Application of Needs Assessment Data in Development of a Data-Driven Behavioral Health System for Children in out-of-Home Care in Kentucky

Background/Purpose:  Child welfare and behavioral health systems struggle with meeting the behavioral health needs of children in out-of-home care (OOHC).  Lack of systematic screening and standardized assessment and poor interagency communication result in delayed service referral, lack of data-informed treatment and monitoring, and unacceptable outcomes.  Kentucky is one of six Children’s Bureau grantees to implement systematic trauma and behavioral health screening of children in OOHC and a data-driven approach to assessment, treatment, case planning and progress monitoring.  To be successful, collaboration both within and between agencies is required. This paper will present the results of the needs assessment study and their application to implementation and intervention development. This study involved three overarching research questions:  1) What are the characteristics and needs of the target population of children entering OOHC which should drive behavioral health treatment?  2) What are the strengths and weaknesses of interagency collaboration and the service array?  3) What readiness and fit-related factors influence the theory of change?

Methods: A mixed methods approach was used to conduct the assessment study.  A statewide survey was conducted with frontline staff, supervisors and administrators in the public child welfare and behavioral health agencies to measure interagency collaboration, capacity and readiness to change, including subscales measuring attitudes and capacity for evidence-based practice and trauma-informed programming.  Nineteen focus groups were conducted with individuals in these roles as well as interagency councils and managed care organizations. Finally, secondary analysis of aggregate data regarding the characteristics and needs of children in OOHC was conducted.

Results: Analysis of child-specific data revealed that approximately 24% of children in OOHC had received six or more behavioral health diagnoses, and the overuse of psychometric drugs was of significant concern.  Insufficient levels of collaboration were reported and were driven primarily by system-level issues regarding communication protocols, confidentiality concerns and lack of coordinated processes to manage treatment and care decisions.  Statistically significant group differences were found comparing child welfare and behavioral health staff regarding capacity trauma-informed care including formal service policies, trauma screening assessment and service planning. Trauma systems readiness was overall higher in behavioral health agencies than in child welfare, with both revealing low subscale ratings of administrative support and human resources practice.   An array of practice and systemic level barriers were documented, informing the resultant theory of change.

Conclusion: The lack of systematic screening and assessment of child needs, inconsistent capacity for evidence-based treatment with fidelity, and poor interagency collaboration and information-sharing to promote effective service delivery guided the development of a set of interventions and implementation strategies to promote improved socio-emotional well-being of children in OOHC.  The practice- and system-level approach to the study and resultant findings related to the needs of the target population and service delivery system has implications for development of similar initiatives as agencies strive to implement data-driven services to serve the needs of children and families. Implications for organizations and management in the behavioral health and child welfare systems include establishment of user-friendly and technology-enhanced processes for information exchange and collaborative decision-making.