Community Based Community Based Interventions In Two Parts: Interventions In Two Parts: Systems Of Care And Systems Of Care And Approaches To Recovery From Approaches To Recovery From Psychological Trauma Psychological Trauma Lenore B. Behar, PhD, Director Child & Family Program Strategies Durham, North Carolina
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Lenore B. Behar, PhD, Director Child & Family Program Strategies Durham, North Carolina
Community Based Interventions In Two Parts: Systems Of Care And Approaches To Recovery From Psychological Trauma. Lenore B. Behar, PhD, Director Child & Family Program Strategies Durham, North Carolina. - PowerPoint PPT Presentation
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Community Based Community Based Interventions In Two Interventions In Two
Parts: Parts: Systems Of Care AndSystems Of Care And
Approaches To Recovery Approaches To Recovery From Psychological From Psychological
TraumaTraumaLenore B. Behar, PhD, Director
Child & Family Program Strategies
Durham, North Carolina
Presentation forPresentation forMississippi Institute on Mississippi Institute on School HealthSchool Health, Wellness Wellness
and Safetyand Safety
The Super ConferenceThe Super ConferenceSeptember 27-29, 2006September 27-29, 2006
The term “children” includes all people eligible for System of Care services, as defined by the State.
Two Paths for Children Two Paths for Children Exposed to TraumaExposed to Trauma
•System of Care as a Mode of Service Delivery for Children with Serious Emotional Problems
•Trauma Focused Interventions,• usually Individual or Family
Therapies
Converging Paths for Converging Paths for Children Exposed to Children Exposed to
TraumaTrauma Since 1985, System of Care
has been federal policy for children with serious emotional disturbances, and their families
Since 1993, System of Care has been state policy in Mississippi
The Focus of System of CareThe Focus of System of Carein Mississippiin Mississippi
To provide community based care and decrease the use of inappropriate out-of-home placements by using pooled resources from mental health, education, child welfare, and Medicaid for children with SED
How Mississippi SOC How Mississippi SOC EvolvedEvolved
• legislatively mandated services—one of the first in the country
• mechanisms to review service quality• policy guidance from the State • state and community level interagency
teams for children who are difficult to serve—multi-agency assessment and planning teams (MAP)
• teams include agencies and parents
Support from the Family Support from the Family OrganizationOrganization
• Mississippi Families as Allies for Children's Mental Health (MSFAA) established in 1990
• one of the first family-run, family focused organizations in the country
• provided ongoing support to System of Care development
System of Care System of Care PrinciplesPrinciples
• Child centered, individualized• Family focused• Community based• Comprehensive• Culturally competent• Accountable/evidence based• Coordinated across agencies• Requires care management
Why Do We Need SOC?Why Do We Need SOC?
•Need collective expertise•Need unified approach to child and family
•Need to use all the resources available to child and family
It Is Rocket Science!!It Is Rocket Science!!
What is the Population What is the Population for the System of Care?for the System of Care?
The definition is clear:• Children with serious/severe
emotional disturbances and their families
• Children and families who need the services of multiple agencies, or who need multiple services
What is SED?What is SED?
An emotional/behavioral disorder diagnosed by a qualified professional that:
•Requires services of several agencies
•Significantly impairs functioning
• Is anticipated to continue for a significant amount of time
Role of AgenciesRole of Agencies
• Identify children needing services• Identify services needed by the
child and family•Coordinate services within
agency•Coordinate services across
agencies•Use a case manager, if needed
How to Access SOC/MAPHow to Access SOC/MAP
•Refer through your agency representative to the MAP Team
•Refer directly to the MAP Team leader
•Refer through community mental health center
Demonstration SitesDemonstration Sites
• 1999-2006, Children of Mississippi and their Parents Accessing Strength Based Services (COMPASS) in Hinds County
• 2006-2012, the Pinebelt System of Care in Forrest, Lamar and Marion Counties
Acceptance of System of Acceptance of System of CareCare
• Surgeon General’s Report, 2000• Report of the President’s New
Freedom Commission, 2003• Over $100 million annual funding by
Congress through the Center for Mental Health Services, SAMHSA
• Lawsuit settlements in several states
• State statutes and policies
Relevance to Children Relevance to Children Exposed to TraumaExposed to Trauma
• 20 years of study of system of care issues has clarified the value of context of services
• Studies of clinical effectiveness of services for children exposed to trauma have evolved separately
• These two paths are merging for improved services to children and families
Definitions Definitions Trauma
• Physical Abuse and Neglect • Sexual Abuse • Traumatic Grief • Domestic Violence • Community and School Violence
National Child Traumatic Stress Network, 2006
DefinitionsDefinitions
Trauma
• Complex Trauma (multiple trauma)
• Medical Trauma • Refugee and War Zone Trauma • Natural Disasters • Terrorism
Two Groups of ChildrenTwo Groups of Children
•Group 1: Children exposed to trauma who exhibit symptoms requiring treatment; show the potential for PTSD (about 20%)
•Group 2: Children exposed to trauma who will recover without treatment (about 80%)
Description of the GroupsDescription of the Groups
Both may show the same symptoms initially
•Group 1: Symptoms increase; children do not recover with initial intervention
•Group 2: Shows resilience, recovery
System of Care for Group System of Care for Group 11
They meet the definition of serious or severe disturbance:
•The disorder interferes with daily functioning (sleep, school, interactions, thinking)
• It is projected to be long term, without treatment
•Long-term effects without treatment can be damaging
SOC Principles Should SOC Principles Should ApplyApply
• Child centered, individualized• Strengths based• Family focused• Community based• Comprehensive; formal and informal• Culturally competent• Accountable/evidence based• Coordinated across agencies• Requires care management
Evidence Based Services Evidence Based Services for Group 1for Group 1
• Include:–Cognitive Behavioral Therapy–Eye Movement Desensitization and Reprocessing (EMDR)
–Trauma Focused Individual, Family and Group Treatment
Online Course in Online Course in Trauma Focused CBTTrauma Focused CBT
www.musc.edu/tfcbtwww.musc.edu/tfcbt
Importance ofImportance of T Trauma rauma Practices in Systems of Practices in Systems of
CareCareChildren exposed to trauma
•Had higher service costs•Used more high-end services, including: psychiatric hospitalization, residential treatment,and crisis intervention services at higher cost
Yoe, Burns et al, 2004
Importance of Trauma Importance of Trauma Practices in Systems of Practices in Systems of
CareCare•Used more Case Management services at higher cost; and
•Used more outpatient-clinical and medication management services at higher cost
Importance of Trauma Importance of Trauma Practices in Systems of Practices in Systems of
CareCareGroups were the same in service use and costs in•Substance Abuse Tx•Home-Based Family Services•Day Treatment•Community Support Services•Behavioral Health Pharmacy•In-Home Services
Group 2, Why Intervene?Group 2, Why Intervene?
•To alleviate traumatic stress reactions
•To provide comfort•To (possibly) prevent longer-term, more serious reactions
•To identify those who need more intensive interventions
SOC Principles for Group SOC Principles for Group 22
• Not child centered, not individualized
• Strengths based• Family involved• Community based• Comprehensive, only informal
services• Culturally competent• Accountable/evidence based• Coordinated across agencies• Does not require care management
Community BasedCommunity Based
•Interventions delivered in the child’s “community”–With peers– In school or other group setting– Involves child’s helpers-parents, teachers, shelter aides
–Uses indigenous assistants
Strengths BasedStrengths Based•Focuses on stabilization•Corrects misperceptions•Emphasizes maintaining psychological control--coping
•Emphasizes support systems•Focuses on health and self-care
Family FocusedFamily Focused
•Parents involved in planning
•Parents involved in learning how to cope
•Parents involved in ongoing support of children
Impact of Trauma on Impact of Trauma on SchoolsSchools
Events of past 16 years:• Desert Storm—the first war
fought on television• Oklahoma City bombing—news
coverage• School shootings• September 11, 2001• Hurricane Katrina
Marlene Wong, 2006
Crisis & Emergency Crisis & Emergency PlanPlan
for Schoolsfor Schools
Mental Health Mental Health ComponentComponent
www.ed.gov/emergencyplan
Mitigation and Mitigation and PreventionPrevention
•Identify possible disasters•Identify potential hazards/ barriers to a good response
transportation routesfactories/other highly
populated areas
Preparation Preparation
Develop an emergency response plan; consider emotional responses
• Establish relationships with mental health professionals
• Develop protocols for response• Train staff in psychological first aid• Establish back-up systems• Practice, practice, practice
ResponseResponse
•Assess level of exposure• Identify those most at risk•Provide support/first aid•Provide timely
information/media messages• Identify those who need
longer-term intervention and arrange it
RecoveryRecovery
• Address long-term needs through interventions using coping strategies
• Address long-term needs through referral to community or in-school specialists
• Plan for anniversaries
Actions forActions for Schools Schools
• Recognize children are vulnerable to many kinds of trauma through direct or indirect exposure
• Central point for community—50% of people involved with school