Developing a Proactive Intervention for Maltreated Children: The ChildTrauma/Children's Crisis Care Center Core Assessment Process :::: Welcome to Child Trauma Academy :::::::::::

Developing a Proactive Intervention for Maltreated Children:

The ChildTrauma/Children's Crisis Care Center Core Assessment Process

Stephanie Schick, M.Ed., Duane Runyan, Ph.D.

Michelle Acker, MA, David Conrad, LMSW-ACP, Christine Dobson, PhD, Lea Hogan, MEd,
Connie F. Nelke, PhD, Jana Rubenstein, MEd, LPC, Elizabeth Tauber, LMSW, & Bruce D. Perry, MD, PhD

The ChildTrauma Academy
www.ChildTrauma.org

ABSTRACT

Each year in the United States, child maltreatment places millions of children at high-risk for physical, emotional, behavioral, cognitive, developmental, and social problems. Despite this knowledge, systematic evaluation of the strengths and weaknesses of children is rarely proactive. Services and placement decisions tend to be reactive and based on subjective factors. Placement disruptions and ineffective service delivery that result from this reactive process are often costly to the child and system.

A proactive assessment model for children entering the CPS system was developed in Harris County, Texas. This model, titled the Children’s Crisis Care Center (4C), was developed by an inter-institutional, multidisciplinary work group led by the CIVITAS ChildTrauma Programs. The 4C model uses reliable and valid psychological measures, to provide immediate screening evaluations on all children entering state custody. This quantitative, objective analysis estimates each child’s functioning in order to better match children to services and placements. Reporting and staffing processes are designed to be practical and useful to caseworkers, judges, teachers, foster parents and other professionals working with these children.

Through systematic data collection and storage in a database designed by the 4C Program, analysis of factors common to the more than 360 children removed from their home has been possible. Findings include the presence of developmental delays in children under 6 years of age. In addition, more than 40% of the more than 200 children who received a 4C evaluation performed significantly better on nonverbal tasks compared with verbal tasks.

INTRODUCTION

Child Protective Services (CPS) in all states has the critical responsibility for finding suitable (if not optimal) placement for children removed from parental care. CPS also has the responsibility for attending to the medical, psychological, social and academic needs of these children.

Most of the children in CPS care are at great risk for a host of problems related to maltreatment. In the overburdened CPS and family court systems, the challenge of addressing various functioning difficulties is often faced blind because objective information about the specific needs of these children is rarely available. As a result, placement decisions often are made without this information, and children are frequently placed according to the availability of beds in the foster-care system.

Resources are even more limited for the mental health, medical, psychosocial and academic needs of these children. Many services to address these concerns are provided in a reactive fashion – after the child has demonstrated some significant problem, disrupted placement, or otherwise failed in some dramatic fashion.

Placement decisions are even more random for infants and young children than for older children. Early intervention services are rarely provided, as these youngest children rarely "disrupt" placement, and they are not yet capable of failing in school. In a reactive system, they will rarely be evaluated. Without appropriate assessment, their developmental problems will go undetected, and no interventions will be provided.

Developing a practical, cost-effective process for early identification of high-risk infants and children, therefore, is an essential step in addressing the complex problems related to the abuse and neglect of children. The Children’s Crisis Care Center (4C) was established as a public-private partnership in Harris County. The three primary partners in this collaborative effort were: (1) Harris County CPS, including the Harris County CPS Fund Board, (2) the Texas Department of Protective and Regulatory Services (TDPRS), and (3) the CIVITAS ChildTrauma Programs of Baylor College of Medicine in Houston. The CIVITAS ChildTrauma Programs was selected to develop and implement the proactive assessment process for the Children’s Crisis Care Center.

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OVERARCHING PROGRAM GOAL:

To provide immediate and accurate information to
decision-makers about the needs of all children and families.

Population & Battery Population: Children ages birth through 17 years All children entering state custody during the CPS investigative stage Measurement: Children 6 months to 6 years participate in a developmental screening Children 6 years, 1 day through 17 years participate in a psychological screening

Domain	Developmental	Psychological
Physical	Height Weight Blood Pressure Pulse FOC Historical Info. Active Problems	Height Weight Blood Pressure Pulse FOC Historical Info. Active Problems
Life Events	CIVITAS Trauma Inventory	CIVITAS Trauma Inventory
Family/ Social	Parenting Stress Index 4C Family Assessment	Parenting Stress Index 4C Family Assessment
Cognitive Academic	Not Applicable	Beery Visual Motor Integration Test Wide Range Achievement Test Kaufman Brief Intelligence Test
Developmental	Caregiver Interview Denver II	Not Applicable
Emotional/ Behavioral	Caregiver Interview Child Behavior Checklist 2 - 3 (CBCL) Child Behavior Checklist 4-18	Caregiver Interview Child Behavior Checklist 4-18 CBCL Youth Self-Report Children’s Depression Inventory Reynolds Child Depression Scale Revised Children's Manifest Anxiety Scale Children’s Perceptual Alteration Scale Child Post-traumatic Stress Disorder Reaction Index Feelings, Attitudes, and Behavior Scale Trauma Symptom Checklist for Children Millon Adolescent Clinical Inventory

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Key Differences CPS Standard Assessment Approach vs. CIVITAS/4C Core Assessment
	CPS Standard	CIVITAS / 4C
Primary Model	Reactive	Proactive
Nature of Evaluation	Focused, typically psychological	Multi-dimensional, including a Family Assessment
Assessment of Young Children	None	Developmental
Psychometric Instruments	Minimal standardization or little cross-clinician consistency	Quantitative, reliable, valid measures; consistency across all 4C clinicians
Report Format	Subjective interpretation of information or primarily narrative reports	Graphical, structured, standardized with subjective and objective data
Report Availability	Evaluation data rarely available at 10d, 30d or other proceedings	Information available for early decision making
Information Management	No electronic record of evaluations or primary test data	Data stored on electronic database; available for multiple appropriate users
Communication with CPS	Rare participation by contract clinicians in CPS staffing	Frequent communication and as-needed participation in CPS team
Relationship with CPS	Contract clinicians with limited investment in CPS systemic issues	True public/private partnership with distributed leadership and shared responsibility
Program Development	None	Continual self-evaluation and correction of program or process innovations

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