Tri-Fold Brochure Front page: Photo of a happy male toddler standing and hugging a stuffed green & white Care Bear. Project Karinu Loving Our Babies EVALUATION REPORT November 2014 GuamÕs Early Childhood System of Care Project Karinu Vision Our children and families will have healthy minds, bodies, and spirits for lifelong success Inside left page: Photo on the top left hand side of the page of a mother posing with four children and lower right hand side above bar graph of a male toddler standing looking to his right. INTRODUCTION Project Karinu is GuamÕs Early Childhood System of Care for young children from birth to age five, who are experiencing challenges in their social, emotional, and/or behavioral development, as well as for young children who are considered Òat risk.Ó Project Karinu works closely with families and other service providers to support young childrenÕs social emotional development and mental health by: * building awareness and parenting skills, * conducting screening and assessments, and * providing family supports, individualized treatment, and interventions. In partnership with other agencies, programs, and initiatives, Project Kari–u works to enhance GuamÕs early childhood workforce and to create systems change and policy reform. Woven throughout all of Project Kari–uÕs activities is the belief that early childhood mental health services should be community-based, child-centered and family-driven, and culturally and linguistically responsive. Who does Project Kari–u Serve? 415 children and their families had contact with Project Kari–u through the referral process and/or outreach events between June 2011 and October 2014. Referrals 253 children have been formally referred, screened, and assessed. * 62% male; 38% female * Average age: 3.5 years * 76% are of Chamorro descent Table with 2-columns, 5 rows 1st column Header: ChildrenÕs 5 Most Common Challenges 2nd Column Header: Percentage 1st row: Developmental Disability 28% 2nd row: Maltreatment 27% 3rd row: Adjustment 25% 4th row: Disruptive Behaviors 25% 5th row: CaregiverÕs Mental Health 18% End of table Colored Bar Chart with Legend Header: Most Children Were Referred by their Caregivers 46% Caregivers 25% Child Welfare 9% Physical Health 9% Early Education 6% Other 5% Mental Health About This Report This report is the second in a series and summarizes findings from the evaluation of Project Kari–u from October 2009 through August 2014. Descriptive data is presented on 248 children and families and outcome data is presented on children and families who enrolled in the longitudinal research study who completed a 12 month follow-up data collection interview (n = 73). Descriptive data was collected using the Enrollment and Demographic Information form (EDIF). Two Colored Bar Graphs 1st Bar Graph Legend: Green: Intake; Blue: 12 Months Center page: POSITIVE OUTCOMES AFTER 2 YEARS Fewer Children Experience Serious Problems * Emotionally Reactive o Intake: 31.1% o 12 Months: 8.9% * Aggressive Behaviors o 33.3% o 17.8% * Attention Problems o 33.3% o 24.4% * Withdrawn o 42.2% o 11.1% Data collected using the Child Behavior Checklist 1 1/2-5 (CBCL 1 1/2-5). Caregiver report. 2nd Colored Single Bar Graph Legend: Blue: Improved; Green: Remained Stable * Improved: 40.5% * Remained Stable: 59.5% Table: 2 column, 7 rows CaregiversÕ Perspectives on Services at 12 Months 1st row: Perspectives on Services: Cultural Sensitivity Caregiver: % Reporting Positively: 96.4% 2nd row: Perspectives on Services: Social Connectedness Caregiver: % Reporting Positively: 85.7% 3rd row: Perspectives on Services: Participation in Treatment Caregiver: % Reporting Positively: 96.4% 4th row: Perspectives on Services: Access to Services Caregiver: % Reporting Positively: 78.6% 5th row: Perspectives on Services: Satisfaction with Services Caregiver: % Reporting Positively: 78.6% 6th row: Perspectives on Services: Outcome Caregiver: % Reporting Positively: 75.0% 7th row: Perspectives on Services: Functioning Caregiver: % Reporting Positively: 75.0% End of table Third Bar Graph next to 1st bar graph Legend: Blue: Improved; Green: Remained Stable; Dark gray: Got worse * Externalizing (Acting Out) Behaviors o Improved: 36.5% o Remained Stable: 57.7% o Got worse: 5.8% * Internalizing (Holding In) Behaviors o Improved: 42.3% o Remained Stable: 51.9% o Got worse: 5.8% Data collected using the Child Behavior Checklist 1 1/2-5 (CBCL 1 1/2-5). Caregiver report. Photo of female toddler smiling, standing, and looking towards the photographer. Inner Right page: BUILDING A STRONGER WORKFORCE Prior to the funding of Project Karinu, the field of early childhood mental health was relatively new to Guam. Few families and providers were aware of the critical relationship between young childrenÕs social emotional development and wellness later in life and very limited mental health services were available to children under the age of five. Addressing the need for parent education and workforce development has been a significant focus of Project Karinu and very much a collaborative effort across GuamÕs early childhood programs and initiatives. Through the braiding of funds, a commitment of in-kind resources, and the sharing of a common vision, over 35 local trainings for families and providers have been offered from October 2011 to September 2014. Providers are now trained to use validated screening and assessment tools (ASQ-3, ASQ:SE, and DC: 0-3R), apply best practice approaches to service delivery (Systems of Care and wraparound), and provide evidence-based interventions (Incredible Years, Pyramid Model, Strengthening Families). Training Timeline: October 2011 Ð September 2014 2011: * Ages & Stages Questionnaire, Version 3 * Ages & Stages Questionnaire: Social Emotional (ASQ:SE) * Incredible Years Basic Preschool Modules * Incredible Years Infant & Toddler Modules * Pyramid Model: Infant & Toddler Modules 2012 * Ages & Stages Questionnaire: Social Emotional Online * Behavioral Health Interpreter Training * Cultural & Linguistic Competency Awareness * Cultural & Linguistic Competency & Language Assistance Services * Incredible Years Booster * Strengthening Families: the Protective Factors * Wraparound: 6 sessions for Staff, Families & Stakeholders 2013 * Behavioral Health Interpreter Training * Building an Early Childhood System of Care Planning Retreat * Cultural Conversations * DC: 0-3R * Early Childhood Mental Health Consultation * Pyramid Model: 2 Train the Trainer Sessions * Strengthening Families: 3 Sessions * Universal Referral Process * Wellness Coaching * Wraparound 2014 * Access to Language Equality Public Forum * Cultural & Linguistic Competency & CLAS Standards * Pyramid Model: Family Coaching * Pyramid Model: Positive Solutions for Families * Pyramid Model: Train the Trainer Preschool Modules * Strengthening Families * Sustaining Our Early Childhood System of Care Planning Retreat Left outer page: Photo of male carrying a male toddler on his shoulders and holding toddlerÕs feet. ENHANCED SERVICE DELIVERY THROUGH SYSTEMS CHANGE * Project Karinu has worked to increase access and the coordination and integration of services through its involvement with the Service Delivery Workgroup which was formed in 2010. Over the past four years, this group has worked to develop and pilot the Universal Referral and Intake Form (URIF) and process. In 2014, the URIF was officially adopted by the Guam Early Learning Council. * An important outcome for GuamÕs Early Childhood System of Care is increased and formalized collaboration across agencies and programs. To date, Project Karinu entered into five (5) memorandum of understandings (MOU) with other early childhood agencies/programs designed to increase access, coordination, and the integration of services. * Cultural and linguistic competency is a core System of Care value that is reflected across Project KarinuÕs activities. In June 2013, Project Karinu sponsored ÒCultural Conversations in Behavioral Health.Ó Thirty-five representatives from GuamÕs most common ethnicities discussed and documented cultural views of 10 behavioral health and early childhood concepts, resulting in increased cross-cultural understanding. Project Karinu also produced a calendar promoting cultural pride and multicultural perspectives on caring for young children. The calendar was widely disseminated locally and at a national System of Care conference. * As of August 2014, Project Karinu has the capacity to collect descriptive data and track childrenÕs progress using the ChildLink database. This provides the Department of Public Health and Social Services with the capacity to sustain Project KarinuÕs evaluation and continuous quality improvement process after federal funding ends. Text in colored box: Systems Change One of the goals of Project Karinu is to create Òsystems changeÓ by working closely with other agencies, programs, and initiatives to transform the way services are provide to children and families. Systems change includes things like joint decision-making across agencies and with families; cultural and linguistic competence; service coordination and integration; sharing of resources; evaluation and data sharing; and changes in public policy. Project Karinu partners with Project Tinituhon (the Early Childhood Comprehensive System), icareguam (GuamÕs System of Care expansion initiative), and Culture and Language Access Service Partners (CLASP) to improve access to services, child and family outcomes, and familiesÕ service experiences through systems change. Back center page: Advertisement in blue box: If YouÕre Concerned About A Young Child Because Of: * Poor weight gain or slow growth * Problems sleeping * Problems being comforted or soothed * Excessive fears or fussiness * Delayed development Contact: Project Karinu (671) 478-5400 Department of Public Health and Social Services Terlaje Professional Building, 2nd Floor 194 Herman Cortez Avenue, Hagatna, Guam 96910 www.projectkarinu.org For More Information About the Evaluation Report Contact: Project Karinu Evaluation Team University of Guam Center for Excellence in Developmental Disabilities Education, Research, and Service House #12 Dean Circle, Mangilao, Guam 96923 (671)735-2397/98/2618 This report was prepared by Bonnie Brandt, M.A. and Keith Villaluna, B.B.A., University of Guam Center for Excellence in Developmental Disabilities Education, Research, and Service (Guam CEDDERS). One hundred percent (100%) funding for this publication was provided by the Child Mental Health Initiative (CMHI) Cooperative Agreement 5U79SM059022-05 between the U.S. Department of Health and Human Services/Substance Abuse and Mental Health Services Administration/Center for Mental Health Services and the Guam Department of Public Health and Social Services.