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

1 www.alamancesoc.org October, 2013

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

CHILDREN’S PRESENTING PROBLEMS .................................................................................................................................. 8

CHILDREN’S DIAGNOSES .................................................................................................................................................. 9

CUSTODY STATUS ......................................................................................................................................................... 10

CHILDREN’S 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 ½-5) ...................................................................................................... 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


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

1 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 diagnosis—these 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

3.4 years old

Gender

Male 62%

Female 39%

Ages

<1 year 1%

1 year 3%

2 year 19%

3 year 26%

4 year 32%

5 year 19%

Race/Ethnicity

American Indian 1%

Black or African American

29%

Hispanic/Latino 17%

Multi-racial 7%

White 46%


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

2 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.

3%

1%

1%

7%

7%

13%

13%

14%

15%

25%

0% 20% 40% 60% 80% 100%

Other

Early Care

Head Start

Preschool Special Ed

Caregiver

Early Intervention

Mental Health

School

Physical Health

Public Child Welfare

Percent of Families Referred by Each Agency

Referring Agency (n=218)


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

88%

51%

32% 29%

21% 16%

8%

0%

20%

40%

60%

80%

100%

PhysicalHealth

School orPreschool

Public ChildWelfare

MentalHealth

Early Care EarlyIntervention

Other

Per

cen

t o

f C

hild

ren

Invo

lved

w

ith

Eac

h A

gen

cy

Agency Involvement at Intake (n=218)


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

42% 40%

16%

0%

20%

40%

60%

80%

100%

Court-ordered in-home services Court-ordered kinship careplacement

Court-ordered foster careplacement

Perc

ent

of

Fam

ilie

s In

volv

ed

in E

ach

Typ

e o

f Se

rvic

e

Types of Welfare Involvement for Children Receiving Services from Child Protective Services at Intake

(n=55)


Children’s Presenting Problems

Figure 4 lists the children’s 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, adjustment-

related 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

25%

31%

33%

37%

41%

48%

77%

0% 20% 40% 60% 80% 100%

Anxiety-Related Problems

Excessive Crying/Tantrums

Maltreatment

Persistent Noncompliance

Sleeping Problems

Hyperactive and Attention-Related Problems

Disruptive Behaviors in Young Children

Percent of Children

Children's Presenting Problem (n=218)


Children’s Diagnoses

Many of these children’s 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. Seventy-

five 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 year’s

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) Percent

Disruptive Behavior Disorder NOS 53%

Adjustment Disorder (all types) 37%

ADHD 6%

Pica 5%

Anxiety Disorder 3%

Posttraumatic Stress Disorder 3%

Asperger’s Disorder, Pervasive Developmental Disorder NOS, Rett’s Disorder 2%

Learning Disorder NOS 1%

Oppositional Defiant Disorder 1%

Parent-Child Relational Problem 1%

Separation Anxiety Disorder 1%

Conduct Disorder, Childhood-Onset Type 1%

Impulse-Control Disorder NOS 1%

Physical abuse of child 1%

Transient Tic Disorder 1%


Custody Status

Figure 5 highlights the children’s 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 year’s report.

Figure 5

1%

2%

3%

3%

4%

11%

33%

43%

0% 20% 40% 60% 80% 100%

Friend (adult friend)

Aunt and/or Uncle

Adoptive Parent(s)

Grandparent(s)

Biological Father Only

Ward of the State

Two Parents

Biological Mother Only

Custody Status at Intake (n=218)


Children’s Life Experiences

Figures 6, 7, and 8 show caregiver responses to questions about the child’s 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

72%

51% 47%

0%

20%

40%

60%

80%

100%

Ever lived with someone whowas depressed?

Lived with someone who wasdepressed in the last 6 months?

Been cared for by someone whowas depressed?

Perc

ent

of

Ch

ildre

n

Has the child...?

Children Living with and Cared for by People with Depression

(n=218)


Figure 7

Figure 8

35% 34% 34%

0%

20%

40%

60%

80%

100%

Lived with someone whohad a mental illness other

than depression?

Lived with someone whohad a substance abuse

problem?

Lived with someone whowas convicted of a crime?

Perc

ent

of

Ch

ildre

n

Has the child...?

Children's Living Situations to Date (n=218 )

43%

26%

9%

0%

20%

40%

60%

80%

100%

Ever witnessed domesticviolence?

Ever experienced orwitnessed physical

assault?

Ever experienced orwitnessed sexual assault?

Perc

ent

of

Ch

ildre

n

Has the child…?

Percent of Children who have Ever Witnessed or Experienced Assault (n=218)


Caregiver Demographics

Table 3 and Figure 9 show demographic and income data for the children’s 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.

Figure 9

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, caregiver’s 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 child’s emotional and behavioral problems. Twenty-five percent of

caregivers who reported missing work missed 10 days or more.

75%

17%

8%

Family/Household Income

Less Than$24,999

$25,000-$49,999

$50,000 andover

Caregiver Characteristics (n=218)

Average Age 34 years old Gender

Male 7%

Female 93%

Race/Ethnicity

Black or African American

29%

Hispanic/Latino 12%

Multi-racial 3%

White 55%

Education Level

Below High School 24%

High School or GED 35%

Some college or Associates Degree

31%

College Degree (e.g., BA, MA, PhD)

10%

Table 3


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 18-

month 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 child’s ability to control his 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

child’s ability to develop and maintain positive relationships with others (e.g., acknowledges

painful feelings, stands up for self). Finally, Family Involvement measures a child’s 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

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 child’s 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 child’s 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 child’s 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 child’s competence at school (e.g., pays

attention in class, attends school regularly). Finally, Affective Strength evaluates a child’s ability

to express feelings and accept affection from others (e.g., expresses affection for others, shows

36%

73% 77%

82%

68%*

77%

86%

95%

68%*

82%

91% 91%

0%

20%

40%

60%

80%

100%

EmotionalRegulation

FamilyInvolvement

School Readiness Social Confidence

Percent of Children Scoring in the Average or Above Range on the PreBERS at Intake, 6 and 12 months

(n=22)

Intake

6 month

12 month


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 child’s school functioning and areas of

concern as the school year progresses and expectations increase.3

Figure 11

3 The n for School Functioning is 6 because 11 children were not yet in school at the time of first interview.

18%

71%

53%

83%

59%

53%*

76%

82%* 83%

76%

41%*

59%

65% 67%

88%*

59%*

76% 76%

50%

71%

0%

20%

40%

60%

80%

100%

InterpersonalStrength

FamilyInvolvement

IntrapersonalStrength

School Functioning Affective Strength

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

(n=17)

Intake

6 month

12 month

18 month


Devereux Early Childhood Assessment (DECA)

The DECA is an early childhood assessment instrument for ages 2-5 years that measures

a child’s 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 child’s 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 child’s 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 child’s 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 child’s 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

Risk-Based Assessments

Child Behavioral Checklist (CBCL ages 1 ½-5)

The CBCL is a 100-question interview administered to the caregiver that measures

behavioral and emotional difficulties in children ages 1 ½ 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 “doesn’t 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 “can’t concentrate.”

Scores above a certain criterion in each scale are considered to be in the clinical range.

44% 48%

26%

48%

63%

52%* 48%

70%*

56%*

33%

70%*

63%*

0%

20%

40%

60%

80%

100%

Attachment Initiative Self-Control

Percent of Children Displaying Average or Above Average DECA Scores at Intake and Follow-up Interviews

(n=27)

Intake

6 month

12 month

18 month


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

51%

80%

49% 51%*

39%

46%* 44%

37%*

0%

20%

40%

60%

80%

100%

Internalizing Behaviors Externalizing Behaviors

Percent of Children with Behaviors Scoring in the Clinical Range on the Child Behavior Checklist at Intake and Follow-up

Interviews (n=41)

Intake

6 month

12 month

18 month


Figure 14

Figure 15

37% 37%

49%

20%* 22%* 27%*

15%* 17%*

32%*

22% 17%*

29%*

0%

20%

40%

60%

80%

100%

Sleep Problems Attention Problems Aggression Problems

Percent of Children Scoring in the Clinical Range on the Externalizing Behavior and Sleep Subscales

(n=41)

Intake

6 month

12 month

18 month

24%

15% 12%

37%

29%

12% 17%

32%

22%

12%

5%

22%* 20%

10% 15%

27%

0%

20%

40%

60%

80%

100%

Emotionally Reactive Anxious/Depressed Somatic Complaints Withdrawn

Percent of Children Scoring in the Clinical Range on the Internalizing Behavior Subscales

(n=41)

Intake

6 month

12 month

18 month


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 above-

average 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 don’t 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 child’s

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 child’s behavior or in

parental expectations for age-appropriate behavior. There was a slight decrease in the Parent-

Child 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 parent’s 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

32%

68%

78%

45%

59%

68%

32%

66% 61%

29%

66% 65%

27%

56% 56*%

0%

20%

40%

60%

80%

100%

Parental Distress Parent-Child Dysfunctional Interaction Difficult Child

Percent of Caregivers Indicating Clinically Significant Stress Levels on the PSI at Intake and Follow-up Interviews

(n=41)

Intake

6 month

12 month

18 month

24 month


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 child’s emotional or behavioral problems?” and “How

much of a problem was disruption of your family’s social activities resulting from your child’s

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 child’s 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 child’s future?” and “How sad or unhappy did

you feel as a result of your child’s 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 child’s behavior.

Figure 17

2.0 2.0

3.0

1.8 1.9

2.7*

1.7* 1.7*

2.6*

1.8 1.8

2.5*

1.7* 1.6*

2.2*

0.0

1.0

2.0

3.0

4.0

5.0

Objective Strain Subjective Externalized Strain Subjective Internalized Strain

Mean Scores on the Caregiver Strain Questionnaire at Intake and Follow-up Interviews

(n=41)

Intake

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 Intake (n=91)

6 Months (n=106)

12 Months (n=93)

18 Months (n=63)

24 Months (n=44)

Preschool 51% 37% 24% 14% 11%

Regular Public Day School 28% 43% 63% 75% 75%

Head Start 24% 18% 8% 6% 9%

Regular Private Day/Boarding School 2% 2% 4% 2% 5%

Home School 0% 0% 2% 2% 0%

Alternative/Special Day School 0% 0% 0% 2% 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 Intake

(n=88)

6 Months (n=103)

12 Months (n=92)

18 Months (n=62)

24 Months (n=43)

Suspended 10% 7% 4% 10% 7%

Expelled 5% 1% 0% 0% 0%

Suspended AND expelled 5% 0% 1% 2% 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 Intake

(n=23)

6 Months (n=30)

12 Months (n=28)

18 Months (n=20)

24 Months (n=18)

Behavioral and/or Emotional Problems

39% 37% 36% 55% 56%

Speech impairment 30% 23% 18% 5% 6%

Developmental Disability

17% 20% 21% 25% 11%

Learning Disability 9% 17% 21% 15% 11%

Vision and/or Hearing Impairment

4% 0% 0% 0% 11%

Physical Disability 0% 3% 4% 0% 6%


Location and Types of Services Received

Families were asked about the types and locations of services they received. Figures 18-

20 compare information about services received in the 6 months prior to the Intake and Follow-

up 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

59%

22%

83%

51%

34%

71%

51%

44%

68%

56%

49%

41% 46% 44%

29%

0%

20%

40%

60%

80%

100%

Mental Health Clinic orPrivate Practice

School Home

Perc

ent

of

Fam

ilie

s R

ecei

vin

g Se

rvic

es

in E

ach

Lo

cati

on

Where Families Received Services (n=41)

Intake

6 month

12 month

18 month

24 month


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 children’s behavior improves, families learn to rely more on 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

95%

5%

66%

12%

32%

15%

78%

15%

22%

71%

7%

37% 34%

56%

2%

39% 37%

46%

5%

0%

20%

40%

60%

80%

100%

Assessment/Evaluation

MedicationMonitoring

Individual Therapy Family Therapy

Per

cen

t o

f Fa

mili

es R

ecei

vin

g E

ach

Typ

e o

f Se

rvic

e

Type of Therapeutic Service Received (n=41)

Intake

6 month

12 month

18 month

24 month


Figure 20

20%

59%

12%

5%

73%

29%

2%

56%

22%

5%

37% 41%

0%

20%

40%

60%

80%

100%

Case Management Family Support AfterschoolPrograms

Flexible Funds Informal Support School-based

Per

cen

t o

f Fa

mili

es R

ecei

vin

g E

ach

Typ

e o

f Se

rvic

e

Types of Support Services Received (n=41)

Intake

6 month

12 month

18 month

24 month


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

What’s 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 Catch-

Up (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 Percent

Male 61%

Female 39%

Average age 3.3 years old

Age Group

0-yr 3%

1-yr 6%

2-yr 15%

3-yr 32%

4-yr 25%

5-yr 19%

6-yr 1%

Race/Ethnicity Asian 1%

Black or African American 20%

Hispanic/Latino 35%

Multi-Racial 8%

White 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

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.

49%

12%

14%

25%

30%

30%

44%

0% 20% 40% 60% 80% 100%

Other

Anxiety-Related Problems

Sleeping Problems

Persistent Noncompliance

Hyperactive and Attention-Related Problems

Excessive Crying/Tantrums

Disruptive Behaviors in Young Children

Children's Presenting Problems (n=159)


Table 9

Diagnosis (n=44) Percent

Disruptive Behavior Disorder Not Otherwise Specified (NOS) 48%

Adjustment Disorder (all types) 30%

Attention Deficit/Hyperactivity Disorder 7%

Autistic Disorder 5%

Posttraumatic Stress Disorder 5%

Pica 2%

Unknown 14%

Figure 29 shows the agencies or people that referred the families to the IY classes. The

largest number of referrals came from the child’s 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

9%

1%

2%

7%

5%

10%

15%

15%

28%

0% 20% 40% 60% 80% 100%

Other

Probation

Mental Health

Early Intervention Program

Physical Health

Public Child Welfare

Alamance Partnership

Caregiver

School or Daycare

Referring Agency (n=159)


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 court-

ordered 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

Partnership’s 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.

4 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 I’m 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 Women’s 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 Children’s 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 Cafés, 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 Café with 18 adults

and 34 children participating and a Spring Café 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 Children’s

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 children’s social emotional issues, on May 9th,

Children’s 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.

Children’s Mental Health Awareness Week events included a Flash Mob and a giant

Chutes and Ladders game focused on the first 2000 days of a child’s 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 children’s 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 can’t 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

http://www.alamancesoc.org/


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 Children’s 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

ABSS’s 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 child’s 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 caregiver’s 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 caregiver’s 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

79% 83%

88%

63%

50% 47%

89% 87%

100% 97%

71% 66%

0%

20%

40%

60%

80%

100%

Access to Services Participation inTreatment

CulturalSensitivity

Satisfaction withServices

Outcomes SocialConnectedness

Per

cen

t o

f ca

regi

vers

fee

ling

"sa

tisf

ied

" o

r "v

ery

sati

sfie

d"

Caregiver Satisfaction with Services Received

6 month(n=152)

12 month(n=100)

18 month(n=59)

24 month(n=38)


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

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.

53% 45%

12%

52%

40%

10%

50% 47%

8%

51%

40%

13%

0%

20%

40%

60%

80%

100%

You and your child have a serviceprovider who understands the

customs, practices, and traditions ofyour child's cultural heritage?

The beliefs, traditions, and practicesof your child's cultural heritage beincluded in service planning and

provision?

The person you and your child haveseen most often is the same cultural

heritage as your child?

Pe

rce

nt

of

care

give

rs w

ho

sai

d t

hat

st

ate

me

nt

was

imp

ort

ant

or

very

imp

ort

ant

How important is it that…?

Importance of Cultural Competence in Service Providers

6 month(n=182)

12 month(n=121)

18 month(n=76)

24 month(n=47)


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

45%

78%

95%

47%

64%

90%

61%

94% 97%

67%

89%

97%

0%

20%

40%

60%

80%

100%

Is the same racialor ethnic group as

my child

Understands myfamily's beliefsabout mental

health

Speaks the samelanguage that I ormy child speaks

Asks about myfamily's

traditions, beliefs,and values when

planning orproviding services

Attends to myand my child'scultural needs

Is comfortableinteracting withme and my child

Perc

ent

of

care

give

rs w

ho

rep

on

ded

m

ost

of

the

tim

e o

r al

way

s

My child's provider…

Cultural Competence of Service Providers

6 month(n=182)

12 month(n=121)

18 mnth(n=76)

24 month(n=47)


Figure 25

82%

11%

80% 86%

6%

77%

91%

7%

86% 94%

14%

89%

0%

20%

40%

60%

80%

100%

Comfortable discussing with mychild's provider alternative

therapies or other ways to workwith my child

Like other children have access tobetter services than my child

That the materials and servicesgiven to me about the program are

easy to understand

Per

cen

t o

f ca

regi

vers

wh

o r

esp

on

ded

m

ost

of

the

tim

e o

r al

way

s

I feel…

Cultural Competence of Service Providers

6 month(n=182)

12 month(n=121)

18 month(n=76)

24 month(n=47)


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 caregiver’s 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

64% 61%

66% 72%

80% 80%

88% 85%

0%

20%

40%

60%

80%

100%

How well did your Family Partner address issuesbrought to her attention?

How available was your Family Partner when youneeded her?

Pe

rce

nt

of

care

give

rs w

ho

re

spo

nd

ed

po

siti

vely

Caregiver Report of Family Partner

6 month (n=131)12 month (n=74)18 month (n=45)24 month (n=26)


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 child’s school and giving

contacts for childcare).

Figure 27

42%

18%

28%

65%

18%

30%

75%

50%

5%

35%

23%

31%

73%

19%

38%

85%

58%

4%

0%

20%

40%

60%

80%

100%

Finances(budgeting,flex funds)

Transportation ObtainingBasic Needs

Dealing withAgencies/ObtainingServices

ObtainingEmployment/

EducationServices

ObtainingEmployment/

EducationServices for

Child

ProvidingSocial or

EmotionalSupport

Parenting Skills Other

Pe

rce

nt

of

care

give

rs w

ho

sai

d "

yes"

Did Your Family Partner Assist You With Any of the Following Activities?

6 month (n=131)12 month (n=74)18 month (n=45)24 month (n=26)


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 Mapping—working with the family to create a document that describes and

documents the family’s support system, their strengths and challenges, and their hopes for

the future;

2. Child and Family Team Meetings—organizing 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 Family Partner 1 Family Partner 2

Emotional Support 71% 37%

Linking to Services 8% 22%

Attending Meetings 5% 2%

Creating Futures Mapping 1% 3%

Advocacy 8% 23%

Navigating the System 7% 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 another’s 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 Children’s 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 County’s 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 Children’s 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 cross-

agency 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

0

10

20

30

40

50

60

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100

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rce

nt

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Dir

ect

ors

wh

o E

nd

ors

ed

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olla

bo

rati

on

wit

h E

ach

Age

ncy

Agency

Memorandum of Understanding

2010

2012

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ach

Age

ncy

Agency

Shared Resources

2010

2012


0

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rs w

ho

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llab

ora

tio

n w

ith

Eac

h A

gen

cy

Agency

Data Sharing

2010

2012

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10

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ach

Age

ncy

Agency

Blended Funds

2010

2012


0

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20

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Eac

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Agency

Common Policies

2010

2012

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Agency

Send and Receive Referrals

2010

2012


0

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h A

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Agency

Talk about Shared Cases

2010

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Agency

Jointly Develop Plans of Care

2010

2012


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h A

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cy

Agency

Jointly Participate in CFTs

2010

2012

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100

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Agency

Use Consent to Share Info

2010

2012


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Agency

Co-locate Services

2010

2012

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

of

Dir

ect

ors

wh

o E

nd

ors

ed

C

olla

bo

rati

on

wit

h E

ach

Age

ncy

Agency

Combine Trainings

2010

2012


0

10

20

30

40

50

60

70

80

90

100P

erc

en

t o

f D

ire

cto

rs w

ho

En

do

rse

d

Co

llab

ora

tio

n w

ith

Eac

h A

gen

cy

Agency

Serve on Boards Together

2010

2012


IX. Appendix B

Agency Collaboration Survey Results for Frontline Staff and Supervisors

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

of

Sta

ff a

nd

Su

pe

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ors

wh

o

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on

wit

h E

ach

Age

ncy

Agency

Send and Receive Referrals

2010

2012

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

of

Sta

ff a

nd

Su

pe

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ors

wh

o

End

ors

ed

Co

llab

ora

tio

n w

ith

Ee

ach

Age

ncy

Agency

Talk about Shared Cases

2010

2012


0

10

20

30

40

50

60

70

80

90

100P

erc

en

t o

f S

taff

an

d S

up

erv

iso

rs w

ho

E

nd

ors

ed

Co

llab

ora

tio

n w

ith

Eac

h A

gen

cy

Agency

Jointly Develop Plans

2010

2012

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

of

Sta

ff a

nd

Su

pe

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ors

wh

o

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do

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d C

olla

bo

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on

wit

h E

ach

Age

ncy

Agency

Jointly Participate in CFTs

2010

2012


0

10

20

30

40

50

60

70

80

90

100P

erc

en

t o

f S

taff

an

d S

up

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iso

rs w

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do

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d C

olla

bo

rati

on

wit

h E

eac

h A

gen

cy

Agency

Use Consent to Share Info

2010

2012

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

of

Staf

f an

d S

up

erv

iso

rs w

ho

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nd

ors

ed

Co

llab

ora

tio

n w

ith

Ee

ach

Age

ncy

Agency

Co-locate Services

2010

2012


0

10

20

30

40

50

60

70

80

90

100P

erc

en

t o

f St

aff

and

Su

pe

rvis

ors

wh

o

En

do

rse

d C

olla

bo

rati

on

wit

h E

eac

h A

gen

cy

Agency

Combine Trainings

2010

2012

0

10

20

30

40

50

60

70

80

90

100

Pe

rce

nt

of

Sta

ff a

nd

Su

pe

rvis

ors

wh

o

En

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olla

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on

wit

h E

eac

h A

gen

cy

Agency

Serve on Boards Together

2010

2012

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)

Third Quarter 2013 (July-Sept, 2013)

Services and Supports

number of people completing an EBP training

0 0 0 0 10 (6 who can serve Alamance County)

Training

number of training events held 14 14 10 5 8

total number of individuals at all training events combined

397 392 150 148 84

Family Involvement

number of family members participating in FIC meetings (does not include FPs)

2 0 NA (no longer having FIC meetings)

NA (no longer having FIC meetings)

NA (no longer having FIC meetings)

number of cafes held 1 1 0 1 0

number of participants in each café 144 50 (18 adults, 32 kids) 0 96 (34 adults, 62 kids, 25 total families)

0

Cultural and Linguistic Competence

number of CLC trainings held 5 9 4 0 4

number of agencies receiving cultural competence training

4 (plus those attending a State

Conference)

25 18 0 8

total number of participants in all trainings combined

71 241 39 0 107


Type of Activity Third Quarter 2012 (July-Sept, 2012)

Fourth Quarter 2012

(Oct-Dec, 2012)




Social Marketing: Events &Publications

number of public awareness events held

2 6 8 10 11

number of articles published for the general public

1 1 1 10 1

number of messages sent on the professional list serve

5 0 15 28 5

number of messages sent on the family/consumer list serve

7 0 3 0 5

average number of people subscribed to the professional list serve

89 89 94 100 200

average number of people subscribed to the family/consumer list serve

70 70 72 74 132

Social Marketing: Website Cumulative # of Hits(# of Hits this

Quarter)

About 2203 (215) 2494 (291) 2803 (309) 3064 (261) 3273 (209)

Services 2143 (198) 2439 (296) 2724 (285) 2972 (248) 3163 (191)

News 1838 (184) 2033 (195) 2226 (193) 2431 (205) 2653 (222)

Resources 1950 (153) 2226 (276) 2481 (255) 2712 (231) 2945 (233)

FAQs 1827 (237) 2233 (406) 2532 (299) 2771 (239) 2950 (176)

Links 1022 (98) 1221 (199) 1448 (227) 1616 (168) 1813 (197)

Families 1122 (109) 1307 (185) 1474 (167) 1609 (135) 1716 (107)

En Español 728 (62) 869 (141) 1021 (152) 1121 (100) 1216 (95)

Social Marketing: Facebook Page Number of members

70 69 74 77 91

Type of Activity Third Quarter 2012 (July-Sept, 2012)

Fourth Quarter 2012 (Oct-Dec, 2012)




Infrastructure number and description of

organizational changes introduced by the Alliance

1 Total:

Addition of annual ECMH training curriculum for community agencies

2 Total:

Elimination of Asst. PD position

1st Annual State ECMH conference

1 Total:

Established process for universal ASQ-SE screening in one organization

0 Total 3 Total:

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 11 19 15 12

ABSS:2

Caregiver:1

Doctor:2

DSS:5

FAS:2

APC:1

ABSS:2

Caregiver:4

Doctor:3

DSS:1 *12 additional children were referred, but screening showed they needed services other than MH

Caregiver: 1

Crisis Center: 1

Doctor: 1

DSS: 8

Head Start: 4

HD: 4

ABSS:2

APC: 1

Caregiver:5

Doctor: 3

DSS:1

HD: 3

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

# from CDSA 18 8 21 8 14

Caregiver:2

CDSA:4

CC4C:2

Doctor:2

DSS:7

HD:1

Caregiver:1

CDSA:1

Doctor:2 DSS:4

Caregiver:2

CC4C:2

CDSA:6

DSS: 11

CDSA:1

DSS: 3

HD: 3

PFC: 1

ARMC-OT: 1

Caregiver: 1

CC4C: 1

CDSA: 1

Doctor: 2

DSS: 7

PFC: 1

#of completed diagnostic evaluations

30 21 27 14 30

#of families enrolled 20 17 21 7 13

# disenrolled because parent initiated disenrollment

5 8 10 5 12

# disenrolled because family never engaged

2 4 1 0 0

alamance alliance annual report 2013

Documents