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.

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 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.)

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.)

Requiring Foster Family Certification for Adoptions May Close Some Family Doors

Just when I think that the administration of the Los Angeles County Department of Children and Family Services (DCFS) is on right path with initiatives to keep families intact with supportive services, to move children in out-of-home care back into their families, extended families or adoptions, they come up with a policy that flies in the face of good practice.

The Department of Child and Family Services and its Director, Trish Phloehn, are insisting that they will not contract with foster family agencies (FFA) who do not certify their foster families for adoption. For those unfamiliar with the process, this direction means the foster family will be required to go through a process for certification that is similar to the process they already go through to be certified foster families. The major difference is that they must be willing to declare that they are interested in adoptions.

At first blush, this would seem to be an improvement in service delivery because it would cut down the time that it takes for a foster home to become an adoptive home. In fact, DCFS is citing this as a reason for wanting it in the contract. They are also saying that an adoptive home study is a higher standard than a foster home study even though FFAs report that they are just as exacting for their foster homes as the adoptive homes. And finally, DCFS is saying they do not want a foster family who wants to adopt to fail the certification and approval process to adopt a child even though DCFS can not cite, nor can the FFAs cite, an instance where this has happened.

What they fail to take into consideration is that foster care homes for some children are temporary homes used to care for the child until reunification or permanency can be worked out. A number of foster care homes would like to assist children in this transition period of their lives, but do not have a desire to adopt. A number of foster care families who entered the foster care system with the idea they did not want to adopt have changed their minds after being foster parents to a child or children. In other words, they fell in love with the child or children and decided to adopt. Demanding that they be certified to adopt prior to accepting foster care children may have stopped these families from being foster parents. The Department could have closed the door of opportunity for adoption at a later date.

Couples like my wife and I who are over 65 who might have the time to do foster care would be eliminated because we are too old to be certified, or because we are not interested in adopting at this stage in our lives. Some wonderful older couples, who take in babies and toddlers while reunification is being worked through, would be eliminated from the pool of potential foster care homes. If, in fact, a foster home does want to adopt, and an infant or toddler is in their care while the biological mother is getting clean and sober, it puts the foster parent in competition with the mother. This unintended competition is not supportive to the reunification process.

Hillsides does not have a foster family agency, however, at one time Hillsides did take in infants and toddlers whose mothers were addicted to drugs and alcohol and worked with them to help them regain their babies. This was one of the most successful programs we operated, because these mothers did not want to be addicted, wanted to get clean and sober, and wanted to regain their babies. Most of the mothers were able to get their children back within 12 months. One of the things we had to do with our own child care staff is to remind them that they were to be role models to these mothers, they were not to put up barriers to helping the mothers bond with their children. Even though they also loved these children, their job was to help the mother regain custody. This would be a difficult task for a foster care mother who wanted to adopt the child she was caring for.

The Department needs both kinds of foster care homes. The Department will have children who will not be able to return to their families and need a permanent home where adoption would be the outcome. Several types of foster care homes exist: those very much interested in adopting children, those that may grow into that frame of mind as the child has lived with them, or those that may have gotten into foster care with the expressed intention of wanting to adopt.

Unfortunately, the Director of DCFS has persuaded the Los Angeles County Board of Supervisors to buy into this policy without hearing some of the strong arguments against doing this. We now have a situation where the Board of Supervisors has publicly supported its DCFS Director, and it is difficult for them to reverse their decision.

The direction taken should not be either or, but a thoughtful discussion on solutions that will meet the needs of all parties involved.