Trauma Informed Baby Court Teams:

Intergenerational Maltreatment Florida Children and Youth Cabinet, July 24, 2014

Dr. Mimi A. Graham FLORIDA STATE UNIVERSITY

Center for Prevention & Early Intervention Policy

mgraham@fsu.edu

“If we use the science and do our jobs well,

we can change the tragedy that brings

children & families into our courtrooms

into an opportunity to heal.” - Judge Cindy Lederman

Trauma & Toxic Stress Task Force

of the Florida Children & Youth

Cabinet

State Advisory Council

on Early Education and Care

Florida Children and Youth Cabinet

Early Learning Workgroup

Trauma and Toxic Stress ECCS State Taskforce

Value of Taskforce For the Cabinet:

• Aligns with Headline Indicators & Strategic Plan

• Serves as additional research arm

• Produces outcomes & data to update and inform

For Improved Health, Well-being & Self-sufficiency:

• Integrates across all agency systems to lead trauma

awareness, increase screening, and expand evidence-

based treatment

• Infuses the protective factors framework to build resilience,

knowledge of child development, concrete supports, social

connections, and social-emotional development while

incorporating nurturing and attachment principles

throughout

• Trauma & Toxic Stress

Workgroups

– State & Local Level

Florida Children & Youth Cabinet’s

Trauma & Toxic Stress Task Force

• Baby Court Team

Initiative

– State Level with Local Pilots

Systems Changes to Mitigate

Trauma & Toxic Stress

Trauma Workgroup Goals Across Systems:

1. Educate on the impact of trauma

2. Increase trauma screenings

3. Expand evidence based treatments

4. Use trauma lens in service provision

Physical Health Problems

Mental Health Problems

Crime & Delinquency Addictions

Poor Parenting Capacity

Academic & School Problems

…is the pipeline to a multitude of societal

problems:

Early Adverse Experiences

Adverse Childhood Experiences

Before Kindergarten

• Physical abuse

• Emotional abuse

• Sexual abuse

• An alcohol and/or drug abuser

in the household

• Someone who is chronically

depressed, mentally, ill,

institutionalized, or suicidal

• One or no parents

• Emotional or physical neglect

Finding Your ACE Score

092406RA4CR

While you were growing up, during your first 18 years of life: 1. Did a parent or other adult in the household often or very often…

Swear at you, insult you, put you down, or humiliate you? or Act in a way that made you afraid tha t you might be physically hurt?

Yes No If yes enter 1 ________

2. Did a parent or other adult in the household often or very often…

Push, grab, slap, or throw something at you? or Ever hit you so hard that you had marks or were injured? Yes No If yes enter 1 ________

3. Did an adult or person at least 5 years older than you ever… Touch or fondle you or have you touch their body in a sexual way?

or Attempt or actually have oral, anal, or vaginal intercourse with you?

Yes No If yes enter 1 ________

4. Did you often or very often feel that … No one in your family loved you or thought you were important or special?

or Your family didn’t look out for each other, feel close to each other, or support each other?

Yes No If yes enter 1 ________

5. Did you often or very often feel that … You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

or Your parents were too drunk or high to take care of you or take you to the doctor if you needed

it? Yes No If yes enter 1 ________

6. Were your parents ever separated or divorced? Yes No If yes enter 1 ________

7. Was your mother or stepmother: Often or very often pushed, grabbed, slapped, or had something thrown at her?

or Sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard?

or Ever repeatedly hit at least a few minutes or threatened with a gun or knife?

Yes No If yes enter 1 ________

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

Yes No If yes enter 1 ________

9. Was a household member depressed or mentally ill, or di d a household member attempt suicide?

Yes No If yes enter 1 ________

10. Did a household member go to prison? Yes No If yes enter 1 _______

Now add up your “Yes” answers: _______ This is your ACE Score.

ACEs Questionnaire

36.7% 36.9% 31.3%

12.9% 22.2% 32.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Child less than 2 years of age

Child is 2-3 years old Child is 4-5 years old

SOURCE: National Survey of Children's Health. NSCH 2011/12

All Children 0-5 Years Old In Households

Between 0%-100% of Family Poverty

Level

All Children 0-5 Years Old

23.0% 26.0% 23.6%

6.1%

13.3% 18.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Child less than 2 years of age

Child is 2-3 years old

Child is 4-5 years old

2 or more ACEs

1 ACE

Prevalence of Adverse Childhood

Experiences Among Young Children: Adversity Almost Double for Children in Poverty

Chronic

Disease

Alcohol,

Tobacco, Drugs

Psychiatric Disorders

Risky Sex

Impaired Cognition

Work/School Attendance,

Behavior,

Performance

Genetics Experience

triggers gene

expression

(Epigenetics)

Critical

& Sensitive

Developmental

Periods

Adverse

Childhood

Experience MORE CATEGORIES – GREATER

IMPACT Physical Abuse, Sexual Abuse

Emotional Abuse, Neglect Witnessing Domestic Violence

Depression/Mental Illness in Home Incarcerated Family Member

Substance Abuse in Home Loss of a Parent

Brain

Development Electrical,

Chemical, Cellular

Mass

Crime

Obesity

Poverty Intergenerational

Transmission, Disparity

Adaptation Hard-Wired Into

Biology

Source: Family Policy Council, 2012

Lifespan Impacts

of Adverse Childhood Experiences (ACEs)

Source: Stein, Zima, Elliott, Burnam, Shahinfar, & Fox, et al. (2001)

90% of children

known to the foster care system

have been exposed to trauma.

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

% o

f C

hild

ren

Re

mo

ved

Age at Removal

Infants are the Largest Age Group

in Florida’s Child

Welfare; 54% Age 5 or younger

12

Source: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. (2014). Child Welfare Outcomes

Florida’s Child Maltreatment Increases

Source: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. (2014). Child Welfare Outcomes Report Data. Retrieved July 7, 2014 from: http://cwoutcomes.acf.hhs.gov/data/downloads/pdfs/florida.pdf

Source: U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. (2014). Child Welfare Outcomes 2008-2011 Report to Congress. Retrieved July 7, 2014 from: https://www.acf.hhs.gov/sites/default/files/cb/cwo08_11.pdf

Percent of children reunified who re-enter within 12 months

Florida Rates of Re-Entry

into Child Welfare Steadily Climb

14

Florida’s Baby

Court Team Healing

intergenerational

trauma to improve

parenting capacity &

child well-being

Trauma Informed

Baby Court

Florida’s Existing & Potential Baby Court Teams

*Judge Duncan & Judge Bilbrey Judge Polson &

Judge Ketchel

Judge Gooding

Judge Walker

Judge Gievers

Judge Schack

Judge Clayton

*Judge Tepper

Judge Essrig

Judge Haworth Judge Bristol

Judge Krier

* Indicates Baby Court Pilot Sites for ECCS Grant Updated: 06/26/14

Judge Alexander

Judge Clark & Magistrate Lord

Judge Todd & Judge Moore

Judge Kroll & Judge Scher

Judge Latimore

Judge Lederman

Baby Court Teams: An Innovative Approach to Improving Outcomes

Zero to Three’s National Safe Baby Court Teams

Miami’s Child Well Being Court Model

Exited foster care approximately

one year earlier than matched sample.

Safe Baby Court Children

18

1.9% 98.1%

New Orleans Baby Court Team

Re-enter Stable

Florida’s rate of re-entry into child

welfare is 15.1% for just one

year…

Baby Court Drastically Reduces

Re-Entry Into Child Welfare

…compared with

New Orleans’ Baby Court,

which has had only

5 re-entries out of 266 children

in almost 16 years. 19

$11.2 Billion The Estimated Lifetime Cost for Florida’s

53,3411 Cases of Child Maltreatment in FY 2012*

Type of Cost Lifetime

Cost

Estimate2

Childhood Health Care Costs $32,648

Adult Medical Costs $10,530

Productivity Losses $144,360

Child Welfare Costs $7,728

Criminal Justice Costs $6,747

Special Education Costs $7,999

Total: $210,012

*Does not include

potential mental health or

substance abuse

treatment many

maltreated children

require later in life. 1. US Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. (2013). Child maltreatment 2012. Washington, DC: Author. 2. Fang, X., Brown, D.,S., Florence, C., & Mercy, J.A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse and Neglect, 36, 156-165.

Total Cost for

2012

$210,012 per child

x 53,341 victims

$11,202,250,092.

• Florida spends more than a billion dollars annually

for child welfare.

• In 2008, child abuse and neglect cost the US $124 billion (Fang et al., 2012).

• 25-40% of young children in foster care diagnosed with significant behavioral problems (Leslie et al., 2005).

• In a 2004 study, 55% of 15-year-olds in foster care had dropped out of school five years later (Courtney et al., 2004).

• Young women in foster care are more than twice as likely to get pregnant as those not in foster care by age 18 (Dworsky

& Courtney, 2010).

• 20% of youth leaving foster care experience chronic homelessness two years later (Fowler et al., 2010).

Cost of Maltreatment

21

22

15 Key Components

of Trauma Informed

Baby Court

Healing Trauma in Child Welfare

Judiciary

& Child

Welfare

Infant Mental

Health

Expertise

Early

Childhood

Systems

Baby Court

Teams

Florida’s Trauma Informed Baby Court Teams

Core Components:

1. Judicial leadership

2. Trauma informed judge

& systems

3. Continuum of behavioral

health services

4. Prominent role of IMH

Specialist

& Child Parent Psychotherapy

5. Community Coordinator who

provides child development

expertise to the judge &team

6. Frequent parent child contact

(visitation)

7. Monthly case reviews

8. Evidence based parenting

supports

9. Developmental supports to

enhance child well-being

10. Placement & concurrent

planning

11. Co-parenting approach

12. Collaborative court team

13. Cross agency training

14. Evaluation

15. Sustainability

Prominence of Infant Mental

Health in the Court

ZERO TO THREE. Helping Babies from the Bench:

Using the Science of Early Childhood Development in Court.

Child Parent Psychotherapy

Healing “Ghosts in the Nursery” Excerpt from Helping Babies From the Bench

Time: 1:35

Linking Early Childhood Systems with Courts

Quality Child Care & School Readiness Early Intervention

Quality Child Care & School Readiness

Quality Child Care & School Readiness

Attachment Based Parent Training

Infant Mental Health Interventions

Baby Court Team

Community Coordinator Provides child development expertise to the judge and

team to facilitate linkages and best practices:

• High quality child care

• Parenting supports

• Home visiting

• Mental health services

• Well baby visits

• Child development

Early

Childhood

Systems

Entire staff trained in

trauma

Mental Health Therapists

onsite, in schools

Head Start Trauma Smart

29

Improved

CLASS Scores

All Sites

October

2010

Baseline

All Sites

April

2011

All Sites

October

2011

All Sites

April

2012

All Sites

October

2012

National

Mean

Positive Classroom Climate 4.56 4.36 5.01 5.16 5.59 5.28

Negative Classroom Climate 1.76 1.73 1.50 1.73 1.39 1.55

Teacher Sensitivity 4.00 3.95 4.15 4.48 4.67 4.70

Respect for Student

Perspectives

3.59 3.65 4.04 4.33 4.44 4.36

Behavior Management 4.20 4.27 4.88 4.61 4.78 4.97

Productivity 4.58 4.63 5.32 5.26 5.00 4.50

Instructional Learning

Formats

3.29 3.05 3.75 3.71 3.83 3.90

Concept Development 1.76 1.55 1.32 1.76 1.90 2.09

Quality of Feedback 2.18 2.02 1.70 2.04 2.55 2.04

Language Modeling 2.58 2.25 2.10 2.19 2.61 2.85

Emotional Support Domain 4.60 4.56 4.92 5.06 5.33 5.00

Classroom Organization

Domain

4.02 3.99 4.65 4.52 4.54 4.50

Instructional Support Domain 2.17 1.94 1.71 2.00 2.35 2.50

Quality Childcare for Child Welfare Children

Protocol to assess the child care center placement for

quality, stability, and for “goodness of fit” with child’s

needs. BEFORE

AFTER Accredited Programs

Licensed Programs

Unregulated Care

UNDERSTANDING QUALITY

Circle of Security

Evidence Based Parenting

for each Baby Court Team

Child Welfare Information Gateway. (2008). Evidence-based and evidence-informed programs. 31

Circle of Security Group Leaders

Existing & Potential

Parent Trainers

Judge Alexander Lisa Benitez Richard Fay

Judge Bristol Sunny Kahn

Judge Clark Magistrate Lord

Kimberly Walters

Judge Clayton Kathy Conrad

Judge Duncan Judge Bilbrey

Christine Chaffin

Judge Essrig Debbie Buie

Judge Gievers Susan Ellis Cindy Evers

Existing & Potential

Parent Trainers

Judge Gooding Leslie Allen, Selma Bacevac

Judge Hayworth

Kristie Skoglund

Judge Krier

Judge Polson Judge Ketchel

Karen Adams

Judge Schack Donna Donato

Judge Tepper Roxanne Mayorca Lisa Negrini

Judge Todd Judge Moore

Liz Jack

Judge Walker Laurie McCort

Evaluation: Office of Court Improvement

Office of the State Courts Administrator

Supreme Court of Florida Federal Adoption & Safe Family Act: Specifically holds states accountable for providing services to address the “safety, permanency and well-being of children and families” (45 C.F.R. Part 1357 §1355.33 b (2)). States must ensure that:

• Families have enhanced capacity to provide for their children's needs

• Children receive appropriate services to meet their educational needs

• Children receive adequate services to meet their physical and mental health needs." (45 C.F.R. Part 1357 §1355.34 b(1)(iii))

Safety Permanency Well-Being

Heal trauma & stop intergenerational

transmission Accelerate permanency

Enhance child

well-being

Improve relationships in child’s life

Reduce reoccurrence of maltreatment

Desired Outcomes for Trauma

Informed Baby Court Teams

DCF is Pipeline to DJJ and DOC

High Adverse Childhood Experiences in

Florida’s DJJ Population Sample Size 64,329

Youth reporting

no ACEs

1,793

3%

97% Youth reporting

one or more ACEs

62,536

ACE Score Florida’s DJJ

ACE Study

0 2.8% 36.1%

1 10% 26%

2 16% 15.9%

3 21% 9.5%

4 + 50% 12.5%

Sources: DJJ data interpolated from data supplied by Nathan Epps, co-author of a forthcoming publication in the Journal of Juvenile Justice entitled “The Prevalence of Adverse Childhood Experiences (ACE) in the Lives of Juvenile Offenders,” by Michael Baglivio and Nathan Epps, Kimberly Swartz, Mona Sayedul Huq, Amy Sheer and Nancy Hardt. The ACE Study data source is prevalence for insured adults based the entire ACE Study sample (n=17,337) as posted by the CDC available at http://www.cdc.gov/ace/prevalence.htm.

F.S. Chapter 985.02 (8)TRAUMA-INFORMED CARE.

The Legislature finds that the department should use trauma-

informed care as an approach to treating children with histories of

trauma. Trauma-informed care assists service providers in

recognizing the symptoms of trauma and acknowledges the role

trauma has played in the child's life. Services for children should be

based on an understanding of the vulnerabilities and triggers of

trauma survivors that traditional service delivery approaches may

exacerbate, so that these services and programs can be more

supportive and avoid re-traumatization. The department should use

trauma-specific interventions that are designed to address the

consequences of trauma in the child and to facilitate healing.

DJJ Leadership

Trauma Informed Care

Public Policy

Early Childhood

Mental Health

Education

Health

Domestic Violence

Delinquency

Substance Abuse

Child Welfare

Judicial

Trauma Lens Across Systems

ACEs Linked to Problems in Learning & Behavior

39

3%

51%

0%

10%

20%

30%

40%

50%

60%

No ACEs 4+ ACEs

Source: National Child Traumatic Stress Network

1 of 4 School

children

exposed to a

traumatic

event.

Trauma Informed Care

40

Have I considered whether trauma has played a role?

1. Ask trauma informed questions

2. Use a trauma lens to understand

behavior

3. Screen as part of services

4. Ensure emotional safety

5. Avoid re-traumatization

6. Consider trauma in all decisions

(childcare placement, referrals,

etc).

Florida Needs Trauma Informed Care

Across All State Agencies & Systems

41

Children & Families

with Trauma

Department of Health

Department of

Education

AHCA

Office of Early

Learning

Department of Juvenile

Justice Department of Children & Families

Department of

Corrections

Judiciary

Time: 0:52

“It’s the most important opportunity for the

prevention of health and social problems and

disease and disability that has ever been seen.”

- Vince Feletti