Family Success: Achieving Outcomes by Promoting Accountability

Family Success: Achieving Outcomes by Promoting Accountability

Presenters:

• Bret Stockton, Director of Business Development

• Catherine Adams: Business Development Manager

Workshop Overview:

• Video Introduction

• Youth Villages’ Overview

• Increasing Family Accountability

• Intensive In-Home Services: Intercept

• Intercept Outcome Data

• Questions/Answers & Discussion

Video – Extreme Measures

Youth Villages’ Mission and Values

OUR MISSIONYouth Villages helps children and families live successfully.

OUR VALUESKids needs come first…Always.

Children are raised best by their families.We provide a safe place.

We strive to achieve positive, lasting results.We are committed to our staff.

We are each responsible for providing the highest level of service to our customers.

We constantly improve our performance to achieve excellence.We create new programs to meet the needs of children, families and

the community.We do what we say we do.

Quick FactsYouth Villages’ Daily Program Census as of 7/31/11

The Youth Villages Specialized Mobile Crisis program in Tennessee received 9,862 calls in FY 2010 and conducted 6,921 face-to-face assessments. Across the state, over 65% of these youth were diverted from hospital placement.

Youth Villages’ Mentoring Program currently has over 325 mentors.

Intensive In-Home Services (Intercept and MST) 1,378 Transitional Living 693 Treatment/Therapeutic Foster Care 436 Community-Based Group Homes 95 Residential Treatment Programs (including Intensive) 516Case Management and Other Therapeutic Services 525

Total 3,643

Goals of Intensive In-Home Services:• Achieve long-term, successful outcomes for youth in the home

– Empower families to be accountable to and for their children and to resolve problems independently whenever possible

– Ensure services rendered focus on providing families with the resources needed to address current and future mental health and behavioral issues

• Reduce the overall cost of services through reduced overall length of stay per youth and treatment in the least restrictive environment– Decrease number of unnecessary out-of-home placements– Prevent disruptions from home-based setting resulting in placement

in detention centers or hospitals

• Increase the number of youth served by reducing the overall cost per youth – Provide cost effective, successful services to states and localities – Increase service capacity to ensure that all children and families

have access to the most appropriate level of service they need

Recommendations for Promoting Accountability: • Before any child is committed to state custody, or if necessary

at the moment the child is committed to state custody, families should be assigned an intensive in-home service provider.

• States should build in a mechanism to intensely monitor every single child who is entering custody, to ensure that all appropriate efforts are being made to provide the most appropriate service(s).

• States should marshal all resources needed to do whatever it takes to resolve family problems so that children can safely stay or return home if at all possible, and monitor to ensure that resources are properly used to their fullest extent.

Youth served July 2000 through May 2011Youth Served by Program

0

5,000

10,000

15,000

20,000

25,000

30,000

Residential Treatment Group Home Foster Care Intensive In-Home Transitional Living

6,918

2,885

5,231

25,112

4,395

Youth may be served in multiple programs.

In-Home Services ProgramsAdmissions by Fiscal Year October 1994 through March 2011

16144

292 377 295 410 490679

862

1,2411,404

1,584

1,854

2,027

2,719

3,744

4,179

3,301

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*

Fiscal Year – July 1 to June 30

Youth may have multiple admissions to

the program.* Represents the first three

quarters of the fiscal year

Youth Villages Locations

Intensive In-Home Services: Intercept

History of Promoting Family Accountability• History of providers’ role in promoting

accountability: Take responsibility for outcomes

• Philosophical change: Seeing families as the solution

• Reasons families don’t accept responsibility and accountability: What is the fit?

• Role of alignment: Can’t speak about families in the ways that you wouldn’t speak to them

Organizational Practices for Promoting Family Accountability• Emphasize our accountability• Describe what accountability looks like for each family,

identify what stands in the way of that, then hold ourselves accountable for addressing those things.

• Eliminate language like “resistant” or “not ready for change.” If the family just needed to be told what to do, we wouldn’t be needed.

• Often need to do non-traditional things to earn trust and communicate a non-judgmental relationship.

• Address alignment as a developmental target with staff.

Why Treatment in the Home is Necessary

• Natural Environment - Resolve problems in the natural environment.

• Present Focused - Address current behaviors relating to: Family Peers School Individual Community

• “Fit” - Understand the fit.• Family Responsibility - Encourage the family to take

responsibility.• Generalization - Develop long-term solutions in the community.• Realistic Setting - Teach youth to function in realistic setting.• Effective Treatment – Treatment based on research is most

effective.• Research - Research indicates that restrictive out-of-home

placements may do more harm than good.• Engage Entire Family – Need to treat entire family.

Intercept Program Overview• Youth Villages developed the Intercept Program to

serve a broader population of youth and families

– Serves youth from infant to age 17

– Utilized with a combination of child welfare, mental health, and juvenile justice systems

– Currently serving AL, FL, GA, MA, MS, NC, NH, OR, and TN

– Ability to divert youth from placement, thus keeping families together safely

– Ability and experience in transitioning youth home from out-of-home placements (detention, RTC, acute hospitalizations, foster homes, etc.) even after extended time out-of-home (more than 3 months)

Current Intercept Locations

Program Key ComponentsYouth Villages' Intercept program offers the following:

• Extremely high levels of staff training and supervision

• Intensive services conducted in the child's home and community by a single Intercept family intervention specialist

• Caseloads of only 4-5 youth/families per Intercept family intervention specialist

• Family sessions conducted 3 times per week

• 24/7/365 on call support to families

• Accountability for success is with the Intercept family intervention specialist and program

Program Key Components (cont.)

• Average 4-6 months per case for diversion and up to 6-9 months per case for reunification

• Involvement in all systems affecting youth and family

• Assistance with concrete needs such as housing, healthcare, and employment

• Nurturance of long-term support from extended family and other natural support systems

• Masters level counselors preferred or Bachelors level with experience working with target population

Ongoing Evaluation of Cases

• Daily Updates and Red Flag E-mails

• Weekly Individual Counselor Development

• Critical Event Reviews

• Supervisor field visits

• Tape reviews

Typical Youth Referral Issues

© Youth Villages, Inc.

ADHDAnimal CrueltyAnxietyChronic Health Condition/Medical AdherenceDelinquencyDepressionDomestic Violence TraumaEating DisorderEmployment IssuesEnuresis/EncopresisFire Setting BehaviorsGeneral Health IssueHomicidal IdeationsHousing InstabilityInappropriate Sexual BehaviorLow Educational Attainment/Maintenance: 18+Other Identified Problem/Issue

Other Trauma HistoryParental Neglect/AbandonmentPhysical Abuse TraumaPhysical AggressionPoor Academic PerformancePoor Money ManagementProblem Sexual Behavior (age 13-18)Problem Sexual Behavior in Children (12 and younger)Risk of Pregnancy/FatheringRunawaySelf HarmSexual Abuse TraumaSubstance Abuse/A&DSuicideTheft/Stealing BehaviorsTransportation IssuesTruancyVerbal Aggression

Typical Parent Referral Issues

© Youth Villages, Inc.

Chaotic home life

Parent contacts to courts and state agencies over struggles with child

Parent personal barriers (substance abuse, divorce, disagreements between children and mother’s new boyfriends)

Lack of commitment by relatives assuming care for youth

Grandparent health problems

Parent depression and other mental health problems

Low warmth, high conflict

Initial and Ongoing Communication With Key Stakeholders

Community Stakeholders:• Case Managers• Current provider (if applicable to reunification cases)• Agency Staff (child welfare, juvenile justice, and/or mental health)• Court Staff (including Judges, GALs, and POs)• Schools (including teachers, principals, guidance counselors)• Mental Health Centers (including psychiatrists)

Communication includes:• In addition to the youth and family, Youth Villages’ Intercept includes key

stakeholders in the assessment and treatment planning process.• Youth Villages provides documentation such as monthly updates, detailed

assessments, weekly treatment plans, discharge plans, and safety plans. • Youth Villages provides ongoing updates as often as requested.

Intervention Targets

• Identification of the primary risk factors associated with referral problems

• Services are all-inclusive

• Services are focused on strengths of the family & child

• Family Members are full partners in the treatment process

• Interventions take place within the multiple systems occurring within the natural ecology

Intercept Program: Common Interventions• Work with family to design and implement an individualized safety

plan• Work with family to design and implement an individualized

behavior plan• Work with family and support network to design and implement a

supervision plan• Work with family to meet basic needs (housing, health care,

transportation, employment, etc.• Work with family on how to manage medications• Work with family to increase and utilize their support network• Find respite with extended family or other supports, as necessary• Engage stakeholders, including caseworkers and courts to find

appropriate relative/support placements when it is necessary to remove a child from the home

Intercept Specialist Characteristics

• Total Commitment to Model • Intense • Critical Thinker• Creative• Flexible • Open to High Levels of Supervision • Outcome Driven

How Intercept Can HelpDiversion

Diversion/Stabilization

Assessments on all youth entering care

Adoption Stabilization

Birth to Four

Reunification

Assessments and intensive family searches

Short-term Reunification

Long-term Reunification

Residential Partnerships

Intercept ProgramOutcomes

Includes youth served through the Intercept Program in Alabama, Florida, Georgia, Massachusetts, Mississippi, New Hampshire, Tennessee and Virginia.

Youth Served July 2006 through December2010

Outcome Evaluation Process

• Research Dept. led by Dr. Sarah Hurley and 14 full time staff

• Follow-up surveys administered to all youth/families who received at least 60 days of Youth Villages’ services (a “full dose”) at 6, 12, and 24 months post-discharge.

Intercept ProgramDemographics

Youth served July 2006 through March 2011N = 9,461

62%

38%

31%

61%

3% 5%

0%

20%

40%

60%

80%

100%

Male Female AfricanAmerican

Caucasian Hispanic Other

Gender Race/Ethnicity

Intercept ProgramAge Group


16% 16%

30%

38%

0%

20%

40%

60%

80%

100%

8 Years Old and Younger 9 to 11 Years Old 12 to 14 Years Old 15 to 18 Years Old

Intercept ProgramPresenting Issues


90%

30%

74%

39%42%

52%

0%

20%

40%

60%

80%

100%

BehavioralDisorders

SubstanceAbuse

EmotionalDisorders

Victim of Abuseand/or Neglect

SuicidalIdeations or

Gestures

Legal Issues

90% of youth have multiple presenting issues.

Intercept Program History of Family DifficultiesYouth served July 2006 through March 2011

N = 9,461

50%

39% 40%36%

32%

0%

20%

40%

60%

80%

100%

Mental Illness Domestic Violence Substance Abuse Legal Trouble ParentExperienced

Abuse as a Child

50% of families have multiple difficulties

Intercept ProgramAdmissions by Fiscal Year

Youth served July 2006 through March 2011

1,411

1,662

2,415

2,840

2,115

0

500

1,000

1,500

2,000

2,500

3,000

2007 2008 2009 2010 2011*

Fiscal Year – July 1 to June 30Youth may have multiple

admissions to the program.*Represents the first three quarters of the fiscal year

Intercept ProgramAdmissions by Region

Youth served July 2006 through March 2011

2,096

3,464

2,489

761

487 417 335

59287

48

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

WestTennessee

MiddleTennessee

EastTennessee

Mississippi Alabama Massachusetts Florida Virginia Georgia NewHampshire

Youth may have multiple admissions to the program.

Intercept ProgramDischarge Location

Youth discharged July 2006 through March 2011N = 7,683

88%

2% 1% 2%7%

0%

20%

40%

60%

80%

100%

Home ResidentialTreatment Center

PsychiatricHospital

Detention/Corrections

Other*

*includes placements such as group homes, runaway, foster care and rehab centers

Only includes youth who received at least 60 days of service; 16.1% (1,469 out of 9,152) of admissions ended prior to 60 days.

Intercept Program Parent Satisfaction at DischargeParents surveyed July 2006 through March 2011

94%97%

91%95% 93%

0%

20%

40%

60%

80%

100%

Family Therapy youreceived

Counselor's Knowledgeand Professionalism

Links to CommunityServices

Overall Satisfaction Would Recommend YV toa Friend

Note: Figures include only youth who received at least 60 days of service.

Intercept ProgramSuccess at Follow-up

Follow-ups conducted through March 2011

84% 84%88%

0%

20%

40%

60%

80%

100%

Six Months Twelve Months Twenty-four Months

Success is defined as living at home with family or living

independently.


Intercept ProgramYouth reporting NO Trouble with the Law


85% 83% 84%

0%

20%

40%

60%

80%

100%



Intercept ProgramSchool Status


95% 93%90%

0%

20%

40%

60%

80%

100%


Indicates the number in school, graduated from high school, or in GED classes at the time of follow-

up.Note: Figures include only youth who received at least 60 days of service.

Intercept ProgramOut of Home Placements


6% 2% 3% 6%3% 4% 6%

2% 4%

0%

20%

40%

60%

80%

100%


Residential Treatment Center Psychiatric Hospital Detention/Corrections


Intercept Program Youth in State Custody at Follow-up


13% 13% 11%

0%

20%

40%

60%

80%

100%


Nearly a quarter (20.7%) of youth were in state custody during enrollment.

Please note: Most youth in parental custody who are admitted to Intercept are at substantially increased risk of placement into state custody, either through the child welfare or juvenile justice system.


About our Response Rates

• Surveys are conducted by research staff via phone with letter surveys to non-respondents.

• Please note: Surveys are completed with youth/families who have discharged from YV services altogether. If a youth re-enters YV services, the survey cycle is reset and begins again at their discharge.

• Parent Satisfaction surveys are only conducted with families who were involved in the youth’s treatment.

Surveys through 03/11

Discharge Surveys 70.0% (4,883 out of 6,977)

6-Month Follow-up 61.2% (3,673 out of 6,005)



• Internet search of public records (Lexis-Nexis) is completed to locate accurate contact information

• While no consensus exists regarding adequate response rates, 40% - 60% has been identified as appropriate for surveys of this type and size1.

• Rate of re-entry into YV services: 6-Month Follow-up – 5.3% (334 out of 6,339) 12-Month Follow-up – 9.6% (501 out of 5,211) 24-Month Follow-up – 14.2% (432 out of 3,050)

1PWGSC (Public Works and Government Services Canada). (2008). Advisory Panel on Telephone Public Opinion Survey Quality: Standards and Guidelines for Response Rate.

QuestionsAnswersDiscussion

Contact Information:

• Bret Stockton: [email protected]

• Catherine Adams: [email protected]

Documents

Family Success: Achieving Outcomes by Promoting Accountability