ROCKINGHAM — The Richmond County Department of Social Services is leading a five-county coalition in the implementation of a new tool to measure the well-being of children in its custody with the hope that it can greatly improve the quality of care that foster children receive in the region.
TOP, or Treatment Outcomes Package, is an evidence-based online survey that is tailored to each person involved in the foster child’s life, including the child (or teen). They each mark how often in the previous two weeks the child has experienced — or for caregivers, how often they have noticed — specific behaviors or emotions.
The survey’s 52 questions are designed to give a holistic picture of the individual case and to allow caregivers to track changes over time, as well as identify and prevent incidences of the child hurting themselves or others. Once completed, the caregivers will receive a report that compares their rating of the child’s state of mind alongside the child’s rating of themselves.
The caregivers can then compare responses with previous ones to track changes over long periods of time. This can help determine the kind of treatment needed for the child and reduce the amount of time the child needs to remain in custody. If a child’s rating — self-reported or otherwise — is in the “severe” spectrum on any of the metrics, an email notification is automatically sent to the relevant parties to make sure that the issue is addressed as soon as possible.
“This tool measures us, too,” said Robby Hall, director of the Richmond County Department of Social Services. “If you had a tool out there and it said this kid was in ‘severe’ in four different areas and you didn’t do anything about it — we’re talking about accountability all the time. You’ll be able to see that everybody said this kid needed this service and I did nothing about it.”
Since implementing TOP in December 2015, Richmond County DSS has been able to reduce the average amount of children in its custody at any given time from 24 children to 20. TOP has also lowered average caseloads for Richmond County from 13 per case worker in 2015 to four by August, according to Director of Special Projects Theressa Smith. This allows DSS to dedicate more resources to individual children and provide more focused care.
“If you have 30 kids and you’re trying to see them all in a week, what’s the likelihood you’re going to do a good job?” Hall said.
The coalition includes Harnett, Montgomery, Hoke, Scotland and Richmond counties. The other four counties started administering TOP in September. Hall said Wake County is the only other county in the state that uses TOP. The tool is used in 34 states, according to Kids Insight’s website.
Wednesday was the first meeting of the coalition. Hall said they will meet quarterly going forward. The program is largely supported by the Duke Endowment, with additional support from the Sandhills Center.
Child welfare services currently use state or federally mandated safety or risk assessment tools, as well as general metrics like how long a child has been in custody, but there is very little that deals with child well-being, according to Alma Shelton, senior project director for Kids Insight.
Shelton, who is in charge of training the five counties to use the tool, said that often child welfare can be “crisis driven” but TOP gives counties the opportunity to be proactive.
To gather the same amount of data that TOP provides under the current model, it would take hours of interviews with each person, according to Dr. David Krauss, who began developing TOP about 30 years ago and is now chief scientific officer of Kids Insight.
This tool is considered much more effective at opening up a dialogue with the children to report issues they are dealing with than the standard “How was your day?” style of questioning. Krauss said that it can be difficult for a child or teen to feel comfortable telling someone face-to-face that they think they are “going crazy” or are considering suicide, especially a stranger who’s been assigned to them.
“One of the things that has always perplexed me is how much of a case worker’s time is spent trying to find information versus using the information that is at their finger tips. The place where I see that dilemma occurring the most … is on the issue of asking your kids how things are going,” Krauss said. “‘Fine.’ That’s the typical response. We believe that with TOP we can actually change that conversation.”
The TOP surveys are administered every 90 days at a minimum, but can be given for any reason deemed necessary, such as a major event in a child’s life, or if there is a change in his or her behavior.
TOP has been used in behavioral health for many years, but started being used in child welfare in Cleveland in 2012, according to Shelton.
Reach Gavin Stone at 910-817-2674 or [email protected].