Imagine You Are 5… And Alone. And Crying. Think You Might Need Help?
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Transcript Imagine You Are 5… And Alone. And Crying. Think You Might Need Help?
Imagine You Are 5…
And Alone.
And Crying.
Think You Might Need Help?
Arizona’s
Urgent Behavioral Health Response
for
Children Entering Foster Care
Frank Rider, AZ Div of Behavioral Health Services
Steve Sparks, AZ Div of Children, Youth & Families
Georgetown University Training Institutes
San Francisco CA – June 26, 2004
“A Virtual Kidnapping”
Imagine You Are 5…
“Children who are removed from their families may
require an intervention to address their separation
issues immediately…”
American Academy of Child & Adolescent Psychiatry,
and Child Welfare League of America,
POLICY STATEMENT, 2003
One Simple Sentence…
“An urgent response should be initiated in a punctual
manner, within a timeframe indicated by the
person’s clinical needs, but no later than 24 hours
from the initial identification of need. Urgent
responses must be initiated upon notification by
DES/CPS that a child has been, or will be, removed
from their home.”
ADHS Policy 3.2: Appointment Standards and Timeliness of Services
[Effective August 15, 2003]
Five Purposes
Identify immediate safety needs and presenting problems
Provide direct therapeutic support to each child
Provide direct support to each child’s new caregiver
Initiate the development of a Child and Family Team
Provide CPS caseworker and Court with findings and
recommendations to inform the caseplan
Assessment Components
Risk Assessment
Mental Status Exam
CPS Addendum
Diagnostic Summary/Clinical Formulation
Next Steps/Interim Service Plan
Demographic Information
CPS Addendum
“The questions contained in this addendum are primarily
intended to be responded to by the Child Protective Services
specialist involved with the child’s case…” along with the
Assessor’s observations of the child, and those of the child’s
caregiver.
“The Assessor may also provide any input he/she has regarding
the types and amount/frequency of contact (e.g. visits, phone
calls, e-mail) the child should have with parents, siblings,
relatives and other individuals important to the child.”
Reference: http://www.hs.state.az.us/bhs/assessment/assess_tool.doc pg 23-24
Next Steps/Interim Service Plan
ADHS Assessment Instructions:
“For urgent response for children removed by Child Protective
Services, the assessor must include as part of the recommended
next steps/interim service plan, identification of:
1. Immediate actions to be taken to mitigate the effects of the
removal itself
2. Supports and services the child’s caregivers may need to meet
the child’s needs, and
3. A plan to ensure that even asymptomatic children are reassessed
and observed for surfacing behavioral health needs within at
most 23 days (sooner if indicated).”
Reference: http://www.hs.state.az.us/bhs/assessment/instruct_gde.pdf
Transition to BH System
Implementation of Next Steps/Interim
Service Plan
Continuity of Behavioral Health Support
No disenrollment from BH system while
child remains in foster care
“Asymptomatic”
“So, this is how it is in foster care: You always have to
move from foster home to foster home and you
don’t have any say in this and you are always
having to adapt to new people and new kids and
new schools. Sometimes you just feel like you are
going crazy inside.”
-- Former foster youth, in Fostering the Future: Safety,
Permanence and Well-Being in Foster Care [The Pew
Commission on Children in Foster Care, May 18, 2004]
Surveillance
“Silent Suffering”
Brain Development – Infancy thru Adolescence
Preparing for Child Welfare-Related Transitions
Building Resiliency
What Do Kids Experience?
Separation from parents
Separation from brothers and sisters
Loss of pets
Move from familiar neighborhood/community
Change of school
Loss of friends
Unfamiliar caretakers, routine, expectations
Loss of comfort objects
Sadness, anger, fear, guilt, shame, differentness, etc.
Direct Support to Each Child
Preparing the Child for His/Her New Placement
Understanding Separation and Grief Experience at
Child’s Developmental Level
Direct Support to Child’s Caregiver
“The death of a child (Patrick T, age 6 weeks) while in
foster care is horrifying; we need to know…if there
are changes that can be made to ensure this can’t
happen again.”
DES Acting Director William Bell, May 23, 2003
Therapeutic Guidance
Therapeutic Lifeline
Caregiver Relief
The Child and Family Team
Essentially a child welfare practice approach
(e.g. Alabama, North Carolina)
“Family Team Conferencing”
“Family Group Decision-Making”/
“Family Unity” Meetings
Congruence with Arizona Child and Family
Teams [Comparison of 4 Models]
The Child and Family Team
Strengths, Needs and Culture Discovery
Highly Individualized
Collaboration across Multiple Systems
Natural and Community Supports
Outcomes Orientation
Informing CPS Case Planning
Turf Battles? No, Gratitude.
Teaching Judges and other Collaterals (e.g.
AAGs, Foster Care Review Boards, CASAs)
Pew Commission recommendations for
Strengthening Courts [May 2004]
Practical Implementation
Elements
How CPS Triggers Referrals
Face-to-Face, Where Child Feels Comfortable
From Rapid Responders to Ongoing BH Support
(Six) Jointly Developed Regional Protocols
Numbers Served
Between August 15, 2003 and June 18, 2004,
over 1,800 children received Arizona’s
urgent BH response within 24 hours of
removal by CPS into protective foster care.
Success Stories
Infants and Toddlers
“Teddy Bears”
A Mutual Partnership
Issues
Understanding Unique Needs of Children
Entering Foster Care [both systems]
Workforce Development to Build Capacity to
Address Needs of Children Entering Foster Care
Early Childhood MH: Infants, toddlers and
preschoolers
Service Capacity
How We Got Here…
Clear, Common Values
Planting Seeds (best practice ideas)
Organizational Awareness
Cross-Pollination
Learning Community
Capitalizing on Opportunities
Defining Moments
The Change Agent Role
Partnership
“Collaboration: An
unnatural act
between nonconsenting adults?”
-- John VanDenBerg PhD
Accomplishments:
Child Welfare BH Assessment Elements
Joint Establishment of Clinical Guidance
Child and Family Teams Practice
Cross-Training (including Collateral Parties)
Co-Location of Personnel
Out-of-State/Out-of-Home Initiatives
Joint Development of TFC Services
Unique Needs => BH Capacity, CW Practice
The Big Vision
Whole Family Focus
Common Outcomes
Service Integration
Optimizing Funding
Seamless Partnership
For More Information:
www.hs.state.az.us/bhs/guidance/guidance.htm
http://www.de.state.az.us/dcyf/default.asp
http://www.aacap.org/publications/policy/collab02.htm
http://www.aecf.org/initiatives/familytofamily/
http://www.childtrauma.org/
http://pewfostercare.org/
For More Information:
Vera I Fahlberg MD, A Child's Journey Through
Placement (Indianapolis: Perspectives Press), 1991.
William C. Madsen, Collaborative Therapy with
Multi-Stressed Families: From Old Problems to
New Futures (NY: The Guilford Press), 1999.
NOW Imagine You Are 5…