Using Community Assessment Data to Plan System Wide Interventions Aimed at Improving Behavioral Health and Well-Being for Children in Foster and out of Home Care

Background/Purpose:  In Vermont, placement stability rates remain high for children and youth in care, a higher than average number of youth in custody are placed in congregate care, and many adoptive placements end with children and youth no longer living with their adoptive families.  Strong inter-organizational collaboration between mental health and child welfare systems is essential for improving wellbeing and stability for children in care, however rare and challenging. In an attempt to address these cores issues, Vermont received funding as part of the third cohort of Children’s Bureau “trauma grants”  which includes an assessment and planning phase to determine implementation activities that most closely fit the identified needs of the locality.  As such, Vermont engaged stakeholders across multiple organizations and service systems in a community assessment to answer the following research questions: (a) What are the strengths and needs related to community readiness for collaboration between child welfare and mental health systems, (b) what are the mental and behavioral health needs of the children in care, and (c) what are the strengths and gaps in the child welfare and mental health service array related to addressing these needs.   

Methods: Community based, participatory research with mixed methods was used in the community assessment.  Data collection involved secondary data analysis of Medicaid and administrative databases, over 400 surveys of VT providers and caregivers across systems, and over 40 focus groups and interviews with managers, leaders, providers, and caregivers throughout the child serving system of care in all districts across the state.  Survey data were analyzed using descriptive and bivariate analyses, including means, proportions and t-tests for differences between groups. Interview and focus group data were analyzed using evaluative coding and initial or open coding.

Results: Administrative data analysis revealed that over, 70% of children and families served by the child welfare system are receiving services from a community mental health agency; however the surveys and focus groups findings strongly suggest that collaboration between child welfare and mental health professionals is poor. Specifically, findings indicate that lack of collaboration in the relationship between mental health and child welfare appears to be systemic in nature. Further, resource parents and providers reported that supports and services diminish significantly after adoption or guardianship is finalized. Additional findings pointed to a need to (a) systematically collect data on well-being, and (b) provide foundational trainings including inter-organizational collaboration,  the utilization of data to inform practice, and trauma informed and adoption competent practices to the entire system of care. 

Conclusion: The results of Vermont’s community assessment led to the development of a theory of change resulting in the identification of 5 specific innovations aimed at improving inter-organizational collaboration and promoting placement stability and well-being for children in custody.  These include (1) foundational workforce trainings on evidence based practices, (2) screening, assessment and progress monitoring for behavioral health, trauma related needs, and overall well- being, (3) interagency collaboration and communication systems, (4) evidence informed, trauma specific treatment, and (5) evidence informed caregiver supports and training.