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.)
Showing posts with label children. Show all posts
Showing posts with label children. Show all posts
Tuesday, January 27, 2009
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.
Wednesday, December 17, 2008
The Second in a Series of Seven Stories
A .K. was first admitted to Hillsides on 4/05/06 and was discharged on 6/5/07. When A.K. entered Hillsides, he was morbidly obese, weighing more than 148 pounds. When he was discharged a year later, he had dropped to 122 pounds through a combination of diet and intensive exercise supervised by the nursing and recreation departments. While still overweight, his general health had improved dramatically. Upon his re-entry into Hillsides’ residential program in July of this year, after having been removed, he weighed 226 pounds.
At the time of discharge, A.K. was still not stabilized, although he had been doing better. Hillsides’ advocates were opposed to the discharge both for his fragility, and also because his mother had barely been released from jail and had not received services to help her deal with this boy. The Los Angeles County’s Department of Children and Family Services made the decision to move him with no input from Hillsides. It wasn’t until Hillsides’ intervention that the County agreed to a post-discharge Team Decision Making meeting (TDM). (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.)
At that point, Wraparound Services were initiated and provided by Hillsides’ team. A.K. did not do well at home, and his mother was not effective. (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). He was readmitted to Hillsides on 7/22/08.
REFLECTION
1. Have a TDM that would include the mother in the planning process
2. Set up a plan that would insure that she was established back into the community with a job that could support A.K. (the mother and son were homeless when he returned to Hillsides).
3. Provide Wraparound services well in advance of his returning home
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.)
At the time of discharge, A.K. was still not stabilized, although he had been doing better. Hillsides’ advocates were opposed to the discharge both for his fragility, and also because his mother had barely been released from jail and had not received services to help her deal with this boy. The Los Angeles County’s Department of Children and Family Services made the decision to move him with no input from Hillsides. It wasn’t until Hillsides’ intervention that the County agreed to a post-discharge Team Decision Making meeting (TDM). (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.)
At that point, Wraparound Services were initiated and provided by Hillsides’ team. A.K. did not do well at home, and his mother was not effective. (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). He was readmitted to Hillsides on 7/22/08.
REFLECTION
1. Have a TDM that would include the mother in the planning process
2. Set up a plan that would insure that she was established back into the community with a job that could support A.K. (the mother and son were homeless when he returned to Hillsides).
3. Provide Wraparound services well in advance of his returning home
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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