by Chris Hilburn-Trenkle
An influx of funding could strengthen a statewide program’s ability to disseminate evidence-based treatments (EBTs) for children.
The North Carolina Department of Health and Human Services in late August announced a $4.5 million investment in the North Carolina Child Treatment Program aimed at expanding behavioral health services for children. The North Carolina Child Treatment Program, founded in 2006, is focused on improving the health of families and children dealing with trauma and behavioral and emotional challenges.
University of North Carolina at Chapel Hill School of Social Work Clinical Assistant Professor Mellicent O’Brien Blythe is an implementation specialist for the program, providing consultation and training to agencies providing evidence-based treatments. Blythe works with agency leaders to help ensure that the evidence-based models are successfully implemented and can be sustained after training.
We spoke with Blythe to learn more about the program’s impact across the state.
How has your organization worked to support evidence-based treatments within the Medicaid system?
We are part of a larger child trauma center — the Center for Child & Family Health in Durham, which is a collaborative effort between Duke, UNC, and North Carolina Central. Our program specifically was initially funded by the Duke Endowment to offer training and support to make trauma-focused cognitive behavioral therapy (TF-CBT) available in 10 counties in Eastern North Carolina.
The program eventually expanded statewide, with authorizing legislation to provide annual state funding to expand training in TF-CBT, add additional EBT trainings, and maintain a public roster of trained providers. We currently disseminate six models across North Carolina. We use a method called learning collaboratives, which includes interactive training as well as clinical consultation calls when clinicians receive one-on-one or small group coaching to apply the treatment to their specific clients. The collaboratives also include an agency leadership track, where we provide the implementation training and coaching. This method allows us to track not only how many clinicians are trained but also how many children and families are served and what the clinical outcomes are for those families. We want to be sure that clinicians can provide each of these treatments independently and confidently after training, and that their clients will continue to experience the same types of improvements and healing that we see in the research.
With this new expansion funding, we are able to reach more clinicians and agencies, and to train with some additional treatment models. We also are able to increase support for providers to be part of the Medicaid system.
Being able to see families and kids getting better is really motivating for clinicians, but one issue with sustaining the public mental health workforce is that those clinicians sometimes leave the Medicaid system. The state has been trying to address that, both by increasing Medicaid rates and by reducing the administrative burden to make it feasible for more providers to be part of the Medicaid system. We have a new project called Pathways to EBTs, where we’re working with provider agencies in underserved areas of the state to offer additional support to build their capacity to be part of Medicaid.
What are the other treatment models being trained through your program?
In addition to TF-CBT, we also have learning collaboratives in the following:
- Child-parent psychotherapy (CPP) – an attachment and trauma-focused treatment for children ages 0-5 and their caregivers;
- Cognitive processing therapy (CPT) – a treatment for clients and caregivers 14 and older with post-traumatic stress disorder (PTSD);
- Parent-child interaction therapy (PCIT) – a specialized behavior management program for children ages 2 to 6 and their families;
- Problematic sexual behavior-cognitive behavioral therapy (PSB-CBT) – a treatment for children ages 3-18 who have engaged in problematic sexual behavior, and their caregivers;
- Structured psychotherapy for adolescents responding to chronic stress (SPARCS) – a strengths-based group model for youth ages 12-21 who have been exposed to chronic trauma or stress.
The new models we’ll be offering beginning this fall include:
- Attachment, regulation and competency framework (ARC) – a clinical and organizational intervention for children and teens who have experienced complex trauma
- Bounceback – a skills-based group for children ages 5-11 who have been exposed to traumatic events.
As we’ve seen the behavioral health crisis grow across the country, what kind of impact can program expansions like this have for countless individuals?
It is really important to make sure that we have well-trained, well-supported clinicians in the workforce to serve those children and their families. Clinicians can learn new treatments, but if they don’t have support when they get back to work on how to integrate those practices into their day, into their workload, it’s really hard for them to put into practice what they’ve been trained in.
The impact of programs like this is in the clinicians and agencies that are able to implement and sustain these models long past training, and in the increased number of children and families all across our state who receive high quality treatment. We want families in every corner of North Carolina to have access to treatment that is most likely to help them improve and thrive.
Is there anything else you would like individuals to know about the work that NC Child Treatment Program does?
We always like to make sure people know about our roster. Once people are trained in these models and have demonstrated their ability to provide them with fidelity, they’re able to be on this roster. For folks working in different service systems, and families looking for treatment, they can go to NCCTP.org and search for trained providers in their county.
We really want to train more clinicians in these models, and we know our School is such an important source of the mental health workforce in our state. We already train a lot of MSW graduates, but we’d love to train even more. We also know a lot of our graduates go into private practice. We would love to work with any clinicians who are interested in these models and offer the technical assistance and peer networking that might help them be able to accept Medicaid. We know our graduates are very mission-driven and really want to provide services for the most vulnerable and the most underserved families and children in our state, and sometimes in the past there have been barriers to doing that. There is a concerted effort to make it more feasible for providers to be part of the Medicaid system. We would love for more graduates to consider coming through the training and becoming part of the Medicaid system.
