Enhancing Parental Behavioral Health Services Integration in Child Welfare
- Heather A. Flynn (Principal Investigator), Ph.D., Florida State University
- Shamra Boel-Studt (Co-Principal Investigartor), Ph.D., Florida State University
The overall goal of this project was to identify gaps and to pilot approaches related to the integration of behavioral health interventions for child welfare-involved adult caregivers. Gaps in detection and intervention for parental behavioral health issues in child welfare were examined using a mixed methods approach. Specific goals and activities of the project included:
- focus groups with child welfare case and behavioral health providers to determine perceived influences on effective detection and intervention for parental behavioral health and needs for training in that arena
- pilot trainings to determine feasibility and initial effectiveness based on focus group data
- reviews of 212 case records to determine whether and how parental behavioral health needs, referrals, and referral follow-up were noted
- interviews of a sample of child-welfare involved parents to determine feasibility of contacting and collecting behavioral health information from parents, including rates of behavioral health and service needs using validated measures (N = 20).
Qualitative data obtained from focus groups revealed challenges to connecting parents with effective behavioral health services. Common issues identified among focus group participants were related to lack of parent motivation to participate in services, a limited use or knowledge of evidence-based screeners, and challenges with communication and service coordination across systems. Trainings that were developed and delivered based on focus group results highlighted the need for further training for case managers to better understand how to effectively: 1) address motivation in parents; 2) work with trauma-affected parents; and 3) use screeners to detect behavioral health issues in parents. The training was feasible, and resulted in high satisfaction ratings and a significant increase in post-test scores of knowledge in each of the domains.
Results of case record reviews and family interviews showed that most parents in our sample had significant and relatively high rates of mental health, substance use, interpersonal violence and other trauma history, as well as medical problems. Most parents were referred for multiple services, but there was inadequate information of service follow through. It is evident from both the qualitative and quantitative results that parental engagement in evidence-based treatments for mental health and substance abuse is problematic and indicates a need for improvement. The pilot training in effective engagement approaches (i.e. Motivational Interviewing) was feasible and well received by the child-welfare case managers. Based on this pilot study, we recommend that additional targeted training and attention be placed on the engagement of parents and families in evidence-based treated for mental health and substance use disorders. Based on family interviews and record reviews, it is highly likely that the type and intensive of behavioral health services are not aligned with the prevalence, co-morbidities, chronicity and severity of behavioral health disorders seen in this population. Our study found no indication that best practice psychiatric treatment guidelines were in place for any parent.
Phase two of this project seeks to determine the capacity of behavioral health providers contracting with Big Bend Managing Entity (Circuits 2 and 14) to effectively address behavioral health issues among parents involved in the child welfare system, and to determine the training and system-level needs that will improve the ability of behavioral health providers to effectively address parental behavioral health. The project will center on the investigation of specific parental behaviors that directly affect child well-being, safety, permanency and risk of future child abuse and neglect. The extent to which such specific behaviors are systematically detected and treated will be determined. Determination of behavioral health providers’ capacities and needs will be directly linked to child welfare behavioral health detection and referral procedures including case manager screening and referral practices, and the behavioral health supervision capacity of the case manager supervisors.
A mixed-methods, longitudinal approach will be used to achieve the project goals. Primary behavioral health providers in the circuits that receive referrals from child welfare will be identified and engaged in the project. Qualitative and quantitative data will be gathered from behavioral health providers, child welfare case managers and supervisors, as well as families referred to child welfare and receiving services throughout the study period. Data from behavioral health staff will include information on perception of roles and responsibilities, detailed information on training, knowledge and skills required to address specific parental behaviors that directly affect child safety, well-being and permanency, as well as training needs. Those behavioral health provider data will be evaluated against the Caregiver Capacity Form and other relevant information gathered from case managers and supervisors. Data from the child welfare side will include information on effective completion of the Caregiver Protective Capacity Form and all other relevant parental behavioral health documentation. Data from the families will include information on their behavioral health status, perceptions of adequacy of their parental risk behaviors being addressed, and detailed information on their motivation and engagement in behavioral health services. Results of the project will be combined with data from Phase 1 and will culminate in detailed recommendations for the Department of Children and Families (DCF) as well as the Managing Entity. The project team will modify the training curriculum that was developed in Phase 1 and will make recommendations for changes to the DCF Pre-Service Curriculum for statewide implementation. Recommendations will center on needed modifications to behavioral health provider training, role conceptualization, relevant policies, as well as practices for behavioral health detection, referral and training for child welfare case managers and supervisors.