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 non-consenting 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…