CURRENT PROJECTS

Enhancing Mental Health Treatment for Youth in Foster Care:

The Casey Foster Care Clinical R&D Project

Project Description

This collaboration among Casey Research Services, Casey Family Programs, the REACH Institute, Harvard Medical School, Northshore Hospital/LIJ, and The Annie E. Casey Foundation intends to improve the mental health functioning of youth in foster care by focusing on four related conditions that limit the functioning and development of youth in out-of-home care; and where there are well-formulated treatments: (1) Depression, (2) Anxiety and Post-Traumatic Stress Disorders (PTSD), (3) ADHD, and (4) Impulsive aggression. The tools and treatment strategies chosen will be those that agencies can provide with current or slightly increased expenditures that could be offset by increased child functioning, and decreased placement disruptions and failed reunifications.  It is anticipated that this project will be deployed in two selected cities, one each in New York and Texas.  However, local (state- and city-level) partners must be identified, both from state-city governments with interest and oversight in these programs, as well as from provider agencies that are often contracted to deliver foster care services.  

Project Phases

Phase I - Adapt methods, prepare and train caregivers and staff to implement the field demonstration

There is growing recognition that parents can be powerful advocates for quality mental health services, with the right training and support.  Based on clinical input from experts, project team, alumni, and parent advisors about what program reform strategies might be most feasible, we will refine some recently developed training materials. The training materials will be delivered partially through locally-delivered training/support and a “train the trainers” manual, and partially through independent study. Based on current work underway with the parent advocacy curriculum, we would implement the following steps and strategies with partners identified from relevant city/state agencies and providers:

1. Adapt and expand current methods to train birth parents and foster parents to become better advocates for the mental health care of their children. This involves refining the PEP curricula and other strategies to increase their appropriateness for foster care.
2. Hire and train birth parents with child welfare system experience and foster parents to become better advocates for the mental health care of their children. 
3. Train foster care caseworkers to help them (a) better recognize and ensure appropriate treatment strategies for Depression, PTSD and other Anxiety Disorders, ADHD, and Impulsive aggression, and (b) understand and reinforce the added power of Birthparent Co-trainers’ roles.
4. Identify and train 10 clinicians in evidence-based mental health treatment methods.

Phase II - Begin the Pilot Demonstration Project in New York and Texas With Two Geographically Distinct Casework Offices or Agencies in Each City

1. Identify and implement the most practical youth mental health screening measures for use in child welfare, as well as the clinical “cut points” for determining when further treatment and/or assessment is needed.  
2. Deploy the birth parent co-trainers to work with the youth, caregivers and caseworkers in Texas and New York City.
3. Monitor the kinds of services the youth access and the changes in youth functioning.

Phase III - Conduct Special Analysis of the NW Alumni Study Data

1. Further analyze the NW alumni study data.
2. Conduct additional analyses of the NCS-R general population mental health data. 

Phase IV - Summarize Mental Health Interventions and Assessment Approaches

1. Contract with key experts to write review papers identifying feasible and sustainable evidence-based methods for treating children in foster care with the four targeted MH conditions listed above.

Phase V - Convene Consensus Roundtable

1. Convene a Consensus Roundtable in October 2007 that involves the key review experts, study collaborators, and other field leaders.

Phase VI - Rigorously Evaluate a Large Scale Implementation of the Strategies

1. Begin a large scale replication project with random assignment of children to groups.
2. Casey Family Programs and/or its collaborators host an annual 3 day certification training on the intervention models.

Products

1. Identification of the most cost-effective mental health screening and assessment instrument(s) for use in public agency settings, and a brief training module for caseworkers on recognizing mental health problems when using that instrument.
2. A brief summary of the core intervention components for treating Depression, Anxiety, PTSD, ADHD and Impulsive aggression. This will be part of the curriculum.
3. The Parent Empowerment Program (PEP) curriculum will be tailored for use in family foster care settings with children and parents of color.
4. Expert summaries of the most effective mental health interventions for children placed in foster care.
5. Manual for implementing an expert case management consultant approach will be outlined and drafted, based on the input from the end of 2007 consensus conference.

Project Funders

Casey Family Programs, Casey Research Services, and The Annie E. Casey Foundation are funding this effort, with additional in-kind resources provided by the local foster care and mental health agencies that will constitute the demonstration sites.