Counseling4Kids - Our Impact

Established in 1997, Counseling4Kids (C4K) provides mental health services to children in the Los Angeles County foster care system. Initially, the Fostering Healthy Kids program started with eight therapists providing treatment services for 25 clients. Today, C4K has four programs and 70 therapists working with over 800 children each year rendering more than 30,000 hours of treatment. In addition to the Fostering Healthy Kids program, our Trauma Treatment Program (TTP) works with children who have experienced extreme trauma from neglect and severe physical, sexual, and emotional abuse, and who exhibit symptoms of Post-Traumatic Stress Disorder (PTSD). Our Multidisciplinary Assessment Team (MAT) program’s primary goal is to ensure that all needs of the family members are met when a child enters foster care. Our MAT program provides an in-depth psychosocial assessment designed to help reduce the risk of a lengthy separation from the family by addressing the specific mental health needs of the child, and facilitating strides toward either reunification or more secure/permanent placements. C4K launched our Parent-Child Interaction Therapy (PCIT) program in March 2009; therapists work with parents and children together to teach parents how to effectively reduce their child’s problem behaviors, including aggression, disobedience, defiance, and temper tantrums. Through teaching parents about healthy attachment, effective discipline, and child management skills, our PCIT program will improve their child’s behavior. Research indicates that PCIT helps parents learn effective parenting techniques, decreases the behavior problems of children, and improves the quality of the parent-child relationship.

Our range of services include: comprehensive initial mental health assessment; in-home individual therapy with the child plus family therapy with foster parents, relative caregivers and/or biological parents; case management; medication evaluation and support; psychological and neuropsychological evaluation; reunification services and permanency planning; 24/7 crisis coverage; and linkage to additional community resources. Our mission is to provide high-quality, effective treatment to as many at-risk children and families as possible. To achieve its mission, C4K uses only licensed therapists and a “clinic without walls” model of in-home service delivery. We provide therapy in the child’s home to increase treatment effectiveness: therapists are able to follow a child through multiple home placements, monitor the home environment, and decrease the number of missed therapy appointments.

In 2002 C4K designed an agency-specific Microsoft Access 2003 Database to help manage our growth. With multiple programs, increasing client numbers, ever changing County and State quality assurance requirements and the agency’s desire to make data more accessible, the need for an electronic tracking method was evident. By capturing all agency data in one electronic location, it has enabled the agency to not only increase service delivery by examining resource utilization within programs, but has improved client treatment as well. The Access database was created to capture: all client referrals; client demographic information; treatment history; diagnosis changes; clinician information; every service a client received and subsequent payment information; program specific outcome information; and quality assurance dates and notes to ensure treatment reviews were being performed regularly.

In addition to simple form entry and data collection, the Access database also has features that simplify routine tasks. We developed more than 30 customized reports to provide quick data retrieval for both clinical and administrative staff. Further, several electronic scoring forms were created through the use of queries and tables that help in reducing mathematical errors that often occur when analyzing large data samples. And, because we can export data from Access with ease to Microsoft Excel, it’s simple to create custom spreadsheets and reports.

In 2008, C4K implemented an online electronic health record system to meet the needs of our field-based clinicians. Because the client data was already stored in Access tables, all information available at the time was easily imported into the new database. Normally a project of this size would require hundreds of staff-hours and drain the agency’s resources. Through simple queries and exports, the agency only required one staff member to handle the task. Within one week’s time, we imported information for over 1,000 clients and the new database was fully functional within 30 days of acquisition.

Though the online database met the needs of our clinicians, much of the functionality present in our Access Database was lost and the need to merge the two databases was palpable. Our software vendor was able to provide an Access export that could be easily linked to the data in the C4K Access database. By simply replacing the existing client table with the new exported table, we could update recent client information without double data entry, combine both sets of data and provide a seamless history for the agency. By integrating the available Access export with historical data in the Access Database, therapists in the field have accessible client data via the online database and full-time staff maintains the functionality of having an in-house Access Database.

Having seven years of service information for over 7,000 clients allows us to accurately predict contract expenditures for upcoming fiscal years as well as determine “best practice” guidelines for service delivery. Using historical data, our agency can determine the approximate number of clients it will be able to serve in a fiscal year to ensure contract expenditure. By evaluating both programs and the agency as a whole, we now have the ability to estimate a client’s estimated length of stay and subsequent service needs. This allows each client to receive necessary services while maximizing the number of clients in the community we are able to treat.

The TTP and PCIT programs both utilize standard outcome measures that are administered throughout the course of treatment to evaluate progress. The programs utilize six different outcome measures that evaluate behavior, depression, and PTSD, and each outcome measure uses a distinct scoring method. To handle the complexities involved with each measure, the agency recently designed a new Outcome Measures Access Database that not only captures the responses for each measure, but also calculates scores previously calculated by hand. After scores are recorded in the database, we use queries and exports within the database to create Microsoft Excel worksheets, create charts, and then present them in a Microsoft Word document that summarizes the client’s progress. Using Microsoft Office products has not only decreased the time it takes to create the reports, but treating therapists also find the new format more effective for determining client progress.

In addition to monitoring individual client progress, we use the data maintained in the Access Database for program evaluation. By tracking client diagnosis changes, average length of stay, and general treatment progress, each program is able to determine whether current treatment models are producing the desired effect, which guides program modification.

In an effort to continue providing quality services as well as meet the administrative needs of the agency, C4K continuously seeks methods for improving data collection and increasing service delivery. With the help of Microsoft TechSoup products, in the next year we hope to relocate both the C4K Access Database and the Outcome Measures Access Database to a Microsoft SQL Server. Once both databases are functional on the SQL Server, our goal is to design Access Databases to manage human resources data, quality assurance tracking, and donor data, and expand the current client and outcomes databases. By localizing all data on one designated server, C4K will be able to maximize reporting potential which will improve client services and modernize the agency’s day-to-day operations.