Comparison/Crosswalk of the Child and Family Resiliency Practitioner and Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundation of a Model

In 2009, the Psychiatric Rehabilitation Association (PRA, formerly USPRA) launched a 30-hour professional development training titled Certificate in Children’s Psychiatric Rehabilitation. The purpose of this course was to prepare practitioners providing community and school-based behavioral health care services with the skills and knowledge necessary to empower young people and their families to develop the skills and access the resources needed to increase their capability to thrive in the living, working, learning, and social environments of their choice. Since its inception, nearly 3,000 practitioners around the world have completed the course, earning the PRA Certificate in Children’s Psychiatric Rehabilitation. (PLEASE NOTE: At the conclusion of 2018, PRA will no longer be recognizing the Children's Certificate in Psychiatric Rehabilitation - the Child and Family Resiliency Pracitioner (CFRP) credential is the designation recognized by PRA in order for CBRS Practitioners to provide services to children.)

Over the past three years, the Certification Commission for Psychiatric Rehabilitation, the governing body of PRA’s credentialing programs, worked to determine the need for standardization across the field of psychiatric rehabilitation services for children. In 2014, PRA and the Commission conducted a Job Task Analysis (JTA) study addressing all of the issues inherent in establishing a single set of credentialing standards that can apply to all child and family resiliency practitioners. The JTA consisted of nine  domain areas, addressing 69 tasks.  Data analysis of the JTA results produced the facts of measurement, thus allowing a deeper understanding of the structure of the discipline of Psychiatric Rehabilitation for children and families.

Upon review of Magellan Healthcare’s document Understanding and Meeting the Needs of Children and Adolescents at High Risk: Foundations of a Model, PRA finds many comparisons to the Child and Family Resiliency Practitioner competency domains can be found. While CFRP’s are not considered “clinicians”, they are competent, credentialed and professional and address many of the same domains and competencies addressed in Magellan Healthcare’s document.

SECTION I
A Focus on Child and Adolescent Development
This section speaks to the importance of being developmentally informed and knowledgeable with regards to the vulnerabilities of children related to developmental disruptions, and the application of services/systems to address these disruptions, alter the exposure to risk factors and strengthen protective factors. 

While addressing the developmental needs of children and adolescents is addressed throughout the CFRP competency domains, this mostly aligns with Domain V: Strategies for Facilitating Resiliency and Recovery. Specifically, Task 9: Assist families in their efforts to modify their child’s learning, social and home environments to enhance the development of resilience and growth, aligns well with this focus area. Additionally, Domain I: Interpersonal Competencies, Task 8: Promote resilience, self-determination, and matching services to age and developmentally appropriate needs and goals, fits well with a focus on developmental needs and considerations.

Children and Adolescents at High Risk: Important Characteristics and Critical Issues
Addressed throughout this section, is the issue and impact of trauma on children and adolescents. The impact of early and prolonged trauma manifests in different ways, depending upon the developmental stage of the child; ranging from regulatory disorders in infancy to attachment and emotional disorders in middle childhood to personality, substance abuse and affective disorders in young adulthood. Risk factors for prolonged, complex trauma often can be traced back to child abuse or neglect, which is complicated by a number of factors, including poverty, parents with mental health or substance abuse disorders, incarcerated parents, as well as children with challenging issues related to mental health, substance use and/or developmental disorders. These are all significantly stressful factors that impact families and relationships.

Again, while the CFRP credential and practice domains all speak to addressing the needs of children and families to promote resilience, Domain VI: Systems Competencies, best aligns with addressing the needs of children and adolescents at high risk. One of the factors impacting families’ ability to engage in services when under stress is that of fear, shame or guilt. Task 3: Combat stigma, oppression, discrimination, and prejudice in all forms, directed against children and families, provided the impetus necessary to normalize and adequately address the challenges multi-stressed families face. Additionally, Domain VII: Supporting Health and Wellness, Task 2: Assist children and families in identifying and accessing specialized services (i.e., early childhood interventions, trauma informed care, health promotion and nutrition services, special education, physical healthcare, etc.)

SECTION II
Foundations of a Comprehensive Community Healthcare System Serving Youth
This section speaks to the importance of early identification and treatment of mental illness in children, and the detrimental impact on the cost of future healthcare, as well as the direct correlation to poor academic performance, poor employment opportunities and potential for poverty for those not adequately screened and treated. Magellan provides case management and care coordination to ensure that treatment options and availability meet the needs of patients. Magellan considers patients and families “essential partners in care” from the identification of strengths and needs to collaboration of care, implementation of treatment and evaluation of treatment outcomes. 

Domain IV: Assessment, Planning and Outcomes, speaks directly to Magellan’s position on early intervention, treatment and evaluation of outcomes. 
Task 1. Assist children and families in identifying personal needs, priorities, strengths, and interests in order to help them establish goals that are consistent with their age and worldview. 
Task 2. Perform assessments across multiple life domains in order to identify needs, strengths, supports, and barriers. 
Task 3. Collaborate with children, families and teachers to help them identify their personal preferences for dealing with crises. 
Task 4. Collaborate with children, families and teachers to establish goals with specific, measurable, time framed action steps in order to develop effective rehabilitation plans. 
Task 5. Identify, assess and plan opportunities that empower children and families to transition, when appropriate and effective, from professional provider services to natural community supports. 
Task 6. Educate families on service options in order for them to choose the best options and levels of service and community supports for their child. 
Task 7. Regularly evaluate and modify the service plan with the child, family and/or Teacher based on the child's progress towards their goals

Core Network Competencies: Child and Adolescent Interventions and Treatments
Regarding the promotion of culturally competent and trauma-informed approaches to care, Magellan stresses the importance of psychosocial interventions carefully planned with explicit developmental components; including early and intensive support by skilled home visitors. This requires “special expertise and unique approaches to ensure the delivery of culturally competent services to children and adolescents.”

Domain II: Professional Role, Task 1: Acquire the knowledge and skills in order to provide services that are evidence based and emerging best practices and consistent with PRA Practice Guidelines, addresses the importance of providing interventions that are carefully planned with explicit developmental components. Domain III: Community Integration, Task 7: Support children and families in developing skills to engage and sustain specific resources to meet their needs and goals, addresses the importance of psychosocial interventions and culturally competent services.

Magellan stresses the importance of screening and assessment and the well-identified gap between assessed needs and accessibility to services, as well as the need for crisis planning and intervention. Domain V: Strategies for Facilitating Resiliency and Recovery, Task 4: Employ crisis intervention strategies as needed, and Task 8: Assist children and families in identifying and developing strategies that support the ongoing use of skills developed to promote mental and physical health, speak to this important factor.

Magellan’s emphasis on Offering Family-Driven, Youth-Guided Components of Care, as led by SAMHSA’s 1992 Children’s Mental Health Initiative, is supported by the following: CFRP Domain V: Strategies Facilitating Resiliency and Recovery: Task 1: Acquire knowledge of and utilize various approaches to engage children and families, including evidence-based practices, best practices, and culturally relevant services; Task 2: Provide best practice approaches to services, including evidence based practices, which help children and their families, develop skills and have confidence that allows them to thrive in their communities; and Task 7: Assist children and families to develop and/or improve the skills, supports and accommodations necessary to foster resiliency and achieve their goals. Additionally, Domain VIII: Transition-Age Youth Services, Task 4: Teach, encourage and support youth to advocate for themselves, Task 5: Facilitate skill building, goal setting, self-discovery, and learning across all life domains; and, Task 8: Assist youth in identifying and accessing specialized services that meet their needs, support the utilization of family-driven, youth-guided care.

With regards to providing evidence-informed psychosocial treatments, Magellan identifies that there are times when medications are prescribed too soon, or before other, potentially effective strategies have been employed. While Magellan focuses on the clinical delivery of treatment, it also recommends the health care system serving youth “should maintain a network of credentialed practitioners demonstrating competency in the following core evidence-based psychosocial interventions:

•    Supportive Therapy
•    Interpersonal Therapy
•    Cognitive Behavioral Therapy (CBT), including Trauma-focused CBT (TF-CBT)
•    Behavior Therapy
•    Individualized Educational Interventions/Skill Development Models
•    Parent Counseling
•    Parent Training Programs
•    Family Therapy

IN SUMMARY 
While CFPR’s are not considered “clinicians”, they are competent, credentialed and professional. As can be seen from the CFRP Practice Domains, a high degree of competence is expected, and the utilization of the skills demonstrated by this professional workforce will enhance the list of clinical services identified by Magellan and other MCO’s. 

PRA strongly encourages MCO’s, employers and state regulatory agencies to visit the PRA website to learn more about the Child and Family Resiliency Practitioner certification program, including the practice domains and candidate eligibility requirements. For more information, contact Casey Ward Goldberg, Associate Vice President, Credentialing Programs at 703-442-2079.