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INTENSIVE CHILD |
Other Issues in Review |
| HOME BASED FAMILY SERVICES NETWORK - JUNE
AGENDA
Intensive
Family Service Staff Safety |
| Intensive Family Service On-Call System 1. Crisis support for any family receiving Intensive Family Service. 2. Safety system for Intensive Family Service Workers in the field. |
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Resource Information |
| Crime
Prevention for Professional Home Visitors Tips and considerations before the visiting a client home. |
| Strategies
for Success - Learning from Families Research and Training Center for Children's Mental Health - University of South Florida |
| Core
Service Design Features Ministry Guidelines for Intensive Child and Family Services |
Review Links
Inside this report you'll find a comprehensive editorial on:
The demand for Children's Mental Health Services
THE EVOLUTION OF FAMILY PRESERVATION SERVICE DELIVERY MODEL IN CHILDREN'S MENTAL HEALTH
The Development and Evolution of a Provincial Network
The Evolution of Home-Based Services (HBS) & Intensive Family Preservation Services (IFPS)
INTENSIVE CHILD AND FAMILY SERVICES TODAY
- Target Population
- Age of Child - 0 to 18 years of age
- Intensity of Problems
- Parental and Child/ Youth Functioning
- Safety Concerns
- Geographic Catchment Area
- In terms of engagement
- PHILOSOPHY AND GUIDING PRINCIPLES
- Empower Families
- Social Ecological Approach
- Home-Based Service Delivery Approach
- Comprehensive Services
- Consumer Responsiveness
- Strength-based Focus
- Intervention Efficacy
- Intake and Referral Route
- Needs Assessment
- Contracting
BACK TO OUR ROOTS...
The demand for Children's Mental Health Services has also been the focus of study of the local Planning and Advisory Group for Children and Adolescents with Acute and Serious Mental Health Needs. This committee, with representatives from Wellington, Waterloo, Bruce and Grey counties, was initiated in 1997 as part of a regional consultation process for Making Services Work for People. Relying on expertise from hospitals, CMHC's, schools and child welfare, as well as consultation from families and other service providers, the group consolidated an ideal comprehensive model of service for children and adolescents. Each community represented used the model to put forward priorities in service. Intensive child and family service is one of the priorities consistently identified.
What has become evident in understanding the role of intensive child and family services within children's mental health is a set of values and principles that are the foundation for improving and enhancing services to families with mental health needs.
- Families of children/youth with complex mental health needs should be provided access to service, which is the least restrictive and the most normative environment but is clinically appropriate.
- Families should have access, voice and ownership in the service planning process throughout the delivery of service. The families expertise of their own situation is recognized, valued and utilized and they are full participants in all aspects of the planning and delivery of service.
- The service is comprehensive and addresses the unique needs of the family unit as a whole. It is recognized that serious and acute mental health needs require a multi-agency approach but that the need for an integrated community-based system of care is critical to reduce service fragmentation.
- The delivery of service needs to be strength-based, culturally sensitive and individualized in accordance with the unique needs and potentials of each family. This requires the development of an individualized, focused, goal oriented service plan.
Each community has an obligation to the consumer to design a
system of community care that provides service options that match
the level of need. Historically, we have either
"under-serviced" or "over-serviced" families
with complex needs. This is due to limited choices on a service
spectrum where services have been polarized. Traditional outpatient
counselling is typically once per week office-based and is not
sufficient for families with complex needs. As a result
children/youth end up in residential service options at a tremendous
cost, both from a financial perspective, the service is very costly
and can only serve a few, and from the perspective of, the cost to
the family when an out-of-home placement occurs. It is not the
intent in this article to debate the cost effectiveness of
residential treatment but to emphasize the importance of this
service option within the context of a community-based system of
care. This service should be viewed as more than an alternative to
residential service. This service is a family focused intervention
which operationalizes the values of a community care approach while
providing a cost-effective service that promotes and supports family
unity. 
THE
EVOLUTION OF FAMILY PRESERVATION SERVICE
DELIVERY MODEL IN CHILDREN'S MENTAL HEALTH
The financial, emotional, and social costs associated with family breakdown and the placement of children in residential, hospital and juvenile detention settings has drawn much attention over the past three decades. Growing recognition of a lack of viable and effective service options for children at risk led the way for the development of alternative interventions. Home-based services (HBS), the most prevalent being Intensive Family Preservation Services (IFPS) became popular in the middle 1970's when Jill Kenney and David Haapala developed the Homebuilders model. Initially, like the Homebuilders model, IFPS programmes were limited to Child Welfare clients of all ages with the main focus being preventing out of home placement. However, over the years the application of the model has branched out. Multi-Systemic Therapy (MST) (Henggeler et. al., 1998), which utilizes a model of IFPS, has received much attention for its effectiveness in work with violent juvenile offenders. More recently, MST is being tested as an alternative to hospitalization for adolescents in psychiatric crisis (Henggeler, et.al., 1999). Despite the variation in target populations many of the original core features of IFPS have remained constant.
According to Coady and Hayward (1998), common programme characteristics of IFPS and HBS in general are:
- that they are home based as opposed to agency based,
- services are centred on the whole family and not just the child or adolescent,
- services are crisis oriented, intensive, and time limited (and thus caseloads are small),
- interventions consist of concrete resources, skills training and counselling, and finally,
- there is an emphasis on client strengths, self-determination
and empowerment.
The Ontario Experience
In southern Ontario The growth of HBS utilizing an IFPS model can
be traced back to the development of programmes at Kinark Child
& Family Services followed by the Children's Aid Society of
Metropolitan Toronto, Catholic Children's Aid Society of
Metropolitan Toronto and Peel Children's Aid Society, to name but a
few. Soon after, the IFPS movement grew outside of child protection
services and into the field of Children's Mental Health. Lynwood
Hall Child and Family Centre, Parry Sound Child and Family Centre,
Peel Children's Centre, Madame Vanier Children's Services and
Lutherwood-CODA all began offering IFPS as one option in a continuum
of services. While many of the child welfare programmes began by
using the Homebuilders model as a template, those that served a
mental health population modified aspects of the service to meet the
varying needs of the clients. The consistent and significant
modification to take place was related to the length of service.
This was in direct response to the complexity of needs of the client
population. Four to six week service delivery models were modified
to 6 months to 2 year time frames, as the shorter models were not
sufficient to achieve good outcomes and sustain any gains made. The
service goals were also modified with less of a focus on
"preserving the family" (preventing an out-of-home
placement) and more of a focus on targeted areas of improved family
functioning and a multi-systemic approach to treatment planning
which incorporates a comprehensive system of care.
The Development and Evolution of a Provincial Network
In the early 1990's a small group of managers and front line
workers in Ontario in the field of IFPS met together to discuss the
development of what would soon become known as the Ontario Family
Preservation Network. They met informally at various locations on a
quarterly basis and kept each other informed of new initiatives and
practices in the field of IFPS. In 1996 the Network hosted its first
conference drawing on the expertise of its members to offer training
and consultation on topics pertinent to home-based work. Over the
past five years the Network has seen programmes and members come and
go as many programs were held together by tenuous budgets and were
vulnerable to service cuts. With the current re-investment of funds
the membership has expanded as new programs come on line and as
others expand their services. The intent of the network was to share
knowledge and resources as services developed and to examine best
practice approaches to achieve better outcomes.
The
Evolution of Home-Based Services (HBS)
& Intensive Family Preservation Services (IFPS)
The Evolution of Home-Based Services (HBS) & Intensive Family Preservation Services (IFPS), Waterloo Region in Children's Mental Health Except for two programmes offered by Child Welfare agencies (Family and Children's Services, Kitchener/Cambridge, closed in 1998, and Guelph Children's Aid Society) IFPS is not a common service modality found in the Waterloo region. Some agencies use a home-base model to deliver services but the service parameters differ from that of IFPS, usually on the dimensions of intensity and scope of service.
Lutherwood-CODA's Partner's Programme, based on a model if IFPS
began serving families in the fall of 1996. Average face to face
contact in the service is 4 to 6 hours per week and the length of
service is typically six months duration. Referrals come directly
from families, hospitals, schools and other treatment agencies.
KidsLINK has also offered home-based service through their Home and
Community Support Program but the intensity of the model was limited
and the focus was on child management.
INTENSIVE CHILD AND FAMILY SERVICES TODAY
When the Ministry of Community and Social Services announced the
re-investment strategy and put out a call for proposals, Lutherwood-CODA
and kidsLINK, opted to submit a joint proposal for a consolidated
program that was consistent with the values and guiding principles
of the intensive child and family service delivery model. KidsLINK a
children's mental health centre serving the 12 and under population
and Lutherwood-CODA operating a children's mental health department
which serves the 12 to 16 population recognized that families have
children of all ages and that by partnering we could reduce service
fragmentation and confusion to families about the agency of choice.
In combination with centralized intake this made the most sense in
matching families to the service of choice based on need. This was
the beginning of the expansion and enhancement of the Partners
Program.
PARTNERS PROGRAM
Target Population
Intensive Child and Family Services (ICFS), has been utilized for
a broad base of clients with diverse service needs. The target
population typically consists of children/youth and their families
in which placement is not necessary at this time given appropriate
amounts and intensity of service geared to the individual needs of
the family. Additional eligibility factors that should also be
considered are; age of child, problem profile, parent/child/youth
functioning, safety concerns, commitment to participate and
geographic limitations.
Age of Child - 0 to 18 years of age
Age of the child/youth does not appear to be an exclusionary
dimension of client suitability in any of the research to date.
While Scott Henggeler and associates have had considerable success
in servicing young offenders, other researchers have had similar
success with younger children including high-risk infants. Given the
variability of the target population research and the Ministry's
guidelines for the service the client population of 0 to 18 years of
age is the current eligibility requirement.
Intensity of Problems
In terms of problem profile, the primary dimension of client
suitability is the intensity of problem impact and the number of
stressors and difficulties the family may be experiencing as opposed
to the type of problem. The service is well suited to clients
requiring medium to high level of intensity. Typically the length of
service dictates the number of needs that can be addressed and the
focus of service as opposed to type of need.
Parental and Child/ Youth Functioning
Parental and child/youth functioning is another important
dimension to be considered. Many programs exclude parent and youth
with active substance abuse issues or accept these referrals under
the parameter that parents/youth must agree to participate in
detoxification or rehabilitation programs. This is not a requirement
for Partners. On a case by case basis consideration is given to the
suitability of parents or youth with severe mental illness or
cognitive difficulties which would impair the ability of the youth
or parent to benefit and fully participate in the program. If any of
the family members can benefit from skill teaching and resource
finding then they are appropriate. It is not necessary that all
family members have buy in. If one of the caregivers is open to the
service and can benefit then that is the starting place.
Safety Concerns
Safety of the child/youth, worker and all family members is an
extremely important selection criteria. A balance must be achieved
between placement prevention and ensuring that safety and treatment
needs can be met. If more intrusive services are warranted to ensure
safety than ICFS should not be utilized. Commitment to Participate
Another important dimension highlighted in the literature is
commitment to participate. Given that services are provided in the
home, the experience of most programs is that the families who are
genuinely committed to family unity and /or an alternative approach
to residential placement have a greater chance for successful
outcomes.
Geographic Catchment Area
Geographic catchment area needs to be taken into consideration
due to funding requirements and viability of servicing remote areas.
Extensive travel time can reduce the responsiveness and client
accessibility. Ideally, assigned workers should not be required to
travel more than one-hour drive to the family's home. The Partners
program accepts referrals from the Waterloo Region and has assigned
workers in two geographically based teams, one for Kitchener-Waterloo
area and one for Cambridge area.
PHILOSOPHY AND GUIDING PRINICPLES
Program Goals
The value base of Partners is founded in family support
principles that are viewed to be essential for successful treatment
outcomes. While structural components of various programs may vary,
most ICFS have 3 primary goals:
- to preserve the integrity of the family and to prevent the unnecessary placement of children/youth while simultaneously ensuring the safety of the child/youth,
- to increase the coping skills of the family and its capacity to function effectively in the community, and
- through collaboration with community agencies, develop a
personal community support system by linking families to
appropriate community resources.
Empower Families
One of the key tenets of this approach is that parents are
engaged as equal partners in the treatment process, with the
ultimate goal being to empower the family to take responsibility for
making and maintaining gains. Parents are encouraged and supported
in developing the skills to solve their own problems rather than
rely on professionals and to be good advocates for their children
and themselves in accessing social service agencies. The expertise
of their family situation is validated and the way they would like
to be served is respected. The family is involved in all aspects of
service planning and delivery. This is a family centred service.
Social Ecological Approach
Research has demonstrated that treating
the child/youth in isolation of the family, school, peer and
neighbourhood means that gains made are quickly eroded when a
child/youth returns to their family and local community. For
example, an underlying premise of MST is that criminal conduct is
multi-causal; therefore effective interventions need to address the
multiple sources of criminogenic influence. Furthermore, custody
stays can be counter-productive because already troubled youth are
immersed in a peer culture where anti-social values predominate.
Given this context, ICFS and MST utilize a social-ecological
approach to understanding and intervening in addressing behavioural
concerns. The child/youth is viewed in the context of the family and
the entire family is viewed in the context of their community and
broader ecological environment. The service then involves the whole
family and assessment is geared towards determining the factors in
the child/youth's broader ecological environment that support the
continuation of problem behaviours and factors that operate as
obstacles to their elimination.
Home-Based Service Delivery Approach
Another important principle is that, home-based treatment is preferable to office-based treatment. Home-based and community-based treatment offers a rare opportunity to observe family interactions in vivo, and is advantageous for the worker, in terms of assessment and engagement. For assessment purposes the worker is able to;
- get a firsthand view of the family's living situation,
- be exposed to the unique culture of the family as well as such realities as poverty, substandard housing, drugs, crime and unsafe neighbourhoods,
- observe the family's child rearing practices, and to experience the living environment through each family members perspective.
In terms of engagement, the worker has the opportunity to meet important family and
extended family members, as well as friend and neighbourhood support
networks. As well, the worker has more exposure to the more powerful
or peripheral family members who may not attend an office-based
appointment.
Comprehensive Services
Another important principle is
that services are multi-faceted and comprehensive. Services include;
counselling, skill training, instrumental support, and co-ordinating
and accessing community resources. The service is also
goal-oriented, time-limited, and is present focused seeking to
identify and extinguish behaviours which are of concern not only to
referring agents but more importantly to the family itself.
Consumer Responsiveness
In order to meet the principle of consumer
responsiveness and accessibility the service delivery hours are
flexible to accommodate the needs of the family and are augmented
with 24- hour crisis support. Workers are given small caseloads
(average caseload between 3 to 8 clients) which allow them to work
in an active and intense manner with each family at a time that is
convenient to the family.
Strength-based Focus
An essential
component that goes hand in hand with clear problem identification
is the identification of individual and systemic strengths. MST, for
example, promotes therapeutic contacts that emphasize the positive
and use systemic strengths as levers for change. Workers are
encouraged to look for protective factors as well as perpetuating
factors related to decreasing undesirable behaviours. Interventions
are designed around the unique strengths of the family.
Intervention Efficacy
One of the most important and underlying principles is that;
intervention efficacy is evaluated continuously from multiple
perspectives with the service providers assuming accountability for
overcoming barriers to successful outcomes. Workers define the
targets of intervention in partnership with the family as well as
the indicators of whether the measures undertaken have been
effective. A strategy should produce observable results in
addressing the problem behaviour or else the strategy is revised.
The service is designed to be short-term but intense which can
result in the generalization of treatment gains over the long-term.
A clearly articulated definition of success permits an objective
definition of when the service can be ended.
Intake and Referral Route
Referrals will come from the current
referring agencies that typically access Children's Mental Health
Services, (Child Welfare, Court and Probation, Schools, Counselling
agencies etc.), and predominately, referrals will come from families
directly. The new Children's Mental Health Access Centre is
currently the intake route for home-based services for both
Children's Mental Health agencies and will serve this function for
the newly enhanced Partners Program. In addition, close linkages to
the Mobile Crisis Response Team would allow expedient processing of
high priority cases. The success of the IFS model increases if
interventions can be timed when the family is most in need and wait
lists for service are minimal. In addition, some spots are sheltered
for high priority crisis cases for children being discharged from
hospital.
Needs Assessment
Given the advantages to home-based assessment and that assessment is a very dynamic process in a high contact service delivery model, in depth individual and/or family assessment is not warranted. Specialized assessments such as; psychiatric or psychological are obtained on a case by case basis as the need is identified. The purpose then of the Needs Assessment is to screen the client for the most suitable service that will match their needs. The assessment format is needs and strength focused which prompts the assessor to look at needs in the major life domain areas going beyond the individual sphere of the child/youth. Tentative treatment goals are proposed as well as the recommended service area.
The current practice of the Children's Mental Health Access
Centre is; to meet with the families for 1-2 sessions following the
initial telephone contact. During this contact intake staff gather
all relevant background information and review the results of the
Standardized Client Information System, or SCIS (a research and
problem identification instrument used across the province in
Children's Mental Health Centres). The Needs Assessment is conducted
by a trained Intake Clinician at a Masters level and can occur in
the family's home or in the office. Once a client's suitability for
the service has been determined the family would be assigned to the
appropriate geographical Partners team. The Team Leader would then
assign the family accordingly or the family would be placed on the
wait list.
Contracting
The assigned Family Support Worker reviews the client file that contains background information, the Needs Assessment, the data collection from the SCIS, and any relevant collateral reports prior to making contact. In making the initial phone contact with families it is important to explain to the family the service delivery model and ensure it is a good fit for the family. It is important for workers to offer an appointment time that is suitable to the family's availability. Prior to the first home visit, workers assess any safety factors and plan accordingly. It is always on option to co-team or have an office-based appointment if warranted.
Assessing the commitment to participate is an important aspect of contracting as well as highlighting the need to report any evidence of child maltreatment. To assist with this process family members are asked to sign a participation agreement, which outlines the duty to report. Clients are also informed that interventions will entail daily or weekly effort by family members and that they are embarking on an endeavour that requires considerable hard work given the intense nature of the work.
Service contracting is done in 3- month time blocks and are
renewable up to a maximum of 6 months of service. In exceptional
circumstances the service can be renewed up to 9 months. Given the
intensity of the service, it is imperative to set treatment goals as
soon as possible into the service. The worker revisits the proposed
treatment goals in the Needs Assessment and either modifies the
tentative goals or confirms the goals already set (usually 3 to 4
overarching goals). This process, ideally, involves the whole family
and parents are key in identifying the treatment focus. The next
step after confirming the overarching goals for treatment is
determining the indicators that will measure outcomes. The
indicators are behaviourally oriented statements that succinctly
describe the desired results that the child/youth are working
towards, statements, which lend themselves well to ratings.
Typically, three indicators are determined for each overarching
goal. At the end of the three-month contract period, a formal review
of the outcomes takes place and either the contract is renewed or
the service is closed. It is important to empower the family through
this process.
PROGRAM COMPONENTS
Family Counselling and Support Strategies
Family counselling is considered the central component of service. Parents are encouraged to restructure their environments in ways that promote development of their children. Parent-child relations are viewed as mutually influencing and considerable therapeutic attention is devoted towards strengthening these relationships. The therapist's role is to empower parents with skills and resources needed to independently address the inevitable difficulties in raising children and to empower the child/youth to cope responsibly with the many stressors in their lives.
This approach seeks to obtain the views of all pertinent participants regarding family and extra-familial strengths and problems and work towards a consensus definition in understanding the contributing factors that maintain the problems. Counselling principles are from a systemic orientation assisting the family in expanding their view of the situation, thereby expanding the possible solutions and intervention strategies, and increasing the understanding of system dynamics. Although each family is unique in their strengths and challenges, there are several problem areas that are typically identified. High rates of child/youth and parent conflict and low rates of child/youth and parent affection are often observable. In addition, parents frequently disagree regarding discipline strategies and often have their own set of personal problems that interfere with effective parenting. Family interventions typically, attempt to provide the parent(s) with the resources and skills needed for effective parenting and for developing increased family structure and cohesion. The counselling addresses ingrained and repetitive circular patterns of interaction that impede the family from moving towards their change goals.
The family workers focus is also on helping the parent and other
family members to develop an enduring social support network within
the natural environment. Family support strategies and instrumental
support are excellent tools to engage reluctant parents and assist
in building a sense of competency and mastery over their situation.
Therefore resource finding and building a support network of
informal and formal supports is seen as essential in crisis
management, promoting client independence and reducing social
isolation from the community.
Individual Counselling
Although individual counselling is utilized, individual treatment approaches are never used in isolation from the clients' systemic context. For example; while a cognitive behavioural intervention is implemented in an attempt to change the beliefs and attitudes of a youth, the family worker is also attempting to change the environment in ways that will reinforce the youth's progress. Youth often require extra support and individualized coaching and direct interventions are followed up with teaching the parents to coach and respond accordingly.
The service is comprehensive, systemically oriented, and present-focused. Therefore, extensive individual sessions are discouraged as they compartmentalize the service and may reinforce the perception that anyone individual is the "problem". Any long-standing issues related to past history are only addressed if they are directing impacting the present. If past trauma issues are seen to be the primary causal factor connection to a community therapist, to contract specifically on these issues is the preferred direction.
Individual coaching and skill training with parents is also a common practice and may occur in an individual format as most often you would not want the child/youth present during such strategizing. This approach is utilized when it becomes apparent that a, child/youth's behaviour problems are being maintained by a parent's disciplinary style or affective response to the child/youth.
Individual counselling, is also utilized in domestic violence
situations to determine safety and risk factors and for situations
in which parents could benefit themselves from cognitive
restructuring interventions related to ingrained "thinking
errors" and thought distortions. It is quite common for parents
with limited parenting education to attribute a child/youth's
non-compliance to a variety of causal factors some of which are
personalized when in fact it is behaviour that is well within the
normal sphere of typical child responses. Educating and normalizing
around "normal" child development is often done in the
individual format.
Instrumental Support
It is recognized in the IFS approach to
service, that families with complex needs may be struggling with
meeting the basic instrumental needs of their children/youth. This
may be related to challenging economic situations or that the
parents are unable for a variety of reasons to organize their energy
to meet the basic needs of food, shelter, and safety. As part of a
comprehensive service, workers are able to access flex funds to
provide the client with instrumental support that is needed. The
underlying premise of this approach is that in order to assist the
family in addressing higher level needs the basic needs must be met
first. The funds are typically used to purchase items such as;
purchasing a bed, reconnecting a phone, house repairs etc. In
addition to the flex fund purchases, practical assistance is
provided in the form of; driving clients to the food bank, taking
them to local community centres, providing information on second
hand stores located in the area, etc.. Families are also coached on
how to advocate for themselves to obtain subsidies, and to become
familiar with community resources such as food banks, neighbourhood
centres and other community support centres.
Access to Community Resources
Collaboration with community agencies is seen as crucial. Community-based treatment is achieved by gleaning a clear understanding of the child/youth's broader ecological environment, and gearing the interventions to addressing several spheres of the child/youth's life.
An important linkage applicable to all children is the connection to school. Parents with the support and coaching of the worker attempt to forge stronger and more positive connections with teachers and school administrators, not only to promote better child monitoring but also to facilitate improvements in the child's academic performance.
The importance of peer interactions is also addressed as positive peer relationships contribute substantially to emotional and social development. Special attention is given to developing strategies to promote connections to positive peer influences and to remove child/youth from deviant peer groups.
Other community links such as probation, other service providers,
neighbourhood associations and community recreation centres are seen
as essential connections in establishing a supportive personal
community for the family.
Psychiatric and Psychological Consultation
It is imperative as
part of a multi-disciplinary approach that Family Workers have
access to regularly scheduled psychiatric consultation. Other
clinical staff such as psychologists, nurse therapists and other
health professionals may also provide consultation and support.
Workers are expected to be broad-based generalists who are astute at
bringing in other professionals with areas of specialization as
required. Access to specialized assessments can be critical in some
situations and lack of these resources may limit intervention
strategies and effect treatment outcomes.
Follow-up Consultation and Service Closure
In planning for
termination of service, the goal is for the parent, to become his or
her own case manager. It is the role of the worker to assist the
family in identifying formal and informal supports as well as
bridging with any agencies that may provide follow-up services that
may be helpful in maintaining the gains that are made. Outcome
indicators are set upon contracting and determine when service is
complete. Service is typically more intense at the beginning and is
gradually tapered off as clients make gains as to not encourage
dependency of service providers. Partners offers the client
"booster" sessions based on need after service is
terminated. Families are invited to call back if their situation
becomes problematic, and in a single session format workers provide
transitional assistance. Given the intensity of the service upon
completion, most families are not wanting extensive follow-up
services and are empowered to forge ahead on their own. Re-referrals
will be considered in circumstances where the client's situation has
changed and clearly new treatment goals are appropriate.
SUMMARY AND CLOSING COMMENTS
As previously mentioned, there has been recognition both at the provincial and the local level, that intensive home based service may provide a meaningful response to the needs of children and adolescents with mental health problems. Lutherwood CODA and kidsLINK believe in the difference this program model can make to the lives of families with children experiencing mental health challenges. This service description reflects the best practice in the development of a comprehensive programme of intensive child and family services and is in compliance with the guidelines set by the Ministry of Community and Social Services.
From the perspective of the helping professions this model of service delivery brings us back to our roots. The old expression of helping the client where they are at is truly reflected in this service. Intensive child and family services challenges and stretches the definition of treatment. Treatment viewed in a broader context and away from a medical definition. When did the helping professions stop viewing community based care and interventions as "non-clinical" and somehow of lesser value? If we reflect on our own lives and what gets us through the turbulent times, it is not only the advice and guidance of professional helpers but the emotional support and practical help of our own personal community of support. A movement away from the "expert" mindset is essential. While the expertise of the worker is certainly utlized the expertise of the family is equally important. It is the goal of this service to work shoulder to shoulder in partnership with the family as they embark on their journey of self-discovery and self-mastery. We are honoured and humbled by the courageous and resilient individuals in our community that we have the privilege to work with.
Sue Lessard, M.S.W. Program Manager of Outreach Services Partners a jointly operated by program by Lutherwood-CODA and kidsLINK
Sections of this article were taken from the original funding proposal, acknowledgements to contributing authors; Laurie Robinson, Walter Mittelstaedt
For more information on the Partners Program contact Sue Lessard,
Program Manager at 749-8305 ext. 228 or E-mail at slessard@lwdcoda.org
References
Blythe,B., Patterson Salley,M.,& Srinika,J. (1994), "A Review of Intensive Family Preservation Research" Social Work Research, Vol:18, Number 4.
Coady, N. & Hayward, K (1998). "A study of the Reconnecting Youth Project: documenting a collaborative inter-agency process of programme development and client views of the process and outcome of service". Unpublished Report, Faculty of Social Work, Wilfrid Laurier University
Cimmarusti, R., (1992), "Family Preservation Practice Based upon a Mulitsystems Approach", Child Welfare League of America, Vol. LXXI: Number 3.
Debicki, Andrew, (April, 2000) Programme Manager, PACT team, Lynwood Hall Child and Family Centre, Hamilton, Ontario. (Personal communication)
Fraser,M., Pecora,J., & Haapala, D., (1991) Families in Crisis -The Impact of Intensive Family Preservation Services. Aldine De Gruyter: New York.
Henggeler SW, Rowland MD, Randall J, Ward D, Pickrel SG, Cunningham PB, Miller SL, Edwards J, Zealberg JJ, Hand LD, Santos AB (1999). Home Based Multisystemic Therapy as an Alternative to the Hospitalization of Youths in Psychiatric Crisis: Clinical Outcomes. Journal of American Adolescent Psychiatry. 38:11, November 1999.
Henggeler SW, Schoenwald SK, Borduin CM, Rowland MD, Cunningham PB (1998). Multisystemic treatment of antisocial behaviour in children and adolescents. New York: Guilford.
Kutash, K., & Robbins-Revera, V. (1996) What Works in Children's Mental Health Services, Baltimore: Paul H. Brookes Publishing Company
Ministry of Community and Social Services (2000), Guidelines for Regional Offices - Intensive Child and Family Services.
Shulman, D. & Athey, M. (1993). Youth Emergency Service: Total Community Effort, A Multisystem Approach. Child Welfare, Volume LXXII, Number 2, March-April 1993: 171-179.
Wells, K., Whittington, D., (1993), "Child and Family Functioning after Family Preservation Services", Social Service Review. University of Chicago.
Whittaker, J., Kinney, J., Tracy, E., Booth, C., (1990) Reaching
High Risk Families - Intensive Family Preservation in Human
Services. Aldine de Gruyter: New York.
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