Governor Steve Bullock today announced a new partnership with Billings Clinic, the University of Montana’s Center for Children, Families and Workforce Development, and the Department of Public Health and Human Services (DPHHS) to provide case consultation on complex child protection cases.
Child and Family Services ECHO links medical experts from Billings Clinic, the UM Center and the DPHHS Child and Family Services Division (CFSD) for monthly 90-minute sessions to evaluate child abuse cases where children have experienced extreme trauma. It connects Montana’s child welfare professionals with regional and national experts for peer support, service knowledge enhancement, case discussions and treatment planning.
“This is an exciting new opportunity that combines additional resources with multiple experts to help support families in Montana and improve outcomes for children,” Governor Bullock said. “I applaud Director Hogan for her efforts to ensure that child protection workers can meet the challenging demands of their jobs and take care of Montana’s most vulnerable kids.”
DPHHS Director Sheila Hogan said each session begins with a brief presentation covering relevant child mental health or child welfare topic. After the presentation, up to two cases are discussed among the network from both the clinical and child protection system perspective. “Ultimately, the goal is to utilize the group’s collective expertise to make meaningful recommendations for caseworkers who work on these very complex cases daily,” Hogan said.
In turn, the child protection workers can ask questions and receive case-specific recommendations from both their peers and medical professionals that will then be implemented into a treatment plan for the children involved in the case. The medical panel consists of a board-certified child and adolescent psychiatrist, trauma-informed psychotherapist, and trauma-informed occupational therapist.
The key part is the consultation piece, Hogan said. “It gives caseworkers a chance to receive clinical insight they would not otherwise receive, and it provides them a chance to talk about difficult challenges they are experiencing,” she said. “Caseworkers will be able to learn from each other, which is another benefit.”
The project is part of Project ECHO (Extension for Community Healthcare Outcomes), a video-based tele-mentoring platform utilized by Billings Clinic to reach clinicians across Montana on a variety of topics including pediatric and adult mental health, opioid use disorders, and adverse childhood experiences. Child and Family Services ECHO makes it possible for CFSD workers around the state to be connected without leaving their offices.
It is being funded through a Billings Clinic Project ECHO grant and the UM Center.
Jeff Folsom of the UM Center said the partnership adds a new component to the child protection system. “Those who work in the child protection system understand how the foster care system works, and now we’re adding clinical oversight focused on children’s mental health and the effects of trauma,” Folsom said.
The UM Center has been translating what is known from cutting edge research to practical every day help for children and families in need. The Center’s Director, Dr. Ryan Tolleson Knee describes how "using available web-based technology we can support families and practitioners anywhere in the state no matter how remote,” he said. “Virtual training connects professionals who are experts in treating children and families with providers around the state - training them, offering on-going support, and following complex cases. Having a team of experts who are armed with the latest research is a tremendous asset."
The Center’s five community-based trainers, who are located across Montana, augment the web-based instruction by providing individualized coaching to CFSD employees’ to maximize their transfer of learning from the virtual training classroom to the children and families they serve.
Mariela Herrera, MD, a child and adolescent psychiatrist and Medical Director at the Billings Clinic, said thus far all participants, both the medical professionals and caseworkers, are benefitting. The first session was held in February.
“It’s key that we understand clinically what might be happening with children who have experienced trauma,” she said. “By sharing information and ideas, we’ll be able to provide valuable clinical insight that could help more children stay home and out of foster care, or help expedite getting those in foster care home more quickly. We may also be able to identify gaps in the child protection system.”
Herrera also said this new collaboration has drawn interest from some of her out-of-state colleagues. “They are very interested in what we are doing with this project,” she said. “The idea is by combining our efforts, we can collectively support each other around some very difficult cases. We’ll use this experience to learn together around things we can do to support these kids and families.”
CFSD supervisor Samantha Kitzenberg of the Hardin CFSD office was the first to present a case when the project first launched. She said the session proved very helpful. “It really resulted in some excellent recommendations for a specific treatment plan for children our staff work with,” she said. “This is an opportunity for us to receive immediate feedback and opinions from a variety of professionals that is truly invaluable.”
Governor Bullock created the Protect Montana Kids Commission in 2015 to provide evidence-based recommendations to improve case management and give further support to Montana families and children. This public-private partnership comes at the recommendation of the Commission.
The ECHO medical education and care management collaborative is also helping to address Montana’s mental health and substance use treatment needs by empowering primary care clinicians in remote settings to integrate mental health and substance use treatment into primary care delivery, in partnership with Montana Medicaid, Blue Cross Blue Shield of Montana, PacificSource, and the Montana Mental Health Trust. This project is the first multi-payer supported ECHO in the country.