number of clinicians that are trained to deliver trauma-responsive treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Parent-Child Interaction Therapy (PCIT), and Child-Parent Psychotherapy (CPP).
The project has established a Center of Excellence at Children鈥檚 Wisconsin to accelerate the implementation and dissemination of these three identified best practices which serve children ages 0-18 and their families. During the first two years of the project, well over 100 clinicians in Milwaukee and Racine counties have received training in one of the project鈥檚 three identified evidence-based treatments. Trainings and consultation are provided by the project for a minimal cost to clinicians and their agencies, and training participants are offered continued access to web-based, intervention-specific communities of practice (CoPs) hosted by the Center of Excellence. In the past year alone, clinicians at the Center of Excellence have participated in over 40 hours of CoP video-conferencing sessions to consult on evidence-based practices, and they have served nearly 400 children. Based on current projections by the ICFW, more than 2,000 children will receive TF-CBT, PCIT, or CPP at the Center by the end of the five-year project. Learn more about implementation of these evidence based practices here.
Importantly, parents and youth are sharing their lived experiences through a Collective Impact process led by OCMH to address access to services and family need.5聽This innovative and structured approach to systems change is helping to identify facilitators and barriers to mental health services that principally affect disadvantaged and underserved communities. Three committees have additionally been formed with membership from the Milwaukee and Racine communities to oversee the work of the Trauma and Recovery Project. One of the committees, Service Access and Family Engagement (SAFE), seeks to expand family voice by creating a collective culture focused on equity and authentic relationships that work toward shared goals and system strategies. As the SAFE committee continues to evolve, project partners recognize that it is critical to include families who have been participants of the project interventions and clinicians who have provided the interventions in future collaborative efforts.
One major barrier that must be addressed is stigma associated with mental health services, and research suggests that perceptions of stigma tend to be particularly common among racial and ethnic minority groups.6聽Parent consumers who are members of the project鈥檚 Collective Impact process have expressed this concern, and they have been actively engaged in developing direct outreach and public messaging strategies to combat the issue.
Learn More
Sources
[1]Office of Children鈥檚 Mental Health (2020). OCMH 2019 Annual Report. Retrieved from:
[2] Baglivio, M. T., Epps, N., Swartz, K., Sayedul Huq, M., Sheer, A., & Hardt, N. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2).
[3] Mental Health America. (2019). The state of mental health in America 2020. Retrieved from
[4]Wisconsin Department of Health Services. (2019). Wisconsin Mental Health and Substance Use Needs Assessment. Received from Wisconsin Office of Primary Care.
[5] Office of Children鈥檚 Mental Health (2020). OCMH Collective Impact Framework. Retrieved from:
[6] Min, J. W. (2019). The Influence of Stigma and Views on Mental Health Treatment Effectiveness on Service Use by Age and Ethnicity: Evidence From the CDC BRFSS 2007, 2009, and 2012. SAGE Open.
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鈥檚 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鈥檚 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 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 are honored to introduce our three newest ICFW Affiliates with whom we look forward to partnering with now and into the future.
Penny Dixon
Penny Dixon is the Shelter Manager at the Milwaukee Women鈥檚 Center, a division of Community Advocates.
Penny joined the Well-Being Team and the Institute for Child and Family Well-Being in 2015 as a licensed professional counselor with extensive experience training foster parents in the greater Milwaukee area. In her role as a clinician and trainer for the Institute, she quickly mastered and provided several well-validated child mental health treatment models – Parent-Child Interaction Therapy and Trauma-Focused Cognitive Behavioral Therapy – to families involved in the child welfare systems.
Penny also utilized Human-Centered Design to develop a psycho-social education group focused on trauma and resilience at the Community Advocates鈥� Milwaukee Women’s Center shelter. In 2019, Penny assumed the manager role of Community Advocates鈥� Milwaukee Women’s Center shelter, an emergency facility for families affected by homelessness and/or domestic violence. In this new role, Penny continues to collaborate with the ICFW on bringing trauma-responsive practices to the Women鈥檚 Center shelter through the HOMES initiative.
Tim Grove
Tim Grove is a senior consultant at SaintA, a human services agency whose mission is to facilitate equity, learning, healing and wellness for all.
Tim鈥檚 partnership with the ICFW team has a long and deep history. Both Tim and ICFW Co-Director Gabe McGaughey led child welfare case management programs at their respective organizations during a time of significant transition. ICFW Co-Director Josh Mersky and Clinical Director Dimitri Topitzes worked closely with Tim when evaluating an implementation project at SaintA funded by the Greater Milwaukee Foundation. Led by Tim, the initiative integrated a comprehensive trauma-informed case management system within several child welfare service units. Results of the evaluation were published in the . In 2011, Drs. Mersky and Topitzes also partnered with SaintA to test an innovative training model with foster parents and children, Project Connect. Funded by the National Institutes of Health, this successful initiative helped launch the Institute for Child and Family Well-Being.
Tim鈥檚 dedication and advocacy around advancing trauma-informed care has been the foundation for transformation change at a wide range of organizations and in our community. His willingness to authentically collaborate and thoughtfully pursue improvements in practice, policy, and systems highlight just a few of the reasons we鈥檙e excited about Tim joining the ICFW as an Affiliate.
Reggie Moore
Reggie Moore serves as the Injury and Violence Prevention Director of the Office of Violence Prevention (OVP) located within the City of Milwaukee鈥檚 Health Department.
In that role, Reggie led the effort to develop the , Milwaukee鈥檚 first comprehensive plan to address violence prevention from a public health perspective. The Blueprint includes six goals and 30 strategies. It was developed through merging extensive community input and the best available evidence, providing a scaffolding to support cross-system collaboration and change efforts. Other OVP programs such as Trauma Response Initiative, ReCAST MKE, and 414Life view addressing trauma as vital to violence prevention and community resilience.
Reggie also serves on the Scaling Wellness in Milwaukee (SWIM) steering committee and leads the group鈥檚 Policy Action Team. In that role, he鈥檚 worked with ICFW Co-Director Gabe McGaughey around the opportunity to align SWIM鈥檚 policy work with the Blueprint for Peace. Reggie鈥檚 commitment to social justice and willingness to collaborate across silos is an asset to advancing systems change in our community.
Program Design & Implementation
The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.
Executive Functioning
The ability to regulate thoughts, emotions, and behavior is central to being a productive and prosperous adult. These skills inform navigating stressful situations, developing long-term plans, understanding the impacts of immediate decisions on those long-term objectives, and parenting children. All of these are key ingredients for providing a nurturing environment that supports the health and well-being of children.
Executive Functioning refers to coordination of multiple types and streams of information in order to arrive at a more effective course of action, including prioritizing tasks, goals, and information1. Executive functioning is a skill developed through practice, using age appropriate experiences and is the foundation for healthy development, cognitive functioning, and successful self-regulation. Strength of executive function skills is predictive of academic and career outcomes.
This edition of the ICFW Newsletter highlights two Executive Functioning projects on which we are currently working.
How Human-Centered Design Led Us to Mobility Mentoring in Our Child Welfare Programs
By Luke Waldo
At the Institute for Child and Family Well-Being (ICFW), we believe that relationships with our program partners at Children鈥檚 are one of our greatest assets to improve child and family well-being. Consequently, we put out a Call for Proposals to improve child and family well-being within those programs. While we received many proposals, our Family Support Program, which serves children and families involved with the child welfare system, submitted five proposals that spanned a variety of challenges, which included the question that leads to today鈥檚 article 鈥� 鈥淗ow might we create a standardized Home Management service that meets the complex needs of families involved in the child welfare system?鈥�
Historically, the Family Support Program provided a Home Management service that 鈥渕eets the family where they鈥檙e at.鈥� Through engagement and informal assessment, the Family Support Specialist (FSS) would attempt to meet basic needs such as housing, education and employment assistance, and financial and parenting support through practices such as providing lists of available homes, contacting landlords, completing applications and budgeting tools, and providing resources. While this approach often yielded short-term progress for families 鈥� i.e., emergency rent assistance, submitted applications for GED classes and job opportunities 鈥� it required extensive time and effort from the FSS as there wasn鈥檛 a blueprint to follow, and it didn鈥檛 yield any sustainable skill-building for the client. In response, the ICFW facilitated a human-centered design process to seek solutions that might address the challenges that the Family Support Program faced.
Human-Centered Design
Human-centered design is a creative problem-solving process grounded in empathy, learning and creativity2. By beginning the problem-solving process with the people for whom you are designing, we end with ideas and solutions that are rooted in their experiences and needs. Ultimately, human-centered design confronts problems with optimism, collaboration, and ongoing learning to create solutions that can be embraced by the people that seek them.
IDEO, a social innovation leader, frames human-centered design as an iterative process that incorporates three 鈥渙verlapping spaces鈥�: inspiration, ideation, and implementation. During the inspiration phase, engaged participants 鈥� leaders, practitioners, community members 鈥� define the challenge for which they seek solutions. Ideation then leads to the brainstorming of ideas, their development into potential solutions, and the rapid-cycle testing that begins to determine what works, what does not, and how it might be implemented more broadly. Implementation is the leap from testing a prototype to delivery into people鈥檚 lives.
With a team composed of program decision-makers, leaders, and direct service staff, we worked through the human-centered design journey with tools such as Frame Your Design Challenge, Expert Interviews, How Might We?, Brainstorming, and Storyboarding. Through this thorough and engaging creative process, we departed from the idea that we were seeking a standardized curriculum that would build skills specific to finding and maintaining stable housing, education and employment. After scanning the environment and consulting with partners from around the country, we arrived at the conclusion that mentoring clients in development of executive functioning skills such as self-regulation and organization would yield better, more sustainable outcomes for families. This conclusion led us to a model called Mobility Mentoring, which 鈥渉elps participants develop and strengthen their own skills and confidence to continue setting goals, even after the mentor-participant relationship ends.鈥�
Mobility Mentoring
Source: EMPath鈥檚 Bridge to Self-Sufficiency
Mobility Mentoring庐 (MM) is an innovative evidence-informed coaching model, developed by EMPath3, focused on building economic self-sufficiency. MM is focused on not just helping participants attain specific goals, but helping them acquire the problem-solving and goal-setting skills necessary for successfully managing their lives. MM is built on a foundation of evidence-based Motivational Interviewing (MI), which utilizes incentives and the Bridge to Self Sufficiency assessment tool to determine their individualized goals within each of the model鈥檚 five pillars:
Family Stability
Well-Being
Financial Management
Education/Training
Employment/Career Management.
Through our Human-Centered Design process, we determined that the adaptation of Mobility Mentoring could solve the long-standing challenge of how to provide a structured and evidence-informed approach to serving families living in poverty, who have experienced trauma, and face complex challenges.
The ICFW has supported implementation of Mobility Mentoring in the Family Support program. While this implementation is early in the process, some of the early lessons learned include improved staff engagement and morale as a result of staff involvement in the human-centered design process; MM provides an Executive-Functioning and strengths-based framework that extends into all program services; MM provides the ability to measure goal completion and its impact on family teaming and reunification; and systems鈥� barriers create challenges to obtaining funding for fiscal incentives.
[1] Center on the Developing Child at Harvard University (2016). Building Core Capabilities for Life: The Science Behind the Skills Adults Need to Succeed in Parenting and in the Workplace.
[2] Greater Good Studio [3] EMPath 鈥� Economic Mobility Pathways. Mobility Mentoring 鈥� In the knowledge-based economy, snapping the cycle of poverty is more complex than ever. .
Science-Based Innovation
By Gabriel McGaughey
When we take the time to ask families about their biggest stressors, family goals, and hopes for their family鈥檚 future, we start to map the gap between the current state of our services and where families want us to be to have impact. In 2017, six Children鈥檚 Home Society of America (CHSA) member organizations, including Children鈥檚 Wisconsin, partnered with the Center on the Developing Child at Harvard to ask families those questions. The response was clear; families鈥� two biggest stressors, across a diverse set of survey respondents and geographic locations, were money and having a better place to live.
The question then became, how can organizations providing family-focused interventions address these issues? Our response focused on Executive Functioning. In the fall of 2019, Children鈥檚 Wisconsin partnered with Children and Families First (Delaware), Nebraska Children鈥檚 Home Society, and The Family Partnership of Minneapolis, the model developer of Executive Functioning (EF) Across Generations, to secure a planning grant from the Center on the Developing Child at Harvard to attend an IDEAS Impact Framework workshop. The goal of the project team attending the workshop was to clarify the core elements of the model to act as a foundation for adapting its use in different program contexts.
IDEAS Impact Workshop
The Center on the Developing Child鈥檚 Frontiers of Innovation initiative is focused on building a research and development platform for science-based innovation that supports change in program design, policy, and systems. ICFW Co-Director Gabriel McGaughey was a member of the CHSA project team focused on EF Across Generations, which was specifically looking to adapt the intervention for a feasibility study in Children鈥檚 Wisconsin鈥檚 Home Visiting program in Wausau.
The IDEAS Impact framework combines elements of design thinking, a focus on precision, and three key brain science concepts to identify the active ingredients for programs. This process helped us get specific about the core activities in EF Across Generations through developing a Theory of Change (TOC), understanding how the program materials for families and staff were tied to the TOC, and how the evaluation plan measures these activities. The project team focused on the core model, as creating the adaptations for other contexts would be easier with that solid foundation.
Source: Center on the Developing Child at Harvard
EF Across Generations
EF Across Generations is a two-generation intervention, developed by The Family Partnership (TFP) (Minneapolis, MN) for use in their preschool classroom setting. It is designed to boost executive function and self-regulation (EF/SR) in young children (ages 4-5) and their parents through the development and use of Internal State Words (ISWs). ISWs, or words for sensations, perceptions, feelings, volition, and ideation/imagining, was used in our model to help parents understand what their child may be trying to communicate, making it easier for parents to initiate or respond to emotionally significant events experienced by their child. EF skills are language-based skills, so children鈥檚 curriculum focuses on children ISWs; while the parent curriculum teaches core brain science and EF/SR concepts to parents, with a focus on helping parents recognize children鈥檚 use of ISWs, so that they can practice serve and return based on these important words.
TFP conducted three pilots of the children鈥檚 curriculum, and one of the parents鈥�, using the Internal State Word Inventory to evaluate progress. Results showed an 80-100% increase in use of ISWs by children, as reported by both classroom teachers and parents. Language analysis of personal narratives from the third pilot showed increases in narrative complexity when pre- and post-intervention narratives were compared. In the second and third children鈥檚 pilots, the Minnesota Executive Function Scale (MEFS) was used to measure EF change:
Pre-intervention: Children in the pilots had age-adjusted MEFS scores that were .5 to 1.5 standard deviations below the age-adjusted median for EF.
In the second pilot, children鈥檚 age-adjusted MEFS score increased post-intervention, but stayed below the national median.
In the third pilot, children again started below the national median, but scored ABOVE the national median for EF post-intervention.
TFP鈥檚 first pilot of the parent curriculum was focused on the overall parent experience, and what we learned is that parents were very interested in brain science and EF and started being warmer with each other and staff.
Children鈥檚 Wisconsin worked with TFP to develop an adapted TOC to deliver EF Across Generations in our Wausau Home Visiting program as part of an Implementation grant submitted in January 2020. The home visiting adaptation would take place over 10 sessions of 30-minute duration, as part of ongoing home visiting programming with enrolled clients with children ages 4-5. If funded, this prototype would provide the adapted model to 20 families to see if the program was feasible, based on the feedback from parents/caregivers, the model developer, and program staff. If the model proves effective in this setting, there is an opportunity to embed this practice into existing home visiting programs, as opposed to developing funding and infrastructure for a new, 鈥渟tand-alone鈥� program.
Research and Evaluation
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.
Mental Health Screening and Reporting: Trauma & Recovery Project Gains and Process Improvement
By Leah Cerwin
The Trauma and Recovery Project (TARP) aspires to build capacity so that clinicians are routinely implementing validated screening and assessment tools in order to improve the identification and treatment of trauma and mental health symptoms in children seen for services at Children鈥檚 Wisconsin and throughout southeast Wisconsin.
The Trauma and Recovery Project is a five-year initiative that is increasing access to evidence-based mental health services in southeast Wisconsin by leveraging partnerships between the Institute for Child and Family Well-being (ICFW), Wisconsin鈥檚 Department of Children and Families, Office of Children鈥檚 Mental Health, and the Milwaukee Child Welfare Partnership for Professional Development.
At the ICFW and Center of Excellence, our clinicians are providing evidence-based treatments to children and families seeking mental health services. Our Lead Clinicians are building a process to track treatment results and demonstrate clinical outcomes. There have been considerable barriers to this data entry process, which is not unique to ICFW as many partner agencies providing mental health services cite similar challenges.
The ICFW Lead Clinicians are working with our Children鈥檚 partners to build an Epic data collection system for mental health screenings and treatments, which would be embedded in the child鈥檚 medical record. Our goal is to unify mental health and medical health records to create a process that can be easily accessed by clinicians and directors, and easily approached and understood by families.
The Center of Excellence prioritizes the importance of screening for trauma and mental health symptoms and implementing evidence-based treatments to address those symptoms. Our data show that clinicians are significantly more likely to use a validated trauma assessment after completing training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Parent Child Interaction Therapy (PCIT). In the first two years of the grant, a total of 337 clinicians completed training in one of three evidence-based treatment modalities (TF-CBT, PCIT, or CPP). During TARP鈥檚 second year, 83 Milwaukee and Racine clinicians completed training in at least one of the three evidence-based treatment models.
An additional objective of the Trauma and Recovery Project is to improve child mental and behavioral health outcomes, which includes assessments of family functioning. Results from Year 2 indicated that 72% of families that received one of the three treatment modalities reported improved family functioning between baseline and discharge. An additional measure of success for this goal involved children鈥檚 report of experiencing trauma symptoms, measured by the Post Traumatic Stress Disorder reaction index. Results from Year 2 indicated that by discharge, all children experienced a decrease in trauma symptoms by 56%.
Despite the inherent difficulties of recording and reporting out data gathered in mental health treatments, the Center of Excellence through the Trauma and Recovery Project has designed its own system for data tracking and will continue to move forward to streamline mental health records into each child鈥檚 medical records. Progress toward these aims will help to fulfill the project鈥檚 ultimate goal of helping trauma-exposed children and families access mental health services that are evidence-based, highly effective, and that provide understandable and accessible results.
The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.
Enhancing Systems through Evidence Based Treatment Training and Lived Experience
By Kate Bennett and Joshua Mersky
According to the 2019 annual report by the Office of Children鈥檚 Mental Health (OCMH), Wisconsin continues to see trends such as increasing rates of diagnosed mental illness in young children and adolescents1,2, increasing rates of untreated depression and anxiety in youth3, and a significant lack of mental health providers available to the community.4 In our state, a common concern shared by families and clinicians alike is the accessibility of early intervention and quality mental health services.
The Trauma and Recovery Project is a five-year initiative that aims to increase access to evidence-based mental health services in southeast Wisconsin by leveraging partnerships between the Institute for Child and Family Well-being (ICFW) and Wisconsin鈥檚 Department of Children and Families (DCF), OCMH, and the Milwaukee Child Welfare Partnership (MCWP). Funded by the Substance Abuse and Mental Health Services Administration, one of the project鈥檚 primary foci has been on growing the number of clinicians that are trained to deliver trauma-responsive treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Parent-Child Interaction Therapy (PCIT), and Child-Parent Psychotherapy (CPP).
The project has established a Center of Excellence at Children鈥檚 Wisconsin to accelerate the implementation and dissemination of these three identified best practices which serve children ages 0-18 and their families. During the first two years of the project, well over 100 clinicians in Milwaukee and Racine counties have received training in one of the project鈥檚 three identified evidence-based treatments. Trainings and consultation are provided by the project for a minimal cost to clinicians and their agencies, and training participants are offered continued access to web-based, intervention-specific communities of practice (CoPs) hosted by the Center of Excellence. In the past year alone, clinicians at the Center of Excellence have participated in over 40 hours of CoP video-conferencing sessions to consult on evidence-based practices, and they have served nearly 400 children. Based on current projections by the ICFW, more than 2,000 children will receive TF-CBT, PCIT, or CPP at the Center by the end of the five-year project.
Importantly, parents and youth are sharing their lived experiences through a Collective Impact process led by OCMH to address access to services and family need.5 This innovative and structured approach to systems change is helping to identify facilitators and barriers to mental health services that principally affect disadvantaged and underserved communities. Three committees have additionally been formed with membership from the Milwaukee and Racine communities to oversee the work of the Trauma and Recovery Project. One of the committees, Service Access and Family Engagement (SAFE), seeks to expand family voice by creating a collective culture focused on equity and authentic relationships that work toward shared goals and system strategies. As the SAFE committee continues to evolve, project partners recognize that it is critical to include families who have been participants of the project interventions and clinicians who have provided the interventions in future collaborative efforts.
One major barrier that must be addressed is stigma associated with mental health services, and research suggests that perceptions of stigma tend to be particularly common among racial and ethnic minority groups.6 Parent consumers who are members of the project鈥檚 Collective Impact process have expressed this concern, and they have been actively engaged in developing direct outreach and public messaging strategies to combat the issue. Learn More
Sources
[1]Office of Children鈥檚 Mental Health (2020). OCMH 2019 Annual Report. Retrieved from: [2] Baglivio, M. T., Epps, N., Swartz, K., Sayedul Huq, M., Sheer, A., & Hardt, N. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2). [3] Mental Health America. (2019). The state of mental health in America 2020. Retrieved from [4]Wisconsin Department of Health Services. (2019). Wisconsin Mental Health and Substance Use Needs Assessment. Received from Wisconsin Office of Primary Care. [5] Office of Children鈥檚 Mental Health (2020). OCMH Collective Impact Framework. Retrieved from: [6] Min, J. W. (2019). The Influence of Stigma and Views on Mental Health Treatment Effectiveness on Service Use by Age and Ethnicity: Evidence From the CDC BRFSS 2007, 2009, and 2012. SAGE Open.
Recent and Upcoming Events
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 presented at and participated in the following conferences and trainings:
January 17
Society for Social Work and Research 24th Annual Conference, Washington, DC
Authors: Joshua Mersky and ChienTi Plummer Lee
Authors: Dimitri Topitzes, Daria Mueller, and Edwin Bacalso
January 30-31
Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Training (DC:0-5) Audience: ICFW and Children鈥檚 Clinicians
February through May (5 Training Sessions)
Building Brains with CARE Trainers: Kate Bennett and Meghan Christian Audience: 51猎奇 Children鈥檚 Learning Center
February 21-23
51猎奇 Community Building Workshop
February 26
Carthage College Trauma and Wellness Conference 2020 Panel: On Trauma, Economics, and the Justice System Panelists: Dimitri Topitzes, Lt.-Gov. Mandela Barnes, Katherine Hilson, Jamaal Smith
March 16-20
Trainer: Dr. Emma Girard Audience: ICFW and Children鈥檚 Clinicians
May 11-13
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Learning Collaborative 鈥� South Milwaukee
May 14-15 Sustaining Advanced Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Practice Session – Madison
The School-Based Mental Health project strives to increase accessibility to mental health care for children in Wisconsin. By placing psychotherapists in schools, we reduce barriers to access to care and build on the undeniable connection between a well child and their ability to succeed in school. In this way not only are healthcare disparities reduced,...
Voith, L. A., Topitzes, J., and Berg, K. A. (2020). The transmission of violence and trauma across development and environmental contexts: Intimate partner violence from the perspective of men with histories of perpetration. Child Abuse & Neglect, 99.
Background Research has established a relation between ecological contexts and intimate partner violence (IPV), but little is known about how environmental factors affect childhood development over time and culminate in IPV perpetration from the perspective of men who perpetrated IPV.
Methods Using grounded theory, this study employed focus groups with 32 predominately low-income, African American men in batterer intervention programs to explore factors and processes through which families, neighborhoods, and policy influence men’s development, contributing to their use of IPV. Using an inductive approach, the researchers cycled between data collection and analysis resulting in a parsimonious conceptual model validated by participants.
Results Three core categories emerged from focused and axial coding: adverse childhood experiences (ACEs) and trauma, structural forces, and systemic forces. Theoretical coding illuminated how these core categories relate to each other, producing a collective narrative illustrating how environmental contexts contributed to men鈥檚 development. Study participants described childhood exposure to adversity and trauma within the home that diminished essential foundations of trust and safety. Positive (e.g., Old Heads, matriarchs) and negative (e.g., gangs, community violence) structural neighborhood forces influenced the social learning of violence and exposed participants to re-traumatization outside the home during their adolescence. Finally, key macro forces such as mass incarceration exacerbated violence and trauma exposure through the proliferation of high-risk neighborhoods, predisposing men toward IPV as young adults.
Conclusions Findings reinforce the notion that environmental stress not buffered by protective adults profoundly affects development and behavior. From the perspective of male perpetrators, our results help identify those stressors and how they might contribute to male-to-female IPV.
Mersky, J.P., Topitzes, J., Janczewski, C.E., Plummer Lee, C., McGaughey, G., & McNeil, C.B. (2020). Translating and Implementing Evidence-Based Mental Health Services in Child Welfare. Adm Policy Ment Health.
Abstract
Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent鈥揷hild interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children鈥檚 mental health research, services, and policy are discussed.
Topitzes, J., Grove, T., Pangratz, S, Meyer, E. E., & Sprague, C. M. (2019). Trauma-responsive child welfare services: A mixed methods study assessing safety, stability and permanency. Journal of Child Custody.
Objective Trauma-informed or trauma-responsive programming has spread across many service sectors including child welfare. However, only a few evaluations of such child welfare programs have been published.
Method The current mixed methods study assessed a trauma-responsive child welfare program implemented within a private agency located in the Midwest region of the U.S. The intervention combined specialized training, assessment, case planning, and case consultation into a trauma-responsive case management model.
Results Quantitative data, gathered through a quasi-experimental design (N=598), revealed that program participation was associated with improved permanency but not with enhanced child safety. Qualitative data, gathered from staff interviews (N=10), helped to contextualize quantitative results, highlighting staff experiences and impressions of the program. Implications of results are discussed.
Blair, K., Topitzes, J., & Mersky, J. P. (2019). Brief, group-based parent-child interaction therapy: Examination of treatment attrition, non-adherence, and non-response. Children and Youth Services Review.
Abstract
Parent-Child Interaction Therapy (PCIT) has been shown to reduce challenging child behavior and improve parenting skills, yet treatment attrition, non-adherence and non-response remain matters of concern. This study analyzes rates and factors associated with attrition, non-adherence, and non-response using data from a randomized controlled trial of foster parent-child dyads who received brief, group-based PCIT. Multivariate logistic regressions demonstrated that, as compared to prior estimates of conventional outpatient PCIT, rates of treatment attrition, non-adherence and non-response from the group-based PCIT intervention were low. Compared to other racial/ethnic groups, rates of attrition were significantly higher among African American foster parents. No study variables were linked to treatment non-adherence. Foster parent ratings of child externalizing symptoms were positively associated with non-response. Implications for promoting retention and treatment effectiveness, successfully integrating PCIT into child welfare services and advancing future research are discussed.
Topitzes, J., Mersky, J. P., Mueller, D. J., Bacalso, E., & Williams, C. (2019). Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T鈥怱BIRT) within employment services: A feasibility trial. American Journal of Community Psychology.
Abstract
Research suggests that low鈥恑ncome adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health鈥恟elated effects of trauma undermine employment and employability. A trauma鈥恑nformed protocol鈥攖rauma screening, brief intervention, and referral to treatment or T鈥怱BIRT鈥攚as therefore implemented within employment service programs serving low鈥恑ncome urban residents. To assess the feasibility of integrating T鈥怱BIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low鈥恑ncome adults (N = 83), the study revealed that T鈥怱BIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post鈥恡raumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T鈥怱BIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T鈥怱BIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three鈥恞uarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.
Herrenkohl, T. I., Mersky, J. P., & Topitzes, J. (2019). Applied and translational research on trauma-responsive programs and policy: Introduction to a special issue of the American Journal of Community Psychology. American Journal of Community Psychology.
Abstract
The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at鈥恟isk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.
Mersky, J. P., & Plummer Lee, C. (2019). Adverse childhood experiences and poor birth outcomes in a diverse, low-income sample. BMC Pregnancy and Childbirth, 19(387), 1-7.
Background
Adverse childhood experiences (ACE) are associated with an array of health consequences in later life, but few studies have examined the effects of ACEs on women鈥檚 birth outcomes.
Methods
We analyzed data gathered from a sample of 1848 low-income women who received services from home visiting programs in Wisconsin. Archival program records from a public health database were used to create three birth outcomes reflecting each participant鈥檚 reproductive health history: any pregnancy loss; any preterm birth; any low birthweight. Multivariate logistic regressions were performed to test the linear and non-linear effects of ACEs on birth outcomes, controlling for age, race/ethnicity, and education.
Results
Descriptive analyses showed that 84.4% of women had at least one ACE, and that 68.2% reported multiple ACEs. Multivariate logistic regression analyses showed that cumulative ACE scores were associated with an increased likelihood of pregnancy loss (OR鈥�=鈥�1.12; 95% CI鈥�=鈥�1.08鈥�1.17), preterm birth (OR鈥�=鈥�1.07; 95% CI鈥�=鈥�1.01鈥�1.12), and low birthweight (OR鈥�=鈥�1.08; 95% CI鈥�=鈥�1.03鈥�1.15). Additional analyses revealed that the ACE-birthweight association deviated from a linear, dose-response pattern.
Conclusions
Findings confirmed that high levels of childhood adversity are associated with poor birth outcomes. Alongside additive risk models, future ACE research should test interactive risk models and causal mechanisms through which childhood adversity compromises reproductive health.
Mersky, J. P., Topitzes, J., & Britz, L. (2019). Promoting evidence-based, trauma-informed social work practice. Journal of Social Work Education, 55(4), 645-657.
Abstract
Given the human costs of psychological trauma, social workers should be well versed in trauma-informed care (TIC). This framework helps guide the efforts of systems, organizations, and practitioners toward reducing trauma or mitigating its effects. The field has created TIC principles, although they have yet to be fully realized as practical applications. This article makes the case that theoretically and empirically grounded content on trauma should be foundational to social work education. We also argue that social work practice will be advanced by clearly defining trauma and by distinguishing TIC from trauma-focused and trauma-sensitive approaches. Finally, a TIC certificate program illustrates how graduate student training and social work practice are enhanced by integrating trauma content into classroom and field settings.
Mersky, J. P., Plummer Lee, C., & Gilbert, R. M. (2019). Client and provider discomfort with an adverse childhood experiences survey. American Journal of Preventive Medicine, 57(2), e51-e58.
Introduction
Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients鈥� discomfort when they are asked similar questions by direct care providers, such as home visitors.
Methods
This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort.
Results
More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31).
Conclusions
Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.
Blair, K., Topitzes, J., & Mersky, J. P. (2019).听 Do parents鈥� adverse childhood experiences influence treatment responses to Parent-Child Interaction Therapy? An exploratory study with a child welfare sample. Child & Family Behavior Therapy, 41(2), 73-83.
Abstract
This exploratory study of 23 parent鈥揷hild dyads receiving child welfare services examined the association between the number of adverse childhood experiences (ACEs) parents reported and their children鈥檚 externalizing behaviors. We also assessed whether the effects of Parent-Child Interaction Therapy (PCIT) on externalizing behaviors varied by parents鈥� ACE histories. Results indicated that parents鈥� ACE scores were associated with child externalizing symptoms at baseline, but not at a second postbaseline assessment. Although all parents reported reductions in child externalizing behavior from baseline to postbaseline, only reductions reported by parents with four or more ACEs were statistically significant. Implications for implementing PCIT with trauma-exposed families are discussed.
Janczewski, C. E., Mersky, J. P., & Brondino, M. J. (2019). Those who disappear and those who say goodbye: Patterns of attrition in long-term home visiting. Prevention Science, 1-11.
Abstract
Most evidence-based home visiting models are designed to support families from pregnancy through a child鈥檚 second birthday, though programs often struggle to retain families for this long. Previous research on client and program factors that predict attrition has produced mixed results, which may be partly because attrition is typically conceptualized as a homogeneous phenomenon. The current study sampled 991 women who received home visiting services from one of 26 agencies in a statewide network of evidence-based programs. Participants who remained in services were compared to three types of early leavers: those who communicated their intent to leave (active attrition), those whose cases closed due to non-participation (passive attrition), and those who moved from the service area. Within a year of enrollment, 42% of women exited services. Cox regression results suggested no differences in the timing of service exit among the three attrition types. Multinomial analyses revealed that, when compared to participants who remained in services, active leavers were more likely to be married or cohabitating, while passive leavers were more likely to be younger, African American, unemployed, and to have a home visitor with low job satisfaction. Participants who moved were less likely to be Latina and employed. An early pattern of inconsistent attendance was the strongest predictor of active and passive withdrawal. Rates of attrition varied by home visiting model, though inconsistent attendance was a robust predictor of passive attrition across models. This study underscores the need to scrutinize service duration as a metric of success in home visiting.
By providing training and access to employment opportunities, job programs help individuals obtain the skills and social connections necessary to achieve sustainable employment.1 The structure and function of these programs vary, though many serve low-income adults with limited education and job training. Despite their public appeal, most job programs in the US struggle to sustain impact over time, as gains in employment and income among program participants seldom last more than six months.2
There are several reasons why these programs often do not produce long-term benefit. First, job programs rely on a pool of low-skilled positions into which they place participants for training and development. However, the availability of low-skilled jobs is shrinking due to automation and out-sourcing.3 Second, employment service participants of color often face systematic discrimination when attempting to land employment, undermining their efforts to attain economic self-sufficiency.4 Finally, personal health challenges and risk factor profiles sometimes sabotage low-income job seekers鈥� attempts to sustain long-term employment. For instance, studies have shown that these job seekers endure stress and trauma at much higher rates than the general population; in addition, their experiences of adversity impair physical and mental health, which exacerbates problems with work.5,6 To address the health and employment effects of trauma, innovative trauma-responsive employment service programs have begun to emerge.
In order to enhance the well-being of their trauma-affected clients and increase the chances that clients will obtain and sustain meaningful employment, these programs integrate key components of trauma-informed care (TIC). They combine, for instance, hallmark TIC principles such as empowerment and peer support7 with emerging TIC practices such as trauma screening, referral to services, and use of evidence-based trauma interventions.8 Results from a few published research studies suggest that such programs promote positive long-term outcomes:
A welfare-to-work program, serving low-income mothers of young children, introduced several key trauma-informed components to their menu of services: financial empowerment training and the well-validated peer support Sanctuary Model庐. The program helped to reduce participants鈥� depression symptoms while increasing income-benefits that endured well after services ended.9
An innovative supported employment program, serving military veterans with post-traumatic stress disorder, provided immediate and extensive mental health referral services along with case management services. An additional key program component, rapid job placement, aimed to facilitate self-empowerment and self-efficacy. Evaluation results indicated that the program increased participants鈥� earnings over a long period.10
Healthy Workers, Healthy Wisconsin
In 2017, Community Advocates Public Policy Institute partnered with the Institute for Child and Family Well-Being to launch聽Healthy Workers, Healthy Wisconsin聽(HWHW), a five-year project designed to increase low-income job seekers鈥� access to trauma-responsive employment services. Funded by the聽听补苍诲听, HWHW integrates trauma-responsive practices within various employment service programs located in Southeast Wisconsin. Types of participating programs include welfare-to-work, non-traditional transitional jobs, and prison reentry. At the heart of the initiative, which runs through 2021, is a protocol titled trauma screening, brief intervention and referral to treatment or聽T-SBIRT.
T-SBIRT
The T-SBIRT protocol is a brief, standardized intervention that integrates trauma-informed care principles and practices into its structure. By directly addressing trauma exposure and its effects, T-SBIRT works to remove critical barriers to health care access. Within employment services, the protocol requires approximately 30 minutes to complete and consists of a number of steps including the following.
Screening for healthcare access, trauma exposure and trauma symptoms
Probing for helpful and unhelpful stress coping skills
Enhancing motivation for help seeking behavior
Referral to health, mental health, behavioral health and/or social services
Evident in the structure of T-SBIRT are hallmark TIC principles and practices such as screening and assessment, a focus on stress coping, client empowerment through motivational interviewing, and referral to treatment and other services (see issue brief in Trauma Responsive Practices). In fact, T-SBIRT providers work closely with referral partner agencies that offer well-validated services, including trauma-specific mental health treatments that reduce PTSD symptoms. Participating employment service agencies also collaborate closely with their employer partners to enhance the trauma-informed nature of stability employment. As such, T-SBIRT and HWHW rely heavily on interagency collaborations, another critical feature of TIC.
HWHW Results
A recent study of HWHW showed that it is feasible to implement T-SBIRT within employment services.11 Several non-traditional stability or temporary jobs programs were the subjects of the study. Expanding the range of programs and number of participants, the authors have conducted ongoing analyses of HWHW data. Results suggest that the protocol was acceptable or tolerable to the 186 project participants. Fully 94.1% of the sample reported feeling the same or better after completing T-SBIRT services, consistent with other research showing that respondents typically experience little to no distress when discussing past trauma exposure in the context of a well-conducted interview (see Asking Sensitive Questions Issue Brief).
Moreover, T-SBIRT addressed common problems among participants, meaning that was suitable for the client group. For instance, 96.6% experienced significant trauma in their lives, and 55% screened positive for post-traumatic stress disorder. Other mental health problems appeared to plague a relatively large portion of the study sample. Over forty percent screened positive for depression, and nearly half endorsed problems with anxiety. An additional barrier to health and well-being that T-SBIRT targets is access to healthcare, and over one-third or 37.7% of the participants indicated that they had no regular place to go for healthcare.
Designed ultimately to facilitate referrals to outside health-related services, T-SBIRT appeared to function as intended with employment service recipients. Nearly three-quarters of the study sample accepted a referral to any type of service. Over half accepted a referral to mental health care, which is surprisingly good news given the stigma that such services carry among low-income groups.12 Finally, over one-quarter of the project participants accepted a referral to primary healthcare services.
Conclusion and Future Directions
As evidenced by the feasibility study results, T-SBIRT shows promise as an efficient, user-friendly tool that employment service providers can implement in non-clinical settings to connect clients to appropriate services such as primary and mental healthcare. If shown to produce meaningful health and employment outcomes, T-SBIRT will have significant implications, not only for individual at-risk job seekers, but also for their families and entire communities suffering from the interrelated cycles of poverty, unemployment, poor health, and untreated trauma.
Currently, ICFW is conducting an impact study to explore whether completion of T-SBIRT within employment services is associated with improved health and employment outcomes. Focus groups with program participants have also been completed in order to assess program satisfaction and explore recommended improvements. In addition, HWHW administrators continue to search for trauma-focused mental health referral partners given the high demand for yet limited supply of such services. Program administrators are additionally involved in collective efforts to define trauma-informed employment practices.
Finally, the ultimate goal of HWHW is to stimulate policy change such that state-run employment services become more trauma-responsive. Implementing T-SBIRT along with other HWHW recommendations will potentially promote more responsive and effective employment services. Therefore, Community Advocates Public Policy Institute in tandem with the Institute for Child and Family Well-Being is disseminating results of the HWHW initiative to policy makers and the public at-large.
References
1 Harper-Anderson, E. (2008). Measuring the connection between workforce development and economic development: Examining the role of sectors for local outcomes. Economic Development Quarterly, 22, 119-135. 2 Redcross, C., Millenky, M., Rudd, T., & Levshin, V. (2011). More than a job: Final results from the evaluation of the center for employment opportunities (CEO) transitional jobs program. OPRE Report, 18. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. 3 Autor, D. H., & Dorn, D. (2013). The Growth of low-skill service jobs and the polarization of the US labor market. American Economic Review, 103, 1553鈥�1597. 4 Levine M. V. (2012). Race and male employment in the wake of the Great Recession: Black male employment rates in Milwaukee and the nation鈥檚 largest metro areas, 2010. Milwaukee, WI: University of Wisconsin-Milwaukee, Center for Economic Development. 5 Cambron, C., Gringeri, C., & Vogel-Ferguson, M. B. (2015). Adverse childhood experiences, depression and mental health barriers to work among low-income women. Social Work in Public Health, 30, 504-515. 6 Topitzes, J., Pate, D. J., Berman, N. D., & Medina- Kirchner, C. (2016). Adverse childhood experiences, health, and employment: A study of men seeking job services. Child Abuse & Neglect, 61, 23-34. 7 Substance Abuse and Mental Health Services Administration (2014). SAMHSA鈥檚 concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Author. 8 Lang, J. M., Campbell, K., Shanley, P., Crusto, C. A., & Connell, C. M. (2016). Building capacity for trauma-informed care in the child welfare system: Initial results of a statewide implementation. Child Maltreatment, 21, 113-124. 9 Booshehri, L. G., Dugan, J., Patel, F., Bloom, S., & Chilton, M. (2018). Trauma-informed Temporary Assistance for Needy Families (TANF): A Randomized Controlled Trial with a Two-Generation Impact. Journal of Child and Family Studies, 27, 1594-1604. 10 Davis, L. L., Kyriakides, T. C., Suris, A. M., Ottomanelli, L. A., Mueller, L., Parker, P. E., 鈥� & Drake, R. E. (2018). Effect of evidence-based supported employment vs transitional work on achieving steady work among veterans with posttraumatic stress disorder: a randomized clinical trial. JAMA Psychiatry, 75, 316-324. 11 Topitzes, J., Mersky, J. P., Mueller, D. J., Bacalso, E., & Williams, C. (2019). Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) within Employment Services: A Feasibility Trial. American Journal of Community Psychology, 64, 298-309. 12 Thornicroft, G., Mehta, N., Clement, S., Evans- Lacko, S., Doherty, M., Rose, D., 鈥� & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123-1132.
鈥淎 recent study of HWHW showed that it is feasible to implement T-SBIRT within employment services.11鈥�
Mersky, J. P., & Janczewski, C. E. (2018). Adverse childhood experiences and postpartum depression in home visiting programs: Prevalence, association, and mediating mechanisms. Maternal and Child Health Journal.
Objectives
In this study, we examined the prevalence of postpartum depression (PPD) and its association with select demographic factors and antenatal conditions. We also investigated whether greater exposure to adverse childhood experiences (ACEs) is associated with PPD, and if antenatal conditions mediate the ACE-PPD relationship.
惭别迟丑辞诲蝉听
Data were collected from 735 low-income women receiving home visiting services. Descriptive and bivariate analyses provided estimates of PPD and its correlates, and nested path analyses were used to test for mediation.
搁别蝉耻濒迟蝉听
We found that rates of PPD were high compared to prevalence estimates in the general population. Sample rates of antenatal depression were even higher than the rates of PPD. Omnibus tests revealed that PPD did not vary significantly by maternal age or race/ethnicity, although Hispanic women consistently reported the lowest rates. American Indian women and non-Hispanic white women reported the highest rates. PPD was significantly associated with increased exposure to ACEs. Nested path models revealed that the effects of ACEs were partially mediated by three antenatal conditions: intimate partner violence (IPV), perceived stress, and antenatal depression.
Conclusions for Practice聽
Supporting prior research, rates of PPD appear to be high among low-income women. ACEs may increase the risk of antenatal IPV and psychological distress, both of which may contribute to PPD. The findings have implications for screening and assessment as well as the timing and tailoring of interventions through home visiting and other community-based services.
