Donna Fayko: Raising the bar on mental health care for children

Published 12:00 am Sunday, September 6, 2015

By Donna Fayko

Special to the Salisbury Post


Partnering for Excellence is an exciting collaboration between Cardinal Innovations, Rowan County Department of Social Services and Benchmarks to improve access to and quality of mental health care for children in in-home services and in foster care.

Partnering for Excellence is a screening, assessment and referral-to-services process that is changing the way Rowan County, Cardinal Innovations and the wider community understand trauma and the need for accessible, appropriate mental health services for traumatized children, youth and families.

Since Partnering for Excellence got up and running about a year ago, 224 children and youth in either in-home services or foster care in Rowan County have entered the pipeline, and 203 of them have been screened for trauma.

The trauma screen is a one-page questionnaire that is filled out by the Social Services social worker after talking with the child, the birth parents, foster parents and any other relevant sources of information about the child. The screening tool directs the social worker to note traumas the child has undergone (physical or sexual maltreatment or assault, emotional maltreatment, exposure to domestic violence, traumatic death of a loved one, etc.) and behaviors the child exhibits (excessive aggression or violence, sleeping problems, excessive mood swings, academic decline, etc.) as well as ask the child some basic questions about his or her experiences.

Early data shows that, unsurprisingly, 92 percent of the children overall have screened positive for trauma, and that 100 percent of children in foster care have screened positive.

Children who screen positive for trauma are referred for a Trauma-Informed Comprehensive Clinical Assessment – an in-depth evaluation by a trained mental health professional that helps the social worker, mental health professional and others involved in the child’s case fully understand what the child has experienced and how those experiences have affected and are continuing to affect the child. After the assessment, referral to appropriate mental health services can be made more confidently. Children are referred to therapists certified in evidence-based mental health treatments such as Trauma-Focused Cognitive Behavioral Therapy or Multi-Systemic Therapy.

Although the first full round of evaluation data for the Partnering for Excellence project will not be available until January 2016, early anecdotal and focus group evidence suggests that, despite inevitable bumps in the road, the project is off to a hugely successful start. Of the children and youth in the Partnering for Excellence pipeline, none are currently in psychiatric residential treatment facilities, and only two are in Level III placements.

Cardinal Innovations has a staff member who conducts face-to-face proactive staffing in the Social Services office, and both Rowan Social Services and Cardinal report that the relationships built from that process have helped immensely in getting children the services they need.

Cardinal is able to approve more requests for services – because they come in properly documented, with all the necessary information – and that uptick in approvals has saved Rowan DSS county money they would have otherwise spent funding the needed services themselves.

Thanks to trauma trainings brought by Partnering for Excellence for members of the community, Rowan County Social Services staff and practitioners in other county systems are becoming more trauma-informed – foster parents, school social workers, intervention specialists, and other who come into daily contact with traumatized children are all starting to view troubling behaviors as symptoms of past or ongoing traumas rather than as defiant behavior from “bad kids.” With that understanding comes changes in practice that help move children towards healing rather than triggering past traumas.

Private providers, Rowan County Social Services staff, Cardinal staff and others involved in the project have regular meetings to share lessons learned, talk over how to move past obstacles and fine-tune the project pipeline.

Next on the docket for the ambitious folks at Partnering for Excellence are the implementation of a holistic, trauma-informed assessment for birth parents, and the development of readiness assessments for counties and private providers, so that when Partnering for Excellence is ready to replicate to another county, there will be partners ready and eager to take on the challenge.


 Donna Fayko is director of the Rowan County Department of Social Services. Mandy Ableidinger, consultant for Benchmarks NC, contributed to the column.