expanding the reach of ebt's through brokers: lessons from project best & pats
TRANSCRIPT
Prof. Benjamin E. Saunders, PhDProf. Rochelle F. Hanson, PhD
Angela D. Moreland, PhDNational Crime Victims Research and
Treatment CenterDepartment of Psychiatry and Behavioral
SciencesMedical University of South Carolina
Charleston, SC USAPresentation 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
Benjamin E. Saunders, Ph.D., 2015
I have no commercial relationships to disclose.
Disclosures
Benjamin E. Saunders, Ph.D., 2015
1U79SM061269 Substance Abuse and Mental Health Services Administration
Benjamin E. Saunders, Ph.D., 2015
Colleagues
Elizabeth Ralston, PhDElizabeth Hinson,
MSWRachael Garrett, MSWCarole Swiecicki, PhD
Kim Reese, MSWDee Norton Lowcountry
Children’s Center
Monica Fitzgerald, PhD
University of Colorado
Michael de Arellano, PhDDan Smith, PhD
Carla Danielson, PhDDean Kilpatrick, PhD
Jan Koenig, MEdEmily FanguyCarrie JacksonNicole Fortune
Medical University of South Carolina
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.
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.
Benjamin E. Saunders, Ph.D., 2015
Solution: Train Therapists!
Mental Health
ChildWelfare
JuvenileJustice
CACs
PrivatePractitioners
Medical
Schools
LawEnforcement
FamilyCourt
RapeCrisis
DomesticViolence
Drug &Alcohol
MentorPrograms
Probation
GALs
CriminalCourt
Medicaid
Drug &Alcohol
MCOs
Victim’sCompensation
AlternativeCare
ParentingPrograms
Sex OffenderTreatment
pRTFs
GroupHomes
VictimAdvocates
No one agency can make it happen.
FosterHomes
Let’s All Get Trauma-Informed!
Benjamin E. Saunders, Ph.D., 2015
Training within Practice Silos
Child
W
elfa
re
Men
tal
Heal
th
Juve
nile
Ju
stice
Sub
Abus
e
Community as the Target
Community-Based Learning Collaborative
Saunders & Hanson, 2014
Referral
Relevant Service Systems
Child Welfare
Juvenile Justice
VictimAdvocates Guardian
Ad Litem
Rape Crisis Center
Bro
kers
MH
Providers
PublicMentalHealth
NonprofitMH
Services
UniversityMH Services
Private Practitioners
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
• Brokers• Consumers• Payers• Broker Service Systems
• Clinical Practitioners• Clinical Service Systems
Social Economic Model
Benjamin E. Saunders, Ph.D., 2015
5 9
Pre-Work LS1 LS2Action Period
Action Period
4+
Community-Based Learning Collaborative Timeline
12
Supervisors1-day
Orient.SL Train.
Comm.Prep
1CBLC Month
Benjamin E. Saunders, Ph.D., 2015
Senior Leader Track
LeadershipSupport
CBLC Curriculum Areas
Clinical Track
TF-CBT
Broker Track
EBTPCMTS
Common Material and ActivitiesClinicians, Brokers, Senior Leaders
Team Building
JointCommunity
Responsibility
Benjamin E. Saunders, Ph.D., 2015
Broker CBCL Completion
Learning Collaborative LS1 All LS
All Calls Rostered
Pee Dee 18 12 1 1Coastal 29 18 3 3Midlands 14 7 2 2Upstate 13 9 3 2North Central 18 9 9 9Edisto 26 17 9 9Total 127 63 27 26
Benjamin E. Saunders, Ph.D., 2015
Edisto and North Central CBLCsBroker Monthly Metrics
Average N=23
Ave
rage
mon
thly
cas
es
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.
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 qualificationsScreening for trauma history and trauma-related
problems with toolsReferring for a particular treatment approachQuestioning the clinical provider regarding initial
assessment and treatment, approachesMonitoring treatment delivery and client progress.Monitoring treatment progress. Monitoring specific, measurable treatment outcomes
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.
Benjamin E. Saunders, Ph.D., 2015
Partnership:• South Carolina Department of Social Services• South Carolina Department of Mental Health• Project BEST