Assistant Professor Julie Bertram aims to meet the mental health needs of youth in foster care through her Wrap Around Wellness Program.

Assistant Professor Julie Bertram aims to meet the mental health needs of youth in foster care through her Wrap Around Wellness Program.

Julie Bertram is an assistant professor in the UMSL College of Nursing. Her research and clinical work includes the Wraparound Wellness program, which focuses on mental health outcomes for children and youth in foster care. (Photo provided by Derrick Holtmann)

Studies have shown that children and adolescents in foster care are prescribed psychotropic medications at two to three times the rate of other children.

Julie Bertram, assistant professor of nursing at the University of Missouri-St. Louis, said: Lewis is well aware of these alarming statistics and has focused much of his research and clinical work on mental health outcomes for children and youth in foster care.

In collaboration with our community partner Children’s Permanency Partnership (a foster care consortium comprised of FamilyForward, Youth in Need, and Epworth Children & Family Services), Bertram will use evidence-based We designed a wraparound wellness program that is a care coordination program. Youth health outcomes in the St. Louis area foster care system.

changing interests

Bertram has always been drawn to service and health care and originally wanted to become a doctor. However, her situation changed when she underwent spinal fusion surgery for scoliosis at the age of 15. As she recovered in the hospital, she became more interested in nursing. Her interest was further strengthened by her friend’s mother, who was her role model at the time.

Bertram went on to earn her BSN and earned a master’s degree in psychiatry and mental health nursing from Saint Louis University. She worked as an RN specializing in psychiatric mental health in a hospital for her 15 years. Because she had expertise in psychiatric mental health nursing and qualifications in child and adolescent psychiatry, in 2008 she was invited as a nurse consultant to a research study on the treatment of older people in children’s homes. . It became a pivotal moment in her career.

Bertram worked with J. Curtis McMillen, then an associate professor at Washington University in St. Louis, to work with young people living in institutions or residential settings through the foster care system to help them return to the community and become independent. We have begun to support students in acquiring these skills. -sufficient. She participated in weekly team meetings, conducted diagnostic and medication reviews, and developed psychoeducational materials for both youth and foster parents. After her team’s research was completed, she began training foster parents in medication management and began developing her own dissertation research.

Although she did not initially intend to study foster care, she felt this research fit into her larger vision of building trauma-informed communities.

“Trauma-informed approaches to service delivery have wide application,” Bertram said. “Foster care is just one of many systems that can benefit from learning and practicing trauma-informed ways of working. Trauma-informed as an approach It goes beyond care and is not tied to just one setting. I used to think that hospital-based psychiatric and mental health nursing care was the last resort for all. Mental health promotion is a much larger field than that. Trauma-informed is a multi-setting approach that can benefit many service-facing professionals and care recipients.”

Solidifying her research interest in the role of psychiatric and mental health nursing in the child welfare and foster care systems, Bertram enrolled in UMSL’s College of Education to pursue a doctorate in educational leadership and policy studies. In her doctoral dissertation on decision-making in the foster care system, she used primarily qualitative methods to examine how stakeholders are involved in decision-making in the context of family support team meetings. I rated it. Mr. Bertram attended these meetings and was able to observe communication dynamics, interview stakeholders, and observe how court hearings were conducted. She then implemented her Empowerment Scale with both youth in foster care and the adults who make up their teams.

From all these data sources, Bertram gained a deeper understanding of how the system worked. Although I had some inkling from my previous work, I was able to learn more about different child welfare policies, the different structures in place, and the issues that make it difficult for families to exit the foster care system.

“Ideally, the child welfare system would communicate and collaborate with the court system, the health care system, the education system, and families, but in reality it is not that easy to communicate and collaborate between all these systems. No,” Bertram said. “That was part of what I was learning and understanding: how and why care becomes fragmented. Hearing their perspective helped me understand that even more.”

Improving health outcomes in foster care

Through writing her doctoral dissertation, Bertram gained a deeper understanding of how the child welfare system works, including potential ideas for improving care. She became known in the community for her work as a nursing consultant and was invited to join her foster care consortium, the Children’s Permanency Partnership, and together they began to develop her research projects. . She joined UMSL’s College of Nursing as an assistant professor in 2017 after serving in a similar position at her SLU.

Aiming to improve communication and coordination between the various child welfare systems, Bertram and Alicia Acosta, then an MSW student at UMSL and working as a Wellness Coordinator for Child Permanency Partnership, created the Wrap Around Wellness Coordinator. program was developed. The two worked together to develop a research problem and eventually trademark the program. The goal of the Wraparound Wellness Program is to improve health outcomes for youth in foster care by fostering collaboration between systems and promoting continuity of care for foster children and youth.

“If anyone would like to learn from us how we have been able to implement effective and comprehensive health programs within foster care organizations, they can take a look at what we have developed,” Bertram said. said. “But we don’t want them to implement it piecemeal. We want them to implement it according to some mechanisms, patterns, processes, procedures, role fidelity that we have developed. I would like to have it.”

In addition to training featuring a comprehensive menu of interventions, the program is a 30-hour web-based program with a variety of modules that address trauma awareness, common illnesses, how the body works, the effects of various medications, and more. It features a curriculum based on The program includes a variety of roles with specific responsibilities, including Wellness Coordinator, Quality Assurance Director, Psychiatric Nurse, and Leadership Officer. The program tracks data such as drug use and patterns, some of which already must be documented by state and federal guidelines.

One unique element of the program is bimonthly housing review meetings between Bertram and his leadership team, including a case manager, and youth in foster care. She said case managers can leave the meeting doing whatever practical things they need to do, such as requesting clinical tests from health care providers or requesting incident reports in the event of seclusion or restraint. , said the conference would stimulate accountability.

“The idea is that if we have a meeting like this and talk about the young person’s situation and what’s going on with the case, we can identify patterns and trends and maybe make recommendations about what needs to change. ” Bertram said. “The goal is to get the person out of that restrictive environment and into a lower level of care.”

Ultimately, they hope that the program will lead to permanent placement with ancestral families, foster parents, or other adult caregivers, or that young people can age out of foster care and successfully live their lives. I hope that this will lead to a level of self-sufficiency. By myself.

“As a general rule of thumb, we want to enable people to move out of their homes and into situations where they can grow and thrive,” Bertram says.

That said, Bertram believes there is a need to develop interventions to support transitional youth with mental health issues and allow them to advocate for themselves after leaving the foster care system. Stated. She has several other future research possibilities and enjoys involving College of Nursing students in developing research questions, analyzing data, and preparing manuscripts.

Ideally, Bertram would like to see if the program can be implemented in other parts of the country, conduct further research, develop data collection, and test youth in foster care in other states. We see an opportunity to provide training, resources and support to those we work to help. . She is also interested in developing new questions, and she sees possibilities for intersecting with different fields.

“If you’re interested in trauma-informed approaches, if you’re interested in foster care, you don’t have to be a certain type of person to participate in those efforts,” she says. . “You might be someone interested in social work, nursing, medicine or psychology. There are a lot of possibilities. There’s a place for everyone to get involved and think about how they can make a difference. .”