The CTA/TDRPS** Core Family and Child Assessment Process

and Web-based Assessment Tool (WBAT)

**ChildTrauma Academy/Texas Department of Protective and Regulatory Services

This data from the current pilot phase, in combination with the existing data from Harris County will provide invaluable information about the strengths and vulnerabilities of abused and neglected children and their families. Quantitative and qualitative data regarding the physical, emotional, behavioral, cognitive and social functioning of more than 2000 maltreated children will be available at the end of this pilot phase. With final implementation, data from more than 10,000 children will be gathered over the next five years. This will make the CTA/TDPRS WBAT data base the largest of its kind, allowing opportunities to track outcomes, understand the many problems of maltreated children and ultimately have the information to help individual children and help refine practice and policy in the area of child abuse and neglect.

This project was conceived of, and remains under the direction of The ChildTrauma Academy (CTA).

Principal Investigator

Bruce D. Perry, M.D., Ph.D.

Project Director

Christine Dobson, Ph.D.

ChildTrauma Academy Director

Jana Rubenstein, M.Ed., LPC

TDPRS Project Supervisor

Sarah Webster, LMSW

CTA has sub-contracted with Digital Consulting & Software Services, Inc. (DCSS) to convert the assessment into a matching Web-based assessment tool (WBAT).

DCSS Project Leader

Alan Hague

 

The project is a public-private partnership funded primarily by the Texas Department of Protective and Regulatory Services (TDPRS) but supported by other foundation grants and the "pro bono" efforts made to the ChildTrauma Academy by its non-public partners (see below).

Key Partners

Texas Department of Protective and Regulatory Services

ChildTrauma Academy

Digital Consulting & Software Services, Inc.

 

Additional Project Support to ChildTrauma Academy:

Pritzker Cousins Foundation

Maconda Brown O'Connor

Trammell Endowment

 

Funding for Complementing Training and Curriculum Development:

Court Improvement Act (administered through TDPRS)

Children's Justice Act (administered through TDPRS)

Brown Family Foundation

Our goal in developing the Core Assessment Process was to develop a practical, cost-effective process for early identification of high-risk infants and children. This model is being used for children entering CPS systems but has broad application for high risk children in any other public or private system including juvenile justice, mental health, special education, public education and medical. In the present project, proactive, multidimensional assessment is an essential step in addressing the complex problems related to the abuse and neglect of children. The project allows the ChildTrauma Academy to further develop and implement its proactive, multi-domain assessment of families and children for the Child Protective Services (CPS) system in Texas.

The original CTA Assessment Process began in a pilot project 1996 in Houston with a unique public-private partnership. The three primary partners in this pilot effort were (1) Harris County CPS; (2) The Texas Department of Protective and Regulatory Services (TDPRS); and (3) the ChildTrauma Academy. The primary objectives of the project have been to develop, implement and evaluate a proactive, practical and timely assessment process for children and their families and, thereby, provide the data necessary to better match placement and target services for children in the care of Harris County CPS. The pilot phase (Phase I) was completed in December 1998. It demonstrated that there is significant value in the Core Assessment Process. This value was present in several areas: 1) children in the pilot program returned home more quickly; 2) case workers in the pilot project reported an increase in skills, and a greater sensitivity to the manifestations of maltreatment in young children; 3) improved systemic decision-making with qualitative and objective data; and 4) more rapid and timely delivery of services. Independent of these areas of value, however, was the immediate economic benefit of the CTA Core Assessment Model. The data from the proactive assessment allows more rapid decision-making; therefore, fewer days in CPS care, fewer days in shelter care and fewer disrupted placement. The cost savings from these factors alone could save the CPS system in Texas over 23 million dollars a year.

From January 1999 to date, a modification of the original CTA Core Assessment Process was integrated into the existing Harris County CPS system. The present project is the first phase of 1) improving and modifying the Core Assessment (hence the CTA/TDPRS Core Assessment Process); 2) developing the training curriculum, policies and procedures for "exporting" the Core Assessment and 3) creating and implementing the WBAT – all in service of taking this proactive, multi-domain assessment to scale in the CPS system in Texas.

5) What are some of the key findings from the pilot project in Harris County?

As described above, the program itself was successful in helping the process become more efficient. The most important findings, however, related to the pervasive nature of emotional, behavioral, cognitive and physical problems in children entering the CPS system.

Young Children (0-6): The young children entering the CPS system demonstrated significant problems across multiple domains. Indeed, 23% of these children were unable to be completely tested due to unresponsiveness, opposition, and/or high emotional distress. Of the remaining children, 62% were found to have at least one developmental delay and over 79% were found to have more than one caution and/or at least one delay on the Denver II (a measure that may under-identify some developmental problems). Of those children found to have delays at their initial screening, 76% were found to have delays in language skills. In other areas, delays were significant with gross motor development being the least effected (only 18%). Within this sample, 60% of the children assessed had delays or a clinical presentation that warranted further evaluation or enrollment in specialized early childhood intervention services. Findings further suggest that the longer a child had been in the neglectful or abusive setting, the more pervasive and severe were the problems.

Children and Adolescents (6-18): As a group, pilot children and adolescents removed from their families by CPS demonstrated many problems. Two of the most striking findings appear to be related to being raised in chaotic and threatening environments. At least mild post-traumatic stress (PTSD) symptoms were reported by 86% of this group, with 22% reporting very severe PTSD symptoms. As a group, these children were more proficient at processing non-verbal information than verbal. Academic problems and other neuropsychiatric problems were more common in these children than in the general pediatric population. Clearly, findings from an examination of data from the Core Assessments suggest that early assessment of children and adolescents as they enter the CPS system are vital in identifying areas for concentrated treatment and services.

6) Who does the actual evaluation for the CTA/TDPRS Core Assessment?

In brief, community clinicians contracted by the state evaluate families and children served by TDPRS. These clinicians have been (and will be) trained and certified (by the ChildTrauma Academy) in the use of the various psychometric and processes used in the assessment. The data (results) from the evaluation are stored in a child's individual record using in Web-based database (WBAT). This facilitates sharing of information with appropriate professionals in the child protective services system.

7) Who has access to the assessment data on the Web?

Only appropriately authorized individuals will have access to the site. In addition, only individuals with consents and further authorization will have access to any individual child or family record. This may include the caseworker, the worker's supervisor, the evaluating clinician, authorized service providers, the judge, the child's attorney and so forth.

8) What about security of confidential information?

This is a major concern and focus of the development of the WBAT. The architecture and authorization process for access provides the degree of security required by state and Federal regulation. We take this issue very seriously and have developed external process and procedure to match the security features of WBAT to increase the safety of this sensitive information. With this stated, however, the "security" of these records in WBAT is greater than the security of paper records of the child distributed widely in offices and file cabinets across a community.

9) What does the availability of this assessment mean for children affected by abuse and neglect?

There are several important implications for the abused child. The first is that they are less likely to languish in the system. They will be less likely to be moved from placement to placement and they are more likely to get recommendations for services that they need.

10) Why are special services needed for abused and neglected children?

Children who are in the CPS system are a very high risk for mental health problems, certain physical problems (e.g., the rate of asthma in our pilot study way 4 times the national average), academic problems, speech and language problems, substance abuse and dependence and learning problems.

11) How can this Web-based assessment process improve the care for children who have suffered from trauma?

The benefit is that it allows a better match between the needs of these children and families and the services available to meet those needs. In addition it allows more rapid implementation of services that helps developing children and their families to make positive changes more quickly and more efficiently. And finally, it helps keep track of important and useful information about the child that will not be lost when the child changes placement or enters another system. This will save the child from unnecessary evaluation and allow tracking of outcomes and will save the systems the expense of repeated evaluations (it is not unusual for some of these children to receive five or six separate and redundant assessments over a two year period, for example.)

12) Are there examples of children or cases that would have gone a totally different way if this Assessment had not been available?

One of the most important benefits of this project is that is identifies very young children (under the age of 6) who are in need of early intervention. Under the current system, very few young children in the CPS system are referred for services while systematic assessment demonstrates that more than 60% of the children in CPS care under age 6 have developmental delays and would benefit from early, aggressive intervention.

13) Is the WBAT and Core Assessment Process available for other communities?

This project is focused on the CPS system in Texas. The ChildTrauma Academy and DCSS are committed to continuing to refine and evolve both the Core Assessment Process and WBAT for other elements of the CPS process and for other systems serving children. This specific program is under the direct partnership with TDPRS. Agencies and communities interested in this project can contact us for more information.

14) Where can I learn more about the CTA/TDPRS Core Assessment and Web-based Assessment Tool (WBAT)?

If you are interested in learning more about this project, or if you are a member of the media seeking to produce a piece about the project, please contact Jana Rubenstein by phone at (281) 932-1375 or via mail at jlrcta@aol.com.

We request the opportunity to review briefs articles or press releases for accuracy.

Please send draft copies to Jana Rubenstein:

Via email: jlrcta@aol.com