Family Success: Achieving
Outcomes by Promoting
Accountability
Presenters:
• Bret Stockton, Director of Business
Development
• Catherine Adams: Business Development
Manager
Workshop Overview:
• Video Introduction
• Youth Villages’ Overview
• Increasing Family Accountability
• Intensive In-Home Services: Intercept
• Intercept Outcome Data
• Questions/Answers & Discussion
Video – Extreme Measures
Youth Villages’ Mission and Values
OUR MISSION
Youth Villages helps children and families live successfully.
OUR VALUES
Kids needs come first…Always.
Children are raised best by their families.
We provide a safe place.
We strive to achieve positive, lasting results.
We are committed to our staff.
We are each responsible for providing the highest level of service to
our customers.
We constantly improve our performance to achieve excellence.
We create new programs to meet the needs of children, families
and the community.
We do what we say we do.
Quick Facts
Youth Villages’ Daily Program Census as of 7/31/11
Intensive In-Home Services (Intercept and MST)
Transitional Living
Treatment/Therapeutic Foster Care
Community-Based Group Homes
Residential Treatment Programs (including Intensive)
Case Management and Other Therapeutic Services
1,378
693
436
95
516
525
Total
3,643
The Youth Villages Specialized Mobile Crisis program in Tennessee
received 9,862 calls in FY 2010 and conducted 6,921 face-to-face
assessments. Across the state, over 65% of these youth were diverted
from hospital placement.
Youth Villages’ Mentoring Program currently has over 325 mentors.
Goals of Intensive In-Home Services:
• Achieve long-term, successful outcomes for youth in the home
– Empower families to be accountable to and for their children and to
resolve problems independently whenever possible
– Ensure services rendered focus on providing families with the
resources needed to address current and future mental health and
behavioral issues
• Reduce the overall cost of services through reduced overall length
of stay per youth and treatment in the least restrictive environment
– Decrease number of unnecessary out-of-home placements
– Prevent disruptions from home-based setting resulting in placement
in detention centers or hospitals
• Increase the number of youth served by reducing the overall cost
per youth
– Provide cost effective, successful services to states and localities
– Increase service capacity to ensure that all children and families
have access to the most appropriate level of service they need
Recommendations for Promoting
Accountability:
• Before any child is committed to state custody, or if necessary
at the moment the child is committed to state custody,
families should be assigned an intensive in-home service
provider.
• States should build in a mechanism to intensely monitor
every single child who is entering custody, to ensure that
all appropriate efforts are being made to provide the most
appropriate service(s).
• States should marshal all resources needed to do whatever
it takes to resolve family problems so that children can safely
stay or return home if at all possible, and monitor to ensure
that resources are properly used to their fullest extent.
Youth served July 2000 through May 2011
Youth Served by Program
30,000
25,112
25,000
20,000
15,000
10,000
6,918
5,231
4,395
2,885
5,000
0
Residential Treatment
Group Home
Foster Care
Intensive In-Home Transitional Living
Youth may be served in multiple programs.
In-Home Services Programs
Admissions by Fiscal Year
October 1994 through March 2011
4,500
4,179
3,744
4,000
3,500
3,301
2,719
3,000
2,500
2,027
2,000
1,854
1,584
1,500
1,241
1,404
862
1,000
679
500
16
144
292
377
295
410
490
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*
Youth may have
multiple admissions to
the program.
Fiscal Year – July 1 to June 30
* Represents the first three
quarters of the fiscal year
Youth Villages Locations
Intensive In-Home Services:
Intercept
History of Promoting Family
Accountability
• History of providers’ role in promoting
accountability: Take responsibility for outcomes
• Philosophical change: Seeing families as the
solution
• Reasons families don’t accept responsibility and
accountability: What is the fit?
• Role of alignment: Can’t speak about families in
the ways that you wouldn’t speak to them
Organizational Practices for
Promoting Family Accountability
• Emphasize our accountability
• Describe what accountability looks like for each family,
identify what stands in the way of that, then hold
ourselves accountable for addressing those things.
• Eliminate language like “resistant” or “not ready for
change.” If the family just needed to be told what to do,
we wouldn’t be needed.
• Often need to do non-traditional things to earn trust and
communicate a non-judgmental relationship.
• Address alignment as a developmental target with staff.
Why Treatment in the Home is Necessary
• Natural Environment - Resolve problems in the natural
environment.
• Present Focused - Address current behaviors relating to:
Family
Peers
School
Individual
Community
• “Fit” - Understand the fit.
• Family Responsibility - Encourage the family to take
responsibility.
• Generalization - Develop long-term solutions in the community.
• Realistic Setting - Teach youth to function in realistic setting.
• Effective Treatment – Treatment based on research is most
effective.
• Research - Research indicates that restrictive out-of-home
placements may do more harm than good.
• Engage Entire Family – Need to treat entire family.
Intercept Program Overview
• Youth Villages developed the Intercept Program to
serve a broader population of youth and families
– Serves youth from infant to age 17
– Utilized with a combination of child welfare, mental health, and
juvenile justice systems
– Currently serving AL, FL, GA, MA, MS, NC, NH, OR, and TN
– Ability to divert youth from placement, thus keeping families together
safely
– Ability and experience in transitioning youth home from out-of-home
placements (detention, RTC, acute hospitalizations, foster homes,
etc.) even after extended time out-of-home (more than 3 months)
Current Intercept
Locations
Program Key Components
Youth Villages' Intercept program offers the following:
• Extremely high levels of staff training and supervision
• Intensive services conducted in the child's home and
community by a single Intercept family intervention
specialist
• Caseloads of only 4-5 youth/families per Intercept
family intervention specialist
• Family sessions conducted 3 times per week
• 24/7/365 on call support to families
• Accountability for success is with the Intercept family
intervention specialist and program
Program Key Components (cont.)
• Average 4-6 months per case for diversion and up to 69 months per case for reunification
• Involvement in all systems affecting youth and family
• Assistance with concrete needs such as housing,
healthcare, and employment
• Nurturance of long-term support from extended family
and other natural support systems
• Masters level counselors preferred or Bachelors level
with experience working with target population
Ongoing Evaluation of Cases
• Daily Updates and Red Flag E-mails
• Weekly Individual Counselor Development
• Critical Event Reviews
• Supervisor field visits
• Tape reviews
Typical Youth Referral Issues
ADHD
Animal Cruelty
Anxiety
Chronic Health Condition/Medical Adherence
Delinquency
Depression
Domestic Violence Trauma
Eating Disorder
Employment Issues
Enuresis/Encopresis
Fire Setting Behaviors
General Health Issue
Homicidal Ideations
Housing Instability
Inappropriate Sexual Behavior
Low Educational Attainment/Maintenance: 18+
Other Identified Problem/Issue
© Youth Villages, Inc.
Other Trauma History
Parental Neglect/Abandonment
Physical Abuse Trauma
Physical Aggression
Poor Academic Performance
Poor Money Management
Problem Sexual Behavior (age 13-18)
Problem Sexual Behavior in Children
(12 and younger)
Risk of Pregnancy/Fathering
Runaway
Self Harm
Sexual Abuse Trauma
Substance Abuse/A&D
Suicide
Theft/Stealing Behaviors
Transportation Issues
Truancy
Verbal Aggression
Typical Parent Referral Issues
Chaotic home life
Parent contacts to courts and state agencies over struggles with
child
Parent personal barriers (substance abuse, divorce, disagreements
between children and mother’s new boyfriends)
Lack of commitment by relatives assuming care for youth
Grandparent health problems
Parent depression and other mental health problems
Low warmth, high conflict
© Youth Villages, Inc.
Initial and Ongoing Communication With Key Stakeholders
Community Stakeholders:
•
•
•
•
•
•
Case Managers
Current provider (if applicable to reunification cases)
Agency Staff (child welfare, juvenile justice, and/or mental health)
Court Staff (including Judges, GALs, and POs)
Schools (including teachers, principals, guidance counselors)
Mental Health Centers (including psychiatrists)
Communication includes:
• In addition to the youth and family, Youth Villages’ Intercept includes key
stakeholders in the assessment and treatment planning process.
• Youth Villages provides documentation such as monthly updates, detailed
assessments, weekly treatment plans, discharge plans, and safety plans.
• Youth Villages provides ongoing updates as often as requested.
Intervention Targets
• Identification of the primary risk factors associated with
referral problems
• Services are all-inclusive
• Services are focused on strengths of the family & child
• Family Members are full partners in the treatment
process
• Interventions take place within the multiple systems
occurring within the natural ecology
Intercept Program: Common Interventions
• Work with family to design and implement an individualized safety
plan
• Work with family to design and implement an individualized
behavior plan
• Work with family and support network to design and implement a
supervision plan
• Work with family to meet basic needs (housing, health care,
transportation, employment, etc.
• Work with family on how to manage medications
• Work with family to increase and utilize their support network
• Find respite with extended family or other supports, as necessary
• Engage stakeholders, including caseworkers and courts to find
appropriate relative/support placements when it is necessary to
remove a child from the home
Intercept Specialist Characteristics
•
•
•
•
•
•
•
Total Commitment to Model
Intense
Critical Thinker
Creative
Flexible
Open to High Levels of Supervision
Outcome Driven
How Intercept Can Help
Diversion
• Diversion/Stabilization
• Assessments on all
youth entering care
• Adoption Stabilization
• Birth to Four
Reunification
• Assessments and
intensive family
searches
• Short-term
Reunification
• Long-term
Reunification
• Residential
Partnerships
Intercept Program
Outcomes
Youth Served July 2006 through December2010
Includes youth served through the Intercept Program in Alabama, Florida, Georgia,
Massachusetts, Mississippi, New Hampshire, Tennessee and Virginia.
Outcome Evaluation Process
• Research Dept. led by Dr. Sarah Hurley and
14 full time staff
• Follow-up surveys administered to all
youth/families who received at least 60 days
of Youth Villages’ services (a “full dose”) at
6, 12, and 24 months post-discharge.
Intercept Program
Demographics
Youth served July 2006 through March 2011
N = 9,461
100%
80%
62%
61%
60%
38%
40%
31%
20%
3%
5%
0%
Male
Female
Gender
African
American
Caucasian
Hispanic
Race/Ethnicity
Other
Intercept Program
Age Group
Youth served July 2006 through March 2011
N = 9,461
100%
80%
60%
38%
40%
30%
16%
16%
20%
0%
8 Years Old and Younger
9 to 11 Years Old
12 to 14 Years Old
15 to 18 Years Old
Intercept Program
Presenting Issues
Youth served July 2006 through March 2011
N = 9,461
100%
90%
74%
80%
52%
60%
39%
40%
42%
30%
20%
0%
Behavioral
Disorders
90% of youth have multiple
presenting issues.
Substance
Abuse
Emotional
Disorders
Victim of Abuse
and/or Neglect
Suicidal
Ideations or
Gestures
Legal Issues
Intercept Program
History of Family Difficulties
Youth served July 2006 through March 2011
N = 9,461
100%
80%
60%
50%
39%
40%
40%
36%
32%
20%
0%
Mental Illness
50% of families have
multiple difficulties
Domestic Violence Substance Abuse
Legal Trouble
Parent
Experienced
Abuse as a Child
Intercept Program
Admissions by Fiscal Year
Youth served July 2006 through March 2011
2,840
3,000
2,415
2,500
2,115
2,000
1,662
1,411
1,500
1,000
500
0
2007
Youth may have multiple
admissions to the program.
2008
2009
Fiscal Year – July 1 to June 30
2010
2011*
*Represents the first three
quarters of the fiscal year
Intercept Program
Admissions by Region
Youth served July 2006 through March 2011
4,000
3,464
3,500
3,000
2,489
2,500
2,096
2,000
1,500
761
1,000
487
500
417
335
287
48
59
0
West
Tennessee
Middle
Tennessee
Youth may have multiple
admissions to the program.
East
Tennessee
Mississippi
Alabama Massachusetts Florida
Virginia
Georgia
New
Hampshire
Intercept Program
Discharge Location
Youth discharged July 2006 through March 2011
N = 7,683
100%
88%
80%
60%
40%
20%
7%
2%
1%
2%
0%
Home
Residential
Treatment Center
Only includes youth who received at least 60 days of
service; 16.1% (1,469 out of 9,152) of admissions ended
prior to 60 days.
Psychiatric
Hospital
Detention/
Corrections
Other*
*includes placements such as group
homes, runaway, foster care and rehab
centers
Intercept Program
Parent Satisfaction at Discharge
Parents surveyed July 2006 through March 2011
100%
94%
97%
91%
95%
93%
80%
60%
40%
20%
0%
Fam ily Therapy you
received
Note: Figures include only youth
who received at least 60 days of service.
Counselor's Know ledge
and Professionalism
Links to Com m unity
Services
Overall Satisfaction
Would Recom m end YV to
a Friend
Intercept Program
Success at Follow-up
Follow-ups conducted through March 2011
100%
84%
84%
88%
80%
60%
40%
20%
0%
Six Months
Note: Figures include only youth
who received at least 60 days of service.
Twelve Months
Twenty-four Months
Success is defined as living at
home with family or living
independently.
Intercept Program
Youth reporting NO Trouble with the Law
Follow-ups conducted through March 2011
100%
85%
83%
84%
80%
60%
40%
20%
0%
Six Months
Note: Figures include only youth
who received at least 60 days of service.
Twelve Months
Twenty-four Months
Intercept Program
School Status
Follow-ups conducted through March 2011
95%
93%
100%
90%
80%
60%
40%
20%
0%
Six Months
Note: Figures include only youth
who received at least 60 days of service.
Twelve Months
Twenty-four Months
Indicates the number in school,
graduated from high school, or in
GED classes at the time of followup.
Intercept Program
Out of Home Placements
Follow-ups conducted through March 2011
100%
80%
60%
40%
20%
6%
2%
3%
6%
3%
4%
6%
2%
4%
0%
Six Months
Residential Treatment Center
Note: Figures include only youth
who received at least 60 days of service.
Twelve Months
Psychiatric Hospital
Twenty-four Months
Detention/Corrections
Intercept Program
Youth in State Custody at Follow-up
Follow-ups conducted through March 2011
100%
Nearly a quarter (20.7%) of youth were in
state custody during enrollment.
80%
Please note: Most youth in parental custody who
are admitted to Intercept are at substantially
increased risk of placement into state custody,
either through the child welfare or juvenile justice
system.
60%
40%
13%
13%
20%
11%
0%
Six Months
Note: Figures include only youth
who received at least 60 days of service.
Twelve Months
Twenty-four Months
About our Response Rates
Surveys through 03/11
Discharge Surveys
70.0% (4,883 out of 6,977)
6-Month Follow-up
61.2% (3,673 out of 6,005)
12-Month Follow-up
54.5% (2,567 out of 4,710)
24-Month Follow-up
49.5% (1,297 out of 2,618)
•
Surveys are conducted by research staff via phone with
letter surveys to non-respondents.
•
Internet search of public records (Lexis-Nexis) is
completed to locate accurate contact information
•
Please note: Surveys are completed with
youth/families who have discharged from YV services
altogether. If a youth re-enters YV services, the survey
cycle is reset and begins again at their discharge.
•
While no consensus exists regarding adequate
response rates, 40% - 60% has been identified as
appropriate for surveys of this type and size1.
•
Rate of re-entry into YV services:
6-Month Follow-up – 5.3% (334 out of 6,339)
12-Month Follow-up – 9.6% (501 out of 5,211)
24-Month Follow-up – 14.2% (432 out of 3,050)
•
Parent Satisfaction surveys are only conducted with
families who were involved in the youth’s treatment.
1PWGSC (Public
Works and Government Services Canada). (2008). Advisory Panel on Telephone Pub
Opinion Survey Quality: Standards and Guidelines for Response Rate.
Questions
Answers
Discussion
Contact Information:
• Bret Stockton: 901-338-6097
Bret.Stockton@youthvillages.org
• Catherine Adams: 901-283-1728
Catherine.Adams@youthvillages.org