Current Landscape of Service Delivery Systems for Identified Survivors of Domestic Minor Sex Trafficking:

Prepared by: C ristine !eys" MS# for Love$%&

Table 'f Contents I( Current Landscape in Connecticut a. Executive Summary b. Interviews with stakeholders II( 'vervie) of Congregate Care Programs in Connecticut a. Congregate Care Programs or !C Involved "outh b. Congregate Care Programs $or %on&!C Involved "outh c. 'icensing (e)uirements $or Congregate Care Settings 'vervie) of *oster Care Programs in Connecticut 1+ a. 'evels o$ oster Care Settings ,b. (e$erral. Intake and Placement c. 'icensing (e)uirements $or Child Placing 0gencies ,ducational Planning for DC* and -on.DC* /out ,+ 0reas of *urt er ,xploration 1ecommendations

3 5 # 13 1*

III.

,/ ,*

I+( +( +I(

33 3*

I( Current Landscape In Connecticut ,xecutive Summary

1his 2ro3ect set out to identi$y the current ca2acity within Connecticut to 2rovide sa$e. treatment a22ro2riate housing $or identi$ied survivors o$ domestic minor sex tra$$icking. 4hile this assessment $ocuses 2redominantly on the work o$ the !e2artment o$ Children and amilies 5!C 6. interviews were conducted with 2rivate residential. grou2 home. and $oster care agencies7 as well as (unaway and 8omeless "outh 2rograms serving non&!C youth. 0ttem2ts to engage service 2roviders in areas o$ 3uvenile 3ustice. child advocacy. and domestic violence were also made. 8owever. res2onse $rom such resources has been minimal. 9ver the 2ast several years. !C has become the lead agency in identi$ying and addressing the issue o$ !:S1. 0s the state child wel$are agency mandated to 2rotect children $rom abuse and neglect. !C has established a variety o$ mechanisms to begin meeting the needs o$ this 2o2ulation. 0ccording to 4illiam (ivera. !irector o$ :ulticultural 0$$airs and co&chair o$ the 8uman 0nti&1ra$$icking (es2onse 1eam 580(16. !C has identi$ied a22roximately 1-- victims o$ !:S1 since ,--#. Since ;anuary ,-1,. there have been ,- identi$ied victims7 1* $emales and 3 males. 022roximately +#< had !C involvement at the time o$ identi$ication7 most residing in residential. grou2 home or $oster care settings. In ,-1,. !C issued =0 Child 4el$are (es2onse to !omestic :inor Sex 1ra$$icking> which outlines historical. current and 2ro2osed initiatives. 5see 022endix 06. !es2ite the e$$orts o$ the !e2artment. there is a lack o$ ex2ert service 2rovisions to address the housing and clinical needs o$ this 2o2ulation. Currently. there are $our short&term assessment beds 51-&,1 days6 allocated $or identi$ied victims. 1here are no treatment s2eci$ic beds or 2rograms at any level o$ care. 1he licensing 2rocess is arduous and can vary greatly on time$rames. 1he ma3ority o$ services 2urchased by !C are re)uisitioned through a ( P 2rocess7 however. the current !C Commissioner is su22ortive o$ innovative and s2eciali?ed community based treatment services. In addition to licensing. seeking accreditation is a critical ste2 in moving towards the develo2ment o$ care $acilities. 4hile there are several entities that can serve in this role. the Council on 0ccreditation 5C906 is an established stakeholder with the develo2ment o$ best case 2ractice standards. 1he current trend in 2roviding out o$ home care as designed by the !C Commissioner. ;ustice ;oette @at?. is towards less restrictive congregate settings and greater integration o$ youth into $amily&like. community based 2rogramming. It is 2ro3ected that over the course o$ the next 1# months. there will be a great reduction in congregate level care. or at least a reduction in the length o$ stay with increased 2lacements in varying levels o$ $oster care. 1he 2rimary challenge to meet this goal is in the recruitment and retention o$ $oster care 2roviders. 1here are two models 2resented that re$lect o22ortunity $or 'ove1/A to 2artner andBor develo2 innovative and e$$ective 2rogramming $or the target 2o2ulation. 0s !C has become a $orerunner in child wel$are systems in identi$ying and addressing the needs o$ the !:S1 2o2ulation. youth. i.e.. runaway and homeless youth. not under the 2urview o$ !C continue to be an unidenti$ied 2o2ulation. Services are even scarcer. long&term sa$e housing o2tions are minimal. and there is limited awareness among runaway and homeless youth 5(8"6 2roviders. 1o date. there has been no s2eci$ic identi$ication o$ a tra$$icking victim $rom 3

the (8" services 2roviders. urthermore. there is a lack o$ knowledge in where and how to locate resources i$ identi$ied. 1his was voiced by several 2rivate agency 2roviders o$ $oster care and grou2 home care as well. 1raining and technical assistance has been an identi$ied need by service 2roviders in all realms as well as !C . Initiatives have included local 2olice de2artments. !C sta$$ and service 2roviders. at&risk youth and school&based 2resentations. 4hile 'ove1/A had served as the 2rimary agency in develo2ing and 2roviding these trainings 5:y 'i$e. :y Choice7 1ell "our riends. sta$$ directed curriculum67 $unding im2eded 2rivate agency utili?ation o$ the agency resources. 0s a result. in ,-11. !C and 2rivate agencies sought to im2lement several 2rograms without the assistance o$ 'ove1/A. Clinical training and consultation is 2resently being coordinated by !C with the assistance o$ ;(I. !es2ite these many e$$orts to educate the community. there is a large ga2 in the level o$ skill and knowledge in how to best serve this 2o2ulation7 including the develo2ment o$ agency 2olicy and 2rocedures. 1his is 2articularly evident in the (8" 2rovider network and at the 2rivate $oster care level. 4ithout con$irmation. it may be also lacking in areas that intersect with at risk youth such as domestic violence networks. $amily 2lanning networks. and medical 2roviders. 1here has been no outcome data 2ublished to the e$$ectiveness o$ the training e$$orts. 1hrough interviews with !C . licensed treatment 2roviders and $acilities. assessment o$ the current landsca2e with regard to the 2lacement o$ children. and a review o$ the literature7 several o2tions exist to build the ca2acity within the state to 2rovide ade)uate. trauma&in$ormed restorative treatment $or minor victims. Pro2osed 2ro3ects $or develo2ment consideration include a com2rehensive case management model that would $ollow the youth regardless o$ 2lacement7 a continuum o$ sa$e housing that ranges $rom assessment beds to transitional housing to community homes7 and the develo2ment o$ a training and technical assistance 2rogram $or and with !C . ;uvenile ;ustice. the ;udicial Cranch and community&based 2roviders. A. Interviews with Community Stakeholders In 2re2aration o$ this re2ort. interviews were conducted with !C licensed 2rograms and (8" 2roviders. 0lthough most 2artici2ants were eager to discuss their service delivery. 2rogram model. and knowledge o$ sub3ect. there were three 2roviders that wished to remain anonymous. 5See 022endix C $or Duestionnaire6. our o$ the six 2rograms that serve non&!C youth were interviewedE Children and amilies. :eriden7 ;anus Center. Cridge2ort7 1he Cridge amily Center. 4est 8art$ord7 and 1'C. :anchester. our !C contracted agencies that 2rovide residential. grou2 home. short term assessment housing andBor thera2eutic $oster care services were interviewedE @lingberg amily Centers. %ew Critain7 4heeler Clinic. Plainville7 and Coys and Firls Gillage. :il$ord7 amily and ChildrenHs 0id. !anbury7 and 1he Cridge amily Center. 4est 8art$ord. 1wo additional residential agencies were contacted and did not res2ond to in)uiries. 4ith the exce2tion o$ 1he Cridge amily Center grou2 home and S10( 2rogram. all 2roviders indicated that they are only 3ust gaining greater awareness o$ minor sex tra$$icking. 1hree agencies. ;anus Center. @lingberg amily Centers grou2 home and the Cridge amily Centers grou2 home and S10( 2rograms. identi$ied that sta$$ had recently been trained or currently being trained by 'ove1/A. 9ne agency had attended a 2resentation through their 2lace o$ /

worshi2. 1he Cridge amily Centers has also utili?ed !C resources to 2rovide in&house training. 1wo agencies identi$ied that they had no working knowledge o$ the to2ic but were aware o$ the issue based on re$errals received $or their 2rograms. Coth (8" 2rograms and the ma3ority o$ !C contracted 2roviders did not believe there was enough training and awareness building o22ortunities a$$orded to them. Several were not aware o$ the re2orting re)uirements to !C or that !C had established a res2onse 2rotocol s2eci$ically $or !:S1. 9ne 2rogram stated that =4hile not minimi?ing the realities o$ sex tra$$icking. I have observed some level o$ hy2er vigilance7 2articularly in the ;uvenile ;ustice system. Sometimes an 049' is 3ust an 049'. Providers need to understand the dynamics o$ sex tra$$icking and not con$use this with other emotional res2onses to stress.> 9$ the (8" 2rograms with the exce2tion o$ the Cridge. none o$ the agencies had any ex2erience with identi$ied victims o$ tra$$icking and had not utili?ed the hotline to re2ort sus2ected tra$$icking cases. :ost o$ the 2rograms believed that they had worked with victims o$ tra$$icking based on their current knowledge o$ the sub3ect. 1wo !C contracted agencies had worked with youth that had been. at a minimum. sus2ected victims o$ tra$$icking at the time o$ 2lacement. Coys and Firls Gillage Program !irector o$ 1hera2eutic oster Care states that there has been an increase in the number o$ re$errals with sus2icion o$ or con$irmed tra$$icking histories. 0ll 2rograms interviewed had at least one case managerBthera2ist res2onsible $or 2roviding case s2eci$ic treatment or re$erring to community based services. %o 2rogram could identi$y a clinical resource that s2eciali?ed in tra$$icking victims. !C congregate care agencies re2orted to have ex2ertise in trauma&in$ormed treatment7 several using evidenced based treatment models such as 1rauma& ocused Cognitive Cehavioral 1hera2y 51 &CC16 or !ialectal Cehavioral 1hera2y 5!C16. oster care agencies did not im2lement any evidenced based training although one agency was ex2loring the 1 &CC1 model $or their sta$$. oster care agencies had access to a community based clinician with trauma ex2ertise. 8owever. none recalled utili?ing an ex2ert in treating P1S! or evidence&based model o$ treatment. (8" 2rograms o$$er re$erral services $or clinical treatment. 0gencies with a strong working knowledge and have had training $or sta$$ were the only agencies re2orting to assess risk $actors s2eci$ic to tra$$icking during the intake 2rocess. %o 2rogram had s2eci$ic 2olicies regarding the treatment o$ !:S1 survivors although the Cridge amily Centers identi$ied a need to integrate a harm reduction model to address 049'Hs . i.e.. sa$ety 2lanning measures. within their 2olicies. Policies that would re)uire revisions to accommodate the needs o$ this 2o2ulation included 049' re2orting 2olicies. restrictions on cell 2hone and internet access. and unsu2ervised community time. Survey 2artici2ants were asked about risk and sa$ety concerns as a result o$ their location. Several 2rograms identi$ied that they did not 2ublish the s2eci$ic address o$ their 2rogram. 9ne congregate care agency had removed 2ictures o$ their buildings. Several 2rograms did not consider their residence at risk $or being targeted by tra$$ickers7 this was 2articularly true $or $oster care agencies.

!C contracted 2roviders indicated that there was a need $or s2eciali?ed treatment and 2lacement services. com2rehensive case management services that could navigate both the criminal andBor investigative 2rocess as well as the clinical treatment needs. 1rends regarding outreach and re$erral services. 2lacement access. and length o$ stay were s2eci$ically targeted to (8" 2roviders as they only acce2t non&!C involved youth. Program models are $urther detailed in Section III. (8" identi$ied that re$errals were $rom 2arents. schools. and youth. "outh who access their 2lacement services are o$ten re$erred by other youth. Several 2rograms indicated that utili?ation o$ national and statewide switchboards or re$erral services were o$ten di$$icult to navigate $or youth. Community based networking and street& level outreach were the most e$$ective means o$ raising 2ublic awareness o$ their services. 9ne such exam2le is the establishment o$ the Sa$e Place 2rogram through ;anus 8ouse. Currently there are 3* Sa$e Place sites and ,5 FC10 buses that act as mobile sites in the Freater Cridge2ort area. :ost o$ these sites are housed at $ire stations. libraries. and community centers and have trained sta$$ who knows how to hel2 the youth when they accesses them. 1he Sa$e Place 2rogram works in con3unction with ;anus CenterHs ,/&hour crisis hotline where sta$$ can be dis2atched immediately to hel2 the youth in trouble. ;anus 8ouse sta$$ o$$er the youth access to $ull ;anus Center services which includes advocacy. mediation. and a tem2orary emergency shelter o2tion i$ the youth is unable to return home.1 Programs in the network dis2lay a bright yellow sign with =Sa$e Place> design $or easy recognition. 0ll (8" 2roviders concurred that length o$ 2lacement. regardless o$ tra$$icking identi$ication. was a challenge. Program models 2rovide short&term 2lacements7 most $alling within the range o$ 1/&,1 days. 9ne 2rogram. 1'C. while able to acce2t emergency 2lacements. is also designated as a grou2 home and can 2rovide long&term 2lacements.

1Council o$ Churches Freater Cridge2ort7 www.ccgb.org

II( 'vervie) of Congregate Care in Connecticut:

A. Congregate Care Facilities for DCF Involved Youth It is the 2hiloso2hy o$ ;ustice ;oette @at?. Commissioner. !e2artment o$ Children and amilies to 2rovide youth with the o22ortunity to be integrated into $amily settings and 2artici2ate in their communities. 2roviding normative childhood o22ortunities. In 0ugust o$ ,-11. !C released =Congregate Care (ightsi?ing and (edesignE "oung Children. Goluntary Placements and a Pro$ile o$ 1hera2eutic Frou2 8omes>7 a re2ort in the = ostering the uture> series. 1his AA 2age re2ort 2rovides an in&de2th assessment o$ current congregate care continuum with outlined 2ractice and 2rogrammatic changes to restrict 2lacement o$ children under 1, in congregate settings. reduce the length o$ stay. and restructure existing 2rograms to accommodate those children in out o$ state 2lacements 5see 022endix C6. or youth that are involved in the child wel$are system re)uiring out o$ home care. 2lacement o2tions vary de2ending on the level o$ clinical need. 0s 2oint in time measure. in ;une ,-11. there were 1/33 youth 2laced in congregate settings both within and outside o$ the state o$ Connecticut. ollowing is a brie$ overview o$ congregate care settings relevant to this 2ro3ectE, Short 1erm 0ssessment and (es2ite 8omes 5S10(6 o tem2orary congregate setting7 youth ages 11&1* o short&term care. clinical evaluation and nursing care o acce2ts 2lacements ,/B*. 3A5 days7 no 2re&2lacement transitions o direct service 2rovided by non&clinical 2ara2ro$essionals 1hera2eutic Frou2 8ome 51F86 o community based7 neighborhood setting o serves as ste2&down $rom residential treatment 2rogram or ste2&u2 a$ter multi2le disru2tions in lower level care. i.e.. $oster care o designed by cohort o$ gender. age. and s2eciali?ed needs o ,/B* sta$$ing and clinical su22ort7 clinically trained sta$$ing 5bachelors level6 o scheduled admissions7 2re&2lacement transition o 2sychiatric services. including medication management are 2rovided on&site o 3&/ hours o$ weekly clinical treatment 2rovided on&site7 includes individual. grou2 and $amily when a22ro2riate 52re$erence $or state licensed clinicians6 o social. recreational and vocational activities are community based ,Connecticut !e2artment o$ Children and
amilies =Congregate Care (ightsi?ing and (edesignE "oung Children. Goluntary Placement and a Pro$ile o$ 1hera2eutic Frou2 8omes> 2ages 5A&AA.

o education is 2rovided o$$&site Psychiatric (esidential 1reatment acilities 5P(1 63 o highly structured. sel$&contained milieu o thera2eutic. medical. educational and recreational activities within milieu o intensively sta$$ed7 clinically trained 5bachelors level and higher6 o /&A hours o$ weekly s2eci$ic clinical treatment. including individual. grou2 and $amily7 2rovided on&site o scheduled intakes7 2re&2lacement transitions Pass Frou2 8omes o moderately si?ed homes. averaging A&1- beds 2er 2rogram o sta$$ed with non&clinical 2ara2ro$essionals 5associatesBhigh school di2loma6 o mild&behavioral health needs o all clinical and educational services are community based Su22ortive 4ork. Education and 1ransition Program 5S4E1P6 o community based. sta$$ed a2artment 2rogram o serves adolescents 1A&,1 o not designed as thera2eutic clinical setting o $ocus on develo2ment o$ building skills $or sel$&su$$iciency

Program Type S10( 1hera2eutic Frou2 8ome Psychiatric (esidential 1reatment acilities P0SS Frou2 8ome S4E1P

-o( of Programs 1, 5, 13 / /

-umber of 2eds *# ,A-I ,#-I 3/ ,/

Lengt of Stay 3L'S4 A- days 5contracted6 1arget o$ A&+ months 1arget o$ + months Estimated 1,&,/ months 1, months

31here are $our (esidential 1reatment Centers s2eci$ically to address substance abuse which is not included in the data

Inumbers are a22roximated based on $igures $rom ;une 3-. ,-11 9$ the 5, licensed thera2eutic grou2 homes. 1, are designated $or 2o2ulation under the age o$ 1,7 the remaining are designed $or the adolescent 2o2ulation. It is the intention o$ !C to consider re2ur2osing the existing grou2 homes $or under 1, 2o2ulation to accommodate s2ecial 2o2ulations andBor youth being treated out o$ state. 1here are no mixed&gender thera2eutic grou2 homes $or adolescents. 8al$ o$ the homes are designated $or s2ecial 2o2ulations that include 2roblem sexual behaviors. develo2ment disabilities andBor 2ervasive develo2mental disorders. ;uvenile ;ustice ProgramsE or youth that are committed !elin)uent. there are two sta$$&secured $acilities $or $emales. both run by %orth 0merican amily Institute 5%0 I. Inc.6. 1ouchstone located in 'itch$ield County and Ste22ingStone. 4aterbury. have a total ca2acity o$ /-. Ste22ingStone has allocated two emergency beds $or the assessment o$ identi$ied victims o$ tra$$icking. 0verage length o$ stay ranges $rom A&1, months7 youth 2laced are 2laced in these 2rograms as an order o$ the 3uvenile court system. 1hree o$ the 5, 1F8Hs re)uire 3uvenile 3ustice involvement $or 2lacement7 two are s2eci$ically designed $or $emales on 2arole. (e$erral Process J Intake 2rocedures In order to access the above 2rograms re$errals are made through !C 5including the ;uvenile ;ustice System6. 1here must be some level o$ legal involvement or acce2ted into the !C Goluntary Services Program 5GSP6. a 2rogram designed to assist $amilies who have exhausted all resources $or securing ade)uate behavioral health services. Children in the GSP are not ad3udicated abuseBneglected or delin)uent7 and 2arents retain their legal status as guardians. 1he assigned !C Social 4orker. Probation 9$$icer. or !C Parole o$$icer com2letes a Child and 0dolescent %eeds and Strengths 5C0%S6 in consultation with !C Cehavioral 8ealth Consultants. 1he com2leted assessment is $orwarded to the C1 Cehavioral 8ealth Partnershi2BGalue 92tions 5C1C8P6 reviews and identi$ies the a22ro2riate level o$ care utili?ing standardi?ed guidelines./ Private 2roviders who meet the criteria $or the identi$ied needs o$ the youth are 2rovided with the o22ortunity to interview the youth. Programs may deny admission to a youth due to clinical incom2atibility. sa$ety issues or con$lict with the milieu. 9nce an agency acce2ts a youth $or 2lacement. C1 C8P issues authori?ation $or 2lacement. including a22roved length o$ stay. Fenerally. 2lacements occur within a short 2eriod o$ time. i.e.. 5&15 business days. $rom date o$ 2re&2lacement interview. S10( 2rograms are excluded $rom the above outlined re$erral and 2lacement 2rocess. Such decisions are made solely between !C and the 2rovider agency. Placements are acce2ted at anytime and there is no 2eriod o$ transition. 'ength o$ Stay 0t the time o$ initial authori?ation $or 2lacement. C1 C8P 2rovides a22roval $or a s2eci$ied amount o$ time. or exam2le. 2lacement into a thera2eutic grou2 home may be authori?ed $or 1#- days. !uring the course o$ 2lacement. C1 C8P will conduct treatment reviews to monitor 2rogress towards clinical goals and identi$y barriers $rom achieving such goals. Such reviews result in the re&authori?ation o$ 2lacement and increase o$ '9S i$ re)uired. ailure to conduct
/C1 Cehavioral 8ealth Partnershi2. legislatively created collaboration that su22orts 3oint 2lanning. $unding and oversight o$ 2ublicly&$unded
behavioral health services $or 8usky 0 and C reci2ients 5:edicaid6 and !C involved youth . www.ctbh2.org

reviews may result in non&2ayment to the 2rovider agency during the unauthori?ed 2lacement time$rame. S10( 2rograms are contracted $or a A- day '9S. 1here are bi&weekly reviews conducted at the !C local level to assess barriers to achieving discharge 2lan. unding 0ll the above 2rograms are $unded by !C . 1y2ically. 2rograms are under contract with !C and are 2rocured through the (e)uest $or Pro2osal 5( P6 2rocess. 9nce agencies are selected through the 2rocurement 2rocess. contracts are negotiated to cover sco2e o$ services and rate setting. See 0ttachment C $or a sam2le o$ a 1hera2eutic Frou2 8ome Sco2e o$ Service. Provider agencies are reimbursed on a monthly basis $or the 2er diem rate $or each youth 2laced in the 2rogram. or thera2eutic grou2 homes. the 2er diem rates vary across 2rograms $rom K33A./# to KA31.##. 1he 2er diem $unds are to cover all com2onents o$ 2rogramming including salaries. general and administrative costs. basic living needs 5i.e.. clothing. hygiene items6. activities $unds. trans2ortation etc. Program Type 0vg( Per Diem 1ate 5 0vg( Per Diem 1ate 5 2e avioral 6ealt 7uvenile 7ustice (esidential 1reatment In&State K,*5 K3*5 (esidential 1reatment 9ut&o$&State K33, K,35 Sa$e 8ome K,#1 nBa P0SS Frou2 8ome K,A/ nBa 1here are several challenges $or 2rivate 2roviders with the current $unding structure. irst there have not been rate increases in the 2ast three years. Secondly. the 2rovider agency will not receive 2ayment $or an un$illed bed. or exam2le. the utili?ation rates $or thera2eutic grou2 homes average between #A<&#+< in " ,-1-&,-11. 'astly. $ailure to meet re2orting re)uirements may result in the loss o$ 2ayment even i$ services were 2rovided. Sta$$ingB(es2onsibilities 0ll congregate care $acilities are res2onsible $or the day to day su2ervision and 2rovision o$ basic needs. including access to medical treatment. administering medication. and 2roviding case management services. 1he $ollowing outlines common sta$$ing 2atterns. 2ositions. and res2onsibilities across congregate care settings. Sta$$ing ratios are based on acuity o$ 2o2ulation served. Sta$$ing levelsB!irect Service Sta$$E direct service sta$$ ty2ically ratio o$ 1 sta$$E3 residents7 sta$$ing ratios vary by shi$t shi$t&based 5*a&327 32&1127 112&*a6 with some overla22ing to cover during shi$t change. all sta$$ are re)uired to be certi$ied in medication administration 5through !C 6 clinically based 2rograms re)uire minimum o$ bachelors degree in social work or related $ield7 non&clinical 2rograms are more $lexible with educationBex2erience Sta$$ing levelsBClinical Services 0ll 2rograms have a designated Program :anager and Clinician7 may also have case managers and shi$t su2ervisors Program :anagers and Clinicians are graduate level sta$$ at a minimum7 re)uire state licensure $or higher acuity 2rograms 1-

 develo2 treatment goals and monitor 2rogress 2rovide ,/B* clinical consultation Programming 2rogramming services include social. recreational. and vocational activities ca2acity building o$ daily li$e skills and 2re2aratory skills towards sel$&su$$iciency (e2orting (e)uirements (e2orting re)uirements $or $unding 2ur2oses vary de2ending on the level o$ care 2rovided. Fenerally. agencies are re)uired to com2lete weekly census re2orts. noti$y C1C8PBGalue 92tions within ,/ hours o$ 2lacement date. and 2artici2ate in 1reatment (eviews $or re& authori?ation o$ 2lacement. In addition. each contract outlines s2eci$ic outcome measures that that are related to 2er$ormance o$ the 2rogram service delivery. Exam2les may include discharge destinations. rate o$ seclusions and restraints. and medication errors.

11

B. Overview of ousing O!tions for "on#DCF involved Youth in Connecticut$ or youth that are involved with !C . including abuseBneglect. delin)uency or through Goluntary Services. the a$orementioned 2rograms are available as 2lacement and treatment resources. 8owever. $or non&!C youth. including runaway and homeless youth. there are $ew o2tions $or sa$e housing. In testimony submitted in :arch ,-1- by the ChildrenHs 0dvocacy Center5. in su22ort o$ (aised Cill %o. ,+,E 0n 0ct Concerning 8omeless "outh. it was re2orted thatE In Connecticut, we do not have an accurate number of runaway and homeless youth. We know that the National Crime Information Center (NCIC), a database maintained by the Federal Bureau of In esti!ation, re"orted on #ctober $%, $%%& that there were $'( acti e runaway cases and ),'%% "ur!ed records for runaway cases in Connecticut for $%%&. We also know that the National *unaway and +omeless ,outh -ana!ement and Information .ystem re"orted a total of $(/ runaway and homeless youth in Connecticut for fiscal year $%%&0%/.A 1 re"ort from the #ffice of 2e!islati e *esearch indicates that thou!h the number is difficult to "recisely count, there are more than '3% unaccom"anied homeless children under the a!e of 4& in Connecticut.*5 Sa$e housing o2tions are very limited in numbers. accessibility and 2rovision o$ services. Currently. there are six 2rograms or a total bed ca2acity o$ ,, throughout the state that will 2rovide housing $or youth not re$erred by !C . 9$ these ,, beds. 2rogram design includingE re$erral. intake. consent $or 2lacement. service delivery and length o$ stay vary greatly. Program -ame
Council o$ ChurchesE ;anus Center $or "outh in Crisis @ids in Crisis 4omen and amilies Center "outh Continuum

Service 0rea
Freater Cridge2ort Southwestern C1 :iddlesex County %ew 8aven

8ender90g e
:aleB emale 11&1* :aleB emale 11&1* :aleB emale :aleB emale 11&,3

Program Model
8ost 8ome ,/hr 9utreachBCrisis Intervention Emergency Shelter ,/ hr 9utreachBCrisis Intervention 8ost 8ome Street 9utreach Emergency Shelter 1ransitional 'iving 8L! 8omes 51#&,3yr old6

: of 2eds fo -on.DC* /out

5 beds / beds , beds / beds 1- beds # beds

50uthored by Stacey Giolente Cote. !irector o$ ChildrenHs 0dvocacy Center 1een 'egal 0dvocacy Clinic and Chair o$ the C1 1eam on (unaway
and 8omeless "outh.

A1his number is believed to be a $ar underestimate o$ the total number o$ homeless youth in C1 as it only includes re2orts $rom grantees o$ a
national grant to work with runaway and homeless youth.

*=Poverty. 8omelessness. and Children.> C1 9$$ice o$ 'egislative (esearch 5;uly *. ,--#6.

1,

Cridge amily Centers 1'C

4est 8art$ord :anchester

emale :aleB emale

Emergency Shelter 1ransitional 'ivingBemergency housing

1 bed A beds

unding unding $or $our o$ the six (8" emergency and transitional housing is generally $unded through (unaway and 8omeless "outh 0ct & 1itle III o$ the ;uvenile ;ustice !elin)uency Prevention 0ct established in 1+*/ 5(8"06. (8"0 has been amended by several subse)uent youth&$ocused legislative acts is currently administered through the amily and "outh Services Cureau. 2art o$ the !e2artment o$ 8ealth and 8uman ServicesH 0dministration $or Children and amilies. 0s currently amended. (8"0 authori?es $ederal $unding $or three 2rogramsE Casic Center Program o designed to accom2lish three goalsE immediate. sa$e shelter and services $or runaway youth7 reuni$ication o$ $amilies whenever 2ossible7 and alternative 2lacements o$ the youth when reuni$ication is not a22ro2riate. o 2rovide a wide range o$ services to runaway and homeless youth. including ,/&hour access to all 2rogram services. emergency shelter. $ood and clothing. medical assistance. counseling. and re$errals to health care and educational systems. 1ransitional 'iving Program 51'P6 o 2rovides shelter and an array o$ com2rehensive social services $or older homeless youth. o youth live in a su22orted. structured environment in which the overall goal is to increase their inde2endent living skills and ability to be sel$&su$$icient. 8ousing and a range o$ li$eskills services are 2rovided $or u2 to 1# months to youth ages 1A&,1 who are unable to return to their homes. Street 9utreach Program o Street 9utreach 2rograms 2rovide street&based education and outreach to youth who have been. or who are at risk o$ being. sexually abused or ex2loited. 1he ultimate goal o$ the 2rogram is to move these young 2eo2le o$$ the streets and into shelters where they can access other needed services. 1he Street 9utreach 2rograms 2rovide access to medical and mental health treatment. counseling. and in$ormation and re$erral services.

In ;une. the Senate 022ro2riations Committee a22roved " ,-13 legislation that would 2rovide K115 million $or (8"0 2rograms.# 1wo remaining 2rograms. 1'C and 1he Cridge amily Centers. have varied $unding sources. 1'C is solely $unded by the 1own o$ :anchester and the :anchester Coard o$ Education. 1he Cridge amily Centers has one bed within their S10( 2rogram that is 2rivately $unded.

#%ational 0lliance to End 8omelessness7 (8"07 www.endhomelessness.org

13

Program :odels 8istorically. runaway and homeless housing has been 2rovided in congregate settings7 i.e.. emergency shelters. 8owever. there is a growing trend $or the im2lementation o$ 8ost 8omes. 1he structure o$ the emergency shelter is a congregate setting which may or may not be housed within another 2rogram. or exam2le. the Cridge amily Centers is licensed as a S10( 2rogram with a ca2acity o$ six. 8owever. they are licensed $or an additional three beds. or Mcommunity bedsH that are accessed $or $amilies in their catchment area and re)uire no re$erral $rom !C . !C has recently $unded two o$ the three beds s2eci$ically $or identi$ied or sus2ected $emale tra$$icked minors. 8ost 8omes are designed in two waysE 8ost $amilies are 2aid em2loyees o$ the agency and reside in an agency& owned home 8ost $amilies are licensed as $oster 2arents and maintain their own residence Coth models are designed have gender s2eci$ic housing. Ca2acity 2er host home ranges $rom 1&3 youth. (egardless o$ the model im2lemented. each 2rogram o$$ers case management services. access to clinical assessment and most 2rovide brie$ treatment. 0ll 2rograms $unded through (8" $unds. are re)uired to 2rovide a$ter care $ollow&u2 weekly $or $irst 3- days a$ter discharge. then at A- and +- days. 1he 1'C 2rogram in :anchester is a uni)uely designed and $unded 2rogram. 1he 2rogram was $ounded in 1+#* to 2rovide a sa$e and nurturing environment $or residents to remain within their community and educational setting. 1he 2rimary 2o2ulations served are youth that are not in !C custody and only acce2ted !C involved youth on a case by case basis. In the 2ast year. 1, youth and $amilies have been served7 two graduated high school. two are living inde2endently. and three have transitioned success$ully home. 1'C has a licensed ca2acity o$ A7 3 males and 3 $emales. 1he 2rogram is sta$$ed with a $ull&time house 2arent who resides in the agency&owned home. 1here is 2er diem shi$t sta$$ assigned to cover as needed.

(e$erral Process J Intake Process (e$errals may be made by 2arents. legal guardians or the youth directly. In)uiries $or services are o$ten made by community stakeholders such as schools. a$terschool 2rograms or connected adults. Programs o$$er ,/&hour access to outreach workers and admissions. :ost 2rograms do not re)uire legal guardian consent at the time o$ intake. 1/

8owever. consent is re)uired within *, hours o$ 2lacement in 2rogram. I$ a 2arent or legal guardian is not available within the s2eci$ied time $rame. a re$erral to !C is made as youth is viewed as abandoned. 'ength o$ Stay 0verage length o$ stay is 1/&,1 days $or the host home and shelter models. 0s noted. two 2rograms o$$er transitional living models to serve homeless youth7 both which have extended length o$ stay7 however. only 1'C o$$ers emergency housing within the same 2rogram. !ata (e2orting (e)uirements 9utcome data is re)uired o$ all $ederal grantees. See 022endix ! $or sam2le outcome measures.

15

c. %icensing &e'uirements for Congregate Settings 6CF is the licensin! a!ency for all con!re!ate care facilities for children and youth under the a!e of 4& re!ardless of their fundin! source. 7his includes all con!re!ate settin!s that "ro ide ser ices to non86CF in ol ed youth such as the identified *+, "ro!rams. In addition, facilities which are not "ri ate family homes may also be licensed under these re!ulations9 therefore, therefore, an a!ency8owned home that is "ro ided as "art of em"loyee benefit may be licensed as a child8care facility. 1!ency re!ulations a""licable are identified in the re!ulations of #"eration of Child8Carin! 1!encies and Facilities: Children;s +omes or .imilar Institutions, *esidential 7reatment Facilities, <rou" +omes, and 7em"orary .helters5. (.ee 1""endi= > for 1!ency *e!ulations9 2icensin! ?acket 1ttachment) For a!encies that ha e no e=istin! contracts, such as 2o e4)(, the "ro ider initiates a 2icensin! In@uiry call to the 2icensin! ?ro!ram .u"er isor, re iew the 6CF website re!ardin! the licensin! "rocess and schedule a technical assistance meetin! +. Initial 2icensin! ?hase: a""lication is assi!ned to *e!ulatory Consultant on8site isit is conducted9 re iew of facility and submitted materials submission to ?ro!ram .u"er isor

?ro isional 2icensure: *e iew of .ubmitted materials 6etermination of Fiscal Aiability: o detailed bud!et submit with e idence of at least four months of fundin! for the "ro!ram Ins"ection "hysical "lant medication mana!ement o -edication 1dministration: facility must ha e a ailable certified staff *e@uired Certifications: o *estraint0C?*: each shift has $ certified staff in restraints9 4 certified staff in C?* ?ersonnel Files
iewed as an 1ttachment or ia htt":00www.ct.!o 0dcf0cw"0 iew.as"B

+7he entire licensin! "acket can be

aC$3(DEFC)$/'%%GForms

1A

.am"le Case *ecords

H"on com"liance with the licensin! re@uirements, 6CF may issue a "ro isional license. 7he "ro isional license allows for a licensed bed ca"acity (2BC) below the intended full ca"acity of the "ro!ram. Considerations for 2BC are in relation to staffin! hired0trained, im"lementation "lan for transitionin! new children into the "ro!ram, and how a!ency will accommodate census increases. 7he im"lementation "lan is a""ro ed by the 2icensin! Hnit. ?ro isional to *e!ular 2icense: 1ssessment of the "ro!ram readiness to increase 2BC9 e=am"les of criteria for consideration: condition of "hysical "lant, com"liance with re!ulatory mandates, staffin! com"liance, "ro ision of s"ecified "ro!ram ser ices, includin! clinical educational and medical "ro!rammin!. Com"liance -onitorin! >ach licensed a!ency will be isited at least @uarterly by the assi!ned *e!ulatory Consultant9 re iews consist of condition of "hysical "lan, "ro!ram staffin!, "ro!ram chan!es9 census and follow8u" to any correcti e actions. 7he 2icensin! Hnit may also conduct unscheduled or follow8u" isits without notification to the licensed a!ency. *enewal of 2icensin! 1""lication 2icenses are renewed e ery two years. 1ccreditation In addition to the licensin! re@uirement, it is recommended that licensed a!encies be accredited by one of se eral different entities, includin! but not limited to: Council on 1ccreditation (C#1), www.coa.or! 7he Ioint Commission, www.Jointcommission.or! Commission on the 1ccreditation of *ehabilitation Facilities (C1*F), www.carf.or!

C90 has engaged in a $ormal collaboration with !C to establish best 2ractice standards to res2ond to !:S1 in congregate care and $oster care settings.

1*

III.

Foster Care Programming

0s clearly identi$ied. there is a growing trend towards $amily&based care settings with both !C involved and non&!C involved youth. In Se2tember ,-11. the second re2ort in the = ostering the uture> series was released7 =4e 0ll %eed SomebodyE Su22orting Children. amilies and the 4ork$orce in ConnecticutHs amily oster Care System> 5022endix 6. Commissioner @at? rein$orces that children deserve an o22ortunity to become members o$ a healthy $amily. to succeed in school and 2artici2ate in the community in a 2ositive and character building way. She continues to challenge that there is an over utili?ation o$ congregate settings and an under utili?ation o$ kinshi2 and $oster $amily homes. Challenges to meeting this goal are basicE the recruitment and retention o$ )uali$ied non&relative caregivers and ca2acity building o$ kinshi2 2roviders. or the targeted 2o2ulation. these challenges are exacerbated by many o$ the survival behaviors exhibited such as $re)uent 049'. sexuali?ed behaviors. and other high risk behaviors such as substance use. 0dditionally. non&kinshi2 $amilies may be $ear$ul o$ ex2osing themselves or their children to the risks that may be involved with a youth who has either not exited the li$e or struggling with sa$ety and reintegration. @inshi2 2lacement resources may be con$licting in the healing 2rocess $or the victim. 1here may be shame involved regarding the tra$$icking history. guilt $or not 2rotecting the youth $rom such harm or in severe cases. $amily engagement in the tra$$icking behaviors. In addition to the recruitment o$ $oster care 2roviders. retention o$ licensed $amilies is an on& going struggle. In a recent study cited by the =4e 0ll %eed Somebody> re2ort. 3-< o$ surveyed $amilies $elt devalued and not res2ected by the !e2artment. amilies o$ten re2ort that they do not $eel they have access to community and agency su22orts7 are have limited access to community su22orts and services when needed7 and sti2ends do not o$ten cover the cost o$ care $or the child. es2ecially $or older adolescents. !e$initions o$ oster Care amiliesE (elativeB@inshi2 Care & $amily members licensed as $oster 2arents $or the 2lacement o$ relative child S2ecial StudyBChild S2eci$ic N non&relatives that 2resent themselves as 2lacement resources $or a s2eci$ic child %on&relative oster amily N$amilies that are licensed to acce2t child and youth unknown to them

A. %evels of Foster Care (rogramming 0s with congregate care settings. there are levels o$ $oster care designed to meet the level o$ acuity 2resented by the youth. C9(E oster Care o !C licensed. trained and su22ort $oster care o (elative. S2ecial Study and %on&(elative $amilies are eligible o Casic 2re&service training7 minimal $ocus on trauma in$ormed care 1#

3- hours $or %on&(elative A&1# hours $or (elative and S2ecial Study

o 1# hours o$ 2ost&licensing training 2er year o Child retains assigned !C Social 4orker o monthly visitation standard !C S4 caseload average 1#&,- cases

amily assigned Su22ort 4orker )uarterly visitation standard

o 9n&callB0$ter 8ours su22ort 2rovided by !C Careline or C0 0P o 1- days o$ res2ite 2er year 0ge 8roup 0ges -&5 0ges A&11 0ges 1,O :edically Com2lex :inor Parent with Child Per Diem 1ate ,5.*3 ,A.-3 ,#.,/ /A.A3 53.+* 0nnual Payment +3+1./5 +5--.+5 1-3-*.A1*-1+.+5 1+A++.-5

1reatmentB1hera2eutic oster Care 51 C6 o 1# 2rivate 2roviders licensed as Child Placing 0gencies o agencies are contracted to 2rovide a s2eci$ic number o$ beds o (elative . S2ecial Study and %on&(elative $amilies are eligible o Pre&Service 1raining and 0ssessment7 heavy $ocus on trauma 3* hours7 * o$ which are child s2eci$ic when child matched to $amily all $amilies are re)uired to com2lete hours

o ,#&3, hours o$ 2ost&licensing training 2er year o sta$$ training re)uired7 annual training 2lan re)uired $or a22roval o Child assigned Case :anager weekly $ace to $ace visitation with child twice a month $ace to $ace visitation with $amily 1+

once a month minimum o$ grou2 session caseload si?e ca22ed at + 4(0P $unding allocated to agency to su22ort $oster $amily and child K3A5- 2er year covers 1# days o$ res2ite $or $oster $amily 2ayment $or social. recreational. educational. vocational and clinical services $or which no other $unds are available

o ,/B* on&call coverage 2rovided by 2rivate agencyB1 C 2rogram ty2ically a case manager who is known to the $amily

o 1 C 2rograms designed to 2rovide ste2&down care $rom residential setting. thera2eutic grou2 homes. or as an intervention $rom re)uiring higher levels o$ care oster Parent Sti2end K55 ,--*5 annual 0dministrative ee KA# ,/#,- annual 1otal 0mount K133 /#5/5 2aid by !C

Position Case :anagerBSocial 4orker (ecruiter Program Su2ervisor Program :anager

Sta$$ing :odel Per Contract Sta$$ing 'evel 1 1E N 1E+ youth .5 1E $or 3- contract slots 1.- 1E .5 1E

Education Cachelor or higher 0ssociates7 ex2erience :S4 :S4B'CS4

:odels o$ Pre&Service 1raining and 1rauma in$ormed training includeE P(I!E. Child 4el$are 'eague :0PPS. (isking Connection. 1raumatic Stress Institute7 C1 1 &CC1. basic training $or $oster care 2roviders 1here are two other levels o$ $oster care utili?ed within C1E :ultidimensional 1reatment oster Care 5:!1 C6 o designed $or the 3uvenile 3ustice 2o2ulation o evidence based model7 rigorously evaluated and $ound to be e$$icacious11-on&line at www.mt$c.comB3ournalParticles.html

,-

o model designed $or s2eci$ic age grou2s o 2rogram 2rovides close su2ervision. 2roviding $air and consistent limits. 2redictable outcomes $or breaking rules o im2lemented in a team modelE Program Su2ervisor. amily 1hera2ist. Individual 1hera2ist. skills trainer. and daily check&in sta$$. o Cehavior is monitored on a daily basis Pro$essional oster Care o trained. 2aid em2loyees o$ the child 2lacing agency o receives salary and bene$its in addition to monthly sti2end o ProsE intensive training. greater direct care o$ child. better 2re2ared to care $or more behaviorally challenged youth7 case managers are graduate level and higher7 internal access to 2sychiatry services. medication management. and behaviorists o ConsE $inancial disincentive to move towards 2ermanent goal. i$ a22ro2riate7 $undamentally inter$eres with the conce2t o$ $amily o Several models across the country have shown 2romising results o unding model exam2leE K/---- annual salary to one 2arent who must be available to the child $ull&time7 co&2arent is not a 2aid em2loyee and may work outside the home.

o :onthly sti2end 2aid to $oster $amily to cover the cost o$ care $or the child %0 I is the only certi$ied agency to 2rovide the :!1 C model and $irst introduced the 2ro$essional 2arenting model in C1 in 1++/. 1here is one other agency. Institute o$ Pro$essional Practice that 2rovides 2ro$essional $oster care services in C1. 1heir $unding rates are unknown at this time. 9ther oster Care (elated 9rgani?ations 1he Connecticut 0ssociation o$ oster and 0do2tive Parents 5C0 0P6 is a non&2ro$it organi?ation $unded by !C to 2rovide training. su22ort and advocacy to the $oster and ado2tive $amilies. both !C and 2rivately licensed. 8owever. their 2rimary $ocus is assisting the !e2artment with the recruitment and 2ost&licensing training o$ !C C9(E $amilies. 1hey have a sta$$ o$ 31 em2loyees and an annual budget o$ 1.++:.

Innovative )odel of Foster Care$ )ocking*ird Society

:ockingbird Society as a model o$ $oster care 5or Community 8omes6 is recommended $or $urther ex2loration. 1hey are not a child 2lacing agency7 they 2rovide technical assistance to child wel$are and 2rivate $oster care agencies to im2lement the model o$ care. 1he model is com2rised o$ Constellations with a 8ub 8ome that serves as res2ite. on&going su22ort and event coordination $or $amilies and youth. 0 constellation is recommended $or u2 to no more than 1- $amilies. 8owever. with higher acuity level youth. it is recommended that there be lower numbers o$ $amilies in the constellation. ,1

8ub 8omeE 1he 8ub 8ome 2arent is ty2ically an ex2erienced $oster 2arent who is 2aid a monthly sti2end $or their role. 1he monthly sti2end covers their role in 2roviding res2ite. su22ort services to constellation $amilies. and monthly activities. o (es2iteE (es2ite is the 2rimary $unction o$ the 8ub 8ome. 1he 8ub 8ome manages a monthly calendar o$ res2ite re)uests which come directly $rom the $amily. (es2ite may include days. evenings or overnight re)uests. o 0ctivities CoordinationE 1he 8ub 8ome 2arent also coordinates monthly activities to $acilitate a sense o$ community. 0ctivities may include a cook&out. game night. 2ot luck. etc. o 9n&going su22ortE in addition to the childHs social worker or case manager. the 8ub 8ome 2arent 2rovides on&going su22ort to the $amily that may include assisting with trans2ortation. visitation with siblings and 2eer mentoring to constellation $amilies. 1he child 2lacing agency is res2onsible $or recruiting. training and licensing the constellation $amilies. 8owever. the 8ub 8ome is o$ten a collaborative 2artner in this 2rocess. 1he child 2lacing agency also maintains the case management res2onsibilities. addresses clinical needs and o$$ers training to the $amilies and youth. 1he goal is to create a sense o$ community among the constellation. In discussion with the :ockingbird Society. there are o22ortunities $or $amilies and youth to develo2 relationshi2 among other members o$ the constellation7 thus. im2roving outcomes $or children in the model. In 2romoting 2ositive outcomes $or children. data has shown that this model has met or exceeded national standards in the areas o$ sa$ety. 2ermanency. well&being. and caregiver su22ort. In the ,--+ :ockingbird amily :odel 5: :6 :anagement (e2ort the $ollowing outcomes were notedE Child Sa$ety o 1here were ?ero CPS re$errals $or caregivers in the : : Constellations Permanency o ,1< o$ youth achieved their 2ermanency goals or made moves that were consistent with achieving 2ermanency. o Child 4ell&Ceing o Placement StabilityE 2lacement #3< o$ : : youth ex2erienced ?ero changes in

o In ,--+. 1< o$ Constellation youth ran away $rom 2lacement Cuilding Strong Community Connections o +1< o$ youth 2artici2ated in 8ub 8ome organi?ed social activities Caregiver Su22ort ,,

o (etention o$ : : $amilies at ##<. 1he national estimate is between 3-&5-< o$ licensed $oster homes are lost each year. 1he high utili?ation o$ res2ite is considered a contributory $actor. 1hese outcomes mirror the goals outlined by the !C Commissioner in the =4e 0ll %eed Somebody> re2ort. 1he :ockingbird Society has been re2licated with 2o2ulations similar to !C C9(E $oster care and 1 C level $oster care. 1here have not been any sites that re2licated the model s2eci$ically $or !:S1 although there is one agency is Seattle. 40 ex2loring the o2tion.

B.

&eferral+ )atching and (lacement (rocess

1here are no $oster care beds through !C and the 2rivate 2rovider network that can assume non&!C involved youth. 0ll youth re$erred must have some level o$ legal involvement or be acce2ted into the Goluntarily Services Program outlined in section IIa. !C is res2onsible $or com2leting all re$errals $or $oster care. I$ there is a )uestion regarding the level o$ a22ro2riate care re)uired. the !C S4 com2letes a 1EI 5unknown acronym6. an inventory o$ 2lacement ex2eriences. at risk behaviors. clinical interventions. academic 2er$ormance. and social $unctioning. Cased on the scoring. a youth may or may not be eligible $or thera2eutic level $oster care 51 C6. 9n occasion. the local o$$ice will re)uest a clinical review to override the score $or 2lacement into 1 C care. or youth that score exce2tionally high yet still a22ro2riate $or thera2eutic $oster care will be re$erred to the two 2ro$essional 2arenting 2rograms and re$erred to as 1 C&Enhanced 51 C&E6. !C has a structured division. oster and 0do2tive Services Lnit 5 0SL6 in each o$ the 1/ local o$$ices. 1hey 2rovide the recruitment. licensing. training and su22ort to !C C9(E $oster $amilies. 0dditionally. they are res2onsible $or matching re$erred youth to their own homes. or youth that )uali$y $or 1 C or 1 C&E. the re$errals. along with the 1EI are submitted to the !C 'iaison and the S0'0 coordinator. In the most recent contract design $or 1 C. !C su22orted the develo2ment o$ the S0'0 5Service 0rea 'ead 0gency611. 0 se2arate contract was awarded to one agency in each o$ the then $ive regions to serve as the gatekee2er $or all 1 C and 1 C&E re$errals. 1he S0'0 is res2onsible $or gathering data on the number. ty2e and dis2osition o$ re$errals. Cecause o$ contract language. there are time$rames in which youth are ex2ected to match and transitioned into their identi$ied $amily. 1he broader goal is that within /5 days o$ the re$erral. youth will be matched and 2laced. 0s the acuity level o$ youth being re$erred increase. there is a longer wait time to match youth with a22ro2riate $amilies. 0t the 2resent time. there is an increase o$ youth 2resented $or 1 C and 1 C&E as the Commissioner moves $orward with the (ightsi?ing and (edesign o$ congregate care settings. Each 2rovider agency 2artici2ates in S0'0Hs that serve their catchment areas. 9n a weekly basis. new re$errals are 2resented. unmatched youth are reviewed. status u2dates on the 2re&2lacement o$ youth is 2rovided and 2resentation o$ any 2ending disru2tions within the !C 2rogram are made. 0s youth are 2resented. 2rivate agencies o$$er any $amily resources that may be available. ask $or more in$ormation or decline 2lacement. 0t the time in which a $amily is o$$ered. !C reviews the $amily 2ro$ile and acce2ts or denies the 2lacement. !enial o$ o$$ered resource re)uires clinical reasoning7 however. it is o$ten noted that !C will re$use a $amily based on location. i.e.. too $ar $rom community o$ origin. In some circumstances. this is an a22ro2riate denial. 111he S0'0 is currently $unded by the 2rivate 2roviders7 rates are established based on the number o$ contracted slots.

,3

8owever. $or this targeted 2o2ulation. this would be highly recommended to minimi?e sa$ety and access. !uring the licensing 2rocess $amilies com2lete a Ca2acity 0ssessment with the licensing s2ecialist. 0t this time the $amily and licensing s2ecialist review all the 2otential behaviors during 2lacement. (ecommendations $or age. gender. behavioral characteristics are develo2ed into a 2ro$ile to $acilitate the matching 2rocess. 9nce 2laced into 1 C or 1 C&E level $oster care. the $amily and youth receive a high level o$ case management services as outlined in the 2revious section. 1he ex2ectation $or 1 C $oster care 2roviders is that they are willing. able and ex2ect to manage more behaviorally challenged youth. 1here$ore. there is a higher ex2ectation that 1 C $amilies will 2roduce lower disru2tion 5un2lanned discharges6 rates. 0lthough the data has not been released $or " ,-11&,-1,7 anecdotally. this a22ears to be true in com2arison to !C C9(E $amilies. Intersection with !:S1 !uring a S0'0 2resentation. the !C Social 4orker andBor treating clinician 2rovide a detailed history and clinical recommendations $or an a22ro2riate 2lacement. 0s noted by one interviewee. there has been an increase in the number o$ re$errals identi$ying at minimum risk o$ tra$$icking. 8owever. there a22ears to be a lack o$ coordination and sharing o$ in$ormation o$ identi$ied or sus2ected tra$$icking victims. In a recent S0'0 2resentation. a youth known to one o$ the 2rivate 2rovider agencies had knowledge that there was an o2en investigation regarding !:S1 as it is sus2ected that she was recruited $rom the 2rivate 2roviderHs $oster home. 4hen asked by the 2rivate 2rovider agencies the status. clinical needs. and recommendation7 there was a dead silence and the 2resenters became uncom$ortable. 1he !C S4 indicated that she had not had any communication with !C 80(1 and was unaware o$ what clinical and sa$ety measures may be needed. 0s earlier stated. among 1 C 2roviders. it is re2orted that there has been little e$$ort by !C to include 2rovider agencies in the training and ca2acity building to ade)uately serve these youth although they are automatically classi$ied as 1 C due to the tra$$icking. or some 1 C $oster $amilies. thera2y is 2rovided outside o$ the home. Case managers 2rovide clinical su22ort to the youth and the $amily but the delivery o$ individual and $amily work is through out2atient clinics. :any 1 C 2roviders o$$er only basic evidence based trauma a22roaches to their sta$$ and minimally to their $amilies. 9$ the agencies utili?ing clinical services $or their youth. there is little em2hasis on securing a clinician trained in trauma based treatment.

,/

C. %icensing &egulations Similar to congregate care settings. 2rivate agencies who wish to 2rovide $oster care services must be licensed by !C . In addition to the regulations $or child 2lacing agencies 5CP06. $oster care $amilies are re)uired to be licensed. Coth re)uirements are outlined in this section in 022endix F. 1he 2rocess $rom becoming a licensed CP0 is the same as $or congregate care settings. 1he regulations set $orth regarding the licensing o$ $oster 2arents are the core com2onents to issues a CP0 license7 however. due to the level o$ care re)uired by re$erred youth. the assessment o$ $oster 2arent thera2eutic ability is a considered $actor. a( *oster Parent Screening ; 0ssessment Process $or the thera2eutic level $oster care 2rogram and will adhere to !C 2olicies and Connecticut Feneral Statutes. Pros2ective $amilies are engaged in the screening and assessment 2rocess to determine their suitability $or 2roviding $oster andBor res2ite care. @lingberg views this as an o22ortunity $or mutual assessment. 1he ste2s $or a $amily seeking licensure are7 Initial screening o$ basic re)uirements $or eligibility and 2rogram descri2tion7 8ome 0ssessment with 'icensing S2ecialists to assess and review the 022lication $or oster Care7 interview o$ $amily members $or motivation7 eligibility $or licensure or identi$ication o$ 2otential barriers7 licensing 2rocess and commitment7 clinical needs o$ youth re$erred to 1 C7 and Casey oster 022licant Inventory. 1here is a $ocus on each $amilyHs availability to 2rovide ,/B* su22ort to the youth in its care and ability to engage in intensive clinical service delivery and weekly 2artici2ation in clinical skills training i$ re)uired. 0ssessment $or suitability $or licensure continues throughout the 2re&service training and licensing 2rocess. b( 0gency Licensing Process" 6ome Study" and Practices9Policies 7he licensin! "rocess is one of mutual assessment, that includes9 Pros2ective amilies are re)uired to attend a minimum o$ 3* hours o$ 2re&service training and 2arenting skills education. Concurrent with the 2re&licensing training re)uirements. all $amily members engage in a series o$ 2ersonal interviews 5minimum o$ three6. Interviews are conducted individually and as a $amily unit. as a22ro2riate. Physical ins2ection o$ the home to ensure com2liance with licensing regulations. Each adult household member must submit three 2ersonal re$erences that address hisBher ex2erience and ability to care $or children. 0dult cou2les in the household must 2rovide at least one re$erence that s2eaks to the stability o$ the relationshi2 and each individualHs ability to co&2arent. 0ll re$erences are veri$ied. Cackground checks $or individuals over the age o$ 1AE CI $inger2rinting7 state and local 2olice checks7 Sexual 9$$ender (egistry check7 Child Protective Services 5CPS6 background checks7 civil court 2roceedings. $inancial statements7 :edical statements and educational statements. as a22ro2riate. 0ny deviation in any o$ the background checks results in $urther ex2loration to determine the 2otential im2act on licensure. I$ there are adult children who reside outside o$ the home or other regular visitors to the $amily household. they are incor2orated into ,5

the home study 2rocess and are re)uired to be interviewed and submit to the local and state criminal. CPS and Sex 9$$ender (egistry background checks. 1he 'icensing S2ecialist reviews and incor2orates the $eedback $rom 2re&licensing training. homework assignments. content o$ the 2ersonal interviews. re$erences. and su22orting documents to develo2 a detailed home study and make a $inal recommendation $or licensure. 1o clari$y. this model assumes that the $oster $amily has sa$e and stable housing. I$ a model 2rogram 2rovides the $oster $amily with an agency&owned home. it may be licensed as a congregate care 2rogram. 9ngoing su22ort and training re)uirements were 2reviously cited. 'icenses are valid $or two years at which time. the $amily submits their a22lication $or re&a22roval and a new study is com2leted.

,A

I+(

,ducational Planning for 6omeless /out < DC* and -on.DC* involved

S2ecial educational 2lanning and $unding considerations are re)uired when ex2loring the develo2ment o$ housing and care $acilities $or !C and %on&!C youth. 1he :c@inney&Gento 0ct. 1+#*. 2rovides grants to state educational agencies to ensure that children and youth ex2eriencing homelessness have the same access to education 2rovided to all children. 1he :c@inney&Gento 0ct de$ines Mhomeless children and youthH as individuals who lack a $ixed. regular. and ade)uate nighttime residence. 1his includes1,E Children and youth who areE & sharing the housing o$ other 2ersons due to loss o$ housing. economic hardshi2. or a similar reason 5sometimes re$erred to as dou*led# u!67 & living in motels. hotels. trailer 2arks. or cam2ing grounds due to lack o$ alternative ade)uate accommodations7 & living in emergency or transitional shelters7 & abandoned in hos2itals7 or & awaiting $oster care 2lacement7 Q Children and youth who have a 2rimary nighttime residence that is a 2ublic or 2rivate 2lace not designed $or. or ordinarily used as. a regular slee2ing accommodation $or human beings7 Q Children and youth who are living in cars. 2arks. 2ublic s2aces. abandoned buildings. substandard housing. bus or train stations. or similar settings7 and :igratory children who )uali$y as homeless because they are living in circumstances described above. In ,--1. under %o Child 'e$t Cehind 'egislation. the :c@inney&Gento 0ct was reauthori?ed with the $ollowing re)uirements 5see 022endix 8613E Q ,-!ress !rohi*ition against segregating homeless students N 1he statute ex2ressly 2rohibits a school or State $rom segregating a homeless child or youth in a se2arate school. or in a se2arate 2rogram within a school. based on the child or youthHs status as homeless. Q &e'uirement for trans!ortation to and from school of originN 1he State and its local educational agencies 5'E0s6 must ado2t 2olicies and 2ractices to ensure that trans2ortation is 2rovided. at the re)uest o$ the 2arent or guardian 5or in the case o$ the unaccom2anied youth. the liaison6 to and $rom the school o$ origin. 1here are s2eci$ic 2rovisions regarding the res2onsibility and costs $or trans2ortation. Q Immediate school enrollment re'uirement N I$ a dis2ute arises over school selection or 2lacement. an 'E0 must admit a homeless child or youth to the school in which enrollment is sought by the 2arent or guardian. 2ending resolution o$ the dis2ute. Q Changes in .*est interest/ determination 0 'E0s must make school 2lacement determinations on the basis o$ the =best interest> o$ the child or youth. In determining what is a child or youthHs best interest. an 'E0 must. to the extent $easible. kee2 a
1,Education $or 8omeless Children and "outh Program7 Lnited States !e2artment o$ Education. ,--/7 2. ,.

13Education $or 8omeless Children and "outh Program7 Lnited States !e2artment o$ Education. ,--/7 2. 3.

,*

homeless child or youth in the school o$ origin. unless doing so is contrary to the wishes o$ the child or youthHs 2arent or guardian. Q %ocal liaison in all school districts N Every 'E0. whether or not it receives a :c@inney& Gento subgrant. must designate a local liaison $or homeless children and youth. "outh being served in non&!C runaway and homeless youth 2rograms are covered under the :c@inney&Gento 0ct. or youth 2laced in the custody o$ !C . there is have limited coverage. In a :emorandum issued dated ebruary 15. ,--5. by the Commissioners o$ !C and State !e2artment o$ Education 5S!E6 an agreement was reached =that all children in !C custody 2laced in emergency or transitional shelter 2lacements are entitled to and will be a$$orded the 2rotections 2rovided by :c@inney&Gento.> 1his was also ex2anded to children and youth who are in the transitioning 2hase into new $oster care setting u2 to 3- days. Educational ;urisdiction or youth that are in !C custody and a non&transitional or emergency setting. !C is re)uired to noti$y the 'E0 5'ocal Educational 0gency6 via !C &A-3 5see 022endix I6. 1his document identi$ies that the child is 2laced in a !C setting and identi$ies the youth as %exus or %o& %exus. 1his %exus status to identi$y as it assigns the legal and $inancial obligation $or the 2ayment o$ educational services to the a22ro2riate school district. %exus is determined by the legal and 2ermanent address o$ a 2arent or guardian. even i$ the youth does not reside in their home. %o&%exus status may be assigned based on the $ollowing criteriaE whereabouts unknown. no Connecticut residence. 2arental rights have been terminated. deceased. identity unknown or currently incarcerated or treatment $acility and does not maintain a C1 residence. In cases o$ regular education students. there is ty2ically little im2act on the receiving school district $or %exus and %o&%exus youth. 8owever. when a student is designated as s2ecial education eligible. the %exus district is $inancially and legally obligated to $und and coordinate the service delivery. %o&%exus youth become the $inancially and legal res2onsibility o$ the town in which the youth reside. or consideration o$ congregate care settings. ?oning o$ 2rograms have been denied by towns i$ limitations on the number o$ %o&%exus youth were not negotiated. or exam2le. ?oning $or a six bed grou2 home may be re)uired to limit the number o$ %o&%exus youth. 1his a22ears to be 2articularly true in towns with limited s2ecial educational 2rogramming. or congregate 2rogramming. the S!E a22roves all educational 2lans. 1he 'E0 is the district that a22roves out o$ district 2lacement or alternative educational 2rogramming $or individual youth. Connecticut does not routinely authori?e youth in !C custody to be homeschooled. Educational Surrogate Parents or children and youth that are in the care o$ !C . !C is res2onsible to ensure that an educational surrogate 2arent is assigned who are eligible1/. 0n educational surrogate 2arent is an 1/CO"". 1,". S2A2. 345#67f through 45#67k8and 349a#:;l<. ,#

individual a22ointed by the State !e2artment o$ Education to service as the educational advocate $or the child in lieu o$ the youthHs 2arent. 1he surrogate 2arentHs attendance is re)uired $or all matters related to s2ecial education services. including re$errals. evaluations and the develo2ment o$ Individual Education Plans. 0 youth is eligible i$E 1. the child re)uires. or may re)uire. s2ecial education or early intervention services and

at least one o$ the $ollowing is a22licableE

o o

1he Commissioner o$ !C has been a22ointed as the childHs guardian or statutory 2arent the childHs 2arent or guardian

cannot be identi$ied cannot be located is unavailable to re2resent the child regarding s2ecial education or early intervention services and agrees. or $ails to ob3ect. to the a22ointment o$ a surrogate 2arent.

or youth that are not in !C custody. homeless youth are guided by the 8omeless 'iaison assigned to each school district. 1he 'iaison is res2onsible to a22ly $or the a22ointment o$ a surrogate 2arent. or victims o$ sex tra$$icking. understanding the educational rights is critical as it has noted in some literature the existence o$ a correlation between school related 2roblems. s2eci$ically learning disabilities and sexual ex2loitation. 4ithout the knowledge o$ how advocate $or the educational rights o$ homeless. runaway and !C &involved youth. there is little o22ortunity to minimi?e this s2eci$ic risk $actor. Im2act on 8igher Education Lnaccom2anied youth are considered inde2endent students or youth that have been in $oster care any time a$ter the age o$ 13 are automatically considered Minde2endent studentsH and can com2lete the 0 S0 without 2arental income or signature. 1hey may also be eligible $or $ee waivers $or the S01 exams.

,+

+( A.

0reas for *urt er ,xploration Best (ractices for the Clinical 2reatment of =ictims of uman 2rafficking

0lthough there has been little research on the best 2ractice standards o$ domestic minor sex tra$$icking victims. there is a growing body o$ research on the understanding o$ trauma. its im2act and recommendations $or treatment. 1rauma in$ormed care suggests that issues o$ sa$ety and reintegration cannot be achieved until the res2onses to trauma are treated. Post&trauma res2onses can result in the diagnosis o$ Post&1raumatic Stress !isorder 5P1S!6. P1S!. once reserved $or war veterans and disaster victims. a22lies to victims o$ other traumas. 1here$ore. reviewing the evidence based models recommended $or the treatment o$ P1S! a22ears to be the most $itting. In researching a best 2ractice model $or the treatment o$ domestic minor tra$$icking victims. the critical com2onent $or services to be trauma&in$ormed. 1raditional models o$ talk thera2y are o$ten not e)ui22ed to meet the needs o$ this 2o2ulation. 1here are a number o$ recommended evidence&based thera2eutic models $or treatment o$ P1S! and similar sym2toms and are generally based on cognitive. behavioral or 2sychodynamic theories o$ treatment. !ue to the com2lexity o$ the trauma ex2erienced. there is not one 2rescri2tive evidence&based model to re$erence. 8owever. in com2arison with the treatment o$ P1S!. success$ul o2tions include E ,vidence.2ased T erapeutic Treatment 'ptions for PTSD Cognitive T erapy 0ims to challenge dys$unctional thoughts based on irrational or illogical assum2tions. Cognitive.2e avioral T erapy 51 &CC1 N 1rauma ocused Cognitive Cehavioral 1hera2y6 Combines cognitive thera2y with behavioral interventions such as ex2osure thera2y. thought sto22ing. or breathing techni)ues. ,xposure T erapy 0ims to reduce anxiety and $ear through con$rontation o$ thoughts 5imaginal ex2osure6 or actual situations 5in vivo ex2osure6 related to the trauma. ,ye Movement Desensiti=ation and 1eprocessing Combines general clinical 2ractice with brie$ imaginal ex2osure and cognitive restructuring 5ra2id eye movement is induced during the imaginal ex2osure and cognitive restructuring 2hases6. Stress Inoculation Training Combines 2sycho&education with anxiety management techni)ues such as relaxation training. breathing retraining. and thought sto22ing. 5(auch J Cahill. ,--36 1here are several models currently under develo2ment $or modi$ication and evaluation o$ im2act on adolescent $emales. 8owever. one model. Seeking Sa$ety. 2resented with 2reliminary 2ositive outcomes. Seeking Sa$ety is a ,5&session manuali?ed intervention $or mental health. trauma sym2toms and substance abuse15. 0lthough a relatively small sam2le si?e. there was signi$icantly better outcomes 2ost&treatment than treatment as usual grou2s. including decreased substance use. trauma sym2toms and im2rovement in cognitive measures o$ P1S! sym2toms. Carriers to securing treatment servicesE
15htt2EBBwww.seekingsa$ety.orgB*&11&-3<,-artsB*&-A<,-adol&bu<,-nds<,-cite.2d$

3-

Con$identialityE "outh in Connecticut can seek mental health treatment without the consent o$ their guardian $or u2 to six sessions. 1he only exce2tion is i$ the 2rovider believes that noti$ication would be seriously detrimental to the minors well being. 1A 8owever. i$ the guardian is not in$ormed o$ the out2atient treatment services. they are not liable $or the costs o$ treatment. 1here$ore. securing treatment services $or 2rivately $unded services may become a barrier. In addition. many insurance carriers. including 2rivate and :edicaid. do not cover all home based clinical services. 4hile there are $ew exce2tions7 these services are re)uire 2re&authori?ation and are ty2ically evidenced based models such as IIC0PS. :! 1. which do not meet the needs o$ tra$$icking victims. 'ack o$ Com2lianceE !ue to the o$ten transience o$ the 2o2ulation. there is di$$iculty in $ul$illing weekly scheduled a22ointments. :any 2roviders will discharge a client a$ter three Mno& showH a22ointments as this is seen as non&com2liance with service delivery. 'ack o$ skilled cliniciansE Fiven that this is a growing area o$ awareness. it is likely that !:S1 will $ind it di$$icult to locate clinicians that have the skill set necessary to begin the healing 2rocess. 1his is evidenced by surveying 2ro$essionals in the $ield who they themselves were challenged to identi$y a resource they would likely re$er to i$ needed. 4hile there are clinicians trained in the models above. not all are ex2erienced with the adolescent 2o2ulation nor with !:S1.

B.

)odels of Intensive Case )anagement

4hile understanding e$$ective clinical methods. 2erha2s the most crucial com2onent to the success o$ treatment $or tra$$icking victims is based on the develo2ment o$ a meaning$ul connection and relationshi21*. 1hrough examination o$ well&established 2rograms such as FE:S. S0FE and CE0SE. com2rehensive case management services are e$$ective yet the most im2ortant as2ect is the )uality o$ the relationshi2 with the case manager1#. 4hile 2ro$essionals agree that com2rehensive case management models 2rovide greater level o$ su22ort there are barriers to the im2lementation that includeE di$$iculty in $unding sources. di$$iculty in establishing collaborative relationshi2s and lack o$ available resources. 0n additional barrier that is 2resent in the current child wel$are system. 4hen a youth is 2laced in a 1 C level $oster home. the youth is 2rovided with intensive case management and su22ort. I$ the 2lacement is not success$ul or the youth transitions to another setting. the case management services end. 4hile in some cases this may be a celebratory event. $or victims o$ tra$$icking there would a22ear to be bene$it to maintaining a consistent case manager that moves throughout the system regardless o$ 2lacement. even i$ youth is engaged high risk activity. 0 case exam2le is that o$ a 1A year old youth who s2iraled downward emotionally7 she had a history o$ high risk sexual behaviors and had been sexually
1AConn. Fen Stat. R1+a&1/c

1*L.S. !e2artment o$ 8ealth and 8uman Services. 8uman 1ra$$icking Into and 4ithin the Lnited StatesE 0 review o$ the 'iterature

1#L.S. !e2artment o$ 8ealth and 8uman Services. 8uman 1ra$$icking Into and 4ithin the Lnited StatesE 0 review o$ the 'iterature7 2. 3,

31

assaulted on more than one occasion. 8er aggression escalated when she was dis2laced $rom her 2re&ado2tive $amily when another relative moved in. She had lost contact with her biological $amily and now lost her ado2tive $amily. In the midst o$ all this. she was engaging in risky sexual behavior. i.e.. texting nude 2hotos. She was 2laced in a tem2orary shelter bed and became increasingly aggressive. 0s she was no longer returning to the ado2tive $amily. the 1 C case manager had to close out her case. 0$ter six months o$ residential treatment. the same youth was re$erred to 1 C. 1he same agency assumed the case. re)uesting to recruit a $amily s2eci$ically $or her. L2on their $irst meeting. the youth asked the case manager why she abandoned her when all M>those horrible things ha22ened to meS are you ashamed o$ meS> 0lthough 2roviding intensive case management may not have 2revented the traumatic ex2eriences7 she would have had one less trauma to heal and relationshi2 to re2air. In addition. the case manager was able to start in a 2lace o$ strengths as she already had a relationshi2 with the youth. 1his allowed their relationshi2 to solidi$y more )uickly and allowed the two o$ them to $ocus on the issues at hand such as kee2ing sa$e and $inding a 2ermanent $amily. %oteE urther ex2loration o$ intensive case management models stemming $rom the disci2lines serving domestic violence victims and homeless youth is recommended. 1he clinical treatment model itsel$ does not a22ear to be the sole core com2onent o$ 2roviding success$ul interventions7 much thought and consideration should be given to the 2rogram design. !esigns that may include sense o$ sa$ety. both 2hysically and emotionally. increased ca2acity o$ housing 2rograms $or length o$ stay and ability to work with the client at whatever stage she is at and the ability to assist in navigating the varied systems that become involved with tra$$icking cases. or the 2ur2oses o$ 2rogram management. $urther ex2loration into the 8arm (eduction :odel7 commonly used in substance abuse treatment. while working towards the goal o$ sa$e behaviors. this model seeks to look at behaviors and determine how to minimi?e the risk i$ acted u2on. 1he 8arm (eduction model utili?es motivational interviewing techni)ues $rom the Stages o$ Change model and that choice is 2art o$ recovery7 and di$$icult conce2t $or !:S1 survivors. Exam2le maybe while a youth is not given 2ermission to 049'. the likelihood a !:S1 youth consistently stated heBshe were going to leave. Ceing able to discuss the event with the youth can allow the youth to sa$ety 2lan. think ahead o$ the 2otential conse)uences may minimi?e the risk events. even i$ the 049' occurs. 1his would be 2articularly use$ul in assisting 2rograms to develo2 2rogram 2olicies1+.

C.

,ngagement with intersecting service systems

!omestic GiolenceE 1hrough this 2rocess. I $ound only 2eri2heral discussions among service 2roviders $rom domestic violence and human tra$$icking although victims share many o$ the same characteristics. 4hile there has been some integration o$ the material in 2ublished materials. there was a lack o$ res2onse $rom the C1 domestic violence advocacy community. Lnknowing
1+htt2EBBdocuments.csh.orgBdocumentsBmiBhousing$irstB8arm(educCom:odel.2d$

3,

the current status o$ collaborative e$$orts made by 'ove1/A. I would recommend continued attem2ts to engage with both CC0!G 5C1 Coalition 0gainst !omestic Giolence6 and with !ave :andel. :andel 0ssociates. CC0!G may be able to 2rovide a national 2ers2ective on the intersection and collaborative e$$orts between the two 2o2ulations. htt2EBBwww.ctcadv.orgB !ave :andel. :andel 0ssociates htt2EBBwww.endingviolence.comB PhoneE 5#A-6 31+& -+AA !ave :andel has established a $ormali?ed 2resence within !C to 2rovide training and consultation $or !C sta$$. 8e has ex2erience in working with both victims and batterers in domestic violence cases. Each local o$$ice is sta$$ed with a !G consultant who is available to 2rovide case consultation. assist in assessment and sa$ety 2lanning. Fiven the commonalities o$ the victims this may be an excellent resource to ta2 into 2roviding a more visible consultative role within the !C community and the community at large.

D.

)edicaid &eim*ursement

0ll youth involved with !C are covered under :edicaid 58LS@"6 insurance. In 2roviding any level o$ clinical care. there is the ability to receive reimbursement. In addition. any 2rivately $unded 2lacement may have health insurance which may reimburse $or a com2onent o$ the clinical services delivered. In consideration o$ any clinical service delivery. it would be bene$icial to obtain additional consultation on the eligibility re)uirements. It should be noted that when treatment is insurance driven. there are o$ten restrictions on length o$ stay and a22roved service delivery. It is suggested that the any reimbursement received be secondary to the $unding allocations.

33

+(

1ecommendations

In synthesi?ing the in$ormation 2resented. there were three emerging themes garnered $rom 2ro$essional ex2erience. interviews with community stakeholders. and a review o$ 2romising 2ractices $or clinical intervention and 2rogram designs. 0( T10I-I-8 0-D C'-S>LT0TI'- S,1+IC,S 1here was an overwhelming res2onse $rom all realms o$ service delivery that there continues to be a need $or awareness raising. training o22ortunities and case consultation services. In the surveys conducted. des2ite being 2ractioners on the ground level. many were only had a very basic knowledge o$ sex tra$$icking. :ore concerning is that as service 2roviders. most lacked the skill to identi$y signs o$ tra$$icking. assess $or risk $actors. and 2rovide a22ro2riate interventions i$ re)uired. 4hile !C has continued to move $orward with the develo2ment o$ curriculum. there a22ears to be large ga2 in many service areas7 2articular in sectors that are not congregate care&$ocused or non&!C involved. 1rainingE 1. Provide two&$our statewide training o22ortunities $or all thera2eutic level $oster care 2rograms. 1here are 1# 2rivate 2rovider agencies that service the entire state. 0gencies $rom Plainville. 8art$ord. !anbury and :il$ord have all ex2ressed interest in coordinating statewide or regional events. 'ove1/A could charge a $ee $or this training. 1arget audience would be both $oster 2arents and 1 C sta$$. ,. Provide training $or Community Cased 'i$e Skills 5CC'S6 Program Educators. CC'S is a !C $unded 2rogram $or youth ages 15&,1 in the custody o$ !C . Classroom and individuali?ed curriculum 2re2are youth $or sel$&su$$iciency. 1hese are well $unded 2rograms and can utili?e $unds $or training. 3. Ex2and to !C C9(E oster Care Systems. 1hey will not have a budget to $und 5or very small6 but it is good P(. Consider collaboration with C0 0P 5www.ca$a2.org 7 ;ean ioiretti. Exec. !irector7 #A-.,5#.3/--6 to $und 2ost&licensing training. /. Provide ollow&u2 consultation to agencies that have had sta$$ trained. ;anus 8ouse re2orted that the agency would like to have a yearly re$resher7 2erha2s discuss s2eci$ic cases to better understand what areas o$ assessment needed im2rovement. unding is 2robably not available. 5. Ex2lore training $or both youth and sta$$ through ;uvenile (eview Coards. "outh Services Cureaus. CSS! is well $unded 2rogramming.

CurriculumE 1. Ex2lore models that have 2ublished data. 4hile :y 'i$e :y Choice is the 2re$erred curriculum. there have been no 2ublished results on the e$$ectiveness o$ the 2rogram. 0dditionally. while there is a ;(I 2rovides 1rain the 1rainer $or $acilitation. there is no measurement on the model7 ie. no observation o$ trainer ability.

3/

a. I$ this model continues to the be the 2re$erred curriculum. recommend engaging in dialogue with ;(I regarding e$$icacy o$ curriculum b. Consider creating new curriculum ,. 1here is no curriculum $or $oster 2arents on how to work with youth that have been tra$$icked. 1his is a much needed curriculum. 3. Incor2orate. i$ not already done so. hel2$ul strategies in a home setting to minimi?e risk to youth and to $amily. Consultation ServicesE 4hile !C has $ormed 80(1 in res2onse to identi$ied !:S1. my 2ro$essional ex2erience that there continues to be an internal disconnect between what occurs at Central 9$$ice 'evel and in the local area. 80(1 is available to 2rovide consultation on cases7 however. it is unclear i$ that is $or only identi$ied or cases re$erred to the Careline. It a22ears that there is a need to have an accessible resource in the local o$$ice to consult on cases. 2artici2ate in clinical team meetings and assist in the sa$ety 2lanning and assessment o$ 2otential cases. 1. Collaborate with !ave :andel. :andel 0ssociates and ex2lore a 2artner relationshi2 as he has existing sta$$ing model in !C . ,. 0ctively 2artici2ate in 80(1 meetings 3. !evelo2 white 2a2er on 2ro2osed service delivery as the 2re&cursor to an Intensive Case :anagement Program a. 4hen victim is identi$ied. 'ove1/A Consultant is assigned to the case. 1he consultant reviews the case record. including the recent re$erral. b. :ake contact with the !C worker to walk through the next ste2s7 ie. 2ending legal involvement. advise on how to engage with youth 2ost&disclosure and 2rovide any necessary su22orts. c. I$ a22ro2riate. visit with youth and com2lete assessment on clinical needs d. consult with clinical team to develo2 case management 2lan. e. meet with !C team bi&weekly7

Sta$$ingE consultantB2er diem Credentialed ServiceE a22lication and $ee schedule 1. Lnder category o$ Cehavior :anagement K5,Bhr 2e avior Management service is intended to develo2 or su22ort a thera2eutic behavior 2lan to be $ollowed by 2arents. caretakers. teachers andBor other service 2roviders. Includes 2re2aration o$ a written thera2eutic behavior 2lan designed to assist in the management o$ the childTs behavior. 35

,. DurationE /- hours or A- days whichever comes $irst 3. 1his would be well&targeted at youth transitioning into 1 C or !C C9(E oster Care $rom 0ssessment beds. (ecommendations o$ Community StakeholdersE 1. Runaway & Homeless Youth Coalition Stacey Violante Cote, Esq., MSW Director, een !e"al #$%ocacy Clinic Center &or Chil$ren's #$%ocacy () Eli*a+eth Street Hart&or$, C ,(1,) -.(,/ )0,1)230 4330 s%iolant56i$scounsel.or" 7e4t meetin" is sche$ule$ &or 893,913: contact has +een initiate$ 3. ;nte"ration with Court Su<<orte$ Ser%ices Di%ision & =u%enile =ustice System CSSD =u%enile >ro+ation <ro%i$es a &ull continuum o& monitorin", su<er%ision an$ re&erral ser%ices &or Delinquency, =u$icial an$ 7on =u$icial Cases, an$ ?amilies with Ser%ice 7ee$s -?WS7/ @u%eniles. CSSD a$ministers =u%enile Detention ser%ices in state run Centers that it o<erates in Hart&or$, 7ew Ha%en an$ Ari$"e<ort. he CSSD also a$ministers contracts &or three <ri%ately run all "irls' $etention centers locate$ in Hart&or$, Ham$en an$ 7orwal6. E4ecuti%e DirectorB William H. Car+one elB .(,1031131,,

DC? =u%enile =usticeB

Arett Ray&or$, Chil$ & #$olescent De%elo<ment & >re%ention #$ministrator +rett.ray&or$5ct."o% #ntonio Donis, >ro"ram Mana"er #ntonio.$onis5ct."o%

Policy !evelo2ment and Program !esign

0s outlined in the 2rotocol $or becoming a licensed care $acility. accreditation is necessary. Currently Council on 0ccreditation is collaborating with !C to develo2 best 2ractice 2olicy $or 2rograms. 8owever. it is my im2ression that this e$$ort is stalled. I$ 'ove1/A considers moving $orward. then this would be o22ortunity to begin working with 2rivate agencies to look at their 2olicies and begin to dra$t measures that 2rovide 3A

sa$e. secure and consistent messages to all the residents. It would entail taking a current a22lication andBor 2rogram model and going through 2olicy by 2olicy. 1here are some basics like cell 2hone. use. 049' 2olicy. etc. :ore challenging would be grou2 2artici2ation and treatment 2rogress.

Community based Su22ort Services7 Community Cased In surveying the services. there is a lack o$ identi$ied clinically trained thera2eutic su22ort sta$$ to work with !:S1. Similar to the structure o$ youth dro2 in centers. allocated Msa$e ?onesH within central areas. Sta$$ 2rograms during evening and weekend hours. 0s the grou2 develo2s. and it will. o$$er trans2ortation $or youth to continue to 2artici2ate. 1his may be a o2en or closed grou2. structured or unstructured grou2. 1he research clearly identi$ies that 2eer su22ort. along with 2ositive relationshi2 with case manager. is essential in the healing 2rocess. 0dditional 2rogram considerations it to also house a mentoring 2rogram targeting the !:S1 2o2ulation. or mentoring o$ !C involved youth. there is a $ee $or service schedule and re)uires credentialing. or the youth dro2 in center. i$ designed as an a$terschool 2rogram. there may be $unding allocated through !C 7 also on a $ee $or service basis.

2( 6ousing Models
1he second emerging theme. and 2erha2s the most signi$icant. is the need $or sa$e. stable yet skilled housing sites $or !:S1. 1here are arguments on both ends o$ the s2ectrum with regard to congregate settings vs. $amily. community based. 1he research overwhelmingly suggests that success$ul treatment is achieved. at best. 1,&1# months and when in settings with 2eers o$ similar backgrounds. 1hat without the ability to address the trauma. there cannot be movement into success$ul integration into the community. 8owever. until a youth $eels sa$e. heBshe cannot begin to address the trauma. 4ithin the course o$ discussion o$ housing models. the third theme will be discussed. intensive case management service delivery.

Proposed Continuum of Care Model for Trafficking +ictims )it Integrated Case Management
0s we ex2lore this model. there will be discussion o$ how com2onents o$ this model may be achieved in stages. In brie$. Phase 9neE 0ssessment Ceds $or sa$ety and stabili?ation services. Clend o$ the (8" Shelter and the S10( 2rogram7 may be designed as host home 5licensed $oster 2arent6 with one youth or grou2 setting with no more than 5 residents i$ grou2 care. '9S 1-&,1 days. Phase ,E 1ransitional 8ousingE congregate setting 2re$erably in rural setting7 no more than 'CC $or A7 only acce2t 2lacement o$ 5. Consideration $or allocation o$ community beds which are not $unded by !C . 4ith maximum 2lacement o$ 5. one bed to remain o2en $or either emergency 2lacement or stabili?ation o$ youth 2laced in Phase 3E Community 8omes. Phase , is a more traditional thera2eutic grou2 home model. 8owever. the research would suggest that this model 3*

is e$$ective $or early treatment o$ survivors. (e$er to 022endix ; $or a sam2le Sco2e o$ Services $or thera2eutic grou2 model. 1he last 2hase. Phase 3 is Community 8omes. I highly recommend the ex2loration o$ the :ockingbird Society amily :odel. In theory. this 2rovides the balance o$ structure yet $luidity within a sa$e community that !:S1 victims would thrive in. 0gain. the model may contain all licensed $oster homes or a mixture o$ grou2 care 5hub home6 and $oster care 5constellation homes6. 1he S2eciali?ed Community 'iving :odel is 2rovided as an alternative sam2le that includes a sco2e o$ service and budget in$ormation. 1his model is similar to a host model with extensive clinical su22ort. 5re$er to olderE S2eciali?ed Community 'iving :odel6. Initial contact has been made with the organi?ation. Executive !irector. ;im 1heo$elis. 5,-A6 /-*&,131. It had been shared that there is an undisclosed agency in Seattle. 40 ex2loring this model $or the same 2o2ulation. 'astly. although not re2resented in the $low chart that in addition to the intensive case management services o$$ered throughout the course o$ 2lacement7 services may be o$$ered $or youth that leave the 2rogram through a$tercare services 52lanned discharge6 or as a result o$ a youth leaving the 2rogram. 9ne challenge as 2reviously mentioned. is that there is no o22ortunity to 2rovide continuity $or youth with regard to treatment and service delivery7 es2ecially when discharge $rom one 2rogram to another. Ceing able to $und 2rogram that would 2rovide outreach. at a minimum. $or a youth that has le$t the 2rogram would 2rovide additional o22ortunities $or intervention and I believe it would result in a greater chance $or returning to the 2rogram. Im2lementationE 0s an overall 2rogram model. this continuum o$ care can o$$er !:S1 consistency in values. treatment modalities. 2ractice models and sta$$ing. 1he Intensive Case :anager would be assigned at the time o$ entry into an assessment bed. 1he Case :anager would be able to $ollow the throughout all 2hases o$ treatment and 2lacement. 1his is the recommended model7 however. by 2artnering with existing 2rograms. I believe there would be greater o22ortunity to move this 2ro3ect $orward in a more timely $ashion. 4ithin the existing structure. there are two agencies that are 2roviding short&term assessment beds. 1wo beds are located in a sta$$&secured residential 2rogram run by %0 I and two are housed within the Cridge amily Centers S10( home. 1hrough the course o$ this assessment. there was extensive discussion with the S10( 2rogram manager. :ike (olnik. #A-&+*#&**+#. regarding his ex2erience and identi$ied needs within the current structure. 1he Cridge S10( 48 is currently receiving training $rom 'ove1/A. have ex2erienced care $or !:S1 victims. and ex2loring how to revise existing 2rogram structure to accommodate !:S1 2lacements. 1he Cridge also has one community bed allocated so there is the 2otential to serve three $emales at one time. 1hroughout our discussion. :ike indicated that the largest ga2 in services was long& term 2lacement. 8is 2rogram can accommodate youth u2 to 3- days. 8owever. a$ter 3- days. there are no skilled treatment beds in any level o$ care. 4ithin 3- days. the youth would be transitioned $rom the Cridge S10( assessment 2rogram into the CP0 $oster home. 1he second 2hase o$ im2lementation is to a currently licensed CP0 who would be willing to 2artner with 'ove1/A. 1his would 2rovide )uick access to an already licensed agency. 'ove1/A could subcontract the CP0 to actually sta$$ the 2rogram. 0 CP0 agency would have the skill and knowledge on the licensing. training and su22ort necessary $or 3#

this 2o2ulation. 1he redesign o$ an existing model would include the identi$ication o$ a22ro2riate treatment model. training $or $oster 2arents and sta$$. (ecommendations $or 2re&service and 2ost&licensing training includeE 9verview o$ the $oster care system. trauma&in$ormed 2ractices and detailed training on the im2act o$ sex tra$$icking on adolescents. 1here would be the need to redesign andBor create com2onents o$ the curriculum to meet the needs o$ this 2o2ulation. 1his should detail antici2ated trauma res2onses. Program and 2olicy design would need to be accommodating to the ex2ected res2onses $rom the youth. 1he current $oster care structure. as will all contracted 2rograms $rom !C . only reimburse $or the days service was 2rovided. It would be likely that a youth may 049' and there$ore. neither the agency nor the $amily receives reimbursement. 0ny new 2rogram structure should be able to 2rovide a $amily with the reimbursement rate during these 2eriods. Ideally. any youth. once acce2ted into the 2rogram would be able to move about the continuum based on their needs. or exam2le. a youth that 049'Hs and returns a$ter an extensive 2eriod o$ time. may re)uire stabili?ation. there$ore be returned to assessment bed and then transition to the 2revious $oster home. 4ith the :ockingbird Society model. i$ that youthHs 2revious home is not available. and is 2laced in another home. it would still be within the same constellation and hub home $amily7 there$ore rein$orcing the sense o$ community and belonging given that there is a high level o$ interaction between the constellation homes and hub home. 0 core value that would need to 2resent throughout the model. regardless o$ the 2hase o$ 2lacement. is that sa$ety is 2rimary and that there is no shame&based conse)uences. It should be ex2ected by all 2rogram sta$$. $oster care 2roviders. and community based 2roviders in the network that the target 2o2ulation may exhibit very di$$icult behaviors. Ltili?ing a trauma& in$ormed model o$ care would suggest that these behaviors are the same skills that have allowed them to survive whatever ex2eriences they may have encountered. 0n Intensive Case :anager would begin the work with the youth while 2laced at the Cridge S10( 2rogram and would assist in the transition to a Community 8ome 5or 1ransitional 'iving when available6. unding $or this Case :anager would be the res2onsibility o$ one agency although has access 5as a consultant6 to youth and 2artnering agencies while 2laced in within the network. 4ith an overall ca2acity o$ 1/ youth at any given time. ,&3 $ulltime case managers would be needed7 de2ending on location and 2roximity o$ 2rograms within one another. 0gain. the 1ransitional 'iving Program will be the most challenging 2rogram to license and negotiate a contract. including rate setting. 1here may be consideration in working with an agency that is licensed as thera2eutic grou2 home and re$ocus the 2o2ulation. 8owever. this is not a recommendation. 4hen changing models o$ treatment and 2o2ulation. buy&in $rom sta$$ is very di$$icult. Change is di$$icult $or sta$$ and to ensure that the model o$ care is consistent across all continuums. this may be very di$$icult when retooling congregate sco2e o$ services. 0lthough 'ove1/A may have the ca2ability to build their own $acility. the Cor2oration $or Inde2endent 'iving 5CI'6. a non&2ro$it organi?ation. has the skill and ex2ertise in develo2ment including converting existing 2ro2erties to meet licensing. ?oning and regulatory codes. 1his may be a consideration in securing a building. htt2EBBwww.cil.orgB Challenges and other considerationsE length o$ time re)uired to become licensed $or 1ransitional 'iving 2rogram 5or any other 2hase o$ the model i$ not utili?ing currently licensed agency6 negotiating length o$ stay $or youth with C1C8PBGalue 92tions 5$or !C $unded youth6 3+

converting an existing models o$ care re)uires extensive retraining o$ sta$$ and does not o2en new beds $or youth in need o2ening beds $or community youth7 not $unded by !C and would re)uire 2rivate $unding $or sustainability any 2ro2osed 2rogram $or $unding through !C should not exceed the minimum cost o$ current grou2 home $unding. educational 2lanning :edicaid (eimbursement re)uirements ex2loration $or the 2lacement o$ youth $rom other states

In addition to demonstrating strong 2artnershi2s. this level o$ collaboration would allow agencies to maximi?e resources and 2erha2s gain a )uicker gras2 on the growing trends and needs o$ the youth being 2laced. 0n additional note. there has been discussion o$ a new ( P to be issued $or 2o2ulation s2eci$ic $oster care. 8owever. it does not a22ear that it has been issued at this time. It would critical $or 'ove1/A to monitor the ( P re)uests to ensure that 2ro2osal is submitted $or the 2rocurement o$ service delivery. 0gain. this grant amount 51C!6. may not be su$$icient to $und the level o$ service delivery desired $or success$ul im2lementation and would be unlikely to cover the costs o$ non&!C youth. 1hroughout the course o$ this 2ro3ect it became evidently clear. that there is still much work to be done in raising 2ublic awareness. educating service 2roviders and reaching the youth 2o2ulation beyond those within the !C system7 however. I am ho2e$ul that there are seedlings o$ 2rogram designs that may be brought to $ruition and begin to identi$y. 2rovide and then evaluate the service delivery $or youth in C1. Duestions 0nsweredE 16 Is there a need $or housing and service delivery s2eci$ic to the !:S1 2o2ulationS a6 "es. "outh are being identi$ied in every level o$ care. including non&!C youth. Current treatment o2tions are limited and do not 2rovide s2eci$ic treatment interventions7 youth are 2laced in settings not e)ui22ed to manage the emotional and 2hysical sa$ety needs7 and current settings do not o$$er the bene$it o$ 2eer recovery. b6 In ,-1, alone. there have been ,- victims identi$ied. 1hey remain within the traditional model o$ care.
,6

Is $unding available to o$$set at least 2art o$ the costsS a6 "es. !C has $unding to covering the costs based on their current contract system. 8owever. as a 2rogram model is $urther develo2ed. the costs may not meet the desired outcomes. /-

b6 0ncillary 2rograms. ie. mentoring. case management. consultation. may be secured through other $unding sources
36

0re there agencies willing to 2artner with 'ove1/AS a6 "es. Several including the Cridge. @lingberg amily Centers are willing to engage in dialogue about 2roviding a continuum o$ care.

%ext Ste2sE 1. ;oin the C1 (unaway and 8omeless "outh Coalition to gain a better understanding o$ the needs o$ (8" 2o2ulation. ,. 0ctive 2artici2ation in 80(1Bcollaboration with !C to assess where 'ove1/A can 2rovide su22ort. 3 Ex2lore :ockingbird Society as a 2otential 2rogram model /. acilitate dialogue with the Cridge amily Centers to 2artner in 2roviding services to !:S1 5. Establish level o$ care and service delivery model to guide the budget7 develo2 menu o$ services at $ixed rate $or !C 7 underwrite the remaining costs

/1