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Empowering and building resilience with youth in congregate care
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Empowering and building resilience with youth in congregate care
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Content
Running head: EMPOWERING AND BUILDING RESILIENCE 1
Empowering and Building Resilience with Youth in Congregate Care
Jill M. Miller
Doctoral Capstone Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Social Work
University of Southern California
Fall 2019
EMPOWERING AND BUILDING RESILIENCE 2
Executive Summary
Ensuring healthy development for all youth, specifically youth in foster care or group home
placement is imperative to society. Youth in congregate care settings have high acuity mental
health issues and often lack social support. Coping Avatar is an innovative game system
developed specifically to support the needs of youth in group home placement. The
implementation of Coping Avatar will empower and build resilience with an increased number of
successful treatment outcomes, and improved skills and support for youth as they transition into
communities. It is essential to add a technological tool within the treatment team of youth placed
by child welfare and juvenile justice systems. The proposed innovation will address the needs
for support, building skills, and self-esteem. The innovation will be usable throughout the entire
population of youth in placement.
Keywords: empower, resilience, mentors, technology, trauma-informed, congregate care
EMPOWERING AND BUILDING RESILIENCE 3
Acknowledgments
I would like to thank my capstone advisor Dr. Karla Arriaran for her continued guidance,
support, and direction. I would also like to thank Dr. Jennifer Lewis for her input and feedback
during my final stretch of this capstone.
I would like to thank California Family Life Center for being supportive of my
innovation project, and pilot. My heartfelt gratitude for the input, and feedback provided by
youth. Coping Avatar is for you!
Lastly, I would like to thank my mother Carolyne for her steadfast emotional support and
encouragement, my children Joshua and Lindsey, friends, family, colleagues, and most of all
God.
EMPOWERING AND BUILDING RESILIENCE 4
Table of Contents
Conceptual Framework…………………………………………………………………..… .6
The Social Problem………………………………………………………………………… 7
Theory of Change………………………………………………………………………….. 14
Proposed Project…………………………………………………………………………… 15
Problems of Practice and Innovative Solutions……………………………………………. 15
Feedback from Stakeholders including Barriers & Facilitators…………………………… 17
Proposed Strategy and Timeline to Implement Solution…………………………………... 19
Evaluation Goals/Process Objectives and Outcome Objectives……………………………20
The Measures of Process and Outcomes of Implementation……………………………… 21
Plan for Monitoring Implementation Process and Objectives……………………………... 21
Project Structure, Methodology, and Action Components………………………………… 22
Stakeholders………………………………………………………………………………... 23
Revenue Strategy and Main Types and Sources…………………………………………….25
Budget Format and Cycle………………………………………………………………..… 25
Revenue Projections………………………………………………………………………... 25
Staffing Plans and Cost…………………………………………………………………….. 26
Other Spending Plans and Costs…………………………………………………………… 26
Line-Item Budget…………………………………………………………………………... 27
Dissemination Plan………………………………………………………………………… 27
Communication Plan……………………………………………………………………….. 27
Complicating Factors and Constraints……………………………………………………... 28
Ethical Concerns…………………………………………………………………………….28
EMPOWERING AND BUILDING RESILIENCE 5
Conclusions, Actions, and Implications…………………………………………………………29
References……………………………………………………………………………………31-35
Appendix A: Logic Model……………………………………………………………………….36
Appendix B: Measures………………………………………………………………………….37
Appendix C: Processes………………………………………………………………………….38
Appendix D: Line-Item Budget…………………………………………………………………39
EMPOWERING AND BUILDING RESILIENCE 6
Conceptual Framework
One of the 12 important Grand Challenges for Social Work in the American Academy of
Social Work and Social Welfare is Ensuring Healthy Development For All Youth. Youth face
many complex behavioral health issues, substance abuse issues, and conduct or delinquent
behavior that cause tremendous burdens on society (Hawkins et al., 2015).
The Grand Challenges of Ensuring Healthy Development for All Youth, and Harnessing
Technology for Social Good are both connected to the proposed capstone. Ensuring healthy
development for all youth is imperative to our society. Youth today are challenged with
navigating many issues including but not limited to substance abuse, mental health issues,
poverty, trauma, and broken homes. Future policy recommendations include focusing on
prevention services, better monitoring of risk and increasing protective factors, focusing on
families, integrative care with primary health care providers, as well as training and empowering
workers (Hawkins et al., 2016).
Harnessing Technology for Social Good is the other Grand Challenge in social work and
is directly related to this innovation. Gamification can be used to reach large numbers of
consumers for a much larger impact (Berzin, Singer, & Chan, 2015).
The Child Welfare System (CWS) is a pertinent system to evaluate when focusing on
ensuring healthy development for all youth. Youth in the CWS have very complex needs. Youth
often experience trauma, difficulties in establishing and maintaining social support, and multiple
placements. Future efforts to ensure healthy development for all youth will need to focus on
reduction of the prevalence of youth in child welfare and include interdisciplinary, multi-level,
technological innovation, and prevention programs. Additionally, numerous changes in
placements and living situations, combined with abuse and neglect histories involving traumatic
EMPOWERING AND BUILDING RESILIENCE 7
experiences produce high acuity mental health issues (Schneiderman & Villagrana, 2010). Their
needs place a very heavy burden on society not only financially but socially. Because youth
represent future adults in society, it is essential to focus efforts and funding on their development.
The Social Problem: Prevalence & Incidence
The social problem identified is the large number of youth in congregate care. Youth in
these settings are often referred to group homes or residential treatment with 24-hour
supervision. Youth in congregate care are three times as likely to have a DSM diagnosis when
compared with other settings. They are also more likely to have three or more placement moves
compared to other settings (U.S. Department of Health and Human Services [HHS],
Administration for Children and Families [ACF], Children’s Bureau [CB], 2015). There are
many youth who have their parent or parents deceased, estranged, incarcerated, whereabouts
unknown, deported, or unavailable for some reason.
The CWS is large with thousands of youth who lack support and are isolated. A report
from the Children’s Bureau (2017) explains trends in foster care and adoption. Their statistics
present a rise in children entering the foster system. The total number of children and youth
served in the child welfare system is 687,000 for 2016. Additionally, 55,916 youth nationwide
reside in congregate care settings, 6,800 of which reside in California (HHS, ACF, CB, 2015).
At the state level, California has the largest number of children entering the CWS. In
2015, 62,035 children and youth resided in foster care. Additionally, of the children who entered
the foster system for the first time, 61% were still in foster care one year later (Kidsdata.org,
2018).
EMPOWERING AND BUILDING RESILIENCE 8
Social
Hook and Courtney (2011) examined employment status with former foster youth and
discuss the importance of parenting youth into adulthood for increased support and success, as
well as policy changes to address barriers. Former foster youth have a higher rate of
unemployment, less social capital, and 16% of young men who transitioned out of foster care
were incarcerated by age 23 or 24 (Hook & Courtney, 2011). Also, the more placements a
youth had before exiting the CWS, the lower their income. This study again indicates the need
for further improved, innovative interventions to address the complex needs of transitional age
youth from foster care. In 2016, Los Angeles County Homeless Services Authority found that
36 % of the chronically homeless had a history of being involved with the foster system at some
point in their life (White, 2018).
Youth transitioning to adulthood, should not leave care without support. It is important to
establish a forever family or permanent home for youth who have been in the system.
Establishing the support of one caring adult should begin as youth enter the CWS (Avery &
Freundlich, 2009).
Foster youth are at a much higher risk of not completing high school, increased risk of
criminal behavior, and limited employment opportunities. Transitional age is a critical time for
foster youth as they exit the CWS into young adulthood with very limited resources not only
emotionally but also fiscally (Lee, Courtney, Harachi, & Tajima, 2015).
Government
The Trump Administration passed a new federal law in February called the Family First
Prevention Services Act which focuses on keeping families together with funds for in home
parenting classes, substance abuse treatment, and mental health. The law limits placing children
EMPOWERING AND BUILDING RESILIENCE 9
in institutional settings such as group homes, and forces states to examine and modify their foster
care systems. The federal government has limited the amount of time a child can spend in group
homes reimbursing states for only two weeks of stay with some exceptions (Wiltz, 2018).
A current massive change in the CWS in the state of California is the Continuum of Care
Reform (CCR). In 2015, the governor signed the comprehensive reform to improve services and
outcomes for youth in the CWS. This reform is in the process of being implemented and rolled
out into the entire CWS including foster family agencies, group home placements, Child
Protective Services (CPS), and Juvenile Justice System (JJS) (California Department of Social
Services).
CCR has a focused effort and increased access to mental health treatment that is
culturally sensitive, and trauma-informed. There is a general view of poor outcomes for youth in
group home placement, resulting in multiple placements and trauma. Group homes are
converting to Short-Term Residential Therapeutic Programs (STRTP), and they will provide core
mental health services. Child and Family Teams (CFT) will coordinate a collaborative effort in
the provision of all services with a strength-based approach while in the system (California
Youth Connection).
The focus of treatment and services with CCR is trauma-informed care to maintain
children or youth in home environments for better outcomes. Home environments include
reunification when possible and long-term foster homes that are called Resource Families, as
well as legal guardianships and adoptions. Evidence-based practices such as trauma informed
treatment focuses on not re-traumatizing children and youth, identification of triggers,
development of coping skills, while remaining mindful of the trauma children and youth have
experienced (California Department of Social Services).
EMPOWERING AND BUILDING RESILIENCE 10
A trend is focusing on prevention services. The former Riverside County Director of the
Department of Social Services is Susan von Zabern. Susan feels families need to be engaged
early on to prevent abuse from occurring, and that efforts should be made to develop community
partnerships (Community Matters, 2016). Challenges in the current system include lack of foster
homes available especially for youth ages 13-18, as well as transitional age youth, 18-21. There
are also youth who have very limited social support. It is common for youth to have no parental
involvement such as parents in prison for life, parents deceased, parent’s whereabouts unknown,
adoptions rescinded, and guardianships rescinded, leaving children, and youth without a forever
family.
There have also been shifts in funding with reductions in county budgets for child
welfare. The reductions in the budget have required a reduction of 16.7 caseworkers and 9.7
support staff. Additionally, the department faces penalties if they do not maintain compliance
with face to face contacts potentially reducing federal funding. Children Services continues to
see caseloads that extend over the recommendations established in 2000 under SB 2030.
(County of Riverside State of California).
The CWS first started as a way to help poor children without burdening society.
(Pokempner & Rodriguez, 2018). It was meant to be short-term protection and was never meant
to be long-term, permanency planning. The entire CWS needs a transformation. An interview
with (L. Bailor, personal communication, June 16, 2018) former CPS supervisor of 14 years and
current Certified Trainer for the Child Welfare Academy reported “It takes a village, CPS needs
to be re-imagined. It was made to protect, not meant for permanency (Bailor, 2018).”
EMPOWERING AND BUILDING RESILIENCE 11
Mentors
An ongoing trend is a need and support for mentoring youth in child welfare. There are
many mentoring programs throughout California, and several throughout Riverside County.
According to California Mentoring Partnerships, California has 112 mentoring programs that
served 29,039 youth through 23,145 mentors in 2016 (California Mentoring Partnership).
Locally in Riverside County, the Riverside County Mentor Coalition reported 183 mentors
served 3,500 youth in 2016 (Riverside County Mentor Coalition). However, there are still youth
who remain without support, or without one caring adult in their life.
Additionally, former foster youth and motivational speaker, Josh Shipp reports every
child needs, “One Caring Adult” (Shipp, 2017). Mentors are especially important in foster youth
due to lack of support (Jones, 2014). Evidence suggests children do well despite major
difficulties if they have one, caring stable, supportive adult. One caring adult helps develop
resilience and adds protective factors to protect children from adversity (Center on the
Developing Child at Harvard University, 2015).
Another area that is currently being focused on is preventing children and youth from
entering the CWS. Screening for trauma in childhood can help identify and prevent development
of mental and behavioral health issues. The Adverse Childhood Experiences (ACES) study
completed by researchers at the CDC and Kaiser between 1995 and 1997 indicated a strong
connection between early childhood trauma and health outcomes (Faulkner, 2017).
Legal
Youth in the child welfare system are often involved with family law related to parental
rights termination, as well as the juvenile justice system with delinquent behavior. Youth may
enter the child welfare system, and eventually become involved with the juvenile justice system,
EMPOWERING AND BUILDING RESILIENCE 12
placed on probation, with frequent stays in juvenile halls in between ejections from failure to
adjust placements. In the year 2017, California expected to spend $271,318 per youth per year
in the juvenile justice system. One of the main issues is the high rate of recidivism, around 54%
are reconvicted within three years of being released. Additionally, the housing and violence,
trauma, and lack of treatment produces poor outcomes (Goldstein, 2017). Youth with violent,
dangerous histories are difficult if not impossible to place into residential settings. The costs
trickle down to tax payers, communities, youth and parents unable to pay fines, fees, probation
and court costs.
Protective Factors
Protective factors help counteract the difficulties children and youth experience in the
child welfare system. They often face deep layers of adversities including but not limited to
grief, loss, trauma, abuse, neglect, multiple moves and changes with placements, homes, and
schools. There must be a protection to counteract so much trauma and pain to assist in building
resilience. Examples of resilience usually result in very few emotional or behavioral issues, and
maintaining functioning without decompensating or regressing in development, socially or
academically. Some areas that strengthen resilience include positive caregiver- child
relationships, routine contact with biological parents when possible, as well as focusing on
specific strengths during development to promote the resources the child or youth may already
have in place (Bell, Roman, and Flynn, 2015).
Technology
Finally, there is a movement to utilize technology as a tool not only for CWS workers but
also for children and youth in the CWS. OPEN MINDS (2015) is a leader in market intelligence
and is a management group specializing in best practices focused on organizations in health and
EMPOWERING AND BUILDING RESILIENCE 13
human service fields. OPEN MINDS suggest, “To meet these unique needs and better
coordinate care for children in the foster care system, many provider organizations are turning to
technology.”
In 2016, the White House hosted the first ever White House Foster Care and Technology
Hackathon. The Hackathon brought together leaders, organizations, philanthropies, attorneys,
children, families, as well as engineers, and technology leaders to discuss and innovate ways to
utilize technology to assist children and families in child welfare. There were many new
suggestions including providing free laptops for transition age foster youth in California. The
Hackathon also encouraged the development of technological applications to assist foster youth
including grants for non-profit organizations seeking unique, innovative ways to assist foster
youth (Obama White House).
In May 2018, Los Angeles hosted a #HackFostercare Hackathon. Child welfare leaders
from government, non-profits, technology professionals, and foster youth collaborated and
explored how technology can address tough issues facing Los Angeles foster care. There are ten
different child welfare mobile applications and around 20 different child welfare websites. The
websites and apps serve a variety of purposes with various programs and information
(https://www.hackfostercare.org). There is a movement to provide access to websites, utilize
mobile applications, and videogames to assist and empower youth in child welfare (Thompson,
2016). Blending mentoring with the use of technology is an innovative approach. Technology is
an excellent resource to utilize in the child welfare population especially those impacted by
trauma, and multiple out of home placements.
Recently, the RAND Corporation published a report on how the CWS could save money
and protect more children. Their recommendations included investing more in specially
EMPOWERING AND BUILDING RESILIENCE 14
designed parenting programs with home visits, prevention services and placing children with
relatives versus foster families. Initially, there would be increased spending on new services
with long term saving of money with better outcomes. Society would see a reduction in the
number of convictions, substance use, homelessness, and unemployment. Data indicated savings
between $5.2 billion and $10.5 billion from the current baseline of $155.9 billion (Rand, 2018).
The problem cause is significant and related to systems theory. There are numerous
systems involved with children and families. Many parents of children and youth have complex
problems such as mental health issues, substance abuse issues, immigration issues, legal issues
including incarceration, and overall health and poverty. All of these challenges directly impact
children and youth. It is imperative to utilize the systems theory in relation to healthy
development for children and youth as there are so many systems that children and youth come
into contact with as they grow.
Theory of Change
The program theory that will be utilized is strength-based and trauma-informed. The
current trends in child welfare treatment are trauma-informed and focus on the strengths youth
have or can access (California Department Social Services). Child welfare recommends use of
trauma-informed practices to identify and build on strengths, minimize or prevent
retraumatization (Child Welfare Information Gateway). Consistent with current trends,
Coping Avatar will focus on individual strengths of youth, as well as integrate trauma-informed
practices such as identifying triggers, developing coping skills, build on strengths and empower
and support youth.
A social norm holding the problem in place include removing children and youth from
their homes when there are safety issues. Recently, a shift in child welfare has been to promote
EMPOWERING AND BUILDING RESILIENCE 15
support services in the homes of identified, high risk or vulnerable situations such as the
evidence-based practice and program called Safecare. Safecare is designed to support children
and families with an interdisciplinary team that provides services in the home environment.
Initial ages for children ages 0-5 lasting approximately 18-20 weeks per family. The program
focuses on parent-infant/child interaction skills, health care skills, and home safety. CPS
generate referrals for the program for at risk children and families (National SafeCare Training
and Research Center).
Proposed Project
This proposed capstone is innovative because there are currently no mentor game systems
being utilized with youth in congregate care settings. Current trends are beginning to utilize
technology to help youth. In 2012, the DREAMR project in Clark County, Nevada provided
smartphones to help foster youth connect with mentors. The results demonstrated positive
outcomes for youth and increased their sense of empowerment, assisted with building
relationships and help improve individuality (Denby-Brinson, Gomez, & Alford, 2015).
Problems of Practice and Innovative Solutions
The proposed solution is the Coping Avatar virtual mentor game system that will be
integrated into the treatment of youth in congregate care. Blending technology and mentoring
with trauma-informed practices is an innovative tool to empower our most vulnerable youth.
Avatars were found to provide a nonjudgmental environment while skill building at an individual
pace without concern for making mistakes in a public forum in an online training simulation
(Bartgis & Albright, 2016).
The game system will include an avatar mentor, avatar mentee and will assist youth with
developing coping skills, self-esteem, and support. The game will be utilized by youth daily to
EMPOWERING AND BUILDING RESILIENCE 16
support those in congregate care. The game will initially be piloted with youth in congregate
care at California Family Life Center (CFLC). Future plans after the successful pilot include
marketing Coping Avatar and making it available for purchase by all agencies that place youth
involved with the child welfare system specifically in residential treatment. The plan will be to
expand the game to youth in foster care, at risk youth, and then eventually open to all youth in
the public for purchase.
The purpose for the innovation of Coping Avatar will be to provide a fun, easy to use,
individualized tool to support youth. Youth will be easily engaged in using the game and will
find it to be a valuable tool integrated into their treatment. The expected outcomes will be youth
reporting higher resilience score on the Connor-Davidson Resilience Scale 25 (CD-RISC-25).
The resilience scale can be used to focus on strengths, positive attributes and may be used with
resiliency interventions. It may also be used to examine adaptive and maladaptive coping with
stress (Conner & Davidson, 2003).
The youth will be introduced to Coping Avatar through their assigned therapist in their
treatment program. Their therapist will initially play the game with them, with the plan to
gradually reduce their level of involvement. The therapist will monitor the progress of skills and
goals and re-engage as needed in coordination with input from youth. The skills that will be
practiced include coping skills, self-care skills, community skills, and problem-solving skills.
Each skill has a scenario with three choices to make; a positive choice, a negative choice and ask
for assistance from their mentor. Individual goals will be determined between youth and their
therapist including logging into Coping Avatar daily for 10-15 minutes to complete some levels.
Youth will create their own individualized avatar and select their own avatar mentor. They will
select which skill they would like to practice and which level. Youth will be rewarded and earn
EMPOWERING AND BUILDING RESILIENCE 17
points as they progress, receive positive reinforcement from their avatar mentor, as well as earn
gift cards or money once goals have been reached. Youth will be able to practice real life
scenarios virtually instead of in real life and observe the consequences of their choices and also
have access to a virtual mentor.
Feedback from Stakeholders including Barriers and Facilitators
Coping Avatar will be effective because it includes feedback received directly from youth
in congregate care, is affordable, and consistent with the current best practices of trauma-
informed care. The innovation was selected because it is consistent with trends of utilizing
technology within the child welfare system such as the #Hackfostercare hackathon in May 2018
that brought together stakeholders to examine ways to use technology within the child welfare
system (https://www.hackfostercare.org).
One barrier involves the staff job descriptions needing to be modified. Roles
will be redefined for CFLC therapists to introduce youth to Coping Avatar. Also, CFLC will
have limited resources for training therapists and staff. Additionally, there will need to be
continued funding for maintaining and upgrading Coping Avatar.
A second barrier is ensuring privacy for youth while playing Coping Avatar. The game
will be accessed and played with their therapist. To ensure privacy, the game will be played in
the therapist office on computer. The consents for treatment are signed at time of being admitted
into the CFLC treatment program.
The main facilitator will be Coping Avatar champions and ambassadors that
have successfully utilized the therapeutic tool. Technology is an excellent resource to utilize in
the child welfare population especially those impacted by trauma, and multiple out of home
placements. The current trends are beginning to use technology in child welfare, and
EMPOWERING AND BUILDING RESILIENCE 18
treatment is trauma-informed and strength-based so Coping Avatar mentor game will likely be
embraced.
A second facilitator includes CFLC. There is great encouragement, and willingness to
implement and support the piloting of Coping Avatar within CFLC. An MOU or Memorandum
of Understanding has been signed for the pilot. Also, CFLC has an established relationship with
Riverside County Child Welfare and has access to opportunities to meet with the leaders and
stakeholders to launch the mentoring game after the pilot.
California’s Continuum of Care Reform (CCR) is a facilitator that includes
comprehensive reform to improve services and outcomes for youth in the CWS. The reform is in
the process of being implemented into the entire CWS including foster family agencies, group
home placements, Child Protective Services (CPS), and Juvenile Justice System (JJS). CCR
also requires trauma-informed evidence-based practice (California Department of Social
Services). Coping Avatar will assist youth through trauma informed approaches such as learning
to identify triggers and coping skills.
A partnership with an in-kind coder found through the Hemet Unified School District
has been established to develop the game. Grant applications are being considered to assist with
the costs of the Coping Avatar. If the innovation is rejected by Child Welfare, Coping
Avatar will be used exclusively at CFLC where it is supported and will be piloted. After further
testing, Coping Avatar will eventually be registered at California Evidence-Based Clearinghouse
for Child Welfare (CEBC). The clearinghouse is a free website that agencies can access to
identify evidence-based practices they can implement into their programs (California Evidence-
Based Clearinghouse for Child Welfare). Coping Avatar will be sold to CWS agencies for use,
and annual fees to cover costs of maintenance and upgrades.
EMPOWERING AND BUILDING RESILIENCE 19
Coping Avatar will be able to be played with either computer, XBOX, or PS4 game
systems. As the game is diffused outside of child welfare into at risk youth, they will be able to
select which type of system they would like to use with Coping Avatar to play the mentor game.
Proposed Strategy and Timeline to Implement Solution
The implementation strategy is blended and involves training the therapists in how to use
Coping Avatar, having youth play Coping Avatar, then audit for feedback on outcomes and
improvements. The phases, or major steps of intervention include Phase 1: support
from CFLC to pilot innovation and the CFLC therapist, support from child welfare to implement
the innovation county wide, apply for a grant that supports costs of developing video games that
assist youth, and partnership with a game developer.
The phase two plan includes presenting the innovation to Riverside County Child
Welfare with outcomes from the prototype test, pilot Coping Avatar with youth placed at
agencies within the county, pilot game with youth, therapist introduces Coping Avatar to youth,
integrates Coping Avatar into treatment goals, and coordinate youth treatment goals with the
Child Family Team.
The phase three plan includes testing the prototype with 24 youth ages 13-18 at CFLC,
with control group, and complete self-report pre-test/post-test.
The phase four plan is for increased acceptance of technology use to assist youth,
increased self-esteem, development of skills, youth achieve goals, increased number of youth
successfully completing treatment, and $65 to cover Provisional Patent costs, integrate outcomes
and feedback to upgrade and maintain Coping Avatar.
The phase five plan involves launching Coping Avatar throughout the entire child welfare
system to support youth in congregate care at the cost of $1,000 per unit and separate annual
EMPOWERING AND BUILDING RESILIENCE 20
maintenance fees for upgrades, increased success during transitional age, register Coping Avatar
with (CEBC) California Evidence-Based Clearinghouse for Child Welfare, and increased support
and improved outcomes for youth (see Appendix A).
The hope is for positive outcomes of youth involved with the child welfare assisting them
in building their self-esteem, as well as many problem-solving and interpersonal skills needed to
navigate life challenges. Youth will be easily engaged in using the game and will find the game
not only to be fun, but also easy to use, and a valuable tool integrated into their treatment while
in placement.
Evaluation Goals/Process Objectives and Outcome Objectives
Evaluation goals will assess the efficacy of Coping Avatar with youth in congregate
care. The hope is to find improved outcomes for youth. Process objectives include: During the
admission process, youth placed in congregate care receive a comprehensive assessment by their
clinical therapist. The treatment team and child and family team will discuss specific,
individualized goals for youth in conjunction with input from youth. The therapist will integrate
Coping Avatar into the treatment plan of the youth in placement. Youth will log
into Coping Avatar daily for a designated time (10-20 minutes) and practice skills (See Appendix
D).
Youth will be rewarded with positive affirmations from their mentor avatar, and they
will earn points at each level they complete, and lastly the agency treatment team will provide
positive reinforcement through gift cards, or cash youth can earn as they complete or achieve
their Coping Avatar goals and treatment plan goals.
The clinical therapists will have direct oversite of Coping Avatar. The skills desired for
clinical therapists are master’s level licensed or pre-licensed with Board of Behavioral Science
EMPOWERING AND BUILDING RESILIENCE 21
and also Certified Clinical Trauma Professionals with experience working with youth and
families in the CWS and JJS. Therapists will need to be team oriented and flexible and willing
to integrate the new Coping Avatar tool into the treatment plan.
Outcome objectives are for youth to develop increased self-esteem, improved skills,
achieve goals, increased numbers of youth who successfully complete treatment and placement.
Youth will self-report increased self-esteem, feeling confident to navigate and handle problems.
Long-term outcomes include overall support from the child welfare system to use Coping Avatar.
If Coping Avatar is successfully implemented in all child welfare programs, the
hope is for increased resilience, empowerment, support for youth in congregate care.
The Measures of Process and Outcomes of Implementation
The program evaluation will focus on youth who are in congregate care. The
number of youth surveyed will be 24 in congregate care with California Family Life Center.
Data collection will be from youth who complete the Connor-Davidson Resilience Scale 25 (CD-
RISC-25) pre-test and post-test (Connor, & Davidson, 2003). The study will compare youth
who utilize Coping Avatar. Data analyzed in the survey will include a Likert scale of 0-4 with 4
measuring the highest and asks youth to scale 25 statements (See Sample Appendix B). The
expected outcome is to prove that the use of Coping Avatar will indicate positive, improved
coping and skills among youth in congregate care.
Plan for Monitoring Implementation Process and Outcomes
The plan is for continued feedback of outcomes to use for diffusing of Coping Avatar.
The sample number is small at 24; it will take some time to acquire larger sample numbers for
gathering data. Youth are diverse and have individualized needs. There may be trust issues that
impede the results. Awareness and influence of individual backgrounds such as trauma may
EMPOWERING AND BUILDING RESILIENCE 22
contribute to variances. Training for therapists will include education on the LGBTQ population,
as well as culturally sensitive training with populations that have multi-ethnic backgrounds,
diverse religious beliefs, disabilities both mental and physical, and any other populations.
Therapists will be culturally diverse, from various backgrounds, and receive training.
They will complete the California Brief Multicultural Competence Scale (CBMCS) to assess
their knowledge and awareness about other cultures (Gamst et al., 2004). A review of the
outcomes of the CBMCS scale will provide guidance and feedback into needed or necessary
training.
After the successful completion of Coping Avatar pilot at CFLC, the plan is to
disseminate the effective findings throughout Riverside County Child Welfare, partners, and
other agencies serving the same population. The outcomes will continue to be monitored, and
then the plan is to register Coping Avatar after subsequent testing at the California Evidence-
Based Clearinghouse for Child Welfare (CEBC). This platform will assist in diffusing the
innovation throughout California.
Project Structure, Methodology, and Action Components
The initial prototype was presented on July 26, 2018, to 12 youth ages 13-18 in
placement at California Family Life Center (CFLC) and received positive feedback and interest.
All of the youth were excited about the use of the game in their placement and shared their ideas
on what they would like to have included in the game system. Other stakeholders during the
presentation included direct care staff, CFLC’s Executive Director, Mental Health Director, and
Clinical Therapist’s all support piloting and implementing Coping Avatar.
The next step is to develop and pilot Coping Avatar within the non-profit agency at
CFLC. A partnership was created, and a Non-Disclosure Agreement (NDA) was signed for a
EMPOWERING AND BUILDING RESILIENCE 23
Lead Executive Programmer to code and develop the Coping Avatar. A pre-test and post-test
will be completed by youth, and the data collected from the pilot of Coping Avatar will be
utilized to market the game within Riverside County.
Finally, the last step is to diffuse the successful piloted game to the local Riverside
County Department of Public Social Services Child Welfare, and eventually statewide,
nationwide, and internationally. An application for a grant will be submitted to help cover the
costs of the game development.
Stakeholders
Coping Avatar will operate under the auspice of the non-profit agency CFLC. The
Executive Director and Board of Directors support the pilot of the innovation. CFLC Board of
Directors will have ongoing fundraising throughout the year and will network with potential
donors, interested investors, philanthropy partners, sponsors, endowments, and other areas of
revenue.
CFLC is the selected auspice as it is directly involved with providing care and services to
youth in congregate care. CFLC has other additional programs, including their own Foster Family
Agency, Kincare Program, Safecare Program, Adoptions, and four Youth Work Centers. They also
have partnerships within the community and with Riverside County and currently operate several
grants in partnership with the county.
Those directly involved and committed to the population and services are social workers,
clinical therapists, interns, volunteers, CFLC Leadership, CFLC staff, Coping Avatar Programmer,
and CFLC Board of Directors. Some internal stakeholders may question the effectiveness of using
technology to assist youth. Stakeholders that create obstacles or barriers may need to be educated
on the correct implementation and monitoring of Coping Avatar, so they are aware of the benefits.
EMPOWERING AND BUILDING RESILIENCE 24
External stakeholders include the federal government and Congress and policymakers.
Identified relevant congressional committees include: The Senate Committee on Health,
Education, Labor, and Pensions that has oversite of the Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institutes of Health, Substance
Abuse and Mental Health Services Administration, and Agency for Healthcare Research and
Quality (Govtrack.us).
There have recently been limitations placed on the amount of time youth can remain or
be placed in congregate care. The Trump Administration signed a new federal law in February
2018 called the Family First Prevention Services Act, which focuses on keeping families together
with funds for in-home parenting classes, substance abuse treatment, and mental health. The law
limits placing children in institutional settings such as group homes, and forces states to examine
and modify their child welfare systems. The federal government has limited the amount of time
a child can spend in group homes reimbursing states for only two weeks of stay with some
exceptions (Wiltz, 2018). As a result, it has caused states to reform their child welfare programs
and limit placement time.
Another external stakeholder is the state of California government programs and agencies
including: the Juvenile Justice Department, Law Enforcement Agencies, Department of Mental
Health, Department of Social Services, Volunteers, Health and Human Services Agency,
Department of Health Care Services, Child Abuse Prevention, and Department of Community
Services and Development (CA.gov).
The County of Riverside is an external stakeholder as well that can be leveraged to launch
Coping Avatar after the successful pilot. It is expected that all levels of government will support
EMPOWERING AND BUILDING RESILIENCE 25
the innovation. Coping Avatar is a trauma-informed, safe, therapeutic tool that can be utilized to
support high-risk youth.
Revenue Strategy and Main Types and Sources
Potential revenue sources include unrestricted funds from (1) individual philanthropic
donors who want to support youth in the child welfare system or vulnerable at-risk youth. (2)
Foundations related to empowering youth and supporting vulnerable at-risk youth. (3) Large
corporate donors involved with technology interested in partnering or sponsoring the innovation
of Coping Avatar. (4) Government contracts related to providing evidence-based practices and
mental health treatment to children and youth. (5) Earned revenue connected with selling of
Coping Avatar to agencies implementing and using game for their clients and products, useable
goods that market Coping Avatar. (6) Lastly, in-kind donations such as volunteers who donate
computers or game systems to be used with Coping Avatar, and any other useable goods needed.
The expected cost to purchase Coping Avatar for use in treatment will be $1000 per
agency. This cost will be a one-time fee. It will only need to be purchased one time and will be
utilized with an unlimited number of clients with individualized log in. Agencies will purchase
and own the game to be utilized with their clients in placement. There will be annual charges for
upgrades and maintenance costs billed directly to agencies that purchase and own the game.
Budget Format and Cycle
The line-item budget for Coping Avatar outlines revenue and costs for the start-up year.
The fiscal year (FY) budget for Coping Avatar will coincide nicely with CFLC’s current FY
budget starting from July 1
st
through June 30
th
. The budget outlines expected revenue of
$182,200 with expected expenses of $153,380 for a surplus of $28,820 the first year (See
EMPOWERING AND BUILDING RESILIENCE 26
Appendix D). Expenses are reduced by percentage of full expected salary until more funds are
secured. Many of the costs are initially offset by in-kind revenue for start-up.
Revenue Projections
The capstone will be funded primarily through foundation grants, as well as human
capital, venture capitalists, and donors. The revenue inputs for Coping Avatar include the human
capital, in-kind CFLC Mental Health Director, Lead Executive Programmer, and CFLC Clinical
Therapists. CFLC office space and computers will also be in-kind and used for the piloting of
Coping Avatar. Other sources of revenue include grants through Grants.gov to address services
in child welfare.
Staffing Plans and Cost
The staffing strategies for this innovation are all in-kind and include the CFLC Mental
Health Director serving as the Project Director of Coping Avatar. The Lead Executive
Programmer will work in conjunction with the Project Director and build Coping Avatar.
Trauma Certified, Masters level CFLC clinical therapists will be trained and responsible for
introducing the youth to Coping Avatar.
Other Spending Plans and Costs
Coping Avatar will operate under the auspice of CFLC and will utilize their computers,
office space, and therapists. The estimated costs are $60 per month for office space. Each
therapist has their own office space located onsite of treatment facility. Computers are already
on-site and being used by therapists for treatment provided.
EMPOWERING AND BUILDING RESILIENCE 27
Training costs will essentially be the time invested and supported by CFLC and their
Mental Health Director to prepare therapists on the use of Coping Avatar in treatment with youth.
Therapists are paid approximately $4200 per month or $26.25 per hour. The estimated length of
time to train the therapist is four hours costing CFLC approximately $105 per therapist. There
are four therapists involved with treatment and a caseload of six. Another cost is for patenting
Coping Avatar. Provisional Patent Application (PPA) can be used at a lower cost of just $65 to
file and is good for 12 months (Key, 2016).
Line-Item Budget
The line-item budget for Coping Avatar outlines first-year projections (See Appendix B).
The crucial program components include the in-kind personnel involving the Project Director,
Clinical Therapists, and Lead Programmer. Office space at CFLC that therapists utilize are
included with furniture and computers. Material cost includes an estimated $20 per month for
photocopying, as well as cost of training therapists, and cost for Provisional Patent.
Dissemination Plan
The plan is to disseminate Coping Avatar using a campaign. Social media with pictures,
videos, and stories of ambassadors or champions who have successfully utilized Coping Avatar
as a tool to assist them in their placement and transition to adulthood. Messaging will include
data related to the needs of youth in congregate care, and the efficacy of Coping Avatar and using
technology to engage and assist youth. Information will be presented to non-profit agencies
serving similar populations, as well as the county, state, and government programs.
EMPOWERING AND BUILDING RESILIENCE 28
Communication Plan
The plan is to communicate the successful outcomes of Coping Avatar and using
technology to support at-risk youth at conferences statewide, nationwide, and then
internationally. The use of social media including Facebook, Twitter, LinkedIn, as well as a
website with Press Releases will be utilized to inform stakeholders and public. The behavior
change of harnessing technology to support at-risk youth will become a norm.
Complicating Factors and Constraints
A complicating factor is that much of the start-up costs are met under in-kind services.
At any time, the in-kind services could change with leadership or board changes at CFLC.
There is a risk of losing support of Coping Avatar with a change of leadership at CFLC with the
Board, Executive Director, or Mental Health Director. Coping Avatar will need ongoing support
and champions or ambassadors that have successfully utilized the therapeutic tool. It will be
important to ensure the ongoing effective use of Coping Avatar through use of performance
outcomes. Ongoing costs may be an issue. There may be unforeseen technological costs.
However, there is a plan to charge an annual fee to cover the costs of upgrades and maintenance
of Coping Avatar after the user purchases the unit. There is also a risk of not obtaining
Foundation grants and financial support needed to advance Coping Avatar. If Coping Avatar is
rejected by Child Welfare, the plan is to use Coping Avatar exclusively at CFLC where it is
supported and will be piloted.
EMPOWERING AND BUILDING RESILIENCE 29
Ethical Concerns
An area of concern is related to privacy. To ensure privacy for youth while playing and
practicing their skills with Coping Avatar, the game will be accessed and played with their
therapist in their office on a computer with password protection and encryption.
Another concern is acquiring consent to use Coping Avatar. The consents for treatment
are signed at the time of admission into the CFLC short-term residential therapeutic program.
Coping Avatar will be integrated as part of a trauma-informed approach blending in opportunities
for youth to practice skills such as mindfulness, deep breathing, build on their strengths, and
individually connected to their treatment goals.
Conclusion, Actions, and Implications
Youth in congregate care lack the support they need to be successful. Blending
technology with mentors and trauma-informed care is innovative. Coping Avatar allows the
youth to observe the consequences to their choices virtually versus in real life. Coping Avatar is
the proposed innovation that will provide support, empower, help build skills and resilience
needed for youth. There is currently support within CFLC, and the plan is to diffuse Coping
Avatar throughout society after launch.
Efforts to support youth involved with the CWS will need to include prevention services,
technological innovation, in-home services, community, and government support. Investment in
improving outcomes for youth in the CWS will hopefully produce better outcomes in the long
term for society. Youth do not get to choose their parents, and they deserve to have a chance at
leading a happy, fulfilling life. Youth will determine much of the future in society. Their success
becomes our success.
EMPOWERING AND BUILDING RESILIENCE 30
The implications of launching Coping Avatar will enable technology to be utilized to
support vulnerable youth and eventually diffuse out to all youth in society. There is a lack of
mentors for youth, although Coping Avatar provides a virtual mentor, it is not a replacement for a
real-life mentor in person.
Limitations other than fiscal support include if youth do not want to use Coping Avatar
and refuse or resist to engage or participate. Additional possible constraints related to using
technology in congregate care settings include staff or professionals viewing Coping Avatar as a
replacement for treatment. Coping Avatar is an innovative tool that is used to support and
supplement the care and treatment already provided to youth in placement.
Current stakeholders are very interested and have reached out and expressed a desire to
learn more about how technology can be used to support child welfare. Recommendations going
forward are to continue to develop, test, and diffuse Coping Avatar. The use of technology to
support all youth not just those in child welfare and juvenile justice systems is suggested.
Technology can be individualized to help support, and develop many skills while providing a
fun, safe, engaging tool. Continuous feedback from youth can be incorporated to upgrades and
maintenance of Coping Avatar.
Conclusion
Youth in congregate care settings have little to no support with poor outcomes and
complex trauma and mental health issues. Coping Avatar is a suggested tool to utilize to
improve support and outcomes to our most vulnerable youth. Blending technology with mentors
and trauma-informed care is an innovative solution. Additionally, Coping Avatar can be
distributed to be used to support all youth.
EMPOWERING AND BUILDING RESILIENCE 31
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EMPOWERING AND BUILDING RESILIENCE 36
Appendix A
Logic Model
EMPOWERING AND BUILDING RESILIENCE 37
Appendix B
Connor Davidson Sample Questions
Scoring is 0-4 with 4 being the highest, and 0 being the lowest
1. I tend to bounce back after illness, injury, or other hardships.
2. I give my best effort no matter what the outcome may be.
3. I believe I can achieve my goals, even if there are obstacles.
4. Even when things look hopeless, I don’t give up.
5. During times of stress/crisis, I know where to turn for help.
EMPOWERING AND BUILDING RESILIENCE 38
Appendix C
Processes
EMPOWERING AND BUILDING RESILIENCE 39
Appendix D
Line Item Budget
Program: CFLC-Coping Avatar
Project Director: Jill Miller, LCSW
Project Period: 07/01/2020 through 06/30/2021
Revenue
Contributions 10,000
Other Grants 50,000
Total Revenue 60,000
Other Revenue
In-Kind Office Space 7,200 6 offices (100/mo)
In-Kind Clinical Therapists 60,000 4 FTE (@30% of salaries 15,000)
In-Kind Supplies 5,000
In-Kind Programmer 50,000
Total Other Revenue 122,200
Total Revenue 182,200
Expenses
Personnel/Salaries
Project Director 15,600 15% of salary
Clinical Therapists 60,000 4 FTE (@30% of salaries 15,000)
Lead Executive Programmer 15,000 30% of salary
Sub-Total 90,600
Benefits 27,180 6 FTE (@30% of salaries)
Total Personnel 117,780
Operating Exp
Rent 7,200 600/mo
Technology 7,000 6 Computers (1,000)
Training 4,000 4 Therapists (1,000 annually)
Material’s/Supplies 1200 100/mo
Travel 1200 100/mo
Marketing & Patent 15,000 (start-up & ongoing)
Total Op’s Exp. 35,600
Total Expenses 153,380
Surplus/Deficit +28,820 Contingency/Reserve
Abstract (if available)
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Asset Metadata
Creator
Miller, Jill Marie
(author)
Core Title
Empowering and building resilience with youth in congregate care
School
Suzanne Dworak-Peck School of Social Work
Degree
Doctor of Social Work
Degree Program
Social Work
Publication Date
12/16/2019
Defense Date
11/22/2019
Publisher
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congregate care,empower,mentors,OAI-PMH Harvest,resilience,Technology,trauma-informed
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Lewis, Jennifer (
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