Imagine You Are 5…

1. Imagine You Are 5… And Alone. And Crying. Think You Might Need Help?

2. 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

3. “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

4. 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]

5. Five Purposes • Identify immediatesafety 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

6. Assessment Components • Risk Assessment • Mental Status Exam • CPS Addendum • Diagnostic Summary/Clinical Formulation • Next Steps/Interim Service Plan • Demographic Information

7. 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

8. 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: • Immediate actions to be taken to mitigate the effects of the removal itself • Supports and services the child’s caregivers may need to meet the child’s needs, and • 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

9. 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

10. “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]

11. Surveillance • “Silent Suffering” • Brain Development – Infancy thru Adolescence • Preparing for Child Welfare-Related Transitions • Building Resiliency

12. 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.

13. Direct Support to Each Child • Preparing the Child for His/Her New Placement • Understanding Separation and Grief Experience at Child’s Developmental Level

14. 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

15. 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]

16. The Child and Family Team • Strengths, Needs and Culture Discovery • Highly Individualized • Collaboration across Multiple Systems • Natural and Community Supports • Outcomes Orientation

17. 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]

18. 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

19. 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.

20. Success Stories • Infants and Toddlers • “Teddy Bears” • A Mutual Partnership

21. 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

22. How We Got Here… • Clear, Common Values • Planting Seeds (best practice ideas) • Organizational Awareness • Cross-Pollination • Learning Community • Capitalizing on Opportunities • Defining Moments

23. The Change Agent Role

24. Partnership “Collaboration: An unnatural act between non-consenting adults?” -- John VanDenBerg PhD

25. 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

26. The Big Vision • Whole Family Focus • Common Outcomes •   Service Integration •   Optimizing Funding •   Seamless Partnership

27. 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/

28. 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.

29. NOW Imagine You Are 5…