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.)

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.

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.)

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.)