Children’s Institute, Inc.


Youth in the child welfare system tend to have been exposed to multiple traumatic events over time. Between one-half and three-fourths of these youth exhibit behavioral or social issues that are severe enough to warrant mental health treatment — a rate up to five times greater than mental health needs among their peers in the community who are not involved in the child welfare system. Children’s Institute, Inc. (CII) works in disadvantaged communities in central and south Los Angeles County to provide clinical mental health treatments and other supports to young people and families who have been harmed by violence or neglect.

CII offers a range of evidence-based treatments (EBTs) for trauma-focused mental health treatment, which have sufficient experimental evidence to meet the gold standard for youth mental health treatments. The evaluation will examine CII’s implementation of EBTs that target youth (between the ages of 9 and 24), with a focus on how CII maintains fidelity to the EBT models.

This program is funded by the federal Social Innovation Fund (SIF), a public-private partnership designed to identify and expand effective solutions to social challenges. The Edna McConnell Clark Foundation, a SIF grantee, is leading a SIF project in collaboration with MDRC and The Bridgespan Group to identify proven programs that can help low-income young people become productive adults. CII is one of nine subgrantees included in that SIF project.

Agenda, Scope, and Goals

The evaluation of Children’s Institute, Inc. (CII) consists of a fidelity assessment of one evidence-based treatments(EBT), a compliance check of a second EBT, and an implementation study. 

The fidelity study will center around one EBT: Trauma-Focused Cognitive Behavior Therapy, which targets post-traumatic stress disorder, depression, anxiety, and feelings of shame and self-blame. 

Functional Family Therapy, which uses both behavioral and cognitive behavioral interventions to develop family members’ strengths towards change, will be reviewed to determine CII’s compliance with the model developer’s standards. 

The implementation study will examine the delivery of the EBTs at CII and provide an assessment of CII as a whole organization. It will also provide critical information related to CII’s implementation of its Integrated Services Model.

Design, Sites, and Data Sources

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) use is widespread in the child welfare field. However, TF-CBT does not have a validated fidelity monitoring tool. As such, organizations like Children’s Institute, Inc. (CII) that are implementing TF-CBT do not have a robust method to determine if their therapists are implementing TF-CBT with fidelity. This research project will serve multiple purposes. First, through a review of audio-recorded therapy sessions and secondary data collected by CII, the researchers will assess the degree to which CII is implementing TF-CBT with fidelity. Second, the research team will compare their findings from the audio-recorded sessions with a therapist self-report measure (the TF-CBT Brief Practice Checklist) to evaluate the extent that the self-report measure accurately captures the model. This aspect of the research will make an important contribution to the field by advancing understanding of the extent to which child welfare agencies and clinicians can use the TF-CBT Brief Practice Checklist to monitor fidelity in community practice settings.

MDRC is subcontracting with experts in TF-CBT and implementation science at the Medical University of South Carolina to assist with the TF-CBT fidelity study.

The major data sources for the implementation study will primarily include interviews with CII leadership, clinicians, and their supervisors; a survey of clinical staff and their supervisors; and interviews with referral providers and others serving a similar population. Both the fidelity assessment and the implementation study will also rely on internal monitoring documents and an analysis of CII’s management information system.