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Service Delivery Innovation Profile

Long-Term Expressive Therapy and Caregiver Support Improves Emotional Health of Low-Income Children Affected by Trauma


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Snapshot

Summary

Jumping Mouse Children’s Center, a nonprofit mental health center, provides free or heavily subsidized long-term, expressive mental health therapy for young, low-income children who have been traumatized by domestic violence, abuse, neglect, and other types of emotional stress. Staff therapists, along with masters-level interns, guide weekly therapy sessions and also teach parenting skills. Using a team approach, they help parents and other primary caregivers access support from health and social service agencies and consult with teachers and others important to the child’s life and development. The program has enhanced access to therapy, improved the emotional health of children, and increased the knowledge and confidence of parents and other primary caregivers.

Evidence Rating (What is this?)

Moderate: The evidence consists of post-implementation data on the number of families served, along with ongoing tracking of the child’s progress in therapy, evaluated through periodic surveys administered every 6 months (using a 5-point scale). Parent/caregiver confidence was measured through quarterly surveys during treatment.
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Developing Organizations

Jumping Mouse Children's Center
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Date First Implemented

1999
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Patient Population

Vulnerable Populations > Children; Impoverishedend pp

Problem Addressed

Many children experience emotional traumas, leading to emotional insecurity, negative behaviors, and mental health disorders. Low-income children, particularly in rural areas, often do not have access to long-term therapy that can help to minimize the adverse effects of such traumas.
  • A common problem: In a nationally representative survey1 of 12- to 17-year-olds, 8 percent reported having been the victim of a sexual assault at some point in their lives, while 17 percent reported being the victim of a physical assault, and 39 percent reported witnessing violence, such as a driveby shooting or mugging. A longitudinal study of 9- to 16-year-olds in western North Carolina found that one-fourth had experienced at least one potentially traumatic event in their lifetime, including 6 percent within the past 3 months.2 In addition to the examples cited above, common traumas can include the stress related to chronic poverty, discrimination, and the loss of important people in one’s life (e.g., due to death, divorce, or broken relationships).
  • Leading to mental health disorders and disturbance: At least 1 in 5 children and adolescents has a mental health disorder, with 1 in 10 (representing roughly 6 million individuals) having a serious emotional disorder.3 Children exposed to specific traumas often experience posttraumatic stress disorder (PTSD), with estimates of PTSD prevalence ranging significantly, from 20 to 63 percent among survivors of child maltreatment, from 12 to 53 percent among those suffering medical illness, and from 5 to 95 percent among disaster survivors.4 In children, emotional disturbances often manifest as negative and/or disruptive behaviors in interactions with family/peers and at school.
  • Many long-term adverse effects if left untreated: As in adults, mental health disorders in children often interfere with the way they think, feel, and act. Left untreated, they frequently lead to school failure, family conflicts, drug abuse, violence, and even suicide.
  • Unrealized benefits of therapy for low-income children: Although long-term expressive therapy has the potential to help child and adolescent victims of trauma significantly, the families of low-income children often do not have access to such therapy. This is due to a lack of insurance coverage or the failure of publicly funded insurance to cover long-term therapy and support; most public programs provide only limited, short-term coverage.

What They Did

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Description of the Innovative Activity

Jumping Mouse Children’s Center provides free or heavily subsidized long-term expressive mental health therapy for young, low-income children who have been traumatized by domestic violence, abuse, neglect, and other types of emotional stress. Staff therapists, along with masters-level interns, lead weekly therapy sessions and also teach parenting skills. Using a team approach, they help parents and other primary caregivers access support from health and social service agencies and consult with teachers and others important to the child’s life and development. Key components of the program include the following:
  • Identification and enrollment of child: Partner organizations, including the school system and the Domestic Violence/Sexual Assault Program, identify children who would benefit from the program. Nearly 90 percent of the children participating come from low-income families. Eligibility requires the parent/caregiver to be healthy enough to keep the child safe. Participation in the program is either free or heavily subsidized, with the center using a sliding-scale based on income to determine the out-of-pocket cost to the family. Approximately 91 percent of the care provided by the center is uncompensated by clients, contracts, or insurance.
  • Long-term, child-centered therapy: The center offers a safe place for the child to participate in expressive, play-based therapy that provides an opportunity for self-discovery. In individual sessions, staff therapists, along with masters-level interns, use multiple expressive mediums, including play, art, movement, and sandtray, to help children express and explore their feelings and perceptions. They allow the child to work at his or her own pace as part of open-ended therapy that lasts as long as therapeutically necessary; often several months or years.
  • Parent and other caregiver education and support: To provide parents and other primary caregivers with the physical and emotional resources necessary to care for their child, therapists teach parents about their child’s age-appropriate behavior and expected developmental milestones. They also instruct them on specific parenting skills. This education occurs through a once-a-month, 60-minute session in which the parent(s) or the child’s primary caregiver meets for consultation with the therapist/intern. For parents who need greater support, Jumping Mouse’s "Securing Connections" parent program provides weekly sessions with the parent clinician. In this program, parents and caregivers identify and address unhealthy patterns, learn how to meet their child’s needs, and gain more confidence as a parent.
  • Consultation with significant others in child’s life: The therapist and/or intern meets with those individuals who play an important role in the child’s life and environment to discuss the child’s current level of development and his or her self-perceptions and needs. Depending on the child’s unique circumstances, meetings may be held with teachers, doctors, attorneys, domestic violence advocates, and others. Advocacy is an integral part of family support and is provided as needed.

Context of the Innovation

The idea for the Jumping Mouse Children’s Center came to Dott Kelly, the program’s founder, after the mental health center in which she worked closed due to a lack of funding. With a master’s degree in child and family psychology; specialized training in adoption, foster care, and abuse; and more than 30 years of experience working with children and families in a variety of settings, Ms. Kelly felt strongly that the community needed and would support a program to serve low-income children at risk of serious mental health problems. Her experience as a teacher and mentor supported her belief that she could train masters-level interns who, under her supervision, would expand the number of children seen at the center. The program initially opened in 1999 with two therapists serving five children in a space shared with a private therapist. The internship program began in 2001.

Did It Work?

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Results

The program has enhanced access to long-term, mental health services for low-income children affected by trauma, leading to improved emotional health for the child and increased knowledge and confidence among parents and other primary caregivers.
  • Enhanced access to therapy: As of the end of 2012, over 450 children and families have received services since the program began in 1999, with approximately 80 children being served in 2009. During that year, the vast majority of participants (87 percent) came from low-income families without access to private health insurance. Assuming they qualified for public assistance, these children would have, at best, had access to between 12 and 20 visits with a mental health professional in the absence of this program.
  • Improved emotional health for children: Among the 82 children served in 2011, the vast majority exhibited improvements in emotional health. This included less instances of acting out and other concerning behaviors (96 percent), greater frequency of ontask behavior at school (95 percent), more support from parents and others (100 percent), increased confidence and self-esteem (98 percent), and demonstration of positive social skills (87 percent).
  • More knowledgeable and confident parents/primary caregivers: Among the 153 primary caregivers (including parents, foster parents, grandparents, stepparents, and others) who took part in the program in 2009, 45 percent had reasonable expectations for their child (based on age and stage of development) and 78 percent reported increased confidence in their parenting skills. These measures reflect a very important outcome of parent education and support—an increased understanding of a child's needs and the parent's ability to meet them based on the child's temperament and developmental capabilities. Information provided in October of 2013 indicates that in 2012 the new close of therapy evaluation demonstrated improvement between the beginning and close of therapy in every category queried (child’s emotional health and well-being; parent relationship with their child; and feeling of support in the community). The average overall score at the beginning of therapy was 3.23 out of 5 and at the end of therapy it had increased to 4.36 out of 5.

According to information provided in October 2013, Jumping Mouse is measuring program outcomes through several different methods including weekly therapist progress notes and supervision and using a new parent close of therapy evaluation form. The close of therapy evaluation is based on a survey from the National Resource Center for Community-based Child Abuse Prevention. It asks parents to rate 23 statements that assess the program’s long term goals: their child’s health and well-being; their relationship with their child; and their feeling of support in the community.

Evidence Rating (What is this?)

Moderate: The evidence consists of post-implementation data on the number of families served, along with ongoing tracking of the child’s progress in therapy, evaluated through periodic surveys administered every 6 months (using a 5-point scale). Parent/caregiver confidence was measured through quarterly surveys during treatment.

How They Did It

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Planning and Development Process

Key elements in the planning and development process included the following:
  • Founding nonprofit organization: In 1999, Ms. Kelly created a nonprofit organization building on the 501(c)(3) status of her previous place of employment, thus allowing her to begin fundraising almost immediately.
  • Identifying volunteer therapists and board members: Ms. Kelly identified and recruited a volunteer therapist along with four individuals to serve on the center’s board of directors; she had worked with these individuals previously.
  • Securing in-kind contributions of office space: The program began using donated, shared space from a therapist. Over time, the center raised enough funds to purchase its own facility. Information provided in October 2013, indicates that the program has purchased the building adjacent to it with the intent of expanding services. By 2015, with the increase in capacity, services should be doubled.
  • Developing internship program: From the start, the founder planned to develop an internship program that would enhance service capacity by teaching interns how to provide expressive therapy under her supervision. To establish the program she met and spoke with internship coordinators from regional universities. Trainees were required to be in a licensed graduate program or to have already graduated. The Rotary Club provided initial funding for the program. As any masters-level training program is required to offer, Jumping Mouse provides each intern with exposure to assessments, diagnosis, treatment planning, and expressive mental health therapy. Interns have served more than half of the children who have participated in the program.
  • Conducting community outreach and fundraising: Staff, volunteers, and board members all participated in outreach and fundraising activities, which included grant writing, public presentations to community organizations and individuals, and networking with systems and organizations that served young children. Initial outreach efforts resulted in the development of partnerships with the Domestic Violence/Sexual Assault Program, Head Start, and with the county school district. These efforts continue on an ongoing basis.

Resources Used and Skills Needed

  • Staffing: The center has four paid, masters-level therapists; five volunteer masters-level student interns; an executive director; a clinical director; a development director; and two certified mental health supervisors. As noted, a certified mental health supervisor supervises two to three student interns and regularly consults with them regarding each child’s progress.
  • Costs: In 2012, the program spent $309,621 to serve 82 families and 119 caregivers (updated October 2013). Nearly two-thirds (64 percent) of these costs related to services directly provided to children and caregivers, with 16 percent going to program development, 16 percent to management, and 4 percent to facility costs.
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Funding Sources

Costco Wholesale; Kitsap Bank; Lucky Seven Foundation; The DV and Ida J McEachen Charitable Trust; The Moyer Foundation; Northwest Children's Fund; Port Townsend Rotary Club; Satterberg Foundation; Target Stores; Women Who Care Giving Circle of Jefferson County Community Foundation
During the first 3 years of the program, donations mainly came from private individuals and local businesses; since that time, the program has secured ongoing funding from foundations and corporations. Current donors include Costco Wholesale; Elizabeth Lynn Foundation; Medina Foundation; Port Townsend Rotary Club; the Norcliffe Foundation; the May and Stanley Smith Charitable Trust; and Jefferson County 1/10 of 1 percent sales tax fund.

In 2012, donations and revenues totaled $312,094, enough to cover the costs outlined above. A breakdown of funding sources follows: contributions (24 percent); grants (36 percent); earned income (19 percent); events (4 percent); and the provision of in-kind, clinical services (17 percent).end fs

Adoption Considerations

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Getting Started with This Innovation

  • Create clear vision and mission: The ability to provide free and/or heavily subsidized, long-term therapy depends on educating the community and potential donors of the program’s benefits for at-risk children, as the program cannot survive without ongoing financial support. The need to educate the community requires program planners to integrate educational activities into the accomplishment of the program’s mission.
  • Educate community leaders and conduct outreach to community organizations: To garner financial support, staff and board members need to make individual and group presentations to community leaders and service organizations (e.g., Rotary and Lions clubs, charities, and other groups tied to the community’s well-being). Additional outreach to health and social service agencies and other community-based systems is necessary for creating linkages with organizations that will serve as referral sources and as partners in helping children and families.
  • Identify qualified clinicians willing to volunteer: During program startup (when funds tend to be limited), volunteer clinicians can add depth and credibility to the services provided without increasing costs.
  • Create working board of directors: Having a board willing to commit time to raising funds and actively promoting the program (as opposed to just lending their names to it) can greatly enhance the likelihood of success and reduce the time needed to get the program up and running.
  • Develop internal environment to support staff and program vision: The program’s ability to provide high-quality services and to grow depends on the creation of a collegial environment in which staff and interns can hold formal and informal meetings to share information, learn new modalities, and discuss challenges. Such an environment also helps staff remain focused on the vision of providing free or heavily subsidized therapy to children in need.

Sustaining This Innovation

  • Undertake formal strategic planning: As the program expands, it will become necessary to have a documented plan for fundraising, supported by program goals and objectives.
  • Explore ways to expand staff capacity: As noted, internship programs and the use of volunteer, licensed mental health providers can provide additional capacity that can expand the reach of mental health services.
  • Consider dedicating a staff member to fundraising: The ability to sustain and expand the program depends on securing ongoing sources of funding. As a result, it may make sense to dedicate a full-time staffer to such activities.
  • Monitor outcomes and provide feedback to community: Continue to educate new community members about expressive therapy. Keep all community members informed about the children and families being helped by the program, including monitoring and reporting on statistics on the program’s impact (e.g., number of families served, improvements in child emotional health, and parent confidence). Sharing the personal stories of individual children and families who have benefited also helps individuals to understand the program's impact.

More Information

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Contact the Innovator

Dott Kelly, MA
Clinical Director
Jumping Mouse Children's Center
1809 Sheridan St.,
Port Townsend WA, 98368
Phone: (360) 379-5109
E-mail: dott@jumpingmouse.org

Jenny Manza
Development Director
Jumping Mouse Children's Center
1809 Sheridan St.,
Port Townsend WA, 98368
Phone: (360) 379-5109
E-mail: jenny@jumpingmouse.org

Innovator Disclosures

Ms. Kelly and Ms. Manza have not indicated whether they have financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

The Jumping Mouse Web site is available at: http://www.jumpingmouse.org.

Footnotes

1 Kilpatrick DG, Saunders BE. Prevalence and Consequences of Child Victimization: Results from the National Survey of Adolescents. National Crime Victims Research and Treatment Center, Medical University of South Carolina, 1997. Available at: http://www.ncjrs.gov/pdffiles1/nij/grants/181028.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).
2 Costello EJ, Erkanli A, Fairbank JA, et al. The prevalence of potentially traumatic events in childhood and adolescence. J Trauma Stress. 2002;15(2):99-112. [PubMed]
3 U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, 1999. Available at: http://profiles.nlm.nih.gov/ps/retrieve/ResourceMetadata/NNBBHS.
4 Gabbay V, Oatis MD, Silva RR, et al. Epidemiological aspects of PTSD in children and adolescents. In: Silva RR, editor. Posttraumatic Stress Disorder in Children and Adolescents: Handbook. (1-17). New York: Norton, 2004.
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Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: November 10, 2010.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: November 06, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: October 10, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

Back Story
“Andy” came to Jumping Mouse at age 3 shortly after child protective services had placed him and his younger twin siblings with a foster family. He suffered from severe neglect and physical abuse and had witnessed ongoing violence. When he first came to his foster family, he exhibited the same...

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