CHILDREN AT RISK: OPTIMIZING HEALTH IN AN ERA OF REFORM · > Optimizing Health in Rural Communities ..... > Promoting Family-Centered, Cross-System ... OPTIMIZING HEALTH IN AN ERA

C H I L D R E N AT R I S K :O P T I M I Z I N G H E A L T H I N AN E R A O F R E F O RM

> REPORT FROM NOVEMBER 2011 SYMPOSIUM

> Hosted by the Social Work Policy Institute of the NASW Foundation

> In collaboration with the School of Social Work, University of SouthernCalifornia, and PolicyLab of The Children’s Hospital of Philadelphia

MA R C H 2 0 1 2

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page 2


This report is a product from the symposium, Children at Risk: Optimizing Health in an Era of Reform,hosted by the NASW Foundation’s Social Work Policy Institute in collaboration with supporting partner,the University of Southern California School of Social Work, and PolicyLab of The Children’s Hospital ofPhiladelphia, on November 17, 2011 in Washington, DC.

NASW and the NASW Foundation thank the University of Southern California School of Social Workfor providing partial financial support for the symposium.

Additional copies of the report can be downloaded from the Social Work Policy Institute’s website,www.socialworkpolicy.org. The PowerPoint presentations can also be viewed at that site.

F O R M O R E I N F O R M AT I O N C O N TA C T

Joan Levy Zlotnik, PhD, ACSW

Director, Social Work Policy Institute

750 First Street NE, Suite 700

Washington, DC 20002

202.336.8393

[email protected]

SocialWorkPolicy.org

Recommended Citation – Social Work Policy Institute (2012).

Children at Risk: Optimizing Health in an Era of Reform.

Washington, DC: National Association of Social Workers.

©2012 National Association of Social Workers. All Rights Reserved.

Preface .................................................................................................................Executive Summary ...............................................................................................About the Symposium ..........................................................................................> Overview of Symposium ............................................................................> Purpose of Report ......................................................................................> Guiding Questions ....................................................................................

Setting the Context ................................................................................................> Lessons from Research on the Health of Children in the Child Welfare System....> Physical Health ......................................................................................> Risks of Injury and Fatality........................................................................> Behavioral and Developmental Risks ........................................................> Young Children in Child Welfare are at the Greatest Risk ............................> Older Youth also Experience High Health Risk Factors ................................> Health Care Utilization ............................................................................> Caregiver Issues ....................................................................................

> Legislative Provisions to Enhance Health Care and Health Outcomes ................> Bridging Research and Policy to Improve the Behavioral Health of

Children in Child Welfare............................................................................> Children’s Stability and Well-Being Study ..................................................> Use of Psychotropic Medications in Foster Care..........................................> PolicyLab’s Lessons Learned......................................................................

> Public Health Care Coverage for Children ....................................................> Opportunities in the Affordable Care Act ..................................................> Medicaid Use by Foster Children ..............................................................> Medicaid and State Revenue....................................................................> Managed Care ......................................................................................

> Innovations for Care of Children in Child Welfare ..........................................> Faces of Medicaid ..................................................................................> Quality Improvement Initiatives ................................................................> Children’s Health Insurance Program Reauthorization Act (CHIPRA) Initiative..

> Behavioral Health Needs of Children in Child Welfare: A View from Behavioral> Measuring Child Health Outcomes ..............................................................

Optimizing Children’s Health Outcomes: Perspectives from the Community ..............> Optimizing Health in Rural Communities ......................................................> Promoting Family-Centered, Cross-System Collaboration to Improve Health and> A Program to Meet Health Care Needs in Child Welfare ................................

Opportunities and Challenges to Optimizing Health and Health Care forAt-Risk Children: Key Issues Identified ..............................................................

Developing an Agenda for Action ..........................................................................References ............................................................................................................Appendix ............................................................................................................

TA B L E O F C O N T E N T S


:I N AN E R A O F R E F O RM

Children at Risk: Optimizing Health in an Era of Reform,k Policy Institute in collaboration with supporting partner,Social Work, and PolicyLab of The Children’s Hospital ofington, DC.

University of Southern California School of Social Worksymposium.

aded from the Social Work Policy Institute’s website,esentations can also be viewed at that site.

F O R M O R E I N F O R M AT I O N C O N TA C T

Joan Levy Zlotnik, PhD, ACSW

Director, Social Work Policy Institute

750 First Street NE, Suite 700

Washington, DC 20002

202.336.8393

[email protected]

SocialWorkPolicy.org

Recommended Citation – Social Work Policy Institute (2012).

Children at Risk: Optimizing Health in an Era of Reform.

Washington, DC: National Association of Social Workers.

kers. All Rights Reserved.

Preface ........................................................................................................................................iExecutive Summary ....................................................................................................................iiiAbout the Symposium ................................................................................................................1> Overview of Symposium ................................................................................................1> Purpose of Report ..........................................................................................................2> Guiding Questions ........................................................................................................2

Setting the Context ......................................................................................................................3> Lessons from Research on the Health of Children in the Child Welfare System........................3> Physical Health ..........................................................................................................4> Risks of Injury and Fatality............................................................................................4> Behavioral and Developmental Risks ............................................................................4> Young Children in Child Welfare are at the Greatest Risk ................................................5> Older Youth also Experience High Health Risk Factors ....................................................5> Health Care Utilization ................................................................................................5> Caregiver Issues ........................................................................................................6

> Legislative Provisions to Enhance Health Care and Health Outcomes ....................................6> Bridging Research and Policy to Improve the Behavioral Health of

Children in Child Welfare................................................................................................7> Children’s Stability and Well-Being Study ......................................................................7> Use of Psychotropic Medications in Foster Care..............................................................8> PolicyLab’s Lessons Learned..........................................................................................9

> Public Health Care Coverage for Children ........................................................................9> Opportunities in the Affordable Care Act ....................................................................10> Medicaid Use by Foster Children ................................................................................10> Medicaid and State Revenue......................................................................................10> Managed Care ........................................................................................................10

> Innovations for Care of Children in Child Welfare ............................................................11> Faces of Medicaid ....................................................................................................12> Quality Improvement Initiatives ..................................................................................12> Children’s Health Insurance Program Reauthorization Act (CHIPRA) Initiative....................12

> Behavioral Health Needs of Children in Child Welfare: A View from Behavioral Health........13> Measuring Child Health Outcomes ................................................................................15

Optimizing Children’s Health Outcomes: Perspectives from the Community ..................................17> Optimizing Health in Rural Communities ........................................................................17> Promoting Family-Centered, Cross-System Collaboration to Improve Health and Well-Being ..17> A Program to Meet Health Care Needs in Child Welfare ..................................................19

Opportunities and Challenges to Optimizing Health and Health Care forAt-Risk Children: Key Issues Identified ..................................................................................20

Developing an Agenda for Action ..............................................................................................23References ................................................................................................................................25Appendix ................................................................................................................................28

TA B L E O F C O N T E N T S


> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M >i

Each day, Child Welfare in the News, distributed by the Child Welfare Information Gateway(www.childwelfare.gov), includes reports of children who have died due to child abuse and neglect;

reports of agencies that are under fire to improve their services; and reports of increasing concerns aboutthe well-being of children served by the public health and social service systems.

Of particular concern in recent years have been the poor physical and behavioral health statusesof children receiving child welfare services, especially those who are in foster care. Increasedattention is being paid to these children through research, policy improvements andimplementation of new models of service delivery. Yet more attention is needed to truly improvechildren’s outcomes. Building on this momentum, it seemed that the Social Work Policy Institute(SWPI) of the NASW Foundation could be a powerful convener of stakeholders across childwelfare and health to catalyze greater action to enhance children’s health and well-being.We were pleased that the School of Social Work at the University of Southern California (USC),with leading child maltreatment researchers, was well positioned to be a collaborator for thissymposium and we appreciate Dean Marilyn Flynn’s promotion of a SWPI/USC collaborationand the provision of financial resources to partially support the symposium. Based on herextensive research and practice expertise at the intersection of child welfare and health, JanetSchneiderman, RN, PhD, Research Associate Professor at the USC School of Social Work, servedas the symposium’s Academic Chair. To further undertake this interdisciplinary endeavor, wereached out to PolicyLab of The Children’s Hospital of Philadelphia, a leader in research topractice/policy initiatives at the intersection of child welfare and health care, which also agreedto serve as a collaborator. Thank you to David Rubin, Director of PolicyLab for his visionary work,and to Sarah Zlotnik, MSW, MSPH, PolicyLab’s Senior Strategist who was a key part of ourplanning team. Additional thanks to Megan Finno of USC and Cara Curtis of PolicyLab whoassisted in the planning and implementation of the symposium. Thanks also to my NASWcolleagues who helped to make the symposium a success by providing logistic support andserving as facilitators during the working groups. Finally, thank you to Alice Cahill, whosegraphic recording helped to capture the symposium’s process and content.

PREFACE

In addition to Janet and Sarah who were panelists atAlker, MPP, Center for Children and Families, GeorgCenter for Health Care Strategies; David Berns, MSWHuman Services; Rachel Dodge, MD, MPH, FAAP, MDepartment of Social Services; Deirdra Robinson, ABSuzanne Theberge, MPH, National Quality Forum anAbuse & Mental Health Services Administration, whopresentations. The 50 participants, representing manlocal, state and national levels, contributed their expethis important agenda for action.

As you read this report and the accompanying actionsteps you can take to optimize the health and well-bestrategies identified by participants, collaboration wicollaboration across systems, collaboration betweenmakers, collaboration between universities and commtheir families are all critical if we are to achieve bette

Joan Levy Zlotnik, PhD, ACSWDirector, Social Work Policy InstituteMarch 2012

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page i

i i> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L WO R K P O L I C Y I N S T I T U T E

News, distributed by the Child Welfare Information Gatewaydes reports of children who have died due to child abuse and neglect;r fire to improve their services; and reports of increasing concerns aboutby the public health and social service systems.

t years have been the poor physical and behavioral health statusesfare services, especially those who are in foster care. Increasede children through research, policy improvements ands of service delivery. Yet more attention is needed to truly improveon this momentum, it seemed that the Social Work Policy Instituteion could be a powerful convener of stakeholders across child

e greater action to enhance children’s health and well-being.ool of Social Work at the University of Southern California (USC),nt researchers, was well positioned to be a collaborator for thise Dean Marilyn Flynn’s promotion of a SWPI/USC collaborationresources to partially support the symposium. Based on herce expertise at the intersection of child welfare and health, Janetearch Associate Professor at the USC School of Social Work, served

Chair. To further undertake this interdisciplinary endeavor, wee Children’s Hospital of Philadelphia, a leader in research to

he intersection of child welfare and health care, which also agreedank you to David Rubin, Director of PolicyLab for his visionary work,MSPH, PolicyLab’s Senior Strategist who was a key part of ournks to Megan Finno of USC and Cara Curtis of PolicyLab whomplementation of the symposium. Thanks also to my NASWke the symposium a success by providing logistic support andhe working groups. Finally, thank you to Alice Cahill, whoseapture the symposium’s process and content.

In addition to Janet and Sarah who were panelists at the symposium, I also want to thank JoanAlker, MPP, Center for Children and Families, Georgetown University; Kamala Allen, MHS,Center for Health Care Strategies; David Berns, MSW, District of Columbia Department ofHuman Services; Rachel Dodge, MD, MPH, FAAP, MATCH Program at Baltimore CityDepartment of Social Services; Deirdra Robinson, ABD, MSW, Morehead State University;Suzanne Theberge, MPH, National Quality Forum and Rita Vandivort-Warren, MSW, SubstanceAbuse & Mental Health Services Administration, who all provided thoughtful and informativepresentations. The 50 participants, representing many disciplines and broad experience at thelocal, state and national levels, contributed their expertise and perspective in helping to createthis important agenda for action.

As you read this report and the accompanying action brief, we hope that you will consider whatsteps you can take to optimize the health and well-being of children at risk. Based on thestrategies identified by participants, collaboration will be key. Collaboration across disciplines,collaboration across systems, collaboration between researchers and practitioners and policymakers, collaboration between universities and communities, and collaboration with youth andtheir families are all critical if we are to achieve better outcomes for children and families.

Joan Levy Zlotnik, PhD, ACSWDirector, Social Work Policy InstituteMarch 2012

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page ii

> Behavioral and developmentalrisks.

> Health status differentialsrelated to age.

> Health care utilization, includingmental health and developmentalservice use.

> Caregiver issues.

> BRIDGING RESEARCHAND POLICY TOIMPROVE PRACTICEOUTCOMES

Recognizing that research findingscan lead to implementation ofevidence-based programs andpolicies, Sarah Zlotnik of PolicyLabprovided information on severalof its current initiatives, especiallyhighlighting the Child Stabilityand Well-being (CSAW) study inPhiladelphia and research relatedto use of psychotropic medications.Following on the finding thatplacement instability was associatedwith poor behavioral healthoutcomes, CSAW was launched.

Funded by foundation andgovernment sources, CSAW isa multi-dimensional study aimedat promoting placement stabilityand child well-being. It isexamining 1) the impact ofplacement stability on educationaloutcomes; 2) agency characteristics(including workforce) affectingplacement stability; and 3) therelationship between kinship care,

placement with siblings, placestability and behavioral healthstrengthen the behavioral heasystem’s capacity to support qinterventions that work, Policyinvestigated evidence- basedbehavioral services and howservices could best be fundedoperationalized and monitoreand sustained beyond the resstudy period.

Another PolicyLab study isexamining national Medicaidand state policies related to thof psychotropic medications fchildren in foster care. PolicyLis a leader in efforts to bridgeresearch and policy to improvthe behavioral health of childin child welfare and serves ascatalyst to use policy-informedresearch to understand barrieto meeting the health needs ochildren in child welfare.

> POLICY CHANGESET THE STAGE FOBETTER HEALTHOUTCOMESSeveral recent legislative provspecifically address health outand health care for foster chilas well other children who arehigh risk for poor health. Thewith relevant provisions includFostering Connections to Succand Increasing Adoptions Act2009 (P.L. 110-351); ChildreHealth Insurance ProgramReauthorization Act of 2009(CHIPRA) (P.L. 111-3); PatientProtection and Affordable Ca

> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M >i i i

>OVERVIEW

The health profiles of children in thechild welfare system indicate high

rates of physical and mental healthdisorders and developmental riskfactors. These are exacerbated byconcerns about access to health care,high rates of use of psychotropicmedication for children in foster care,and insufficient attention to preventionand early intervention. The NationalStudy of Child and AdolescentWell-being (NSCAW) and other recentresearch have provided morecomprehensive data on these poorhealth and mental health outcomes,demanding attention by practitioners,administrators and policy-makers.

To further explore these issues andto set an agenda to improvechildren’s health outcomes, theSocial Work Policy Institute (SWPI)of the NASW Foundation withcontributing partner, the Universityof Southern California School ofSocial Work (USC), and withPolicyLab of The Children’s Hospitalof Philadelphia, convened keystakeholders for a think tanksymposium, Children at Risk:

Optimizing Health in an Era ofReform, on November 17, 2011.The symposium brought together aninterdisciplinary group, working inpolicy, practice, research andeducation, including representativesof state and federal governmentagencies, community-basedagencies, national professional andprovider organizations, universitiesand policy entities. The symposiumparticipants explored:

> Findings from research on healthcare delivery and the healthcharacteristics of children in thechild welfare system.

> Research to policyimplementation strategies toimprove physical and behavioralhealth outcomes, access andcoverage for children served bythe child welfare system.

> Implications of recent legislativeprovisions and theirimplementation includingdirectives to ensure thatbehavioral health needs aremore adequately met.

> Initiatives to develop measuresfor quality children’s health caredelivery.

> Innovative practice models toguide improved outcomes forchildren, including perspectivesfrom community-basedprevention, health promotion,care coordination and servicedelivery models.

> FINDINGS FROMRESEARCHDrawing from NSCAW dataand other recent research, JanetSchneiderman of USC, who servedas the symposium’s AcademicChair, set the context, indicatingthat health profiles of children inthe child welfare system are similar,whether or not they are living in anout-of-home care setting. Datareported on covered:

> Physical health status includingchronic conditions and obesity.

> Risks of injury and fatalities.

EXECUTIVE SUMMARY


Hosted by the NASW Foundation’s Social Work Policy InstituteIn collaboration with the School of Social Work, University of Southern California, andPolicyLab of The Children’s Hospital of Philadelphia

March 2012

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page iii

> Behavioral and developmentalrisks.

> Health status differentialsrelated to age.

> Health care utilization, includingmental health and developmentalservice use.

> Caregiver issues.

> BRIDGING RESEARCHAND POLICY TOIMPROVE PRACTICEOUTCOMES

Recognizing that research findingscan lead to implementation ofevidence-based programs andpolicies, Sarah Zlotnik of PolicyLabprovided information on severalof its current initiatives, especiallyhighlighting the Child Stabilityand Well-being (CSAW) study inPhiladelphia and research relatedto use of psychotropic medications.Following on the finding thatplacement instability was associatedwith poor behavioral healthoutcomes, CSAW was launched.

Funded by foundation andgovernment sources, CSAW isa multi-dimensional study aimedat promoting placement stabilityand child well-being. It isexamining 1) the impact ofplacement stability on educationaloutcomes; 2) agency characteristics(including workforce) affectingplacement stability; and 3) therelationship between kinship care,

placement with siblings, placementstability and behavioral health. Tostrengthen the behavioral healthsystem’s capacity to support qualityinterventions that work, PolicyLabinvestigated evidence- basedbehavioral services and how theseservices could best be funded,operationalized and monitoredand sustained beyond the researchstudy period.

Another PolicyLab study isexamining national Medicaid dataand state policies related to the useof psychotropic medications forchildren in foster care. PolicyLabis a leader in efforts to bridgeresearch and policy to improvethe behavioral health of childrenin child welfare and serves as acatalyst to use policy-informedresearch to understand barriersto meeting the health needs ofchildren in child welfare.

> POLICY CHANGESSET THE STAGE FORBETTER HEALTHOUTCOMESSeveral recent legislative provisionsspecifically address health outcomesand health care for foster childrenas well other children who are athigh risk for poor health. The lawswith relevant provisions include:Fostering Connections to Successand Increasing Adoptions Act of2009 (P.L. 110-351); Children’sHealth Insurance ProgramReauthorization Act of 2009(CHIPRA) (P.L. 111-3); PatientProtection and Affordable Care

Act of 2010 (ACA) (P.L. 111-148);and the Child and Family ServicesImprovement and Innovation Act(P.L. 112-34).

Symposium speakers highlightedpolicy enhancements targeted toimproving health care delivery andhealth outcomes. This included thedevelopment of children’s healthoutcome measures by the NationalQuality Forum; provisions to movetoward integration of health andbehavioral health care and expandcoverage due to the ACA, ashighlighted by the Substance Abuseand Mental Health ServicesAdministration (SAMHSA); thestatus of health care coverage forchildren, in the context of the ACA,Medicaid and managed care,addressed by the Center forChildren and Families atGeorgetown University’s HealthPolicy Institute; and innovativeMedicaid managed care pilots,quality improvement initiatives andMedicaid data analysis focused onunderstanding utilization andimproving behavioral healthoutcomes for children in foster care,being implemented through theCenter for Health Care Strategies.

i v> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L WO R K P O L I C Y I N S T I T U T E

izing Health in an Era ofm, on November 17, 2011.mposium brought together ansciplinary group, working inpractice, research andion, including representativese and federal governmentes, community-basedes, national professional ander organizations, universitiesolicy entities. The symposiumpants explored:

ings from research on healthe delivery and the healthracteristics of children in thed welfare system.

earch to policyementation strategies torove physical and behavioralth outcomes, access and

erage for children served bychild welfare system.

ications of recent legislativevisions and theirementation includingctives to ensure thatavioral health needs aree adequately met.

> Initiatives to develop measuresfor quality children’s health caredelivery.

> Innovative practice models toguide improved outcomes forchildren, including perspectivesfrom community-basedprevention, health promotion,care coordination and servicedelivery models.

> FINDINGS FROMRESEARCHDrawing from NSCAW dataand other recent research, JanetSchneiderman of USC, who servedas the symposium’s AcademicChair, set the context, indicatingthat health profiles of children inthe child welfare system are similar,whether or not they are living in anout-of-home care setting. Datareported on covered:

> Physical health status includingchronic conditions and obesity.

> Risks of injury and fatalities.

UTIVE SUMMARY

R E N AT R I S K :Z I N G H E A L T H I N AN E R A O F R E F O RM

he NASW Foundation’s Social Work Policy Instituten with the School of Social Work, University of Southern California, and

he Children’s Hospital of Philadelphia

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page iv

> Clarify the authority to consentfor healthcare, early interventionand other services for those whoare in the foster care system andthose who are served in theirown home.

> Promote the establishment ofcross-disciplinary initiatives inuniversities to serve as modelsfor interdisciplinary community-based practice.

This convening covered a greatdeal of territory in a short time andreinforced the understanding that:

> Legislative changes have broughtnew opportunities and greaterattention to the health outcomesof at-risk children.

> Success will require peopleworking together – engaginwith families and communitand using a strength’s baseperspective.

> State and local governmentalong with insurance payercommunity agencies all havrole to play in working withfederal government to imprhealth outcomes and createcoordinated service deliver

> Research plays an importanin both understanding whoserved and in testing innov

> Dissemination of effectiveinnovations is critical toimproving health outcomes

> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M >v

>COMMUNITY-BASEDSTRATEGIES FOCUSON PREVENTION ANDCOORDINATION OFCARECommunity-based, collaborativeprevention and coordinated caremodels were highlighted. Theyincluded preventive health careeducation and screening efforts ina rural community in Kentucky; theimplementation of a medicalmanaged care unit for children infoster care, a collaborationbetween health, child welfare andmental health service systems inBaltimore; and efforts to promotemore comprehensive, integratedcoordinated and preventive careacross public health and socialservice systems, that isfamily-centered and strengths-basedand promotes wellness and safety,in the District of Columbia.

>OVERARCHINGISSUES IDENTIFIED> Children transition in and out of

foster care and in and out of thechild welfare system, suggestingthat there must be a more holisticapproach to primary care andbehavioral health services andconsistent use of screening.

> There are a growing number ofevidence-based practices andinnovations at the individualand system level (e.g., earlychildhood home-visiting,parent-child interaction therapy)that can be adopted andadapted into routine servicedelivery, requiring attention tothe implementation process.

> Cross-system andinterdisciplinary collaborationand training are essential toimprove outcomes, along withincreased engagement withcaregivers, including birthfamilies.

> The changes occurring due torecent federal legislation willhave impact on the health careof high risk children. As moreadults have access to health carecoverage in 2014, they mayincrease their use of health andbehavioral health services,perhaps resulting in better childwelfare outcomes as well.

>AGENDA FORACTIONThe participants grappled withidentifying what changes need tooccur to enhance, policies,practices, partnerships andprofessional development tostrengthen quality of care, accessto care, and health care coverageto improve children’s health andwell-being. This resulted indevelopment of an agenda thatcalls for the following actions:

> Promote access and continuityof care for children who havecontact with the child welfaresystem.

> Create systems of communicationto achieve better accountabilityand to improve communicationsbetween agencies, providersand managed careorganizations.

> Create better focused andcoordinated efforts to addresshealth care needs of childrenserved in the child welfaresystem at the highest levels withinstate and federal governments.

> Ensure that the voices of families,communities and foster carealumni are included in thedevelopment of models toaddress healthcare needs inthe child welfare system.

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page v

> Clarify the authority to consentfor healthcare, early interventionand other services for those whoare in the foster care system andthose who are served in theirown home.

> Promote the establishment ofcross-disciplinary initiatives inuniversities to serve as modelsfor interdisciplinary community-based practice.

This convening covered a greatdeal of territory in a short time andreinforced the understanding that:


> Success will require peopleworking together – engagingwith families and communitiesand using a strength’s basedperspective.

> State and local governmentsalong with insurance payers andcommunity agencies all have arole to play in working with thefederal government to improvehealth outcomes and createcoordinated service delivery.

> Research plays an important rolein both understanding who isserved and in testing innovations.

> Dissemination of effectiveinnovations is critical toimproving health outcomes.

This collaboration between theNASW Social Work Policy Institute,USC and PolicyLab can serve as anexample of cross-system andcross-disciplinary knowledgedevelopment and can also serve asa model for others to emulate toaddress critical issues facing ourmost vulnerable children andfamilies.

v i> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L WO R K P O L I C Y I N S T I T U T E

VERARCHINGUES IDENTIFIED

dren transition in and out ofer care and in and out of thed welfare system, suggestingthere must be a more holisticroach to primary care andavioral health services andsistent use of screening.

e are a growing number ofence-based practices andvations at the individualsystem level (e.g., early

dhood home-visiting,ent-child interaction therapy)can be adopted andpted into routine servicevery, requiring attention tomplementation process.

ss-system andrdisciplinary collaborationtraining are essential to

rove outcomes, along witheased engagement withegivers, including birthlies.

changes occurring due tont federal legislation wille impact on the health caregh risk children. As morets have access to health care

erage in 2014, they mayease their use of health andavioral health services,haps resulting in better childare outcomes as well.

>AGENDA FORACTIONThe participants grappled withidentifying what changes need tooccur to enhance, policies,practices, partnerships andprofessional development tostrengthen quality of care, accessto care, and health care coverageto improve children’s health andwell-being. This resulted indevelopment of an agenda thatcalls for the following actions:

> Promote access and continuityof care for children who havecontact with the child welfaresystem.

> Create systems of communicationto achieve better accountabilityand to improve communicationsbetween agencies, providersand managed careorganizations.

> Create better focused andcoordinated efforts to addresshealth care needs of childrenserved in the child welfaresystem at the highest levels withinstate and federal governments.

> Ensure that the voices of families,communities and foster carealumni are included in thedevelopment of models toaddress healthcare needs inthe child welfare system.

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page vi

C H I L D R E N AT R I S K :O P T I M I Z I N G H E A L T H I N AN E R

> REPORT FROM NOVEMB

> Hosted by the Social Work

> In collaboration with the ScCalifornia, and PolicyLab o

SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page vii





SWPI-RPT-16312.ChildrenAtRisk:Layout 1 5/15/12 1:50 PM Page viii

third panel provided on-the-groundperspectives and helped raise issuesthat needed further consideration.

In addressing the health of children inchild welfare, the presentations anddiscussions identified gaps in policiesand services as well as areas thatrequire further study. Engaging in smallgroup deliberations, using a WorldCafé model, participants shaped theaction agenda focusing on what needsto occur to enhance policies, practices,partnerships and professionaldevelopment to strengthen quality ofcare, access to care, and health carecoverage to improve children’s healthand well-being. Change strategies thatwere identified focused on workforcedevelopment, training and technicalassistance; dissemination andimplementation efforts, and promotionof interprofessional andinter-organizational collaborationsand cross-system innovations.

> PURPOSE OF THISREPORTThis report is intended to serve asa resource for practitioners,administrators, educators, researchersand policy-makers who are concernedwith the health and health care ofchildren, especially of those children

involved with the child welfare syIt provides an overview of the sppresentations along with a discusthe key gaps and concerns that widentified. It then providesrecommendations that emerged fthe participants’ deliberations whled to the formulation of the agenfor action. The report also includan extensive appendix that proviresources and links to informationthat stakeholders might find usefuimplementing the action agenda.We hope that the information procan be a catalyst for undertakingto enhance the health and well-bof children and to improvecollaboration and communicationamong the health, behavioral heand social service systems.

> GUIDING QUESTIOIn advance of the symposium, theparticipants received backgroundmaterials and the following list ofquestions that served to guide thepresentations and discussions.

> What can we learn from reseaabout the health care needs ofchildren in the child welfare sy

> What are the current economisocietal risk factors that resultincreased health risks and injuof children?

> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M >1

Across the United States, increasingconcerns are being raised about

the health care and the healthoutcomes for children involved withthe child welfare system. TheChildren’s Health Insurance Program(CHIP) and the Patient Protection andAffordable Care Act (ACA) providesome benefits and safeguards forvulnerable children, but still moreneeds to be done. To examine thehealth care needs of children in thechild welfare system and those whomight be in jeopardy of futureinvolvement with the system (dueto abuse, neglect, immigration,and other child and family riskfactors), a think tank symposiumwas convened by the NationalAssociation of Social Workers(NASW) Social Work PolicyInstitute (SWPI) in collaboration withPolicyLab of The Children’s Hospitalof Philadelphia and contributingpartner, the University of SouthernCalifornia School of Social Work(USC). Children at Risk: OptimizingHealth in an Era of Reform took placeon November 17, 2011 at NASWheadquarters in Washington, DC.

> OVERVIEW OF THISSYMPOSIUMThe symposium brought together aninterdisciplinary group of keystakeholders from policy, practice,research and education, includingrepresentatives of state and federalgovernment agencies, community-basedagencies, national professional andprovider organizations, universities andpolicy entities (see Appendix 2).Focusing on the health and health carefor children in the child welfare system,the symposium agenda (see Appendix 1)

included three panel presentations(see Appendix 3 for speakerbiographies) that addressed researchfindings on health care delivery and thehealth characteristics of children in thechild welfare system; research to policyimplementation strategies to identifyand improve health care outcomes,access and coverage for childrenserved by the child welfare system;revisions of federal policies and theirimplementation; efforts to developoutcome measures for quality children’shealth care delivery, and innovativepractice models that can help to guideimproved outcomes for children. The

ABOUT THE SYMPOSIUM


third panel provided on-the-groundperspectives and helped raise issuesthat needed further consideration.

In addressing the health of children inchild welfare, the presentations anddiscussions identified gaps in policiesand services as well as areas thatrequire further study. Engaging in smallgroup deliberations, using a WorldCafé model, participants shaped theaction agenda focusing on what needsto occur to enhance policies, practices,partnerships and professionaldevelopment to strengthen quality ofcare, access to care, and health carecoverage to improve children’s healthand well-being. Change strategies thatwere identified focused on workforcedevelopment, training and technicalassistance; dissemination andimplementation efforts, and promotionof interprofessional andinter-organizational collaborationsand cross-system innovations.

> PURPOSE OF THISREPORTThis report is intended to serve asa resource for practitioners,administrators, educators, researchersand policy-makers who are concernedwith the health and health care ofchildren, especially of those children

involved with the child welfare system.It provides an overview of the speakers’presentations along with a discussion ofthe key gaps and concerns that wereidentified. It then providesrecommendations that emerged fromthe participants’ deliberations whichled to the formulation of the agendafor action. The report also includesan extensive appendix that providesresources and links to informationthat stakeholders might find useful inimplementing the action agenda.We hope that the information providedcan be a catalyst for undertaking effortsto enhance the health and well-beingof children and to improvecollaboration and communicationamong the health, behavioral healthand social service systems.

> GUIDING QUESTIONSIn advance of the symposium, theparticipants received backgroundmaterials and the following list ofquestions that served to guide thepresentations and discussions.

> What can we learn from researchabout the health care needs ofchildren in the child welfare system?

> What are the current economic andsocietal risk factors that result inincreased health risks and injuryof children?

> What strategies are states andlocalities currently using to improvethe health outcomes for Medicaideligible high risk children,especially those known to thechild welfare system?

> What opportunities were includedin recent legislation that targetimproving health outcomes forat-risk children?

> How can interdisciplinary,cross-system education and trainingbe enhanced to improve healthoutcomes? Are there professionaldevelopment and training modelsthat integrate child welfare andmaternal and child health (in socialwork and other disciplines) to moreholistically address the practice,programs and policies that couldenhance child health outcomes?

> What are the special issues relatedto addressing behavioral healthoutcomes for children in the childwelfare system?

> How can we best ensure thatchildren’s health outcome measurescapture the unique needs of childrenserved by the child welfare system?

> What actions at the state and federallevels are needed to enhancepolicies and better disseminateinformation to improve practices?

2> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L WO R K P O L I C Y I N S T I T U T E

VERVIEW OF THISPOSIUM

mposium brought together anciplinary group of key

olders from policy, practice,h and education, includingntatives of state and federalment agencies, community-basedes, national professional ander organizations, universities andentities (see Appendix 2).g on the health and health caredren in the child welfare system,posium agenda (see Appendix 1)

included three panel presentations(see Appendix 3 for speakerbiographies) that addressed researchfindings on health care delivery and thehealth characteristics of children in thechild welfare system; research to policyimplementation strategies to identifyand improve health care outcomes,access and coverage for childrenserved by the child welfare system;revisions of federal policies and theirimplementation; efforts to developoutcome measures for quality children’shealth care delivery, and innovativepractice models that can help to guideimproved outcomes for children. The

ABOUT THE SYMPOSIUM


and children under age six who are infoster care have more medicalproblems and development delays thanthe general population and than theirolder counterparts in child welfare(Berkoff, Leslie & Stahmer, 2006; Leslie,et al., 2005; Stahmer, et al., 2005;Vandivere, Chalk & Moore, 2003).

Physical HealthChronic health conditions are commonfor many children in the child welfaresystem. National studies on physicalhealth problems of children in the childwelfare system found that 27.9% ofchildren had a chronic medicalcondition, with children under age twomore likely to report a chronic medicalcondition than older children; with ratesnot differing by placement, in fostercare or remaining at home (Ringeisen,et al., 2008). Of children who havebeen in foster care for more than oneyear, Table 1 describes their chronichealth conditions.

TABLE 1: CHRONIC HEALTHCONDITIONS OF CHILDREN IN FOSTERCARE FOR MORE THAN ONE YEAR

30% of the children have a chronichealth condition> 20% one chronic condition,> 3.8% had two chronic conditions, and> 3.1% had three or more conditions.Most common chronic conditions> 32.8 % asthma;> 2% other respiratory problem;> 6% allergies, repeated ear infections,

and eczema or other skin disease

There is an increased risk of chroniccondition for children under two years ofage, if the caregiver’s race/ethnicity isother than Hispanic, and if there arerelatively few household members.(Jee et al, 2006)

ObesityEvidence is starting to show thatchildren in child welfare have higrates of obesity than the generalpopulation. Childhood obesity isrecognized as a problem for chilin child welfare (Steele & Buchi,Schneiderman, et al., 2011) andcommentary and judicial decisiohave suggested that perhaps extrobesity, especially coupled with achronic health condition, shouldconsidered child neglect (MurtagLudwig, 2011; Varness, et al., 20Furthermore, drawing on the AdvChildhood Experiences (ACEs) stlink has been identified between sviolence-related stressors, includichild abuse and neglect, and riskbehaviors and health problems inadulthood (Felitti, et al., 1998). Tretrospective ACEs study found threports of childhood maltreatmenrelated to obesity in adulthood. Tof obesity increased with the sevethe maltreatment, and childhoodphysical and verbal abuse werestrongly related to Body Mass Ind(BMI) and obesity (Williamson,Thompson, Anda, Dietz & Felitti,

Risks of Injury and FatalityChildren known to the child welfasystem may be at greater risk ofaccording to recent data analyzePutnam-Hornstein (2011). She fothat, in California, after adjustingrisk factors at birth, a prior allegaof maltreatment was a significantfactor for later death due to injurFurthermore, continuing to adjustrisk factors at birth, children withprior allegation of maltreatment dfrom intentional injury at a rate thwas 5.9 times greater than unrepchildren, and died from unintentiinjuries at twice the rate of unrepchildren.


> LESSONS FROMRESEARCH ON THEHEALTH OF CHILDRENIN THE CHILD WELFARESYSTEM

To understand the current state ofhealth needs and health services for

children in the child welfare system,Janet Schneiderman, ResearchAssociate Professor at the School ofSocial Work, University of SouthernCalifornia, who also served as theAcademic Chair of this symposium,provided an overview of recentresearch. Schneiderman began byhighlighting some overall statistics,noting that child neglect is moreprevalent than child abuse, and thatover the past several years there hasbeen a decline in the number ofchildren in foster care, with manychildren actually receiving childwelfare services in their own home.

The presentation painted a pictureof the health status and healthcare needs of children in the childwelfare system. This section of thereport reviews some of the keyfindings that were presented,covering a range of factorsincluding:

> Physical health status includingchronic conditions and obesity> Risks of injury and fatalities.> Behavioral and developmentalrisks.> Health status differentialsrelated to age.> Health care utilization,including mental health and

developmental service use.> Caregiver issues.

Important data on the health of childrenin child welfare can be drawn from theNational Study of Child and AdolescentWell-being (NSCAW). Schneiderman’spresentation drew upon her ownresearch, using NSCAW data and datafrom Los Angeles, CA, supported by theNational Institute on Child Health andHuman Development (NICHD), and thatof many other researchers who havebeen carefully analyzing the NSCAWfindings. The presentation broughttogether NSCAW findings and otherdata, addressing health care needs,health status, and utilization. It shouldbe noted that some of the citationsrelate to national data and some aremore state specific. (The PowerPoint ofSchneiderman’s full presentation andthe references are available on theSWPI website,[www.socialworkpolicy.org]).

ABOUT THE NATIONAL STUDY OF CHILDAND ADOLESCENT WELL-BEING (NSCAW)

Created from a Congressional mandate aspart of the Personal Responsibility and WorkOpportunities Reconciliation Act of 1996, theDepartment of Health and Human Serviceslaunched NSCAW. It is the first national studythat examines child and family well-beingoutcomes in detail and seeks to relate thoseoutcomes to their experience with the childwelfare system and to family characteristics,community environment, and other factors.The study describes the child welfare systemand the experiences of children and familieswho come in contact with the system. It isintended to increase the knowledge neededto support service, program, and policyplanning. Data presented at the symposiumwas based on analysis from the findings ofthe first longitudinal sample (NSCAW I). Formore information visit www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/#overview.

According to NSCAW and other data,the developmental and physicalproblems of children, especially youngchildren, who remain at home, aresimilar to those of children who areplaced in foster care (Leslie, et al.,2005; Ringeisen, Casanueva, Urato& Cross, 2008; Schneiderman, et al.,2010). With one quarter to one thirdof children in foster care having adiagnosed medical problem (Sullivan& Zyl, 2008; Kortenkamp & Ehrele,2002), it is surmised that children inchild welfare may be among the mostmedically fragile children in the UnitedStates. Being in foster care longer, andhaving more visits from the agency inthe past six months increases thechance that children have a diagnosedhealth problem (Sullivan & Zyl, 2008)

SETTING THE CONTEXT


and children under age six who are infoster care have more medicalproblems and development delays thanthe general population and than theirolder counterparts in child welfare(Berkoff, Leslie & Stahmer, 2006; Leslie,et al., 2005; Stahmer, et al., 2005;Vandivere, Chalk & Moore, 2003).

Physical HealthChronic health conditions are commonfor many children in the child welfaresystem. National studies on physicalhealth problems of children in the childwelfare system found that 27.9% ofchildren had a chronic medicalcondition, with children under age twomore likely to report a chronic medicalcondition than older children; with ratesnot differing by placement, in fostercare or remaining at home (Ringeisen,et al., 2008). Of children who havebeen in foster care for more than oneyear, Table 1 describes their chronichealth conditions.

TABLE 1: CHRONIC HEALTHCONDITIONS OF CHILDREN IN FOSTERCARE FOR MORE THAN ONE YEAR

30% of the children have a chronichealth condition> 20% one chronic condition,> 3.8% had two chronic conditions, and> 3.1% had three or more conditions.Most common chronic conditions> 32.8 % asthma;> 2% other respiratory problem;> 6% allergies, repeated ear infections,

and eczema or other skin disease

There is an increased risk of chroniccondition for children under two years ofage, if the caregiver’s race/ethnicity isother than Hispanic, and if there arerelatively few household members.(Jee et al, 2006)

ObesityEvidence is starting to show thatchildren in child welfare have higherrates of obesity than the generalpopulation. Childhood obesity is nowrecognized as a problem for childrenin child welfare (Steele & Buchi, 2008;Schneiderman, et al., 2011) and recentcommentary and judicial decisionshave suggested that perhaps extremeobesity, especially coupled with anotherchronic health condition, should beconsidered child neglect (Murtagh &Ludwig, 2011; Varness, et al., 2009).Furthermore, drawing on the AdverseChildhood Experiences (ACEs) study, alink has been identified between specificviolence-related stressors, includingchild abuse and neglect, and riskybehaviors and health problems inadulthood (Felitti, et al., 1998). Theretrospective ACEs study found thatreports of childhood maltreatment wererelated to obesity in adulthood. The riskof obesity increased with the severity ofthe maltreatment, and childhoodphysical and verbal abuse were moststrongly related to Body Mass Index(BMI) and obesity (Williamson,Thompson, Anda, Dietz & Felitti, 2002).

Risks of Injury and FatalityChildren known to the child welfaresystem may be at greater risk of fatalityaccording to recent data analyzed byPutnam-Hornstein (2011). She foundthat, in California, after adjusting forrisk factors at birth, a prior allegationof maltreatment was a significant riskfactor for later death due to injury.Furthermore, continuing to adjust forrisk factors at birth, children with aprior allegation of maltreatment diedfrom intentional injury at a rate thatwas 5.9 times greater than unreportedchildren, and died from unintentionalinjuries at twice the rate of unreportedchildren.

Using NSCAW data, Schneidermanand colleagues (2010) found that10.3% of children who remain at homeafter a Child Protective Services (CPS)investigation had a serious injury, andthis was 2.1 times more likely if thechild had a chronic medical problemor if the caregiver was depressed(especially in younger caregivers).

Behavioral and Developmental RisksWhen focusing on mental health anddevelopmental problems in maltreatedchildren, researchers found that 80% ofchildren in child welfare are estimatedto have emotional or behavioraldisorders, developmental delays orother indications of needing mentalhealth intervention, compared to 20%of the general population (Korenkamp& Ehrele, 2002; Dore, 2005).

Behavioral ProblemsThe rates for delinquent behavior(15%) and aggressive behavior(11%) for children in foster care areover twice as high as the rates amongchildren in the general population(Armsden, et al., 2000). Analysis ofdata from NSCAW (2005) suggeststhat those children who are maltreatedhave increased likelihood ofdepression, subsequent substanceabuse, sexual activity at an earlyage, and are at greater risk for teenpregnancy.

In terms of the mental health problemsfor children in child welfare, McCrae’s(2009) analysis of NSCAW data foundthat 50% of child welfare-involvedchildren score in the clinical rangefor disorders, with more childrenhaving externalizing rather thaninternalizing symptoms.


he presentation painted a picturef the health status and healthare needs of children in the childelfare system. This section of the

eport reviews some of the keyndings that were presented,overing a range of factorscluding:

Physical health status includinghronic conditions and obesity

Risks of injury and fatalities.Behavioral and developmental

sks.Health status differentials

elated to age.Health care utilization,

cluding mental health andlopmental service use.

egiver issues.

ant data on the health of childrenwelfare can be drawn from the

al Study of Child and Adolescenteing (NSCAW). Schneiderman’sation drew upon her ownh, using NSCAW data and datas Angeles, CA, supported by theal Institute on Child Health andDevelopment (NICHD), and that

y other researchers who havearefully analyzing the NSCAWs. The presentation broughtr NSCAW findings and otherddressing health care needs,status, and utilization. It shouldd that some of the citationso national data and some areate specific. (The PowerPoint ofderman’s full presentation andrences are available on the

website,ocialworkpolicy.org]).

ABOUT THE NATIONAL STUDY OF CHILDAND ADOLESCENT WELL-BEING (NSCAW)

Created from a Congressional mandate aspart of the Personal Responsibility and WorkOpportunities Reconciliation Act of 1996, theDepartment of Health and Human Serviceslaunched NSCAW. It is the first national studythat examines child and family well-beingoutcomes in detail and seeks to relate thoseoutcomes to their experience with the childwelfare system and to family characteristics,community environment, and other factors.The study describes the child welfare systemand the experiences of children and familieswho come in contact with the system. It isintended to increase the knowledge neededto support service, program, and policyplanning. Data presented at the symposiumwas based on analysis from the findings ofthe first longitudinal sample (NSCAW I). Formore information visit www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/#overview.

According to NSCAW and other data,the developmental and physicalproblems of children, especially youngchildren, who remain at home, aresimilar to those of children who areplaced in foster care (Leslie, et al.,2005; Ringeisen, Casanueva, Urato& Cross, 2008; Schneiderman, et al.,2010). With one quarter to one thirdof children in foster care having adiagnosed medical problem (Sullivan& Zyl, 2008; Kortenkamp & Ehrele,2002), it is surmised that children inchild welfare may be among the mostmedically fragile children in the UnitedStates. Being in foster care longer, andhaving more visits from the agency inthe past six months increases thechance that children have a diagnosedhealth problem (Sullivan & Zyl, 2008)

SETTING THE CONTEXT


Sullivan and Zyl (2008) of utilizationdata in Kentucky found that whether thechild was in an urban or rural settingdid not determine the adequacy ofavailable health care resources.

According to the Department of Healthand Human Services (HHS) (2005),about 30% of foster children do notget adequate health services due toproviders not taking Medicaid, resultingin the absence of timely health andmental health assessments; and the lackof preventive health and dental care.Findings from NSCAW indicate thatemergency room visits are higher forchildren who receive child welfareservices than the national average,with 36% of children who remain athome using emergency departments(Schneiderman, et al., 2012) and 31%of children who are in foster care forone year (Jee, et al., 2005). The highuse of emergency room care suggeststhat children in child welfare may nothave regular primary and preventativehealth care services available to them.

Mental Health and DevelopmentalService UseLatinos, African Americans and Asianchildren in foster care are less likely toreceive mental health services thanother children in foster care (Garland,Lau, Yeh McCabe, Hough & Landsverk,2005). However it should be noted thatnot all children receiving child welfareservices need mental health care andthat the use of mental health care has acultural component. On average, only11% of children nationally who had achild protection investigation, in theNSCAW, sample received services toaddress all of their specific needs(Burns, et al., 2004).

Numerous studies indicate that childwelfare agencies lack the necessary

services, training and supports tothe mental health and developmeneeds of the children in the syste(Cooper, et al., 2010: Cooper, e2008; McCarthy, et al., 2004).Research indicates that there is aabsence of a systemic approachidentifying children with mental hand developmental needs, a lackcollaboration across agencies ansystems, and inadequate capacitamong mental health providers tobest serve these vulnerable childr

Caregiver IssuesCaregivers, whether birth familiekinship care providers or unrelatefoster parents should have a rolehealth care provision. However,according to Schneiderman, et a(2007), the voices of caregivers,as foster parents are not part of thealth delivery team. Foster pareoften receive inadequate health tand may not receive the child’sMedicaid card or sufficient mediinformation at the time of placemnor at any time soon after placem(Schneiderman, et al., 2011). Chwelfare caseworkers may help winsurance and referrals, howeverkinship caregivers may receive lesupport from caseworkers thanunrelated foster caregivers. Unrefoster caregivers, as opposed tocaregivers, noted that children incare often have poor continuity ohealth care and difficulties withtransportation to their usual healtproviders. Health care was improif the caregiver had a pre-existingrelationship with a pediatrician, wfacilitated use of health care serv(Pasztor, et al., 2006).

Birth parents are not necessarilyincluded in conversations regardtheir children’s health care needs


The findings indicate:

> Clinical-level thought problems (25%)> Aggressive behavior (21%)> Delinquent behavior (19%)> Attention problems (18%)> Social behavior problems (14%)> Anxious/depressed behavior (13%)> Withdrawn behavior (11%)> Sexualized behavior (9%)> Somatic complaints (7%)

Children in foster care are twice aslikely as in-home children who are notreceiving services to report problembehaviors; and those in group care aremore likely to exhibit serious behaviorproblems and depression comparedwith children in other out-of-homesettings (NSCAW, 2005). This may bedue to selection bias related to whichchildren end up in group care settings.

In regard to kinship care, placementswith kin resulted in improvements inbehavior problems over those childrenwho were in other foster care settings(Barth, Green, Guo, & McCrae, 2007).Furthermore, those children who werein foster care have an increasedlikelihood of mental health disordersand social dysfunction in adulthood(Casey Family Programs, 2005).

Burns and colleagues (2004) found thatonly 7% of young people in theNSCAW sample received mental healthservices. For those young people whodo receive mental health services, theyare more likely to be male, to be inout-of-home placements, to experiencemultiple risk factors, to be white, and tohave a caregiver with higher education(McCrae, Barth, & Guo, 2010).

It is also important to note that themental health of caregivers is also anissue for children in child welfare, asrisks for maltreatment and foster careplacement can be linked to the parent’smental status, especially the mother’s.Drawing from NSCAW data,Schneiderman, et al. (2010) found thatinjury after a CPS report is more likelyif the caregiver is depressed.

Developmental DelaysChildren in foster care nationally havedevelopmental delays at five times therate of all other children (Zimmer &Panko, 2006), with children youngerthan six years of age in foster carehaving a likelihood of developmentaldelays between 16 to 62% comparedto 4–10% for the general population(Halfon et al., 1995; Leslie, Gordon,Ganger, & Gist, 2002; Stahmer et al.,2005; Drillien, Pickering, & Drummond,1988; Fox & McManus, 1996). Inalmost half of young children in fostercare in a national study, delays incognitive, behavioral, and social skillswere severe enough to indicateeligibility for early intervention services(Stahmer et al., 2005). Besides fosterchildren having a likelihood of delays,Cooper and colleagues (2008) foundthat these children are not receiving theservices and supports that they need tomeet their developmental needs.

Young Children in Child Welfare are atthe Greatest RiskPreschoolers, in general, exposed tofamily violence show increased rates ofdisturbances in self- regulation and inemotional, social, and cognitivefunctioning (Cooper, Banghart &Aratani, 2010); and 32 to 42% ofchildren in child welfare with emotionaland behavioral needs are under agesix (McCrae, 2009). Furthermore, theage of the first episode of maltreatmentis associated with mental healthproblems in adulthood; noting that theyounger the age of the child at the firstepisode, the more significant the mentalhealth problems are in adulthood(Kaplow & Widom, 2007).

Older Youth also Experience HighHealth Risk FactorsAccording to NSCAW (2005) findings:

> Youth over age 11 are twice as likelyto exhibit conduct problems asyounger children receiving childwelfare services.

> Youth receiving child welfareservices are almost four times aslikely as youth in the generalpopulation to have been pregnant orgotten someone pregnant.

> Youth living in out of home care aremore likely to report problembehaviors and substance use issuesthan those youth receiving childwelfare services in their own homes.

Health Care UtilizationA disproportionate share of Medicaidexpenditures are spent on children infoster care due to the magnitude ofmental health services they receive(Geen, Sommers, & Cohen, 2005) andnationally, the use of targeted casemanagement increases Medicaidspending on foster care. Analysis by


Sullivan and Zyl (2008) of utilizationdata in Kentucky found that whether thechild was in an urban or rural settingdid not determine the adequacy ofavailable health care resources.

According to the Department of Healthand Human Services (HHS) (2005),about 30% of foster children do notget adequate health services due toproviders not taking Medicaid, resultingin the absence of timely health andmental health assessments; and the lackof preventive health and dental care.Findings from NSCAW indicate thatemergency room visits are higher forchildren who receive child welfareservices than the national average,with 36% of children who remain athome using emergency departments(Schneiderman, et al., 2012) and 31%of children who are in foster care forone year (Jee, et al., 2005). The highuse of emergency room care suggeststhat children in child welfare may nothave regular primary and preventativehealth care services available to them.

Mental Health and DevelopmentalService UseLatinos, African Americans and Asianchildren in foster care are less likely toreceive mental health services thanother children in foster care (Garland,Lau, Yeh McCabe, Hough & Landsverk,2005). However it should be noted thatnot all children receiving child welfareservices need mental health care andthat the use of mental health care has acultural component. On average, only11% of children nationally who had achild protection investigation, in theNSCAW, sample received services toaddress all of their specific needs(Burns, et al., 2004).

Numerous studies indicate that childwelfare agencies lack the necessary

services, training and supports to meetthe mental health and developmentalneeds of the children in the system(Cooper, et al., 2010: Cooper, et al.,2008; McCarthy, et al., 2004).Research indicates that there is anabsence of a systemic approach toidentifying children with mental healthand developmental needs, a lack ofcollaboration across agencies andsystems, and inadequate capacityamong mental health providers tobest serve these vulnerable children.

Caregiver IssuesCaregivers, whether birth families,kinship care providers or unrelatedfoster parents should have a role inhealth care provision. However,according to Schneiderman, et al.(2007), the voices of caregivers, suchas foster parents are not part of thehealth delivery team. Foster parentsoften receive inadequate health trainingand may not receive the child’sMedicaid card or sufficient medicalinformation at the time of placement,nor at any time soon after placement(Schneiderman, et al., 2011). Childwelfare caseworkers may help withinsurance and referrals, howeverkinship caregivers may receive lesssupport from caseworkers thanunrelated foster caregivers. Unrelatedfoster caregivers, as opposed to kinshipcaregivers, noted that children in fostercare often have poor continuity ofhealth care and difficulties withtransportation to their usual health careproviders. Health care was improvedif the caregiver had a pre-existingrelationship with a pediatrician, whichfacilitated use of health care services(Pasztor, et al., 2006).

Birth parents are not necessarilyincluded in conversations regardingtheir children’s health care needs while

the children are in foster care. Theyalso may not access health or mentalhealth care for themselves, perhapsdue to a lack of coverage, even if theirchild has access to coverage throughMedicaid or CHIP. The expandedaccess that parents will have tocoverage, beginning in 2014, maywell have substantial health benefitsfor children and parents as parentsmay be more likely to attend to theirchildren’s health care needs when theyare also able to attend to their own.As previously noted, caregivers’mental health status is also a riskfactor for children.

Thus, children in child welfare havehigh physical and mental health needsand developmental delays. However,they may not have regular access to theservices that would best meet theirneeds to optimize their health andwell-being.

> LEGISLATIVEPROVISIONS TOENHANCE HEALTHCARE AND HEALTHOUTCOMESSeveral recent legislative changes haveespecially addressed the health needsand health outcomes for children in thechild welfare system. The PatientProtection and Affordable Care Act(ACA) addresses foster care in severalsections, but also addresses overallissues of access, enhanced coverageand prevention. These shouldpotentially result in improved healthof children in the child welfaresystem. Table 2 highlights themost relevant provisions.


nd colleagues (2004) found that% of young people in theW sample received mental healths. For those young people whoeive mental health services, theyre likely to be male, to be inome placements, to experiencee risk factors, to be white, and tocaregiver with higher education

ae, Barth, & Guo, 2010).

o important to note that thehealth of caregivers is also anr children in child welfare, asr maltreatment and foster careent can be linked to the parent’sstatus, especially the mother’s.g from NSCAW data,derman, et al. (2010) found thatafter a CPS report is more likelyaregiver is depressed.

pmental Delaysn in foster care nationally havepmental delays at five times theall other children (Zimmer &2006), with children younger

x years of age in foster carea likelihood of developmentalbetween 16 to 62% compared0% for the general population

et al., 1995; Leslie, Gordon,r, & Gist, 2002; Stahmer et al.,Drillien, Pickering, & Drummond,Fox & McManus, 1996). Inhalf of young children in fostera national study, delays in

ve, behavioral, and social skillsevere enough to indicatety for early intervention serviceser et al., 2005). Besides fostern having a likelihood of delays,r and colleagues (2008) foundse children are not receiving thes and supports that they need toeir developmental needs.

Young Children in Child Welfare are atthe Greatest RiskPreschoolers, in general, exposed tofamily violence show increased rates ofdisturbances in self- regulation and inemotional, social, and cognitivefunctioning (Cooper, Banghart &Aratani, 2010); and 32 to 42% ofchildren in child welfare with emotionaland behavioral needs are under agesix (McCrae, 2009). Furthermore, theage of the first episode of maltreatmentis associated with mental healthproblems in adulthood; noting that theyounger the age of the child at the firstepisode, the more significant the mentalhealth problems are in adulthood(Kaplow & Widom, 2007).

Older Youth also Experience HighHealth Risk FactorsAccording to NSCAW (2005) findings:

> Youth over age 11 are twice as likelyto exhibit conduct problems asyounger children receiving childwelfare services.

> Youth receiving child welfareservices are almost four times aslikely as youth in the generalpopulation to have been pregnant orgotten someone pregnant.

> Youth living in out of home care aremore likely to report problembehaviors and substance use issuesthan those youth receiving childwelfare services in their own homes.

Health Care UtilizationA disproportionate share of Medicaidexpenditures are spent on children infoster care due to the magnitude ofmental health services they receive(Geen, Sommers, & Cohen, 2005) andnationally, the use of targeted casemanagement increases Medicaidspending on foster care. Analysis by


O’Reilly, Luan, Localio, 2007). To betterunderstand the mechanisms throughwhich the system influences a child’splacement and behavioral healthtrajectories, Rubin launched the CSAWstudy (supported by the NICHD, theWilliam Penn Foundation, and theStoneleigh Foundation). Developed inclose collaboration with child welfare,school district, and foundation partners,CSAW followed a cohort of 403 childrenages three to eight for 24 months.

Specifically, the study sought to betterunderstand the structural opportunities topromote placement stability and childwell-being by examining the following:

1 . The impact of placement stabilityon educational outcomes;

2 . Agency characteristics (includingworkforce) affecting placementstability; and

3 . The relationship between kinshipcare, placement with siblings,

placement stability andbehavioral health.

Early CSAW findings indicated thchildren in foster care have signibehavioral health needs. Over aof children entering their first plahad behavioral problems, as meaby the Child Behavior Checklist (Further, children’s behavior was aleading reason cited for childrenplacement moves (Noonan, et al2009; Rubin, et al., 2007). Evidalso demonstrates that children incare often have limited access toquality behavioral health servicesthat these services and child welfservices are poorly integrated (Bet al., 2004). To understand wharequires to build a system of careimproves behavioral health outcoof children in child welfare, Policinvestigated evidence-based behhealth services for children, bothpharmacological and non-


TABLE 2: RECENT FEDERALLEGISLATION IMPACTING CHILDRENIN THE CHILD WELFARE SYSTEM

Fostering Connections to Success andIncreasing Adoptions Act of 2009 (P.L.110-351) (www.gpo.gov/fdsys/pkg/PLAW-110publ351/pdf/PLAW-110publ351.pdf).> Requires states to develop a plan for the

on-going oversight and coordination ofhealth services for children in foster care,in consultation with the state Medicaidagency.

> Requires oversight of medicationsprescribed to children in foster care

> Provides option for youth remain in careto age 19, 20, or 21 (perhaps resulting inmore consistent access to health care).

> Increases support to kinship careproviders (perhaps resulting in moreconsistent access to health care).

Children’s Health Insurance ProgramReauthorization Act of 2009 (CHIPRA)(P.L. 111-3) (http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_laws&docid=f:publ003.111.pdf%20).> Provides incentives to undertake active

outreach to enroll more children.

Patient Protection and Affordable Care Act of2010 (ACA) (P.L. 111-148) (www.gpo.gov/fdsys/pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf).> Promotes focus on health outcomes.> Promotes integration of behavioral

health care and primary care.> Promotes Health Homes (section 2703),

Medication Management (Section 3503),and Pediatric Accountable CareOrganizations (Section 2706).

> Provides Medicaid coverage for childrenwho were in foster care through age 26(Section 2004) and supports transitionplanning (Section 2955).

> Provides $500 million for evidence-basedearly childhood home visiting (Section2951).

> Provides federal subsidies for healthinsurance purchasing (may be throughhealth exchanges) for families withincomes up to 400% of the federalpoverty level (FPL), by 2014.

Child and Family Services Improvement andInnovation Act (P.L. 112-34)www.gpo.gov/fdsys/pkg/PLAW-112publ34/pdf/PLAW-112publ34.pdf.> Includes provisions to track and monitor

use of psychotropic medications.> Expands demonstration programs related

to drug use, beyond justMethamphetamine.

> BRIDGING RESEARCHAND POLICY TO IMPROVETHE BEHAVIORALHEALTH OF CHILDRENIN CHILD WELFAREImproving the health, includingbehavioral health, of children in childwelfare requires an understanding ofthe individual, organizational andpolicy factors that impact outcomes forchildren. PolicyLab, an interdisciplinaryresearch center at The Children’sHospital of Philadelphia (for informationon PolicyLab see Appendix 10), usespractice-informed research to promoteprogram and policy change forvulnerable children. In particular,

PolicyLab has strong expertise in childwelfare, and is currently engaged in anumber of projects to more effectivelyand efficiently bridge research, practiceand policy in the child welfare system.Because of this work, PolicyLab was animportant collaborator, along with USC,in planning this symposium (and was acatalyst in engaging pediatricians andhealth care professionals in the event).Sarah Zlotnik, PolicyLab’s SeniorStrategist, provided an overview ofseveral PolicyLab projects thatdemonstrate the center’s systems-levelapproach and attention to strategicimpact in its work.

Children’s Stability and Well-beingStudyThe Children’s Stability and Well-being(CSAW) study investigates the impact ofchild welfare system characteristics onplacement stability and child well-being.Previous work with NSCAW data byDr. David Rubin, PolicyLab director,informed the design and execution ofthis study with its finding that placementinstability was associated with poorbehavioral health outcomes (Rubin,

FIGURE 1: THE STEPS IN BUILDING POLICYLAB’SPOLICY-RELEVANT RESEARCH PORTFOLIO


O’Reilly, Luan, Localio, 2007). To betterunderstand the mechanisms throughwhich the system influences a child’splacement and behavioral healthtrajectories, Rubin launched the CSAWstudy (supported by the NICHD, theWilliam Penn Foundation, and theStoneleigh Foundation). Developed inclose collaboration with child welfare,school district, and foundation partners,CSAW followed a cohort of 403 childrenages three to eight for 24 months.

Specifically, the study sought to betterunderstand the structural opportunities topromote placement stability and childwell-being by examining the following:

1 . The impact of placement stabilityon educational outcomes;

2 . Agency characteristics (includingworkforce) affecting placementstability; and

3 . The relationship between kinshipcare, placement with siblings,

placement stability andbehavioral health.

Early CSAW findings indicated thatchildren in foster care have significantbehavioral health needs. Over a thirdof children entering their first placementhad behavioral problems, as measuredby the Child Behavior Checklist (CBCL).Further, children’s behavior was aleading reason cited for children’splacement moves (Noonan, et al.,2009; Rubin, et al., 2007). Evidencealso demonstrates that children in fostercare often have limited access toquality behavioral health services andthat these services and child welfareservices are poorly integrated (Burns,et al., 2004). To understand what itrequires to build a system of care thatimproves behavioral health outcomesof children in child welfare, PolicyLabinvestigated evidence-based behavioralhealth services for children, bothpharmacological and non-

pharmacological, and how theseservices could be best funded,operationalized, and monitored.

PolicyLab is piloting the implementationof evidence-based behavioral healthinterventions in the City of Philadelphiain an effort to strengthen the behavioralhealth system’s capacity to supportquality interventions that work.Specifically, PolicyLab is evaluating thedelivery of a two-tiered intervention:Parent- Child Interaction Therapy andChild Adult Relationship Enhancement,a behavioral management training forcaregivers. Efforts were made toprioritize capacity building andsustainability by co-locating behavioralhealth services in two foster careagencies, training local mental healthproviders to deliver the services, andidentifying public funding (blending ofMedicaid and child welfare funding) tosupport the services beyond theconclusion of the research study.

Use of Psychotropic Medications inFoster CareAs PolicyLab is on-the-ground learningabout the operational challengesfamilies face in the receipt ofevidenced–based behavioral services,the center is concurrently engaged ina national project to examine trendsin psychotropic medication usage forchildren in foster care. With fundingfrom the Agency for HealthcareResearch and Quality (AHRQ),PolicyLab is using 50-state Medicaiddata from 2002-2007 to examinerates of psychotropic medicationand antipsychotic medicationprescription for a) children in fostercare, and b) all children enrolledin Medicaid. In addition, thestudy incorporates an analysisof states’ child welfare andmental health policies


ealth care and primary care.Promotes Health Homes (section 2703),Medication Management (Section 3503),nd Pediatric Accountable CareOrganizations (Section 2706).Provides Medicaid coverage for childrenwho were in foster care through age 26Section 2004) and supports transitionlanning (Section 2955).Provides $500 million for evidence-basedarly childhood home visiting (Section2951).Provides federal subsidies for healthnsurance purchasing (may be throughealth exchanges) for families withncomes up to 400% of the federaloverty level (FPL), by 2014.

d and Family Services Improvement andvation Act (P.L. 112-34)w.gpo.gov/fdsys/pkg/PLAW-112publ34//PLAW-112publ34.pdf.ncludes provisions to track and monitorse of psychotropic medications.xpands demonstration programs relatedo drug use, beyond justMethamphetamine.

IDGING RESEARCHPOLICY TO IMPROVE

BEHAVIORALLTH OF CHILDRENHILD WELFAREng the health, includingoral health, of children in childrequires an understanding ofvidual, organizational andactors that impact outcomes forn. PolicyLab, an interdisciplinaryh center at The Children’s

al of Philadelphia (for informationcyLab see Appendix 10), usese-informed research to promotem and policy change forble children. In particular,

PolicyLab has strong expertise in childwelfare, and is currently engaged in anumber of projects to more effectivelyand efficiently bridge research, practiceand policy in the child welfare system.Because of this work, PolicyLab was animportant collaborator, along with USC,in planning this symposium (and was acatalyst in engaging pediatricians andhealth care professionals in the event).Sarah Zlotnik, PolicyLab’s SeniorStrategist, provided an overview ofseveral PolicyLab projects thatdemonstrate the center’s systems-levelapproach and attention to strategicimpact in its work.

Children’s Stability and Well-beingStudyThe Children’s Stability and Well-being(CSAW) study investigates the impact ofchild welfare system characteristics onplacement stability and child well-being.Previous work with NSCAW data byDr. David Rubin, PolicyLab director,informed the design and execution ofthis study with its finding that placementinstability was associated with poorbehavioral health outcomes (Rubin,

FIGURE 1: THE STEPS IN BUILDING POLICYLAB’SPOLICY-RELEVANT RESEARCH PORTFOLIO


enrollment (www.medicaid.gov/State-Resource-Center/Medicaid- and-CHIP-Program-Portal/Medicaid- and-CHIP-Program-Portal.html).

Opportunities in the AffordableCare ActOnce the full provisions of the ACAkick-in in 2014, it is expected that 32million people will access health carecoverage and that 94% of thepopulation will be covered. The goalfor 2014 is that a culture of coveragewill develop. For children in the childwelfare system, there will be arequirement that states maintainMedicaid coverage when childrenleave foster care, up to age 26,although the federal guidance is not yetissued. The ACA also included $1.5billion over 5 years for the establishmentof evidence- based home visitingprograms for young children and theirparents, providing an expanded focuson prevention. In addition, thedevelopment of medical homes, it is

believed, will lead to more stcare and greater coordinatiocomprehensive care, benefittchildren in the child welfare

This culture of coverage shiftbe viewed as a pillar for servkids. The expansion of Medito cover people with incomesto 133% of the federal poveline (FPL) will include manyparents/adults of these highchildren, and may help stimumore regular access to care.parents able to access coverthemselves, they also may msure that their children receivneeded care.

Families with incomes up to 4of the FPL will be eligible to rfederal subsidies to purchase

care through the new state exchathat will be operational in 2014.Federal law requires states to dev“no wrong door” enrollment procallowing families to enroll in theprogram (exchange, Medicaid, Cthat best fits their circumstances.are also required to offer web-baenrollment, and much needs to bto create easily accessible healthinformation technology systems foto move forward effectively. For min the managed care industry, 20viewed as a business opportunitythe high level of new funds that wavailable through Medicaid.

Medicaid Use by Foster ChildrenSpecific to children in the foster csystem, it is important to understatheir relationship to Medicaid. Achildren in foster care are categoeligible for Medicaid. Although fchildren represent only 3.7% ofnon-disabled children enrolled inMedicaid, they account for 12.3


examining their rules for oversight (redflags), consent, and mental healthscreening and assessment, as well asthe states’ overall Medicaid structure.This analysis enables PolicyLab toexamine the Medicaid data in thecontext of policy changes in order toidentify how patterns in systems’approaches potentially shape patternsof usage. Moving forward, a centralgoal of the analysis is to inform bestpractices in prescription and oversight.

PolicyLab’s Lessons LearnedPolicyLab serves as a catalyst andconvener in the field of health policyfor children. The center works withstakeholders to address implementationand sustainability concerns and it usespolicy-informed research to understandbarriers to meeting the health andbehavioral health needs of children inchild welfare.

From PolicyLab’s efforts to bridgeresearch and policy, there are anumber of lessons to be learned:

> Attention to timeliness and asolution-oriented approach areessential;

> Development and maintenance oftruly collaborative relationships isnecessary.

> A focus on both process andcontent is needed when trying toshift approaches to both researchand policy.

> Researchers can play a criticalrole in strengthening a publicsystem’s capacity to better meetthe needs of children.

LEGISLATION AND GAO REPORTRAISES PROFILE OF PSYCHOTROPICMEDICATION USE

It should be noted that there is growingconcern about high rates of psychotropicmedication use in children in foster care,resulting in the provisions related tooversight and monitoring of usage thatwere included in the 2011 Child and FamilyServices Improvement and Innovations Act.In addition, a high rate of media attentionwas garnered when the GovernmentAccountability Office (GAO) released aDecember 2011 report HHS GuidanceCould Help States Improve Oversight ofPsychotropic Prescriptions(www.gao.gov/assets/590/586570.pdf),spurring action by HHS (Samuels, 2012).

> PUBLIC HEALTH CARECOVERAGE FORCHILDRENTo understand how we can bettermeet children’s health care needs it isimportant to understand the currentnational landscape related to publicprograms that cover children as thishas implications for children served inchild welfare as well as those who areat risk of entering care. Joan Alker,co-executive director of theGeorgetown University Health PolicyInstitute’s Center for Children and

Families (ccf.georgetown.edu),provided a detailed review of Medicaidand Children’s Health InsuranceProgram (CHIP) coverage, including theimplications for coverage in the ACA.

Acknowledging that there has beenremarkable progress to lower the rateof uninsured children, 2008 had thelowest rate since data began to becollected in 1987. This is due to boththe availability of Medicaid and CHIP;and despite budget challenges, almostall states are holding Medicaid andCHIP coverage steady. This is also dueto the “maintenance of effort”provisions of the ACA. A number ofstates are also continuing to moveforward with initiatives that are aimedat increasing coverage (13 states) andachieving administrative efficiencies toenrollment and renewal procedures(14 states). However, as more childrenaccess coverage, the disparity ofcoverage between children and adultsis growing since the rate of uninsuranceis lower for children than adults.Moreover, children’s rates ofuninsurance are decreasing whileadults’ rates are increasing.

To increase children’s coverage rates,one important area of focus has beenenrolling children who are eligible forcoverage but are uninsured. It isbelieved that 65% of children who arecurrently uninsured would be eligiblefor Medicaid and CHIP (Kenney,2011). Many of these children arein mixed immigration households.There are a number of initiativesfocused on addressing the barriersat the state level and to enhancecommunications among differentservice sectors to increase coverage foreligible children. The Centers forMedicaid and Medicare Services(CMS) has issued grants to stimulate


enrollment (www.medicaid.gov/State-Resource-Center/Medicaid- and-CHIP-Program-Portal/Medicaid- and-CHIP-Program-Portal.html).

Opportunities in the AffordableCare ActOnce the full provisions of the ACAkick-in in 2014, it is expected that 32million people will access health carecoverage and that 94% of thepopulation will be covered. The goalfor 2014 is that a culture of coveragewill develop. For children in the childwelfare system, there will be arequirement that states maintainMedicaid coverage when childrenleave foster care, up to age 26,although the federal guidance is not yetissued. The ACA also included $1.5billion over 5 years for the establishmentof evidence- based home visitingprograms for young children and theirparents, providing an expanded focuson prevention. In addition, thedevelopment of medical homes, it is

believed, will lead to more stablecare and greater coordination ofcomprehensive care, benefittingchildren in the child welfare system.

This culture of coverage shift canbe viewed as a pillar for servingkids. The expansion of Medicaidto cover people with incomes upto 133% of the federal povertyline (FPL) will include manyparents/adults of these high riskchildren, and may help stimulatemore regular access to care. Withparents able to access coverage forthemselves, they also may makesure that their children receive theneeded care.

Families with incomes up to 400%of the FPL will be eligible to receivefederal subsidies to purchase health

care through the new state exchangesthat will be operational in 2014.Federal law requires states to develop“no wrong door” enrollment processes,allowing families to enroll in theprogram (exchange, Medicaid, CHIP)that best fits their circumstances. Statesare also required to offer web-basedenrollment, and much needs to be doneto create easily accessible healthinformation technology systems for thisto move forward effectively. For manyin the managed care industry, 2014 isviewed as a business opportunity withthe high level of new funds that will beavailable through Medicaid.

Medicaid Use by Foster ChildrenSpecific to children in the foster caresystem, it is important to understandtheir relationship to Medicaid. Allchildren in foster care are categoricallyeligible for Medicaid. Although fosterchildren represent only 3.7% ofnon-disabled children enrolled inMedicaid, they account for 12.3% of

this group’s expenditures according toa study by the Urban Institute (Geen,Sommers & Cohen, 2005). Restatingthe high incidence of mental healthneeds of foster children that has beenpreviously noted, mental health serviceuse is 8 to 15 times higher for childrenin foster care than other high risk, lowincome children enrolled in Medicaid(Harman, et al., 2000) and thesechildren are prescribed psychotropicdrugs at a higher rate than otherchildren. Some are concerned that asstates look to cut costs in tight budgettimes, these users of a disproportionateamount of services might be at risk.

Medicaid and State RevenueIn thinking about the funding of healthcare services through Medicaid it isimportant to consider that there are twosides to the state budget equation:expenditures and revenue. Medicaidenrollment has gone up, while revenuesgo down, and the enhanced FederalMedical Assistance Percentages (FMAP)are vital to states addressing budgetshortfalls. Per capita Medicaid isgrowing more slowly than privatesector health care and it costs less,partially due to the low reimbursementrates for providers.

Managed CareMany states are continuing to look tomanaged care to solve their problemsrelated to both budgets and coverage.As of 2010 all states and DC (exceptfor Alaska, New Hampshire andWyoming) were using comprehensiveMedicaid Managed Care. Nearly66% of all Medicaid beneficiariesare enrolled in managed care andabout 17 states have statewidecapitated managed care forfoster children. Children incare cannot be placed intomanaged care without a

1 0> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L WO R K P O L I C Y I N S T I T U T E

cus on both process andent is needed when trying toapproaches to both researchpolicy.archers can play a criticalin strengthening a publicm’s capacity to better meeteeds of children.

SLATION AND GAO REPORTSES PROFILE OF PSYCHOTROPICDICATION USE

ould be noted that there is growingern about high rates of psychotropicication use in children in foster care,ting in the provisions related tosight and monitoring of usage thatincluded in the 2011 Child and Familyices Improvement and Innovations Act.ddition, a high rate of media attentiongarnered when the Governmentuntability Office (GAO) released amber 2011 report HHS Guidanced Help States Improve Oversight ofhotropic Prescriptionsw.gao.gov/assets/590/586570.pdf),ring action by HHS (Samuels, 2012).

BLIC HEALTH CAREVERAGE FORDRENerstand how we can betterhildren’s health care needs it isant to understand the currentl landscape related to publicms that cover children as thisplications for children served inelfare as well as those who areof entering care. Joan Alker,utive director of the

etown University Health Policy’s Center for Children and

Families (ccf.georgetown.edu),provided a detailed review of Medicaidand Children’s Health InsuranceProgram (CHIP) coverage, including theimplications for coverage in the ACA.

Acknowledging that there has beenremarkable progress to lower the rateof uninsured children, 2008 had thelowest rate since data began to becollected in 1987. This is due to boththe availability of Medicaid and CHIP;and despite budget challenges, almostall states are holding Medicaid andCHIP coverage steady. This is also dueto the “maintenance of effort”provisions of the ACA. A number ofstates are also continuing to moveforward with initiatives that are aimedat increasing coverage (13 states) andachieving administrative efficiencies toenrollment and renewal procedures(14 states). However, as more childrenaccess coverage, the disparity ofcoverage between children and adultsis growing since the rate of uninsuranceis lower for children than adults.Moreover, children’s rates ofuninsurance are decreasing whileadults’ rates are increasing.

To increase children’s coverage rates,one important area of focus has beenenrolling children who are eligible forcoverage but are uninsured. It isbelieved that 65% of children who arecurrently uninsured would be eligiblefor Medicaid and CHIP (Kenney,2011). Many of these children arein mixed immigration households.There are a number of initiativesfocused on addressing the barriersat the state level and to enhancecommunications among differentservice sectors to increase coverage foreligible children. The Centers forMedicaid and Medicare Services(CMS) has issued grants to stimulate


> In spite of the relatively small numbers,efforts at federal, state, and locallevels focusing on access, quality andoutcomes of health-related care for thechild welfare population are emerging,warranted and gaining traction.

> Psychotropic medication use is acentral issue to improving the qualityof care and outcomes for children inchild welfare.

> Continued attention to developingeffective systems to monitor andimprove care – and the policies tosupport them – is needed.

Faces of MedicaidThe Faces of Medicaid project examinedMedicaid claims data for 2005 andspecifically looked at children in fostercare. Findings indicate that fosterchildren are 3% of the Medicaidpopulation and 15% of the Medicaidusers of behavioral health services; and32% of foster children used Medicaidbehavioral health services compared to5% of TANF recipients. A significantnumber of foster children in the samplereceived the following mental healthservices:

> 60% used therapeutic outpatientcounseling.

> 44% used psychotropic medications.> 20% used family therapy/

education/training.> 17% used substance abuse treatment.

Further, the use of other high-costrestrictive services among children infoster included:

> 6% used Medicaid residentialtreatment.

> 5% used Medicaid inpatientpsychiatric treatment.

The rate of use of behavioral heaby children in foster care exceedthat of children who qualify for Medue to their SSI/disabled status,26.4% of those children using suservices. Consequently, it might beto look at care and payment strarelated to both groups. The MediManaged Care Enrollment reporCMS indicates that, based on 20data, 35 states now enroll fosterchildren into some form of managcare and 73% of Medicaid childoverall are enrolled in managed(CMS, 2010). These figures indicas has previously been discusseduse of managed care is on the up

Quality Improvement InitiativesTo ensure that the health and behhealth needs of children in fosterare being met through these mancare efforts, CHCS launched a thyear initiative, the Child WelfareQuality Improvement Collaborati2008. Working in nine states witMedicaid managed care organiz(MCO), the goal of the collaborawas to improve access, coordinaand appropriateness of care. Theoutcomes of the project found thaoverall aims were achieved andestablished partnerships betweenMCO and the child welfare agenSee Appendix 4 for an overviewMCO child welfare initiatives. Ahighlighting these efforts will be av(in March 2012) on the CHCS w(www.chcs.org/info-url_nocat5108/info-url_nocat_list.htm?attrib_id=14260).

> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M >1 1

waiver, but states are mandating morepopulations into managed care thatwere previously excluded. Mentalhealth, once carved out of managedcare, is now being carved back in.Under health reform Medicaid willexpand, especially with the many moreadults receiving coverage. Concerncontinues, however, that budgetpressures to manage care may pose athreat to health care access forhigh-using children, as accessingquality care might become even morecompromised. This also occurs whenthere are restrictions on the number oftypes of therapies or the number ofdoctor visits that might be covered inone day. Issues related to essentialbenefits under the ACA may also affectwhat benefits are available as we moveforward to 2014.

> INNOVATIONS FORCARE OF CHILDRENIN CHILD WELFARERecognizing that children in childwelfare have high mental health needsthat need to be better addressed,Kamala Allen, Vice President forProgram Operations of the nationally-

focused Center for Health CareStrategies (CHCS)(www.chcs.org) providedinformation on models that arebeing developed to achievebetter outcomes for thesechildren who are high serviceusers. Allen noted that this is awatershed moment as severalforces have come together toleverage improvements tobehavioral health care forchildren in foster care, andthese levers are helping toshape several CHCS initiatives.Levers include three key piecesof previously highlighted recentlegislation:

> Patient Protection andAffordable Care Act: HealthHomes and MedicationManagement Provisions.

> Fostering Connections to Successand Increasing Adoptions Act:Coordinated Health Plans,Medication Oversight programs.

> Child and Family ServicesImprovement & Innovations Act:Psychotropic medication,Demonstration Grants.

These legislative imperatives, togetherwith the Center for Medicaid andMedicare Services (CMS) federal grantprogram, the Children’s HealthInsurance Program Reauthorization Act(CHIPRA) Quality Demonstration GrantProgram (www.cms.gov/CHIPRA/Downloads/CHIPRA_Quality_Demo.pdf) and support from several foundationshave provided CHCS with the resourcesto undertake independent qualityimprovement projects, data mining andpolicy analysis. The key projectsfocused on children in foster care are:

> Faces of Medicaid: Children’sBehavioral Health Service Utilizationand Expenditure Study.

> CHIPRA Care Management EntitiesCollaborative.

> Child Welfare Quality ImprovementCollaborative.

In addition, CHCS has launched anational initiative, Improving the Useand Monitoring of PsychotropicMedication among Children in ChildWelfare: A Multi-State Collaborative inwhich up to five states will participatein a learning network to reduceinappropriate prescribing of thesemedication. Further, they will launch aChild Welfare Model of Care Projectnext year. These CHCS efforts are allbased on the following premises:

> Children in child welfare andparticularly those in foster care are aspecial needs population.


> In spite of the relatively small numbers,efforts at federal, state, and locallevels focusing on access, quality andoutcomes of health-related care for thechild welfare population are emerging,warranted and gaining traction.

> Psychotropic medication use is acentral issue to improving the qualityof care and outcomes for children inchild welfare.

> Continued attention to developingeffective systems to monitor andimprove care – and the policies tosupport them – is needed.

Faces of MedicaidThe Faces of Medicaid project examinedMedicaid claims data for 2005 andspecifically looked at children in fostercare. Findings indicate that fosterchildren are 3% of the Medicaidpopulation and 15% of the Medicaidusers of behavioral health services; and32% of foster children used Medicaidbehavioral health services compared to5% of TANF recipients. A significantnumber of foster children in the samplereceived the following mental healthservices:

> 60% used therapeutic outpatientcounseling.

> 44% used psychotropic medications.> 20% used family therapy/

education/training.> 17% used substance abuse treatment.

Further, the use of other high-costrestrictive services among children infoster included:

> 6% used Medicaid residentialtreatment.

> 5% used Medicaid inpatientpsychiatric treatment.

The rate of use of behavioral health careby children in foster care exceeds eventhat of children who qualify for Medicaiddue to their SSI/disabled status, with26.4% of those children using suchservices. Consequently, it might be usefulto look at care and payment strategiesrelated to both groups. The MedicaidManaged Care Enrollment report fromCMS indicates that, based on 2008data, 35 states now enroll fosterchildren into some form of managedcare and 73% of Medicaid childrenoverall are enrolled in managed care(CMS, 2010). These figures indicate,as has previously been discussed, theuse of managed care is on the uptick.

Quality Improvement InitiativesTo ensure that the health and behavioralhealth needs of children in foster careare being met through these managedcare efforts, CHCS launched a threeyear initiative, the Child WelfareQuality Improvement Collaborative, in2008. Working in nine states with theirMedicaid managed care organization(MCO), the goal of the collaborativewas to improve access, coordinationand appropriateness of care. Theoutcomes of the project found thatoverall aims were achieved and it alsoestablished partnerships between theMCO and the child welfare agencies.See Appendix 4 for an overview of theMCO child welfare initiatives. A toolkithighlighting these efforts will be available(in March 2012) on the CHCS website(www.chcs.org/info-url_nocat5108/info-url_nocat_list.htm?attrib_id=14260).

Children’s Health Insurance ProgramReauthorization Act (CHIPRA) InitiativeA third CHCS initiative is a five yearCHIPRA quality demonstration grantfrom CMS to test provider- based modelsthat look across all of the systems withwhich the children in foster care areinvolved. The project – being undertakenby a three-state collaborative, includingMaryland, Georgia, and Wyoming –focuses on the implementation andexpansion of Care ManagementEntities (CME). CME are anorganizational entity that provides ayouth-guided, family-driven, andstrengths-based approach to care,offering intensive care coordinationacross public agencies and providersand access to home- and community-based services and peer supports asalternatives to costly residential andhospital stays. The state-specific CMEsare to achieve four goals:

> Improving access to home andcommunity-based care.

> Improving clinical and functionaloutcomes.

> Improving youth and familyresiliency.

> Improving costs of care.

The initiative includes both national andcollaborative- sponsored evaluations.


d Center for Health Careies (CHCS)chcs.org) providedation on models that aredeveloped to achieveoutcomes for thesen who are high serviceAllen noted that this is ahed moment as severalhave come together toe improvements tooral health care forn in foster care, andevers are helping toseveral CHCS initiatives.nclude three key piecesously highlighted recenton:

ent Protection andrdable Care Act: Healthes and Medicationagement Provisions.ering Connections to SuccessIncreasing Adoptions Act:rdinated Health Plans,ication Oversight programs.d and Family Servicesovement & Innovations Act:hotropic medication,onstration Grants.

egislative imperatives, togethere Center for Medicaid andare Services (CMS) federal grantm, the Children’s Healthce Program Reauthorization ActA) Quality Demonstration Grantm (www.cms.gov/CHIPRA/oads/CHIPRA_Quality_Demo.pdfupport from several foundationsrovided CHCS with the resourcesrtake independent qualityement projects, data mining andanalysis. The key projectsd on children in foster care are:

> Faces of Medicaid: Children’sBehavioral Health Service Utilizationand Expenditure Study.

> CHIPRA Care Management EntitiesCollaborative.

> Child Welfare Quality ImprovementCollaborative.

In addition, CHCS has launched anational initiative, Improving the Useand Monitoring of PsychotropicMedication among Children in ChildWelfare: A Multi-State Collaborative inwhich up to five states will participatein a learning network to reduceinappropriate prescribing of thesemedication. Further, they will launch aChild Welfare Model of Care Projectnext year. These CHCS efforts are allbased on the following premises:

> Children in child welfare andparticularly those in foster care are aspecial needs population.


> Comprehensive care management.> Care coordination and health

promotion.> Family and patient support.> Comprehensive transitional care.> Referral to community and social

support services.

Although not specific to children withsubstance abuse and mental healthdisorders, some of the critical issuesfrom the perspective of SAMHSAregarding integrated care and theMedicaid Health Home option forstates include:

> Screening: Even if person onlysuffering from chronic physicalillnesses, still need to screen forsubstance abuse, tobacco anddepression, since those with chronichealth needs are also at risk forbehavioral disorders. [SAMHSAModel: Screening, Brief Intervention

Referral and Treatment (SBIRT)www.samhsa.gov/prevention/SBIRT/index.aspx].

> Services: If Health Home includthose with behavioral healthdisorders, the array of commuand evidenced-based servicesas medication assisted treatmeaddictions; assertive communitreatment including crisis teamsupported employment;, peerrecovery support services, mulsystemic therapy, etc. should bconsidered.

> Linkage: Assess how primary cand behavioral health care intfor joint planning and treatmepractical terms.

> Behavioral Health Providers asHealth Homes: When programincludes persons with mental hand/or substance abuse needbehavioral health providers be


> BEHAVIORAL HEALTHNEEDS OF CHILDREN INCHILD WELFARE: A VIEWFROM BEHAVIORALHEALTHFocusing more specifically on overallbehavioral health, Rita Vandivort-Warren,Senior Public Health Analyst at theSubstance Abuse and Mental HealthServices Administration (SAMHSA)(www.SAMHSA.gov) provided anoverview related to how provisions ofthe ACA can expand behavioral healthcare coverage, improve care andpromote healthy communities. Thegoals of the ACA are to:

> Expand coverage> Better integrate primary care> Emphasize prevention and wellness

for those who may have chronicconditions

> Pay for outcomes, not visits or unitsof service.

It is critical that the efforts on reducingcosts and lowering health care growthalso include attention to behavioralhealth as these conditions drive uphealth care costs. In regard to the

expanded coverage in 2014, theplans must include essentialmental health and substanceabuse benefits at parity withother health needs, and there willalso be a focus on prevention.Access to either Medicaid orstate exchange plans will bethrough a single portal and therewill be simplified documentation.As previously noted, those whoare up to the 400% of the federalpoverty level (FPL) will be eligiblefor participating in a state healthexchanges.

As a result of the implementationof the ACA many with substanceabuse needs will become coveredby health insurance for the first time.However there are concerns about howadequately Medicaid currently coverstreatment for those with substanceabuse diagnosis. Also, since Medicaidis mostly implemented throughmanaged care, there is a lack of clarityabout how exactly the benefits andservices will be provided.

For behavioral health care there isintent for bi-directional integration, withbehavioral health care provided in theprimary care setting and with primarycare accessible through the mentalhealth and substance abuse treatmentproviders. It is not currently clear howto best serve persons with high rates ofco-occurrence with multi-disciplinaryteam treatment, and if technology canfacilitate virtual integration, when careis received at different sites. In addition,there are concerns about confidentialityfor those persons receiving substanceabuse treatment, with the morerestrictive confidentiality requirementsof 42CFR Part II.

In these integrated care models, boththe advent of Medicaid Health Homesand accountable care organizations(ACO) will have the potential ofbringing new care models that arebetter coordinated, higher quality andmore cost-effective. Both Health Homesand ACOs emphasize team planningand care coordination, patient-centeredtreatment, support for transitions fromhospitals and patient and caregiversupport.

According to Section 2703 of the ACArelated to Medicaid Health Homes,optional coverage can include thosewith chronic conditions (or at risk)including mental health and substanceuse disorders. For the initial two years,CMS will provide a 90% match,providing a big incentive to states.Section 2703 also requires states toconsult with SAMHSA on preventionand treatment of mental health andsubstance abuse conditions. NewHealth Home services include:

FIGURE 1: 2014 COVERAGE EXPANSION


> Comprehensive care management.> Care coordination and health

promotion.> Family and patient support.> Comprehensive transitional care.> Referral to community and social

support services.

Although not specific to children withsubstance abuse and mental healthdisorders, some of the critical issuesfrom the perspective of SAMHSAregarding integrated care and theMedicaid Health Home option forstates include:

> Screening: Even if person onlysuffering from chronic physicalillnesses, still need to screen forsubstance abuse, tobacco anddepression, since those with chronichealth needs are also at risk forbehavioral disorders. [SAMHSAModel: Screening, Brief Intervention

Referral and Treatment (SBIRT) -www.samhsa.gov/prevention/SBIRT/index.aspx].

> Services: If Health Home includesthose with behavioral healthdisorders, the array of community-and evidenced-based services, suchas medication assisted treatments foraddictions; assertive communitytreatment including crisis teams;supported employment;, peer andrecovery support services, multi-systemic therapy, etc. should beconsidered.

> Linkage: Assess how primary careand behavioral health care integratefor joint planning and treatment inpractical terms.

> Behavioral Health Providers asHealth Homes: When programincludes persons with mental healthand/or substance abuse needs, canbehavioral health providers be

Health Homes if they meet all of thephysical health requirements?

The move to greater use of electronichealth records and health informationtechnology are also bringing newissues to health care delivery in regardto privacy and confidentiality as well asrelated to coordination of care.

Overall, the major drivers of the ACAare that more people will haveinsurance coverage; Medicaid willhave a bigger role in mental health andsubstance abuse disorders than before;there will be an increased emphasis onprimary care and coordination withspecialty care; and home andcommunity-based services areencouraged with less reliance oninstitutional care. Preventing diseasesand promoting wellness will become ahigher priority and there will be a movetoward paying for episodes andoutcomes of care, and not for visits orhigh use of advanced technology.

Balancing these drivers of the ACA, areconcerns about the flexibility that stateswill have as the major implementers.Yet the ACA says 3157 times that “theSecretary shall…”, so clearly there arefederal tasks on which the HHSSecretary must either provide guidanceor regulations. In addition, two keyactions yet to take place are how HHSdefines the essential benefits and whatthe outcome will be when the SupremeCourt takes action related to the ACAcase now before it.


ed coverage in 2014, themust include essentialhealth and substancebenefits at parity withealth needs, and there willa focus on prevention.to either Medicaid or

xchange plans will bea single portal and there

simplified documentation.viously noted, those whoto the 400% of the federal

y level (FPL) will be eligibleicipating in a state healthges.

sult of the implementationACA many with substanceneeds will become coveredth insurance for the first time.er there are concerns about howtely Medicaid currently coversnt for those with substancediagnosis. Also, since Medicaidy implemented throughed care, there is a lack of clarityhow exactly the benefits ands will be provided.

havioral health care there isor bi-directional integration, withoral health care provided in they care setting and with primaryccessible through the mentaland substance abuse treatmenters. It is not currently clear howserve persons with high rates ofrrence with multi-disciplinaryeatment, and if technology cane virtual integration, when careved at different sites. In addition,re concerns about confidentialitye persons receiving substancereatment, with the moreve confidentiality requirementsFR Part II.

In these integrated care models, boththe advent of Medicaid Health Homesand accountable care organizations(ACO) will have the potential ofbringing new care models that arebetter coordinated, higher quality andmore cost-effective. Both Health Homesand ACOs emphasize team planningand care coordination, patient-centeredtreatment, support for transitions fromhospitals and patient and caregiversupport.

According to Section 2703 of the ACArelated to Medicaid Health Homes,optional coverage can include thosewith chronic conditions (or at risk)including mental health and substanceuse disorders. For the initial two years,CMS will provide a 90% match,providing a big incentive to states.Section 2703 also requires states toconsult with SAMHSA on preventionand treatment of mental health andsubstance abuse conditions. NewHealth Home services include:

FIGURE 1: 2014 COVERAGE EXPANSION


> Hearing screening prior to hospitaldischarge.

> Annual dentist visit.> Asthma emergency department visit.> Developmental screening by two

years of age.

For more information visitwww.qualityforum.org/Projects/c-d/Child_Health_Quality_Measures_2010/Child_Health_Quality_Measures_2010.aspx.


> MEASURING CHILDHEALTH OUTCOMESWith the emphasis in the ACA onoutcomes, it is important to betterunderstand the development and use ofstandardized measures to assess healthoutcomes. The symposium includedinformation on the work of the NationalQuality Forum (NQF) which reviews,endorses and disseminates measuresregarding health care delivery. (SeeAppendix 11 for more detailedinformation about NQF’s work).

Suzanne Theberge, Project Manager atthe NQF, provided an overview ofNQF’s work related to endorsingvoluntary national consensus standardsfor measuring and publicly reporting onhealth care performance. As a standardsetting organization, NQF’s roles are todevelop voluntary consensus standardsrelated to performance measures,serious reportable events, preferredpractices and frameworks. Theyaccomplish this by bringing togethergovernment representatives, payers,clinicians, researchers and other healthcare industry stakeholders, togetherwith consumers. NQF serves as aneutral convener, hosting both the

Measurement Application Partnership(www.qualityforum.org/ map/) and theNational Priorities Partnership(www.qualityforum.org/Setting_Priorities/NPP/National_Priorities_Partnership.aspx) created as part of the ACA.

Standardized performance measuresare tools to assess quality that can beused to compare the performance ofproviders, facilities, and states.Measurement is important becauseit can drive improvement, informconsumers and other stakeholders,and can influence payment.

Measures endorsed by NQF considerimportance (impact on patientoutcomes) and meeting scientificreliability criteria. In addition, thefollowing issues are all consideredwhen identifying and endorsingmeasures.

> Feasibility of data collection.> How the measure is being

used.> How understandable it is to

multiple audiences.

The health care deliverystakeholders, includingconsumers, are invited tocomment on NQF proposedmeasures and to useperformance measures intheir work. A database ofmeasures is available atwww.qualityforum.org/qps.

In regard to outcome measuresin child health, the NQF, inFebruary 2011, completed achild health outcomes projectwhich endorsed 15 outcomemeasures that cover overallhealth and care for children.

They cover both the results of care suchas admission rates and mortality ratesfor various conditions and also assessmortality or adverse event rates relatedto procedures, like certain surgeries. Atthe population level, they assess issuesof access to care as well as insurance.Examples include:

> Healthy term newborn.> Standardized mortality ratio for

neonates undergoing non-cardiacsurgery.

> Number of school days childrenmiss due to illness.

> Children who have inadequateinsurance coverage for optimal health.

The NQF, as of November 2011, hasendorsed over 140 measures related tochild health, most recently in the ChildHealth Quality Measures project thatwas completed at that time. Endorsedchild health measures include:


> Hearing screening prior to hospitaldischarge.

> Annual dentist visit.> Asthma emergency department visit.> Developmental screening by two

years of age.

For more information visitwww.qualityforum.org/Projects/c-d/Child_Health_Quality_Measures_2010/Child_Health_Quality_Measures_2010.aspx.

As the work of NQF moves forward inregard to outcomes measures, there willbe expanded focus on disparities andpopulation health; an increasingnumber of patient-reported outcomes, amove toward electronic measures andadditional outcome measures that willrespond to stakeholder needs. For moreinformation visit,www.qualityforum.org.


rement Application Partnershipqualityforum.org/ map/) and theal Priorities Partnershipqualityforum.org/Setting_Prioritie/National_Priorities_Partnership.reated as part of the ACA.

rdized performance measuresls to assess quality that can becompare the performance of

ers, facilities, and states.rement is important becauserive improvement, informers and other stakeholders,n influence payment.

res endorsed by NQF considerance (impact on patientes) and meeting scientificty criteria. In addition, the

ng issues are all considereddentifying and endorsinges.

ibility of data collection.the measure is being

.understandable it is to

ple audiences.

alth care deliveryolders, includingers, are invited tont on NQF proposedes and to use

mance measures inork. A database ofes is available atualityforum.org/qps.

rd to outcome measureshealth, the NQF, in

ry 2011, completed aealth outcomes projectendorsed 15 outcomees that cover overalland care for children.

They cover both the results of care suchas admission rates and mortality ratesfor various conditions and also assessmortality or adverse event rates relatedto procedures, like certain surgeries. Atthe population level, they assess issuesof access to care as well as insurance.Examples include:

> Healthy term newborn.> Standardized mortality ratio for

neonates undergoing non-cardiacsurgery.

> Number of school days childrenmiss due to illness.

> Children who have inadequateinsurance coverage for optimal health.

The NQF, as of November 2011, hasendorsed over 140 measures related tochild health, most recently in the ChildHealth Quality Measures project thatwas completed at that time. Endorsedchild health measures include:


Human Services in the District ofColumbia (DC) provided his perspectiveon the importance of family-centered,strengths-based service delivery, with afocus on prevention and economicsecurity. The details about Berns’perspective can be found in a recentarticle, “Is our business family-centered”that was published in the Journal ofFamily Strengths and can be accessedat http://digitalcommons.library.tmc.edu/jfs/vol11/iss1/3/.

Berns, who recently came to DC tomodernize the District’s TemporaryAssistance to Needy Families (TANF)program, noted that if we can providefor the economic security of families,we have a better chance of preventingthem from coming into contact with thechild welfare or juvenile justicecommunities. Furthermore, if we canstrengthen health departments andhealth care delivery, then as theyengage with families there can beprevention of more serious healthproblems and a greater focus onwell-being.

From Berns’ experience, rather thanfamilies having multiple case managersfor each of their presenting problems, atruly family-centered approach wouldhave one case manager with the bigpicture. For families involved with thechild welfare system, for example, it isimportant to gather clear informationabout what brought the family to theattention of child welfare in first place –was it homelessness; being left alonebecause the parents had to take onmultiple jobs; was it due to immigrationissues. It is important to look atsolutions across systems rather than tothink that families’ lives can beimproved with a focus from just withinone system. This often just makes thingsharder for them. Berns suggested that

designing a system that works fopeople needs to be done at acommunity level rather than tryinchange just one agency. He alsoreinforced the need to invest morup-front services.

When Berns was director of HumServices in El Paso County, CO –very conservative community – hable to make changes to developof the most successful and humanwelfare programs in the country(Hutson, 2003). Now in DC, heworking to reform the system so tfamilies can progress out of the wsystem. With a goal of eliminatinpoverty, there needs to be a diffeapproach to welfare. For examprather than adding one more casmanager to a family, Berns suggethat efforts should be made tomaximize current funding andresources by using an existing camanagement provider and to onlone service plan so that needs caaddressed more holistically. Bernsuggests maximizing use of commservice providers and supplementhem with state resources rather t


To provide a more local perspectiveon optimizing the health of children

at risk, a panel of people whorepresent prevention and healthpromotion and coordinated health andhuman service delivery offered theirinput at the symposium.

> OPTIMIZING HEALTHIN RURAL COMMUNITIESDeirdra Robinson, a health careresearcher and faculty member atMorehead State University in Kentuckyand the incoming president of theNASW Kentucky Chapter provided aperspective from rural communities.Quoting NASW 2010 Sarnat Awardrecipient, Dr. Gilbert Friedell, she cited“if the problem is in the community, thesolution is in the community.”

This should be an important mantrawhen addressing issues of healthoutcomes and health care access.Using a strengths perspective she notedthat Appalachia is not necessarilydeprived of resources. Rather, there areresources that can be more fullyaccessed to promote health andwell-being. She also noted there areoften trans-generational outcomesrelated to both child welfare and

health, with new generationshaving similar needs as those whohave come before them. This canbe because in rural areas theretraditionally has not been a focuson preventative care. Additionally,there are not always timelyreferrals to services, such asmeeting the behavioral needs ofchildren in schools.

In rural areas, the use ofnon-traditional providers isimportant and should berecognized. This might includeorganizations like the countyExtension Offices which hostvarious groups such ashomemakers. As the ACA isimplemented, health departments incommunities need to be engaged as thecornerstones of community-based publichealth care. In addition, to improvehealth outcomes and to highlight healthrisks, it is important to have data anduse it clearly and make it meaningful tothe people that it impacts.

As one example of an effectivecommunity-based health intervention,Robinson highlighted a recentcommunity-based event held in her areato promote awareness of diabetes. Toincrease the focus on prevention and tobegin to stem the high rates of diabetesin rural communities, fun communityevents related to diabetes managementwere staged at Wal-Mart. Rather thanexpecting people to come to the serviceproviders – the community events getthe health providers to go to thecommunity. Having events and

community-based programs wherepeople naturally go in the community(e.g., Wal-Mart) decreases anxiety andallows for more positive interactions. Thisrecent community event on a Saturdayat Wal-Mart included representativesfrom Medicaid (who want to ensurethat eligible children are enrolled inCHIP), and others who were engagedin health education and awareness.

> PROMOTING FAMILY-CENTERED, CROSS-SYSTEM COLLABORATIONTO IMPROVE HEALTHAND WELL-BEINGDrawing from his extensive experiencein directing public agencies in severalstates and localities, David Berns, thecurrent director of the Department of

OPTIMIZING CHILDREN’S HEALTHOUTCOMES: PERSPECTIVES

FROM THE COMMUNITY

FIGURE 4: INTEGRATTHE MOST EFFE


Human Services in the District ofColumbia (DC) provided his perspectiveon the importance of family-centered,strengths-based service delivery, with afocus on prevention and economicsecurity. The details about Berns’perspective can be found in a recentarticle, “Is our business family-centered”that was published in the Journal ofFamily Strengths and can be accessedat http://digitalcommons.library.tmc.edu/jfs/vol11/iss1/3/.

Berns, who recently came to DC tomodernize the District’s TemporaryAssistance to Needy Families (TANF)program, noted that if we can providefor the economic security of families,we have a better chance of preventingthem from coming into contact with thechild welfare or juvenile justicecommunities. Furthermore, if we canstrengthen health departments andhealth care delivery, then as theyengage with families there can beprevention of more serious healthproblems and a greater focus onwell-being.

From Berns’ experience, rather thanfamilies having multiple case managersfor each of their presenting problems, atruly family-centered approach wouldhave one case manager with the bigpicture. For families involved with thechild welfare system, for example, it isimportant to gather clear informationabout what brought the family to theattention of child welfare in first place –was it homelessness; being left alonebecause the parents had to take onmultiple jobs; was it due to immigrationissues. It is important to look atsolutions across systems rather than tothink that families’ lives can beimproved with a focus from just withinone system. This often just makes thingsharder for them. Berns suggested that

designing a system that works forpeople needs to be done at acommunity level rather than trying tochange just one agency. He alsoreinforced the need to invest more inup-front services.

When Berns was director of HumanServices in El Paso County, CO – avery conservative community – he wasable to make changes to develop oneof the most successful and humanewelfare programs in the country(Hutson, 2003). Now in DC, he isworking to reform the system so thatfamilies can progress out of the welfaresystem. With a goal of eliminatingpoverty, there needs to be a differentapproach to welfare. For example,rather than adding one more casemanager to a family, Berns suggeststhat efforts should be made tomaximize current funding andresources by using an existing casemanagement provider and to only haveone service plan so that needs can beaddressed more holistically. Berns alsosuggests maximizing use of communityservice providers and supplementingthem with state resources rather than

supplanting them or creating duplicativeservices. Another key principle relatesto client choice. Thus, if a client feelsmore comfortable working withsomeone from the domestic violenceagency rather than the child welfareagency or the school – let them, andthen train the workers to maximizecommunication and to report back.Figure 4 is illustrative of Berns’ vision.

Berns also noted that within publicagencies we often hear that the staffcan be victims, too, consideringthemselves to be overworked,underpaid, and underappreciated.No matter where you are in anorganization, he posited that 85percent of what we do is controlled bysomeone else, and thus we need to fullytake control over the 15 percent ofwhat we do that we control ourselves.He suggested that a healthier workforcerequires that we work on what we havecontrol over and let go of what we donot have control over and that thosewithin health and human services needto build hope and promote strengths inorder to have better outcomes forthemselves and for their clients.


with new generationssimilar needs as those who

ome before them. This canause in rural areas therenally has not been a focusventative care. Additionally,re not always timelys to services, such asg the behavioral needs ofn in schools.

areas, the use ofditional providers isant and should bezed. This might include

zations like the countyon Offices which hostgroups such asakers. As the ACA isented, health departments innities need to be engaged as thetones of community-based publiccare. In addition, to improveoutcomes and to highlight healthis important to have data andearly and make it meaningful to

ople that it impacts.

example of an effectivenity-based health intervention,on highlighted a recentnity-based event held in her area

mote awareness of diabetes. Toe the focus on prevention and too stem the high rates of diabetescommunities, fun community

related to diabetes managementaged at Wal-Mart. Rather thanng people to come to the serviceers – the community events getlth providers to go to thenity. Having events and

community-based programs wherepeople naturally go in the community(e.g., Wal-Mart) decreases anxiety andallows for more positive interactions. Thisrecent community event on a Saturdayat Wal-Mart included representativesfrom Medicaid (who want to ensurethat eligible children are enrolled inCHIP), and others who were engagedin health education and awareness.

> PROMOTING FAMILY-CENTERED, CROSS-SYSTEM COLLABORATIONTO IMPROVE HEALTHAND WELL-BEINGDrawing from his extensive experiencein directing public agencies in severalstates and localities, David Berns, thecurrent director of the Department of

MIZING CHILDREN’S HEALTHOUTCOMES: PERSPECTIVES

FROM THE COMMUNITY

FIGURE 4: INTEGRATED APPROACHES CAN STRENGTHENTHE MOST EFFECTIVE PREVENTION PROGRAMS


Drawing from the presentations anddiscussions by the participants the

following key issues were discussed.

It is critical to continue to grow theresearch base, both in terms of analysisof available NSCAW, administrativeand other data, across systems, andalso to support and encourage testingof interventions. These will further ourunderstanding of the clinical,organizational and policy issues thatcan support or impede enhancedoutcomes for children at risk and theirfamilies. In regard to NSCAW:

> NSCAW data have provided animportant window to more fullyunderstand the characteristics/profiles and needs of children inthe child welfare system.» Advocacy for continuing funding

for NSCAW, and support foranalysis of NSCAW data areimportant, as there was some lackof clarity about the current statusof NSCAW’s funding.

» It is useful that NSCAW II includesmore focus on linkages to thejuvenile justice system than didNSCAW I.

> Investments in intervention researchas well as in more comprehensivedata collection continue to be needed.

> The comparative analysis ofnational, state and intra-state data isvaluable and leads to betterunderstanding of who is in the childwelfare system. This should then lead

to provision of more targeted,developmentally appropriate aevidence-based services.

> There is a need for more inforabout children in kinship carewhat the impact of provisionsrecent legislation will be on thhealth outcomes.

The health profiles of children whin foster care are similar to childrwho are receiving child welfareservices in their homes.

> There is a need to attend to thhealth and mental health needchildren who receive child weservices, and at all ages.

> Preventive services for those chand families who are risk of ethe child welfare system due tohealth, behavioral health ordevelopmental needs should bavailable.

> More supportive services to adthe health and behavioral heaneeds of high risk parents canprevent children from needingwelfare services and also enhathe children’s health outcomes

Innovations are underway to betmeet the health needs of childrenfoster care, at both individual ansystems levels.

> Developing strategies that maicontinuity of care and coveragessential, especially since child


> A PROGRAM TO MEETHEALTH CARE NEEDS INCHILD WELFAREThe consent decree from a class actionlawsuit in Baltimore City required thataction be taken to meet the healthneeds of the children in foster care.Thus a medical managed care unit,MATCH (Making All of the ChildrenHealthy), was created in 2009 as aproject of Baltimore HealthCare Access,Inc. (just renamed HealthCare AccessMaryland), the Baltimore CityDepartment of Social Services (DSS)and the Baltimore Mental HealthSystems. The MATCH program (seeoverview in Appendix 8) is a projectthat combines the medical casemanagement expertise of HealthCareAccess with partners who are staff ofthe Baltimore city child welfare andmental health agencies.

Rachel Dodge, a pediatrician who isdirector of MATCH, described theservices that their interdisciplinary teamprovides which include: health caresystem navigation; care coordinationfor children in foster care; medicalassistance enrollment; education; andadvocacy. MATCH teams are matchedwith permanency units at Baltimore City

DSS to improve communicationbetween the two agencies.

To be able to resolve challengesaround medical assistance andenrollment in managed care,MATCH is listed as the address forall Medical Assistancecorrespondence. All children newlyentering foster care are required tohave an initial health screen withinfive days; a comprehensivemedical exam; a dental exam (ifthree years or older); a mentalhealth assessment, and adevelopmental assessment (if lessthan three years old). Medical casemanagement is provided by nursesfor children with complex medicalneeds and by licensed social workersfor children with complex mental healthneeds. In Baltimore there are a highnumber of older children in the systembecause of historical challenges that thesystem has faced, and children havesat in the system for a long time. Thiscreates a need to support health caretransition as they age out of the system.

Some of the barriers to meeting thehealth care needs of children in fostercare, mirroring the research describedearlier, include discontinuity of care;incomplete health histories; difficulty inmonitoring access to and provision ofhealth care; multiple placements; andgaps in health coverage, sometimesdelayed by moving on and off MedicalAssistance (MA) and between MA andthe managed care organization (MCO)(where getting back into the MCO cantake an additional 10 days). Otherchallenges include difficulty accessingmedical providers to see children withinfive days of entry; foster parents whowant to take children to their ownproviders, suggesting there needs to bea cultural shift to maintain continuity of

care for the children with their usualprimary care providers; and challengesin infant and toddler assessmentcompletion because of issues regardingfoster/kinship parents agreeing toparticipate in the assessment,confidentiality issues, and issuesworking with and within earlychildhood systems. In addition,Medicaid enrollment codes do noteasily identify the children who are infoster care, and there is confusionaround sharing of health informationdue to the child’s legal status andconcerns regarding HIPAA.

It is hoped that the development andimplementation of Medical Homes andMedicaid Health Homes will furtherreinforce the maintenance of childrenwith their primary health care providers(especially when the goal isreunification) and will help to optimizetheir health outcomes. For fosterparents, this is a transition as they havebeen used to taking foster children intheir care to the health care providerschosen by the foster parents, ratherthan maintaining their connections totheir family of origin providers.

CHALLENGES AND OOPTIMIZING HEALTH AND

AT RISK CHILDREN: KEY


Drawing from the presentations anddiscussions by the participants the

following key issues were discussed.

It is critical to continue to grow theresearch base, both in terms of analysisof available NSCAW, administrativeand other data, across systems, andalso to support and encourage testingof interventions. These will further ourunderstanding of the clinical,organizational and policy issues thatcan support or impede enhancedoutcomes for children at risk and theirfamilies. In regard to NSCAW:

> NSCAW data have provided animportant window to more fullyunderstand the characteristics/profiles and needs of children inthe child welfare system.» Advocacy for continuing funding

for NSCAW, and support foranalysis of NSCAW data areimportant, as there was some lackof clarity about the current statusof NSCAW’s funding.

» It is useful that NSCAW II includesmore focus on linkages to thejuvenile justice system than didNSCAW I.

> Investments in intervention researchas well as in more comprehensivedata collection continue to be needed.

> The comparative analysis ofnational, state and intra-state data isvaluable and leads to betterunderstanding of who is in the childwelfare system. This should then lead

to provision of more targeted,developmentally appropriate andevidence-based services.

> There is a need for more informationabout children in kinship care andwhat the impact of provisions ofrecent legislation will be on theirhealth outcomes.

The health profiles of children who arein foster care are similar to childrenwho are receiving child welfareservices in their homes.

> There is a need to attend to thehealth and mental health needs of allchildren who receive child welfareservices, and at all ages.

> Preventive services for those childrenand families who are risk of enteringthe child welfare system due to theirhealth, behavioral health ordevelopmental needs should beavailable.

> More supportive services to addressthe health and behavioral healthneeds of high risk parents canprevent children from needing childwelfare services and also enhancethe children’s health outcomes.

Innovations are underway to bettermeet the health needs of children infoster care, at both individual andsystems levels.

> Developing strategies that maintaincontinuity of care and coverage isessential, especially since children

go in and out of foster care.> Assuring communication among

health care providers should be apriority; and transfer of informationamong different health care providersand between the health and socialservice systems needs to be enhanced.

> Implementation of some healthprograms in child welfare arecreating changes in foster families’roles. It has been an acceptedpractice in many locales for fosterfamilies to choose foster children’shealth providers based on the fosterfamilies’ preference and location.Program models like MATCH work tokeep children’s health care with theirprimary care provider to promotegreater continuity of care. This maybe viewed as less convenient by thefoster family. Thus, optimizingchildren’s health care may requireadjustments and changes inexpectations, as efforts to providehigher quality and more consistenthealth care services are implemented.

There are variations among how MCOsoperate. This may be due to variationsin states’ policies in terms of structure ofMCO programs, including differences inhow they work with and communicatewith other agencies and serviceproviders.

> It would be helpful to haveeffective early adaptors serveas guides and mentors tothose who are


improve communicationn the two agencies.

ble to resolve challengesmedical assistance andent in managed care,

H is listed as the address forical Assistanceondence. All children newlyg foster care are required ton initial health screen withinys; a comprehensivel exam; a dental exam (ifears or older); a mentalassessment, and apmental assessment (if lessree years old). Medical caseement is provided by nursesdren with complex medicaland by licensed social workersdren with complex mental healthIn Baltimore there are a highr of older children in the systeme of historical challenges that thehas faced, and children havehe system for a long time. Thisa need to support health care

on as they age out of the system.

of the barriers to meeting thecare needs of children in fosterirroring the research describedinclude discontinuity of care;lete health histories; difficulty inring access to and provision ofcare; multiple placements; andhealth coverage, sometimes

d by moving on and off Medicalnce (MA) and between MA andnaged care organization (MCO)getting back into the MCO canadditional 10 days). Other

ges include difficulty accessingl providers to see children withinys of entry; foster parents whotake children to their own

ers, suggesting there needs to beal shift to maintain continuity of

care for the children with their usualprimary care providers; and challengesin infant and toddler assessmentcompletion because of issues regardingfoster/kinship parents agreeing toparticipate in the assessment,confidentiality issues, and issuesworking with and within earlychildhood systems. In addition,Medicaid enrollment codes do noteasily identify the children who are infoster care, and there is confusionaround sharing of health informationdue to the child’s legal status andconcerns regarding HIPAA.

It is hoped that the development andimplementation of Medical Homes andMedicaid Health Homes will furtherreinforce the maintenance of childrenwith their primary health care providers(especially when the goal isreunification) and will help to optimizetheir health outcomes. For fosterparents, this is a transition as they havebeen used to taking foster children intheir care to the health care providerschosen by the foster parents, ratherthan maintaining their connections totheir family of origin providers.

CHALLENGES AND OPPORTUNITIES TOOPTIMIZING HEALTH AND HEALTH CARE FOR

AT RISK CHILDREN: KEY ISSUES IDENTIFIED


PARTNERING TO IMPROVE HEALTHCARE FOR CHILDREN IN FOSTER CARE

In November 2010, growing out of PolicyLab’sresearch on system factors influencing thehealth of children in foster care, PolicyLabtogether with the National Association ofPublic Child Welfare Administrators(NAPCWA) and the Fostering ConnectionsResource Center at Child Trends sponsored across-system meeting for states to sharestrategies how to best coordinate health carefor children in child welfare. At the meeting,over 100 people came together includingchild welfare directors, health experts,Medicaid leadership, and key healthpartners and included ten state cross-systemteams with representatives from both healthand child welfare. The sessions highlightedleading efforts from around the country tobetter coordinate and deliver care in the eraof Fostering Connections with a particularfocus on data sharing and the oversight ofpsychotropic medications. For more see:www.fosteringconnections.org/healthconvening.

Expansion of access to health coveragefor parents beginning in 2014 may alsoimprove access to care for at riskchildren and a decrease in health andmental health problems (includingdepression) for mothers.

> Outreach is essential to encouragecoverage and use of the health caresystem for those who need it.

There are a growing number ofavailable evidence-based practices(EBP) that can be used to enhanceoutcomes for at risk children.

> Different evidence-based practicestarget different populations andproblems.

> Information on a wide array ofevidence-based practices needs tobe available.

RESOURCES ON EVIDENCE-BASECHILD WELFARE INTERVENTION

> California Evidence-Based Child WClearinghouse — www.cebc4cw.o

> CDC Community Guides —www.thecommunityguide.org

> Child Welfare Information Gatewwww.childwelfare.gov/managemctice_improvement/evidence/eb

> National Child Traumatic Stress Nwww.nctsn.org

> National Registry of Effective Proand Practices — www.nrepp.samh

> Agencies need assistance in thprocess of effectively adaptingadopting evidence-practices, wrequires an understanding oforganizational climate and cureadiness to adapt and staff caand competency.

> Issues of staff turnover can imphow programs are implementealso affect client outcomes.

> Implementation of EBPs needswith the community’s culture aneeds.

Training and availability of compand qualified health and humanservices professionals to bridge thealth and child welfare systemsessential.

> Low reimbursement rates forspecialty care often discouragphysicians from participating iMedicaid. This which may bereversed by provisions in the Athat require that rates be raiseMedicare levels.

> Caregivers may have difficultylocating specialty care provide

> Health care providers and chiwelfare staff need to be traine


developing new health care programmodels for children served by thechild welfare system.

> Enhancing health care services forchildren receiving child welfareservices will require addressingchild, family and system issues; andalso require grappling with concernsrelated to confidentiality, cross-systemdata access and shared outcomes.

> The physical and behavioral healthneeds of both children at risk andtheir parents need to be more fullyand consistently addressed,including enhancement ofpreventative services.

High risk populations are now betteridentified, suggesting that new, moretargeted and evidence-based servicescould be provided.

> There are a number of innovationsunderway to better meet the mentalhealth needs of children in care.However, more attention is alsoneeded to physical health concerns –e.g., control of diabetes and asthmain children.

> Examination of obesity finds thatwhen obese children enter fostercare, they continue to be obesewhile in care, suggesting the needfor targeted interventions for thechild and the caregivers.

> For children in immigrant families,especially if families areundocumented, they may notregularly access health care forthemselves or their children.

> Children in the system have highrates of developmental delayssuggesting that screening and earlyintervention are important.

> The evidence-based early childhoodhome visiting program included inthe ACA is one vehicle to meet thedevelopmental needs of high riskchildren and to support and trainparents.

MATERNAL, INFANT AND EARLYCHILDHOOD HOME VISITING PROGRAM

The Patient Protection and Affordable CareAct (P.L. 111-148) established a $1.5 billionfederal grant program, the Maternal, Infantand Early Childhood Home Visiting Program,to support state-based home visitingprograms serving families with youngchildren and families expecting children.This program is being implemented throughcollaboration between the Maternal andChild Health Bureau at HRSA and theChildren’s Bureau in coordination withseveral other federal agencies. In September2011 the Secretary of HHS announced that$224 million dollars had been awarded to49 states in both formula and discretionarygrants. Resources on evidence-based homevisiting programs can be found atwww.pewcenteronthestates.org/initiatives_detail.aspx?initiativeID=52756;http://supportingebhv.org/; &http://mchlibrary.info/guides/homevisiting.html.

Children receiving foster care services arehigh users of psychotropic medications.

> There is insufficient availability ofhigh quality behavioral healthservices for children in the fostercare system.

> Despite the focus on usingpsychotropic medications, effectivepsychotherapeutic evidence-basedinterventions have been identified,but are not widely implemented.

> Greater emphasis should be placedon what services and interventionswould work best, and not based oncost or which interventions areeasiest to administer.

There is a need for better communicationand collaboration across systems.

> Several of the efforts to providehealth care within the child welfaresystem can serve as models to otherstates and localities (e.g., MATCHBaltimore, MD and StarlightPediatrics, Rochester, NY).

> HHS is making efforts to enhancecommunication and collaborationamong state child welfare directors,Medicaid directors and behavioralhealth directors to decrease the rateof usage of psychotropic medicationsand to improve mental healthoutcomes.» A recent letter from ACF, CMS and

SAMHSA’s a good federal start(www.childwelfare.gov/systemwide/mentalhealth/effectiveness/jointlettermeds.pdf).

» The three agencies will convenewebinars and meetings with stateMedicaid and child welfaredirectors in 2012(www.childwelfare.gov/systemwide/mentalhealth/effectiveness/psychotropic.cfm).


PARTNERING TO IMPROVE HEALTHCARE FOR CHILDREN IN FOSTER CARE

In November 2010, growing out of PolicyLab’sresearch on system factors influencing thehealth of children in foster care, PolicyLabtogether with the National Association ofPublic Child Welfare Administrators(NAPCWA) and the Fostering ConnectionsResource Center at Child Trends sponsored across-system meeting for states to sharestrategies how to best coordinate health carefor children in child welfare. At the meeting,over 100 people came together includingchild welfare directors, health experts,Medicaid leadership, and key healthpartners and included ten state cross-systemteams with representatives from both healthand child welfare. The sessions highlightedleading efforts from around the country tobetter coordinate and deliver care in the eraof Fostering Connections with a particularfocus on data sharing and the oversight ofpsychotropic medications. For more see:www.fosteringconnections.org/healthconvening.

Expansion of access to health coveragefor parents beginning in 2014 may alsoimprove access to care for at riskchildren and a decrease in health andmental health problems (includingdepression) for mothers.

> Outreach is essential to encouragecoverage and use of the health caresystem for those who need it.

There are a growing number ofavailable evidence-based practices(EBP) that can be used to enhanceoutcomes for at risk children.

> Different evidence-based practicestarget different populations andproblems.

> Information on a wide array ofevidence-based practices needs tobe available.

RESOURCES ON EVIDENCE-BASEDCHILD WELFARE INTERVENTIONS

> California Evidence-Based Child WelfareClearinghouse — www.cebc4cw.org

> CDC Community Guides —www.thecommunityguide.org

> Child Welfare Information Gateway —www.childwelfare.gov/management/practice_improvement/evidence/ebp.cfm

> National Child Traumatic Stress Networkwww.nctsn.org

> National Registry of Effective Programsand Practices — www.nrepp.samhsa.gov.

> Agencies need assistance in theprocess of effectively adapting andadopting evidence-practices, whichrequires an understanding oforganizational climate and culture,readiness to adapt and staff capacityand competency.

> Issues of staff turnover can impacthow programs are implemented andalso affect client outcomes.

> Implementation of EBPs needs to fitwith the community’s culture andneeds.

Training and availability of competentand qualified health and humanservices professionals to bridge thehealth and child welfare systems areessential.

> Low reimbursement rates forspecialty care often discouragephysicians from participating inMedicaid. This which may bereversed by provisions in the ACAthat require that rates be raised toMedicare levels.

> Caregivers may have difficulty inlocating specialty care providers.

> Health care providers and childwelfare staff need to be trained to

work together and to collaborate toenhance outcomes.

> Providers need to work together andpartner with families and withchildren in care.

> Training and support onevidence-based interventions andhow they can be implemented areneeded.

> Health and child welfare serviceproviders need to recognize andsupport family strengths andencourage family members’ voices inhealth decisions.

> Universities can facilitateinterdisciplinary training andeducational opportunities amongphysicians, nurses, social workers,psychologists and educators to bettersupport foster children and otherchildren and families at risk.

The politicization surrounding the ACAshould be viewed as a very high stakesconcern.

> Many see it as a proxy debatearound the role of government inintervening in social problems.

> Controversy focuses on issues ofenhanced access and the breadth ofMedicaid coupled with the tightbudgets in states and at the federallevel.

> The ACA provides opportunities forexpanded and higher quality healthcare for at risk children and theirfamilies.


children in immigrant families,cially if families are

ocumented, they may notlarly access health care forselves or their children.

dren in the system have highof developmental delaysesting that screening and earlyvention are important.evidence-based early childhoode visiting program included inACA is one vehicle to meet thelopmental needs of high riskren and to support and trainnts.

TERNAL, INFANT AND EARLYLDHOOD HOME VISITING PROGRAM

Patient Protection and Affordable CareP.L. 111-148) established a $1.5 billionral grant program, the Maternal, InfantEarly Childhood Home Visiting Program,pport state-based home visitingrams serving families with youngren and families expecting children.program is being implemented throughboration between the Maternal andd Health Bureau at HRSA and thedren’s Bureau in coordination withral other federal agencies. In Septemberthe Secretary of HHS announced that

4 million dollars had been awarded totates in both formula and discretionaryts. Resources on evidence-based homeng programs can be found at

w.pewcenteronthestates.org/initiatives_il.aspx?initiativeID=52756;//supportingebhv.org/; &//mchlibrary.info/guides/evisiting.html.

Children receiving foster care services arehigh users of psychotropic medications.

> There is insufficient availability ofhigh quality behavioral healthservices for children in the fostercare system.

> Despite the focus on usingpsychotropic medications, effectivepsychotherapeutic evidence-basedinterventions have been identified,but are not widely implemented.

> Greater emphasis should be placedon what services and interventionswould work best, and not based oncost or which interventions areeasiest to administer.

There is a need for better communicationand collaboration across systems.

> Several of the efforts to providehealth care within the child welfaresystem can serve as models to otherstates and localities (e.g., MATCHBaltimore, MD and StarlightPediatrics, Rochester, NY).

> HHS is making efforts to enhancecommunication and collaborationamong state child welfare directors,Medicaid directors and behavioralhealth directors to decrease the rateof usage of psychotropic medicationsand to improve mental healthoutcomes.» A recent letter from ACF, CMS and

SAMHSA’s a good federal start(www.childwelfare.gov/systemwide/mentalhealth/effectiveness/jointlettermeds.pdf).

» The three agencies will convenewebinars and meetings with stateMedicaid and child welfaredirectors in 2012(www.childwelfare.gov/systemwide/mentalhealth/effectiveness/psychotropic.cfm).


services and research studies.> Greater attention be paid to

developing, testing and endorsinghealth outcomes that addresspsychosocial needs and well-being.

> Recent legislative enhancementsrelated to the health and well-beingof at-risk children and families bewell communicated to stakeholdersand effectively implemented.

> Policy-makers seek input andguidance from family members,foster care alumni and serviceproviders in order to implementthe most effective andevidence-based services.

> Federal research agencies, i.e.,the National Institutes of Health(NIH) and the Agency for HealthcareResearch and Quality (AHRQ) workin consort with entities that fundprograms and innovations so that

research can inform policy andpractice and so that practice iscan inform future researchendeavors.

Children at Risk: Optimizing HeaAn Era of Reform brought togethstakeholders with experiences atfederal, state and local levels, drfrom research, practice, and poliexpertise. This convening coveredgreat deal of territory in a short tand reinforced the understanding

> Legislative changes have brounew opportunities and greaterattention to the health outcomeof at-risk children.

> Success will require people wotogether – engaging with famiand communities and using astrengths-based perspective.


The goal of the six working groupswas to identify action steps that

should be taken to improve healthoutcomes, enhance communication andcollaboration, promote the use ofevidence-based practices, and to betterserve children and families. Thefollowing six questions were addressedwith each participant having anopportunity to provide input into three,using the World Café process.

Questions for Working Groups

1) What communication strategies canbe improved to acquaint serviceproviders and agency administratorswith effective models, resourceinformation, and policy opportunitiesto better meet the health needs ofchildren in the child welfare system?

2) What further research, measuresand data are needed to betterunderstand the health needs, healthoutcomes, and health care accessissues for children in the childwelfare system or at risk of being inthe child welfare system?

3) What roles can nationalorganizations take, working togetherwith federal agencies to more fullyenhance access and quality healthcare for children at risk? Who needsto work together? To what ends?

4) What can universities, includingschools of social work, medicine,law, public health and nursing, doto improve health outcomes forchildren at risk? What is needed inthe curriculum? What kinds ofpartnerships are needed amongdisciplines and with communityservice providers?

5) What policy changes (enhancements)at the state and federal levels arenecessary to improve outcomes forchildren in the child welfare systemand those at risk of the child welfaresystem? What are specific (andpotentially winnable) opportunitieson the horizon?

6) What stakeholders need to worktogether at the federal and statelevels? - What leadership is needed?What tools are needed?

After the working groups output wasposted so that each participant couldvote for their three priority actions.Of the more than 60 recommendationssuggested by the working groups,the following list identifies therecommendations that were prioritizedby the participants. Based on the votingthe following recommendations wereprioritized:

> Improve communications betweenagencies, providers and managedcare organizations.

> Create a more focused andcoordinated effort to address healthcare needs of children served in thechild welfare system at the highestlevels with state and federalgovernments.

> Ask children and families whatoutcomes are important to them.

> Promote access and continuity of

care for children who have contactwith the child welfare system.

> Ensure that the voices of families,communities and foster care alumniare included in the development ofmodels to address health care needsin the child welfare system.

> Clarify the authority to consent forhealth care, early intervention andother services for those who are inthe foster care system and those whoare served in their own home.

> Create systems of communication toachieve better understanding andaccountability.

> Promote the establishing ofcross-disciplinary committees,working groups and projects withinuniversities to examine how toimprove health outcomes.

> SUMMARYRECOMMENDATIONSIn order to accomplish these effortsit will be required that:

> National organizations continueto work together.

> Research to policy efforts like thoseundertaken by PolicyLab beemulated in other jurisdictions andsupported through government,foundation and insurer funding.

> Model program efforts besystematically and competentlyevaluated and that findings bebroadly disseminated.

> Interdisciplinary education, training,planning and service delivery besupported and encouraged.

> Families and communities be engagedin planning and implementing

DEVELOPING AN AGENDA FOR ACTION


services and research studies.> Greater attention be paid to

developing, testing and endorsinghealth outcomes that addresspsychosocial needs and well-being.

> Recent legislative enhancementsrelated to the health and well-beingof at-risk children and families bewell communicated to stakeholdersand effectively implemented.

> Policy-makers seek input andguidance from family members,foster care alumni and serviceproviders in order to implementthe most effective andevidence-based services.

> Federal research agencies, i.e.,the National Institutes of Health(NIH) and the Agency for HealthcareResearch and Quality (AHRQ) workin consort with entities that fundprograms and innovations so that

research can inform policy andpractice and so that practice issuescan inform future researchendeavors.

Children at Risk: Optimizing Health inAn Era of Reform brought together keystakeholders with experiences at thefederal, state and local levels, drawingfrom research, practice, and policyexpertise. This convening covered agreat deal of territory in a short timeand reinforced the understanding that:


> Success will require people workingtogether – engaging with familiesand communities and using astrengths-based perspective.

> State and local governments alongwith insurance payers andcommunity agencies all have a roleto play in working with the federalgovernment to improve healthoutcomes and create coordinatedservice delivery.

> Research plays an important role inboth understanding who is servedand in testing innovations.

> Dissemination of effectiveinnovations is critical to improvinghealth outcomes.

This collaboration between the SocialWork Policy Institute, USC andPolicyLab can serve as an example ofcross-system and cross-disciplinaryknowledge development and can alsoserve as a model for others to emulateto address critical issues facing ourmost vulnerable children and families.


at can universities, includingols of social work, medicine,public health and nursing, do

mprove health outcomes fordren at risk? What is needed incurriculum? What kinds ofnerships are needed amongplines and with communityce providers?

at policy changes (enhancements)e state and federal levels are

essary to improve outcomes fordren in the child welfare systemthose at risk of the child welfare

em? What are specific (andntially winnable) opportunitieshe horizon?at stakeholders need to workther at the federal and states? - What leadership is needed?

at tools are needed?

e working groups output wasso that each participant couldr their three priority actions.more than 60 recommendationsted by the working groups,owing list identifies themendations that were prioritizedparticipants. Based on the votingowing recommendations werezed:

ove communications betweenncies, providers and managedorganizations.te a more focused anddinated effort to address healthneeds of children served in thewelfare system at the highests with state and federalernments.children and families whatomes are important to them.mote access and continuity of

care for children who have contactwith the child welfare system.

> Ensure that the voices of families,communities and foster care alumniare included in the development ofmodels to address health care needsin the child welfare system.

> Clarify the authority to consent forhealth care, early intervention andother services for those who are inthe foster care system and those whoare served in their own home.

> Create systems of communication toachieve better understanding andaccountability.

> Promote the establishing ofcross-disciplinary committees,working groups and projects withinuniversities to examine how toimprove health outcomes.

> SUMMARYRECOMMENDATIONSIn order to accomplish these effortsit will be required that:

> National organizations continueto work together.

> Research to policy efforts like thoseundertaken by PolicyLab beemulated in other jurisdictions andsupported through government,foundation and insurer funding.

> Model program efforts besystematically and competentlyevaluated and that findings bebroadly disseminated.

> Interdisciplinary education, training,planning and service delivery besupported and encouraged.

> Families and communities be engagedin planning and implementing

NG AN AGENDA FOR ACTION


Harman, J.S., Child, G.E., Safer, D.J., &Kelleher, K.J. (2000). Mental health careutilization and expenditures by children infoster care. Archives of Pediatrics &Adolescent Medicine, 154 (11):1114-1117.

Hutson, R. (2003). A Vision for EliminatingPoverty and Family Violence: TransformingChild Welfare and TANF in El Paso County,Colorado. Washington, DC: Center for Lawand Social Policy. Retrieved fromwww.clasp.org/admin/site/publications/files/0109.pdf.

Jee, S.H., Antonucci, T.C., Aida, M.,Szilagyi, M.A., & Szilagyi, P.G. (2005).Emergency department utilization bychildren in foster care. AmbulatoryPediatrics, 5(2), 102-106.

Jee, S.H., Barth, R.P., Szilagyi, M.A., &Szilagyi, P.G. (2006). Factors associatedwith chronic conditions among children infoster care. Journal of Health Care for thePoor and Underserved, 17(2), 328-341.

Kenney, G., Lynch, V., Haley, J.M.,Huntress, M., Resnick, D., Coyer, C.(2011). Gains for Increased Participation inMedicaid and CHIP in 2009. Washington,DC: Urban Institute. Retrieved fromwww.urban.org/UploadedPDF/412379-Gains-for-Children.pdf.

Kaplow, J.B.; Widom, C.S. 2007. Age ofOnset of Child Maltreatment PredictsLong-Term Mental Health Problems. Journalof Abnormal Psychology 116(1): 176-187.

Kortenkamp, K., & Ehrele, J (2002). Thewell-being of children involved with thechild welfare system: A National overview.Washington, DC: Urban Institute.

Leslie, L.K., Gordon, J.N, Meneken,Premji, K., Michelmore, K.L., & GanM.A. (2005). The physical, developand mental health needs of young cin child welfare by initial placementJournal of Developmental Pediatrics177-185

Maza P. (2008). AFCARS trends oveIn: National Research Conference FoWelfare Data and Technology (NRCWashington, DC.

McCarthy, J.; Marshall, A.; Irvine, MB. (2004). An Analysis of Mental HeIssues in States’ Child and Family SeReviews and Program ImprovementWashington, DC: National TechnicaAssistance Center for Children’s MeHealth, Georgetown University CentChild and Human Development andAmerican Institutes of Research.

McCrae, J.S. (2009). Emotional andbehavioral problems reported in chiwelfare over 3 years. Journal of Emo& Behavioral Disorders 17(1): 17-2

McCrae, J.S.; Barth, R.P.; Guo, S. (2Changes in Maltreated Children’sEmotional-Behavioral Problems FolloTypically Provided Mental Health SeAmerican Journal of Orthopsychiatry350-361.

Murtagh L, Ludwig DS. (2011). Stateintervention in life-threatening childhobesity. JAMA. 2011;306(2):206-2doi:10.1001/jama.2011.903.

National Survey of Child and AdoleWell-being: Introduction to the wavegeneral and restricted use releases.Ithaca, NY: Cornell University, NatioData Archive on Child Abuse and N


Armsden, G., Pecora, P.J., Payne, V.H., &Szatkiewicz, J.P. (2000). Children placedin long-term foster care: An intake profileusing the Child Behavior Checklist/4-18.Journal of Emotional and BehavioralDisorders, 8, 49-65.

Barth, R.P., Green, S.G., Guo, S., &McCrae, J.S. (2007). Kinship care andnonkinship foster care: Informing the newdebate. In F. Wulczyn, M. Webb, & R.Haskins (Eds.), Child protection: Usingresearch to improve policy and practice(pp. 187-206). Washington, DC: BrookingsInstitution.

Berkoff, M.C., Leslie, L.K., & Stahmer, A.C.(2006). Accuracy of caregiveridentification of developmental delaysamong young children involved with childwelfare. Journal of Developmental andBehavioral Pediatrics, 27(4), 310.

Burns, B.J.; Phillips, S.D.; Wagner, R.H.;Barth, R.P.; Kolko, D.J.; Campbell, Y.;Landsverk, J. (2004).Mental Health Needand Access to Mental Health Services byYouths Involved With

Center for Medicaid and MedicareServices. (2010). 2010 MedicaidManaged Care Enrollment Report.Accessed from www.cms.gov/MedicaidDataSourcesGenInfo/04_MdManCrEnrllRep.asp.

Child Welfare: A National Survey. Journalof the American Academy of Child andAdolescent Psychiatry 43(8): 960-970.

Casey Family Programs, 2005. ImprovingFamily Foster Care: Findings from theNorthwest Foster Care Alumni Study.Retrieved Oct. 26, 2011 fromwww.casey.org/resources/publications/ImprovingFamilyFosterCare.htm

Casey Family Programs, 2011. Ensuringsafe, nurturing and permanent families forchildren: Foster care reductions and safety.Retrieved 10/27/11 www.casey.org/Resources/Publications/pdf/FosterCareReductionsandChildSafety.pdf.

Cooper, Banghart & Aratani, 2010.Addressing the mental health needs ofyoung children in the child welfare system:What every policymaker should know.New York, NY: Columbia University,National Center for Children and Poverty.

Cooper, J., Aratani, Y.; Knitzer, J.,Douglas-Hall, A., Masi, R., Banghart, P.,Dababnah, S., 2008. Unclaimed ChildrenRevisited, The Status of Children’s MentalHealth Policy in the United States. NewYork, NY: Columbia University, NationalCenter for Children in Poverty

Dore, M. 2005. Child and adolescentmental health. In G. Mallon and P. Hess(eds.), Child Welfare for the Twenty-firstCentury: A Handbook of Practices, Policiesand Programs. 488-503. New York:Columbia University Press.

Dowd, K., Kinsey, S., Wheeless, S.,Thissen, R., Richardson, J., & Mierzwa, F.(2002).National Survey of Child andAdolescent Well-being (NSCAW):Introduction to the wave 1 general andrestricted use releases. Ithaca, NY: Cornell

University, National Data Archive on ChildAbuse and Neglect.

Felitti, V.J., Anda, R.F., Nordenberg, D.,Williamson, D.F., Spitz, A.M., Edwards, V.,et al. (1998) Relationship of childhoodabuse and household dysfunction to manyof the leading causes of death in adults:The Adverse Childhood Experiences (ACE)study. American Journal of PreventiveMedicine, 14(4), 245-258.

Fox, H.B., & McManus, M.A. (1996). Theeffect of managed care on Medicaidfinancing for public programs servingchildren with special health needs.Washington, DC: Maternal & Child HealthPolicy Research Center.

Garland, Lau, Yeh, McCabe, Hough, &Landsverk, 2005. Racial and EthnicDifferences in Utilization of Mental HealthServices Among High-Risk Youths. Am JPsychiatry, 162, 1336-1343.

Geen, R., Sommers, A., & Cohen M.(2005)Medicaid spending on fosterchildren. The Urban Institute: Child WelfareResearch Program, Brief #2. RetrievedOctober 20, 2011 fromwww.urban.org/UploadedPDF/311221_medicaid_spending.pdf

Halfon, N., Mendonca, A., & Berkowitz,G. (1995). Health status of children infoster care: The experience of the center forthe vulnerable child. Archives of Pediatricsand Adolescent Medicine, 149(4),386-392.

Hansen, R.L., Mawjee, F.L., Barton, K.,Metcalf, M.B., & Joye, N.R. (2004).Comparing the health status of low-incomechildren in and out of foster care. ChildWelfare, 83(4), 367-381.

REFERENCES


Harman, J.S., Child, G.E., Safer, D.J., &Kelleher, K.J. (2000). Mental health careutilization and expenditures by children infoster care. Archives of Pediatrics &Adolescent Medicine, 154 (11):1114-1117.

Hutson, R. (2003). A Vision for EliminatingPoverty and Family Violence: TransformingChild Welfare and TANF in El Paso County,Colorado. Washington, DC: Center for Lawand Social Policy. Retrieved fromwww.clasp.org/admin/site/publications/files/0109.pdf.

Jee, S.H., Antonucci, T.C., Aida, M.,Szilagyi, M.A., & Szilagyi, P.G. (2005).Emergency department utilization bychildren in foster care. AmbulatoryPediatrics, 5(2), 102-106.

Jee, S.H., Barth, R.P., Szilagyi, M.A., &Szilagyi, P.G. (2006). Factors associatedwith chronic conditions among children infoster care. Journal of Health Care for thePoor and Underserved, 17(2), 328-341.

Kenney, G., Lynch, V., Haley, J.M.,Huntress, M., Resnick, D., Coyer, C.(2011). Gains for Increased Participation inMedicaid and CHIP in 2009. Washington,DC: Urban Institute. Retrieved fromwww.urban.org/UploadedPDF/412379-Gains-for-Children.pdf.

Kaplow, J.B.; Widom, C.S. 2007. Age ofOnset of Child Maltreatment PredictsLong-Term Mental Health Problems. Journalof Abnormal Psychology 116(1): 176-187.

Kortenkamp, K., & Ehrele, J (2002). Thewell-being of children involved with thechild welfare system: A National overview.Washington, DC: Urban Institute.

Leslie, L.K., Gordon, J.N, Meneken, L,Premji, K., Michelmore, K.L., & Gander,M.A. (2005). The physical, developmental,and mental health needs of young childrenin child welfare by initial placement type.Journal of Developmental Pediatrics, 26(3).177-185

Maza P. (2008). AFCARS trends over time.In: National Research Conference For ChildWelfare Data and Technology (NRCWDT);Washington, DC.

McCarthy, J.; Marshall, A.; Irvine, M.; Jay,B. (2004). An Analysis of Mental HealthIssues in States’ Child and Family ServiceReviews and Program Improvement Plans.Washington, DC: National TechnicalAssistance Center for Children’s MentalHealth, Georgetown University Center forChild and Human Development andAmerican Institutes of Research.

McCrae, J.S. (2009). Emotional andbehavioral problems reported in childwelfare over 3 years. Journal of Emotional& Behavioral Disorders 17(1): 17-28.

McCrae, J.S.; Barth, R.P.; Guo, S. (2010).Changes in Maltreated Children’sEmotional-Behavioral Problems FollowingTypically Provided Mental Health Services.American Journal of Orthopsychiatry 80(3):350-361.

Murtagh L, Ludwig DS. (2011). Stateintervention in life-threatening childhoodobesity. JAMA. 2011;306(2):206-207.doi:10.1001/jama.2011.903.

National Survey of Child and AdolescentWell-being: Introduction to the wave 1general and restricted use releases. (2005).Ithaca, NY: Cornell University, NationalData Archive on Child Abuse and Neglect.

National Survey of Child and AdolescentWell-being. 2005. CPS Sample ComponentWave 1 Data Analysis Report. AccessedSept. 1, 2011 www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/cps_sample/cps_report_revised_090105.pdf.

Noonan, K., Rubin, D., Mekonnen, R.,Zlotnik, S. & O’Reilly, A. (2009). Securingchild safety, well-being, and permanencythrough placement stability in foster care.PolicyLab Evidence to Action No. 1, Fall2009. Retrieved fromwww.policylab.us/images/pdf/evidencetoactionbrief1_csaw_final.pdf.

Pasztor, E.M., Hollinger, D.S., Inkelas, M.,& Halfon, N. (2006). Health and mentalhealth services for children in foster care:The central role of foster parents. ChildWelfare, 85, 33–57.

Putnam-Hornstein, E. (2011) Report ofmaltreatment as a risk factor for injurydeath: A prospective birth cohort study.Child Maltreatment. DOI:10.1177/1077559511411179.

Ringeisen, H., Casanueva, C., Urato, M., &Cross, T. (2008). Special health care needsamong children in the child welfare system.Pediatrics, 122(1), E232 - E241.

Rubin D, O’Reilly A, Luan, X. & Localio A.(2007). The Impact of placement stabilityon behavioral well-being for children infoster care. Pediatrics; 119: 336-344.

Samuels, B. (2012). Promoting Social andEmotional Well-Being for VulnerableChildren and Youth: What WeKnow and Where We Are Going.Presentation at the 2012 Society forSocial Work and ResearchConference, Washington, DC,January 13th , 2012.


Welfare: A National Survey. Journalmerican Academy of Child andent Psychiatry 43(8): 960-970.

amily Programs, 2005. Improvingoster Care: Findings from the

est Foster Care Alumni Study.d Oct. 26, 2011 fromsey.org/resources/publications/

ngFamilyFosterCare.htm

amily Programs, 2011. Ensuringrturing and permanent families for: Foster care reductions and safety.d 10/27/11 www.casey.org/es/Publications/pdf/FosterCareonsandChildSafety.pdf.

Banghart & Aratani, 2010.ing the mental health needs ofhildren in the child welfare system:very policymaker should know.rk, NY: Columbia University,l Center for Children and Poverty.

J., Aratani, Y.; Knitzer, J.,-Hall, A., Masi, R., Banghart, P.,ah, S., 2008. Unclaimed Childrend, The Status of Children’s MentalPolicy in the United States. NewY: Columbia University, Nationalor Children in Poverty

M. 2005. Child and adolescenthealth. In G. Mallon and P. HessChild Welfare for the Twenty-first: A Handbook of Practices, Policiesgrams. 488-503. New York:a University Press.

K., Kinsey, S., Wheeless, S.,R., Richardson, J., & Mierzwa, F.

National Survey of Child andent Well-being (NSCAW):tion to the wave 1 general andd use releases. Ithaca, NY: Cornell

University, National Data Archive on ChildAbuse and Neglect.

Felitti, V.J., Anda, R.F., Nordenberg, D.,Williamson, D.F., Spitz, A.M., Edwards, V.,et al. (1998) Relationship of childhoodabuse and household dysfunction to manyof the leading causes of death in adults:The Adverse Childhood Experiences (ACE)study. American Journal of PreventiveMedicine, 14(4), 245-258.

Fox, H.B., & McManus, M.A. (1996). Theeffect of managed care on Medicaidfinancing for public programs servingchildren with special health needs.Washington, DC: Maternal & Child HealthPolicy Research Center.

Garland, Lau, Yeh, McCabe, Hough, &Landsverk, 2005. Racial and EthnicDifferences in Utilization of Mental HealthServices Among High-Risk Youths. Am JPsychiatry, 162, 1336-1343.

Geen, R., Sommers, A., & Cohen M.(2005)Medicaid spending on fosterchildren. The Urban Institute: Child WelfareResearch Program, Brief #2. RetrievedOctober 20, 2011 fromwww.urban.org/UploadedPDF/311221_medicaid_spending.pdf

Halfon, N., Mendonca, A., & Berkowitz,G. (1995). Health status of children infoster care: The experience of the center forthe vulnerable child. Archives of Pediatricsand Adolescent Medicine, 149(4),386-392.

Hansen, R.L., Mawjee, F.L., Barton, K.,Metcalf, M.B., & Joye, N.R. (2004).Comparing the health status of low-incomechildren in and out of foster care. ChildWelfare, 83(4), 367-381.

REFERENCES



Schneiderman, J.U., Brooks, D., Facher, B.,& Amis, J. (2007). Improving healthservices for foster youth: Multidisciplinaryand multi-stakeholder perspectives andrecommendations. Children and YouthServices Review, 29(3), 313-329

Schneiderman, J.U., Hurlburt, M., Leslie,L.K., Zhang, J., & Horwitz, S. (in press)Child, caregiver, and family characteristicsassociated with emergency department useby children who remain at home after achild protective services investigation. ChildAbuse and Neglect.

Schneiderman, J.U., Leslie, L.K., Hurlburt,M., Zhang, J. & Horwitz, S. (2010)Caregiver reports of serious injuries inchildren who remain at home after a childprotective services investigation. Maternaland Child Health Journal DOI:10.1007/s10995-010-0714-4

Schneiderman, J.U., Leslie, L.K., ArnoldClark, J., McDaniel, D. & Xie, B. (2011)Pediatric health assessments of youngchildren in child welfare by placements.Child Abuse and Neglect 35, 29-39.

Schneiderman, J.U., Traube, D.T., &McDaniel, D.D. (2011) Improving access topediatric care: Views of caregivers whoreceive child welfare services. Journal ofPublic Child Welfare, 5:5 546-563.DOI:10.1080/15548732.2011.617282.

Sedlak, A., Mettenburg, J., Basena, M., etal. The Fourth National Incidence Study ofChild Abuse and Neglect (NIS-4): Report toCongress. Washington, DC: U.S.Department of Health and Human Services,Administration for Children and Families;2010.

Stahmer A.C., Leslie L.K., Hurlburt M.,Barth, R.P., Webb, M.B., Landsverk J., &Zhang J. (2005). Developmental andbehavioral needs and service use for youngchildren in child welfare. Pediatrics,116(4), 891-900.

Steele, J.S., & Buchi, K.F. (2008). Medicaland mental health of children entering theUtah foster care system. Pediatrics, 122(3),e703-e709. doi: 10.1542/peds.2008-0360

Sullivan, D.J., & van Zyl, M.A. (2008).The well-being of children in foster care;Exploring physical and mental healthneeds. Children and Youth ServicesReview, 30, 774-786.

U.S. Department of Health and HumanServices, Administration for Children andFamilies (2005). General Findings From theFederal Child and Family Services Review.Retrieved October 20,1011 fromwww.acf.hhs.gov/programs/cb/cwmonitoring/results/genfindings04/index.htm

U.S. Department of Health and HumanServices.(2011) The afcars report:preliminary fy 2010 estimates as of june2011. In: administration for children andfamilies: children’s bureau. Retrieved oct20, 2011 from www.acf.hhs.gov/programs/cb; 2011.

U.S. Department of health and humanservices.(2009). Children’s Bureau, ChildMaltreatment Report, 2009. Retrieved Oct20, 2011 from www.acf.hhs.gov/programs/cb/pubs/cm09/index.htm

Vandivere, S., Chalk, R., & Moore, K.A.(2003). Children in foster homes: How arethey faring? Retrieved September 22,2009, from www.childtrends.org/Files//Child_Trends-2003_12_01_RB_FosterHomes.pdf.

Varness T, Allen, D.B., Carrel, A.L., Fost, N.(2009). Childhood obesity and medicalneglect. Pediatrics. 123(1):399-406.doi:10.1542/peds.2008-0712

Williamson, D.E., Thompson, T. J., Anda,R.F., Dietz, W.H., & Felitti, V. (2002). Bodyweight and obesity in adults andself-reported abuse in childhood.International Journal of Obesity, 26(8),1075-1082.

Zimmer, M.H.; Panko, L.M. 2006.Developmental Status and Service UseAmong Children in the Child WelfareSystem: A National Survey. Archives ofPediatrics and Adolescent Medicine 160:183-188.

APPENDIXES

1 > AGENDA – CHILDREN AT RISK: OPTIMIZING HEA

2 > PARTICIPANTS

3 > SPEAKER BIOGRAPHIES

4 > CENTER FOR HEALTH CARE STRATEGIES’OVERVIEW OF THE CHILD WELFARE INITIATIVES

5 > SELECTED RESOURCES FOR HEALTH CARE & CHI

6 > EXAMPLES OF ORGANIZATION POLICY POSITIO

7 > USEFUL WEBSITES

8 > MATCH: OVERVIEW

9 > NASW RESOURCES

1 0 > POLICYLAB RESOURCES

1 1 > THE NATIONAL QUALITY FORUM & CHILD HEALT

12 > ABOUT THE COLLABORATORS



A., Mettenburg, J., Basena, M., etFourth National Incidence Study ofbuse and Neglect (NIS-4): Report toss. Washington, DC: U.S.ment of Health and Human Services,tration for Children and Families;

A.C., Leslie L.K., Hurlburt M.,.P., Webb, M.B., Landsverk J., &. (2005). Developmental andral needs and service use for youngin child welfare. Pediatrics,891-900.

.S., & Buchi, K.F. (2008). Medicalntal health of children entering theter care system. Pediatrics, 122(3),

709. doi: 10.1542/008-0360

, D.J., & van Zyl, M.A. (2008).-being of children in foster care;g physical and mental healthChildren and Youth Services30, 774-786.

partment of Health and Human, Administration for Children and(2005). General Findings From theChild and Family Services Review.d October 20,1011 fromcf.hhs.gov/programs/cb/cwmonitorults/genfindings04/index.htm

partment of Health and Human.(2011) The afcars report:ary fy 2010 estimates as of junen: administration for children andchildren’s bureau. Retrieved oct1 from www.acf.hhs.gov/

ms/cb; 2011.

partment of health and human.(2009). Children’s Bureau, Childtment Report, 2009. Retrieved Oct1 from www.acf.hhs.gov/

ms/cb/pubs/cm09/index.htm

Vandivere, S., Chalk, R., & Moore, K.A.(2003). Children in foster homes: How arethey faring? Retrieved September 22,2009, from www.childtrends.org/Files//Child_Trends-2003_12_01_RB_FosterHomes.pdf.

Varness T, Allen, D.B., Carrel, A.L., Fost, N.(2009). Childhood obesity and medicalneglect. Pediatrics. 123(1):399-406.doi:10.1542/peds.2008-0712

Williamson, D.E., Thompson, T. J., Anda,R.F., Dietz, W.H., & Felitti, V. (2002). Bodyweight and obesity in adults andself-reported abuse in childhood.International Journal of Obesity, 26(8),1075-1082.

Zimmer, M.H.; Panko, L.M. 2006.Developmental Status and Service UseAmong Children in the Child WelfareSystem: A National Survey. Archives ofPediatrics and Adolescent Medicine 160:183-188.

APPENDIXES

1 > AGENDA – CHILDREN AT RISK: OPTIMIZING HEALTH IN AN ERA OF REFORM

2 > PARTICIPANTS

3 > SPEAKER BIOGRAPHIES

4 > CENTER FOR HEALTH CARE STRATEGIES’OVERVIEW OF THE CHILD WELFARE INITIATIVES MANAGED CARE ORGANIZATIONS’

5 > SELECTED RESOURCES FOR HEALTH CARE & CHILDREN AT RISK

6 > EXAMPLES OF ORGANIZATION POLICY POSITIONS

7 > USEFUL WEBSITES

8 > MATCH: OVERVIEW

9 > NASW RESOURCES


1 1 > THE NATIONAL QUALITY FORUM & CHILD HEALTH MEASUREMENT: OVERVIEW



1 > CHILDREN AT RISK: OPTIMIZING HEALTH IN ANERA OF REFORMAGENDA

Thursday, November 17, 2011

Hosted by the NASW Foundation Social Work Policy InstituteIn collaboration with contributing partners, The School of Social Work, University ofSouthern California, and PolicyLab of The Children’s Hospital of Philadelphia.

NASW National Office: 750 First Street, NE, Suite 700, Washington, DC

2 > PARTICIPANTS

Joan Alker, MPPCo-Executive DirectorCenter for Children and FamiliesGeorgetown UniversityWashington, DC

David Berns, MSWDirectorDepartment of Human ServicesGovernment of the District of ColumbiaWashington, DC

Kamala Allen, MHSDirectorChild Health QualityCenter for Health Care StategiesLawrenceville, NJ

Fran Bernstein, JDPolicy AnalystAmerican Federation of State, County

and Municipal EmployeesWashington, DC

Thomas Birch, JDLegistative CounselNational Child Abuse CoalitionWashington, DC

Zaneta BrownBureau ChiefDepartment of Health, Community

Health AdministrationGovernment of the District of Columbia

Alice CahillOrganizational ConsultantSilver Spring, MD

Cindy Christian, MDMedical DirectorDepartment of Human ServicesCity of PhiladelphiaPhiladelphia, PA

Theodore Cross, PhDResearch Full ProfessorChildren and Family Research CenterUniversity of Illinois Urbana-ChampaignUrbana, IL

Cara Curtis, BAResearch AssistantPolicyLabChildren’s Hospital PhiladelphiaPhiladelphia, PA

Pamela Day, MSWCo-DirectorChild Welfare Information GatewayICF InternationalFairfax, VA

Rachel Dodge, MD, MPH, FAAPMedical DirectorThe MATCH ProgramState of Maryland Department of

Human Resources

Cecilia Fiermonte, JDDirectorChild Welfare PolicyAlliance for Children and FamilesWashington, DC

Megan Finno, MSWDoctoral StudentSchool of Social WorkUniversity of Southern CaliforniaLos Angeles, CA

Isadora Hare, MSW, LCSWPublic Health AnalystHealth Resources and ServicesAdministration

Adolescent Health BranchRockville, MD

Theresa Huizar, MPPExecutive DirectorNational Children’s AllianceWashington, DC

Denise Juliano-Bult, MSWChief, Systems Research ProgramNIMHBethesda, MD

Christine James BrownChief Executive OfficerChild Welfare League of AmericaWashington, DC


REGISTRATION AND CONTINENTAL BREAKFAST

WELCOME, INTRODUCTIONS AND GOALS

PANEL 1 – SETTING THE CONTEXT• Lessons from Recent Research on Children

in Child Welfare and Health CareJanet Schneiderman, USC, SymposiumAcademic Chair

• Bridging Research and Policy to Improvethe Behavioral Health of Children inChild WelfareSarah Zlotnik, PolicyLab

• Measuring Children’s Health Outcomes –Current Status and Future EffortsSuzanne Theberge, National Quality Forum

PANEL 2 – LEGISLATION AND IMPLEMENTINGPOLICIES TO IMPROVE HEALTH OUTCOMES

• Public Coverage for Children in an Eraof ReformJoan Alker, Georgetown University Centerfor Children and Families

• Innovations in Health-Related Care forChildren in Child WelfareKamala Allen, Center for HealthCare Strategies

PANEL 3 – IMPROVING SYSTEMS, DEVELOPINGLINKAGES, PROVIDING CARE ON THE GROUND

• A View from AppalachiaDeirdra Robinson, Morehead State University

• A State and Local Perspective – AgenciesWorking Together for FamiliesDavid Berns, Department of HumanServices, Washington, DC

• Integrating Behavioral Health Care intoHealth CareRita Vandivort-Warren, Substance Abuseand Mental Health Services Administration

• Health Care in Child WelfareRachel Dodge, MATCH Program,Baltimore, MD

LUNCH

ACTION GROUPS

REPORT BACK & SUMMARY AND CONCLUSIONS

ADJOURN

APPENDIX


ILDREN AT RISK: OPTIMIZING HEALTH IN ANOF REFORM

November 17, 2011

by the NASW Foundation Social Work Policy Instituteration with contributing partners, The School of Social Work, University ofCalifornia, and PolicyLab of The Children’s Hospital of Philadelphia.

ational Office: 750 First Street, NE, Suite 700, Washington, DC

2 > PARTICIPANTS

Joan Alker, MPPCo-Executive DirectorCenter for Children and FamiliesGeorgetown UniversityWashington, DC

David Berns, MSWDirectorDepartment of Human ServicesGovernment of the District of ColumbiaWashington, DC

Kamala Allen, MHSDirectorChild Health QualityCenter for Health Care StategiesLawrenceville, NJ

Fran Bernstein, JDPolicy AnalystAmerican Federation of State, County

and Municipal EmployeesWashington, DC

Thomas Birch, JDLegistative CounselNational Child Abuse CoalitionWashington, DC

Zaneta BrownBureau ChiefDepartment of Health, Community

Health AdministrationGovernment of the District of Columbia

Alice CahillOrganizational ConsultantSilver Spring, MD

Cindy Christian, MDMedical DirectorDepartment of Human ServicesCity of PhiladelphiaPhiladelphia, PA

Theodore Cross, PhDResearch Full ProfessorChildren and Family Research CenterUniversity of Illinois Urbana-ChampaignUrbana, IL

Cara Curtis, BAResearch AssistantPolicyLabChildren’s Hospital PhiladelphiaPhiladelphia, PA

Pamela Day, MSWCo-DirectorChild Welfare Information GatewayICF InternationalFairfax, VA

Rachel Dodge, MD, MPH, FAAPMedical DirectorThe MATCH ProgramState of Maryland Department of

Human Resources

Cecilia Fiermonte, JDDirectorChild Welfare PolicyAlliance for Children and FamilesWashington, DC

Megan Finno, MSWDoctoral StudentSchool of Social WorkUniversity of Southern CaliforniaLos Angeles, CA

Isadora Hare, MSW, LCSWPublic Health AnalystHealth Resources and ServicesAdministration

Adolescent Health BranchRockville, MD

Theresa Huizar, MPPExecutive DirectorNational Children’s AllianceWashington, DC

Denise Juliano-Bult, MSWChief, Systems Research ProgramNIMHBethesda, MD

Christine James BrownChief Executive OfficerChild Welfare League of AmericaWashington, DC

Brooke Lehmann, MSWCenter for Children and FamiliesGeorgetown UniversityWashington, DC

Anita Light, BSW, MA, CAEDirectorNAPCWA and Children and Family

ServicesAmerican Public Human Services

AssociationWashington, DC

Heather McCabe, PhDOffice of the Deputy Mayor for Health

and Human ServicesOffice of the MayorGovernment of the District of ColumbiaWashington, DC

Rebecca McElroyMSW-MPA Candidate 2012School of Social Policy and PracticeUniversity of Pennsylvania

Charlotte Mullican, BSW, MPHSenior Advisor, Mental Health ResearchAgency for Healthcare Research andQuality

Rockville, MD

Jessica NewmanPolicy Research FellowFirst FocusWashington, DC

Denise Pintello, MSW, PhDSpecial Assistant to the NIDA DeputyDirector

National Institute on Drug AbuseBethesda, MD

James Resnick, MHSPublic Health AnalystBureau of Maternal and Child HealthHealth Resources and ServicesAdministration

Rockville, MD

Deirdra Robinson, ABD, MSWInstructor of Social WorkMorehead State University, AshlandCampus

Ashland, KY


AKFAST

ALS

ildren

um

prove

mes –

y Forum

NTINGMESEra

Center

for

PANEL 3 – IMPROVING SYSTEMS, DEVELOPINGLINKAGES, PROVIDING CARE ON THE GROUND

• A View from AppalachiaDeirdra Robinson, Morehead State University

• A State and Local Perspective – AgenciesWorking Together for FamiliesDavid Berns, Department of HumanServices, Washington, DC

• Integrating Behavioral Health Care intoHealth CareRita Vandivort-Warren, Substance Abuseand Mental Health Services Administration

• Health Care in Child WelfareRachel Dodge, MATCH Program,Baltimore, MD

LUNCH

ACTION GROUPS

REPORT BACK & SUMMARY AND CONCLUSIONS

ADJOURN

APPENDIX


3 > SPEAKERBIOGRAPHIESKamala Allen, MHSVice President, Program OperationsDirector, Child Health Quality Center forHealth Care Strategies (CHCS)Kamala Allen, MHS is the vice president forprogram operations and director of childhealth quality at the Center for Health CareStrategies (CHCS). In these roles, Ms. Allenis responsible for ensuring the quality andefficiency of overall organizationalprogramming, and providing directoversight of all CHCS’ child-focusedinitiatives. She has extensive experience inthe application of quality improvementmethodologies and the use of managedcare in public child-serving systems, and isalso responsible for the direction andfinancial management of the Children inManaged Care initiative, which has beenfunded since 1995 by the Annie E. CaseyFoundation. Ms. Allen holds a master ofhealth science in maternal and child healthfrom the Johns Hopkins University’sBloomberg School of Hygiene and PublicHealth. She earned a bachelor’s degree inpsychology with a concentration indevelopmental disabilities from theUniversity of California at Los Angeles.

Prior to assuming her currentresponsibilities, Ms. Allen was associatedirector for special projects for the RobertWood Johnson Foundation’s MedicaidManaged Care Program, where sheoversaw the development and execution ofstate agency training programs in healthcare quality, and served as associatedirector for program analysis andcommunications. She also worked as aprogram analyst in the U.S. Department ofHealth and Human Services’ Maternal andChild Health Bureau’s Office of ProgramDevelopment, where she was a contributingauthor to the 1994 Bureau White Paper;and as project coordinator for the states’responses to the Title V Block GrantGuidance. Ms. Allen was the projectcoordinator at the Centers for Disease

Control’s Maryland Center for AdoleHealth Promotion and Disease Prevewhere she co-developed and oversaimplementation of a school-based hepromotion curriculum in two Baltimomiddle schools.

Joan Alker, MPPCo-Executive Director, GeorgetownCenter for Children and FamiliesResearch Associate Professor, GeorgUniversity Health Policy InstituteJoan Alker, MPP is co-executive direthe Georgetown Center for ChildrenFamilies and a Research AssociateProfessor at the Georgetown UniversHealth Policy Institute. Her work focuhealth coverage for low-income childand families, with an emphasis on sMedicaid initiatives including waivepremium assistance policies, immigrissues, and cost-sharing.

A frequent speaker and commentatohas over twenty years of experienceon issues affecting low-income familholds a Master of Philosophy in polifrom St. Antony’s College, Oxford Uand a Bachelor of Arts with honors ipolitical science from Bryn Mawr Co

David A. Berns, MSWDirector, Department of Human ServGovernment of the District of ColumbDavid A. Berns, MSW appointed byof Columbia, Mayor Vincent C. Graserves as the Director of the Departmof Human Services (DHS). Mr. Bernsto DHS from the Casey Family Progrwhere he served as the Executive ViPresident for Child and Family Servisince 2006. He provided strategic dto the foundation’s nine field officesArizona, California, Idaho, Texas anWashington, and its Indian Child Woffice in Colorado. Prior to joining thCasey Family Programs, Mr. Berns sas director of the Arizona DepartmeEconomic Security. In Arizona, he ma staff of 10,000 employees and aof $2.7 billion, leading Arizona’s wprograms, development disabilities s


Janet Schneiderman, RN, PhDSymposium Academic ChairResearch Associate ProfessorUniversity of Southern CaliforniaSchool of Social WorkLos Angeles, CA

John SciamannaDirectorAmerican Humane AssociationPolicy and Government RelationsWashington, DC

Nadia Sexton, PhDSenior AdvisorKnowledge ManagementCasey Family ProgramsWashington, DC

Kate StepletonSpecial AssistantAdministration on Children,

Youth & Families

Moira Szilagyi, MD, PhDStarlight PediatricsRochester, NY

Suzanne Theberge, MPHProject ManagerNational Quality ForumWashington, DC

Melvina Thornton, MSWProgram AnalystODUSD Miltary Community and Family

Policy, Family Advocacy ProgramWashington, DC

J. Ann Tickner, PhDProfessor of International RelationsUniversity of Southern CaliforniaLos Angeles, CA

Rita Vandivort-Warren, ACSWPublic Health AnalystSubstance Abuse and Mental HealthAdministration

Rockville, MD

YaMinco Vanner, MSWPolicy AssociateHealthChild Welfare League of AmericaWashington, DC

Randi Walters, MSW, PhDChild Welfare Program SpecialistChildren’s BureauWashington, DC

Reva Winkler, MD, MPHSenior DirectorNational Quality Forum

Edward Woomer, MSW, LCSWSenior Director, Dept. of Patient and

Family ServicesNemours duPont Hospital for ChildrenWilmington, DE

Sarah Zlotnik, MSW, MSPHSenior StrategistPolicy LabChildren’s Hospital PhiladelphiaPhiladelphia, PA

NASW STAFF:Robert Arnold, MPSDirectorNASW Foundation

Stacy Collins, MSWSenior Practice Associate

Elizabeth Hoffler, MSWSpecial Assistant to the Director

Sharon Issurdatt, MSWSenior Practice Associate

Kelsey Nepote, MSWSenior Governance Associate

Ausa Ofosu, JDManager, Government Relations

Danielle Spears, BSExecutive Assistant

Roxana Torrico Meruvia, MSWSenior Practice Associate

Rita Webb, MSWSenior Practice Associate

Tracy Whitaker, DSW, ACSWDirectorCenter for Workforce Studies & Social

Work Practice

Joan Levy Zlotnik, PhD, ACSWDirectorSocial Work Policy Institute

SPECIAL GUESTS

Tanzania Social Work AssociationDar-Es-Salaam, Tanzania

Dr. Leonard MbilinyiChairperson

Enock MbiseExecutive Committee MemberFormer Director in the Ministry of

Youth and Sports

Anna SwaiDevelopment Director


3 > SPEAKERBIOGRAPHIESKamala Allen, MHSVice President, Program OperationsDirector, Child Health Quality Center forHealth Care Strategies (CHCS)Kamala Allen, MHS is the vice president forprogram operations and director of childhealth quality at the Center for Health CareStrategies (CHCS). In these roles, Ms. Allenis responsible for ensuring the quality andefficiency of overall organizationalprogramming, and providing directoversight of all CHCS’ child-focusedinitiatives. She has extensive experience inthe application of quality improvementmethodologies and the use of managedcare in public child-serving systems, and isalso responsible for the direction andfinancial management of the Children inManaged Care initiative, which has beenfunded since 1995 by the Annie E. CaseyFoundation. Ms. Allen holds a master ofhealth science in maternal and child healthfrom the Johns Hopkins University’sBloomberg School of Hygiene and PublicHealth. She earned a bachelor’s degree inpsychology with a concentration indevelopmental disabilities from theUniversity of California at Los Angeles.

Prior to assuming her currentresponsibilities, Ms. Allen was associatedirector for special projects for the RobertWood Johnson Foundation’s MedicaidManaged Care Program, where sheoversaw the development and execution ofstate agency training programs in healthcare quality, and served as associatedirector for program analysis andcommunications. She also worked as aprogram analyst in the U.S. Department ofHealth and Human Services’ Maternal andChild Health Bureau’s Office of ProgramDevelopment, where she was a contributingauthor to the 1994 Bureau White Paper;and as project coordinator for the states’responses to the Title V Block GrantGuidance. Ms. Allen was the projectcoordinator at the Centers for Disease

Control’s Maryland Center for AdolescentHealth Promotion and Disease Prevention,where she co-developed and oversaw theimplementation of a school-based healthpromotion curriculum in two Baltimoremiddle schools.

Joan Alker, MPPCo-Executive Director, GeorgetownCenter for Children and FamiliesResearch Associate Professor, GeorgetownUniversity Health Policy InstituteJoan Alker, MPP is co-executive director atthe Georgetown Center for Children andFamilies and a Research AssociateProfessor at the Georgetown UniversityHealth Policy Institute. Her work focuses onhealth coverage for low-income childrenand families, with an emphasis on stateMedicaid initiatives including waivers,premium assistance policies, immigrantissues, and cost-sharing.

A frequent speaker and commentator, Alkerhas over twenty years of experience workingon issues affecting low-income families. Sheholds a Master of Philosophy in politicsfrom St. Antony’s College, Oxford Universityand a Bachelor of Arts with honors inpolitical science from Bryn Mawr College.

David A. Berns, MSWDirector, Department of Human ServicesGovernment of the District of ColumbiaDavid A. Berns, MSW appointed by Districtof Columbia, Mayor Vincent C. Gray,serves as the Director of the Departmentof Human Services (DHS). Mr. Berns comesto DHS from the Casey Family Programswhere he served as the Executive VicePresident for Child and Family Servicessince 2006. He provided strategic directionto the foundation’s nine field offices inArizona, California, Idaho, Texas andWashington, and its Indian Child Welfareoffice in Colorado. Prior to joining theCasey Family Programs, Mr. Berns servedas director of the Arizona Department ofEconomic Security. In Arizona, he manageda staff of 10,000 employees and a budgetof $2.7 billion, leading Arizona’s welfareprograms, development disabilities services,

employment services, child welfare, childsupport, aging and community services.

Mr. Berns received his Master of Arts inPublic Administration from NorthernMichigan University and his Master inSocial Work and bachelor’s degree fromMichigan State University. Mr. Berns wasnamed Social Worker of the Year in 1999by the Colorado chapter of the NationalAssociation of Social Workers. He alsoreceived the Award for Excellence in PublicChild Welfare Administration from theNational Association of Public ChildWelfare Administrators.

Rachel Dodge, MD, MPH, FAAP MedicalDirector for Foster Care, BaltimoreHealthCare Access, Inc.The MATCH Program at BCDSSRachel Dodge, MD is a generalpediatrician with training in publichealth, research methods, leadership,and advocacy. She received her medicaldegree from the University of Maryland,School of Medicine in 2002 and completedthe pediatric residency program atRainbow Babies and Children’sHospital/University Hospitals of Clevelandin 2005. Dr. Dodge completed the GeneralPediatric Academic DevelopmentFellowship at the Johns Hopkins School ofMedicine and earned a Master’s of PublicHealth degree from the Johns HopkinsBloomberg School of Public Health.Currently, Dr. Dodge is the medical directorof the MATCH (Making All The ChildrenHealthy) Program, a project of BaltimoreHealthCare Access and Baltimore CityDepartment of Social Services. In this role,she oversees the coordination of healthcare for Baltimore City children in fostercare and works closely with the pediatricprimary care, dental and mental healthcommunities. In addition, Dr. Dodge is anAssistant Professor of Pediatrics at JohnsHopkins University School of Medicineand is an Attending Physician in theJohns Hopkins Harriet LanePediatrics Clinic.


ickner, PhDr of International Relationsty of Southern Californiaeles, CA

ndivort-Warren, ACSWealth Analystce Abuse and Mental Healthistratione, MD

o Vanner, MSWssociate

Welfare League of Americagton, DC

Walters, MSW, PhDWelfare Program Specialistn’s Bureaugton, DC

inkler, MD, MPHDirectorl Quality Forum

Woomer, MSW, LCSWDirector, Dept. of Patient andy Servicess duPont Hospital for Children

gton, DE

lotnik, MSW, MSPHStrategistabn’s Hospital Philadelphiaphia, PA

STAFF:Arnold, MPS

Foundation

ollins, MSWPractice Associate

h Hoffler, MSWAssistant to the Director

Issurdatt, MSWPractice Associate

Nepote, MSWGovernance Associate

Ausa Ofosu, JDManager, Government Relations

Danielle Spears, BSExecutive Assistant

Roxana Torrico Meruvia, MSWSenior Practice Associate

Rita Webb, MSWSenior Practice Associate

Tracy Whitaker, DSW, ACSWDirectorCenter for Workforce Studies & Social

Work Practice

Joan Levy Zlotnik, PhD, ACSWDirectorSocial Work Policy Institute

SPECIAL GUESTS

Tanzania Social Work AssociationDar-Es-Salaam, Tanzania

Dr. Leonard MbilinyiChairperson

Enock MbiseExecutive Committee MemberFormer Director in the Ministry of

Youth and Sports

Anna SwaiDevelopment Director



Deirdra Robinson, ABD, MSWInstructor, Morehead State UniversityDeirdra Robinson received her BSW andMSW from the University of Kentucky.Having grown up in a rural town in EasternKentucky, her passion for social justice ledher to work in community development. Ms.Robinson is an instructor at Morehead StateUniversity in the Department of Sociology,Social Work and Criminology. Her researchand community development work focuseson health disparities and rural health issues.She is currently the President-elect for theNational Association of Social Workers-Kentucky Chapter. Deirdra is also workingon her dissertation, with an anticipatedcompletion of her Doctorate of Philosophyin Social Work in 2011.

Janet U. Schneiderman, PhD, RNAssociate Professor, University of SouthernCalifornia, School of Social WorkSymposium Academic ChairJanet U. Schneiderman, PhD, RN, is anassociate professor at the University ofSouthern California, School of Social Work.She has been researching the health andhealth care of children in child welfare forthe last 10 years. Dr. Schneiderman has aKO1 from the Eunice Kennedy ShiverNational Institute of Child Health andHuman Development to study the preventionof medical neglect in the child welfaresystem. The emphasis of this mentoredresearch award is to study health problemsof maltreated children and how caregivers

(birth parents and foster caregivers) accessand use pediatric health services to preventand treat their child’s health problems.Recently, she has begun looking at obesityin maltreated children, the relationship ofpsychological problems and developmentalchanges with obesity, as well as how fostercare affects obesity rates.

Suzanne Theberge, MPHProject Manager, National Quality ForumSuzanne Theberge is a project manager atthe National Quality Forum, where she workson NQF’s child and maternal health projects.She has worked at a range of reproductivehealth and child health-focused organizationsin Boston, New York City, and Washington,DC. She holds an MPH in Population andFamily Health from the Mailman School ofPublic Health at Columbia University.

Rita Vandivort-Warren, MSWSenior Public Health Analyst, Divisionof Services Improvement, CSAT, SAMHSARita Vandivort-Warren, MSW is a SeniorPublic Health Analyst in the Division ofServices Improvement, CSAT, SAMHSA.She serves as the expert on financing andcost of treatment, center lead on Medicaidand health reform issues, directs coststudies, and provides technical assistanceon financing to states, grantees andproviders. Previously, she worked at theNational Association of Social Workers onmanaged care, mental health andsubstance abuse, and Medicaid. In Hawaii,Rita worked at the Queen’s Medical Centerin Honolulu as Ambulatory PsychiatricManager and created a foster family forelderly program funded under a Home andCommunity Based Waiver.

Joan Levy Zlotnik, PhD, ACSWDirector, Social Work Policy InstituteJoan Levy Zlotnik, PhD, ACSW is directorof the Social Work Policy Institute in theNASW Foundation. She previously servedas executive director of the Institute for theAdvancement of Social Work Research andas staff director of NASW’s FamilyCommission and as a Government

Relations Associate at the NASW. Shewas also Director of Special Projects andSpecial Assistant to the Executive Directorat the Council on Social Work Education.

She holds a PhD in Social Work from theUniversity of Maryland, an MSSW from theUniversity of Wisconsin-Madison, and a BAfrom the University of Rochester. Dr. Zlotnikis a fellow of the Gerontological Society ofAmerica and an NASW Social WorkPioneer® and was recognized by theNational Institute of Health’s (NIH) SocialWork Research Working Group for her effortson behalf of social work research at NIH.

Sarah Zlotnik, MSW, MSPHSenior Strategist, PolicyLab: Center toBridge Research, Practice, and Policy atThe Children’s Hospital of PhiladelphiaResearch InstituteSarah Zlotnik, MSW, MSPH, is a seniorstrategist at PolicyLab: Center to BridgeResearch, Practice, and Policy at TheChildren’s Hospital of PhiladelphiaResearch Institute. Ms. Zlotnik providesorganizational support across the Centerand leads the Center‘s strategy for researchimpact. She works with project teams toincorporate the policy and practice contextin research design and coordinates theCenter’s communications strategy andengagement with stakeholder partners.Ms. Zlotnik’s most recent projects focus oncross-system efforts to improve physical andmental health care for children in the childwelfare system. Additionally, Ms. Zlotnik isa course instructor with the University ofPennsylvania School of Medicine’s Mastersof Science of Health Policy program. Priorto joining PolicyLab, Ms. Zlotnik providedtechnical support to HIV/AIDS organizationsin the United States, Cambodia, and SouthAfrica. Ms. Zlotnik’s direct-service experienceincludes running programs for families inpublic housing and working in therapeuticfoster care. Ms. Zlotnik holds a master ofsocial work and masters of science ofpublic health with a specialization inmaternal and child health from theUniversity of North Carolina - Chapel Hill.

4 >CENTER FOR HEALTH CARE STRATEGIES’OVERVIEW OF THE CHILD WELFARE INITIATIVES MAN



arents and foster caregivers) accesspediatric health services to prevent

at their child’s health problems.y, she has begun looking at obesityeated children, the relationship ofogical problems and developmentals with obesity, as well as how fosterects obesity rates.

e Theberge, MPHManager, National Quality Forume Theberge is a project manager atonal Quality Forum, where she works’s child and maternal health projects.worked at a range of reproductive

nd child health-focused organizationsn, New York City, and Washington,

e holds an MPH in Population andHealth from the Mailman School ofealth at Columbia University.

ndivort-Warren, MSWPublic Health Analyst, Divisionces Improvement, CSAT, SAMHSAdivort-Warren, MSW is a Seniorealth Analyst in the Division ofImprovement, CSAT, SAMHSA.

ves as the expert on financing andreatment, center lead on Medicaidlth reform issues, directs costand provides technical assistancecing to states, grantees andrs. Previously, she worked at thel Association of Social Workers ond care, mental health and

ce abuse, and Medicaid. In Hawaii,rked at the Queen’s Medical Centerlulu as Ambulatory Psychiatricer and created a foster family forprogram funded under a Home andnity Based Waiver.

vy Zlotnik, PhD, ACSWSocial Work Policy Institute

vy Zlotnik, PhD, ACSW is directorocial Work Policy Institute in theFoundation. She previously servedutive director of the Institute for theement of Social Work Research anddirector of NASW’s Familysion and as a Government

Relations Associate at the NASW. Shewas also Director of Special Projects andSpecial Assistant to the Executive Directorat the Council on Social Work Education.

She holds a PhD in Social Work from theUniversity of Maryland, an MSSW from theUniversity of Wisconsin-Madison, and a BAfrom the University of Rochester. Dr. Zlotnikis a fellow of the Gerontological Society ofAmerica and an NASW Social WorkPioneer® and was recognized by theNational Institute of Health’s (NIH) SocialWork Research Working Group for her effortson behalf of social work research at NIH.

Sarah Zlotnik, MSW, MSPHSenior Strategist, PolicyLab: Center toBridge Research, Practice, and Policy atThe Children’s Hospital of PhiladelphiaResearch InstituteSarah Zlotnik, MSW, MSPH, is a seniorstrategist at PolicyLab: Center to BridgeResearch, Practice, and Policy at TheChildren’s Hospital of PhiladelphiaResearch Institute. Ms. Zlotnik providesorganizational support across the Centerand leads the Center‘s strategy for researchimpact. She works with project teams toincorporate the policy and practice contextin research design and coordinates theCenter’s communications strategy andengagement with stakeholder partners.Ms. Zlotnik’s most recent projects focus oncross-system efforts to improve physical andmental health care for children in the childwelfare system. Additionally, Ms. Zlotnik isa course instructor with the University ofPennsylvania School of Medicine’s Mastersof Science of Health Policy program. Priorto joining PolicyLab, Ms. Zlotnik providedtechnical support to HIV/AIDS organizationsin the United States, Cambodia, and SouthAfrica. Ms. Zlotnik’s direct-service experienceincludes running programs for families inpublic housing and working in therapeuticfoster care. Ms. Zlotnik holds a master ofsocial work and masters of science ofpublic health with a specialization inmaternal and child health from theUniversity of North Carolina - Chapel Hill.

4 >CENTER FOR HEALTH CARE STRATEGIES’OVERVIEW OF THE CHILD WELFARE INITIATIVES MANAGED CARE ORGANIZATIONS’


HHS – ACFINTEROPERABILITY TOOLKIT ENHANCES SERVICEINTEGRATION

National Institutes of HealthSurgeon General'sWORKSHOP ON MAKINGPREVENTION OF CHILD MALTREATMENT ANATIONAL PRIORITY: IMPLEMENTINGINNOVATIONS OF A PUBLIC HEALTH APPROACH

HHS – CDC THE EFFECTS OF CHILDHOOD STRESS ONHEALTH ACROSS THE LIFESPAN

HHS – Administration for Children and Families, Office ofChild Support EnforcementPROMOTING CHILD WELL-BEING AND FAMILYSELF-SUFFICIENCY

www.acf.hhs.gov/interop/toolkit.pdf

www.surgeongeneral.gov/topics/childmaltreatme

www.cdc.gov/ncipc/pub-res/pdf/Childhood_Stre

www.acf.hhs.gov/programs/cse/pubs/factsheetschild_support/health_care_coverage.pdf


5 > SELECTED RESOURCES — HEALTH CARE & CHILDREN AT RISKGOVERNMENT REPORTS

Organization/TITLE URL Description

HHS – CMS Low Cost Health Insurance for Childrenand Families OVERVIEW CHILDREN’S HEALTHINSURANCE PROGRAM

HHS the Health Resources and Services Administration(HRSA) and the Administration for Children and Families(ACF) AFFORDABLE CARE ACT (ACA) MATERNALINFANT AND EARLY CHILDHOOD HOME VISITINGPROGRAM

US Preventive Services Task ForceFIRST ANNUAL REPORT TO CONGRESS ONHIGH-PRIORITY EVIDENCE GAPS FORCLINICAL PREVENTIVE SERVICES

HHS – National Institute of Mental Health –CHILD AND ADOLESCENT MENTAL HEALTH

HHS Administration for Children and Families –Office of Refugee Resettlement: HEALTH BENEFITS

HHS – Agency for Healthcare Research and Quality:CHILDREN'S HEALTH INSURANCE PROGRAMREAUTHORIZATION ACT (CHIPRA)

www.cms.gov/LowCostHealthInsFamChild/www.cms.gov/CHIPRA

www.acf.hhs.gov/earlychildhood/docs/ACA_home_visiting_overview.pdf

www.uspreventiveservicestaskforce.org/annlrpt/tfannrpt2011.pdf

nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

www.acf.hhs.gov/programs/orr/benefits/health.htm

www.ahrq.gov/chipra/

The Low Cost Health Insurance for Children and Families onthe CMS website provides an array of information includingan overview of the reauthorization, information for stateMedicaid Directors and information on outreach grants andinformation on the Healthy Start, Grow Smart" healtheducation series

Describes home visiting program established under the ACA

Oct. 2011 USPTF report to Congress, required by the ACA,notes that further research is needed regardinginterventions in primary care to prevent child abuse andneglect ; and that evidence gaps relating to specificpopulations and age groups that deserve further researchinclude screening and treatment for depression in children

Contains featured publications and current research topicson child and adolescent mental health.

Provides information on health challenges to refugees,the medical screening process, health promotion andprevention.

Describes efforts of the AHRQ, Centers for Medicare &Medicaid Services (CMS), and CHIPRA Federal QualityWorkgroup to implement selected provisions of thelegislation related to children's health care quality.

Organization/TITLE URL

ORGANIZATION REPORTS AND POLICY BRIEFS


PolicyLab: Center to Bridge Research, Practice, and PolicyMEETING THE MENTAL HEALTH NEEDS OF CHILDREN

Center for Health Care StrategiesMEDICAID MANAGEDCARE FOR CHILDREN IN CHILD WELFARE

American Public Human Services Association Health ServicesDivisionMEDICAID AND CHIP IN 2014: A SIMPLESEAMLESS PATH TO AFFORDABLE COVERAGE

Alliance for Health ReformTHE FUTURE OF CHILDREN’S HEALTH COVERAGE

http://policylab.us/images/pdf/e2a2-mental%20health.pdf

www.chcs.org/publications3960/publications_show.htm?doc_id=683204

http://hsd.aphsa.org/Home/doc/CMCS_MAGI_

www.allhealth.org/publications/Child_health_inThe_Future_of_Childrens_Health_Coverage_98


HHS – ACFINTEROPERABILITY TOOLKIT ENHANCES SERVICEINTEGRATION

National Institutes of HealthSurgeon General'sWORKSHOP ON MAKINGPREVENTION OF CHILD MALTREATMENT ANATIONAL PRIORITY: IMPLEMENTINGINNOVATIONS OF A PUBLIC HEALTH APPROACH

HHS – CDC THE EFFECTS OF CHILDHOOD STRESS ONHEALTH ACROSS THE LIFESPAN

HHS – Administration for Children and Families, Office ofChild Support EnforcementPROMOTING CHILD WELL-BEING AND FAMILYSELF-SUFFICIENCY

www.acf.hhs.gov/interop/toolkit.pdf

www.surgeongeneral.gov/topics/childmaltreatment/

www.cdc.gov/ncipc/pub-res/pdf/Childhood_Stress.pdf

www.acf.hhs.gov/programs/cse/pubs/factsheets/child_support/health_care_coverage.pdf

As States prepare for various technological changes andupgrades associated with the implementation of theAffordable Care Act (ACA), the Department of Health andHuman Services (HHS) and the Administration for Childrenand Families (ACF) have released a toolkit, which aims tofacilitate greater communication and service integrationbetween State agencies and their health partners. Thetoolkit provides up-to-date information and resources tosupport the efforts of workers and agencies in order tobetter serve clients and achieve better outcomes.

Summarizes exchange of perspectives from leaders ofdiverse disciplines during a workshop aimed at elucidatingways to implement effective strategies for preventing childmaltreatment using a public health approach.

This 2008 report from the CDC by Middlebrook and Audageprovides an overview of the Adverse Childhood Experiencesstudy and its implications.

Describes how the Child Support Enforcement Programassists in increasing health coverage for children and theirparents.


EALTH CARE & CHILDREN AT RISK

Description

ov/LowCostHealthInsFamChild/ov/CHIPRA

s.gov/earlychildhood/docs/ACA_home_erview.pdf

ventiveservicestaskforce.org/annlrpt/1.pdf

ov/health/topics/child-and-adolescent-mental-ex.shtml

s.gov/programs/orr/benefits/health.htm

gov/chipra/

The Low Cost Health Insurance for Children and Families onthe CMS website provides an array of information includingan overview of the reauthorization, information for stateMedicaid Directors and information on outreach grants andinformation on the Healthy Start, Grow Smart" healtheducation series

Describes home visiting program established under the ACA

Oct. 2011 USPTF report to Congress, required by the ACA,notes that further research is needed regardinginterventions in primary care to prevent child abuse andneglect ; and that evidence gaps relating to specificpopulations and age groups that deserve further researchinclude screening and treatment for depression in children

Contains featured publications and current research topicson child and adolescent mental health.

Provides information on health challenges to refugees,the medical screening process, health promotion andprevention.

Describes efforts of the AHRQ, Centers for Medicare &Medicaid Services (CMS), and CHIPRA Federal QualityWorkgroup to implement selected provisions of thelegislation related to children's health care quality.


ORGANIZATION REPORTS AND POLICY BRIEFS


PolicyLab: Center to Bridge Research, Practice, and PolicyMEETING THE MENTAL HEALTH NEEDS OF CHILDREN

Center for Health Care StrategiesMEDICAID MANAGEDCARE FOR CHILDREN IN CHILD WELFARE

American Public Human Services Association Health ServicesDivisionMEDICAID AND CHIP IN 2014: A SIMPLESEAMLESS PATH TO AFFORDABLE COVERAGE

Alliance for Health ReformTHE FUTURE OF CHILDREN’S HEALTH COVERAGE

http://policylab.us/images/pdf/e2a2-mental%20health.pdf

www.chcs.org/publications3960/publications_show.htm?doc_id=683204

http://hsd.aphsa.org/Home/doc/CMCS_MAGI_Slides.pdf

www.allhealth.org/publications/Child_health_insurance/The_Future_of_Childrens_Health_Coverage_98.pdf

This 2010 Examines the evidence surrounding key issues inchildren’s mental health and proposes policy actions toimprove outcomes for children and their families

This 2008 issue brief examines the complex physical andbehavioral health care needs and associated costs forchildren in child welfare and outlines critical opportunitiesand challenges within Medicaid to better manage care forthis high-risk, high-cost population.

The Health Services Division of APHSA provides an overviewof expanded coverage that kicks-in in 2014.

Reviews changes in children’s health coveragebased on provisions of the ACA


Mathematica Policy Research, Inc. CHILDREN IN FOSTERCARE: CHALLENGES IN MEETING THEIR HEALTHCARE NEEDS THROUGH MEDICAID

ALL CHILDREN MATTER: HOW LEGAL AND SOCIALINEQUALITIES HURT LGBT CHILDREN

Annie E. Casey Foundation – KIDS COUNT: STATE FACTSHEETS ON HEALTH AND WELL-BEING OFAMERICA’S CHILDREN

Annie E. Casey Foundation – ADDRESSING THE MENTALHEALTH NEEDS OF YOUNG CHILDREN IN THE CHILDWELFARE SYSTEM: WHAT EVERY POLICYMAKERSHOULD KNOW

National Immigration Law Center – HEALTH CARE FORIMMIGRANTS AND REFUGEES

Tufts University Clinical and Translational Science InstituteMULTI-STATE STUDY ON PSYCHOTROPICMEDICATION OVERSIGHT IN FOSTER CARE

Council on Social Work Education – CSWE GUIDE TOPATIENT PROTECTION AND AFFORDABLE CARE ACT

NASW Legal Defense Fund SOCIAL WORKERS ANDHEALTH CARE REFORM

www.mathematica-mpr.com/publications/PDFs/fostercarebrief.pdf

www.children-matter.org/

www.aecf.org/MajorInitiatives/KIDSCOUNT/StateFactSheets.aspx

www.aecf.org/KnowledgeCenter/Publications.aspguid={1FA2AA3F-9C9A-4DAA-A36D-5FC99CA8B99

www.nilc.org/immspbs/health/index.htm

http://160.109.101.132/icrhps/prodserv/docs/Executive_Report_09-07-10_348.pdf

http://160.109.101.132/icrhps/prodserv/docs/Study%20Appendix_FINAL.pdf

www.cswe.org/File.aspx?id=48334

www.socialworkers.org/ldf/legal_issue/2011/042011.asp



American Humane Assn, Children’s Defense Fund, Center forthe Study of Social Policy, Child Welfare League of Americaand ZERO to THREE – A CALL TO ACTION ON BEHALFOF MALTREATED INFANTS AND TODDLERS

Kaiser Family Foundation – Kaiser Commission on Medicaidand the Uninsured – KEY FACTS: CHILDREN’S HEALTHINSURANCE PROGRAM REAUTHORIZATION ACT OF2009 (CHIPRA). KEY FACTS: STATE ADOPTION OFCOVERAGE AND ENROLLMENT OPTIONS IN THECHILDREN'S HEALTH INSURANCE REAUTHORIZATIONACT OF 2009

Child Welfare Information GatewayUSE OF PSYCHOTROPIC MEDICATIONS:STATE AND LOCAL EXAMPLES

National Resource Center for Permanency and FamilyConnections FOSTERING CONNECTIONS:HEALTH CARE PROVISIONS OVERVIEW

National Resource Center for Permanency and FamilyConnections: FOSTERING CONNECTIONS INHEALTH CARE

National Federation of Families for Children’s MentalHealth – PUBLIC POLICY: HEALTH CARE REFORMIMPLEMENTATION

Technical Assistance Partnership for Child and FamilyMental Health (TA Partnership): SUPPORTING PARENTSWITH MENTAL HEALTH NEEDS IN SYSTEMS OF CARE

Georgetown University Health Policy Institute Center forChildren and Families FULFILLING THE PROMISE OFHEALTH CARE REFORM – IMPLEMENTATIONRESOURCES FOR STATES

www.americanhumane.org/assets/pdfs/children/zero_to_three.pdf

www.kff.org/medicaid/www.kff.org/medicaid/upload/7863.pdfwww.kff.org/medicaid/8146.cfm

www.childwelfare.gov/systemwide/mentalhealth/effectiveness/pmslexamples.cfm

www.nrcpfc.org/fostering_connections/PL110-351.html#205

www.nrcpfc.org/fostering_connections/health_care_services.html#overview

http://ffcmh.org/what-we-do/policy

www.tapartnership.org/docs/Supporting%20Parents%20With%20Mental%20Health%20Needs%20Issue%20Brief.pdf

http://ccf.georgetown.edu/index/hcr

This document represents the collective vision of importantsteps that can and should be taken in policies, programs,and practices to better address the developmental needs ofinfants and toddlers who come to the attention of the childwelfare system.

Kaiser Commission provides Links and a range of Resourcesand information Fact Sheets on Medicaid and children’shealth insurance coverage.

This resource provides examples of State policies,guidelines, and information regarding the use ofpsychotropic medications for children and youth, with afocus on foster care.

Provides overview of the health care provisions of Sections202 and 205 of the Fostering Connections Act, andamendments to Fostering Connections based on the ACA.

Links to reports on promising practices and policiesregarding health for children in foster care and those agingout of care. Includes resources on transition age youth andexemplar comprehensive health care oversight andcoordination plans addressing continuity of care, medicalhomes, and unique needs of special populations. Includeslinks to wealth of evidence based practices and researchreports on these topics.

Includes FAQs about health care reform implementation andmental health parity, child enrollment information, thePatient’s Bill of Rights, and eliminating health caredisparities.

Drawing on the responses of 15 communities implementingsystems of care (SOC) grants through the U.S. Departmentof Health and Human Services' Comprehensive CommunityMental Health Services for Children and Their FamiliesProgram, this issue brief explores how SOC principles andpractices can be used to assess parental mental healthneeds, engage and support caregivers, and increase accessto services. Several successful approaches to assessingpotential mental health needs were highlighted.

Provides a broad array of resource information includingGuides and regulations for implementing Medicaid andCHIP changes, exchange coverage and tax credits, andinsurance market reforms,



Mathematica Policy Research, Inc. CHILDREN IN FOSTERCARE: CHALLENGES IN MEETING THEIR HEALTHCARE NEEDS THROUGH MEDICAID

ALL CHILDREN MATTER: HOW LEGAL AND SOCIALINEQUALITIES HURT LGBT CHILDREN

Annie E. Casey Foundation – KIDS COUNT: STATE FACTSHEETS ON HEALTH AND WELL-BEING OFAMERICA’S CHILDREN

Annie E. Casey Foundation – ADDRESSING THE MENTALHEALTH NEEDS OF YOUNG CHILDREN IN THE CHILDWELFARE SYSTEM: WHAT EVERY POLICYMAKERSHOULD KNOW

National Immigration Law Center – HEALTH CARE FORIMMIGRANTS AND REFUGEES

Tufts University Clinical and Translational Science InstituteMULTI-STATE STUDY ON PSYCHOTROPICMEDICATION OVERSIGHT IN FOSTER CARE

Council on Social Work Education – CSWE GUIDE TOPATIENT PROTECTION AND AFFORDABLE CARE ACT

NASW Legal Defense Fund SOCIAL WORKERS ANDHEALTH CARE REFORM

www.mathematica-mpr.com/publications/PDFs/fostercarebrief.pdf

www.children-matter.org/

www.aecf.org/MajorInitiatives/KIDSCOUNT/StateFactSheets.aspx

www.aecf.org/KnowledgeCenter/Publications.aspx?pubguid={1FA2AA3F-9C9A-4DAA-A36D-5FC99CA8B99E}

www.nilc.org/immspbs/health/index.htm

http://160.109.101.132/icrhps/prodserv/docs/Executive_Report_09-07-10_348.pdf

http://160.109.101.132/icrhps/prodserv/docs/Study%20Appendix_FINAL.pdf

www.cswe.org/File.aspx?id=48334

www.socialworkers.org/ldf/legal_issue/2011/042011.asp

2001 Policy Brief -- To address problems related to thehealth care of children in foster care, policymakers musthave detailed information about health status, health careutilization, and Medicaid expenditures.

A compendium of resources related to outcomes for LGBTQyouth, put together by the Movement Advancement Project,including NASW, Evan Donaldson Adoption Institute & CWLAas partners.

Fact sheets comparing indicators of health and well-beingfor children in low-income and higher-income families,based on data from the American Community Survey andthe National Survey of Children's Health.

An issue brief exploring what is known about youngchildren in the child welfare system, how maltreatmentimpacts their development, and services currently offered tohelp them.

Links to policy summaries on the implementation of theImmigrant Children’s Health Improvement Act (ICHIA), theexpanded state option coverage for immigrants after thepassage of CHIPRA in 2009, and how the ACA affectsimmigrants.

This study identifies the states that have policies or writtenguidelines regarding psychotropic medication oversight foryouth in foster care and describes challenges and innovativesolutions implemented by States.

The accompanying Appendix includes State tools andresources.

Provisions relating to social work that were includedin the Patient Protection and Affordable Care Act of 2010

Legal Defense Fund Legal Issue of the Month, April 2011


Description

canhumane.org/assets/pdfs/children/hree.pdf

g/medicaid/g/medicaid/upload/7863.pdfg/medicaid/8146.cfm

welfare.gov/systemwide/mentalhealth/ss/pmslexamples.cfm

c.org/fostering_connections/PL110-351.

c.org/fostering_connections/health_care_ml#overview

mh.org/what-we-do/policy

tnership.org/docs/Supporting%20Parents%20ental%20Health%20Needs%20Issue%20Brief.pdf

georgetown.edu/index/hcr

This document represents the collective vision of importantsteps that can and should be taken in policies, programs,and practices to better address the developmental needs ofinfants and toddlers who come to the attention of the childwelfare system.

Kaiser Commission provides Links and a range of Resourcesand information Fact Sheets on Medicaid and children’shealth insurance coverage.

This resource provides examples of State policies,guidelines, and information regarding the use ofpsychotropic medications for children and youth, with afocus on foster care.

Provides overview of the health care provisions of Sections202 and 205 of the Fostering Connections Act, andamendments to Fostering Connections based on the ACA.

Links to reports on promising practices and policiesregarding health for children in foster care and those agingout of care. Includes resources on transition age youth andexemplar comprehensive health care oversight andcoordination plans addressing continuity of care, medicalhomes, and unique needs of special populations. Includeslinks to wealth of evidence based practices and researchreports on these topics.

Includes FAQs about health care reform implementation andmental health parity, child enrollment information, thePatient’s Bill of Rights, and eliminating health caredisparities.

Drawing on the responses of 15 communities implementingsystems of care (SOC) grants through the U.S. Departmentof Health and Human Services' Comprehensive CommunityMental Health Services for Children and Their FamiliesProgram, this issue brief explores how SOC principles andpractices can be used to assess parental mental healthneeds, engage and support caregivers, and increase accessto services. Several successful approaches to assessingpotential mental health needs were highlighted.

Provides a broad array of resource information includingGuides and regulations for implementing Medicaid andCHIP changes, exchange coverage and tax credits, andinsurance market reforms,



American Academy of Child andAdolescent Psychiatry and theChild Welfare League of America

National Association of SocialWorkers

AACAP/CWLA Policy Statement onMental Health and Use of Alcoholand Other Drugs, Screening andAssessment of Children in FosterCare

Relevant Public and ProfessionalPolicy Positions

www.aacap.org/cs/root/policy_statements/aacap/cwla_policy_statement_on_mental_health_and_use_of_alcohol_and_other_drugs_screening_and_assessment_of_children_in_foster_care

www.naswpress.org/publications/practice/inside/speaks-toc.html


Organization Title URL Date Description

American Academy of Pediatrics-Committee on Early Childhood,Adoption, and Dependent Care

American Academy of Pediatrics-Committee on Pediatric AIDS

American Academy of Pediatrics-Committee on Early Childhood,Adoption, and Dependent Care

American Academy of PediatricsCommittee on PsychosocialAspects of Child and FamilyHealth, Committee on EarlyChildhood, Adoption, andDependent Care, and Section onDevelopmental and BehavioralPediatrics

Health Care of Young Children inFoster Care

Identification and Care ofHIV-Exposed and HIV-InfectedInfants, Children, and Adolescentsin Foster Care

Developmental Issues for YoungChildren in Foster Care

Translating DevelopmentalScience Into Lifelong HealthEarly Childhood Adversity, ToxicStress, and the Role of thePediatrician:

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;109/3/536



http://aappolicy.aappublications.org/cgi/reprint/pediatrics;129/1/e224.pdf

March 3, 2002

2000; Reaffirmed Sept 3, 2011

Nov. 2000

2011

All children in foster care need toreceive initial health screeningsand comprehensive assessmentsof their medical, mental, dentalhealth, and developmental status,with results of these assessmentsincluded in court-approved socialservices plan and linked to theprovision of individualized compre-hensive care that is continuousand part of a medical home.

As a consequence of the expandinghuman immunodeficiency virus(HIV) epidemic and major advancesin medical management ofHIV-exposed and HIV-infectedpersons, revised recommendationsare provided for HIV testing ofinfants, children, and adolescentsin foster care.

The following issues should beconsidered when social agenciesintervene and when physiciansparticipate in caring for children inprotective services: early brain andchild development, attachment,children’s sense of time, responseto psychological stress, effects ofneglect, comprehensive assessmentsof children before and afterplacement in foster care, treatment,placement issues, parental roles andkinship, parent-child visitation,stables placement versus legalcustody versus permanence.

AAP endorses a developingleadership role for the entirepediatric community—one thatmobilizes the scientific expertise ofboth basic and clinical researchers,the family-centered care of thepediatric medical home, and thepublic influence of AAP and itsstate chapters—to catalyzefundamental change in earlychildhood policy and services.

6 > EXAMPLES OF ORGANIZATION POLICY POSITIONS Organization Title URL


American Academy of Child andAdolescent Psychiatry and theChild Welfare League of America

National Association of SocialWorkers

AACAP/CWLA Policy Statement onMental Health and Use of Alcoholand Other Drugs, Screening andAssessment of Children in FosterCare

Relevant Public and ProfessionalPolicy Positions

www.aacap.org/cs/root/policy_statements/aacap/cwla_policy_statement_on_mental_health_and_use_of_alcohol_and_other_drugs_screening_and_assessment_of_children_in_foster_care

www.naswpress.org/publications/practice/inside/speaks-toc.html

2003

2009-2012

Children removed from theircaregivers by child welfareagencies should receiveimmediate mental health and useof alcohol and other drugsscreening followed by acomprehensive mental health anduse of alcohol and other drugsassessment and periodicreassessments.

Published in Social Work Speaks –new edition to be published inJanuary 2012. Adolescent Health;Adolescent Pregnancy andParenting; Child Abuse andNeglect; Early Childhood Care andServices, Family Policy; FamilyViolence, Foster Care andAdoption; Health Care Policy; HIVand AIDS; Homelessness;Immigrants and Refugees;Lesbian, Gay, and Bisexual;Mental Health; PhysicalPunishment of Children; Povertyand Economic JusticePublic Child Welfare; Racism;Rural Social Work; Youth Suicide.


URL Date Description




http://aappolicy.aappublications.org/cgi/reprint/pediatrics;129/1/e224.pdf

March 3, 2002

2000; Reaffirmed Sept 3, 2011

Nov. 2000

2011

All children in foster care need toreceive initial health screeningsand comprehensive assessmentsof their medical, mental, dentalhealth, and developmental status,with results of these assessmentsincluded in court-approved socialservices plan and linked to theprovision of individualized compre-hensive care that is continuousand part of a medical home.

As a consequence of the expandinghuman immunodeficiency virus(HIV) epidemic and major advancesin medical management ofHIV-exposed and HIV-infectedpersons, revised recommendationsare provided for HIV testing ofinfants, children, and adolescentsin foster care.

The following issues should beconsidered when social agenciesintervene and when physiciansparticipate in caring for children inprotective services: early brain andchild development, attachment,children’s sense of time, responseto psychological stress, effects ofneglect, comprehensive assessmentsof children before and afterplacement in foster care, treatment,placement issues, parental roles andkinship, parent-child visitation,stables placement versus legalcustody versus permanence.

AAP endorses a developingleadership role for the entirepediatric community—one thatmobilizes the scientific expertise ofboth basic and clinical researchers,the family-centered care of thepediatric medical home, and thepublic influence of AAP and itsstate chapters—to catalyzefundamental change in earlychildhood policy and services.

ON POLICY POSITIONS Organization Title URL Date Description



Organization URL

7 >USEFUL WEBSITES

Alliance for Health Reform www.allhealth.orgAmerican Academy of Pediatrics www.aap.orgCenter for Health Care Strategies – Children’s Health www.chcs.orgChild Health Insurance Research Initiative www.ahrq.gov/chiriChild Welfare Information Gateway (includes access to the T/TA NETWORK) www.childwelfare.govChild Welfare League of America www.cwla.orgChildren’s Defense Fund www.childrensdefense.orgChildren’s Health Matters www.childrenshealthmatters.orgChildren’s Partnership www.childrenspartnership.orgThe Commonwealth Fund www.commonwealthfund.orgCovering Kids and Families www.coveringkidsandfamilies.orgFirst Focus www.chcs.org http://firstfocus.net/Georgetown University

Center for Child and Human Development gucchd.georgetown.eduCenter for Children and Families ccf.georgetown.edu/National Technical Assistance and Training Center for Children’s Mental Health gucchdtacenter.georgetown.edu/

Fostering Connections Resource Center www.fosteringconnections.orgKaiser Family Foundation www.kff.orgKidsHealth www.kidshealth.orgMedicaid Medical Directors Learning Network www.ahrq.gov/news/kt/mmdln.htmNational Traumatic Stress Network www.nctsn.orgNational Academy for State Health Policy www.nashp.orgNational Federation of Families for Children’s Mental Health www.ffcmh.org/PolicyLab, The Children’s Hospital of Philadelphia www.research.chop.edu/policylabSocial Work Policy Institute, NASW www.socialworkpolicy.orgNASW Center for Workforce Studies & Social Work Practice http://workforce.socialworkers.org/

www.socialworkers.org/practice/The Reach Institute www.thereachinstitute.orgThe Robert Wood Johnson Foundation www.rwjf.orgUrban Institute www.urban.org

8 >MATCH



URL

www.allhealth.orgwww.aap.orgwww.chcs.orgwww.ahrq.gov/chiriwww.childwelfare.govwww.cwla.orgwww.childrensdefense.orgwww.childrenshealthmatters.orgwww.childrenspartnership.orgwww.commonwealthfund.orgwww.coveringkidsandfamilies.orgwww.chcs.org http://firstfocus.net/

gucchd.georgetown.educcf.georgetown.edu/

Health gucchdtacenter.georgetown.edu/www.fosteringconnections.orgwww.kff.orgwww.kidshealth.orgwww.ahrq.gov/news/kt/mmdln.htmwww.nctsn.orgwww.nashp.orgwww.ffcmh.org/www.research.chop.edu/policylabwww.socialworkpolicy.orghttp://workforce.socialworkers.org/www.socialworkers.org/practice/www.thereachinstitute.orgwww.rwjf.orgwww.urban.org

8 >MATCH


9 >NASW RESOURCESSocial Work Practice Perspectives and Practice Updates

> Supporting the Child Welfare Workforce to ReduceChild Maltreatmentwww.socialworkers.org/assets/secured/documents/practice/children/child_maltreatment.pdf

> The Medical Home Model: What Is It and How DoSocial Workers Fit In?www.socialworkers.org/assets/secured/documents/practice/health/medical%20home%20practice%20update_April_2011.pdf

> Accountable Care Organizations (ACOs):Opportunities for the Social Work Professionwww.socialworkers.org/assets/secured/documents/practice/health/ACOs%20Opportunities%20for%20SWers.pdf

> 2011 Medicare Changes for Clinical Social Workerswww.socialworkers.org/assets/secured/documents/practice/clinical/PP%202011%20Medicare%20Changes.pdf

> Adolescent Depression and Suicide Risk: HowSocial Workers Can Make a Differencewww.socialworkers.org/assets/secured/documents/practice/adolescentDepression0211.pdf

> Domestic Violence and Human Trafficking: DoubleJeopardy for Immigrant Women in the United Stateswww.socialworkers.org/login.asp?ms=restr&ref=/assets/secured/documents/practice/diversity/WKF-NL-67710.DomesticViolence.pdf

> Domestic Violence and Women of Color: ComplexDynamicswww.socialworkers.org/assets/secured/documents/practice/diversity/Domestic%20violence%20and%20women%20of%20color2011.pdf

> Engaging Young People in Their Transition Planningwww.socialworkers.org/assets/secured/documents/practice/engaging%20young%20people%20in%20transition.pdf

> Healthy People 2020: Social Work Values in a PublicHealth Roadmapwww.socialworkers.org/assets/secured/documents/practice/healthyPeople2020.pdf

> The Impact of Immigration Detention on Children andFamilieswww.socialworkers.org/practice/intl/2011/HRIA-FS-84811.Immigration.pdf

> The Childhood Obesity Epidemic: The Social WorkResponsewww.socialworkers.org/assets/secured/documents/practice/health/childhood%20obesity%20practice%20update.pdf

NASW Center for Workforce Studies(workforce.socialworkers.org)

> Assuring the Sufficiency of the Front-Line Workforce:National Study of Licensed Social Workersworkforce.socialworkers.org/studies/natstudy.asp#spe

To better predict the adequacy and sufficiency of thesocial work labor force, in 2004, the Center carried outa landmark study and also did special sector reports forChildren and Families, Aging, Behavioral Health andHealth Care.

NASW Occupational Profileshttp://workforce.socialworkers.org/whatsnew.asp#profiles

NASW Standards

> NASW Standards for Social Work Practice with Clientswith Substance Use Disorderswww.socialworkers.org/practice/standards/NASWATODStatndards.pdf

> NASW and ASWB Standards for Technology andSocial Work Practicewww.socialworkers.org/practice/standards/NASWTechnologyStandards.pdf

> NASW Standards for Social Work Practice in HealthCare Settingswww.socialworkers.org/practice/standards/NASWHealth careStandards.pdf

> NASW Standards for Clinical Social Work in SocialWork Practicewww.socialworkers.org/practice/standards/NASWClinicalSWStandards.pdf

> NASW Standards for Social Work Practice inChild Welfarewww.socialworkers.org/practice/standards/NASWChildWelfareStandards0905.pdf

> Continuing Education and the Social Work Professionwww.socialworkers.org/practice/standards/NASWContinuingEdStandards.pdf

> NASW Standards for the Practice of Social Workwith Adolescentswww.socialworkers.org/practice/standards/NASWAdolescentsStandards.pdf

> NASW Standards for Integrating Genetics intoSocial Work Practicewww.socialworkers.org/practice/standards/GeneticsStdFinal4112003.pdf

> NASW Standards For Cultural Competence inSocial Work Practicewww.socialworkers.org/practice/standards/NASWCulturalStandards.pdf

> NASW Standards For School Social Work Serviceswww.socialworkers.org/practice/standards/NASW_SSWS.pdf

> Indicators For Cultural Competence in Social Work Practicewww.socialworkers.org/practice/standards/NASWCulturalStandardsIndicators2006.pdf

NASW Pub

Social Worcomprehensstatements a2008. (Updwill be avafound in Ta

Relevant NACare SocialThe followinwelfare and> Certified

Worker (social woand fami

> Certified(C-ASWCworkers

> CertifiedThe C-SWrange of

> Certified(C-CYFSWfor the BSchildren,

> CertifiedThe C-SWworkers whealth anand userecommeensure pquality a

> DiplomatThe DCSand exce

> AcademyThe ACSfrom direfor indivi



dates

uce

ents/

Do

ents/%

ents/or%

rkersments/

ments/

bleStatesf=/

> Domestic Violence and Women of Color: ComplexDynamicswww.socialworkers.org/assets/secured/documents/practice/diversity/Domestic%20violence%20and%20women%20of%20color2011.pdf

> Engaging Young People in Their Transition Planningwww.socialworkers.org/assets/secured/documents/practice/engaging%20young%20people%20in%20transition.pdf

> Healthy People 2020: Social Work Values in a PublicHealth Roadmapwww.socialworkers.org/assets/secured/documents/practice/healthyPeople2020.pdf

> The Impact of Immigration Detention on Children andFamilieswww.socialworkers.org/practice/intl/2011/HRIA-FS-84811.Immigration.pdf

> The Childhood Obesity Epidemic: The Social WorkResponsewww.socialworkers.org/assets/secured/documents/practice/health/childhood%20obesity%20practice%20update.pdf

NASW Center for Workforce Studies(workforce.socialworkers.org)

> Assuring the Sufficiency of the Front-Line Workforce:National Study of Licensed Social Workersworkforce.socialworkers.org/studies/natstudy.asp#spe

To better predict the adequacy and sufficiency of thesocial work labor force, in 2004, the Center carried outa landmark study and also did special sector reports forChildren and Families, Aging, Behavioral Health andHealth Care.

NASW Occupational Profileshttp://workforce.socialworkers.org/whatsnew.asp#profiles

NASW Standards

> NASW Standards for Social Work Practice with Clientswith Substance Use Disorderswww.socialworkers.org/practice/standards/NASWATODStatndards.pdf

> NASW and ASWB Standards for Technology andSocial Work Practicewww.socialworkers.org/practice/standards/NASWTechnologyStandards.pdf

> NASW Standards for Social Work Practice in HealthCare Settingswww.socialworkers.org/practice/standards/NASWHealth careStandards.pdf

> NASW Standards for Clinical Social Work in SocialWork Practicewww.socialworkers.org/practice/standards/NASWClinicalSWStandards.pdf

> NASW Standards for Social Work Practice inChild Welfarewww.socialworkers.org/practice/standards/NASWChildWelfareStandards0905.pdf

> Continuing Education and the Social Work Professionwww.socialworkers.org/practice/standards/NASWContinuingEdStandards.pdf

> NASW Standards for the Practice of Social Workwith Adolescentswww.socialworkers.org/practice/standards/NASWAdolescentsStandards.pdf

> NASW Standards for Integrating Genetics intoSocial Work Practicewww.socialworkers.org/practice/standards/GeneticsStdFinal4112003.pdf

> NASW Standards For Cultural Competence inSocial Work Practicewww.socialworkers.org/practice/standards/NASWCulturalStandards.pdf

> NASW Standards For School Social Work Serviceswww.socialworkers.org/practice/standards/NASW_SSWS.pdf

> Indicators For Cultural Competence in Social Work Practicewww.socialworkers.org/practice/standards/NASWCulturalStandardsIndicators2006.pdf

NASW Public and Professional Policy Statements

Social Work Speaks, Eighth Edition presents, in onecomprehensive and unabridged collection, the policystatements adopted by the NASW Delegate Assembly in2008. (Updated policies from the 2011 Delegate Assemblywill be available in January 2012). A list of policies can befound in Table 2 above.

Relevant NASW Credentials for Child Welfare and HealthCare Social WorkersThe following NASW certifications are relevant to childwelfare and/or health care social workers:> Certified Advanced Children, Youth and Family Social

Worker (C-ACYFSW) – The C-ACYFSW is designed forsocial workers who promote the well-being of childrenand families.

> Certified Advanced Social Work Case Manager(C-ASWCM) – The C-ASWCM establishes socialworkers as professionals in a range of settings.

> Certified Social Work Case Manager (C-SWCM) –The C-SWCM is established for case managers in arange of settings with a BSW degree.

> Certified Children, Youth and Family Social Worker(C-CYFSW) – The C-CCYFSW is a specialty credentialfor the BSW, gives credibility to professionally trainedchildren, youth and family social workers.

> Certified Social Worker in Health Care (C-SWHC) –The C-SWHC is a specialty credential designed for socialworkers who address the biopsychosocial components ofhealth and/or mental health from a strengths perspectiveand use their knowledge to develop standards of practice,recommend health policy, improve health programs andensure patients, families and organizations receive highquality and state of the art social work services.

> Diplomate in Clinical Social Work (DCSW) –The DCSW represents the highest level of expertiseand excellence in clinical social work.

> Academy of Certified Social Workers (ACSW) –The ACSW represents leadership of the professionfrom direct service to research and systems analysisfor individuals, families, groups, and communities.



1 1 > THE NATIONAL QUALITY FORUM& CHILD HEALTH MEASUREMENT:OVERVIEW (prepared by the NQF)

The National Quality Forum (NQF) is a nonprofitorganization that operates under a three-part mission toimprove the quality of American health care by:Building consensus on national priorities and goals forperformance improvement and working in partnership toachieve them;

> Endorsing national consensus standards for measuringand publicly reporting on performance; and

> Promoting the attainment of national goals througheducation and outreach programs.

> NQF’s membership includes a wide variety of health carestakeholders, including consumer organizations, publicand private purchasers, physicians, nurses, hospitals,accrediting and certifying bodies, supporting industries,and health care research and quality improvementorganizations.

Over the past two years, NQF has endorsed almost 60measures of child health, in two recent projects, Child HealthOutcomes and Child Health Quality Measures, adding to ameasure portfolio that already included many child healthmeasures addressing children of all ages from neonates toadolescents, and including topics from general health andcare to condition-specific measures.

In early 2010, we completed the endorsement process for15 child health outcome measures, addressing generalhealth assessments as well as specific procedures andconditions such as neonatal surgery and asthma. Themeasures endorsed in the 2009 Child Health Outcomesproject provide important data on the outcomes, or results ofcare provided to children, such as admission rates andmortality rates for conditions like asthma and gastroenteritis.Measures also assess mortality rates and adverse events forprocedures like non-cardiac surgery and cardiaccatheterization. Additional measures address populationhealth outcomes, including the number of school days misseddue to illness and the number of children who haveinadequate insurance to achieve optimal health.

Just this fall, NQF endorsed an additional 44 measures ofgeneral child health. The 2010 Child Health QualityMeasures project was designed to enrich NQF’s portfolio ofchild health standards, at the request of the Centers forMedicare and Medicaid Services. The new measure set isthe result of an increased need for population-health basedmeasures addressing the unique needs of children, fromprenatal screenings to adolescent-specific check-ups, andthey cover a range of issues important to the healthydevelopment of children, including well-child care, obesityscreening, oral health, and mental health.

In addition, NQF has recently launched a new project onPerinatal and Reproductive Health. This project will endorsemeasures on reproductive health care, pregnancy, childbirth,and neonatal care. The project is currently reviewing thesubmitted measures and expects endorsement of the set inMay, 2012.

> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L W O R K P O L I C Y I N S T I T U T E4 5

POLICYLAB RESOURCES (www.policylab.us)The mission of PolicyLab at The Children’s Hospital ofPhiladelphia is to achieve optimal child health andwell-being by informing program and policy changesthrough interdisciplinary research.

PolicyLab develops evidence-based solutions for the most challenging health-related issues affecting children. As part of our commitment to transform “evidence to action,”we bridge the gap between academic communities and thereal world by engaging in research that is both responsive to community needs and relevant to policy priorities. Thisapproach requires that PolicyLab projects involveinvestigators, practitioners, policymakers, and familiesthroughout the research process, from design todissemination. By partnering with stakeholders in traditional health care and across the community, PolicyLab identifies the programs, practices, and policies that support the best outcomes for children and their families.

Evidence to Action Briefs> Securing Child Safety, Well-being, and Permanency

Through Placement Stability in Foster Carehttp://policylab.us/index.php/publications/evidence-to-action/45-policylab-position-paper.html

> Meeting the Mental Health Needs of Childrenhttp://policylab.us/index.php/publications/evidence-to-action/150-meeting-the-mental-health-needs-of-children-.html

> Preventing Adolescent Pregnancyhttp://policylab.us/index.php/publications/evidence-to-action/211-preventing-adolescent-pregnancy.html

Research at a Glance Brief> Psychotropic Medication Use among Children in Foster

Care: A National and State-Level Perspective http://policylab.us/images/pdf/policylab2012_psychotropic_medication_in_foster_care_study.pdf



1 1 > THE NATIONAL QUALITY FORUM& CHILD HEALTH MEASUREMENT:OVERVIEW (prepared by the NQF)

The National Quality Forum (NQF) is a nonprofitorganization that operates under a three-part mission toimprove the quality of American health care by:Building consensus on national priorities and goals forperformance improvement and working in partnership toachieve them;

> Endorsing national consensus standards for measuringand publicly reporting on performance; and

> Promoting the attainment of national goals througheducation and outreach programs.

> NQF’s membership includes a wide variety of health carestakeholders, including consumer organizations, publicand private purchasers, physicians, nurses, hospitals,accrediting and certifying bodies, supporting industries,and health care research and quality improvementorganizations.

Over the past two years, NQF has endorsed almost 60measures of child health, in two recent projects, Child HealthOutcomes and Child Health Quality Measures, adding to ameasure portfolio that already included many child healthmeasures addressing children of all ages from neonates toadolescents, and including topics from general health andcare to condition-specific measures.

In early 2010, we completed the endorsement process for15 child health outcome measures, addressing generalhealth assessments as well as specific procedures andconditions such as neonatal surgery and asthma. Themeasures endorsed in the 2009 Child Health Outcomesproject provide important data on the outcomes, or results ofcare provided to children, such as admission rates andmortality rates for conditions like asthma and gastroenteritis.Measures also assess mortality rates and adverse events forprocedures like non-cardiac surgery and cardiaccatheterization. Additional measures address populationhealth outcomes, including the number of school days misseddue to illness and the number of children who haveinadequate insurance to achieve optimal health.

Just this fall, NQF endorsed an additional 44 measures ofgeneral child health. The 2010 Child Health QualityMeasures project was designed to enrich NQF’s portfolio ofchild health standards, at the request of the Centers forMedicare and Medicaid Services. The new measure set isthe result of an increased need for population-health basedmeasures addressing the unique needs of children, fromprenatal screenings to adolescent-specific check-ups, andthey cover a range of issues important to the healthydevelopment of children, including well-child care, obesityscreening, oral health, and mental health.

In addition, NQF has recently launched a new project onPerinatal and Reproductive Health. This project will endorsemeasures on reproductive health care, pregnancy, childbirth,and neonatal care. The project is currently reviewing thesubmitted measures and expects endorsement of the set inMay, 2012.

4 6> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L W O R K P O L I C Y I N S T I T U T E

POLICYLAB RESOURCES (www.policylab.us)The mission of PolicyLab at The Children’s Hospital ofPhiladelphia is to achieve optimal child health andwell-being by informing program and policy changesthrough interdisciplinary research.

PolicyLab develops evidence-based solutions for the most challenging health-related issues affecting children. As part of our commitment to transform “evidence to action,”we bridge the gap between academic communities and thereal world by engaging in research that is both responsive to community needs and relevant to policy priorities. Thisapproach requires that PolicyLab projects involveinvestigators, practitioners, policymakers, and familiesthroughout the research process, from design todissemination. By partnering with stakeholders in traditional health care and across the community, PolicyLab identifies the programs, practices, and policies that support the best outcomes for children and their families.

Evidence to Action Briefs> Securing Child Safety, Well-being, and Permanency

Through Placement Stability in Foster Carehttp://policylab.us/index.php/publications/evidence-to-action/45-policylab-position-paper.html

> Meeting the Mental Health Needs of Childrenhttp://policylab.us/index.php/publications/evidence-to-action/150-meeting-the-mental-health-needs-of-children-.html

> Preventing Adolescent Pregnancyhttp://policylab.us/index.php/publications/evidence-to-action/211-preventing-adolescent-pregnancy.html

Research at a Glance Brief> Psychotropic Medication Use among Children in Foster

Care: A National and State-Level Perspective http://policylab.us/images/pdf/policylab2012_psychotropic_medication_in_foster_care_study.pdf



> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L W O R K P O L I C Y I N S T I T U T E4 7


NASW SOCIAL WORK POLICY INSTITUTE(www.socialworkpolicy.org)The Social Work Policy Institute, founded in 2009, is adivision of the NASW Foundation. Its mission is:

> To strengthen social work’s voice in public policydeliberations.

> To inform policy-makers through the collection anddissemination of information on social work effectiveness.

> To create a forum to examine current and future issues inhealth care and social service delivery.

Through convenings, briefings, development of action reports,and collaborations and partnerships, the Social Work PolicyInstitute strengthens the connections between research,practice, policy and education. Reports from previoussymposium, information on evidence-based practice and anarray of resources and tool-kits are available on its website.

POLICY LAB, Children’s Hospital of Philadelphia(www.policylab.us/)The mission of PolicyLab at The Children’s Hospital ofPhiladelphia is to achieve optimal child health andwell-being by informing program and policy changesthrough interdisciplinary research.

PolicyLab develops evidence-based solutions for the mostchallenging health-related issues affecting children. As partof their commitment to transform “evidence to action,” theybridge the gap between academic communities and the realworld by engaging in research that is both responsive tocommunity needs and relevant to policy priorities. Thisapproach requires that PolicyLab projects involveinvestigators, practitioners, policymakers, and familiesthroughout the research process, from design todissemination. By partnering with stakeholders in traditionalhealth care and across the community, PolicyLab identifiesthe programs, practices, and policies that support the bestoutcomes for children and their families.

UNIVERISTY OF SOUTHERN CALIFORNIA SCHOOL OFSOCIAL WORK (www.usc.edu/socialwork)

The University of Southern California’s School of Social Work(www.usc.edu/socialwork) ranks among the nation’s top 10social work graduate programs (U.S. News & World Report),with the oldest social work master’s and PhD programs in theWest. A recognized leader in academic innovation,experiential learning, online education and translationalresearch, the school prepares students for leadership roles inpublic and private organizations that serve individuals,families and communities in need. This is the only program inthe nation offering a military social work curriculum track toprepare social workers to meet the needs of veterans andtheir families. The school is also a campus exemplar for itsresearch efforts, with funding exceeding $30 million. Theirresearch institute, the Hamovitch Center for Science in theHuman Services, was the first endowed center forinterdisciplinary social work research and remains a pioneerin translational science.

NASW and the NASW Foundation thank the University ofSouthern California School of Social Work for its financialsupport for this symposium.


4 8> C H I L D R E N AT R I S K : O P T I M I Z I N G H E A L T H I N A N E R A O F R E F O R M > S O C I A L W O R K P O L I C Y I N S T I T U T E


NASW SOCIAL WORK POLICY INSTITUTE(www.socialworkpolicy.org)The Social Work Policy Institute, founded in 2009, is adivision of the NASW Foundation. Its mission is:

> To strengthen social work’s voice in public policydeliberations.

> To inform policy-makers through the collection anddissemination of information on social work effectiveness.

> To create a forum to examine current and future issues inhealth care and social service delivery.

Through convenings, briefings, development of action reports,and collaborations and partnerships, the Social Work PolicyInstitute strengthens the connections between research,practice, policy and education. Reports from previoussymposium, information on evidence-based practice and anarray of resources and tool-kits are available on its website.

POLICY LAB, Children’s Hospital of Philadelphia(www.policylab.us/)The mission of PolicyLab at The Children’s Hospital ofPhiladelphia is to achieve optimal child health andwell-being by informing program and policy changesthrough interdisciplinary research.

PolicyLab develops evidence-based solutions for the mostchallenging health-related issues affecting children. As partof their commitment to transform “evidence to action,” theybridge the gap between academic communities and the realworld by engaging in research that is both responsive tocommunity needs and relevant to policy priorities. Thisapproach requires that PolicyLab projects involveinvestigators, practitioners, policymakers, and familiesthroughout the research process, from design todissemination. By partnering with stakeholders in traditionalhealth care and across the community, PolicyLab identifiesthe programs, practices, and policies that support the bestoutcomes for children and their families.

UNIVERISTY OF SOUTHERN CALIFORNIA SCHOOL OFSOCIAL WORK (www.usc.edu/socialwork)

The University of Southern California’s School of Social Work(www.usc.edu/socialwork) ranks among the nation’s top 10social work graduate programs (U.S. News & World Report),with the oldest social work master’s and PhD programs in theWest. A recognized leader in academic innovation,experiential learning, online education and translationalresearch, the school prepares students for leadership roles inpublic and private organizations that serve individuals,families and communities in need. This is the only program inthe nation offering a military social work curriculum track toprepare social workers to meet the needs of veterans andtheir families. The school is also a campus exemplar for itsresearch efforts, with funding exceeding $30 million. Theirresearch institute, the Hamovitch Center for Science in theHuman Services, was the first endowed center forinterdisciplinary social work research and remains a pioneerin translational science.

NASW and the NASW Foundation thank the University ofSouthern California School of Social Work for its financialsupport for this symposium.


7 5 0 F I R S T S T R E E T N E , S U I T E 7 0 0WA S H I N G T O N , D C 2 0 0 0 1 - 4 2 4 1S O C I A LWO R K P O L I C Y . O R G

C H I L D R E N AT R I S K :O P T I M I Z I N G H E A L T H I N AN E R A O





Documents

CHILDREN AT RISK: OPTIMIZING HEALTH IN AN ERA OF REFORM · > Optimizing Health in Rural Communities ..... > Promoting Family-Centered, Cross-System ... OPTIMIZING HEALTH IN AN ERA