the building bridges initiative (bbi) · q a qualified residential treatment program (qrtp) for...

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TheBuildingBridgesInitiative(BBI):AdvancingPartnerships.ImprovingLives.

TexasBuildingBridges:Youth,Families,Agencies,andProvidersTransformingResidentialInterventionandAchievingPositiveOutcomes– OverviewofBBIMay 23, 2018

Presentedby:SherriHammack,Coordinator,BuildingBridgesInitiative

Top5 ToExpect*inthenext3-5years

1. Expectlessmoneyfromlocal,stateandfederalgovernments.

2. Expectservicepurchaserstowanttobuyresultsandnotservices.

3. Expectanemphasisondurableresultsthatcanbesustainedfor6– 12monthspost-residentialdischarge.

4. Expectmovementfromchild-centeredtofamily-focusedservicedelivery.

5. Expectfastermovestowardpermanency forchildrennotreturninghome.

*FromTomWoll’s40TrendsReport,January2014

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ManyCompellingReasonsToReduceOverrelianceOnCongregateCare.

Youth placed in congregate care are less likely to find permanent homes than

those who live in family settings.

Congregate care placements cost child welfare systems three to five times the

amount of family-based placements, and for poorer outcomes.

Current law requires that children be placed in the least restrictive setting

possible while maintaining the child’s safety and

health.

Youth who live in institutional settings are at greater risk of

developing physical, emotional, and behavioral

problems

Rightsizing Congregate Care: A Powerful First Step in Transforming Child Welfare Systems, Annie E. Casey Foundation, 2000-http://www.aecf.org/resources/rightsizing-congregate-care/Kids Count Data Snapshot on Foster Care Placement, Annie E. Casey Foundation, May 2011 – http://www.aecf.org/resources/kids-count-data-snapshot-on-foster-care-placement/Dozier, M., Zenanah, C.H., Wallin, A.R., Shauffer, C., 2012, Institutional Care for Young Children: Review of Literature and Policy Implications – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600163/Barth R.P., 2002 Institutions vs. Foster Homes: The Empirical base for a Century of Action (says “Debate” but article says “Action”) –https://bettercarenetwork.org/sites/default/files/Institutions%20vs%20Foster%20Homes.pdf

KVCContactInformation

ChadE.Anderson,LSCSWChiefClinicalOfficerWayneSimsKVCHealthSystems,Inc.ChairBoardofDirectors(FormerPresidentandCEO)KVCHealthSystems,Inc.21350W.153rdStreet,Olathe,KS66061(913)[email protected]@kvc.org

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FamilyFirstLegislation:What’sComing?

FamilyFirst

TheFamilyFirstPreventionServicesActwaspassedintolawonFebruary9,2018aspartoftheBipartisanBudgetActof2018.

Thelaw,P.L.115-123expandstheuseofTitleIV-Echildwelfareentitlementdollarstoprevententryintofostercare

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PreventionServicesØServicesandprogramsmustbetrauma-informedandbeclassifiedas“promising”,“supported”,or“well-supported”basedonanevidencestructuredevelopedbytheCaliforniaEvidence-BasedClearinghouseforChildWelfare

ØAllqualifiedthreeprogramcategoriesmustbe:• Providedunderanorganizationalstructureandtreatmentframeworkthatusesatrauma-informedapproachandprovidestrauma-specificinterventionsthataddresstrauma’sconsequencesandfacilitatehealing

• Documentationofwhatthepracticeconsistsofandhowitisadministered

• Noevidenceofharmorriskofharm• Overallevidencesupportsthebenefits• Outcomemeasuresarereliable,validandadministeredconsistentlyandaccurately

5/17/18

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RestrictionsonFederalReimbursementOtherthanFosterFamilyHomes

EligibleSettingsforTitleIV-Ereimbursement:

1. Licensed(stateortribalapproved)fosterfamilyhomewithsixoffewerchildrenthatadherestothereasonableandprudentparentingstandard

q Exceptionscanbemadeforyouthwithachildtheyareparenting,siblinggroups,childrenwithseveredisabilities

2. Licensedprivate,orpublicchildcareinstitutionwithnomorethan25children:

q AQualifiedResidentialTreatmentProgram(QRTP)forchildrenwithseriousemotionalorbehavioraldisordersordisturbances

q Asettingthatspecializesinprenatalorparentingsupportsq Asupervisedindependentlivingprogramforyouthover18q Ahigh-qualityresidentialcareprogramforyouthatriskoforfoundto

beavictimofsextrafficking

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RestrictionsonFederalReimbursementOtherthanFosterFamilyHomes

EligibleSettingsforTitleIV-Ereimbursement:

3. Alicensedresidentialfamily-basedsubstanceusetreatmentfacilityforfamilies

q ThechildiseligibleforTitleIV-Emaintenancepaymentsforupto12monthsregardlessofeligibilityundertheAFDClink

q Thechildmusthaveacaseplanthatrecommendssuchaplacement

q Thechildmustbeconsideredacandidateforfostercare

q Facilitymeetsrequirements:substanceabuse,parenteducation,individualfamilycounselingservicesundertreatmentframeworkthatunderstands&recognizestypesoftraumaandprovidedinatrauma-informedapproach

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BBICorePrinciplesFamilyDriven

&YouthGuidedCare

Cultural&Linguistic

Competence

ClinicalExcellence&

QualityStandards

Accessibility&

CommunityInvolvement

TransitionPlanning&Services*

*betweensettings&fromyouthtoadulthood

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ForMoreInformationonFamilyFirstPreventionServicesActP.L.115-123

ØFamilyActLaw- summary:https://www.congress.gov/bill/115th-congress/house-bill/253 andfulltext:https://www.congress.gov/bill/115th-congress/house-bill/253/text

ØChildWelfareLeagueofAmerica:https://www.cwla.org/families-first-act/

ØTheAnnieE.CaseyFoundation:http://www.aecf.org/blog/family-first-prevention-services-act-will-change-the-lives-of-children-in-f/

ØChildren'sDefenseFund-� shortsummary:http://www.childrensdefense.org/library/data/ffpsa-short-summary.pdf

� detailedsummary:http://www.childrensdefense.org/library/data/family-first-detailed-summary.pdf

� implementationtimeline:http://www.childrensdefense.org/library/data/ffpsa-implementation.pdf

BBIMissionIdentifyandpromotepracticeandpolicyinitiativesthatwillcreatestrongandcloselycoordinatedpartnershipsandcollaborations betweenfamilies,youth,community- andresidentially-basedtreatmentandserviceproviders,advocatesandpolicymakerstoensurethatcomprehensiveservicesandsupportsarefamily-driven,youth-guided,strength-based,culturallyandlinguisticallycompetent,individualized,evidenceandpractice-informed,andconsistentwiththeresearchonsustainedpositiveoutcomes.

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BBIhasMANYPartners;severallisted:

EndorsetheBBIJointResolution

• GotoBBIWebSite(www.buildingbridges4youth.org)

• ReadBBIJointResolution(JR)

• E-mailDr.GaryBlau([email protected])orBethCaldwell([email protected])orSherriHammack([email protected])thatYouWouldLiketoEndorseBBIJR

• BePutonListServetoReceiveBBINewlyDevelopedDocuments

• BeFirsttobeInvitedtoBBIEvents

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BBIJointResolution

Includesacommitmentto:

“…strivetoeliminatecoercionandcoerciveinterventions(e.g.,seclusion,restraintandaversivepractices)…”

(http://www.buildingbridges4youth.org/sites/default/filesBB-Joint-Resolution.pdf)

RECENTLY RELEASED!: ▫ Successfully Engaging Families Formed by Adoption: Strategies

for Residential Leaders ▫ How-to Guide for Transforming to Short-term Residential (supported

by the Casey Foundation) ▫ Guide for Judges on Best Practices in Residential (w/ ACRC) ▫ Case Study: Leading Innovation Outside the Comfort Zone: The

Seneca Family of Agencies Journey▫ Fiscal Strategies that Support the Building Bridges Initiative Principles▫ Cultural and Linguistic Competence Guidelines for Residential Programs▫ Handbook and Appendices for Hiring and Supporting Peer Youth

Advocates▫ Numerous documents translated into Spanish (e.g., SAT; Family and

Youth Tip Sheets)▫ Engage Us: A Guide Written by Families for Residential Providers▫ Promoting Youth Engagement in Residential Settings

GotoBBIWebsitewww.buildingbridges4youth.org

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BBIWeb-BasedTrainingProgramsAvailablehttps://theinstitute.umaryland.edu/onlinetraining/programcategory.cfm?ottype_id=30

•BestPracticesintheUseofPsychiatricMedicationsforYouthDuringResidentialInterventions(1.5CEUs)•CulturalandLinguisticCompetence(Part1):WhyDoesitMatter?(2CEUs)•CulturalandLinguisticCompetence(Part2):ImplementationStrategies(2CEUs)•CulturalandLinguisticCompetence(Part3):OnaOne-to-OneLevel(1.5CEUs)•FirstStepsforLeadersinResidentialTransformation(2CEUs)•IncludingFamilyPartnersonYourTeam(2CEUs)•Pre-hiring,Hiring,Supporting,andSupervisingYouthPeerAdvocatesinResidentialPrograms(2CEUs)•SuccessfulStrategiesforTrackingLong-termOutcomes(1CEU)•Youth-GuidedCareforResidentialInterventions(2.5CEUs)

2014Book:ResidentialInterventionsforChildren,AdolescentsandFamilies:ABestPracticeGuide

Thereareseveraloptionsforordering:• tollfreephone:at1-800-634-7064• fax:1-800-248-4724• email:[email protected]• website:www.routledgementalhealth.com• (20%discountw/webordersusingcodeIRK71;• freeglobalshippingonanyordersover$35)

Ordersmustincludeeither:theTitle: ResidentialInterventionsforChildren,AdolescentsandFamilies:ABestPracticeGuideOR theISBN:978-0-415-85456-6

Note: Asafederalemployee,GaryBlaureceivesnoroyaltiesoranyotherremunerationforthisbook. AnyroyaltiesreceivedbyBethCaldwellandBobLiebermanwillbeusedtosupportyouthandfamilyempowermentconsistentwithBBI.

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Comingin2019~ANewBook!

TransformingResidentialInterventions:

PracticalStrategiesandFutureDirections

• FamilyDriven&YouthGuidedCare

• Cultural&LinguisticCompetence

• ClinicalExcellence&QualityStandards

• Accessibility&CommunityInvolvement

• TransitionPlanning&Services(betweensettings&fromyouthtoadulthood)

BBICorePrinciples

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ResearchonResidentialEffectiveness

▫ Recidivism– AllCategoriesofChildren/Youth

• 68%inOneState(2009)forallLicensedResidentialProgramsvs.Damar Services(BBIimplementer)withrangesfrom3-15%

▫ LengthsofStay– Children/YouthinMHSystem

• NYS(Average:14monthsin12+years)vs.Florida(<6monthsin3years)

SomeOfTheCriticalIssues

FromtheResearchResidential-SpecificResearchShowsImprovedOutcomesWith:

▫ ShorterLengthsofStay▫ IncreasedFamilyInvolvement▫ StabilityandSupportinthePost-ResidentialEnvironment(Walters&Petr,2008).

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SOMEEXAMPLESOFWHEREBBIISHAPPENING

ExamplesofWhereBBI/ResidentialTransformationWorkHAS/IS Happening

• ComprehensiveStateInitiatives(DE,IN,MA,CA- Initially4Regions/Pilots– goingstatewidebycountyin2017/2018)

• StateLevelActivitiesHappenedorCurrentlyUnderway(AZ,FL,IL,KY,LA,MI,ND,NH,NJ,NM,NV,ND,NY,OK,RI,SC,TX,VA,WA,WV&Georgia;inCA&MD– ProviderAssociationsLed)

• Current orPreviousCounty/CityLevelInitiatives(Cities:NYC,Philadelphia;Counties:Monroe/Westchester,NY;Maricopa,AZ;PA:clusterofsixcountiesNEpartofstate)

• ManyIndividualResidentialandCommunityProgramsAcrosstheCountry

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NEW HAMPSHIRE

NFINorth,Inc.

NFINorth- DavenportSchooltakesgreatprideintheBuildingBridgesInitiativeanddecidedfromthestartofthisprojectthattheonlywaytoevokeonthisjourneywastoduesothroughalensthatallowedforopenandhonestexaminationofpracticesaswellasopenandhonestcommunicationamongstFamily,Youth,andStaff.

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NFINorthContactInformation

NFINorthArrayofServicesJenniferAltieri603-586-4328jenniferAltieri@Nafi.com

Massachusetts

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BBIinMassachusetts:CaringTogether

• AdoptionofBBIframeworkforreprocurementofallDMH&DCFresidentialservicesforyouth

• Adoptionofinteragencyrestraint/seclusioninitiative&SixCoreStrategies©

• Commitmenttotrauma-informedcare

• Development/expansionoffamily&youthroles▫ ParentPartners▫ PeerMentors

• Developmentof:▫ Continuum(in-homeresidentialservicewithteam)▫ OccupationalTherapyinmoreintensiveprograms▫ Highintensitycommunityservices

BBIinMassachusetts:CaringTogether

FlexibleServiceModels▫ Followingintocommunity (includingsupportinhomeschools)

DCF&DMHJointly:▫ Developedstandards&outcomes▫ Overseeingimplementation▫ Providingoversight▫ Coordinatingutilizationmanagement▫ Engaginginqualitymanagementactivities▫ DevelopingsharedIT(reporting/documentation)

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PlummerYouthPromise

Acommunitycommittedtoprovidingallchildrenthesupportnecessarytosuccessfullynavigateintoadulthood

Everyyoungpersonhasafamilyunconditionallycommittedtonurture,protect,andguidethemtosuccessfuladulthood

TheVision TheDreamAdopted 2009 Adopted 2015

• BetterprogrammingdidNOT=betteroutcomes

• PrimaryFocusonPermanency• FocusonFamilySearchandEngage&ParentingSupport/Education

• FocusonBuildingCommunitySupportNetwork

PlummerYouthPromise

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ContactInformationBBIMassachusetts

JaniceLeBel,PhD,ABPPDirectorofSystemsTransformation,

Child,Youth&FamilyServicesMADept.ofMentalHealth25Staniford StreetBoston,MA02114Phone:[email protected]

PlummerYouthPromise

JamesE.ListerExecutiveDirectorPlummerYouthPromise37WinterIslandRoadSalem,MA01970978.744.1099ext.113978.744.9772faxhttps://[email protected]

CALIFORNIA

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CaliforniaResidentialProject

Transformationfromlong-termcongregatecareandtreatmenttoshort-termstabilizationandtreatmentwithfollowalongcommunity-basedservices

Vision:LACountyRBSProjectThecreationofastrength-based,family-centered,needs-drivensystemofcarethattransformresidentialfacilitiesfromlong-termplacementstoshort-termfamilydrivenopentherapeuticcommunities,whicharenotplace-basedandconcurrentlyprovideforseamlesstransitionstocontinuingcommunitycare,whichsupportthesafety,permanencyandwell-beingofchildrenandtheirfamilies.

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KeyElementsofPracticeModel• OneChildandFamilyTeamAcrossallEnvironments

• CarePlanningUnifiesResidentialandCommunityTreatment(Wraparound)

• FamilySearch,Engagement,PreparationandSupportfromDay1

• BuildingLifeLongConnectionsandNaturalSupportsfromDay1

• ConcurrentCommunityWorkWhileinResidential

• 24/7MobileCrisisSupportWheninCommunityPhase

• CrisisStabilizationWithoutReplacement(14days)

• RespiteintheCommunity

ImportantCARBSStudyFindings• Thenegativerelationshipbetweenthetotalnumberofresidentiallybasedservices(RBS)placementchangesandachievingpermanencyishighlysignificant,indicatingthatthechanceofachievingpermanencydecreasedby84%witheachadditionalplacement.Inaddition,thechanceofachievingpermanencydecreasedby28%witheveryadditionalmonthofayouth’saveragelengthofstayinanRBSplacement.

• ThechanceofcompletingRBSdecreasesby15%witheveryadditionalmonthofayouth’sstayinanRBSplacement,basedonaveragelengthofstay,andthechanceofcompletiondecreasesby66%witheachadditionalplacement.

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SenecaFamilyofAgenciesMarkNickell

RegionalExecutiveDirector

Comingin2018:JournalofResidential

TreatmentforChildren&Youth:

TheChangingRoleofResidentialInterventionby:LeBel,Galyean,Nickell,Caldwell,Johnson,Rushlo

&Blau

FAMILIES TAKE CARE OF KIDS BEST

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Who Is Your Loneliest

Child?

LIGHTING THE FIRE OF URGENCYFAMILY FINDING AND THE WRAP-AROUND PROCESS

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AdditionalRBSResources

InformationontheCaliforniaRBSReformCoalitionprojectandotherCountymodelscanbefoundat:www.rbsreform.org

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ContactInformationLosAngelesCounty

Dr.MichaelJ.Rauso,DivisionChiefDepartmentofChildrenandFamilyServicesResourceManagementDivision425ShattoPlace,Suite303LosAngeles,CA90010(213)351-5861/[email protected]

WilliamP.Martone,Former/Long-termPresident&CEOHathaway-SycamoresChildandFamilyServices210SouthDeLaceyAve.Suite#110Pasadena,CA 91105626-831-6850/[email protected]

SanFrancisco/SantaClaraCounty

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MarkNickell,RegionalExecutiveDirectorSanFrancisco&[email protected] m.(510)432-278

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MINNESOTA

FamilyAdolescentsandChildrenTherapyServicesInc(FACTS)/MN

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KeyElementsofPracticeModelCollaborativeIntensiveBridgingServicesSM – CIBS• BuildsCollaborativePartnershipsbetween:

CaseManager,FamilyTherapist,ChildandFamily,andRTC

• Ecologyisthetargetofinterventionnotjustthefamily

• CIBSisa3PhaseIntensiveSystemicIn-homeTherapyModelIntegratedwitha30dayResidentialplacement▫ Phase1: Initialengagementandassessmentoffamilyandchildin-home,2to4weeks▫ Phase2: IntensiveRTCservices,continuationofintensivein-homeandRTCtherapy30-45days,childspendsregulartimewithfamilyinthehome,socanpracticeskillsbeinglearnedinRTCwithhome;▫ Phase3: Intensivein-hometherapywithchildhome

KeyElementsofPracticeModel• CIBSisnotRTCasusual– RTCfocusduringPhase230daysison:▫ SkillsPracticenotMastery▫ IntenseFamilyFocus▫ FrequentHomeTime▫ Co-TherapywithChildandFamilywithFamilyTherapistandRTCTherapist▫ 3Staffingwithin30dayswithallpartnersandchildandfamily.

• SameFamilyTherapiststayswiththefamilyfrombeginningtoclosingthroughall3phasesofCIBS,FamilyTherapisthas5to7weeklycontacts

• FamilyTherapisthassmallcaseloadsbetween4to5

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KeyElementsofPracticeModel• Focusisonbuildingskillsofchildrentobettermanagetheiremotionsandbehaviorandtoincreaseparents’capacitytomanagetheirchild’semotionsandbehaviors

• 2014DakotaCountyMNDataEvaluation24monthsafterRTC30dayplacementtocompareCIBSYouthswithYouthinResidentialPlacement.▫ CIBSyouths– 58ComparisonYouth– 34

• SubsequentRTCPlacements24monthsafterRTC:• CIBS76%youthhadnofurtherplacements• Comparisonyouth35%hadnofurtherplacement

• Costsforadditionalservicesduring2yearspostRTCplacement• CIBS(14youth)$236,928.10• ComparisonGroup(22youth)$689,780.89

• CostSavingsof $452,852.80• ServicesarepaidthroughInsuranceandCounty

ContactInformation

•LynnVanBlarcum,MA,LMFTExecutiveDirector(651)[email protected]

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ExamplesfromtheNewBBIGuide!

NEW YORK

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TheChildren’s Village

Jeremy Kohomban

INDIANA

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DamarServices,Inc.FocusonFamilies:• believingthatyouthbelongwiththeirfamilies• rapidengagementisessential▫ “everydaymatters!”

• creatingmultiplemodesofengagingyouth&families▫ insistingondailycontact

• cliniciansofficesareinthecommunity– notintheprogram(s)• empoweringfamiliestochoosetheirstaffandbearbitersofinterventionswiththeirchild

• recognizingfamiliesasexpertsinneedofadditionalskillsandsupport

• harnessing‘youthpower’andactivelyincludingtheirexpertiseand/ordevelopingnewroles

Jim Dalton

DamarServices,Inc.Long-TermOutcomes(Recidivism)

• Datadynamicallycollectedto5-yearspost“discharge”

2005 4% 2011 9%2006 11% 2012 6%2007 9% 2013 11%2008 3% 2014 12%2009 8% 2015 15%2010 6% 2017 12%

• Recidivismtypicallyoccurswithinthefirst12monthspostdischarge

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Damar:PracticeImprovement

Definitionof“Recidivism”

Duringthe5-yearspost“discharge”fromtheresidentialcaresetting,theyouthisnotplacedinasimilar

orhigherlevelofcare.

DamarServices,Inc.

CriticalIncidentofPrimaryConcernIf24hoursgoesbyandayouthisnotwithhis/herfamily

and/orinhis/herhomecommunity,itisconsideredaCriticalIncidentfortheAgencyandaplanofaction/correctionmustbesubmittedtotheCOO*.(Note:Phonecallsdonotcount.)

*InternalQualityPlusThresholdis95%forAgency.Ifit’snotmeasured,it’snotmanaged.

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Damar:NowWeKnow!!

OurJobisnottocurekidsbutrathertohelpkidsandtheirfamiliesnegotiatethebasictasksofeverydaylife.

“Residentialtreatment” shouldbeorientednotsomucharoundremovingproblemskidsbringtocarebuttowardestablishingconditionsthatallowchildrenandfamiliestomanagesymptomsandcrisesmoreeffectivelyathomeandinthecommunity.

COULDYOURTEXASRESIDENTIALPROGRAMSDOTHIS?

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2009>>>GuaranteedOutcomes!

Ifayouthrequiresre-admissionpost“discharge,”

itisFREE.

What if youguaranteed your outcomes?

DamarContactInformation

Dr.JimDalton,PresidentandCEODamarServices,Inc.www.damar.org(317)[email protected]

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DoYouTakeBigSteps?SmallSteps?

• TakeAnyStep!AllStepsCount

• ANumberofFamily-Driven&Youth-GuidedPracticesHaveBeenIdentifiedThatSupportBetterOutcomes

StepsBeingTakenacrosstheCountry…

• UsingBBIdocumentstoprovideguidancetoresidentialandcommunityproviders

• Holdingregionaland/orstatewideBBIforums

• Rewritingregulation/licensingbasedonBBIprinciples/practices

• DevelopingBBIteamsanddevelopingplansforstate-specificprojects

• RevisingfiscalstrategiestosupportreplicationofBBIinformedprogrammodels

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ConsistentChallengesFaced• Moststateagencydocuments/regulatoryoversight(e.g.,contracts;licensing;Medicaid)donothavebestpracticeexpectationsandoftenhavepracticescontra-indicatedforeffectiveoutcomes

• Differentsystems(e.g.,probationofficers;childwelfareworkers)notsupportiveoffocusonreunification/workingw/familyinhome/community

• Manyresidentialprogramshavenothadopportunitytolearn/understand/implementeffectivepracticestoengagefamilies/promotefamily-drivencare

• PermanencyPracticeModels(e.g.,FamilySearch&Engage/FamilyFinding/ExpandingSupportNetwork):nourgency

• Insufficientcommunitybasedresources&supports• Residentialprogramsstillstrugglingwithcoerciveinterventionsandhigh#ofincidents(e.g.,restraint/seclusion/policecalls/runaways/aggression)

“You never change things by fighting existing reality. To change something, build a new model that makes the

old model obsolete.”- Buckminster Fuller

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AfterreviewofResidentialResearch

• Dr.JamesWhittaker:“Ihavemorefaithinawholeclothapproachwherewestartwithasetofprinciples,changetheory,structureandthenselectalimitedarrayofkeyinterventionstoimplementit….Thisseemstomemoreconsistentwithwhatsuccessfulnon-TRCEBP’ssuchasMulti-systemicTherapyandMulti-DimensionalTreatmentFosterCarehavedone,thansimplyanapproachthataggregatesevergreaternumbersofEBP’sinaresidentialsetting.”

ElementsofEffectivePracticeforChildrenandYouthServedbyTherapeuticResidentialCare

|ResearchBrief/CaseyFamilyPrograms(2016)

Expecttofliptheresidentialparadigm:bringresidentialinterventionintothehomeandFULLYincorporatefamily&youthvoiceandchoiceintotheprogram!

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BBIContactInformationwww.buildingbridges4youth.org

Dr. Gary [email protected]

240-276-1921

Beth [email protected]

413-717-0855

Sherri [email protected]

512-964-6164

Lloyd Bullard [email protected]

301-437-2378

JuRon [email protected]

404-242-3150

ReferencesBazelon CenterforMentalHealthLaw(n.d.).Factsheet:Childreninresidentialtreatmentcenters.RetrievedonOctober4,2016,http://www.bazelon.org/LinkClick.aspx?fileticket=D5NL7igV_CA%3D&tabid=247Beherns,E.&Satterfield,K.(2006,August).Reportoffindingsfromamulti-centerstudyofyouthoutcomesinprivateresidentialtreatment.Presentedatthe114thAnnualConventionoftheAmericanPsychologicalAssociationatNewOrleans,LA.RetrievedonMarch28,2017,http://aspeneducation.crchealth.com/files/2012/06/Residential_Treatment_Outcomes_Study.pdfDodge,K.A.,Dishion,T.J.,&Lansford,J.E.(2006).Deviantpeerinfluencesininterventionandpublicpolicyforyouth.SocialPolicyReport,XX,1. AnnArbor,MI:SocietyforResearchinChildDevelopment.Frensch,K.M.,andCameron,G.,(2002).Treatmentofchoiceoralastresort?Areviewofresidentialmentalhealthplacementsforchildrenandyouth,ChildandYouthCareForum ,31(5),307-399.

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ReferencesHair,H.J.(2005).Outcomesforchildrenandadolescentsafterresidentialtreatment:Areviewofresearchfrom1993to2003.JChildFamStud,14(4),551-575.

Noftle,J.W.,Cook,S.,Leschied,A.,St.Pierre,J.,Stewart,S.L.,Johnson,A.M.(2011).Thetrajectoryofchangeforchildrenandyouthinresidentialtreatment.ChildPsychiatryandHumanDevelopment,42,65-77.

OntarioCentreforExcellenceforChildandYouthMentalHealth(2012,April).Evidencein-sight:Optimallengthofstayinresidentialtreatmentforhighriskyouth.RetrievedonFebruary7,2017,http://www.excellenceforchildandyouth.ca/sites/default/files/eib_attach/LengthofStayResidential_FINAL_REPORT.pdf

Rhule,D.M.(2005).Takecaretodonoharm:Harmfulinterventionsforyouthproblembehavior.ProfessionalPsychology:ResearchandPractice,36(6),618-625.

Walter,U.M.&Petr,C.(2007).Residentialtreatment:Areviewofthenationalliterature.Lawrence,KS:UniversityofKansas.RetrievedonSeptember10,2016,http://childrenandfamilies.ku.edu/sites/childrenandfamilies.drupal.ku.edu/files/docs/residential%20treatment.pdf

The Children’s VillageKeeping Children Safe and Families Together since 1851

Jeremy Christopher Kohomban, Phd.President and CEO

The Children’s Village and Harlem [email protected]

childrensvillage.org@jeremycv (twitter)

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Iftheseweremyownchildren

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Hastings Hornell Hart (1851-1932): The Children’s Village, Prison Authority, Children’s Advocate and President the National Conference of Charities and Correction

“Inordertorestrictandultimatelytoputanendtotheproductionofdefectivedelinquents,itisnecessarytorestrictthepropagationofthefeeble-minded varietyofthehumanrace.HastingsHart,Nov12th,1912

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Howdoesthishappen?

VALUE

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BECAUSE,implicitbias influenceshowweseethosewhoweserve.

Implicitbiasdrivespersonal/groupactionandinfluencespolicy.

Implicitbias-relativelyunconsciousandautomaticprejudicejudgment,attitudesandsocialbehaviortowardssociallystigmatizedgroups

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Boarder Baby

Throw-Away Kid

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Sexually Trafficked

Toxic Stressed

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Attachment Disordered

Disconnected Youth

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OppositionalDefiant

APERSISTENTTHEME

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And….Whenitcomestothesechildren

…theoneswhocomefromcommunitiesweleastvalue,weoftenignore orareintentionally blindtothesocialjusticecontext.Rather,weveryquicklybegintoseethesechildrenasHastingsHartdid,defectivedelinquentsandfeeble-minded.Ourlanguagehaschanged,butweoftencommunicatethesamemessage.Theyarebroken,theyaredifferent,theyarenotlike“mychildren”


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included

treated as important

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supported

encouraged

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celebrated

listened to

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belong

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breath

PRACTICE #1Belonging is the non-negotiablefoundation on which success is achieved. All cognitive & social-emotional competence begins here.

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Actions we can take • Find and engage family (one parent

only represents 50% of all options)• One appropriate, willing adult

relationship.• Reject any solution that is not

connected to a person or a true relationship

PRACTICE #2be cognizant of

unconscious bias

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Actions we can take:• We are all impacted by implicit bias.

Recognize it• Raise above Racial Anxiety.• Reject the convenient. Kids need all of us.• Engage in the conversation, we are the

greatest aspirational democracy.• Create privilege!

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Actions we can take:• Remind yourself and everyone you know,

most often pain, loss, loneliness, hopelessness and despondency is the truebattle we fight.

• Remember, poverty is rarely a choice

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17,300adultslivinginSanDiego65%reportedatleastoneACE20%reportedatleast3ormoreACEs75%werewhite95%wereover30yearsofage40%graduatedfromcollege36%hadsomecollegeTheyweremiddleincome($40Kand$150K)

Actions we can take:Remind yourself of what you know:

• Trauma does not = failure

• Resilience is what we value in our own lives and in the people we love.

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PRACTICE #3 Give Voice

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CredibleMessengersTHEBRAVEHEARTShttps://www.facebook.com/BraveheartsMOVENY/

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PRACTICE #4Evidence and Outcomes Matter

Example:AfterCare WestchesterCountyNY

Year Total Recidivism2013 144 6%2014 155 5%2015 173 3.5%2016 190 2.6%2017 152 1.3%

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PRACTICE #5

Inaworldofexperts,beaservant

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The Children’s VillageKeeping Children Safe and Families Together since 1851

Jeremy Christopher Kohomban, Phd.President and CEO

The Children’s Village and Harlem [email protected]

childrensvillage.org@jeremycv (twitter)

TheBuildingBridgesInitiative(BBI):AdvancingPartnerships.ImprovingLives.

TexasBuildingBridges:Youth,Families,Agencies,andProvidersTransformingResidentialInterventionandAchievingPositiveOutcomes– Family-DrivenCareMay 23, 2018

Presentedby:SherriHammack,Coordinator,BuildingBridgesInitiative

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FamilyDrivenCare:What’sItAllAbout?

WhatisFamilyDriven?FamilyDrivenmeansfamilieshaveaprimarydecisionmakingroleinthecareoftheirownchildrenaswellasthepoliciesandproceduresgoverningcareforallchildrenintheircommunity,state,tribe,territoryandnation.

Thisincludes:• Choosingculturallyandlinguisticallycompetentsupports,services,andproviders;

• Settinggoals;• Designing,implementingandevaluatingprograms;• Monitoringoutcomes;and• Partneringinfundingdecisions.

Source:FederationofFamiliesforChildren’sMentalHealth

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WhyIsItImportant?• Strongestpredictorofpost-transitionsuccess,aftereducation,issupportfromfamily

• Fiftypercent(50%)ofyouthwhohaveagedoutwilllivewithsomememberoftheirfamilywithinacoupleofyears (aboutequallydividedbetweenparentsandotherrelatives)

Source:Courtney,M.,2007;Courtney,M.,etal,2004

• “Workwithfamilyissuesandonfacilitatingcommunityinvolvementwhileadolescentsareinresidentialtreatmentmayhaveassistedtheseadolescentstomaintaingainsforasmuchasayearafterdischarge..”

Source:Leichtman,M.,etal,2001

“Theeffectivenessofservices,nomatterwhattheyare,mayhingelessontheparticulartypeofservicethanonhow,when,andwhyfamiliesorcaregiversareengagedinthedeliveryofcare.Whiletraditionalformsofcareapproachedmentalhealthtreatmentinahierarchicaltopdownapproach(withtheclinicianmaintainingsomedistancefromtherecipientsoftreatment),thisapproachisnotreflectedinnewerformsofservicedelivery.Itisbecomingincreasinglyclearthatfamilyengagementisakeycomponentnotonlyofparticipationincare,butalsointheeffectiveimplementationofit.“

Source:Burns,B.etal,1999,p.238

WhyisitImportant?

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Family-drivenCare:WhatareyourProgram’s

Strengths?

Writedown1or2strengths

What Can Programs Do?

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PutanURGENTANDSTRONGFocusonPermanencyPractices– ‘doingwhateverittakes’toensureeverychild

hasapermanenthomeANDthatyourstaffareworkingwiththefamilymemberstoensuresuccessfuldischarge

FROMPRE-ADMISSION

DownloadfollowingdocumentfromtheBBIwebsite:ABuildingBridgesInitiativeGuide:FindingandEngagingFamiliesforYouthReceivingResidentialInterventions:KeyIssues,Tips,andStrategiesforResidentialLeaders

ESPECIALLY:AppendixA:FamilyFindingandEngagementModels

www.buildingbridges4youth.org

1st:THEMOSTIMPORTANTSTEP:

TheImportanceofPermanency• Familyconnectionsareassociatedwithimprovedoutcomes

• Lackofpermanencymakespasttraumaticeventsmoredifficulttomanage

• Connectionswithfamilyincreasespositiveidentitydevelopment

• Treatmentalonedoesnotmeettheneedsofyouthwithoutfamilyconnections

“RightsizingCongregateCare:APowerfulFirstStepinTransformingCWSystems”,AnnieE.CaseyFoundation,2009

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HireFamilyPartners/Advocates2nd MOSTIMPORTANTSTEP:

• Hiremultiplefamilypartners/advocates

• Haveseniorfamilypartneraspartofexecutiveteam&providesupervisiontoallfamilypartners

• Havefamilypartners(ANDFAMILYMEMBERS)aspartofEVERYorganizationalworkgroup/committee/taskforce

• Havefamilypartnersshareofficeswithotherstaff–spreadthroughouttheorganization

HireFamilyPartners/Advocates

• Theyserveasco-trainersinstafforientationandongoingtrainingprograms

• Theyserveaspartofhiringgroupstohirestaff

• Theyserveaspartofevaluationteamstoevaluateeachindividualstaff

• “Nothingaboutuswithoutus!”

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• DevelopAStrategicPlantoSuccessfullyEngageFamiliesandOperationalizeFamily-drivenCare

Go to the BBI website download, review and planto use the BBI Self-Assessment Tool as part of your strategic plan

www.buildingbridges4youth.org

3rd MOST IMPORTANT STEP:

AsPartofaStrategicPlanHaveallleadershipteammembersreadandreadandread:

• BBIFamilyTipSheets (longandshortversions)&BBIEngageUs:AGuideWrittenbyFamiliesforResidentialProviders

• MassachusettsDepartmentofMentalHealthCreatingPositiveCulturesofCareGuideChapters:

▫ SuccessfullyWorkingwithFamilyPartners

▫ EmbracingFamily-drivenCare

• Avarietyofothermaterialstosupportincreasedunderstandingandimprovedknowledge-base(seereferencesatendofthischapterandinthePositiveCulturesofCareGuideChaptersreferencedabove)

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Board/ExecutivesFocusingonSpecificAreas

IfTheseAreasareNotAlreadyinPlace,ConsiderIncludinginaStrategicPlan

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Board/ExecutiveFocusAreas▫ LeadershipPassionatefocusontransformationtowardsFDC(alaBillAnthony:walkthewalkvs.justtalkthetalk)

▫ Agencyclearvalues(e.g.,strength-based,trauma-informed,individualized&flexible;family-driven;youth-guided;culturalandlinguisticcompetence;communityintegrated)

▫ 100%staffcompetentinskills which=values(primarily:respect/compassion/empathy/listening/choice/kindness/patience)

▫ Multipleprogrampracticesclearlyspelledoutforeachvalue

▫ SophisticatedSupervision Systems– especiallyClinical

SmallStepExampleRaquelHatter,CEOoflargeresidentialprogram,wentbacktoheragencyafterthefirstBBISummitandimplementedmultipleimprovements,including:

• Primaryfocusonwelcomingfamiliesasfullpartners

• Hiredseniorexecutivefocusedonfamily• RewrotejobdescriptionstoincludeFDC• Madesupervisorsaccountable(someeventuallyaskedtoleave)

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Board/ExecutiveFocusAreasFullyimplementing:▫ FamilySearch&EngageorFamilyFindingorOtherPermanencyPractices▫ Wraparound/Child&FamilyTeams▫ BestPracticeClinicalEngagementSkills(i.e.variationsofFunctionalFamilyTherapy/Multi-systemicTherapy)▫ Clearexpectationsforalldisciplinesofstafftoworkinterchangeablyinresidential,home&community

Board/ExecutiveFocusAreasUsingDatatoInformPractice:▫ Restraint/Seclusion▫ AchievingPermanencyforEveryChildinaSHORTTimeframe▫ PuttingintoPlaceforEveryChildaBroadCommunitySupportNetwork▫ PrecipitousDischarges▫ Hospitalizations▫ Re-admissionsintoOut-of-homeCare/HospitalsforallYouthatLeast1to2YearsPostDischarge

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THE NEW BAR IS HOW CHILDREN AND FAMILIES ARE DOING 6 MONTHS TO 3 YEARS POST DISCHARGE

WHATS HAPPENING IN THE COMMUNITY IS WHAT COUNTS

Board/ExecutiveFocusAreasQualityImprovement:▫ %ofYouthSpendingTimeEveryDaywithFamilyMembersand/orinCommunityEngaginginPro-socialActivitiesw/Pro-socialPeers

▫ %ofFamilyMembersMetwithEveryWeek

▫ %ofFamiliesConnectedtoandPartofFamilySupportGroupsinCommunity

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Board/ExecutiveFocusAreas▫ EnsureFiscalStrategiesthatSupportWorkingwithFamiliesintheirHomesandCommunitiesduringandpostresidentialstays(i.e.6monthsto2yearspost)

▫ OfferLongTermSupport:Respite/In-homeservice

▫ SetExpectationsinStaffJobDescriptions/ContractsforMinimum%ofTimeStaffSpendinCommunitiesw/Families

▫ RenamePositions(i.e.‘ClinicalStaff’ Become‘ReunificationSpecialists’)toEmphasizeFocusonPermanency/Reunification

Board/ExecutiveFocusAreasEnsureExecutiveTeamMembers:▫ HaveOpenDoorPolicyforFamilyMembers

▫ AtLeastOneTeamMemberMeets/GreetsEvery NewFamily

▫ AtLeastOneTeamMemberInterviewsEveryFamilyIndividuallyatDischargeandAgain– 6MonthsPostDischarge

▫ AndAllAgencyStaffRepresenttheCultures/Ethnicities/Races&SpeaktheLanguagesoftheYouthandFamiliesServed

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StaffofAllDisciplinesImplementingaVarietyofFamily-DrivenPractices

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ExamplesofPracticesYouWouldSee:

▫ EveryStaffis‘DirectorofFirstImpressions’(TitleUsedInNewZealandorganization)

▫ FamiliesCanCometoProgram24/7▫WarmandComfortablePhysicalEnvironments▫ FamiliesCangotoEveryPartoftheProgram–SpendingTimeinTheirChild’sRoomandClassroomandActivities

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• LoseTheWords‘Home-Visits’

• FamilyFocusGroupsDecideEducationOfferingsforFamilies

• FamiliesCalledEverydaytoShareChildStrengths– NotJustAboutIssues&EncouragedtoCallMultipleTimesDaily

• YouthCallDifferentFamilyMembersMultipleTimesDaily


• EnsureFamiliesHaveDedicatedTimetoTalkwithFrontLineStaff

• MakeitaPracticetoConsultwithFamiliestoSeekCounselandEngageTheminDecision-making

• CreateOpportunities(i.e.WeekendCamping)forFamiliestobeProudoftheirChildren/toCreatePositiveMemories

• SupportSiblings

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• NOMOREGROUPREC– AllRecreationFocusedonYouthIndividualInterests/Talentsandany‘Group’ActivityInvolvesSiblings/Families/ExtendedFamilies- i.e.Cousins

• GatherTickets/Freebies forFamiliestoUsewithChildren(maybewithastaffforsupport)

• DevelopCloseCollaborationswithClinicalExpertiseinCommunity(e.g.,Trauma;SubstanceAbuse;DomesticViolence)&Supports(e.g.,Housing;CommunityActivities;PeerMentors;Respite)

StrategiesForEngagingwithFamiliesFromLongDistances

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HavePolicies/Practices/StaffTrainingtoENCOURAGE:

• YouthCallingasManyFamilyMembersasPossibleANDFriendsWheneverWant/NeedTo

• HaveManyPhones/NoRestrictionsonWhenCanUse(ExceptMaybeSchool/AfterCertainTimeofNight)

• AllowCellPhones(w/Security– i.e.PhotosTaking/VideoTurnedOff)

• Skype/GoogleChatDAILY


• Do‘WhateverItTakes’ toGetYouthHome2xWeekMinimum(andWhenCrisisComesUp;ALSO- DONOTALLOWYOUTHTOMISSANYIMPORTANTFAMILYEVENTS)– Upto3PlusHoursDrive1-way/WorkedonRevisingBudgetItemsi.e.Gas$

• Develop/LicenseCommunityProgramsinCommunitiesYouthComeFromAND/ORDevelopStrongPartnerships(e.g.,JointValues;JointTraining;FormalSign-offs)

• HaveStaffPhoneandEmailRegularly– ESPECIALLYTOSHARESTRENGTHS;CommunicateOften;

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• Trainclinicalstafftodofamilysystemsworkonthephone(justforsomemeetings– MOSTSHOULDHAPPENINHOMES)

• Haveaclinicalstaffandafamilyadvocateworkinthecommunitymostyouth/familiesreside(alaSCO/NYC)

• Getagranttobuyi- Pads/laptopsandrent(i.e.$1)forfamilies(or- ifchargemore- return$’swhenreturned)

• Createbackandforthartproject/binderforfamiliesandyouthtoworkon2to3xweeklyordailyandeithertakeeachweekendhomeand/orscan/emailbackandforth(alaSCO/NYC)

ExamplesofAFEWFDCPractices

• Mission/ValuesemphasizeFDCasprimaryfocus• Orientation/Training/SupervisiononFDCCommitment• UseofFamilyFinding/Search&Engage;focusonpermanency

• HiringofFamilyPartners/Advocates• SiblingSupport• Clinical/otherexpertiseinengaging/workingw/families(e.g.,MST;FFT;Wraparound)

• Clinical/staffworkinhomestosupportproblem-solvingrealissues(notresidentiallycreatedchallenges)

• Familieswelcome24/7• Losewords‘homevisits’/’homepasses’– timewithfamilyandinhomecommunitybeginsatadmission(notprivilege)

• Staff/youthcallfamiliesfrequently

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WhatToBeCautiousOf:• EventsonResidentialCampuses(why?)

• LackofSophisticated/CommittedClinicalSupervisors

• GroupResidentialRecreation(why?/whotoinvite?(BuildMemorieswithFamilies)

• ResidentialHolidayTraditions(“IsitAbouttheProgramorAbouttheYouth/Family?”)

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ExamplesofAFEWYGCPractices• Mission/ValuesemphasizeYGCasprimaryfocus• YouthAdvocates/peerMentors• MeaningfulYouthAdvisoryCouncil• Orientation/Training/SupervisiononYGC/TICInterface&Commitment• UnderstandingofImpactofTrauma(e.g.,useofsensory;repetitive/rhythmical;NO/VERYLOWrestraint/Seclusion/AWOLS/Police calls

• Individualized(truly)approaches(safety/soothingplans–PREVENTION/TEACHINGapplicableathome/school

• Eliminatepoints/levels/focusonconsequencesandbehaviormanagement(Compassionateinquiryvspraise)

• Majorstafffocusonyouthvoice/choice• Youthengaged/supportedincommunityactivitiesmatchingindividualskills/talents/passions

• Youthhavecellphones(w/filters)callfamily/approvedfriendoften• Focusonyouthleadership/advocacyskills• Educationflexibility/creativity

Whatcanyoudotoimprovefamily-drivencareoryouth-guidedcareinyourprogram?

Thinkof:•1improvementyoucanmakeinthenexttwoweeks?

•1improvementyoucanmakeinthenextsixmonths?

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240-276-1921


413-717-0855


512-964-6164


301-437-2378


404-242-3150

Presentedby:TaraThomas,CertifiedFamilyPartner:TheHarrisCenterfor

MentalHealthandIDD

WhatFamiliesWantfromProviders

May23,2018

TexasBuildingBridges:Youth,Families,Agencies,andProvidersTransformingResidentialInterventionandAchievingPositiveOutcomes

87

WhatFamiliesWantfromProviders

• AcknowledgementAttheDoor

• OpenCommunication• IdentifytheFamilyConnection

• Access to NurturingEnvironment

• Resource Tools• Trauma-Informed• Continuing Education• CompassionandEmpathy

Acknowledgement At the Door

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IdentifytheFamilyConnection

89

AccessToaNurturingEnvironment

Resource Tools

• ParentPeerSupportfromaParentwithResidentialInterventionExperience

• SupportGroups• FamilyTherapy• EducationalPrograms• EmploymentOpportunities

90

Trauma-Informed• CreatingaSafeEnvironment

• IdentifyingTriggers• BuildingRelationshipsandConnectedness

• SupportingandTeachingEmotionalRegulations

ContinuingEducation

91

FindingHisWay…..KristopherAlexanderThomas

CompletedasuccessfulprograminaTexasResidentialTreatmentFacility,graduatedfromHighSchoolintheSummerof2017andwentontostartcollegethatfall.Kristopherisnowinanindependentlivingprogram,livingonhisown(witharoommate),workingfull-timewhileattendingclasses.Although,hestillexperienceshisowndailystrugglesandtrials,heishappy,confidentandblessedbeyondmeasureJ

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MeetTaraThomas

• Certified Family Partner at TheHarris Center for MentalHealth and IDD for 3years.

• Mother of 3 Young Men (18-21yrs)

• Has walked alongside over100+ families in Harris County

ResourcesforFamilies:

www.ffcmh.orgwww.samsha.orgwww.nami.orgwww.mha.org

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Thankyou.

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THE KRAUSE CHILDREN’S CENTER•OPENED IN 1995•PROVIDES 24 HOUR THERAPEUTIC RESIDENTIAL SERVICES TO GIRLS AGES 12-

17 WHO HAVE EXPERIENCED “SIMPLE” TRAUMA TO CHRONIC AND COMPLEX TRAUMA.

•TOTAL CAPACITY OF 60 WITH AVERAGE DAILY CENSUS OF 57.•SERVE SPECIALIZED AND INTENSIVE LEVEL OF CARE.•ONE OF 10 RESIDENTIAL TREATMENT CENTERS IN TEXAS WHO WORK WITH

INTENSIVE PSYCHIATRIC TRANSITION PROGRAM (IPTP) LEVEL OF CARE.•ON-SITE CHARTER SCHOOL THROUGH TRINITY CHARTER SCHOOLS (TCS).

WHAT STARTED OUR BBI JOURNEY•OUR BEGINNING… OPENING STORY

BY AMANDA•WE STARTED WITH RESEARCH.. A

LOT OR RESEARCH•A PILOT WITH BBI•TRAINING, TRAINING, TRAINING •COMMUNITY PARTNERSHIPS This Photo by Unknown Author is licensed under CC BY

95

POSITIVE OUTCOMES

•WE HAD AMAZING OUTCOMES IN RESTRAINT REDUCTION BY 60% AFTER A 9 MONTHS PILOT WITH BBI

•YOUTH AND EMPLOYEE MORALE WHEN UP AS WELL ON SATISFACTION SURVEYS

• NO MORE REFUSALS BY YOUTH DURING ADMISSIONS•REDUCED EMPLOYEE TURNOVER

RESTRAINT REDUCTION 2016

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21 34 51 37 55 30 30 16 9 13 4050

100150

2016 Monthly Personal Restraint Totals

Restraints

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RESTRAINT REDUCTION 2017

14 14 20 14 7 12 4 5 4 8 11 1020406080

100120

2017 Monthly Restraint Totals

Restraints

RESTRAINT DATA – 3 YEARS

•2015= 504 RESTRAINTS•2016= 404 RESTRAINTS•2017= 114 RESTRAINTS•EACH YEAR OUR ACUITY MIX OF IPTP/INTENSE/SPECIALIZED

LOC SERVED WENT UP

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ROAD BLOCKS • MOVING AWAY FROM A LEVEL SYSTEM-

DON’T DO TOO MUCH AT ONE TIME

• GETTING EVERYONE TRAINED AND ON THE SAME PAGE

• EDUCATING THE COMMUNITY- CHANGE TAKES TIME

This Photo by Unknown Author is licensed under CC BY-NC

This Photo by Unknown Author is licensed under CC BY-NC-ND

FUTURE FOR KRAUSE•MOVING AWAY FROM THE LEVEL SYSTEM WITH A DEFINED PLAN•SEEKING A FAMILY ADVOCATE VOLUNTEER POSITION•FUNDRAISING FOR ADDITIONAL RESOURCES FOR FAMILIES •ADDITIONAL TRAINING ON CULTURAL AND LINGUISTIC COMPETENCE•SETTING UP WRAPAROUND SERVICES PARTNERSHIPS•ONGOING NETWORKING IN THE COMMUNITY TO HAVE ADDITIONAL

RESOURCES AND PARTNERSHIPS

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240-276-1921


413-717-0855


512-964-6164


301-437-2378


404-242-3150