Pilot Child Welfare System Redesign
Strategic Action Plan
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5.6 Redesigned Temporary Therapeutic Respite Care System
Removal of a child from their home is a traumatic event for an already traumatized child. The Law Enforcement officer must have compassion and understanding of the many forms this trauma may be displayed by the child and the family. If the family is volatile, Law Enforcement will have to resolve the violence in the home first.
In some cases, Law Enforcement may have already removed the offending parent from the home, but the child also needs to be removed from the home for physical, mental, and/or emotional treatment. Calm, composed, yet compassionate behavior is of benefit to the Law Enforcement officer.
5.6.1 Law Enforcement determines that the child needs immediate medical and/or mental health treatment
When Law Enforcement determines that the child needs immediate medical and/or mental health treatment, Law Enforcement requests an ambulance and notifies the designated Hospital of the incoming traumatized child.
5.6.2 Child is placed in the ambulance and taken to the designated equipped Hospital
Every child removed from the home is to be taken by ambulance to the nearest Hospital equipped to conduct a complete physical exam and a psychological assessment. The Hospital will have been previously designated, doctors and staff trained, and Hospital equipped to treat a traumatized child. If possible, a Law Enforcement officer accompanies the child in the ambulance, to provide continuity for the child and assurance that the child is being helped. This closes out Law Enforcement’s role in the Child and Family Support System.
5.6.3 Hospital provides emergency medical care and mental health assessment of the child
The Hospital begins a detailed physical injury report and prescribed actions, medications, and treatments from the physician, plus detailed psychological profiling, medications, and treatments from the psychologist or psychiatrist on call at the Hospital. The Hospital visit is required even if no physical signs of abuse are present; often the trauma has resulted in psychological issues that need to be addressed by a professional. Although not possible in every city or county in the U.S., a children’s hospital, or a hospital with a quiet wing for the physical and psychological exams would reduce the child’s further trauma after the experience of being removed from home.
Due to HIPAA regulations, medical and mental health information about the assaulted or neglected child remains within the Hospital’s database. Thus, any “Child Welfare” reports made to the federal level must gather data from the Law Enforcement, Family Services, and Hospital databases.
The Child and Family Support System is a close alliance of Law Enforcement, Family Services, and Hospital, plus local nonprofit organizations, individuals, and groups. Each entity shares all information pertaining to the child with the appropriate public agency: Law Enforcement, Family Services, or Hospital. Alliances and contracts are maintained, showing clear lines of authority and reporting.
5.6.4 Hospital takes child to Temporary Therapeutic Recovery Home
Hospital will have previously identified a set of authorized, accredited Temporary Therapeutic Recovery Homes, including the preferred child age, race/cultural heritage, and physical/mental conditions the Temporary Therapeutic Recovery Home staff is trained and experienced to accept.
The Temporary Therapeutic Recovery Home search for the child is conducted by a specialist in the Hospital office, knowledgeable of the types and availability of TTRHs in the area, and alerting an appropriate TTRH that the Hospital will be in contact about the status of the child and the potential arrival time at the TTRH.
The most significant change in the Out-of-Home-Placement process of the Redesigned Child and Family Support System is the definition and structure of the place to which the child is taken. Instead of Foster Homes, the traumatized child is taken to a Temporary Therapeutic Recovery Home, where one or both “parents” are trauma-informed and trained to understand the behavior that may be presented by child victims of assault/battery or criminal neglect. The entire intent of the TTRH is to provide a safe, warm, friendly home where the child is welcomed and nurtured. The “parents” are made fully aware of both the physical and psychological treatment plans and follow the treatment plans explicitly. Additional support is provided to the TTRH parents, based on the specific needs of the child.
Recovery from the trauma of child assault/battery and criminal neglect is the first goal of the TTRH. The length of time of the recovery depends on the child’s trauma, severity of the assault or neglect, and recommendations of the physician and therapist assigned to the child by the Hospital. The TTRH reports to the Hospital all treatments, programs, and status for the child to the Hospital daily, via a special TTRH app on their cell phones. Calls for assistance from the Hospital can also be made through the TTRH app or by calling 911.
Age-dependent, possible reunification with the family is a topic only to be brought up by the child, with the child leading the discussion about their desire to return home or not. Introducing the thought of reunification to the child before the child has recovered may result in unintended further trauma for the child. Let the child know that they are in charge of what happens; they first need to focus on recovery. Of course, all of this guidance is age-defined. An infant is not going to understand “reunification” and a defiant 16-year-old may not want to be called a “child” or treated like one.
An important aspect to the Temporary Therapeutic Recovery Home is that the child matures at the level expected for a child of that age, mental development, and physical development. For example, a school-age child should be in school (either public school or home-schooled, depending on the child’s needs) at the appropriate grade level for the child’s age and mental health, whenever possible. In addition, the child should be taught the usual age-appropriate family chores, such as doing laundry, cooking, cleaning up their room, getting an allowance, budgeting their money, etc. Even children expected to be reunited with their birth family within a short period should be given these “normal” tasks of daily living, so the child returns to the family feeling more empowered.
The Casey Family Programs Northwest Foster Care Alumni Study was of various aspects of children who had been in foster care. Individuals who were in foster care experience higher rates of physical and psychiatric morbidity than the general population and suffer from not being able to trust and that can lead to placements breaking down. In the Casey study of foster children in Oregon and Washington state, they were found to have double the incidence of depression, 20% as compared to 10% and were found to have a higher rate of posttraumatic stress disorder (PTSD) than combat veterans with 25% of those studied having PTSD. Children in foster care have a higher probability of having attention deficit hyperactivity disorder (ADHD), and deficits in executive functioning, anxiety as well as other developmental problems. Later in life, these children experience higher degrees of incarceration, poverty, homelessness, and suicide.
All of the above symptoms are due to the untreated trauma experienced by the children who were then placed in “warehouse-type” facilities and ignored. These conditions last the lifetime of the child/adult.
5.6.5 Hospital Staff visits child weekly
Weekly visits by the Hospital staff are mandatory, and scheduled in the Hospital’s database to ensure adherence to the schedule. If available, a CASA (Court Appointed Special Advocate) volunteer may be assigned to the child, particularly if legal issues and/or family complications are involved. It is important that the community share in the nurturing of the child’s recovery. It is also critically important that the child be protected from further harm or injury – whether from someone else or the child’s self-injury.
There is not a straight sequence of processes or steps to be applied to every child. The main focus is that the child feels in control of their current environment – which may be a totally new concept to a child who has experienced years of assault or neglect in a dysfunctional family.
5.6.6 Federal and State Funding Paid to the Child’s Account
One additional major change in the Redesigned Child and Family Support System involves the funding provided by federal or state grants for the welfare of the child while under the care of the CFSS.
Funding for children who have been assaulted/battered or criminally neglected and are placed in Temporary Therapeutic Recovery Homes is no longer paid directly to the “foster care home” – now Temporary Therapeutic Recovery Home.
Funding is held in the child’s name and account, to be applied to the TTRH and all other services required by the child to heal. Funds are paid only when the child thrives.
No longer will foster care parents be paid for abusing a child.
Although it may be argued that, with the replacement of foster care homes with Temporary Therapeutic Recovery Homes, there may not be a need to control the funding in that way, it emphasizes to all within the Child and Family Support System that the child IS the center, the focus.
To submit questions or comments, please email Jo@Jo-Calk.com. I welcome all input, ideas, and suggestions. Thank you for caring for children.