Center for Resilience 2022-2023 Annual Report

FROM THE FOUNDER + CEO

When the Center for Resilience transitioned to its non-profit status in 2018, I set three ambitious goals for the organization, and for myself as the founding Chief Executive Officer:

1. Secure a long-term home for our program;

2. Formalize a partnership agreement with an area hospital system;

3. Develop a revenue model with increased Medicaid funding that reflects a reduced reliance on philanthropic support and presents a path to financial sustainability; and

4. Build out more services along the continuum of pediatric behavioral health care.

As we close out the 2022-23 program year, I am excited to share that we have accomplished these goals. We are finalizing a five-year partnership agreement with Children’s Hospital New Orleans which, in addition to providing security regarding our program facility, outlines financial benefit to CfR and serves as the foundation upon which we hope to grow our partnership. In August 2022, we received our license to operate as a partial hospitalization program from the Louisiana Department of Health, which enabled us to negotiate a bundled, daily rate with Louisiana’s six Medicaid plans. In addition to that, since 2018 our program has grown to include a high school, the Prism Program for children with autism and related spectrum disorders, and a small team leading the Preventing Long-term Anger and Aggression in Youth intervention both at CfR and with community partners.

Center for Resilience’s mission has always been to ensure access to high-quality, healing-centered, and relationshipsbased care and to address gaps in our region’s behavioral health services and placements. As I reflect on what CfR has accomplished in its first eight years of service, I am proud of the work we’ve done and the results we’ve achieved for children. This past program year was pivotal in beginning the work that will sustain the organization in the years to come, especially with our hospital partnerships and anticipated increased Medicaid revenue. Although there is still more work to be done, I feel confident in CfR’s foundation. I also believe that leadership comes in phases, and there are critical points in organizations when they can benefit from fresh perspectives and new skill sets. For these reasons, I announced my own transition out of the role of CEO earlier this have been excited to welcome Alex Gray as my successor this spring. Alex’s background in development, operations, and talent reflects the current needs of the organization and is the right set of skills to build on the foundational programmatic, relationship, and financial accomplishments we’ve achieved thus far.

Center for Resilience came out of the recognition of a critical need for pediatric mental health care, and services CfR provides are needed now more than ever. Alex is poised to lead CfR into the future. In the coming year, we will: continue to work with Medicaid and the Louisiana Department of Health to secure additional funding; engage in multi-year financial forecasting and cost modeling; launch an innovative approach, led by our clinical team, to increase parental engagement; and continue to provide services to some of our region’s most vulnerable youth. While it is bittersweet for me to draft this last Annual Report, I am proud of what CfR has accomplished and excited about what the future holds. Together, we are working to build a healthier, more resilient Greater New Orleans region.

Liz Marcell Williams Founder + CEO

vision + STRATEGY

The Center for Resilience is the only therapeutic day treatment program in Louisiana. We provide educational and intensive mental health supports in an innovative partnership with the Tulane University Medical School Department of Child and Adolescent Psychiatry to ensure the emotional well-being and academic readiness of children with behavioral health needs in the Greater New Orleans region. Children with behavioral health and autism or related spectrum diagnoses receive instructional, medical, and therapeutic services at our day program site with the goal of building the skills necessary to successfully transition back to the traditional school setting. Our mission is to improve the emotional well-being and academic readiness of children by delivering high-quality, interdisciplinary care, and collaborating with partners to develop new programs that meet the needs of our region’s children and families.

Our vision is that all children, regardless of their behavioral health needs, have access to environments that allow them to thrive.

We believe we can realize our mission and vision by providing tailored, high-quality care provided through an interdisciplinary approach and by experts in the educational, clinical, and medical fields. We do this work in intentionally constructed, expertly designed therapeutic settings. This intentional therapeutic milieu is a social and cultural environment that is positive and asset-based, loving and supportive, and seeks to provide appropriate interventions rather than negative consequences. We also know we cannot do this work alone, and so we continue to seek partners –such as Children’s Hospital New Orleans – with whom we collaborate to identify and fill gaps in the pediatric behavioral health ecosystem.

our PROGRAMS

Center for Resilience operates three distinct, high quality, interdisciplinary programs.

RELATIONSHIPS BASED DAY TREATMENT (RBDT)

RBDT was our inaugural program and began serving children in Fall 2015. RBDT is a relationships-based, trauma informed therapeutic day treatment program for children with significant emotional health and trauma-related needs. RBDT is characterized by a strongly interdisciplinary approach offering academic instruction, counseling and therapy, and medication management, and approaches children and families from a strengths-based perspective. Today, CfR operates three separate RBDT programs: elementary, middle, and high school, each of which has specific programming informed by evidence-based and appropriate developmental practices. For example , our elementary program features time for community-wide meetings and daily structured play, including opportunities for children to invent games to play; the middle school features an emphasis on community time for kids to “hang out” and incentivized programming that encourages kindness and contributions; and the high school; and the high school program includes virtual learning models and offers schedule flexibility such as opportunities to take walks in Audubon Park.

All programs feature group and individual therapy; small-group instruction; therapeutic enrichment activities such as yoga, art therapy, and music therapy; community-based activities and field trips; and robust parent engagement activities.

PRISM PROGRAM

The Prism Program supports children with autism and related spectrum disorders experiencing acting-out behaviors at home or in the community. The Prism Program was created after our RBDT program experienced an increase in referrals for children of this profile and is tailored to meet the needs of children with autism spectrum and related disorders. Like RBDT, Prism is characterized by a strongly interdisciplinary approach offering academic instruction, counseling and therapy, and medication management, and approaches children and families from a strengths-based perspective. The Prism Program also offers intensive Applied Behavioral Analysis (ABA) supports in a one-on-one setting, ensuring each child is making progress on individualized treatment goals. ABA is the only evidence-based treatment for children with autism spectrum and related disorders, and at Prism, we couple the principles of ABA therapy with an environment that celebrates each child’s unique abilities.

The Prism Program is staffed by a full-time counselor who leads social skills groups and provides individual therapy as needed. A full-time occupational therapist and speech and language therapist provide group and individual therapy to children in the Prism Program as well as in RBDT, as needed. Like RBDT, Prism offers small-group instruction; therapeutic enrichment activities such as yoga, art therapy, and music therapy; community-based activities and field trips; and robust parent engagement activities.

PLAAY AT CFR

Preventing Long-Term Anger and Aggression in Youth (PLAAY) is a culturally responsive group therapy intervention developed at the University of Pennsylvania to teach children the skills needed to reduce stress and resolve conflict during intense events, including racially stressful events. PLAAY uses sports, and other naturally-occurring competitive environments such as video and board games, to engage children and equip them with the tools they need to navigate face-to-face conflict in ways that lead to healthier and safer outcomes, including reduced referral behavior incident and school suspension rates and increased engagement via attendance and homework completion rates.

Today, CfR has a Memorandum of Understanding with the University of Pennsylvania to operate as the only regional training and dissemination hub for PLAAY, and we have two full-time staff members leading this work. They coach and supervise CfR staff who implement PLAAY in all of our RBDT settings. In addition, they offer PLAAY group facilitation in partner schools; lead community PLAAY workshops; and offer train-the-trainer workshops to community and youth-serving organizations. PLAAY is highly replicable because you do not need a clinical license to lead PLAAY groups, and we are excited to bring it to more children and youth-serving organizations in the future.

2022/23 ACCOMPLISHMENTS

Center for Resilience secured a partial hospitalization program (PHP) license, which opened the door to more sustainable funding streams through Louisiana Medicaid, ensuring the ongoing sustainability of the organization. More specifically, the accomplishments include:

SECURED LICENSURE TO OPERATE AS A PARTIAL HOSPITALIZATION PROGRAM

In August 2022, Center for Resilience received a license to operate as a Partial Hospitalization Program (PHP). CfR was already providing the services required by PHP regulations, which include a minimum of 20 contact hours per week; access to educational services and/or coordination with the child’s school district; a licensed physician on-call; a clinical supervisor on-site at least 10 hours a week and on-call; at least one Licensed Mental Health Provider on-site at all times when clinical services are being provided; and nursing services available. The receipt of PHP licensure is significant because it provides a common and recognized language and status for the work done at CfR, and it allowed CfR to pursue negotiations toward a bundled daily rate with Louisiana’s Managed Care Organizations.

SUCCESSFULLY NEGOTIATED “IN LIEU OF” AGREEMENTS WITH FOUR LOUISIANA MANAGED CARE ORGANIZATIONS

Because Louisiana does not have a published rate for Partial Hospitalization Programs in its Medicaid Fee Schedule, Center for Resilience worked with each Medicaid plan to submit an “in lieu of” (ILO) request to the Louisiana Department of Health. The ILO request forms outlined the services provided by CfR; requested to process claims from CfR at a daily, bundled rate in lieu of the standard fee-for-service model; stated the daily rate at which the claims would be paid; and suggested the Medicaid claim code that would be used to process claims. Once the ILOs were approved, each Medicaid plan had to reissue a contract with Center for Resilience and reconfigure its claims system, and process that took between four to six months. By the end of the program year, four plans had submitted and received approval for their ILOs, and two plans had completed the contracting and recredentialing process and were able to process claims. CfR projects all six Medicaid plans will have approved ILOs by the end of the second quarter of Fiscal Year 2024.

ADDITIONAL ACCOMPLISHMENTS INCLUDE:

INITIATED A PARTNERSHIP AGREEMENT WITH CHILDREN’S HOSPITAL NEW ORLEANS

During the course of this program year, Center for Resilience and Children’s Hospital CHNOLA collaborated on a draft of a five-year partnership agreement. This partnership agreement formalizes ongoing conversations regarding opportunities for collaboration between CfR and CHNOLA. The agreement also outlines multiple benefits to CfR, including: a below-market lease amount; annual grant and in-kind support; an annual capital improvement allowance; and the ability to appoint a member of the CHNOLA leadership team to CfR’s Board of Directors. CfR anticipates the agreement will be signed in the first quarter of the next program year.

2022/23 ACCOMPLISHMENTS cont.

EXPANDED THE PLAAY TEAM TO SERVE MORE NEW ORLEANS-AREA YOUTH

Center for Resilience continued its commitment to expanding PLAAY to the Greater New Orleans Community. This year, CfR added a second full-time PLAAY staff member to increase capacity to lead school- and community-based PLAAY groups, workshops, and trainings. Through this investment, PLAAY was able to increase the number of children involved in PLAAY by 43%. In addition to existing school partners, PLAAY added a new partner in the Orleans Parish District Attorney’s office, where it successfully piloted a diversion program for nonviolent offenders.

COLLABORATED WITH NEW ORLEANS PUBLIC SCHOOLS TO INFORM THE NEED FOR CITYWIDE FUNDING FOR SPECIALIZED AUTISM PROGRAMMING

Throughout 2022-23, Center for Resilience worked with New Orleans Public Schools during NOLAPS’s revisions to the Systemwide Needs Program, a fund that supports initiatives resulting in districtwide improvements in areas that can be more efficiently and effectively addressed at the system level than at the school level. In Spring 2023, NOLAPS announced funding to support specialized programming for children with autism. This recognition of the need for citywide funding in this area reflects the awareness of the demand for specialized autism programming and its related costs, and increases the amount of available funding to support programs such as the Prism Program. Center for Resilience anticipates responding to the NOLAPS Request for Proposals as soon as it is posted.

2022/23 OUTCOMES

The Center for Resilience has two overarching programmatic goals. Those are:

• 80% of children transition successfully back to their home schools

• Significantly reduce hospitalization rates for short- and long-term behavior crisis-related hospitalizations However, CfR measures outcome data on a variety of programmatic indicators, outlined below.

ENROLLMENT & REFERRALS

In our seven years of service to children and families, the Center for Resilience has served over 113 unique students, representing an additional 23 new students since the previous year.

During the 2022-23 school year, we received 34 referrals. On average, CfR receives approximately 35 referrals per year. We had an acceptance rate of 62 percent, which is comparable to the previous year (68 percent). While CfR’s orientation to admission, assuming the referral is appropriate, is to ‘say yes until we have to say no,’ there are various considerations to acceptance, including the needs of currently-enrolled children and the impact a new child will have on their program; the level of support and staffing a referred child may need; and the consideration of co-occurring disorders (for example, a child with a concurrent substance use issue would first be referred for treatment to address substance use prior to being admitted to CfR).

Acceptance rates can vary; for example, the acceptance rate in 2018-19 was 96 percent and 2017-18 was 74 percent, by comparison). We observe that the schools submitting referrals are highly successful identifying children who may benefit from services at the Center for Resilience.

ACADEMIC PROGRESS

Academic progress in literacy and math is routinely tracked and assessed. Outcome data from 2022-23 includes:

Two factors rendered Math grade level growth data, as measured by the MAP assessment, inconclusive: (1) a significant number of students declined to participate in the assessment or did not complete the assessment; and (2) the students who completed the fall assessment did not complete the spring assessment, and vice versa. Assessment readiness is an ongoing aspect of our clinical work with students at CfR and will be an area of focus in the coming year.

There are three additional academic priorities for 2023-24:

1.

Collect weekly progress monitoring data regarding mastery of IEP goals

2.

Gather academic intervention and general curriculum progress data

3.

Hire an intervention teacher to focus on remedial math and literacy skills

Over the past seven years of serving children, the New Orleans Therapeutic Day Program/Center for Resilience transitioned the following numbers of children back to their home schools:

2015-16

2017-18

2019-20

(other transitions delayed due to COVID-19 closure)

2021-22

2016-17

2018-19

2020-21

2022-23

The average length of stay in our program fell from over 16 months at the end of 2016-17 to just 11 months at the end of 2018-19, the most recent year from which we can extrapolate reliable data. We interpret this to mean that we have gotten better at providing adequate support and intervention to children in our program; we have also been able to better identify when children in our program need more intensive services, such as referral to a psychiatric residential treatment facility.

We see an 86 percent overall success rate in transitioning children back to their home schools, which exceeds our target of 80 percent.

Over time, we have seen a 48 percent reduction in incidents of psychiatric hospitalizations (including both short-term acute care stays, and referrals to longer-term psychiatric residential treatment facilities). To date, at least 36 percent of admitted children have experienced at least one hospitalization prior to referral; just 23 percent of enrolled children experience a hospitalization during time. This is especially noteworthy because, from March 2020 to October 2020, mental health-related emergency department visits increased by 24 percent among 12-17-year-olds1, a significant increase in a short period of time. That our hospitalization rates continue to decrease speaks to the lasting impact of our interventions.

It is worth noting that 90 percent of children referred to Center for Resilience experience a reduction in hospitalizations while onsite.

2022/23 OUTCOMES cont.

PARTNER SATISFACTION

Center for Resilience surveys its partner schools twice a year and caregivers and families once a year. Data from our partners informs our program planning. Highlights from the 2022-23 school year surveys include the following data points:

100%

100%

71%

PARTNER SCHOOL OVERALL SATISFACTION WITH CFR

DEMOGRAPHIC DATA

For the first time in 2021-22, CfR began collecting two critical pieces of information during our intake process.

FAMILY OVERALL SATISFACTION WITH CFR FAMILIES REPORTING LESS STRESS SINCE CHILD PLACED AT CFR ACES

First, using a methodology described by California Surgeon General Nadine Burke Harris in her book “The Deepest Well,” CfR asked parents to complete an anonymous questionnaire in which they self-reported their child’s Adverse Childhood Experiences Score (ACES). As described by the Centers for Disease Control (CDC):

“Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). For example:

• experiencing violence, abuse, or neglect

• witnessing violence in the home or community

• having a family member attempt or die by suicide

Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding, such as growing up in a household with:

• substance use problems

• mental health problems

• instability due to parental separation or household members being in jail or prison ACEs are linked to chronic health problems, mental illness, and substance use problems in adolescence and adulthood. ACEs can also negatively impact education, job opportunities, and earning potential. However, ACEs can be prevented.”2

Families reported the following:

An ACE score of 3 suggests a person at moderate risk of toxic stress. Center for Resilience takes this data seriously and would not presume to update or modify it at any point, since it is volunteered by the family member; however, after working with children in our program, we believe each child’s individual ACE score may be under-reported in this data set; we suspect most of the children we serve have ACE scores of 4 or higher, on average, indicating high risk for toxic stress. In the 2023-24 program year, we plan to ask families to report this data after the child has been enrolled at CfR for at least six weeks to increase their potential level of comfort in disclosing information.

2 Retrieved from https://www.cdc.gov/violenceprevention/aces/fastfact.html August 17, 2022.

2022/23 OUTCOMES cont.

DEMOGRAPHIC DATA CONT.

CALOCUS

CfR also began collecting “levels of care” assessment data using a tool called the CALOCUS. This type of assessment is designed to identify the setting in which an individual needs medical or long-term care. Based on our first year of data collection, all of the children referred to Center for Resilience required high-intensity services. This suggests the need for our programming as well as other intensive programming, such as residential services. It also is a clear indicator that schools are not referring children for placement at CfR who are not in need of significant intervention.

2022/23 BOARD OF DIRECTORS

Adam Hawf BoardChair,Chief Executive Officer, Radion Health

Paulette Carter BoardViceChairandSecretary,Perinatal, Infant and Early Childhood Mental Health Consultation Program Manager at Bureau of Family Health, Office of Public Health, Louisiana Department of Health

Louis Bartels Treasurer , Vice President of Commercial Banking, b1BANK

Kelly McClure Director of PreK-12 Education Programs and Professor of Practice, Tulane School of Professional Advancement

Karina Castillo Executive Director of English Language Learners, Jefferson Parish Public Schools

Angela James Assistant Director, Goldman Center for Student Accessibility, Tulane University

Nandi Campbell Judge, Orleans Parish Criminal Court

Robert Pearson Founding Partner, Pearson & Mitchell, LLC, & Support Performance Coordinator, Jefferson Parish Public Schools

Aimee Quirk Chief Executive Officer, innovationOchsner

Dr. Kedrick Perry Vice President for Equity and Inclusion, Loyola University New Orleans

John Goodwin CPA, Daigrepont + Brian

As a result of CfR, I’ve noticed the following changes in my child:

He has grown a longer fuse, starting to take responsibility for actions, starting to understand how his actions affect others.

increase in expressive language, more communication, [and] we have learned how to manage outbursts/tantrums

Better communication and peer interactions

What are the best aspects of the CfR program?

They staff who work closely with my son really cares for him and it shows clearly

The staff is extremely supportive and caring, they feel like family.

The staff is incredible and it is a safe place to send our children

Making us feel that they are completely on our family’s team in working to help our child thrive... small setting, one on one therapy