ICFW Newsletter, Fall 2019

The mission of the Institute for Child and Family Well-Being is to improve the lives of children and families with complex challenges by implementing effective programs, conducting cutting-edge research, engaging communities, and promoting systems change.

The Institute for Child and Family Well-Being is a collaboration between Children’s Wisconsin and the Helen Bader School of Social Welfare at the University of Wisconsin-Milwaukee. The shared values and strengths of this academic-community partnership are reflected in the Institute’s three core service areas: Program Design and Implementation, Research and Evaluation, and Community Engagement and Systems Change.

ICFW’s Leadership Team

ICFW Associate Director Luke Waldo and Co-Director Gabe McGaughey in Vancouver for the Tamarack Community Change Festival.

Gabriel McGaughey is currently the Director of Child Well-Being at Children’s Wisconsin and is a founding Co-Director of the Institute for Child and Family Well-Being. Gabriel is focused on leveraging innovative methodologies, research evidence, and data analytics to advance systems change that support child health and well-being.

Gabriel has over 20 years of experience working in and around the child welfare system and has contributed to the increased use of data analytics in child welfare, implementing trauma-responsive procedures and programs, elevating issues of trauma and well-being, advocating for prevention-focused policies, and increasing access to evidence-based interventions such as Parent Child Interaction Therapy (PCIT). His career has been driven by taking the lessons learned from experience, research, and the community and putting them into action that advances social justice.

Gabriel has a master’s degree in social work from UW Madison.


ICFW Co-Director Joshua Mersky presenting at ICFW’s “Moving from Trauma-Informed to Trauma-Responsive” event.

Dr. Joshua Mersky is a professor of social work in the Helen Bader School of Social Welfare and founding co-director of the Institute for Child and Family Well-Being (ICFW). Dr. Mersky’s research interests include the study of adverse and traumatic experiences that undermine health and well-being over the life course. He applies his expertise to developing, testing, and disseminating effective strategies in community settings to promote resilience.

Dr. Mersky holds a master’s degree in social work from Virginia Commonwealth University and a Ph.D. in social welfare from the University of Wisconsin-Madison, where he also earned an advanced certificate in prevention science.



ICFW Clinical Director Dimitri Topitzes presenting at ICFW’s “Moving from Trauma-Informed to Trauma-Responsive” event.

Dr. James “Dimitri” Topitzes is co-founder and associate director of program design and clinical services at the Institute for Child and Family Well-Being and also serves as an associate professor at the University of Wisconsin-Milwaukee’s Helen Bader School of Social Welfare. His research interests include the etiology, effects, treatment and prevention of early childhood trauma. Dr. Topitzes devotes his time to applied research projects that adapt, implement, test, and disseminate evidence-informed practices and trauma-responsive programs within public service sectors. He partners with community-based health clinics, workforce development programs, and child welfare service systems to evaluate usual care and implement, test, and disseminate promising trauma-informed practices.

Dr. Topitzes holds a master’s degree in social work and a doctoral degree in social welfare from the University of Wisconsin-Madison, where he also earned an advanced certificate in prevention science.


Luke Waldo is associate director of implementation and community partnerships for the Institute for Child and Family Well-Being and well-being manager with Children’s Wisconsin.

Luke has dedicated his career to child well-being in Europe, South America and his native Milwaukee where he has worked with children adversely impacted by immigration, homelessness, family violence, and abuse and neglect. He has nearly two decades of experience in the non-profit sector working in the fields of interpersonal violence, childhood trauma and well-being, homelessness, and education and prevention, with a particular focus on engagement and innovative solutions to personal and community challenges.

Luke earned his master’s degree in cultural foundations of education from the University of Wisconsin-Milwaukee.


ICFW’s Recent Arrivals

Allison Amphlett is a new research program manager with the Institute for Child and Family Well-Being at UW-Milwaukee. She supports the work of ICFW, including coordinating the development and implementation of research protocols, promoting the work of the Institute, and managing community partnerships. Prior to her work with ICFW, Allison managed community-based research projects on health and wellness for parents, violence prevention, and childhood obesity prevention with community collaboratives and coalitions.

Allison earned a Bachelor of Arts in sociology from Grinnell College and a Master of Arts in public service – nonprofit leadership from Marquette University. She lives in Milwaukee with her husband and energetic dog, Juniper.

Haley Challoner is a PCIT Practitioner with the well-being team at Children’s Wisconsin and the Institute for Child and Family Well-Being. She is a Certified Advanced Practice Social Worker (CAPSW) working toward her clinical licensure (LCSW).

Haley began working in mental and behavioral health in various clinics within Children’s during her clinical master of social work program. Haley then worked as a Child and Family therapy extern at Affiliated Clinical Services for a period of time before returning to Children’s in 2019. Haley has gained experience with exceptional training in evidence-based therapy models such as Trauma-Focused Cognitive Behavior Therapy, Cognitive Behavior Therapy, and Parent-Child Interaction Therapy. Haley utilizes these models for the basis of her practice and integrates other behavioral management and creative therapeutic interventions throughout the therapy process.

Haley earned her master’s degree in social work from the University of Wisconsin-Milwaukee in 2018, along with a certificate in Trauma-Informed Care.


Program Design & Implementation

The Institute develops, implements and disseminates validated prevention and intervention strategies that are accessible in real-world settings.

Developing a Group-Based Solution for the Growing Demand for Parent-Child Interaction Therapy

By Myra Werner

The Institute for Child and Family Well-Being has provided evidence-based Parent Child Interaction Therapy (PCIT) to families for the last six years, with the intention of integrating the therapy into the child welfare system. We initially provided in-home PCIT services to break down access barriers for families. We also provided an adaptation called Project Connect which was composed of two, six hour in-office trainings for foster parents on the skills learned in PCIT. We found in-home PCIT and group-based PCIT to be effective and rated highly by our clients. Currently, the demand for PCIT is greater than the number of therapists trained in PCIT in the Milwaukee area, often leading to long wait lists for families. Additionally, we identified that parents often report feeling isolated when parenting children with defiant or difficult to manage behaviors. In an effort to bring families together to create a sense of community, reduce the time families wait for services, and increase access to services, we developed a ten week multi-family group called Families Empowered Together (FET).

As we work closely with families involved with the child welfare system who experience great pressure to receive timely services within complex system demands, we offered our first group to foster parents and their children ages 3-6 years old. Guided by PCIT principles, goals were to teach and coach skills to enhance the parent-child relationship while increasing compliance and decreasing negative behaviors. We made the following modifications to the PCIT protocol: 1) Provided PCIT to three families at one time; 2) Two therapists facilitated the group sessions; 3) Provided a predetermined number of group sessions; 4) Did not require parents to meet “mastery” of skills to move from phase one to phase two.

In order to provide efficient and effective services, we paid close attention to several factors to meet each family’s unique needs. First, we prioritized coaching order and time by the level of each family’s need, spending more time coaching parents who required more support in developing their skills, and whose children continued to exhibit more intense behaviors. Second, we provided extra homework and skill-building activities to expedite the learning of skills, such as playing a skill drill game with parents before the first coaching session. Third, we personalized the room set up for each child despite the group format to meet individual needs. Fourth, as we are constantly striving to enhance family voice and quality improvement, we utilized rapid cycle feedback through surveys after each group and provided immediate modifications to the process when appropriate. Fifth, we provided individual therapy sessions for the first Parent Directed Interaction (PDI) coaching session and as needed throughout the group to enhance skills. Lastly, we worked with the Children’s Billing department to determine the most appropriate billing code – the Multi-Family Group code.

Through qualitative and quantitative data collection and evaluation, FET showed to be effective at improving behaviors and relationships, and was also highly rated on weekly participant surveys. Parents reported value in seeing other families work through similar situations and noted that this exposure helped to normalize their child’s problem behaviors. Parents reported feeling supported by group facilitators and members, and were observed sharing resources and exchanging phone numbers. All parents reported they would highly recommend this group to another parent. The process of rapid cycle feedback was helpful from a clinician standpoint to make improvements to each group, i.e. provided name tags, changed room temperature.

Although we were not requiring mastery of the skills before ending treatment, of the three children, three of their parents met mastery of all skills in CDI and PDI. In addition to parent mastery success, all child behaviors decreased on the Child Behavior Checklist (CBCL) and Eyberg Child Behavior Inventory (ECBI) assessment tools – the majority to sub-clinical levels.

Learn More:

PCIT
Become trained in PCIT
PCIT in Child Welfare


Research and Evaluation

The Institute accelerates the process of translating knowledge into direct practices, programs and policies that promote health and well-being, and provides analytic, data management and grant-writing support.

T-SBIRT Protocol Addresses Trauma Exposure

By Dimitri Topitzes

Trauma screening, brief intervention, and referral to treatment, or T-SBIRT, is a brief, standardized, semi-structured protocol developed at the Institute for Child and Family Well-Being for use within health and social service settings. Adapted from the original SBIRT for substance misuse,1 T-SBIRT addresses trauma exposure and symptoms among recipients of health and social services. Research has shown that psychological trauma can have lasting negative effects on physical, psychological and social well-being.2 Even more, trauma can undermine peoples’ ability to engage in and respond well to professional services such as primary healthcare and employment services.3,4 With this in mind, the Institute designed the protocol to help remove barriers to: a) effective service engagement and b) personal well-being.

T-SBIRT consists of the following elements: (1) seeking permission to address stress and trauma; (2) assessing for stress and trauma exposure; (3) screening for post-traumatic stress symptoms; (4) asking open-ended questions about positive and negative coping strategies; and (5) prompting and reinforcing statements reflecting motivation to improve coping strategies such as help-seeking behaviors. Requiring anywhere from 10 to 30 minutes to complete within health or social service settings, the protocol culminates in a referral to mental health treatment or other supports when indicated along with instrumental and motivational strategies to facilitate referral completion. T-SBIRT providers offer referrals when participants endorse trauma exposure along with any related effects such as formal PTSD symptoms or negative coping strategies. Referral procedures follow best practices, i.e., appointments are made during T-SBIRT sessions, and common referral destinations include trauma counselors, primary care physicians, and housing support specialists.

Evident in the structure of T-SBIRT are hallmark trauma-informed principles and practices such as client empowerment and choice, provider-client collaboration, and screening and referral processes.5,6 In fact, T-SBIRT providers work closely with referral partners that offer well-validated services, including trauma-specific mental health treatments that reduce PTSD symptoms. As such, T-SBIRT relies on interagency collaboration and evidence-based practices, both important components of trauma-responsive practice.7

The T-SBIRT model has been implemented in multiple service contexts. Results from a study assessing the feasibility of implementing T-SBIRT within community-based primary care clinics suggested that the protocol was acceptable to the patient sample (N=112). Moreover, it addressed a common problem among the patients, as 92% experienced significant trauma in their lives and 55% screened positive for post-traumatic stress disorder. Finally, 63% of the sample accepted a referral to a behavioral or mental health treatment provider as a result of participating in the T-SBIRT protocol.8 When integrated within alternative healthcare and social service settings, such as a nurse home visiting program and an employment service program, T-SBIRT produced similar feasibility results.9 For more information, see the T-SBIRT Issue Brief.

Learn More:

ICFW T-SBIRT Issue Brief
Journal Article: Complementing SBIRT for Alcohol Misuse with SBIRT for Trauma: A Feasibility Study
Journal Article: Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within Employment Services: A Feasibility Trial

Sources:

1.Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, Brief Intervention, and Referral to Treatment (SBIRT) toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7-30.
2.Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the US. Child Abuse & Neglect, 37(11), 917-925.
3.Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse & Neglect, 34(6), 454-464.
4.Topitzes, J., Pate, D. J., Berman, N. D., & Medina-Kirchner, C. (2016). Adverse childhood experiences, health, and employment: A study of men seeking job services. Child Abuse & Neglect, 61, 23-34.
5.Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville,MD: Author.
6.Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child Maltreatment, 21(2), 168-172.
7.Lang, J. M., Campbell, K., Shanley, P., Crusto, C. A., & Connell, C. M. (2016). Building capacity for trauma-informed care in the child welfare system: Initial results of a statewide implementation. Child Maltreatment, 21(2), 113-124.
8.Topitzes, J., Berger, L., Otto-Salaj, L., Mersky, J. P., Weeks, F., & Ford, J. D. (2017). Complementing SBIRT for alcohol misuse with SBIRT for trauma: A feasibility study. Journal of Social Work Practice in the Addictions, 17(1-2), 188-215.
9.Topitzes, J., Mersky, J. P., Mueller, D. J., Bacalso, E., & Williams, C. (in press). Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T‐SBIRT) within Employment Services: A Feasibility Trial. American Journal of Community Psychology.


Community Engagement & Systems Change

The Institute develops community-university partnerships to promote systems change that increases the accessibility of evidence-based and evidence-informed practices.

Family First Prevention Services Act Explained

By Gabe McGaughey

Child-parent separation is an adverse event that can contribute to negative lifelong health and well-being outcomes. Historically, federal, state, and local funding for child welfare has placed very few resources into preventing child removals, with funding for services that preserve or reunite children and families only accounting for about 8% of the roughly $8 billion in federal child welfare spending.[i]

In Wisconsin, between 2010 and 2017 there was a 12.6% increase in the annual number of children removed from their caregivers and placed in foster care.[ii] The Family First Prevention Services Act (FFPSA) presents a significant opportunity to prevent children from experiencing the trauma of being placed in foster care. Currently, Wisconsin uses 4.5% of child welfare funds for child abuse prevention services.[iii] 35% of Wisconsin’s child welfare funding comes from federal sources, mostly Title IV-E (72%).[iv] Wisconsin spends a smaller proportion of state/local child welfare funds on preventative services, and a larger proportion on out-of-home placements when compared to the overall state average in the US.[v] The FFPSA shifts federal funding from congregate care to evidence-based services to prevent children at imminent risk of entering foster care, designated as “candidates for foster care,”[vi] [vii] from being separated from their family.

Funding provisions related to the Act are available starting in October 2019, after states submit their initial state plan. Wisconsin opted to defer implementation of FFPSA for two years; 17 states have also deferred implementation.[viii]

The FFPSA is tied inextricably to the child welfare system; the purpose of FFPSA is to prevent the entry of children into the foster care system, and children cannot be deemed a candidate for foster care without child welfare involvement and creation of a family-specific prevention plan. Accordingly, the prevention services funded by the FFPSA is early intervention for families. The early intervention model, and the funding to support it, represents a significant shift from the traditional mindset related to the child welfare system and provision of evidence-based services.

FFPSA provides an opportunity to bring together mental and behavioral health providers, child welfare systems, child abuse prevention efforts, and substance abuse treatment providers to collaborate to meet the needs of families often served by several of those systems. While the FFPSA requires a systemic shift that will take years beyond the initial implementation date to realize, it represents the most significant opportunity in years to revisit how we serve families differently across systems to prevent children from entering foster care while also advancing proven practices.

ICFW issue brief on Family First Prevention Services Act to be released soon.

Learn More:

IV-E Prevention Services Clearinghouse
PCIT International
TF-CBT

Sources:

[i] Stoltzfus, E. (2014). Child welfare: An overview of federal programs and their current funding. Washington, DC: Congressional Research Service.
[ii] Wisconsin Out-of-Home Care Reports, 2010-2017, retrieved from https://dcf.wisconsin.gov/reports
[iii] Rosinsky, K., & Williams, S., (2018). Child welfare financing SFY 2016: A survey of federal, state, and local expenditures. Retrieved September 12, 2019 from: https://www.childtrends.org/research/research-by-topic/child-welfare-financing-survey-sfy-2016
[iv] Rosinsky, K., & Williams, S., (2018). Child welfare financing SFY 2016: A survey of federal, state, and local expenditures. Retrieved September 12, 2019 from: https://www.childtrends.org/research/research-by-topic/child-welfare-financing-survey-sfy-2016
[v] Rosinsky, K., & Williams, S., (2018). Child welfare financing SFY 2016: A survey of federal, state, and local expenditures. Retrieved September 12, 2019 from: https://www.childtrends.org/research/research-by-topic/child-welfare-financing-survey-sfy-2016
[vi] Kelly, J. (2018). A Complete Guide to the Family First Prevention Services Act. Retrieved from https://chronicleofsocialchange.org/finance-reform/chronicles-complete-guide-family-first-prevention-services-act/30043
[vii] Family First Prevention Services Act, Bipartisan Budget Act of 2018, H.R. 1892, 115th Cong., Title VII (2018).
[viii] Kelly, J. (2019). At Least 17 States Have Requested Delay of Family First Act Since November. Retrieved from https://chronicleofsocialchange.org/child-welfare-2/seventeen-states-have-requested-delay-family-first-

Recent and Upcoming Events

The Institute provides training, consultation and technical assistance to help human service agencies implement and replicate best practices. If you are interested in training or technical assistance, please complete our speaker request form.

ICFW presented at and participated in the following conferences and trainings:

August 28-30:
PCIT International Convention, Chicago

September 4-6 and November 7-8:
Parent-Child Interaction Therapy Training, Milwaukee   

September 16-18:
Prevent Child Abuse America National Conference, Milwaukee 

September 30-October 3:
Tamarack Community Change Festival, Vancouver, British Columbia

October 7-8:
SDC Summit on Poverty and SWIM Conference, Milwaukee

October 16-18:
Alliance for Strong Families and Communities National Conference, Indianapolis

October 24:
Presentation at Milwaukee Continuum of Care Consortium, Milwaukee

October 25:
Presentation at Next Door, Milwaukee

October 29:
Wisconsin Department of Children and Families Work Programs Conference, Elkhart Lake

October 30:
MRA Conference: Creating Workforce Resilience, Waukesha

November 6:
Presentation on trauma at Justice Point, Milwaukee

November 18-21:
Center on the Developing Child at Harvard University’s IDEAS Framework, Cambridge, MA  

December 5:
Presentation on vicarious trauma at UWM Dean of Students Office, Milwaukee


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