Therapist uses “pay it forward” mindset while managing youth assessment program

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Natalie Stepp, a senior project manager for qualified residential treatment programs (QRTP), understands the struggles at-risk youth encounter. At only nine years old, her mother died of cancer, leaving her father and two siblings devastated.

Stepp saw her community, local schools, and church embrace her family, providing much-needed support while the family adjusted to their new normal.

Her loss and the positive support she experienced afterward led her to a career that would allow her to give back by providing encouragement, care, and support to others.

Stepp earned a bachelor's degree in child and family development from San Diego State University and a master's degree in marriage and family therapy from Chapman University in Orange, California.

"When I began my career path in college with internships and part-time jobs, I found myself gravitating toward vulnerable populations, to 'pay it forward,' or give back, to the community that supported my family during such a challenging time," she said.

Stepp worked with various agencies in the Los Angeles area, including the Homes for Life Foundation, which provides therapy, residential services, and care management for adults with serious mental illness. She then worked with their transitional-aged youth program, ages 18-21, who were preparing to leave foster care or juvenile probation programs, to provide the same services and supports to ensure their transition in independent living was a success.

Throughout her early career experiences, Stepp found an interest in using assessment tools that helped her identify high-risk healthcare needs and at-risk individuals. This skillset helped her when applying with Maximus in 2018. Her first job with Maximus was supervising evaluators for California's adult pre-admission screening and resident review process.

When she relocated to New York City in 2020, she took on her current role managing the North Dakota Independent Assessment project, and 6 months later, implemented the same project for the state of Michigan, which conducts placement recommendations for at-risk youth in foster care and state justice systems.

"The federal government wanted to improve 'group home' settings and restructure the appropriate services children in this demographic needed on an individual basis," Stepp said.

In addition to North Dakota and Michigan, Maximus holds QRTP contracts for foster and juvenile justice youth and conducts independent assessments on behalf of state agencies in Indiana and New Hampshire.

Stepp added some children from particular states are part of diverse populations. In North Dakota, many come from indigenous tribes, so her team works with tribal agencies. In Michigan, many might be homeless or living in shelters in urban environments.

Stepp and her team use a functional assessment tool called the CANS, the Child and Adolescent Needs and Strengths assessment tool to determine a child's strengths and needs. Her team comprises of Licensed Social Workers and Marriage and Family Therapist staff trained in a series of treatment modalities, although trauma-informed care is most common in the QRTP assessments.

"Our assessment helps outline specific strengths and needs, to later develop goals and interventions, so we can identify whether a child should be in a family setting or a treatment facility," she said.

Treatment facilities are 24-hour residential sites of care that are usually recommended for youth with high-risk behaviors – those who are a danger to themselves or others or those with complex mental health needs, for example.

"Treatment is based on the implementation of evidence-based practices," Stepp said. "The goal is to stabilize and treat the child and discharge them back into the community to a family setting. My team makes those decisions and determines whether a child needs that level of care or not."

In North Dakota specifically, Stepp's team has been partnering with the state’s criteria, to push the needle for more children to be in a home or community setting.

"Research suggests that children really thrive in a family setting like a foster home, treatment foster home or with family, and our goal is to best identify and recommend community settings whenever possible," she said.

QRTP team members conduct interviews with children, their caseworkers, caregivers, medical providers, and therapists. Interviews with children include identifying their strengths and needs, hobbies and talents, and where they would prefer to live.  

"Maximus assessors are getting the full picture of the child," Stepp said. "We don't only go on the word of the foster parents' or providers' experiences. We have information coming directly from the children."

Some assessments result in hard decisions and emotionally charged conversations, but Stepp believes it's critical to try to get insight from the children.

"I don't think a lot of them get to tell their stories, so that is nice to be able to incorporate their input and feelings into the overall assessment," she said.

Many states have been investing in more preventive measures for children, which Stepp believes will improve support services overall.

"I think that is driving this focus on child welfare and really improving the services and support available for children," she said. "We're focusing on making decisions that will help with creating productive, happy and healthy adults in their future."