Project SAFESPACE: Improving the Wellbeing of Children in Out-of-Home Care through Standardized Screening and Assessment

Over the past six years, Kent School faculty and staff have been working closely with the Kentucky child welfare and Project SAFESPACEbehavioral health agencies to transform the way they respond to the needs of children in foster care and residential treatment. Kentucky, like most states, struggled with promoting the social-emotional wellbeing of children served by the child welfare system. Children removed from their homes due to abuse and neglect were not systematically screened for trauma exposure and symptoms, or behavioral health needs. They often did not receive mental health services until their behaviors escalated to the point of crisis, and, once referred, no standardized functional assessment was used to drive treatment. The state had little information on evidence-based treatment provided or the effectiveness of particular approaches.

As a result of this project, all Kentucky children entering out-of-home care are screened for trauma and behavioral health needs within 10 days. Screening data entered into the child welfare agency’s management information system determines whether the child should be referred for functional assessment by a behavioral health clinician. Clinicians statewide use a standardized instrument as a part of their assessment to inform treatment decisions, and repeat the process every 90 days to measure progress. Lizzie Minton, LCSW, Clinical Consultant, explained, “The clinicians’ assessment results, and treatment recommendations are electronically transferred to the child welfare workers though an interface, informing case planning and decision-making. Communication between the child welfare and behavioral health practitioners has been enhanced through the use of technology.”

Becky Antle, lead evaluator, observed a number of positive outcomes through project research. Collaboration between child welfare and behavioral health agencies, and trauma readiness-related organizational outcomes improved over time. Statistically significant functional improvement was observed for the majority of children in treatment over time. Given that this state had no standardized way to measure this prior to the project, this is a tremendous achievement. In addition, statistically significant improvement in federally mandated child wellbeing outcomes were also found. Crystal Collins-Camargo, principal investigator, stated “Equally important to these positive outcomes on a case level are the rich data regarding the needs, strengths, and potential impact of specific treatment modalities on children in out-of-home care that was never before available to the state to inform interorganizational service capacity decision-making. We are now a more evidence-informed child welfare system.”

These interventions are now standard practice in Kentucky. What do these practice changes mean for the children involved? Sixteen-year-old Lisa had a severe history of substance abuse and self-harming behavior. When her child welfare worker asked her the screening questions, Lisa was able to identify some of the reasons she has felt depressed. As a result of making those connections she was more open to treatment to overcome her drug addiction. Twelve-year-old Ethan entered foster care due to educational neglect, but when screened, he disclosed that he had also been “hog tied and beat with a belt.” The screening assisted DCBS with linking the family to needed services to prevent future maltreatment that otherwise would not have been provided.