Alamance Alliance Annual Report 2013

Alamance Alliance
Final Annual Report October 2013
Christina Christopoulos, Katie Rosanbalm & Sonya Fischer
Bridging the gap between research and public policy to improve the lives of children and families
Contents
I. OVERVIEW .......................................................................................................................................................... 3 II. ALAMANCE ALLIANCE FAMILIES: DEMOGRAPHIC AND DESCRIPTIVE DATA ........................................................ 3 CHILD CHARACTERISTICS ..................................................................................................................................................4 REFERRAL SOURCE..........................................................................................................................................................5 AGENCY INVOLVEMENT AT INITIAL INTERVIEW (INTAKE) .........................................................................................................6 CHILDRENS PRESENTING PROBLEMS ..................................................................................................................................8 CHILDRENS DIAGNOSES ..................................................................................................................................................9 CUSTODY STATUS .........................................................................................................................................................10 CHILDRENS LIFE EXPERIENCES ........................................................................................................................................11 CAREGIVER DEMOGRAPHICS ...........................................................................................................................................13 III. CHILD AND PARENT OUTCOMES ..................................................................................................................... 14 STRENGTH-BASED ASSESSMENTS ....................................................................................................................................14 Behavioral and Emotional Rating Scales (BERS and PreBERS) ............................................................................14 Devereux Early Childhood Assessment (DECA) ....................................................................................................17 RISK-BASED ASSESSMENTS.............................................................................................................................................18 Child Behavioral Checklist (CBCL ages 1 -5) ......................................................................................................18 Devereux Early Childhood Assessment Behavioral Concern Subscale (DECA) .....................................................21 Parental Stress Index (PSI-short form) ................................................................................................................21 Caregiver Strain Questionnaire ...........................................................................................................................23 EDUCATION.................................................................................................................................................................25 LOCATION AND TYPES OF SERVICES RECEIVED ....................................................................................................................27 IV. GRANT-FUNDED ACTIVITIES ............................................................................................................................ 30 WORKFORCE DEVELOPMENT AND COMMUNITY EDUCATION ................................................................................................30 INCREDIBLE YEARS CLASSES ............................................................................................................................................30 CULTURAL AND LINGUISTIC COMPETENCE (CLC) ................................................................................................................35 FAMILY VOICE .............................................................................................................................................................35 SOCIAL MARKETING ......................................................................................................................................................36 FLEXIBLE FUNDS ...........................................................................................................................................................37 V. CONTINUOUS QUALITY CONTROL (CQI) TO INFORM CHANGE AT THE LOCAL LEVEL ........................................ 38 MONTHLY STATUS REPORT ............................................................................................................................................38 QUARTERLY REPORT .....................................................................................................................................................38 AGENCY COLLABORATION SURVEY ...................................................................................................................................39 How we assessed agency collaboration ..............................................................................................................39 Results .................................................................................................................................................................40 Agency Directors .................................................................................................................................................40 Front-line staff/Supervisors .................................................................................................................................41 FAMILY SATISFACTION WITH SERVICES ..............................................................................................................................42 CULTURAL COMPETENCE ...............................................................................................................................................44 CAREGIVER SATISFACTION WITH FAMILY PARTNERS.............................................................................................................47
1 www.alamancesoc.org October, 2013
FAMILY PARTNERS AS CASE MANAGERS............................................................................................................................49 Futures Mapping .................................................................................................................................................49 Child and Family Team Meetings (CFTs) .............................................................................................................49 Other Case Management Services ......................................................................................................................50 Conclusions and Recommendations ....................................................................................................................50 VI. LEVERAGING CHANGE AND SUSTAINABILITY EFFORTS IN THE PAST YEAR ...................................................... 51 VII. CONCLUDING THOUGHTS .............................................................................................................................. 52 VII. APPENDIX A ................................................................................................................................................... 55 Agency Collaboration Survey Results for Agency Directors ................................................................................55 IX. APPENDIX B .................................................................................................................................................... 62 Agency Collaboration Survey Results for Frontline Staff and Supervisors ...........................................................62 X. APPENDIX C ..................................................................................................................................................... 66 Quarterly Report .................................................................................................................................................66
I. Overview
The Alamance Alliance for Children and Families is completing its fifth year. As a System of Care for families with children birth through five, the Alliance is an integrated network of community services and resources that work together with families and their children to address families comprehensive needs. The evaluation team of the Alliance asks all enrolled families to participate in a longitudinal study to assess whether the program is reaching its goals. Participants in the longitudinal study are interviewed 5 times over the course of 2 years. Using data gathered through the longitudinal study and other sources, the evaluation team provides the Alliance governing bodies with information that helps them review services and programs to identify what works and make improvements as needed. Armed with this information, the Alliance leaders can then decide where to focus sustainability efforts to continue services beyond the life of the grant. This Annual Report is an updated version of the 2012 Annual Report. It is similar in scope, but includes data through August 2013. It highlights demographic characteristics and descriptive information about all of the families who have enrolled in the longitudinal study and participated in the first interview by August 2013. It further presents child and parent outcomes for the subset of families who have completed follow-up interviews up to 18 or 24 months after enrollment. Finally, it describes additional programs and services funded by the grant along with all local continuous quality improvement efforts as well as plans for sustainability.
II. Alamance Alliance Families: Demographic and Descriptive Data

Alamance County is centrally located in North Carolina with a total population of 153,920, over 11,000 of whom are children between the ages of 0 and 5. The county is composed of urban and rural settings with a majority white population (67%) along with significant numbers of black or African American (19%) and Latino (11%) minorities1. Consistent with the entire state, Alamance County is experiencing a significant increase in Latino populations. In terms of mental health, conservative projections based on national percentages of preschool children with a clinical diagnosis related to emotional and/or behavior problems indicate that between 1,113 and 1,699 preschool children in Alamance County have serious mental health needs. The following sections highlight data on children who have received services through September 2013. The referral process officially started in September 2009. Since then: 561 children have been referred for a diagnostic evaluation 409 have had a diagnostic evaluation; 118 declined or could not be reached for an evaluation; 20 did not meet Alliance criteria and were referred to appropriate portals for further evaluation; 14 were pending evaluation
Data based on United States Census Bureau data for 2012.
309 children were found to be eligible for Alliance services; 100 were not eligible because they did not get a diagnosisthese families were referred to other services 283 children were enrolled in the Alliance; 25 declined; 1 was pending enrollment 251 were assigned a mental health provider; 32 families declined a mental health provider, but received other services 224 families were assigned a Family Partner; 56 declined; 3 were still unsure whether they want a family partner
Child Characteristics Of the 283 children enrolled in the Alliance, 218 of them and their families also enrolled in the Longitudinal Study. Table 1 shows the demographic characteristics of the children in the Longitudinal Study during their first interview. The majority of children were male (62%) with an average age of 3.4 years. These percentages have remained fairly consistent over the years; however there has been an increase in the number of very young children who qualify for services through the Alamance Alliance in the last year. The race and ethnicity of children enrolled in the Alliance has remained consistent throughout the entire study.
Table 1 Child Characteristics

(n=218)
Average Age Gender Male Female Ages <1 year 1 year 2 year 3 year 4 year 5 year Race/Ethnicity American Indian Black or African American Hispanic/Latino Multi-racial White
3.4 years old 62% 39% 1% 3% 19% 26% 32% 19% 1% 29% 17% 7% 46%
4
www.alamancesoc.org October, 2013
Referral Source Figure 1 portrays the agencies that referred the children to the Alamance Alliance over all the years of the grant. The largest groups of children were referred by the child welfare system, followed by physical health agencies and the school district. 2 The percentage of families referred by different agencies or individuals has not changed in the past year. In 2012 we saw an increase in the percentage of physician and child welfare referrals, but these percentages have remained stable this year. Figure 1
Referring Agency
(n=218)
Public Child Welfare Physical Health School Mental Health Early Intervention Caregiver Preschool Special Ed Head Start Early Care Other 0%
1% 1% 3% 7% 7% 15% 14% 13% 13% 25%
20%
40%
60%
80%
100%
Percent of Families Referred by Each Agency
Child Protective Services policy dictates that any child in foster care is automatically referred to the community portals for an evaluation. Additionally, children in families who have a substantiated child welfare report, are in the assessment process of a report, or for whom there is documented history of child welfare involvement, domestic violence, parental substance abuse, or parent mental illness or cognitive impairment are automatically screened for social/emotional concerns using the Ages and Stages Questionnaire Social/Emotional (ASQ-SE). Children who receive clinically significant scores on the ASQ-SE or whose social workers deem it necessary are then referred to the community portals for a diagnostic assessment.
Agency Involvement at Initial Interview (Intake) Figure 2 shows agencies with which the children were involved at the time of their referral to the Alliance. Most families had a connection to a physical health care provider and over half of the families were involved with school or preschool. Close to a third of the families had some involvement with child welfare. Some of those families were in the midst of an assessment or investigation that was found to be unsubstantiated, but most families involved with child welfare were receiving services of some kind from child welfare. Figure 2
Agency Involvement at Intake

(n=218)
100% Percent of Children Involved with Each Agency 80% 60% 40% 20% 0% Physical Health School or Public Child Preschool Welfare Mental Health Early Care Early Intervention Other
51% 88%
32%
29% 21% 16% 8%
Fifty-five families were directly involved with child welfare services at the time of the Intake interview. Figure 3 shows the percent of families involved in each of 3 types of child welfare services. This list is not inclusive of all of the types of services provided by child welfare; it represents the types of services the children in this study were receiving. The largest group of children was receiving court-ordered in-home services or the children were in kinship care. Figure 3
Types of Welfare Involvement for Children Receiving Services from Child Protective Services at Intake
(n=55)
100%
Percent of Families Involved in Each Type of Service
80%
60% 42% 40% 40%
20%
16%
0% Court-ordered in-home services Court-ordered kinship care placement Court-ordered foster care placement
Childrens Presenting Problems Figure 4 lists the childrens presenting problems identified in the initial diagnostic evaluation based on caregiver report and evaluator observation (only problems identified in at least 25% of the children are included here). Over three quarters of the children were reported to have disruptive behaviors such as aggression, severe defiance, acting out, impulsivity, and recklessness, and almost half displayed hyperactive and attention-related problems. Eighty-four percent of the caregivers reported other problems such as a family history of mental health challenges or witnessing domestic violence, but due to the variety of those responses, they are not included in the chart. Other challenges such as developmental disabilities, adjustmentrelated problems or depression-related problems had lower occurrences and were not included in this chart. These percentages have remained consistent over the past few years.
Figure 4
Children's Presenting Problem

(n=218)
Disruptive Behaviors in Young Children Hyperactive and Attention-Related Problems Sleeping Problems Persistent Noncompliance Maltreatment Excessive Crying/Tantrums Anxiety-Related Problems
77% 48% 41% 37% 33% 31% 25% 0% 20% 40% 60% 80% Percent of Children 100%
Childrens Diagnoses Many of these childrens challenges are severe enough to warrant a mental health diagnosis by a mental health professional based on the criteria laid out in the DSM-IV. Seventyfive percent of all of the children evaluated were given a DSM-IV diagnosis. Table 2 outlines the diagnoses the children enrolled in the longitudinal study received. Consistent with last years report, about half of the children were diagnosed with Disruptive Behavior Disorder NOS (not otherwise specified). Thirty-seven percent of the children were diagnosed with an adjustment disorder. Note that some children have more than one diagnosis.
Table 2
Diagnosis (n=218)
Disruptive Behavior Disorder NOS Adjustment Disorder (all types) ADHD Pica Anxiety Disorder Posttraumatic Stress Disorder Aspergers Disorder, Pervasive Developmental Disorder NOS, Retts Disorder Learning Disorder NOS Oppositional Defiant Disorder Parent-Child Relational Problem Separation Anxiety Disorder Conduct Disorder, Childhood-Onset Type Impulse-Control Disorder NOS Physical abuse of child Transient Tic Disorder
Percent
53% 37% 6% 5% 3% 3% 2% 1% 1% 1% 1% 1% 1% 1% 1%
Custody Status Figure 5 highlights the childrens legal custody status at Intake. Forty-four percent of the children were in the custody of their biological mother only, while over a third of the children were in the custody of both parents. The Department of Social Services had custody of 11% of the children, a slight increase from last years report.
Figure 5
Custody Status at Intake

(n=218)
Biological Mother Only Two Parents Ward of the State Biological Father Only Grandparent(s) Adoptive Parent(s) Aunt and/or Uncle Friend (adult friend) 0%
4% 3% 3% 2% 1% 11% 33% 43%
20%
40%
60%
80%
100%
Childrens Life Experiences Figures 6, 7, and 8 show caregiver responses to questions about the childs living situations and assault history. As in past reports, over 70% of the children have lived with someone who was depressed. Approximately half of the children have recently lived with and been cared for by someone who was depressed, and over a third of the children lived with someone who had either a substance abuse problem, was convicted of a crime, or had a mental illness other than depression. Over forty percent of the children have witnessed domestic violence and 26% have experienced or witnessed physical assault. Figure 6
Children Living with and Cared for by People with Depression

(n=218)
100%
Percent of Children
80% 60% 40% 20% 0%
72% 51% 47%
Ever lived with someone who Lived with someone who was Been cared for by someone who was depressed? depressed in the last 6 months? was depressed?
Has the child...?
Figure 7
Children's Living Situations to Date

(n=218 ) 100%
Percent of Children
80% 60% 40% 20% 0% Lived with someone who had a mental illness other than depression? Lived with someone who had a substance abuse problem? Lived with someone who was convicted of a crime? 35% 34% 34%
Has the child...?
Figure 8
Percent of Children who have Ever Witnessed or Experienced Assault

(n=218) 100%
Percent of Children
80% 60% 43% 40% 20% 0% Ever witnessed domestic violence? Ever experienced or witnessed physical assault? Ever experienced or witnessed sexual assault? 26% 9%
Has the child?

Caregiver Demographics Table 3 and Figure 9 show demographic and income data for the childrens caregivers. The majority of the primary caregivers were female with an average age of 34. Over half of the caregivers were white, 28% were black or African American and 13% were Hispanic or Latino. Twenty-four percent of the caregivers never completed High School and 41% have either attended college or have an advanced degree. Three quarters of the families have incomes less than $25,000 a year.
Table 3 Caregiver Characteristics

(n=218)
Figure 9 34 years old 7% 93% 29% 12% 3% 55% 24% 35% 31% 10%
17%
Average Age Gender Male Female Race/Ethnicity Black or African American Hispanic/Latino Multi-racial White Education Level Below High School High School or GED Some college or Associates Degree College Degree (e.g., BA, MA, PhD)
Family/Household Income
8% Less Than $24,999 $25,000$49,999 $50,000 and over
75%
Just under half of the caregivers reported working during the 6 months prior to the initial interview. The main barriers to working cited by caregivers who were not working were childcare problems, caregivers health problems or disability and inability to find work at the desired salary. Thirty-six percent of the caregivers who were employed reported missing at least one day due to their childs emotional and behavioral problems. Twenty-five percent of caregivers who reported missing work missed 10 days or more.
III. Child and Parent Outcomes

After families enroll in the Alliance they are offered individualized services and treatment options based on what they want and need. By providing treatment to families while their children are young, we hope to reduce or eliminate many of the behaviors and difficulties that are contributing to stress or disharmony in the family. Caregivers are interviewed every six months beginning at the time of their enrollment (Intake) and continuing every six months thereafter for up to 2 years. Data from these interviews allow us to assess and analyze changes in the child and families over time. Analyses have been run on the results of these data and changes that are statistically significant from scores at intake (i.e., changes that are unlikely to have occurred due to chance) are indicated by asterisks on the graphs. Because of the small number of families who have completed assessments through 24-month follow-up, most outcomes were assessed only through 18 months post-service initiation. Strength-Based Assessments Behavioral and Emotional Rating Scales (BERS and PreBERS) The PreBERS (for preschool age) and BERS (for school age) questionnaires assess the emotional and behavioral strengths of children. Caregivers are given the PreBERS or BERS depending on the age of their child. For example, a caregiver may be given the PreBERS at Intake and the BERS at 6 and 12 months once their child has reached school age. Still another caregiver may be given the same assessment for all 5 time frames. We can only compare scores if the caregiver has received the same assessment at all interviews because the PreBERS and BERS have different scales. Therefore, even though 74 caregivers completed the BERS at the 18month interview, only 17 were given the BERS at all four interviews and could be included in Figure 11 below. Only 2 caregivers were given then PreBERS at all four interviews; Figure 10 thus includes only information on the larger number of caregivers (n = 22) who received the PreBERS at Intake, 6 and 12 months. Pre-Behavioral and Emotional Rating Scale (PreBERS) The PreBERS is a 42-item caregiver questionnaire for children ages 3 to 4 years, 11 months. It uses 4 subscales: Emotional Regulation, School Readiness, Social Confidence, and Family Involvement. Emotional Regulation measures a childs ability to control h is or her behavior or emotions in social situations (e.g., controls anger towards others, handles frustration with challenging tasks). School Readiness measures skills like attention and language that are critical for entry to a preschool environment (e.g., understands the meaning of words similar to same-age peers, persists with tasks until completed). Social Confidence focuses on a childs ability to develop and maintain positive relationships with others (e.g., acknowledges painful feelings, stands up for self). Finally, Family Involvement measures a childs relationship and involvement with his or her family (e.g., demonstrates a sense of belonging to family,
maintains positive family relationships). Higher scores indicate greater overall strengths, based on parental perceptions. Figure 10 shows the percent of children who scored in the average range or higher on the PreBERS at Intake, 6 and 12 months. According to their parents, preschool children improved significantly on emotional regulation, with smaller (non-significant) improvements on school readiness, family involvement, and social confidence. Figure 10
Percent of Children Scoring in the Average or Above Range on the PreBERS at Intake, 6 and 12 months
(n=22) 100% 80% 60%
Intake
68%* 68%* 73% 77% 82% 86% 77% 91% 82% 95% 91%
40% 20% 0%
36%
6 month 12 month
Emotional Regulation
Family Involvement
School Readiness Social Confidence
Behavioral and Emotional Rating Scale (BERS) For children 5 and older, the 57-item BERS measures strengths in six areas: Interpersonal Strength, Family Involvement, Intrapersonal Strength, School Functioning, Affective Strength and Career Strength. Interpersonal Strength focuses on a childs ability to control his or her behavior and emotions in social situations (e.g., loses a game gracefully, reacts to disappointment in a calm manner). Family Involvement assesses a childs relationship and involvement with his or her family (e.g., demonstrates a sense of belonging to family, maintains positive family relationships). Intrapersonal Strength measures a childs view of his or her competence and accomplishments (e.g., is enthusiastic about life, talks about positive aspects of life). School Functioning focuses on a childs competence at school (e.g., pays attention in class, attends school regularly). Finally, Affective Strength evaluates a childs ability to express feelings and accept affection from others (e.g., expresses affection for others, shows
concern for the feelings of others). As with the PreBERS, higher scores indicate greater strengths. Figure 11 shows the percent of children who scored in the average range or higher on the BERS at Intake, 6, 12, and 18 months. Scores in all categories except School Functioning increased between Intake and 18 months, though there is some variability in between. The largest increases were in Interpersonal and Intrapersonal Strength. Interpersonal Strength measures the extent to which a child can control his or her emotions and Intrapersonal Strength measures the way a child views him or herself, so it is nice to see these increases. The percent of children scoring in the average or above range on the School Functioning scale decreased. This is likely due to the fact that these children have just started attending school, so caregivers develop more realistic perceptions of their childs school functioning and areas of concern as the school year progresses and expectations increase.3 Figure 11
Percent of Children Scoring in the Average or Above Range on the BERS

(n=17)
100%
88%* 82%* 83% 83% 76% 65% 67% 59% 53% 50% 76% 71%
80%
59%* 53%* 41%*
76% 71% 59%
76%
60%
Intake 6 month
40%
18%
20%
12 month 18 month
0% Interpersonal Strength Family Involvement Intrapersonal Strength School Functioning Affective Strength
The n for School Functioning is 6 because 11 children were not yet in school at the time of first interview.
Devereux Early Childhood Assessment (DECA) The DECA is an early childhood assessment instrument for ages 2-5 years that measures a childs behavioral characteristics that act as protective factors. It consists of 3 subscales: Attachment, Initiative, and Self-Control. The Attachment subscale measures the strength of the attachment between the child and significant adults (i.e., the extent to which it is mutual, strong, and long-lasting). Examples of items in the Attachment subscale are: responds positively to adult comforting when upset, trusts familiar adults and believes what they say. The Initiative subscale measures the childs ability to use independent thought and actions to meet his or her own needs (e.g., does things for himself/herself, chooses to do a task that is challenging for him/her), and the Self-Control subscale measures the childs ability to experience a range of emotions and express those feelings in a socially acceptable manner (e.g., controls his/her anger, handles frustration well). As a child gains skills, strengths and coping strategies, the subscales scores should increase. Low scores on the Attachment, Initiative, and Self-Control scales would be considered at risk. Figure 12 shows the percent of children whose DECA scores were in the Average or Above Average range on the 3 DECA subscales at the Intake and Follow-up interviews. Statistically significant increases in the percent of children scoring in the average or above range can be seen in the Initiative and Self-Control scales. This is very positive as it shows that the children are becoming more independent and also expressing their emotions in more socially acceptable ways. The decrease in the Attachment scores is somewhat concerning and can be interpreted many ways. It is possible that as a childs self-control and initiative increase the child seems less attached because the child is relying less on significant adults. Another possibility is that the caregivers presented an overly positive view of their childs attachment relationships with significant adults at the beginning, and as they got more informed about child development, their view of those relationships became more realistic. Finally, it is also possible that the DECA is not an accurate measure of attachment for this particular population. Notably, this pattern of decreasing scores on the attachment scale was also evident in other 2008 grantees when we examined just their birth through five populations.
Figure 12
Percent of Children Displaying Average or Above Average DECA Scores at Intake and Follow-up Interviews
(n=27)
100%
80% 70%* 70%* 63% 60% 44% 40% 48% 48% 33% 26% 20% 48% 52%* 63%* 56%* Intake 6 month 12 month 18 month
0% Attachment Initiative Self-Control
Risk-Based Assessments Child Behavioral Checklist (CBCL ages 1 -5) The CBCL is a 100-question interview administered to the caregiver that measures behavioral and emotional difficulties in children ages 1 through 5 years. Caregivers rate statements on a 3-point scale indicating the extent to which a statement is very true, somewhat true, or not true. The results can be grouped into two broad categories, Internalizing and Externalizing Behaviors, and into 7 subscales. The Internalizing Behavior scale measures concerns such as anxiety, depression, social withdrawal, somatic symptoms and emotional reactivity. Examples of questions include headaches without medical cause, clings to adults or too dependent and doesnt answer when people talk to him. The Externalizing Behavior scale measures behaviors that are more visible such as aggression and attention problems. Examples of questions include gets in many fights, angry moods, and cant concentrate. Scores above a certain criterion in each scale are considered to be in the clinical range.
Figures 13, 14, and 15 show the percent of children whose scores were in the clinical range for the broad scales and for each subscale as assessed during the Intake and Follow-up interviews. The biggest and statistically significant decrease can be seen in the percent of children scoring in the clinical range for externalizing behaviors. This scale is comprised of the Attention and Aggression subscales which can be seen in Figure 14. From Intake to 18 months, the percent of children displaying clinical levels of attention and aggression problems dropped significantly by 20 percentage points. The sleep subscale is also shown in Figure 14. The Sleep scale is its own category; it is not part of the Externalizing or Internalizing scales. The percent of children scoring in the clinical range on the Internalizing Behavior scale also decreased. Figure 15 shows the scores for the 4 subscales that make up the Internalizing Behavior scale. The Withdrawn Scale has largest decrease in children scoring in the clinical range. This scale measures the extent to which a child is disengaged with the people in his or her environment (e.g., avoids eye contacts, refuses to play active games, shows little affection toward people), so decreases in these scores indicate that children are interacting more with the people and activities around them. Figure 13
Percent of Children with Behaviors Scoring in the Clinical Range on the Child Behavior Checklist at Intake and Follow-up Interviews
(n=41)
100%
80%
80%
60%
51%
49% 44%
39%
51%*
46%* Intake
40%
37%*
6 month 12 month
20%
18 month
0% Internalizing Behaviors Externalizing Behaviors
Figure 14
Percent of Children Scoring in the Clinical Range on the Externalizing Behavior and Sleep Subscales
100%
(n=41)
80% Intake
49%
60%
37% 20%* 22% 15%* 37% 22%* 27%* 17%* 17%*
6 month 40%
32%* 29%*
12 month 18 month
20%
0% Sleep Problems Attention Problems Aggression Problems
Figure 15
Percent of Children Scoring in the Clinical Range on the Internalizing Behavior Subscales
100%
(n=41)
80%
Intake 6 month 32% 27% 22%* 12 month 18 month
60%
37% 24% 29% 22% 20% 15% 12% 12% 12% 17% 5% 15%
40%
20%
10%
0% Emotionally Reactive Anxious/Depressed Somatic Complaints Withdrawn
Devereux Early Childhood Assessment Behavioral Concern Subscale (DECA) In addition to the 3 strength-based subscales discussed earlier, the DECA also has a Behavioral Concern subscale that indicates the degree to which a child is displaying challenging behaviors (e.g., has temper tantrums, has a short attention span). A higher Behavioral Concern score indicates that the child is exhibiting more troubling behaviors than a child with a lower score. Thus, as a child gains skills, strengths, and coping strategies, the Behavioral Concern score should decrease. At Intake, 96% of the children received above-average Behavioral Concern scores, whereas at the 18-month interview, 85% of the children displayed aboveaverage Behavioral Concern scores. We hope to see this decrease continue. Parental Stress Index ( PSI-short form) The Parental Stress Index (PSI/SF) is a 36-item caregiver questionnaire designed to measure areas of stress in the parent-child system. Results are given in terms of 3 subscale scores (Parental Distress, Parent-Child Dysfunctional Interaction, Difficult Child) that indicate which parent or child characteristics contribute to stress in the family. The Parental Distress scale measures how the parent feels as a function of personal factors directly related to parenting, including depression (e.g., having a child has caused more problems than I expected in my relationship with my spouse, I dont enjoy things as I used to). The Parent-Child Dysfunctional Interaction scale measures the strength of the relationship between the parent and child (e.g., my child rarely does things for me that make me feel good, my child is not able to do as much as I expected). It identifies the extent to which the parent perceives that the child is meeting his or her expectations and whether the interactions between the child and parent are positive or strained. High scores on this scale indicate that the parent-child bond has not been adequately established or is threatened. The Difficult Child scale measure child characteristics such as being overly demanding, impatient or moody that make them easier or more difficult to manage (e.g., my child generally wakes up in a bad mood, there are some things my child does that bother me a lot). Higher scores on this scale indicate that the childs temperament is more challenging than a child with a lower score. Figure 16 compares the percentage of caregivers who reported clinically significant stress levels at Intake and Follow-up interviews. Results are given in terms of 3 subscale scores that indicate which parent or child characteristics contribute to stress in the family. Decreases in the percent of caregivers reporting clinically significant stress levels at Intake and 18 months later were seen in each subscale, with a significant decrease in the Difficult Child subscale. The Difficult Child scale measures child characteristics that contribute to stress in the parent-child relationship, so decreases in this scale are likely due to changes in the childs behavior or in parental expectations for age-appropriate behavior. There was a slight decrease in the ParentChild Dysfunctional Interactions subscale, suggesting that the parent-child relationship may be getting stronger. Finally, the Parental Distress scale slightly decreased. This particular subscale had not improved in the previous years, a finding that was not particularly surprising given that
this scale measures stresses in the parents life such as conflict with the other parent, stresses connected to restrictions placed on other tasks due to parenting responsibilities, lack of social support and depression. These factors may take longer to address and thus the percent of caregivers reporting clinically significant scores on the Parental Distress scale were not expected to decrease as readily as the other scales. It is encouraging to see that by 24 months of services, caregivers feel more positive and less distressed in their role as parents. Figure 16
Percent of Caregivers Indicating Clinically Significant Stress Levels on the PSI at Intake and Follow-up Interviews
100% 80%
68% 66% 66% 59% 45% 56%
(n=41)
78% 68% 61% 65% 56*%
60% 40% 20% 0% Parental Distress
Intake
32%
32%
6 month
29% 27%
12 month 18 month 24 month Parent-Child Dysfunctional Interaction Difficult Child
Caregiver Strain Questionnaire The Caregiver Strain Questionnaire (CGSQ) is a 21-item survey designed to assess the extent to which the stress of raising a child with social and emotional difficulties is affecting the caregiver. The CGSQ is comprised of 3 subscales (Objective Strain, Subjective Externalized Strain, and Subjective Internalized Strain) with mean scores in each ranging from 0-5. Objective Strain measures observable disruptions in family and community life such as lost work time, financial strain or interruption of personal time. Examples of questions include: How much of a problem was missing work due to your childs emotional or behavioral problems? and How much of a problem was disruption of your familys social activities resulting from your childs emotional or behavioral problem? Subjective Externalized Strain measures negative feelings such as anger, embarrassment or resentment. Examples of questions include: How angry did you feel toward your child? and How embarrassed did you feel about your childs emotional or behavioral problems? Subjective Internalized Strain measures negative feelings the caregiver may have such as worry, guilt or fatigue. Examples of these types of questions include: How worried did you feel about your childs future? and How sad or unhappy did you feel as a result of your childs emotional or behavioral problems?
Figure 17 shows the mean caregiver scores on the 3 CGSQ subscales during the Intake and Follow-up interviews. Caregiver stress levels decreased across all subscales with the largest decrease in Subjective Internalized Strain. Overall, these results support those seen on the PSI, all of which indicate a steady decrease in parental stress. However, it is worth noting that the lowest score on the Subjective Internalized scale is still higher than the highest scores on the other 2 scales. This is consistent with past reports and suggests that the stress of worrying or feeling guilty about a child can cause more strain than other factors such as anger towards the child or disruption of family life due to a childs behavior. Figure 17
Mean Scores on the Caregiver Strain Questionnaire at Intake and Follow-up Interviews
(n=41)
5.0 4.0 3.0 2.0 2.0 1.0 0.0
Objective Strain Subjective Externalized Strain Subjective Internalized Strain 1.8 1.8 1.7* 1.7* 2.0 1.9 1.7* 1.8 1.6*
3.0
2.7* 2.6* 2.5*
Intake
2.2*
6 month 12 month 18 month 24 month
Education Educational placements for the children who were in school at the time of each interview are shown in Table 4. In the 6 months prior to Intake, over half of the children attending school were in preschool and almost a quarter of the children were in a Head Start program. As would be expected, as the children got older, the percentage of children attending regular public school increased and the percentage of children in preschool decreased.
Table 4
Educational Placements for Children

Placement
Preschool Regular Public Day School Head Start Regular Private Day/Boarding School Home School Alternative/Special Day School
Intake
(n=91)
6 Months
(n=106)
12 Months
(n=93)
18 Months
(n=63)
24 Months
(n=44)
51% 28% 24% 2% 0% 0%
37% 43% 18% 2% 0% 0%
24% 63% 8% 4% 2% 0%
14% 75% 6% 2% 2% 2%
11% 75% 9% 5% 0% 0%
Table 5 shows the percent of children suspended or expelled in the 6 months prior to the Intake and Follow-up interviews. This table represents all of the children who were attending school (including any of the educational placements listed in Table 4) at each time point. Prior to the Intake interview, 20% of the children attending school had been suspended, expelled or both. Prior to the 24-month interview, 7% of the children attending school had been suspended and none had been expelled. Table 5
Percent of Children with Disciplinary Actions

Disciplinary Action Suspended Expelled Suspended AND expelled Intake
(n=88)
6 Months
(n=103)
12 Months
(n=92)
18 Months
(n=62)
24 Months
(n=43)
10% 5% 5%
7% 1% 0%
4% 0% 1%
10% 0% 2%
7% 0% 0%
In the 6 months prior to the Intake and Follow-up interviews, between 18 and 30 children were reported to have Individual Education Plans (IEP). Table 6 shows the primary
reasons these children had IEPs and the percent of children in each category. The majority of children had IEPs for behavioral/emotional difficulties, followed by speech impairments, developmental disabilities, and learning disabilities. Table 6
Reasons for Individualized Education Plan

Reason Behavioral and/or Emotional Problems Speech impairment Developmental Disability Learning Disability Vision and/or Hearing Impairment Physical Disability Intake
(n=23)
6 Months
(n=30)
12 Months
(n=28)
18 Months
(n=20)
24 Months
(n=18)
39% 30% 17% 9% 4% 0%
37% 23% 20% 17% 0% 3%
36% 18% 21% 21% 0% 4%
55% 5% 25% 15% 0% 0%
56% 6% 11% 11% 11% 6%
Location and Types of Services Received Families were asked about the types and locations of services they received. Figures 1820 compare information about services received in the 6 months prior to the Intake and Followup interviews. Figure 18 shows the location where 15% or more families reported receiving services in the 6 months prior to each interview. The percentage of children who received services at home decreased while the percentage of children who received services at school increased. This may reflect a transition from receiving intense mental health services at home to receiving less intensive services such as speech therapy or occupational therapy at school. The percentage of families receiving services in a mental health clinic or private practice decreased slightly. Figure 18
Where Families Received Services

(n=41) Percent of Families Receiving Services in Each Location 100%
83%
80% 60% 40%

22% 59% 51% 51% 56% 46% 34% 44% 49% 44%
71% 68% Intake 6 month 41% 29% 12 month 18 month 24 month
20% 0% Mental Health Clinic or Private Practice School Home
Figures 19 and 20 show the types of therapeutic and support services the families received in the 6 months prior to each interview. The percent of families receiving most types of support decreased between the Intake and 24-month interview. These results are not surprising because therapy is meant to be short-term. However, the percent of families receiving school-based support, afterschool services and medication monitoring increased. Many children are identified as needing school-related services once they officially enter the school system, so this increase is to be expected. The percentage of children receiving medication monitoring may have increased because more children are identified as needing medication as they get older and begin school. It is also worth noting the decrease in informal support. Ideally as their childrens behavior improves, families learn to rely more o n informal supports and less on therapists or Family Partners, but the data indicate that informal support is decreasing along with therapeutic support. This may reflect less need for any kind of assistance because the children are easier to manage and also because they are in school and caregivers require less hands-on support than when the children were younger.
Figure 19
Type of Therapeutic Service Received

(n=41)
100%
95% 78%
Percent of Families Receiving Each Type of Service
80%
66%
71%
56% 46%
Intake 6 month 12 month 18 month

15%
60%
37% 32% 39% 34% 37%
40%
22%
20%
5%
15%
24 month
7%
2% 5%
12%
0%
Assessment/ Evaluation
Medication Monitoring
Individual Therapy Family Therapy
Figure 20
Types of Support Services Received

(n=41)
100%
80% Percent of Families Receiving Each Type of Service
73%
Intake
60%
59%
56% 41%
6 month 12 month 18 month 24 month
40% 20% 12% 2% 0%

Case Management Family Support Afterschool Programs Flexible Funds
37% 29% 22%
20%
5%
5%
Informal Support School-based
IV. Grant-funded Activities

Workforce Development and Community Education Workforce development trainings continued in the fifth year of the grant, including basic system of care training and the effects of trauma on brain development for new staff in all child-serving agencies, as well as more in depth seminars. Examples of the trainings offered are listed below: Introduction to Alamance Alliance 101 System of Care Modules 1 & 2 Whats Up with Domestic Violence? Early Childhood Mental Health: Brain Development, Child Development, and the Effects of Trauma on Both How to Use Family Strengths in the Child and Family Team Plan Serving Latinos Fetal Alcohol Spectrum Syndrome Developing and Using Natural Supports Child and Family Team 1
Additionally, through the training efforts of the Alliance and Project LAUNCH, Alamance County currently has clinicians trained in the following five evidence-based practices: Child Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Triple P Levels 3 and 4, and Attachment and Biobehavioral CatchUp (ABC). The Attachment and Biobehavioral Catch-Up (ABC) Learning Collaborative, financed by Project LAUNCH, has supported training for 6 providers who will be ready to serve families in Alamance County by the end of October 2013. ABC provides a critical service for very young children (6 to 24 months) who have suffered as a result of attachment disruptions from their caregivers. Incredible Years Classes The Alamance Alliance has been providing financial support to the Alamance Partnership for Children (APC) so that the APC can deliver Incredible Years (IY) classes for members of the Alamance community. The IY program is an evidence-based series of weekly parenting skills classes for caregivers of high-risk children ages birth through 5 years old. As of May 2013, the APC has conducted 17 Incredible Years parenting classes supported by the Alliance. Two IY classes were specifically for caregivers of infants and toddlers, four classes were conducted in Spanish for caregivers of preschool-aged children, one class for caregivers of preschool-aged children was conducted in Spanish and English, and the remaining classes were conducted in English for caregivers of children ages 3-5 years old. A total of 159 families have enrolled in these Incredible Years classes and filled out the Enrollment and Demographic
Information Form that provided us with the information presented below. In many cases more than one caregiver per family participated in the class, but we only counted one member per family. Table 8 highlights some demographic information about the caregivers children. The average age of the children is 3.3 years old, although the percent of 0- to 2-year-olds increased this year. This is due to the addition of a second class specifically for caregivers of very young children. Table 8
Demographics (n=159) Gender Male Female Average age Age Group 0-yr 1-yr 2-yr 3-yr 4-yr 5-yr 6-yr Race/Ethnicity Asian Black or African American Hispanic/Latino Multi-Racial White Percent 61% 39% 3.3 years old 3% 6% 15% 32% 25% 19% 1%
1% 20% 35% 8% 36%
Figure 28 shows the concerns or problems that caregivers reported at the start of the IY classes. This table represents the problems reported in over 10% of the children, and these percentages are very similar to those presented in the 2012 report. Note that one child can present with more than one difficulty or challenge. Almost half of the caregivers reported difficulties with disruptive behaviors in their child, 30% reported problems with excessive crying and tantrums or hyperactivity and attention difficulties. Close to half of the caregivers checked other as a reason they were interested in the IY classes. Of those families, 42 were seeking more information about child development, parenting strategies, and behavior management and 13 reported that their child had experienced a traumatic event such as witnessing domestic violence or the incarceration of a parent.
Figure 28
Children's Presenting Problems

(n=159)
Disruptive Behaviors in Young Children Excessive Crying/Tantrums Hyperactive and Attention-Related Problems Persistent Noncompliance Sleeping Problems Anxiety-Related Problems Other 0% 20% 40% 14% 12% 49% 60% 80% 100% 30% 30% 25% 44%
Forty-four caregivers involved in IY classes reported that their child had received a formal mental health diagnosis. Twenty-nine of these children received their diagnoses from a child psychologist, 10 from a licensed mental health practitioner, 2 from a primary care provider, 1 from a child psychiatrist, 1 from a licensed physical health practitioner and one person left that answer blank. Table 9 shows the diagnoses the children received and the percent of children who received each diagnosis. Note that these percentages are based on the 44 children who had received a diagnosis and that 4 children have more than one diagnosis. In the June 2011 report, 15% of the children had diagnoses, compared to 26% in 2012 and 28% this year. This increase occurred because more families already enrolled in the Alliance with established child diagnoses were referred to and participated in IY classes, as compared to previous years.
Table 9
Diagnosis (n=44) Disruptive Behavior Disorder Not Otherwise Specified (NOS) Adjustment Disorder (all types) Attention Deficit/Hyperactivity Disorder Autistic Disorder Posttraumatic Stress Disorder Pica Unknown Percent 48% 30% 7% 5% 5% 2% 14%
Figure 29 shows the agencies or people that referred the families to the IY classes. The largest number of referrals came from the childs school or daycare, followed by the caregiver and Alamance Partnership for Children. Nine percent of the caregivers found out about IY classes through other means. Among those, 8 people were referred by community agencies or service providers, four people saw flyers in local establishments, and 2 were referred by friends. Figure 29
Referring Agency
(n=159)
School or Daycare Caregiver Alamance Partnership Public Child Welfare Physical Health Early Intervention Program Mental Health Probation Other 0% 2% 1% 9% 20% 40% 60% 80% 100% 5% 7% 15% 15% 10% 28%
Other Important Characteristics of these Children and their Families Many of the caregivers reported that their child had been involved with various educational, social, mental or physical health agencies at the time of the IY classes. (Please note that these are based on answers provided directly by the caregivers.) 55% had physical health care4 65% of the children attended daycare, preschool or regular school 5 14% received early intervention or preschool special educational services 8% had mental health care 71% were on Medicaid 3% received SSI benefits 2% were on Temporary Assistance for Needy Families (TANF) 24% had private insurance 11% were involved with child welfare services, half of these children were in courtordered kinship care.
Summary In the last 4 years that the Alamance Partnership for Children has received financial support from the Alamance Alliance to conduct IY classes, 17 classes have been completed successfully. Families served by the APC represent a broad spectrum in terms of age, race, living situations, and income. Community awareness of IY classes through the APC continues to increase and more referrals are coming from a variety of sources. In fact, 15% of referrals came from the caregivers themselves, suggesting that word of mouth about IY classes is also increasing. In the past year, the Alamance Partnership secured funding for IY Parent classes through another source which reduced the funds that the APC needed from the Alliance to provide IY Parents. The Alliance was then able to allocate more funding to the Alamance Partnerships Parents as Teacher program, which allowed them to hire another Parents as Teacher provider. Parents as Teachers is a promising practice that provides education and support for parents of children birth to kindergarten through home visiting by certified parent educators. Incredible Years - Teacher classes, which were previously funded by the Alliance, were not funded this year because the class is now offered by the Alamance Community College.
Questions on physical health care are based on a caregiver-completed questionnaire. We suspect these numbers would be higher if the questions were asked in an interview format. 5 This is a 5% decrease from last year and is most likely due to the addition of a second Infant/Toddler class.
Cultural and Linguistic Competence (CLC) The Cultural and Linguistic Competence Committee continued to play a central role in the Alamance Alliance System of Care in its fifth year. The CLC trained an additional 277 individuals in a variety of topics, including: Communication and the Cultural Lens It's My Story and Im Sticking To It! Diversity: Why is it Complex? Working with Difficult Parents No Matter What Cultural Competence: Using Family Strengths
The Alliance also continued support of a Cultural Broker who serves as a liaison with the Latino community. The Cultural Broker has provided outreach services through the faith-based community and has facilitated a Hispanic Womens Support Group, covering topics like breast and cervical cancer, gang prevention and child development topics. She also facilitated school registration of Latino children to an Alamance County elementary school that serves a substantial number of this population. In November of 2012, a Professional Learning Community called the AlaScene was created. Its members are professionals from a variety of child-serving agencies. The purpose of the group is to allow the members to learn about culturally competent service delivery, with the ultimate goal of providing workforce development opportunities and support around culturally competent services in their own organizations. Finally, the Cultural and Linguistic Competence Committee has created two online cultural competence training modules that will soon be available to the entire state.
Family Voice Family Partners have played a significant role in the Alliance since its inception. The North Carolina Families United Executive Director (the state agency providing TA around family voice to the Alliance) and the Lead Family Partner Coordinator both sit on the NC State Collaborative, and the Lead Family Partner Coordinator also sits on both governing bodies of the Alliance: the Childrens Executive Oversight Committee and the Local Interagency Coordinating Council. Furthermore, Family Partners continue to sit on all the subcommittees of the Alliance. Sustainability for Family Partners continues to be an issue and discussions have been under way with Cardinal Innovations (our local Managed Care Organization) to explore possible options for funding Family Partners. The Family Involvement Committee was created to help families get to know and support each other. The Family Involvement Committee has organized Family Cafs, gatherings
where families can meet, attend discussion/support groups on a variety of parenting topics, and children can have an opportunity to play and socialize with each other. This past year the Family Involvement Committee organized the Cookies with Santa Family Caf with 18 adults and 34 children participating and a Spring Caf which attracted 34 adults and 62 children. Furthermore, Family Partners are regular co-trainers in early childhood mental health seminars, system of care and child and family team trainings, and two of them are nationally certified parent support providers. They have co-presented at national conferences such as the School-Based Mental Health Conference held in Utah this past year, and many local venues as well. A new bilingual Family Partner was hired this year to provide further support to our Hispanic families.
Social Marketing This year the Alliance broadened its efforts in awareness and outreach to the larger community by: merging social marketing and outreach with the Alamance Partnership for Children, planning different activities in which the community could participate for Childrens Mental Health Awareness Week, broadly disseminating comprehensive information about early childhood mental health and Alliance work, and premiering the documentary Behind the Seen, a film about four Alamance County families struggling with their young childrens social emotional issues, on May 9 th, Childrens Mental Health Awareness Day.
The Alamance Alliance for Children and Families merged its newsletter with that of the Alamance Partnership for Children in the fall of 2012, thereby increasing the distribution of its newsletter fourfold. This enhanced the opportunities for outreach events, collaborations, access to other mailing lists, etc. All of the events that the Partnership was involved in became an opportunity to share information about the Alliance as well. Childrens Mental Health Awareness Week events included a Flash Mob and a giant Chutes and Ladders game focused on the first 2000 days of a childs life and the state of young children in North Carolina. In collaboration with Project LAUNCH, an eight-page newspaper insert, Give Your Child the Best Beginning, discussing very young childrens social-emotional health was circulated to 25,000 people. Finally, the Behind the Seen documentary premiered in May. Behind the Seen was the culmination of a project that focused on the experiences of four Alamance County families as seen through the eyes of sixteen artists that worked with them over a period of time. The resulting art show traveled around the state this year to more than five venues sharing the message of trauma and how it affects young children.
The Alliance is continuing to use web- and email-based marketing to reach more people. iContact messages about child development, community trainings, breaking early childhood news, etc., were sent bimonthly and the contact list more than doubled from last year. The Alliance website (http://www.alamancesoc.org) continues to be a focal place where community members can learn about the Alamance County System of Care. Flexible Funds Flexible Funds (i.e., discretionary funds used to support Alliance families with a variety of needs that fall outside of traditional third-party reimbursements) are continuing to be used in Alamance County. These funds can be used for a variety of purposes from medical care and groceries to camps or recreation programs, but must be used for items or activities that are specifically related to a need addressed in the Wraparound Care Plan. They are not intended to be used on an on-going basis, but rather to fill a short term or specific need that cant be funded through another source. The first Flex Funds were distributed in early 2010. Since then, $41,893.39 has been distributed to enrolled families. Figure 21 shows the percentage of funds spent on each flex funds category. Over the course of the grant, the majority of this money has been spent on day care and camps, with somewhat smaller percentages spent on housing, utilities and other activities. Figure 21
V. Continuous Quality Control (CQI) to Inform Change at the Local Level

In an effort to provide feedback for quality improvement purposes, our local evaluation focused on multiple components: 1) a monthly status report, 2) Quarterly Report, 3) an agency collaboration survey, 4) information about family partner services, cultural competence of and satisfaction with services, and 5) a review of Family Partner charts to examine their efforts to assume care coordination for the families with whom they worked.
Monthly Status Report The monthly status report is a 2-page summary describing Alliance activities in terms of children served. The report provides the Project team with a monthly cumulative picture of: a. Cumulative numbers of completed, ineligible, pending, and declined referrals, diagnostic evaluations, enrollments, children assigned mental health providers and children assigned family partners b. Month by month information on number of DSS referrals, completed diagnostic evaluations, and number of enrollments c. Number of disenrolled families and reasons thereof d. Number and percent of intake, 6-month, 12-month, 18-month and 24-month interviews completed for the Longitudinal Study e. Demographic and descriptive information of all children ever enrolled or ineligible f. A breakdown of the number of children and families served with each support provider in the System of Care The monthly report gives the Alliance staff members an opportunity to review their progress from a larger perspective. It is often hard to see the big picture when one is dealing with the day to day activities of a project. The monthly report gives the staff members a chance to analyze the numbers to spot trends, see where there might be problems or concerns, and make sure everything is progressing as planned. For example, based on the monthly status report we decided to stay vigilant about the number of diagnostic evaluations that are still pending in case we needed to add another provider to do diagnostic evaluations.
Quarterly Report The Quarterly Report was added to the CQI process as a way to track in a single document specific indicators across all Alliance subcommittees: Training, Social Marketing, Services and Supports, and Evaluation. Examples of items tracked include the number of trainings that have occurred, the number of people or agencies attending those trainings, the number and type of social marketing events and publications, the number of hits on specific
pages of the Alamance Alliance website, and the referral sources of children referred to the Alliance for an evaluation. The report is reviewed by the Evaluation Committee so everyone can evaluate trends, discuss concerns and propose new targets or changes in process as needed. An example of the Quarterly Report can be found in Appendix C.
Agency Collaboration Survey One of the major tenets of Systems of Care is interagency collaboration. Collaboration focuses on efficient and effective coordination of services provided by all agencies that serve families and children whose needs cross multiple agencies. The goal of interagency collaboration is to overcome silos, discrete or duplicative services, categorical funding and individual agencies unique mandates in an attempt to create a safety net of well -coordinated services for each family. Given its importance in a System of Care, we decided to examine the collaboration of child-serving agencies as part of our Continuous Quality Improvement Plan. We assessed agency collaboration in 2010 and again in 2012. We hoped to see changes in collaboration over time. The 2012 Annual Report described the 2010 Agency Collaboration report in detail. This report will compare the results of the 2010 survey with the results of the 2012 survey. How we assessed agency collaboration In 2010 and 2012, we sent an electronic survey to each of the Directors and frontline staff and supervisors of 14 family-serving agencies. Respondents were asked to report on several collaborative activities with each of the other agencies included in the survey. Specifically, with regard to each other agency listed, frontline staff and supervisors were asked whether they: Send and receive referrals Talk and problem solve about shared cases Jointly develop plans of care Jointly participate in Child and Family Teams (CFTs) Use parental consent to share information Co-locate services Coordinate/combine training events Serve on community nonprofit partner boards together
The Directors were asked about four additional types of collaboration more likely to occur at a higher management level. These additional items were: Have a signed Memorandum of Understanding (MOU) Have a signed data sharing agreement Blend funds
Have developed common policies that align with SOC
The results of the 2010 and 2012 surveys were analyzed to examine changes in collaboration in each of the above areas. Summarized scores were based on answers other agencies gave about each agency (e.g., the DSS scores are based on what all other agencies said about collaboration with DSS). 6 The survey administered to the frontline staff and supervisor was slightly different from the survey administered to the CEOs, so we analyzed these results separately. Results Front-line staff and supervisors from 8 of 14 agencies and Directors from 10 of 14 agencies responded to the 2012 survey, resulting in a lower participation rate than in the 2010 survey (where respondents included front-line staff/supervisors from 10 and Directors from 13 agencies). The attrition was most notable for front-line staff and supervisors. In 2010, 83 staff responded to the survey, whereas in 2012 only 36 completed it. In discussing the results below, the lower participation rate and following points need to be kept in mind: Some agencies are more likely to collaborate with one another because of their focus and target populations. For example, the Department of Social Services (ACDSS) would be expected to work closely with Crossroads (working with victims of sexual abuse), Alamance Family Center (working on prevention and treatment of child abuse) and Horizons (serving women with substance abuse issues), but would be less likely to work with agencies that do not specifically focus on children who have experienced or are at risk for maltreatment, such as the Alamance Regional Medical Center. Some types of collaboration may be more feasible than others. For example, a domestic violence shelter cannot co-locate with any other agency given the nature of the services it provides; however, it can facilitate the streamlining of services for its residents through participation in CFTs and service plan development. Because this was an electronic survey and not a face-to-face interview, respondents may have interpreted the descriptions of collaboration types differently.
The major results of the survey are described below; graphs depicting the results can be found in Appendices A and B. Agency Directors 1. Agency Directors reported higher levels of collaboration in 2012 than in 2010 across all types of collaboration. Directors reported that more Memoranda of Understanding have been put in place, that agencies are more likely to share financial or in-kind resources, they blend funds more, and have more common policies that align with SOC. These results likely
6
In-depth details about the methodology used to analyze the survey results can be provided upon request.
reflect, in part, the activities of the Childrens Executive Oversight Committee (CEOC). In the past two years, the CEOC has been purposefully working to create a more collaborative System of Care for all children in Alamance County. It is also true, however, that smaller agencies that are not part of the CEOC, like Crossroads, Family Abuse Services, Alamance Family Center and Horizons, are reported to have improved in most of those areas. This finding is very encouraging, especially because in 2010 smaller agencies felt they were less well known and not in the radar of the bigger and public family-serving agencies. These findings suggest that big strides have been made towards collaboration at the management level. 2. In addition, agency Directors reported large increases in collaboration among their staff in sending and receiving referrals, talking about shared cases, jointly developing plans of care, jointly participating in CFTs, combining trainings and serving on community nonprofit partner boards together. 3. The only area with somewhat smaller gains is the area of co-locating services, which is not surprising because co-location requires not only the will to collaborate, but also additional financial resources for office space and other such issues. Regardless, increased co-location was reported. Front-line staff/Supervisors 1. Front-line staff and supervisors reported overall more moderate increases in collaboration across all types of collaboration. This may reflect differences in how much of the collaboration they can see in their day-to-day work, but it may also mean that the top-level collaboration has not yet filtered down to impact change in work at the front lines. 2. Two agencies stood out among front-line staff and super visor reports of collaboration. The Alamance Burlington School System (ABSS) and Crossroads. a. ABSS was voted by all participating staff as improved in all but jointly developing plans of care, which is understandable because of the different requirements imposed on the school system for their version of a plan of care, the Individualized Educational Plan. This spike in the school collaborative efforts is likely due to two reasons: a) the work of the preschool social worker, who has been working closely with families of preschool children and addressing their needs through referrals to appropriate agencies, and b) the work of the school social worker supervisor, who has been participating in numerous collaborative efforts. It is very exciting to see the increase in ABSSs efforts because school systems are typically very difficult to engage in initiatives that have a focus that is broader than education. b. Crossroads had lower overall levels of collaboration than did ABSS (due to its more narrow focus), but was consistently voted by staff to have increased their collaborative efforts in all types of collaboration. 3. In terms of front-line/supervisor report of types of collaboration, the most consistent improvement across agencies was in jointly participating in CFTs. Smaller agencies like
Crossroads, Family Abuse Services, Horizons and the Partnership for Children showed the biggest gains, along with ABSS and the Department of Social Services. Overall, the 2010 and 2012 agency collaboration surveys show that collaborative efforts have paid off over the past two years. Under the leadership of the CEOC, the public family-serving agencies have steadily worked towards creating a better System of Care for all children in Alamance County. At the same time, the smaller family-serving agencies have diligently worked to make themselves known in Alamance County in order to provide better and more coordinated services to all the families they serve.
Family Satisfaction with Services As part of the longitudinal study, caregivers were given a questionnaire designed to assess caregiver satisfaction with the services their family received. This survey measures caregiver satisfaction across a variety of domains, six of which are presented in this report. Access to Services measures how convenient the location and times of services were. Participation in Treatment reflects how involved the caregiver was in the development and planning of the childs treatment plan. Cultural Sensitivity measures whether the caregiver believed that the treatment staff interacted with the family in a culturally sensitive manner. Satisfaction with Services is assessed by questions relating to the caregivers overall perception of services received (e.g., the extent to which the family received the help they wanted, felt that the people helping them would stick by them no matter what happened, and that their child had someone who he or she could talk to when needed). The Outcomes domain measures the caregivers assessment of how well the child is functioning at school and home. Finally, Social Connectedness refers to how well the caregiver seeks out and accepts support from people other than service providers. Figure 22 shows the percent of caregivers who reported feeling satisfied or very satisfied in response to questions related to each of the above-mentioned domains. These questions are only asked of caregivers whose families have received services in the preceding 6 months. The categories with the highest satisfaction scores are Cultural Sensitivity and Access to Services. Satisfaction scores for Outcomes and Social Connectedness are lower than the other categories, but satisfaction with both categories increases over time. This could be because families who stay involved with services longer have better outcomes and have more opportunities to expand their social support networks or because people who feel good about the outcomes they are seeing tend to stay involved in services longer. Either way, it is nice to see that a higher percentage of caregivers are feeling positive about the services they are receiving.
Figure 22
Caregiver Satisfaction with Services Received

100%
100% Percent of caregivers feeling "satisfied" or "very satisfied" 80% 60% 40% 20% 0%
79%
97%
89% 83%
87%
88% 71% 63% 50% 47% 66% 6 month (n=152) 12 month (n=100) 18 month (n=59) 24 month (n=38)
Access to Services Participation in Treatment
Cultural Sensitivity
Satisfaction with Services
Outcomes
Social Connectedness
Cultural Competence Families were also asked about the importance of cultural competence in their service providers (i.e., the degree to which support providers respect and are sensitive to cultural traditions and beliefs and/or are of the same racial or ethnic group as the child). These questions are first asked at the 6 month interview after the families have had time to get involved with service providers and have a sense of what they feel is important in a provider. Figure 23 shows the percent of caregivers who responded that specific items were important or very important to them. Caregivers beliefs remain fairly consistent across all time frames. Approximately half of caregivers reported that having a service provider who understands the customs, beliefs and practices of their cultural heritage was important. Fewer than half thought that these customs and practices should be included in the service plan and fewer than 15% of caregivers felt that their service provider should have the same cultural heritage as their child. Figure 23
Importance of Cultural Competence in Service Providers

Percent of caregivers who said that statement was important or very important 100% 80% 60% 40% 20% 0%
You and your child have a service The beliefs, traditions, and practices The person you and your child have provider who understands the of your child's cultural heritage be seen most often is the same cultural customs, practices, and traditions of included in service planning and heritage as your child? your child's cultural heritage? provision? 6 month (n=182) 12 month (n=121)
53% 52% 50% 51%
45%
47% 40% 40%

18 month (n=76)
13% 12% 10% 8%
24 month (n=47)
How important is it that?
Moreover, as seen in Figure 24, the majority of families feel that their service providers are sensitive to their culture, beliefs and background and that the providers are comfortable interacting with their child. Fewer caregivers report that their provider asks about their traditions, beliefs and values when planning services. The perceived cultural competence of service providers increased over time, which may reflect the training provided by the Cultural and Linguistic Competence committee. Alternately, it may be that families who perceived providers as sensitive to their cultural beliefs were more likely to remain in services over the long-run.
As seen in Figure 25, most caregivers feel comfortable discussing alternative therapies or other ways of working with their child with their providers, and very few caregivers believe that other children have access to better services than do their children. The majority of caregivers feel that the materials and services they received were easy to understand, but it would be better if all caregivers reported that the materials they receive about services are easy to understand. Figure 24
Cultural Competence of Service Providers

Percent of caregivers who reponded most of the time or always
100% 80%
61% 78% 67% 64% 47%
6 month (n=182) 12 month (n=121) 18 mnth (n=76) 24 month (n=47) Is the same racial Understands my Speaks the same Asks about my Attends to my or ethnic group as family's beliefs language that I or family's and my child's my child about mental my child speaks traditions, beliefs, cultural needs health and values when planning or providing services Is comfortable interacting with me and my child
94%
95%
97% 89% 90%
97%
60%
45%
40% 20% 0%
My child's provider
Figure 25
Cultural Competence of Service Providers

Percent of caregivers who responded most of the time or always 100% 82% 80% 60% 40% 20% 0%
Comfortable discussing with my child's provider alternative therapies or other ways to work with my child Like other children have access to That the materials and services better services than my child given to me about the program are easy to understand
86%
91% 94% 80% 77%
86% 89%
6 month (n=182) 12 month (n=121) 18 month (n=76) 24 month (n=47)
11%
6% 7%
14%
I feel
Caregiver Satisfaction with Family Partners During the Follow-up interviews, caregivers were asked a variety of questions about the relationship they share with their family partners. These included questions about how often the caregiver met with the family partner, the types of assistance given to them by the family partner, how well the partner responded to the caregivers concerns, and whether the caregiver felt that the family partner was available to the caregiver. Figure 26 shows caregiver responses to questions about their family partner at all Follow-up interviews. Only caregivers who responded that they had a family partner were included in this analysis. The majority of caregivers felt that their family partner addressed their issues and was available when needed. This percentage increases steadily from the 6-month interview to the 24-month interview. This is expected because the caregivers who continue with their family partners long-term are likely quite satisfied. Figure 26
Caregiver Report of Family Partner

Percent of caregivers who responded positively 100% 88% 80% 80% 64% 60% 66% 61% 72% 80% 85%
40%
20%
0% How well did your Family Partner address issues How available was your Family Partner when you brought to her attention? needed her?
Caregivers were also asked a series of yes or no questions regarding whether the family partner had helped with or participated in a variety of activities. Figure 27 shows the percentage of caregivers who responded affirmatively to each question. As in previous reports, the most common activities in which the family partners were reported to engage were providing social or emotional support, assisting the caregivers in dealing with agencies and obtaining services (e.g., medical care, legal assistance, IEPs, child welfare), and helping caregivers with parenting skills. The least common activities reported were helping the caregiver obtain employment or educational services and other activities (comments recorded in the other category included activities such as visiting the childs school and giving contacts for childcare).
Figure 27
Did Your Family Partner Assist You With Any of the Following Activities?
100%
85%
Percent of caregivers who said "yes"
80%
65%
73%
75%
60%
50% 42% 38% 35% 28% 23% 31% 18% 19% 30%
58%
40%
20%
18%
5%
4%
0%
Finances Transportation Obtaining (budgeting, Basic Needs flex funds) Dealing with Obtaining Obtaining Agencies/ Employment/ Employment/ Obtaining Education Education Services Services Services for Child Providing Social or Emotional Support Parenting Skills Other
Family Partners as Case Managers In the last three years, North Carolina has witnessed drastic cuts in case management services. Families whose children qualify for intensive in-home services receive case management services from their mental health providers. However, families whose children receive outpatient mental health services do not qualify for case management services. Thus there are many high need families who do not qualify for case management services, but could certainly benefit from having a care coordinator. In 2012, the Alamance Alliance decided to try a new case management model in which family partners were trained to act as case managers. Two Family Partners were trained in care coordination and case management techniques, documentation and support. These Family Partners were assigned to act as case managers for high need families who would not otherwise qualify for this service. This report presents the results of a chart and log review of case management services provided by the family partners to 27 families. In the context of the Alliance and this report, case management includes the following: 1. Futures Mappingworking with the family to create a document that describes and documents the familys support system, their strengths and challenges, and their hopes for the future; 2. Child and Family Team Meetingsorganizing and facilitating Child and Family Team meetings (CFTs), during which creation of the service plan and subsequent progress monitoring occurs; 3. Other support services such as linking families to resources; assisting families in navigating the system; attending meetings with families; and advocating for families while teaching them how to advocate for themselves. The results of the chart review are described below. Futures Mapping 19 of the 27 charts (70%) included a Futures Mapping document Six charts included the date the Futures Mapping document was created. Of those, the average number of days from enrollment to creation of the Futures Mapping was 64.
Child and Family Team Meetings (CFTs) Child and Family Team meetings are expected to occur once a month so that progress can be reviewed and documented and goals can be adjusted, if necessary. Five of the 27 charts (19%) had documented Child and Family Team meetings One of the five charts had five documented CFTs and a second one had two. The remaining three charts had one documented CFT each.
In addition to the number of CFTs, we also looked at whether the documentation included the previously decided-upon goals that need to be reviewed, future goals and who would be responsible, and the date of the next CFT meeting. Of the 10 documented CFTs: Three (30%)had the goals from the previous meeting recorded Six (60%) had at least some documentation of future goals Four (40%) had at least some documentation of who would be responsible for each goal Two (20%) had the date for the next CFT documented
Other Case Management Services Family Partners are asked to document the time they spend with each family and categorize the purpose of each contact. The following categories are used to describe case management activities: Emotional Support, Linking to Services, Attending Meetings, Creating Futures Mapping, Advocacy and Navigating the System. The two Family Partners documented the content of their visits quite differently, which may reflect lack of clarity around their role or the definitions of the different categories. Table 7 shows the percent of time each partner documented in each activity. Table 7
Contact Purpose Emotional Support Linking to Services Attending Meetings Creating Futures Mapping Advocacy Navigating the System Family Partner 1 71% 8% 5% 1% 8% 7% Family Partner 2 37% 22% 2% 3% 23% 10%
Conclusions and Recommendations The review of the documentation of case management services revealed that case management activities by Family Partners occurred to a limited degree. Even though the majority of families had a Futures Mapping, a small minority had documented Child and Family Team Meetings. The available documentation included limited future goals and responsible parties for each goal. The small number of documented CFTs and the lack of clear documentation of goals, progress on each and measureable outcomes is concerning. Moreover, there appears to be lack of clarity either around the role Family Partners are supposed to play as case managers, the documentation of those roles (i.e., they may be acting as case managers,
but the documentation of their activities make it appear as if they are acting more like traditional Family Partners), or the definitions of each of the activities they are supposed to undertake. Family Partners play a significant role supporting families of children with serious social and emotional challenges. As case managers, they are not only supposed to provide emotional support, but also be knowledgeable and well-trained to assume more complicated responsibilities. Assisting families in linking to services, navigating complicated and siloed systems, problem-solving, advocating for families and facilitating CFTs are skills that can be learned by Family Partners, but require time and frequent supervision. The Alliance Family Partners have made an admirable attempt to provide families with most-needed case management that they cannot receive anywhere else. The chart review suggests more resources, supports and training need to be in place to allow Family Partners to play that role in an effective manner.
VI. Leveraging Change and Sustainability Efforts in the Past Year

During its fifth year, the Alliance continued to work towards sustainability and leverage change through the creation or expansion of numerous positions to support other agencies in their efforts to provide services to children ages birth through five and their families. Below is a summary of those activities: The Alliance Clinical Services Director has provided several ASQ-SE screening and referral trainings to multiple agencies in the community in an attempt to increase workforce knowledge and capacity in all family-serving agencies in Alamance County. She has further created a Facebook page called the Alamance County MH Clinicians." Twenty -nine clinicians have been using this page on a regular basis to post information about resources, upcoming events or groups, consult with and support one another, and exchange information about billing as they are implementing evidence-based services with the Alliance families. A sub-committee of Alliance staff completed the development of core competencies for individuals/professionals working with young children in Alamance County. In early December, this document will be presented to the Local Interagency Coordinating Council, one of the governing bodies of the Alliance, and will be utilized for staff development across all agencies participating in the council. The Alliance website has now available a list of all the mental health professionals in the county with areas of expertise, evidence-based models practiced and insurance accepted, a very useful addition for all families in the county. The Alliance has been closely involved in the planning, development, and implementation of strategies that support infant and young child mental health statewide. Alliance leaders
provided support for and directly participated in the North Carolina Institute of Medicine (NCIOM) Study on early childhood mental health. They further played a key role in the establishment in 2012 of the North Carolina Infant Mental Health Association (NCIMHA). NCIMHA has been tasked by NCIOM with statewide workforce development. Within its first year it reached a membership of 150 early childhood professionals, organized its first successful conference with an attendance of more than 200 professionals and organized 9 regional meetings across the state to roll out the NCIOM recommendations. NCIMHA has received a grant to provide an early childhood mental health train-the-trainer series focused on early intervention. Project LAUNCH, which was recently awarded to Alamance County, has been collaborating with the Alliance to provide prevention services to children birth to 8 years of age and their families. Realizing that the two projects are natural complements of each other, the leadership of both projects has blended funds to create new positions. A half-time Early Childhood Community Mental Health (ECMH) Specialist was hired in the spring of 2013 to work in local child care centers to provide services to children and families with behavioral difficulties. The ECMH Specialist does screenings and provides consultation to child care providers about specific children and also works with caregivers to incorporate Triple P positive parenting concepts to foster change in parenting behaviors. Since she began in April, she has received 14 referrals and has made 52 visits to child care facilities, working closely with child care teachers and caregivers to effect positive behavior change in young children at home and at child care. The two projects further collaborated on social marketing efforts to inform the community of the combined resources the two projects have made available to the Alamance community. In addition, and depending on the need, the two projects make regular efforts to refer families to each other and their leaders attend one anothers governing body meetings. Finally, Project LAUNCH has trained multiple family service providers in ABC and Triple P 3 and 4, expanding the capacity for evidence-based practices that the Alliance has brought to Alamance County.
VII. Concluding Thoughts

The Alamance Alliance System of Care is currently starting its 6th and final year. This year will bring changes to the Alliance as funding winds down and we start to see processes implemented without the overarching support of the grant. However, the Alliance has always kept sustainability at the forefront of all decisions and we expect that the processes and programs implemented through the grant will continue even after grant funds are gone. With notable forethought, referral portals were set up through well-known public agencies. The Childrens Development Services Agency (CDSA) will remain the referral portal for children birth to three and the Alamance Burlington School System (ABSS) will remain the
referral portal for older children. Agencies already familiar with this referral process should be able to continue referring young children in exactly the same way as before. Moreover, regular and repeated trainings on the social and emotional needs of very young children, the effects of trauma on brain development, System of Care primers, Child and Family Team trainings, screening and assessment seminars, and trainings in state-of-the art evidence-based practices have increased Alamance Countys capacity to provide services to its youngest citizens. Childcare providers, pediatricians, teachers, social workers, even police officers, are ready to identify, refer and serve young children with social or emotional challenges immediately and decrease the likelihood they will need more intense and expensive services when they are older. Furthermore, significant sustainability activities have occurred this past year in Alamance and the state. First, the Early Childhood Core Competencies document that was developed to increase early childhood providers knowledge, attitudes and skills has been completed and will be utilized for staff development purposes across all early childhood agencies in Alamance County. Second, Alamance County mental health providers, and especially ones trained in evidence-based practices through the Alliance and Project LAUNCH, have, through the Alamance County Mental Health Clinicians Facebook page, a way of supporting each other and working to sustain these practices in Alamance County. The addition on the Alliance webpage of a list of mental health clinicians with the evidence-based practices in which they are trained will also make these practices and clinicians more widely known to the Alamance community. Third, the Childrens Executive Oversight Committee (CEOC) has taken on a more active role in improving services for young children and their families in Alamance County. Through the efforts of the Alliance and Project LAUNCH, the CEOC has expanded its membership to include institutions of higher education and faith-based groups, has put in place more crossagency Memoranda of Understanding and has become a much stronger advocate for the Alamance county families. Furthermore, the CEOC will develop its first strategic plan and is in the process of creating a cross-system Alamance County Child Health Report Card that will be endorsed by the entire group. As the agency collaboration survey showed, the CEOC leaders as well as the leaders of the smaller nonprofit agencies in the County have stepped up their collaborative efforts and will hopefully infuse their energy throughout their agencies. At the state level, the Alliance supported the North Carolina Institute of Medicine Study (NCIOM) and the establishment of the North Carolina Infant Mental Health Association (NCIMHA). The Association has taken on the task of statewide workforce development and has organized 9 regional meetings to facilitate the rolling out of the NCIOM recommendations. It is also sponsoring a train-the-trainer series of early childhood mental health.
This year was also the last year of the longitudinal evaluation of the early childhood System of Care. Two-hundred and twenty families were enrolled in the longitudinal evaluation and follow-up interviews were conducted until September 30, 2013. The results of this study show that the children who participated in the Alamance Alliance show significant improvements in their behavior and their parents are feeling less stressed. It is our hope that these children will continue to improve, be able to do well in school and eventually become productive adults. The Alliance has made great efforts to create a strong foundation for the young children of Alamance County that we hope will continue beyond the end of the grant.
VII. Appendix A
Agency Collaboration Survey Results for Agency Directors
Memorandum of Understanding
Percent of Directors who Endorsed Collaboration with Each Agency 100 90 80 70 60 50 40 30 20 10 0
2010 2012
Agency
Shared Resources
2010 2012
Agency
Data Sharing
2010 2012
Agency
Blended Funds
2010 2012
Agency
Common Policies
2010 2012
Agency
Send and Receive Referrals

100 90 80 70 60 50 40 30 20 10 0 Percent of Directors who Endorsed Collaboration with Each Agency
2010 2012
Agency
Talk about Shared Cases

2010 2012
Agency
Jointly Develop Plans of Care

2010 2012
Agency
Jointly Participate in CFTs

2010 2012
Agency
Use Consent to Share Info

2010 2012
Agency
Co-locate Services
2010 2012
Agency
Combine Trainings
2010 2012
Agency
Serve on Boards Together

2010 2012
Agency
IX. Appendix B
Agency Collaboration Survey Results for Frontline Staff and Supervisors
Send and Receive Referrals

Percent of Staff and Supervisors who Endorsed Collaboration with Each Agency 100 90 80 70 60 50 40 30 20 10 0
2010 2012
Agency
Talk about Shared Cases

Percent of Staff and Supervisors who Endorsed Collaboration with Eeach Agency
100 90 80 70 60 50 40 30 20 10 0
2010 2012
Agency
Jointly Develop Plans

2010 2012
Agency
Jointly Participate in CFTs

2010 2012
Agency
Percent of Staff and Supervisors who Endorsed Collaboration with Eeach Agency 100 90 80 70 60 50 40 30 20 10 0
Percent of Staff and Supervisors who Endorsed Collaboration with Eeach Agency 100 90 80 70 60 50 40 30 20 10 0
Use Consent to Share Info
Co-locate Services
Agency 2012 2010
Agency 2012 2010
64
Percent of Staff and Supervisors who Endorsed Collaboration with Eeach Agency 100 90 80 70 60 50 40 30 20 10 0 100 90 80 70 60 50 40 30 20 10 0

Percent of Staff and Supervisors who Endorsed Collaboration with Eeach Agency
Combine Trainings
Serve on Boards Together
Agency 2012 2010
Agency 2012 2010
65
X. Appendix C
Quarterly Report
Type of Training
Third Quarter 2012 (July-Sept, 2012)
Fourth Quarter 2012 (Oct-Dec, 2012)
First Quarter 2013 (Jan-Mar, 2013)
Second Quarter 2013 (April-June, 2013)
Services and Supports number of people completing an EBP training Training number of training events held total number of individuals at all training events combined Family Involvement number of family members participating in FIC meetings (does not include FPs) number of cafes held number of participants in each caf Cultural and Linguistic Competence number of CLC trainings held number of agencies receiving cultural competence training total number of participants in all trainings combined
10
(6 who can serve Alamance County)
14 397
14 392
10 150
5 148
8 84
NA (no longer having FIC meetings) 0 0
NA (no longer having FIC meetings) 1 96 (34 adults, 62 kids, 25 total families) 0 0 0
NA (no longer having FIC meetings) 0 0
1 144
1 50 (18 adults, 32 kids)
5 4
(plus those attending a State Conference)
9 25 241
4 18 39
4 8 107
71
Type of Activity
Social Marketing: Events &Publications

number of public awareness events held number of articles published for the general public number of messages sent on the professional list serve number of messages sent on the family/consumer list serve average number of people subscribed to the professional list serve average number of people subscribed to the family/consumer list serve
2 1 5 7 89 70
6 1 0 0 89 70
8 1 15 3 94 72
10 10 28 0 100 74
11 1 5 5 200 132
Social Marketing: Website Cumulative # of Hits(# of Hits this Quarter) About Services News Resources FAQs Links Families En Espaol Social Marketing: Facebook Page Number of members
2203 (215) 2143 (198) 1838 (184) 1950 (153) 1827 (237) 1022 (98) 1122 (109) 728 (62) 70
2494 (291) 2439 (296) 2033 (195) 2226 (276) 2233 (406) 1221 (199) 1307 (185) 869 (141) 69
2803 (309) 2724 (285) 2226 (193) 2481 (255) 2532 (299) 1448 (227) 1474 (167) 1021 (152) 74
3064 (261) 2972 (248) 2431 (205) 2712 (231) 2771 (239) 1616 (168) 1609 (135) 1121 (100) 77
3273 (209) 3163 (191) 2653 (222) 2945 (233) 2950 (176) 1813 (197) 1716 (107) 1216 (95) 91
Type of Activity
Infrastructure
number and description of organizational changes introduced by the Alliance 1 Total:

2 Total:

1 Total:

0 Total

3 Total:
Addition of annual ECMH training curriculum for community agencies
Elimination of Asst. PD position 1st Annual State ECMH conference
Established process for universal ASQ-SE screening in one organization
Creation of Clinical/Trauma Specialist position in CWS Elimination of 1 FTE FP position Reduction in CLC position to .5 FTE
Evaluation
referral source: # from ABSS 12 ABSS:2 Caregiver:1 Doctor:2 DSS:5 FAS:2 11 APC:1 ABSS:2 Caregiver:4 Doctor:3 DSS:1 *12 additional children were referred, but screening showed they needed services other than MH 8 Caregiver:1 CDSA:1 Doctor:2 DSS:4 19 Caregiver: 1 Crisis Center: 1 Doctor: 1 DSS: 8 Head Start: 4 HD: 4 15 ABSS:2 APC: 1 Caregiver:5 Doctor: 3 DSS:1 HD: 3 12 ABSS: 4 Caregiver: 1 Doctor: 2 DSS: 3 Centro La Communidad: 2 *5 are re-referrals; children who have already been evaluated, but were ineligible or declined services at the time of the evaluation 14 ARMC-OT: 1 Caregiver: 1 CC4C: 1 CDSA: 1 Doctor: 2 DSS: 7 PFC: 1 30 13 12 0
# from CDSA
18 Caregiver:2 CDSA:4 CC4C:2 Doctor:2 DSS:7 HD:1
21 Caregiver:2 CC4C:2 CDSA:6 DSS: 11 CDSA:1 DSS: 3 HD: 3 PFC: 1
#of completed diagnostic evaluations #of families enrolled # disenrolled because parent initiated disenrollment # disenrolled because family never engaged
30 20 5 2
21 17 8 4
27 21 10 1
14 7 5 0

Alamance Alliance Annual Report 2013

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Alamance Alliance

Final Annual Report October 2013

Christina Christopoulos, Katie Rosanbalm & Sonya Fischer

1 www.alamancesoc.org October, 2013

2 www.alamancesoc.org October, 2013

II. Alamance Alliance Families: Demographic and Descriptive Data

Data based on United States Census Bureau data for 2012.

3 www.alamancesoc.org October, 2013

Table 1 Child Characteristics

www.alamancesoc.org October, 2013

Percent of Families Referred by Each Agency

5 www.alamancesoc.org October, 2013

Agency Involvement at Intake

29% 21% 16% 8%

6 www.alamancesoc.org October, 2013

Percent of Families Involved in Each Type of Service

60% 42% 40% 40%

7 www.alamancesoc.org October, 2013

Children's Presenting Problem

8 www.alamancesoc.org October, 2013

9 www.alamancesoc.org October, 2013

Custody Status at Intake

10 www.alamancesoc.org October, 2013

Children Living with and Cared for by People with Depression

80% 60% 40% 20% 0%

72% 51% 47%

Has the child...?

11 www.alamancesoc.org October, 2013

Children's Living Situations to Date

Has the child...?

Percent of Children who have Ever Witnessed or Experienced Assault

Has the child?

Table 3 Caregiver Characteristics

13 www.alamancesoc.org October, 2013

III. Child and Parent Outcomes

School Readiness Social Confidence

Percent of Children Scoring in the Average or Above Range on the BERS

76% 71% 59%

16 www.alamancesoc.org October, 2013

17 www.alamancesoc.org October, 2013

0% Attachment Initiative Self-Control

18 www.alamancesoc.org October, 2013

0% Internalizing Behaviors Externalizing Behaviors

19 www.alamancesoc.org October, 2013

0% Sleep Problems Attention Problems Aggression Problems

0% Emotionally Reactive Anxious/Depressed Somatic Complaints Withdrawn

20 www.alamancesoc.org October, 2013

60% 40% 20% 0% Parental Distress

12 month 18 month 24 month Parent-Child Dysfunctional Interaction Difficult Child

22 www.alamancesoc.org October, 2013

23 www.alamancesoc.org October, 2013

2.7* 2.6* 2.5*

6 month 12 month 18 month 24 month

24 www.alamancesoc.org October, 2013

Educational Placements for Children

51% 28% 24% 2% 0% 0%

37% 43% 18% 2% 0% 0%

Percent of Children with Disciplinary Actions

Reasons for Individualized Education Plan

39% 30% 17% 9% 4% 0%

37% 23% 20% 17% 0% 3%

36% 18% 21% 21% 0% 4%

55% 5% 25% 15% 0% 0%

56% 6% 11% 11% 11% 6%