COMPASS Clinic serves adolescents in child welfare system

June 17, 2015

Pilot program, funded through a Rhode Island Foundation grant, will care for behavioral health needs of Rhode Island youth in foster care

Compass_ClinicThe Bradley Hasbro Children’s Research Center (BHCRC) and Adoption Rhode Island have partnered in a yearlong pilot project to develop a mental health clinic serving adolescents in the child welfare system. The COMPASS Clinic is funded through a $64,665 pilot grant from the Rhode Island Foundation and will offer a program of integrated clinical care that will work to address the behavioral health needs of youth in foster care in Rhode Island.

Annually in Rhode Island, there are approximately 2,000 children in the Department of Children, Youth and Families’ (DCYF) care. Current data indicates that nearly 50 percent of youth in foster care have significant mental health needs that require treatment. The COMPASS Clinic introduces another evidence-informed treatment model to the community to address the shortage of trauma informed and adoption competent services for this population.

“Currently, youth with emotional or behavioral mental health needs are often referred to community providers for more extensive evaluation and outpatient treatment, a process that can result in delays in services,” said Wendy Hadley, PhD, a staff psychologist from the BHCRC. “However, research has found that early identification and treatment of mental health problems can offset the negative outcomes associated with delays in treatment, such as school drop-out, substance abuse, early pregnancy, and later, unemployment or underemployment.”

“Children who have been removed from their homes due to abuse or neglect are particularly vulnerable, at risk for psychiatric illness, at risk for more and higher doses of psychotropic meds, and have a harder time getting into appropriate outpatient treatment,” said Elizabeth Lowenhaupt, MD, a psychiatrist from the BHCRC who helped develop the pilot program. “Many of these children end up in the hospital, at the Rhode Island Training School, or in out-of-state residential placement if they are unable to get enough mental health support for them and their families.”

One of the priorities of the COMPASS Clinic is to address the current shortage of evidence-based clinical care for children in the foster care system and to meet the unique needs of this community. In this yearlong pilot project, adolescents in foster care experiencing mental health issues such as depression or anxiety will be paired with a mental health clinician from either Bradley Hospital or Adoption Rhode Island. Clinicians are cross-trained in best practice interventions for delivering adoption competent and trauma-informed mental health treatment.

“Many youth in foster care, certainly those who have experienced the most significant trauma, may become confused or ambivalent about their permanency goal, including that of adoption. This ambivalence can contribute to an array of complex and conflicting emotions, the negative of which include feelings of grief, loss, identity confusion, and urges to seek validation from others in ways that can be self-destructive,” said Rita Capotosto, clinical director of Adoption Rhode Island. “For some youth, the drive to connect with birth families, and the sense of divided loyalty between one's birth family and current adult caretakers can be quite strong, which can contribute to ambivalent relationships and conflicts with current caregivers.”

The COMPASS Clinic will address the sensitivity required for the complicated and unique aspects of caring for children in the foster care system. Clinicians in the treatment program will integrate these considerations within all aspects of treatment, starting from the point of assessment, in order to communicate empathy and to establish a strong therapeutic alliance with the youth.

“We’re so excited about this opportunity to bring comprehensive, evidence-based models of treatment to youth in foster care in Rhode Island,” said Darlene Allen, executive director of Adoption Rhode Island. “Youth in foster care experience losses and trauma that no child should have to experience. This team will be able to bring hope and a brighter future to these kids.”

The project aims to develop a model that can be sustained as an on-going treatment clinic for youth in the child welfare system. While this clinic model is the first in Rhode Island devoted to the evaluation and care of a foster care population, there are similar models in other areas of the country, including Dallas, Texas and Cuyahoga County, Ohio.

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