My friend, Charlie, said that he does not think we should give the government more money to solve the budget crisis. He sees raising taxes or throwing money at the problem is the easy solution. I was in an intense discussion with him about what California’s leadership was doing, pointing out that the politicians did not want to raise taxes on those who could best afford it, but instead they “taxed” those who could least afford it by cutting back on the safety net of children, the elderly, the poor, the disabled.
Taxing those vulnerable and who are least able to resist is also “the easy solution.” These individuals are less likely to make the difference in an election and certainly in no position to gather signatures or congregate in protest because they are working too hard to live day to day.
The harder solution would be to look realistically at how much we are being taxed. What is the corporations, businesses and citizens contribution to our tax base? Is it fair, reasonable and equitable? After all, don’t they benefit from the services provided by the state and local government? Is it really out of proportion to the rest of the country? Are we really over taxed for what we get?
What about the waste within our government? I recently wrote about the cost of L.A. County to audit Hillsides’ contract estimated at $200,000 to $250,000 to recoup $37,000 (which we believe is in error). Is there a better, more efficient way to audit? I think so.
How about the number of audits we get from different departments (many times a duplication of what another entity has done), by the state and local governments? We have approximately two audits a month. What about the amount of time and staff it takes to submit an invoice to Los Angeles County?
A business would never stand for this. If I can identify waste in my little corner of business with the County, multiply it by the thousands who do business with the state and local governments. Let’s start at the State and then move to local entities. Do we need all the commissions that we have? Do the legislators need all the staff they have? Are there procedures that could be streamlined or eliminated? I am sure that, taking an honest look, we could preserve the level of services for those vulnerable and still cut costs.
An example of this is our local school district’s new Superintendent reorganized the infrastructure of the district and saved millions of dollars. We should do the same thing across the State and Counties.
But no, the sad thing is our government would rather raise taxes or cut services to those who need them without ever looking at the real culprit.
Tuesday, August 18, 2009
Thursday, June 4, 2009
DCFS Chooses Procedures over Substance
Recently the Department of Children and Family Services has been working on a pilot program to demonstrate that children will fair better if the residential treatment program includes parents in all phases of the child’s experience while in residence. In addition, the residential treatment program will follow the child’s return to the parents. It makes sense: the residential treatment program that knows the child in residence is better equipped to help the parents when the child returns home.
So I was hopeful that when Hillsides wraparound program was referred a child from another residential treatment center that DCFS would be open to and refer this child back to that residential treatment program for the follow up wraparound service. This was in line with this new movement of “the program that has the child in residence is the program that follows him home.”
I was wrong to assume that DCFS would follow sound substance over procedures.
It turned out that DCFS was not used to an agency turning down business in favor of another agency doing it. There was no clear cut procedure, so my attempt to refer the child back to the original agency was bungled and DCFS reaffirmed their decision to have Hillsides do the wraparound service.
Further attempts to get DCFS to “act in the best interest of the child” were ignored, in favor of following the proper procedures. This back and forth took four weeks of negotiations. Hillsides reluctantly opened the case when DCFS refused to reconsider, even though some of their administrators believed that it probably was in the best interest of the child for the other program to provide the wraparound services.
A few months ago, I praised DCFS for doing a study on the re-entry rate of children placed into the community from foster homes, kinship homes and group homes. It was an honest look at their practices and it came out of their concern that their re-entry rate rose from 4% to10% over a three year period. One of the major findings was that “there is a lack of after-care services to provide ongoing formal and informal support.”
What is most troubling about this situation is that, on the heals of releasing this report, the Department is unable to bend over backwards, jump through hoops, do what ever it takes to do what is clearly “in the best interest” of one of their clients.
So I was hopeful that when Hillsides wraparound program was referred a child from another residential treatment center that DCFS would be open to and refer this child back to that residential treatment program for the follow up wraparound service. This was in line with this new movement of “the program that has the child in residence is the program that follows him home.”
I was wrong to assume that DCFS would follow sound substance over procedures.
It turned out that DCFS was not used to an agency turning down business in favor of another agency doing it. There was no clear cut procedure, so my attempt to refer the child back to the original agency was bungled and DCFS reaffirmed their decision to have Hillsides do the wraparound service.
Further attempts to get DCFS to “act in the best interest of the child” were ignored, in favor of following the proper procedures. This back and forth took four weeks of negotiations. Hillsides reluctantly opened the case when DCFS refused to reconsider, even though some of their administrators believed that it probably was in the best interest of the child for the other program to provide the wraparound services.
A few months ago, I praised DCFS for doing a study on the re-entry rate of children placed into the community from foster homes, kinship homes and group homes. It was an honest look at their practices and it came out of their concern that their re-entry rate rose from 4% to10% over a three year period. One of the major findings was that “there is a lack of after-care services to provide ongoing formal and informal support.”
What is most troubling about this situation is that, on the heals of releasing this report, the Department is unable to bend over backwards, jump through hoops, do what ever it takes to do what is clearly “in the best interest” of one of their clients.
Monday, March 16, 2009
The Final Story in a Series of Seven Stories
T.C. had been neglected from infancy. Lacking in self-esteem, she had no hygiene or self-care abilities, and reacted with angry resistance to all efforts aimed at parenting her. Through patience, kindness and structure, her cottage staff achieved remarkable results and T. developed not only age-appropriate social skills, but a sense of her self-worth.
Admitted 3/27/03 and discharged 5/17/05; readmitted 11/02/05 and discharged 7/21/06; readmitted 11/19/07 and discharged 6/27/08. Hillsides staff was not in favor of any of these discharges. T is very unstable. She was discharged the first two times to a previous foster mother who was very uncooperative and was not amenable to services either before or after discharge.
During the third stay at Hillsides, a P3 worker located relatives of her mother in Pennsylvania. T had never met these people. DCFS sent her for a visit on Spring Break in 2008, and by 6/08, had cleared the home as an acceptable placement. Our request to keep her bed open was denied. In less than 2 weeks, the relatives called child services in Pennsylvania and they removed her from the home. Shortly thereafter, she was returned to California and is currently living in a foster home in Los Angeles County. The Los Angeles County Department of Children and Family Services child social worker made it clear upon our inquiry that Hillsides was not an option for placement again. We have no reason to think she will be any more successful in this home than in the others.
REFLECTION
1. Back in 2003, LA DCFS should have conducted a TDM that would address her needs and the support services she would need in transitioning to a new placement. (A TDM meeting is an opportunity for all interested parties in the life of the foster care child to convene and address his discharge and treatment plan for a successful replacement.)
2. The County should never place a child with a foster home that will not be open to supportive services.
3. When considering a new placement out of state have some graduated visits which get longer each time to determine the suitability of the fit. Note, this might be expensive, but would cut down on the trauma of the child involved.
Supervisors comment:
This was a very unstable plan. I am worried about the outcome. This mother has a history of serious problems, and she had very little in the way of pre-placement services. She is also extremely resistant and suspicious, making it difficult for her to make use of the services that were offered.
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
Tuesday, February 3, 2009
The Sixth in a Series of Seven Stories
J.R. was a victim of severe child abuse, who suffered from profound Post Traumatic Stress Disorder, resulting in dangerous acting out, typically as the evening approached. Yet by day, she successfully attended a local parochial school through funding support by private donors. School achievement helped rebuild her trust in herself and others, and led to a big reduction in abuse-reactive behavior.
J. was admitted on 3/14/05 and discharged on 6/25/08 at the recommendation of Hillsides and confirmed at a Team Decision Making meeting of the Los Angeles County Department of Children and Family Services. (A TDM meeting is an opportunity for all interested parties in the life of the foster care child to convene and address his discharge and treatment plan for a successful replacement.)
She went to the home of her father and stepmother, with whom she had never lived. Her mother is a mentally ill substance abuser. She received Wraparound services in the home by another agency. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).
She was in the home for less than a month before she reported that she was sexually abused by her father. The accusation was confirmed by her stepmother. J. was removed to a foster care home, and we have been unable to locate her to find out how she is doing. The father and stepmother, who came on the scene fairly late in J’s stay while at Hillsides, received family therapy prior to J.’s discharge from Hillsides. We also sent a rehabilitation specialist into the home for several months prior to the discharge. Obviously, no one saw this coming.
REFLECTION
Again, no one saw this coming. We would assume that the father had no record of child molestation.
Supervisor’s comments:
This is another case where it would have been very helpful if Hillsides Wraparound could have been involved. We know her and would have been able to offer crisis services when she reported the abuse.
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
J. was admitted on 3/14/05 and discharged on 6/25/08 at the recommendation of Hillsides and confirmed at a Team Decision Making meeting of the Los Angeles County Department of Children and Family Services. (A TDM meeting is an opportunity for all interested parties in the life of the foster care child to convene and address his discharge and treatment plan for a successful replacement.)
She went to the home of her father and stepmother, with whom she had never lived. Her mother is a mentally ill substance abuser. She received Wraparound services in the home by another agency. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).
She was in the home for less than a month before she reported that she was sexually abused by her father. The accusation was confirmed by her stepmother. J. was removed to a foster care home, and we have been unable to locate her to find out how she is doing. The father and stepmother, who came on the scene fairly late in J’s stay while at Hillsides, received family therapy prior to J.’s discharge from Hillsides. We also sent a rehabilitation specialist into the home for several months prior to the discharge. Obviously, no one saw this coming.
REFLECTION
Again, no one saw this coming. We would assume that the father had no record of child molestation.
Supervisor’s comments:
This is another case where it would have been very helpful if Hillsides Wraparound could have been involved. We know her and would have been able to offer crisis services when she reported the abuse.
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
Tuesday, January 27, 2009
The Fifth in a Series of Seven Stories
S. A. was first admitted to Hillsides on 2/07/06 and was discharged to his grandmother and legal guardian 8/27/08. S. came to Hillsides after multiple suicide attempts resulting in numerous psychiatric hospitalizations. While living here, program staff had to intervene repeatedly to prevent self-harm. Over time, these crisis contacts developed into healthy, secure relationships, and the self-injurious behavior gradually disappeared.
They received family therapy during his entire stay, Therapeutic Behavior Services from Hillsides upon discharge and Wraparound from another agency. (Therapeutic Behavior Services offer intensive one-on-one services to children whose needs go beyond a weekly therapy session. Trained therapeutic behavior specialists work with a child in school, in the community, and in the home, devising an attainable behavioral goal, and then meeting with the child to assist him or her in developing the skills to reach that goal. ) In spite of everything, he was readmitted 12/24/08. We have reinstituted family therapy with a new focus.
REFLECTION
This was a case in which Hillsides and the County agreed on the plan. The one thing that “may” have made a difference would have been if Hillsides provided the Wraparound services since we had the relationship with the client and the family. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
They received family therapy during his entire stay, Therapeutic Behavior Services from Hillsides upon discharge and Wraparound from another agency. (Therapeutic Behavior Services offer intensive one-on-one services to children whose needs go beyond a weekly therapy session. Trained therapeutic behavior specialists work with a child in school, in the community, and in the home, devising an attainable behavioral goal, and then meeting with the child to assist him or her in developing the skills to reach that goal. ) In spite of everything, he was readmitted 12/24/08. We have reinstituted family therapy with a new focus.
REFLECTION
This was a case in which Hillsides and the County agreed on the plan. The one thing that “may” have made a difference would have been if Hillsides provided the Wraparound services since we had the relationship with the client and the family. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
Friday, January 23, 2009
Working Together to Resolve Foster Care Concerns
Some good news has developed as a result of sharing the stories of the children in foster care who have re-entered the system after leaving Hillsides. While I have been concerned and writing about the need for the Los Angeles County Department of Children and Family Services (LA DCFS) to take up the issue of children who are moved into homes and then re-enter the system within six to 12 months, another advocate has been looking at the issue. It turns out that one of the Commissioners from the Los Angeles Commission for Children and Families, Helen Kleinberg, has been concerned about the same issue.
She and selected LA DCFS staff have been involved in taking a sample of some of these re-entering clients, studying the issues and listing the causes (not unlike what I have been doing with the children that we have in our program). They have a laundry list of issues that should be addressed. However, two important conclusions they highlighted was the need for a better discharge planning process to be developed and the need for a better way of engaging support services to the families receiving these children be introduced. These are some of the same issues that I identified in the stories of the children who re-entered the system after leaving Hillsides.
Commissioner Kleinberg and the LA DCFS staff working on this study invited a limited group of providers to look at what had been identified and the areas that we thought they should address. It was a most meaningful discussion and, for the most part, their findings reflected our experience. All participants agreed we needed to address a better process for transitioning the children from foster care and group care into the “family homes.” The meeting ended with suggestions of a few more avenues for collecting data and then a commitment to work on developing systems to increase the probability of a successful transition.
I look forward to future meetings of working together with the Department of Children and Family Services in developing those systems.
She and selected LA DCFS staff have been involved in taking a sample of some of these re-entering clients, studying the issues and listing the causes (not unlike what I have been doing with the children that we have in our program). They have a laundry list of issues that should be addressed. However, two important conclusions they highlighted was the need for a better discharge planning process to be developed and the need for a better way of engaging support services to the families receiving these children be introduced. These are some of the same issues that I identified in the stories of the children who re-entered the system after leaving Hillsides.
Commissioner Kleinberg and the LA DCFS staff working on this study invited a limited group of providers to look at what had been identified and the areas that we thought they should address. It was a most meaningful discussion and, for the most part, their findings reflected our experience. All participants agreed we needed to address a better process for transitioning the children from foster care and group care into the “family homes.” The meeting ended with suggestions of a few more avenues for collecting data and then a commitment to work on developing systems to increase the probability of a successful transition.
I look forward to future meetings of working together with the Department of Children and Family Services in developing those systems.
Tuesday, January 13, 2009
The Fourth in a Series of Seven Stories
Although here for only three months, J.B. participated well in group and individual therapy, per her therapist’s discharge summary. She made use of the opportunities here to explore art, music, dance and other expressive media. This helped her develop healthy, constructive outlets to address issues of abandonment and loss.
First admitted to Hillsides 6/28/07 and discharged to her aunt on 8/24/07. J was discharged by LA DCFS against our advice as she was extremely unstable. The aunt lived in Sacramento and refused to accept any offers for services that we recommended. She was with her aunt for a very brief time before being admitted to another like agency. She was readmitted to Hillsides on 9/10/08. It is unclear why she left the other agency for Hillsides, but it seems to have been a decision of the LA DCFS CSW, not the agency.
REFLECTION
1. Hillsides should have insisted on better joint planning.
2. If the aunt was a viable placement, the County and Hillsides should have made Wraparound or some wrap like services a condition of placement with the aunt. (Wraparound is a program where the process of creating safe places for a child includes wrapping support services around the child and the entire family to increase the possibility of successful outcomes).
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, LA DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
Tuesday, January 6, 2009
The Third in a Series of Seven Stories
M.F. was admitted to Hillsides on 4/11/05 and discharged on 7/18/07. M had severe and sometimes violent tantrums at home and in school which led to this youngster’s placement at Hillsides. Intensive use of Therapeutic Behavioral Services helped him develop a number of substitute behaviors as an alternative to having tantrums, which led to experiencing more success in school and on home visits. He also became an avid swimmer, participating in aquatics activities at the Rose Bowl.
The Hillsides therapist worked intensively with his grandparents and his mother although she felt that the DCFS Social Worker’s plan to send him to live with the grandparents was not feasible. The mother was an active substance abuser and clearly unable to provide a home for M. The court concurred that sending M to his grandparents was not advisable, but an aunt living in another county showed up and petitioned the court to let her take him.
The court agreed in spite of his very vocal opposition. As M was very unstable at the time, we recommended that a little more time was necessary to help prepare him. The court discharged him immediately into the aunt’s care. She was opposed to any outside services to help her with him. Within a month, he was back into the system and, as far as we know, is doing well in a foster home.
REFLECTION
1. Outside County and Court should have allowed Hillsides to spend time with County’s social worker in planning M’s movement out of Hillsides.
2. Listen to M’s objections about living with his aunt (after all he has control on how cooperative he is going to be in the placement).
3. See if there are things that would make this aunt more acceptable to M.
4. If there are no alternatives to the aunt’s acceptability of M, explore alternative permanent placements.
CONCLUSION
1. Family involvement in the treatment process is a key factor.
2. A plan for discharge agreed by all parties, Hillsides, DCFS, the child and the family is necessary for a successful transition. (A plan is not going to work if the child or the receiving party is saying they are not ready.)
3. We should consider mandatory supportive services in the home.
4. Once a plan has been agreed upon, there should be some benchmarks set to determine the move-in date.
5. As a general rule, the residential treatment agency should provide Wraparound services to the receiving family where ever possible, since they are the ones who know the child and the family. (This would entail an exception to the Service Provider Areas (SPA) specific structure of the Wraparound program, since most residential treatment centers do not have Wraparound programs in all the SPAs.)
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