CFSR/CFSP COORDINATOR’S NETWORK
Staffed by
The National Child Welfare Resource Center for Organizational Improvement (NRCOI) and the National Resource
Center for Child Welfare Data and Technology (NRC-CWDT)
Minutes from the Webinar Meeting
Tuesday, April 10, 2012
3:00-4:30 PM Eastern
Welcome:
Steve Preister (NRCOI) welcomed all participants. Lynda Arnold, who has helped to facilitate this
Network for quite some time, has retired from her position as Director of NRC-CWDT. George Gable
Team Leader from Westat, will be the new representative from NRC-CWDT.
Roll call:
17 States participated: Alaska, Arkansas, Colorado, Indiana, Kentucky, Maryland, Michigan, Minnesota,
Montana, Nebraska, New Jersey, New Mexico, Oklahoma, Oregon, South Carolina, Tennessee, and
Texas.
Topic:
A Trauma Informed Child Welfare System – Policies and Practice
Presenters:
 Lisa Conradi, Psy.D.
Chadwick Center for Children and Families
 Heather Langan, MA. LPCS
National Center for Child Traumatic Stress - Duke
 George (Tripp) Ake
Center for Child and Family Health – Duke
PowerPoint Presentation
Lisa provided an overview of the National Center for Child Traumatic Stress (NCTSN), and the Breakthrough
Series Collaborative (BSC) they were a part of. The goal of this presentation is to have participants be able to
describe the NCTSN and BSC methodology, describe a trauma-informed system, and become familiar with the
improvements developed out of the BSC.
A poll indicated that 12 participants were familiar with the NCTSN, while 9 were not.
The NCTSN, established by Congress in 2000 and funded by SAMHSA, was described as a “A unique
collaboration of academic and community-based service centers whose mission is to raise the standard of care
and increase access to services for traumatized children and their families across the United States.”
Participants were encouraged to visit NCTSN’s Learning Center website: learn.nctsn.org. This site contains
numerous training tools, webinars, publications, etc. to help people gain a deeper understanding of the work
happening related to child trauma. The NCTSN Child Welfare Committee also developed numerous
publications:
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Helping Children in the Child Welfare System Heal from Trauma: A Systems Integration Approach
(2005)
Child Welfare Trauma Training Toolkit (2008, currently being revised)
Caring for Children Who Have Experienced Trauma: A Workshop for Resource Parents (2010)
Sponsoring a Breakthrough Series Collaborative focused on foster care placement stability (2010-2012)
Fact sheets on birth parent trauma (2011-2012)
The definition of a trauma-informed child welfare system, as put together by the CTISP National Advisory
Committee, reads:
“A trauma-informed child welfare system is one in which all parties involved recognize and respond to the
varying impact of traumatic stress on children, caregivers and those who have contact with the system.
Programs and organizations within the system infuse this knowledge, awareness and skills into their
organizational cultures, policies, and practices. They act in collaboration, using the best available science, to
facilitate and support resiliency and recovery.”
There has to be a real recognition that there are individual responses to trauma, and all children vary in how
they respond to certain events. It’s important that the child welfare trauma system has an impact across all
levels.
There has been a lot of recent energy and focus on trauma informed child welfare systems. The discussions
are being elevated to a new level. When thinking of such a system, the individual and family factors and
overall organizational and agency structure within the system are taken into account.
The following were identified as essential elements of a trauma-informed child serving system:
- Maximize Physical and Psychological Safety for the Child, Family and CW Workforce
- Identifying Trauma-related Needs of the Child, Family and the Workforce
- Enhancing Child Well-Being and Resiliency
- Enhancing Family Well-being and Resiliency
- Enhancing the Well-Being and Resiliency of those Working in the System
- Partnering with Youth and Families
- Partnering with System Agencies
These elements are meant to be a guide post. For more details on each element, please refer to the
PowerPoint presentation.
Heather discussed the Breakthrough Series Collaborative on improvement placement stability. A poll indicated
that 9 participants were familiar with the BSC model, while 13 were not. The model is based on a quality
improvement model developed by IHI that started out as more of a business QI system approach. IHI first
applied this model to the healthcare settings, and the Casey Foundation then applied it to child welfare in the
late 90’s. It is a method that addresses the need for system-wide change and improvement that utilizes
planning teams and “expert” faculty. This particular BSC utilized staff from the child welfare and mental health
fields. There is a competitive application process, with teams coming together from all over the country.
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Most BSCs last about a year in length, some more, and involve three to four face to face meetings with
dynamic “Action Periods” in between with conference calls, online learning, and activities occurring.
In a Breakthrough Series they ask three big questions:
- What are we trying to accomplish? (What’s the point of what they’re doing? They’re really looking at
team priorities here)
- What changes can we make that will result in improvement? (What can they do to make things better?
This will be their strategy)
- How will we know that a change is an improvement? (Change happens frequently, how many of them
are improvements is a bigger question)
The Plan-Do-Study-Act cycle is really what this all rests on (also know as the Plan-Do-Study-Test cycle). This is
the core for the model of improvement. This can be used by individuals, teams, and at a larger organizational
level.
The NCTSN BSC started in 2010, although the planning for it started much in advance. They also received a
one-year extension through a supplemental grant. The project consisted of 9 teams from 8 different States:
California (two teams), Texas, Florida, Massachusetts, North Carolina, New Hampshire, Colorado and
Oklahoma. The teams consisted of both child welfare and mental health staff, and the child welfare
administrators acted as the “Senior Leaders.” Supervisors, line workers, mental health clinicians and
consumers (such as youth, foster parents or biological parents that had been through the system) were also
part of the teams. The youth were some of their strongest most important voices.
The BSC goal was stated as:
“To develop and promote trauma-informed policies and practices related to foster care placement, thereby
increasing placement stability and promoting a sense of permanency among children in care.”
The Collaborative Change Framework (CCF) is a document that served as a blueprint or roadmap for the
project. The BSC planning team drafted the collaborative change framework, and this was then further
developed by an expert panel. This framework consists of two primary sections: the Collaborative Charter
(which contains the mission and sets out the rationale – the problem statement section) and the Key
Objectives (which includes the themes and big topical areas, with key objectives).
Framework Themes:
1. Knowledge Building and Developing Practice
2. Trauma-Informed Mental Health Assessment
3. Case Planning and Management
4. Externally Delivered Trauma-Informed Services
5. Child Welfare Systems, Cross-System Partnerships and System Collaboration
They utilized Dashboard Updates – which provided an interesting exercise where all of the objectives from the
framework were put into a grid, and using a color key teams rated themselves on how they were doing in each
particular area. Please refer to the presentation PowerPoint for detailed examples.
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Tripp discussed initiating and maintaining strong partnerships with State child welfare agencies, using his
experience on the North Carolina team as an example.
Their team consisted of senior leaders from the NC child welfare division, and a supervisor, program director,
and line worker from Wilson County. Tripp served as the mental health administrator, along with 2 other
mental health clinicians. Birth parents that had been involved in the child welfare system and a former foster
youth also participated. They decided to target Wilson County, with youth ages 13 and over. They thought it
was important to be part of this BSC because they have too many children moving from placement to
placement, and really wanted to look at how they can help them to stay in more stable and predictable
placements.
Plan-Do-Study-Act Examples from NC:
One PDSA was used to increase sensitivity and awareness among foster care workers and child welfare staff
about the impact of trauma on children was provided. Utilizing a section from the Resource Parenting
Curriculum they provided training to 25 child welfare child workers and then engaged these folks in a focus
group discussion. This feedback was used to help plan additional trainings.
Another example provided included: Increase use of trauma-informed screening/assessment in child welfare
setting. Four questions from the UCLA PTSD RI screener were used by a front line worker. The worker asked
these four screening questions to four youth on her caseload. They were all very surprised to find that 3 out of
the 4 children, whom had already been in care for over a year, disclosed new traumas they did not know
about. As a result, they trained additional foster care workers on the use of this screening tool, and added a
component for secondary trauma to try and avoid creating more stress for workers.
The last example provided was to identify and use information needed by foster parents to facilitate a
collaborative and trauma-informed placement. The biological parent on the team indicated that it would be
nice for someone to have asked questions regarding the habits, likes, and dislikes of their child before placing
them into foster care (such as what time they go to bed or what they like to eat). This would help to make the
transition a little easier. Because of this, the biological parent and youth created a survey to use with families
before placement.
Wilson County has mental health clinicians on staff. This allows for children to get the services they need
quickly, as there is a direct flow from front line staff to the in house clinician.
The presenters shared their lessons learned, and the next steps for this BSC. Please refer to the PowerPoint
presentation for full details.
Topic
Network Logistics, Next Call, Wrap Up
Network members were asked if there was anything in particular that people wanted to change about the
Network. The following polls were administered:
Should we change the time of Network meetings? (4 responded yes, 6 responded no)
Should we focus more in the CFSP? (6 responded yes, 2 responded no)
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Suggested topics for the next call:
- CFSP and where people are with their PIPs (if they’ve had to do any major changes again due to the
economy or lessons learned) (Roni Spaulding, CO)
- More on trauma-informed services – what programs look like in the day-to-day, budget to implement,
resources required, etc. (Roni Spaulding, CO)
- Credit checks (Daphne, TN)
- What States are doing to track psychotropic medication use in foster children (Melissa Soto)
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Next Quarterly Meeting: July 17, 2012 @ 3:00PM Eastern
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