Expanding the Reach of EBT's Through Brokers: Lessons from Project BEST & PATS
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Prof. Benjamin E. Saunders, PhD Prof. Rochelle F. Hanson, PhD Angela D. Moreland, PhD National Crime Victims Research and Treatment Center Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Charleston SC USA
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Expanding the Reach of EBT's Through Brokers: Lessons from Project BEST & PATS
- 1. Prof. Benjamin E. Saunders, PhD Prof. Rochelle F. Hanson, PhD Angela D. Moreland, PhD National Crime Victims Research and Treatment Center Department of Psychiatry and Behavioral Sciences Sciences Medical University of South Carolina Charleston, SC USA Presentation at the 9th BASPCAN Congress, April 14, 2015, University of Edinburgh, Edinburgh, Scotland. Expanding the Reach of EBTs Through Brokers: Lessons from Project BEST & PATS
- 2. Benjamin E. Saunders, Ph.D., 2015 I have no commercial relationships to disclose. Disclosures
- 3. Benjamin E. Saunders, Ph.D., 2015 1U79SM061269 Substance Abuse and Mental Health Services Administration
- 4. Benjamin E. Saunders, Ph.D., 2015 Colleagues Elizabeth Ralston, PhD Elizabeth Hinson, MSW Rachael Garrett, MSW Carole Swiecicki, PhD Kim Reese, MSW Dee Norton Lowcountry Children’s Center Monica Fitzgerald, PhD University of Colorado Michael de Arellano, PhD Dan Smith, PhD Carla Danielson, PhD Dean Kilpatrick, PhD Jan Koenig, MEd Emily Fanguy Carrie Jackson Nicole Fortune Medical University of South Carolina
- 5. Benjamin E. Saunders, Ph.D., 2015 Need for Trauma Services Exposure to violence and other traumatic events is highly prevalent among children and youth. Significant portion of youth exposed to potentially traumatic events will develop trauma-related mental health problems. Effective treatments (EBTs) exist for many of these problems. Relatively few children that need these effective interventions receive them.
- 6. Benjamin E. Saunders, Ph.D., 2015 Why do victimized children not receive effective trauma treatment? Lack of service capacity. Not enough therapists trained in ESIs. Lack of use of the ESI by those trained. Limited service delivery systems. Children and families not identified and referred to trained therapists. Brokers of mental health services unaware of ESIs. Generic service plans. Lack of case management skills related to ESIs. Lack of collaboration between service providers. Poor initial engagement in treatment. Sporadic attendance. High premature dropout rates. Lack of focus on treatment outcomes.
- 7. Benjamin E. Saunders, Ph.D., 2015 Solution: Train Therapists!
- 8. Mental Health Child Welfare Juvenile Justice CACs Private Practitioners Medical Schools Law Enforcement Family Court Rape Crisis Domestic Violence Drug & Alcohol Mentor Programs Probation GALs Criminal Court Medicaid Drug & Alcohol MCOs Victim’s Compensation Alternative Care Parenting Programs Sex Offender Treatment pRTFs Group Homes Victim Advocates Foster Homes
- 9. Let’s All Get Trauma-Informed!
- 10. Benjamin E. Saunders, Ph.D., 2015 Training within Practice Silos ChildWelfare Mental Health Juvenile Justice Sub Abuse
- 11. Community as the Target Saunders & Hanson, 2014
- 12. Referral Relevant Service Systems Child Welfare Juvenile Justice Victim Advocates Guardian Ad Litem Rape Crisis Center Brokers MHProviders Public Mental Health Nonprofit MH Services University MH Services Private Practitioners
- 13. National Survey of Child and Adolescent Well-Being N=1,613 children within 75 child welfare agencies over 36 months Examined Interorganizational Relationships (IORs) • Number of coordination approaches between each child welfare agency and mental health service providers Tested relationships between IORs, Service Use, and Outcomes Greater intensity of IORs greater likelihood of service use and mental health improvement. Conclusions: Greater number of ties with mental health providers may help child welfare agencies improve children’s mental health service access and outcomes Encourage different types of organizational ties between child welfare and mental health systems Bai, Y., Wells, R., Hillemeier, M.M. (2009). Coordination between child welfare agencies and mental health service providers, children’s service use, and outcomes. Child Abuse & Neglect, 33, 372-381. Community Coordination Improves Outcomes for Children
- 14. •Brokers •Consumers •Payers •Broker Service Systems •Clinical Practitioners •Clinical Service Systems Social Economic Model
- 15. Benjamin E. Saunders, Ph.D., 2015 5 9 Pre-Work LS1 LS2 Action Period Action Period 4+ Community-Based Learning Collaborative Timeline 12 Supervisors 1-day Orient. SL Train. Comm. Prep 1 CBLC Month
- 16. Benjamin E. Saunders, Ph.D., 2015 Senior Leader Track Leadership Support CBLC Curriculum Areas Clinical Track TF-CBT Broker Track EBTP CMTS Common Material and Activities Clinicians, Brokers, Senior Leaders Team Building Joint Community Responsibility
- 17. Benjamin E. Saunders, Ph.D., 2015 Broker CBCL Completion Learning Collaborative LS1 All LS All Calls Rostered Pee Dee 18 12 1 1 Coastal 29 18 3 3 Midlands 14 7 2 2 Upstate 13 9 3 2 North Central 18 9 9 9 Edisto 26 17 9 9 Total 127 63 27 26
- 18. Benjamin E. Saunders, Ph.D., 2015 Edisto and North Central CBLCs Broker Monthly Metrics Average N=23 Averagemonthlycases
- 19. Benjamin E. Saunders, Ph.D., 2015 Lessons Learned -- Brokers Half-life of a child welfare worker – staff turnover. Training and practice culture of child welfare. Directive about specific procedures to follow. Low reliance on independent choices by front-line caseworkers. Intensive, advance training of frontline case workers is rare. Time is precious. Essential tasks take priority. Crises take priority. More advanced case management procedures often left behind Procedures that are not mandated will be low priority. Many of the procedures and skills taught were not supported adequately by policy, senior leaders and supervisors.
- 20. Benjamin E. Saunders, Ph.D., 2015 Lessons Learned – Brokers Lack of clarity about broker responsibilities for: Coordinating treatment planning with other community professionals Assessing clinical provider qualifications Screening for trauma history and trauma-related problems with tools Referring for a particular treatment approach Questioning the clinical provider regarding initial assessment and treatment, approaches Monitoring treatment delivery and client progress. Monitoring treatment progress. Monitoring specific, measurable treatment outcomes
- 21. Benjamin E. Saunders, Ph.D., 2015 Lessons Learned – Brokers Brokers can learn and apply these skills. Brokers will shift task to another part of the treatment system if possible, e.g., screening. Therapists like working with trained brokers A trained broker will fill up a trained therapist quickly.
- 22. Benjamin E. Saunders, Ph.D., 2015 Partnership: • South Carolina Department of Social Services • South Carolina Department of Mental Health • Project BEST