live / 2014

Happy kids Healthy Families for a Better LA: bringing mental health into families homes.

Idea submitted in the My LA2050 Maker Challenge by Westside Infant-Family Network (WIN)

When kids are free of trauma and abuse, their brains form architecture key to lifelong physical, mental & social health--we know how to help

Please describe yourself.

Collaboration (partners are signed up and ready to hit the ground running!)

In one sentence, please describe your idea or project.

We bring high-quality psychotherapy and integrated basic services into families’ homes to help parents and children heal from trauma.

Does your project impact Los Angeles County?

Yes (benefits a region of LA County)

Which area(s) of LA does your project benefit?

  • South LA
  • Westside

What is your idea/project in more detail?

At WIN, we make psychotherapy house calls to kids and parents who are dealing with multiple traumas and poverty during the most critical point of brain development in the human lifespan. We coordinate our mental health therapy with the food, health care, early intervention and other services of our 3 partner agencies so families recover in a “nest” of integrated care. And it works: our kids overcome developmental delays, families have measurably stronger relationships, and our parents and less stressed and depressed. Plus, WIN provides over 700 hours of professional consultation to agencies throughout LA so they can better help families thrive–and we have an ongoing project with Harvard to create better outcomes for kids nationwide.

What will you do to implement this idea/project?

Through it’s therapy and consultation work WIN affects the lives of 1000s of individuals yearly, and the core of our program is our intensive clinical work: WIN will provide in-home, dyadic child-parent psychotherapy and individual therapy for parents along with integrated health, early care/education and social services through our referring partner agencies to 350-400 children, parents and family members annually. Our bilingual, master’s-level therapists will work with young children (prenatal through 3+) and parents whose relationships have been disrupted by trauma, neglect and mental illness to affect substantive, measurable improvement in 1) secure attachment, 2) children’s social, emotional and cognitive development, and 3) parental stress. While WIN therapists provide these direct services, our partner agency case managers ensure that families get intensive, cross-agency early care, social services and health clinic support before and throughout the therapeutic process, such that unmet basic needs don’t interrupt treatment. We will manage the entire network of services in “real time” via WIN’s innovative communications infrastructure and web-based data system to make sure families facing substantial challenges get what they need, when they need it, without the service barriers of an agency working in isolation, and without the “red tape” typical of cross-agency collaborations. Along with these services, WIN will help families build relationships and social networks though our monthly Family Night gatherings. And, in order to positively affect the lives of children and families beyond the geographic reach of our direct services, we will also provide professional-level early childhood mental health training to clinicians and providers throughout LA County, and mental health consultation to Early Head Start programs and other agencies, including Venice Family Clinic, Westside Children’s Center, El Nido Family Center, Pediatric Therapy Center and St. Joseph Center.

How will your idea/project help make LA the healthiest place to LIVE today? In 2050?

Just like adults, infants and toddlers suffer from mental health issues. But untreated, impacts can be far more pernicious and entrenched, developing into lifetimes of mental and physical illness, behavior and educational problems, with root causes deeply embedded in brain structures and chemistry. Children’s brains are particularly vulnerable to stress and trauma during this critical period from prenatal through three years old, when brain architectures are being formed, but therapy during this window is also more impactful than at other times in the human lifespan. WIN’s early therapeutic and case management interventions work to prevent long-term, ill effects for children and families, as well as ongoing social costs to educational, medical and legal systems.

Early childhood mental health issues are often caused or exacerbated by parental/caregiver lack of attunement, or abuse or neglect resulting from caregivers’ own depression, unresolved traumas or other mental health issues. By providing both in-home, child-parent dyadic therapy and individual therapy for parents, as well as critical, integrated basic services including health care, food pantry, employment training, and early intervention for special needs, WIN comprehensively addresses intergenerational mental health issues and unmet basic needs, while re-attuning child-parent relationships, building resilience, and helping families move on from past traumas.

Since the strongest indicator of the type of relationship a child will have with a parent, is the relationship that parent had with their parents, abuse and neglect have a tendency to move from generation to generation, bringing along with it the cognitive, mental health and physical health issues and societal costs associated with toxic stress (see Harvard University Center on the Developing Child’s research : However, if children are securely attached to parents, their brains are in the best possible position to develop to their full potential–and their children are highly likely to benefit from the same strong, resilient parenting. The research is clear: if every kid in LA has a happy childhood, LA becomes more creative, more innovative, less violent and a better place for all of us to live, in 2050–and beyond.

Whom will your project benefit?

WIN targets low-income families with children prenatal through three who are facing attachment issues across 26 Los Angeles Country zip codes from Inglewood to Hollywood, Venice to West LA. Annually, our intensive clinical program serves 350-400 individual children, parents and family members who are facing critical challenges (approximately 75-90 families). All (100%) of our clients are from low income families across 26 local zip codes including Inglewood and Mar Vista. Of current WIN clients, 83% are Latino (most are recent immigrants from Mexico and Central America who speak Spanish or indigenous languages); 2% are multiracial (Asian/African American/Latino); 5% are Caucasian; 8% are African American; and 2% have other ethnic backgrounds). We typically work with families for 12-18 months—and the process is an intensive one. Our consultation program provides 700 hours of direct service to 125-150 staff of 5 agencies in LA to affect the lives of 1000s of additional children and families annually.

Please identify any partners or collaborators who will work with you on this project.

Since 2006, WIN’s network partners have included Venice Family Clinic, Westside Children’s Center and St. Joseph Center. Respectively, they bring a host of high-quality medical care; early care and early intervention services; and food pantry, housing support and homelessness support to our shared clients. All of the families who come to WIN are referred from our three partners, and that allows us to ‘nest’ our intensive mental health care within the context of their home-agencies services. WIN’s partnership relationships are some of the most deeply rooted we’ve encountered, and are critical to our success with families.

All WIN families receiving therapy get a home visiting case manager from their home agency, as well as a Master’s level WIN therapist. Because WIN pays the salaries of partner-agency case managers, our web based data system rates services on a monthly basis, which helps ensure high quality care. Because WIN releases its clinical outcomes biannually, our partners know how their families are doing in our care.

Lead clinical staff from each agency and WIN meet to coordinate work at our monthly Program Committee Meetings, and partner agency case managers and supervisors, plus WIN therapists and our clinical director meet weekly for shared case reviews. WIN trains its partner agency staff with 20-40 hours of multi-disciplinary training each year, plus provides dedicated, weekly mental health consultation to the Early Head Start and/or programmatic staff of each of our partner agencies.

Thanks to WIN’s HIPAA-compliant data system (a system that has become the model for one the state of Connecticut has adopted for its early childhood mental health services), WIN and its partners coordinate care for each family though a jointly prepared on-line service plan that is updated by each agency regularly. The system reports monthly on how well we’re helping families achieve their goals, and allows staff to communicate in ‘real-time’ regarding family progress—as well as to coordinate care during emergencies. The system tabulates our biannual outcomes, gathering data input by staff at various levels from all partners, and reminds case managers and therapists when screenings, assessments and releases are due.

How will your project impact the LA2050 “Live” metrics?

  • Access to healthy food
  • Healthcare access
  • Rates of homelessness
  • Rates of mental illnesses
  • Prevalence of adverse childhood experience (Dream Metric)
  • Percentage of residents receiving coordinated healthcare services (Dream Metric)

Please elaborate on how your project will impact the above metrics.

Because WIN integrates its mental heath services with the health, social services, food and housing support, and early care and early intervention services of its three agency partners, WIN families are connected with a medical home and get integrated mental health care (in-home!). We work to ensure families are securely housed, receive food support, and that families have the skills and resources they need to shield their kids from abuse and neglect. Because families are deeply connected to WIN and our partners, even after goals are met, families can reconnect with WIN at any time if they face a crisis, need supplementary resources–or would just like reassurance and support as they raise their children.

Please explain how you will evaluate your project.

Our goals for children and families are based on substantial data demonstrating that children who are securely attached to their parents and caregivers are happier, healthier and do better in school, work and life over the long-term. WIN’s program goals are as follows: 1) children will be securely attached to their parents/caregivers; 2) if children enter with developmental delays, we will see substantial improvement; 3) parents will feel less stress and more competence in their roles as parents; 4) our network will proactively link families to the basic services they need to stabilize and improve their lives such that our therapy can be more effective; 5) and staff throughout the WIN network will be better able to identify, refer and provide services for families who are in need. We evaluate our work using the following indicators:

  1. Children will improve in developmental outcomes: 70% will show improvement in identified areas of concern after one year of WIN therapy, as screened by the Ages and Stages Questionnaire, administered every six months throughout program involvement.
  2. Children will increase in secure attachment behaviors: 70% will show an increase after one year of WIN therapy, as observed and reported by licensed clinicians and/or master’s-level therapists using the PIR-GAS (Parent-Infant Relationship Global Assessment Scale).
  3. Parents will feel less stress and anxiety: 70% of adults demonstrating need will improve after one year of WIN therapy, as screened by the Parenting Stress Index Short Form.
  4. Families will be successfully linked to services in the community: 60% of identified needs will be linked to services, as tracked through the case management needs assessment and case notes from each agency.
  5. Direct service staff will be better able to identify, refer and provide services for families: 75% will show increased knowledge and competency, as indicated by pre- and post- questionnaires collected at WIN-sponsored trainings.
    WIN outcomes are calculated biannually by our Clinical Information Systems Manager and our Clinical Director, using data gathered from the WIN Network. Data are collected on an ongoing basis, using our data tracking system, standardized screenings, assessments and interviews. We also ask families to rate our services through anonymous Parent Satisfaction Surveys, given to all client families biannually and upon graduation.

What two lessons have informed your solution or project?

  1. Just like adults, infants and toddlers suffer from mental health issues. But untreated, impacts can be far more pernicious and entrenched, developing into lifetimes of mental and physical illness, behavior and educational problems, with root causes deeply embedded in brain structures and chemistry. And children who have experienced early childhood trauma and adversity, the primary cause of early mental health issues, are three to fifty times more likely, depending on the severity and types of trauma, to develop severe mental health issues like psychosis, borderline personality disorder and paranoid schizophrenia than the general population—diagnoses that have been linked to recent tragedies around the country. Children’s brains are particularly vulnerable to stress and trauma during the critical period from prenatal through three years old, when brain architectures are being formed, but therapy during this window is also more impactful than at other times in the human lifespan. WIN’s early therapeutic and case management interventions work to prevent long-term, ill effects for children and families, as well as ongoing social costs to educational, medical and legal systems. (Sources: Danese, Pariante, Caspi, Taylor Poulton, 2007; R. P. Bentall, S. Wickham, M. Shevlin, F. Varese. Do Specific Early-Life Adversities Lead to Specific Symptoms of Psychosis? A Study from the 2007; The Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin, 2012; National Scientific Council on the Developing Child, 2008)
  2. In Los Angeles, there are few mental health services for the uninsured, and for the low-income insured, agencies have long waiting lists, limited services in languages other than English and restricted treatment duration. Within this landscape, WIN fills an important niche. We provide critically needed early childhood and infant mental health therapy in areas where so many families with young children are facing multiple challenges. However, unlike many programs, WIN’s therapy is based on treatment goals, not time-limits. Our services are provided by bilingual therapists, are free to all low-income families, regardless of insurance or immigration status, and are provided in-home to alleviate transportation barriers and improve outcomes.

Explain how implementing your project within the next twelve months is an achievable goal.

WIN is an ongoing project, and since launching in 2006, WIN has annually met and/or exceeded its goals. WIN’s highly trained, bilingual therapy staff, as well as partner agency case managers trained by WIN, work in-home with families identified by our partner agencies using a combination of: 1) child-parent dyadic therapy, 2) adult individual therapy for parents, and/or 3) intensive, in-home, cross-agency case management for basic needs, to meet clinical and life goals established by families to ensure that their children are able to thrive in safe, nurturing homes. WIN will use its deep, collaborative infrastructure to ensure that all partners are working together with families to deliver seamless health, mental health, social services and early education such that families can make real, substantive gains.

Please list at least two major barriers/challenges you anticipate. What is your strategy for ensuring a successful implementation?

Risks & Limitations: As demonstrated above, WIN is effective at increasing childhood developmental-educational and child-parent attachment outcomes for families that receive a year or more of child-parent psychotherapy. However, the long-term effectiveness of our work may be limited by the following factors: a. Parental physical, mental and social issues: Our client parents often face chronic health, mental health, economic and social issues resulting in the insecure attachment with their children that brought them to WIN initially. Moreover, some parents with severe mental health issues, such as untreated schizophrenia, are beyond WIN’s ability to treat, and may no longer have children in their custody because the State feels that they are incapable of caring for them. b. Family Transience: Los Angeles is an expensive city in which to live, and many of our client families are marginally employed and inadequately housed, living with friends, relatives or unauthorized communal rental situations with strangers. Although the collaboration partners are able to help some families find permanent housing, oftentimes families must leave WIN treatment for work, housing or shelter in areas outside our treatment area (e.g. when a family moves to a domestic violence shelter on the Eastside). In these cases, where WIN and the family have not reached treatment goals, the family remains at risk for each of the childhood mental health issues. c. Capacity: To be sure, WIN is achieving its initial purpose: we were created to meet the needs of children and families amongst our agency partners who were struggling with the effects of trauma, mental health issues and insecure attachment during their children’s most important window of neurological development. Our outcomes are good. We’ve won several national awards and are one of a small group that have been invited to advise Harvard University and others on creating better systems of care for young children. However, we can serve only a limited number through our clinical work, and touch perhaps a thousand more though our mental health consultation for other agencies. In no way is this meeting the needs of thousands of LA children whose brain architectures and futures are being adversely affected for the long-term right now. Hence, our ongoing work with Harvard: it is our goal to work with the researchers and model programs involved with the Frontiers of Innovation initiative to assess & address needs earlier.

What resources does your project need?

  • Infrastructure (building/space/vehicles, etc.)
  • Quality improvement research