ICFW Newsletter, Winter 2020

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.


In This Issue


Meet the ICFW Affiliates

As Community Engagement and Systems Change are a core service area of the ICFW, collaboration with our community and systems partners is critical to fulfilling our mission. In recognition of those that value collaboration and whose mission seeks to improve child and family well-being, we have invited those partners to join us as ICFW Affiliates. We are honored to introduce our three newest ICFW Affiliates with whom we look forward to partnering with now and into the future.

Penny Dixon

Penny Dixon is the Shelter Manager at the Milwaukee Women’s Center, a division of Community Advocates.

Penny joined the Well-Being Team and the Institute for Child and Family Well-Being in 2015 as a licensed professional counselor with extensive experience training foster parents in the greater Milwaukee area. In her role as a clinician and trainer for the Institute, she quickly mastered and provided several well-validated child mental health treatment models – Parent-Child Interaction Therapy and Trauma-Focused Cognitive Behavioral Therapy – to families involved in the child welfare systems.

Penny also utilized Human-Centered Design to develop a psycho-social education group focused on trauma and resilience at the Community Advocates’ Milwaukee Women’s Center shelter. In 2019, Penny assumed the manager role of Community Advocates’ Milwaukee Women’s Center shelter, an emergency facility for families affected by homelessness and/or domestic violence. In this new role, Penny continues to collaborate with the ICFW on bringing trauma-responsive practices to the Women’s Center shelter through the HOMES initiative.


Tim Grove

Tim Grove is a senior consultant at SaintA, a human services agency whose mission is to facilitate equity, learning, healing and wellness for all.

Tim’s partnership with the ICFW team has a long and deep history. Both Tim and ICFW Co-Director Gabe McGaughey led child welfare case management programs at their respective organizations during a time of significant transition. ICFW Co-Director Josh Mersky and Clinical Director Dimitri Topitzes worked closely with Tim when evaluating an implementation project at SaintA funded by the Greater Milwaukee Foundation. Led by Tim, the initiative integrated a comprehensive trauma-informed case management system within several child welfare service units. Results of the evaluation were published in the Journal of Child Custody. In 2011, Drs. Mersky and Topitzes also partnered with SaintA to test an innovative training model with foster parents and children, Project Connect. Funded by the National Institutes of Health, this successful initiative helped launch the Institute for Child and Family Well-Being.

Tim’s dedication and advocacy around advancing trauma-informed care has been the foundation for transformation change at a wide range of organizations and in our community. His willingness to authentically collaborate and thoughtfully pursue improvements in practice, policy, and systems highlight just a few of the reasons we’re excited about Tim joining the ICFW as an Affiliate.


Reggie Moore

Reggie Moore serves as the Injury and Violence Prevention Director of the Office of Violence Prevention (OVP) located within the City of Milwaukee’s Health Department.

In that role, Reggie led the effort to develop the Blueprint for Peace, Milwaukee’s first comprehensive plan to address violence prevention from a public health perspective. The Blueprint includes six goals and 30 strategies. It was developed through merging extensive community input and the best available evidence, providing a scaffolding to support cross-system collaboration and change efforts. Other OVP programs such as Trauma Response Initiative, ReCAST MKE, and 414Life view addressing trauma as vital to violence prevention and community resilience.

Reggie also serves on the Scaling Wellness in Milwaukee (SWIM) steering committee and leads the group’s Policy Action Team. In that role, he’s worked with ICFW Co-Director Gabe McGaughey around the opportunity to align SWIM’s policy work with the Blueprint for Peace. Reggie’s commitment to social justice and willingness to collaborate across silos is an asset to advancing systems change in our community.


Program Design & Implementation

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

Executive Functioning

The ability to regulate thoughts, emotions, and behavior is central to being a productive and prosperous adult. These skills inform navigating stressful situations, developing long-term plans, understanding the impacts of immediate decisions on those long-term objectives, and parenting children. All of these are key ingredients for providing a nurturing environment that supports the health and well-being of children.

Executive Functioning refers to coordination of multiple types and streams of information in order to arrive at a more effective course of action, including prioritizing tasks, goals, and information1. Executive functioning is a skill developed through practice, using age appropriate experiences and is the foundation for healthy development, cognitive functioning, and successful self-regulation. Strength of executive function skills is predictive of academic and career outcomes.

This edition of the ICFW Newsletter highlights two Executive Functioning projects on which we are currently working.


How Human-Centered Design Led Us to Mobility Mentoring in Our Child Welfare Programs

By Luke Waldo

At the Institute for Child and Family Well-Being (ICFW), we believe that relationships with our program partners at Children’s are one of our greatest assets to improve child and family well-being. Consequently, we put out a Call for Proposals to improve child and family well-being within those programs. While we received many proposals, our Family Support Program, which serves children and families involved with the child welfare system, submitted five proposals that spanned a variety of challenges, which included the question that leads to today’s article – “How might we create a standardized Home Management service that meets the complex needs of families involved in the child welfare system?”

Historically, the Family Support Program provided a Home Management service that “meets the family where they’re at.” Through engagement and informal assessment, the Family Support Specialist (FSS) would attempt to meet basic needs such as housing, education and employment assistance, and financial and parenting support through practices such as providing lists of available homes, contacting landlords, completing applications and budgeting tools, and providing resources. While this approach often yielded short-term progress for families – i.e., emergency rent assistance, submitted applications for GED classes and job opportunities – it required extensive time and effort from the FSS as there wasn’t a blueprint to follow, and it didn’t yield any sustainable skill-building for the client. In response, the ICFW facilitated a human-centered design process to seek solutions that might address the challenges that the Family Support Program faced.

Human-Centered Design

Human-centered design is a creative problem-solving process grounded in empathy, learning and creativity2. By beginning the problem-solving process with the people for whom you are designing, we end with ideas and solutions that are rooted in their experiences and needs. Ultimately, human-centered design confronts problems with optimism, collaboration, and ongoing learning to create solutions that can be embraced by the people that seek them.

IDEO, a social innovation leader, frames human-centered design as an iterative process that incorporates three “overlapping spaces”: inspiration, ideation, and implementation. During the inspiration phase, engaged participants – leaders, practitioners, community members – define the challenge for which they seek solutions. Ideation then leads to the brainstorming of ideas, their development into potential solutions, and the rapid-cycle testing that begins to determine what works, what does not, and how it might be implemented more broadly. Implementation is the leap from testing a prototype to delivery into people’s lives.

With a team composed of program decision-makers, leaders, and direct service staff, we worked through the human-centered design journey with tools such as Frame Your Design Challenge, Expert Interviews, How Might We?, Brainstorming, and Storyboarding. Through this thorough and engaging creative process, we departed from the idea that we were seeking a standardized curriculum that would build skills specific to finding and maintaining stable housing, education and employment. After scanning the environment and consulting with partners from around the country, we arrived at the conclusion that mentoring clients in development of executive functioning skills such as self-regulation and organization would yield better, more sustainable outcomes for families. This conclusion led us to a model called Mobility Mentoring, which “helps participants develop and strengthen their own skills and confidence to continue setting goals, even after the mentor-participant relationship ends.”

Mobility Mentoring

Source: EMPath’s Bridge to Self-Sufficiency

Mobility Mentoring® (MM) is an innovative evidence-informed coaching model, developed by EMPath3, focused on building economic self-sufficiency. MM is focused on not just helping participants attain specific goals, but helping them acquire the problem-solving and goal-setting skills necessary for successfully managing their lives. MM is built on a foundation of evidence-based Motivational Interviewing (MI), which utilizes incentives and the Bridge to Self Sufficiency assessment tool to determine their individualized goals within each of the model’s five pillars:

  • Family Stability
  • Well-Being
  • Financial Management
  • Education/Training
  • Employment/Career Management.

Through our Human-Centered Design process, we determined that the adaptation of Mobility Mentoring could solve the long-standing challenge of how to provide a structured and evidence-informed approach to serving families living in poverty, who have experienced trauma, and face complex challenges.

The ICFW has supported implementation of Mobility Mentoring in the Family Support program. While this implementation is early in the process, some of the early lessons learned include improved staff engagement and morale as a result of staff involvement in the human-centered design process; MM provides an Executive-Functioning and strengths-based framework that extends into all program services; MM provides the ability to measure goal completion and its impact on family teaming and reunification; and systems’ barriers create challenges to obtaining funding for fiscal incentives.

Learn More

Human-Centered Design

IDEO’s Field Guide to Human-Centered Design
Greater Good Studio
ICFW Human-Centered Design Practice Brief

Mobility Mentoring

EMPath Mobility Mentoring
The Intergenerational Mobility Project
Using Brain Science to Design New Pathways Out of Poverty
ICFW Mobility Mentoring Practice Brief

Sources

[1] Center on the Developing Child at Harvard University (2016). Building Core Capabilities for Life: The Science Behind the Skills Adults Need to Succeed in Parenting and in the Workplace.
http://www.developingchild.harvard.edu
[2] Greater Good Studio http://greatergoodstudio.com/hcdprocess/
[3] EMPath – Economic Mobility Pathways. Mobility Mentoring – In the knowledge-based economy, snapping the cycle of poverty is more complex than ever. https://www.empathways.org/approach/mobility-mentoring.


Science-Based Innovation

By Gabriel McGaughey

When we take the time to ask families about their biggest stressors, family goals, and hopes for their family’s future, we start to map the gap between the current state of our services and where families want us to be to have impact. In 2017, six Children’s Home Society of America (CHSA) member organizations, including Children’s Wisconsin, partnered with the Center on the Developing Child at Harvard to ask families those questions. The response was clear; families’ two biggest stressors, across a diverse set of survey respondents and geographic locations, were money and having a better place to live.

The question then became, how can organizations providing family-focused interventions address these issues? Our response focused on Executive Functioning. In the fall of 2019, Children’s Wisconsin partnered with Children and Families First (Delaware), Nebraska Children’s Home Society, and The Family Partnership of Minneapolis, the model developer of Executive Functioning (EF) Across Generations, to secure a planning grant from the Center on the Developing Child at Harvard to attend an IDEAS Impact Framework workshop. The goal of the project team attending the workshop was to clarify the core elements of the model to act as a foundation for adapting its use in different program contexts.

IDEAS Impact Workshop

The Center on the Developing Child’s Frontiers of Innovation initiative is focused on building a research and development platform for science-based innovation that supports change in program design, policy, and systems. ICFW Co-Director Gabriel McGaughey was a member of the CHSA project team focused on EF Across Generations, which was specifically looking to adapt the intervention for a feasibility study in Children’s Wisconsin’s Home Visiting program in Wausau.

The IDEAS Impact framework combines elements of design thinking, a focus on precision, and three key brain science concepts to identify the active ingredients for programs. This process helped us get specific about the core activities in EF Across Generations through developing a Theory of Change (TOC), understanding how the program materials for families and staff were tied to the TOC, and how the evaluation plan measures these activities. The project team focused on the core model, as creating the adaptations for other contexts would be easier with that solid foundation.

Source: Center on the Developing Child at Harvard

EF Across Generations

EF Across Generations is a two-generation intervention, developed by The Family Partnership (TFP) (Minneapolis, MN) for use in their preschool classroom setting. It is designed to boost executive function and self-regulation (EF/SR) in young children (ages 4-5) and their parents through the development and use of Internal State Words (ISWs). ISWs, or words for sensations, perceptions, feelings, volition, and ideation/imagining, was used in our model to help parents understand what their child may be trying to communicate, making it easier for parents to initiate or respond to emotionally significant events experienced by their child. EF skills are language-based skills, so children’s curriculum focuses on children ISWs; while the parent curriculum teaches core brain science and EF/SR concepts to parents, with a focus on helping parents recognize children’s use of ISWs, so that they can practice serve and return based on these important words.

TFP conducted three pilots of the children’s curriculum, and one of the parents’, using the Internal State Word Inventory to evaluate progress. Results showed an 80-100% increase in use of ISWs by children, as reported by both classroom teachers and parents. Language analysis of personal narratives from the third pilot showed increases in narrative complexity when pre- and post-intervention narratives were compared. In the second and third children’s pilots, the Minnesota Executive Function Scale (MEFS) was used to measure EF change:

  • Pre-intervention: Children in the pilots had age-adjusted MEFS scores that were .5 to 1.5 standard deviations below the age-adjusted median for EF.
  • In the second pilot, children’s age-adjusted MEFS score increased post-intervention, but stayed below the national median.
  • In the third pilot, children again started below the national median, but scored ABOVE the national median for EF post-intervention.

TFP’s first pilot of the parent curriculum was focused on the overall parent experience, and what we learned is that parents were very interested in brain science and EF and started being warmer with each other and staff.

Children’s Wisconsin worked with TFP to develop an adapted TOC to deliver EF Across Generations in our Wausau Home Visiting program as part of an Implementation grant submitted in January 2020. The home visiting adaptation would take place over 10 sessions of 30-minute duration, as part of ongoing home visiting programming with enrolled clients with children ages 4-5. If funded, this prototype would provide the adapted model to 20 families to see if the program was feasible, based on the feedback from parents/caregivers, the model developer, and program staff. If the model proves effective in this setting, there is an opportunity to embed this practice into existing home visiting programs, as opposed to developing funding and infrastructure for a new, “stand-alone” program.

Learn More

Center on the Developing Child IDEAS Impact Framework
Children’s Wisconsin Wausau Home Visiting
EF Across Generations Model: Contact John Till, The Family Partnership, at JTill@thefamilypartnership.org, 612-728-2086


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.

Mental Health Screening and Reporting: Trauma & Recovery Project Gains and Process Improvement

By Leah Cerwin

The Trauma and Recovery Project (TARP) aspires to build capacity so that clinicians are routinely implementing validated screening and assessment tools in order to improve the identification and treatment of trauma and mental health symptoms in children seen for services at Children’s Wisconsin and throughout southeast Wisconsin.

The Trauma and Recovery Project is a five-year initiative that is increasing access to evidence-based mental health services in southeast Wisconsin by leveraging partnerships between the Institute for Child and Family Well-being (ICFW), Wisconsin’s Department of Children and Families, Office of Children’s Mental Health, and the Milwaukee Child Welfare Partnership for Professional Development.

At the ICFW and Center of Excellence, our clinicians are providing evidence-based treatments to children and families seeking mental health services. Our Lead Clinicians are building a process to track treatment results and demonstrate clinical outcomes. There have been considerable barriers to this data entry process, which is not unique to ICFW as many partner agencies providing mental health services cite similar challenges.

The ICFW Lead Clinicians are working with our Children’s partners to build an Epic data collection system for mental health screenings and treatments, which would be embedded in the child’s medical record. Our goal is to unify mental health and medical health records to create a process that can be easily accessed by clinicians and directors, and easily approached and understood by families.

The Center of Excellence prioritizes the importance of screening for trauma and mental health symptoms and implementing evidence-based treatments to address those symptoms. Our data show that clinicians are significantly more likely to use a validated trauma assessment after completing training in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) or Parent Child Interaction Therapy (PCIT). In the first two years of the grant, a total of 337 clinicians completed training in one of three evidence-based treatment modalities (TF-CBT, PCIT, or CPP). During TARP’s second year, 83 Milwaukee and Racine clinicians completed training in at least one of the three evidence-based treatment models.

An additional objective of the Trauma and Recovery Project is to improve child mental and behavioral health outcomes, which includes assessments of family functioning. Results from Year 2 indicated that 72% of families that received one of the three treatment modalities reported improved family functioning between baseline and discharge. An additional measure of success for this goal involved children’s report of experiencing trauma symptoms, measured by the Post Traumatic Stress Disorder reaction index. Results from Year 2 indicated that by discharge, all children experienced a decrease in trauma symptoms by 56%.

Despite the inherent difficulties of recording and reporting out data gathered in mental health treatments, the Center of Excellence through the Trauma and Recovery Project has designed its own system for data tracking and will continue to move forward to streamline mental health records into each child’s medical records. Progress toward these aims will help to fulfill the project’s ultimate goal of helping trauma-exposed children and families access mental health services that are evidence-based, highly effective, and that provide understandable and accessible results.

Learn More

Trauma and Recovery Project
Journal Article: Translating and Implementing Evidence-Based Mental Health Services in Child Welfare
ICFW Screening and Assessment Video
TARP TF-CBT Training 2020


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.

Enhancing Systems through Evidence Based Treatment Training and Lived Experience

By Kate Bennett and Joshua Mersky

According to the 2019 annual report by the Office of Children’s Mental Health (OCMH), Wisconsin continues to see trends such as increasing rates of diagnosed mental illness in young children and adolescents1,2, increasing rates of untreated depression and anxiety in youth3, and a significant lack of mental health providers available to the community.4 In our state, a common concern shared by families and clinicians alike is the accessibility of early intervention and quality mental health services.

The Trauma and Recovery Project is a five-year initiative that aims to increase access to evidence-based mental health services in southeast Wisconsin by leveraging partnerships between the Institute for Child and Family Well-being (ICFW) and Wisconsin’s Department of Children and Families (DCF), OCMH, and the Milwaukee Child Welfare Partnership (MCWP). Funded by the Substance Abuse and Mental Health Services Administration, one of the project’s primary foci has been on growing the number of clinicians that are trained to deliver trauma-responsive treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Parent-Child Interaction Therapy (PCIT), and Child-Parent Psychotherapy (CPP).

The project has established a Center of Excellence at Children’s Wisconsin to accelerate the implementation and dissemination of these three identified best practices which serve children ages 0-18 and their families. During the first two years of the project, well over 100 clinicians in Milwaukee and Racine counties have received training in one of the project’s three identified evidence-based treatments. Trainings and consultation are provided by the project for a minimal cost to clinicians and their agencies, and training participants are offered continued access to web-based, intervention-specific communities of practice (CoPs) hosted by the Center of Excellence. In the past year alone, clinicians at the Center of Excellence have participated in over 40 hours of CoP video-conferencing sessions to consult on evidence-based practices, and they have served nearly 400 children. Based on current projections by the ICFW, more than 2,000 children will receive TF-CBT, PCIT, or CPP at the Center by the end of the five-year project.

Importantly, parents and youth are sharing their lived experiences through a Collective Impact process led by OCMH to address access to services and family need.5 This innovative and structured approach to systems change is helping to identify facilitators and barriers to mental health services that principally affect disadvantaged and underserved communities. Three committees have additionally been formed with membership from the Milwaukee and Racine communities to oversee the work of the Trauma and Recovery Project. One of the committees, Service Access and Family Engagement (SAFE), seeks to expand family voice by creating a collective culture focused on equity and authentic relationships that work toward shared goals and system strategies. As the SAFE committee continues to evolve, project partners recognize that it is critical to include families who have been participants of the project interventions and clinicians who have provided the interventions in future collaborative efforts.

One major barrier that must be addressed is stigma associated with mental health services, and research suggests that perceptions of stigma tend to be particularly common among racial and ethnic minority groups.6 Parent consumers who are members of the project’s Collective Impact process have expressed this concern, and they have been actively engaged in developing direct outreach and public messaging strategies to combat the issue.

Learn More

Office of Children’s Mental Health
Wisconsin Department of Children & Families: Wisconsin Trauma Project
Mental Health America

Sources

[1]Office of Children’s Mental Health (2020). OCMH 2019 Annual Report. Retrieved from: https://children.wi.gov/pages/annualreport.aspx
[2] Baglivio, M. T., Epps, N., Swartz, K., Sayedul Huq, M., Sheer, A., & Hardt, N. S. (2014). The prevalence of adverse childhood experiences (ACE) in the lives of juvenile offenders. Journal of Juvenile Justice, 3(2).
[3] Mental Health America. (2019). The state of mental health in America 2020. Retrieved from https://mhanational.org/issues/ state-mental-health-america
[4]Wisconsin Department of Health Services. (2019). Wisconsin Mental Health and Substance Use Needs Assessment. Received from Wisconsin Office of Primary Care.
[5] Office of Children’s Mental Health (2020). OCMH Collective Impact Framework. Retrieved from:
https://children.wi.gov/Pages/Integrate/CollectiveImpact.aspx
[6] Min, J. W. (2019). The Influence of Stigma and Views on Mental Health Treatment Effectiveness on Service Use by Age and Ethnicity: Evidence From the CDC BRFSS 2007, 2009, and 2012. SAGE Open. https://doi.org/10.1177/2158244019876277


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:

January 17

Society for Social Work and Research 24th Annual Conference, Washington, DC

Integrating and Sustaining Evidence-Based Mental Health Services in Child Welfare
Authors: Joshua Mersky and ChienTi Plummer Lee

Trauma-Responsive Employment Services: Support for Socio-Economically Disadvantaged Adults
Authors: Dimitri Topitzes, Daria Mueller, and Edwin Bacalso

January 30-31

Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Training (DC:0-5)
Audience: ICFW and Children’s Clinicians

February through May (5 Training Sessions)

Building Brains with CARE
Trainers: Kate Bennett and Meghan Christian
Audience: UWM Children’s Learning Center

February 21-23

UWM Community Building Workshop

February 26

Carthage College Trauma and Wellness Conference 2020
Panel: On Trauma, Economics, and the Justice System
Panelists: Dimitri Topitzes, Lt.-Gov. Mandela Barnes, Katherine Hilson, Jamaal Smith

March 16-20

PCIT-Toddler Training
Trainer: Dr. Emma Girard
Audience: ICFW and Children’s Clinicians

May 11-13

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Learning Collaborative – South Milwaukee

May 14-15

Sustaining Advanced Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Practice Session – Madison


Publications

Mersky, J. P., Topitzes, J., Janczewski, C. E., Plummer Lee, C., McGaughey, G., & McNeil, C. (2020). Translating and implementing evidence-based mental health services in child welfare. Administration and Policy in Mental Health and Mental Health Services.

Voith, L. A., Topitzes, J., and Berg, K. A. (2020). The transmission of violence and trauma across development and environmental contexts: Intimate partner violence from the perspective of men with histories of perpetration. Child Abuse & Neglect, 99.

ICFW Screening and Assessment Video


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