Best Practices for Residential Interventions for …...Best Practices for Residential Interventions...

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Best Practices for Residential Interventions for Youth and their Families A Resource Guide for Judges and Legal Partners with Involvement in the Children’s Dependency Court System February 2017

Transcript of Best Practices for Residential Interventions for …...Best Practices for Residential Interventions...

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BestPracticesforResidentialInterventionsforYouthandtheirFamilies

AResourceGuideforJudgesandLegalPartnerswithInvolvementintheChildren’s

DependencyCourtSystem

February2017

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Acknowledgements

ThisresourceguidewasfundedbytheAnnieE.CaseyFoundation.Wethankthemfortheirsupportbutacknowledgethatthefindingsandconclusionspresentedinthisreportarethoseoftheauthorsalone,anddonotnecessarilyreflecttheopinionsoftheFoundation.TheAssociationofChildren’sResidentialCenters(ACRC)andtheNationalBuildingBridgesInitiative (BBI) provided extensive expertise specific to the residential best practicesidentifiedinthisguideandwouldliketothankthefollowingcontributors.

Contributors

• WilliamPMartone,M.S.,LeadWriter/WPMConsultingInc.andBBIConsultant• BethCaldwell,M.S.,Director,BuildingBridgesInitiative• RobertFoltz,Psy.D.,AssociateProfessor,ChicagoSchoolofProfessionalPsychology• JodyLevison-Johnson,LCSW-C,ChiefClinicalOfficer,ChoicesCoordinatedCareSolutions• KariSisson,B.A.,ExecutiveDirector,AssociationofChildren’sResidentialCenters• BBIFamilyandYouthAdvocates,membersoftheBBINationalAdvisoryCommitteeandtheBBICulturalandLinguisticCompetencyWorkgroup,arerecognizedfortheirreviewandinputintotheguide’scontent.

• The National Center for State Courts (NCSC) and the National Council of Juvenile andFamilyCourtJudges(NCJFCJ)alsoprovidedsupportinthereviewanddisseminationofthecontentofthisguide.

FormoreinformationabouttheBuildingBridgesInitiative(BBI)Pleasegoto:http://www.buildingbridges4youth.org

FormoreinformationaboutTheAssociationofChildren’sResidentialCenters(ACRC)

Pleasegoto:http://www.togetherthevoice.org

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TableofContents

I. Introduction...................................................................................................................................................................................................4OverviewoftheGuide...........................................................................................................................................................................4OverviewofResidentialInterventions..........................................................................................................................................4KnowingWhentoUseResidentialasanIntervention............................................................................................................5CriticalStepsThatJudgesandLegalPartnersNeedtoTake................................................................................................6

II. CriticalComponentsofSafe,QualityandEffectiveResidentialPrograms.........................................................................7FocusonPermanency............................................................................................................................................................................7Engage,SupportandPartnerwithFamilies................................................................................................................................8Engage,SupportandEmpowerYouth.........................................................................................................................................11ProvideCulturallyandLinguisticallyCompetentServices.................................................................................................12ProvideTrauma-InformedCare......................................................................................................................................................13LinkResidentialProgrammingwiththeHomeCommunitiesoftheYouthandFamilies.....................................14PreventSeclusionandRestraint.....................................................................................................................................................15WorkwithYouthinTransitiontoAdulthood...........................................................................................................................17EngageintheInformedUseofPsychotropicMedications..................................................................................................17CreateOrganizationalCulturesSupportiveofBestPractices............................................................................................19FocusonOutcomes...............................................................................................................................................................................20

III. ChildrenUnder12YearsofAgeandTheirFamilies..................................................................................................................21WhattheResearchTellsUs...............................................................................................................................................................21BestPractices..........................................................................................................................................................................................21

IV. Closing............................................................................................................................................................................................................22InSummary..............................................................................................................................................................................................22

V. References....................................................................................................................................................................................................23VI. AdditionalInformation...........................................................................................................................................................................25

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OverviewoftheGuideThisguideisintendedasaresourceguideforjudgesandlegalpartnerswithinvolvementinthechildren’sdependencycourtsystem.Judgesareresponsibleforcriticallegaldecisionsconcerningthepermanency,safetyandwellbeingofchildrenandadolescents.Thesedecisionscanattimesrevolvearoundwhetherachildoradolescentshouldremainintheirhomeorbeplacedinaresidentialprogramtoaddressbehaviorscurrentlypreventingthemfromlivingsafelyathomeandinthecommunity.Tohelpguidejudgesandlegalpartnersinmakingdecisionsabouttheappropriateuseofaresidentialprogramthisguideprovidesanoverviewofwhenaresidentialinterventionisindicatedandwhattolookforindeterminingasafe,qualityandeffectiveprogram.Thisguidewillfocusonyouth12to17yearsofageandtheirfamilies,butalsoprovideasectiononsomeoftheuniqueissuesandneedsofchildrenunder12andtheirfamilies.EachareareferencedinSectionIIcontainsthecomponentsofasafe,qualityandeffectiveresidentialprogram.Foreachcomponentidentified,thefollowingareincluded:anexplanationofthearea,alistofkeyactionitemsresidentialprogramsshouldbeincorporatingintotheirpractices,andkeyquestionsforthecourttoaskinregardstoeachoftheseareas.OverviewofResidentialInterventionsChildrenincongregatecarecomprised14%ofthefostercarepopulationin2013(402,387),andapproximately55,916wereplacedinagrouphomeorinstitution(U.S.DepartmentofHealthandHumanServices,AdministrationforChildrenandFamilies,Children’sBureau,2015,p.ii).TheseresidentialsettingsareknownbymanynamesdependinguponthejurisdictioninwhichtheyresideandaretypicallyreferredtoasaGroupHome(GH),ResidentialTreatmentCenter(RTC),ResidentialTreatmentProgram(RTP),PsychiatricResidentialTreatmentFacility(PRTF),ShortTermResidentialTherapeuticProgram(STRTP),ResidentialTreatmentFacility(RTF),TherapeuticResidentialCare(TRC),oraResidentialCenter(RC).ResidentialtreatmentsettingsintheUnitedStatesserveapproximately200,000youthannually(Blau,Caldwell,&Lieberman,2014,p.143).Reducingtherelianceonresidentialinterventionshasbeenonthenationalagendaandtherehavebeensignificantlegislativechangesinthepastfewyearsfocusinguponthereductionofcongregatecareasaplacementchoice.Therecentchangestofederallegislation(P.L.113-183)in2014andCalifornia’scongregatecarereformeffortscontainedin(AB403)in2015arebuttworecentexamples.Forpurposesofthisguidethesetypesoffacilitieswillbereferredtoasresidentialprogramsorresidentialinterventions.Youthandfamiliesservedbytheseresidentialprogramscomefromdiversecultures,classes,races,sexualorientations,andethnicbackgrounds,andarelivingwithemotionalandbehavioralchallenges(BBI:CreatingandMaintainingCulturalandLinguisticCompetenceinHumanServiceAgencies:RationaleandRecommendationsforPromisingPractices,p.2).Residentialprogramsshouldbecomponentsoflocalcoordinatedsystemsofcareforchildrenandadolescents(hereafterreferredtoas‘youth’),andtheirfamilies,andthisguideviewsresidentialasabrieftherapeuticintervention,notaplacementoraspecifictreatmentmodality.Itisimportanttonotethatthereisadistinctionbetweenresidentialprogramsandsheltersservingyouthwithbehavioraland/oremotionalchallengeswhousebestpracticesandthosethatdonot.ThecourtsshouldattempttoavoidtheuseofanyresidentialprogramsthatarenotimplementingthecriticalbestpracticecomponentsdescribedinSectionIIbelow.Manyofthecurrentstateandfederalregulationscontinuetoworkagainstasystemofcareorientationwithkeyrequirementsevolvingfromabasicassumptionthatisinstitution/residentialprogramcentered.Infact,residentialprogramsarenottypicallyconnectedtothelocalsystemofcareinthefamilies’homecommunity.Thestate/federalrequirementshavealsoresultedininstitutingpracticesfocusedprimarilyon‘fixingyouthproblembehaviors’withintheresidentialprogram(i.e.reducingorcontainingproblematicbehaviors)ratherthanrequiringpracticesthatareconsistentwithachieving

I. Introduction

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sustainedpositiveoutcomespost-residentialdischarge(AssociationofChildren’sResidentialCentersPositionPaper[ACRC]-FirstinSeries,2005,p.3).Itisimportanttonotethatimprovedoutcomesareachievedforyouthreceivingresidentialinterventionswhenthereisincreasedfamilyinvolvement,shorterlengthsofstay,andstabilityandsupportinthepost-residentialenvironment(Walters&Petr,2008,p.4).Researchhasalsoconsistentlyshownthatpost-dischargegainsaremaintainedwiththeactiveinvolvementoffamilyduringtheresidentialprocessandcontinuityofsupportinthecommunity.Theliteratureemphasizesthesignificanceofviewingresidentialasaspecializedintervention,whichisindividualizedtotheneedsofeachyouthandhis/herfamily(Blauetal.,2014,p.223).KnowingWhentoUseResidentialasanInterventionMostoftenservicesandsupportsforyouthandtheirfamiliesarebestdeliveredintheirhomeandcommunity.However,undercertaincircumstances,whenbehaviorshavenotsuccessfully,orsafely,beenaddressedinthecommunity,aresidentialinterventionmaybeappropriate.Ifthatisthecase,itisessentialthattheresidentialinterventionincludeconsistentsupportforthefamily(birth,kinorfoster)intheirownhomeandcommunity.Thismustbetheresponsibilityoftheresidentialprogram,hopefullyinpartnershipwiththeircommunitypartners.Residentialinterventionsshouldbedesignedtoamelioratetheissues/challenges/problemsthatarepreventingtheyouthandfamilyfromsafelylivingtogetherintheircommunity.And,theseinterventionsshouldbedesignedtoachievepositiveoutcomesintheshortesttimepossible,andbeindividualizedtowhateachfamilyneedstoreturntheyouthhomesafely.Residentialprogramsmaybeoperatedbyprivateorpublicagenciesandoftenprovideanarrayofservices,includingtherapeuticandancillaryservicesforyouthandtheirfamilies.Acomprehensiveandculturallyappropriateassessmentwithaculturallyappropriatestandardizedtoolshouldbeusedtodeterminetheappropriatenessofaresidentialintervention.Commonlyusedtoolsinclude,butarenotlimitedto:theChildandAdolescentNeedsandStrengths(CANS),theMulti-DimensionalYouthAssessment(MDYA)360,ortheTreatmentOutcomePackage(TOP).Theseassessmenttoolsshouldbeusedtodetermineifthebehavioralissuesareindeedsoseverethattheyprohibitayoungpersonfromsafelylivinginthecommunitywithsupportsprovidedinthefamilysettingandthattherearenoalternativecommunity-basedoptions.Afamilyassessment,utilizingtoolssuchastheAmericanPsychiatricAssociation(APA)CulturalFormulationInterview(CFI),ortheFamilyAssessmentofNeedsandStrengths(FANS),shouldbeconductedsimultaneouslytodeterminethestrengthsandneedsofthefamily,theirracial,ethnic,andculturalidentities,primarylanguage,andanyhealth,mentalhealth,substanceuse,orcopingskillchallenges.Thisassessment,inconjunctionwiththeassessmentoftheyouth,shouldbeusedtodeterminetheuniqueneedsofthefamilyandyouth,andifaresidentialinterventionisaviablesolutiontomeetthoseneeds.Thesocio-culturalcontextoftheyouthandfamilyrepresentsanadditionalfactortoconsiderinthedeterminationofthepotentialutilityofaresidentialintervention.Reasonableeffortsguidedbyachildandfamilyteam1shouldhavebothformalandinformalsolutionstomeetthefamily’sneeds.Iftheseassessmentscannotbecompletedpriortoadmission,theyshouldbecompletedwithinthefirstfivedaysofplacementtodeterminethataresidentialinterventionisindeedindicated,andifitisnot,alternativecommunity-basedservicesshouldbesought.Thelackofappropriatecommunity-basedinterventions,includingfosterfamilies,shouldnotbethereasonresidentialprogramsareused.Giventherestrictiveness,andhighercostofresidentialprograms,thecourtsandthelegalcommunityshouldpressuretheplacingandoversightagenciestodevelopneededalternativestoresidentialprograms.

1Achildandfamilyteamconsistsofindividualswhoprovidebothformalandinformalsupportstoafamily(seechildandfamilyteamonpage9).Thisteamisdifferentthanthetreatmentteamalthoughsomemembersmayserveonboth.

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CriticalStepsThatJudgesandLegalPartnersNeedtoTakeAskQuestionsItisessentialthatthecourtsprovideongoingoversightandreviewwithrespecttodecisionstouse,orcontinuetouse,aresidentialintervention.Itisalsoimperativeforthecourtstodetermineifarangeoflessrestrictive,community-basedalternativeshasbeenevaluatedpriortoadecisiontousearesidentialintervention.Tohelpguidejudgesandlegalpartnersinmakingthesedecisions,thisguideprovidesanoverviewofwhenaresidentialinterventionisindicated,andwhattolookforindeterminingaqualityresidentialintervention.Includedineachsectionofthisguideisasetofkeyquestionsthatjudgescanasktodeterminetheneedforaresidentialinterventionandthequalityoftheprogram.Thesekeyquestionsshouldbeaskedoftheplacingagencyanytimeaninitialrecommendationforplacementisbeingconsideredforayouth.Additionally,thesequestionscanalsobeusedanytimeaplacementchangeisrequested,oraton-goingcourtreviewsoftheresidentialintervention,whentypically,thepublicagencyandresidentialstaffsarepresentalongwiththeyouthandfamilymembers.Judgeshaveanessentialroleinconveningmembersofthecommunityandengagingthemindiscussionsaroundthesequestions.Judgesshouldalsoconsiderdevelopingadditionalquestionsnotcoveredinthisguidethatmaybespecifictotheneedsoftheircommunities.Juvenilecourtjudgesarealsoinauniquepositiontoengagetheircommunitiesincriticaldiscussionsaroundthestateandfederalfundingnecessarytosupportthecriticalservicesforyouthandtheirfamiliesthatareidentifiedthroughoutthisguide.Conducton-goingReviewsOn-goingreviewsofresidentialinterventionsareessentialtodeterminewhethertheissuesthatoriginallyledtoarecommendationforaresidentialintervention(ayouth’semotionaland/orbehavioralchallengesinthecommunity,challengesthefamilyorothersupportnetworksareexperiencing,etc.)havebeensufficientlyrespondedto,therebymitigatingtheneedforcontinuedresidentialintervention.Iftheinitialplacementisnotthedesiredplacement,acasereviewshouldbescheduledwithinthefirstfivedaysoftheresidentialintervention.Whiletypicallycourtsreviewcasesonaquarterlyorsemiannualbasis,tomaintainasenseofurgency,itishighlyrecommendedthatresidentialinterventionsbereviewedevery30daysataminimum(evenstrivingforevery15daysifpossible),andthatfamilies,youth,andkeymembersofthecommunitysupportteambepresentatallreviews.Reviewsshouldaddressthefollowingissues:

1) feedbackfromthefamilyandyouthonwhethertheresidentialintervention,includingin-homesupportsduringtheresidentialintervention,havebeenhelpfulandculturallyappropriatetomeetthefamilies’needs

2) whattheyouthandfamilybelievewouldbehelpfultosupportsuccessfulreunification3) resultsanddetailsofpermanencyworkthathasbeencompletedifthereisnotanidentified

familyfortheyouthtoreturntoatthattime4) whatworkhasbeendonetosupporttheyouthtoengageinhomeandcommunityactivities,that

he/sheispassionateaboutortalentedin,duringtheresidentialintervention5) resultsofanddetailoftheworkthathasbeendonetosupportthefamilyinlearningskills,and

identifyingandsecuringresourcestosupportlivingsuccessfullywiththeirchild6) whatisbeingdonetosupportasuccessfultransitionbacktohomeandschool7) whathasresultedfromthecomprehensiveassessmentscompletedfortheyouthandfamily,

bothinitiallyandon-going,todetermineprogressandneedsovertime8) whattreatmentandsupportshavebeenidentifiedintheresidentialprogram,thehome,andthe

community,toaddressanyassessmentfindings9) whatsupportsandserviceshavebeenputintoplacefortheyouthandfamilyintheirhomeand

community;ifnone,orfew,why;andwhataretheresultsoftheseinterventions10) theroleofthesocio-culturalcontextthatpromotesorinterfereswithyouthandfamilyprogress

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FocusonPermanencyTheChildWelfareInformationGatewaydefinespermanencyas“alegallypermanent,nurturingfamilyforeverychild”andplanningforpermanencyas,“decisive,time-limited,goal-orientedactivitiestomaintainchildrenwithintheirfamiliesoforiginorplacethemwithotherpermanentfamilies.”Itfurtherstates,“theconceptofpermanencyisbasedoncertainvalues,includingtheprimacyoffamily,significanceofbiologicalfamiliesandtheimportanceofparent-childattachment.”Researchhasshownthatchildrengrowupbestinnurturing,stablefamilies.Whenyouthenduprequiringresidentialinterventions,itisimperativethatprofessionalsandadvocatesidentifywhatsupportisneededtomaintaintheyouthinasafe,permanenthomeasquicklyaspossible.Inmostcases,childrencanbereunitedwiththeirfamilies,butinsomecaseschildrenfindhomeswithrelativesoradoptivefamilies.Whenhelpingyouthandtheirfamiliesachievepermanency,professionalsmustbalanceanarrayofissues,includingtheneedsoftheyouthandtheirfamily,aswellaslegalrequirements(ACRC-ThirteenthinSeries,2015,p.2).Permanencyworkshouldbeanurgentandprimaryroleofeveryresidentialprogramforyouthwithnoidentifiedpermanencyresource.KeyActionItemsbyResidentialPrograms:• Conductin-depthyouthandfamilyassessmentstodetermineifaresidentialprogramisneeded

andwhatispreventingtheyouthfrombeinghelpedinafamilysetting• Haveastrongandpassionatecommitmenttoeveryyouthhavingapermanentfamily,this

includesolderyouthwhodeservepermanentfamilieswhentheyarenotabletoreturntotheirownfamilies

• Findfamilymemberswhenthereisnoidentifiedfamily:thisprocessshouldbeinitiatedbythepublicorprivateentity,bothworkingcollaboratively,utilizingFamilyFinding,FamilySearchandEngage,orotherPermanencyPracticetechniquestofindfamilymembers(orfictivekinwhoarenon-relatedpersonswhofunctionasfamilymembers)whocanbecomepermanentresourcesforyouth;thisprocessshouldbeginimmediatelyuponorevenpriortoadmission.Youthshouldbeaskedwhatadultsintheirlivesaremeaningfultothem,andtheresidentialprogramshouldbeencouragedtoapproachtheseadultsinsearchingforpermanencyfortheyouth

• Adoptasenseofurgencyincreatingpermanencyandinhelpingyouthreturntoafamilyinthecommunity-dischargeplanningshouldbeginatintakeandbediscussedateachtreatment/child&familyteammeeting

• Usetheresidentialinterventionforasshortatimeaspossibletoaddressthecriticalbehaviorspreventingtheyouthfromlivingsafelyinthecommunityandforanyfamilyneeds/issuestobesupportedandaddressed,andcontinuetoaskwhycontinuedresidentialinterventionisnecessary

• Assurethereareseveralpositiveadultconnections,withcaringindividualsand/orfamilymembers,foreveryyouth,andthateachyouthvoicesthattheseconnectionsarepositive.Theyouthshouldhaveopportunitiesthroughouttheresidentialinterventiontospendmeaningfultimewiththeseconnections

II. CriticalComponentsofSafe,QualityandEffectiveResidentialPrograms

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Engage,SupportandPartnerwithFamiliesImportanceofFamily-DrivenCareFortheresidentialinterventiontobesuccessful,familiesmustbeengagedinallaspectsoftheintervention,andresidentialstaffmustbecomefamiliarwiththeenvironmenttowhichtheyouthisreturning.Alltreatmentandsupportinterventionsusedinresidentialmustbeapplicabletothedailylivesoftheyouthandfamily,athomeandintheircommunity,andbebasedonrealworldapproaches.Afamilyisthemosteffectivestructureinwhichtoraiseayouthasthisiswheretheylearntrust,asenseofself-identity,cultureandtraditions,andhowtoloveandliveintheworld.Formany,familiesaretheprimarysourceofunconditionalloveandacceptanceandremainlongafterserviceprovidersaregone(ACRC,PositionPaper-SecondinSeries,pp.2-3).Whenfamiliesaregenuinelyinvolvedandrespected,outcomesimproveinschools,inmedicalcare,andinthesystemofcarethatserveschildrenwithmentalhealthchallenges(Obrochtaetal.,2011,pp.1-6).Residentialprogramshavestruggledinpastyearswithhowtoeffectivelyrespondtotheneedsoffamilies.Inthepast,programshavebeenyouthcentered,onlyseeingfamiliesascontributingtotheiryouth’schallenges,needingtreatmentthemselves,and/ortypicallyfocusingontheyouth’sresponsetohis/herparentsandsiblingsversushavingafamily-centricapproachtotreatmentandsupport(ACRC,PositionPaper-SecondinSeries,p.1).Familiesshouldhaveaprimarydecisionmakingroleinthecareoftheirownchildren,includingsettinggoalsandchoosingculturallyandlinguisticallyappropriatesupportsandservices(bothformalandinformal)(NationalFederationofFamilies,2008,para.1).Buildingempathyforfamiliesisanimportantpartofagenciesbecomingfamilyfocusedandsupportiveintheirwork.KeyActionItemsbyResidentialPrograms:• Putapriorityandurgentfocusonensuringthatyouthstayconnectedwithfamilyfromthe

firstdayofadmission–andthroughouteverydayoftheresidentialintervention;recognizethepowerfulconnectionbetweenayouthandtheirfamily;youthwhohavebeenseparatedfromtheirfamiliesoftenseekreconnectionwiththemuponexitingcare.ItisNOTbestpracticetorestrictyouthcontactwithfamilymembersforanyperiodoftime(i.e.firstthreedaysorweekpost-admission)unlessitiscourtorderedforaspecificfamilymember.Evenifonefamilymemberisnotallowedtobeincontactwithayouth,theresidentialprogramshouldputapriorityonkeepingtheyouthengagedwithmultipleotherfamilymembersthroughouttheresidentialintervention

• Engagethefamilyaspartnersbyprovidingtheopportunityforresidentialstafftoworktogetherwithparents,and/orprimarycaregivers.Usethefamilyexperienceandexpertisetoincreasestaffunderstandingoftheyouthwithinthecontextoftheirfamily.Providetherapy,coachingandencouragementstothefamilyintheirhomestobuildthenecessaryskillstosuccessfullyhavetheyouthreturnhome

KeyQuestionsfortheCourtstoAskAboutPermanency:1. Wereinitialyouthandfamilyassessmentsconductedandifsodidtheyindicatetherewereno

alternativecommunityservicesthatcouldsafelyandeffectivelymeettheyouth’sneedsotherthana residentialintervention?2. Wasadischargeplanestablishedatintakethatidentifiedtheanticipateddurationofthe

interventionandthefamilytowhomtheyouthwillreturn?3. Doesthedischargeplandemonstrateasenseofurgencyinreturningtheyouthtohomewithatimeline

ofideallylessthanthreemonths?4. Ifthereisnoidentifiedfamily,whowillberesponsibleforimmediatelyinitiatingafamilyfinding

searchandengagementprocess,andwhaturgentstepswillbetakentofindandengagethefamily?5. Haveanumberofpositiveadultconnectionsbeenmadefortheyouthearlyintheresidential

interventionandistheyouthallowedtospendmeaningfultimewiththeseconnectionsthroughout thedurationoftheintervention?6. Hastheyouthvoicedtheseadultconnectionstobeapositiveoneforhim/her?

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• CreateaChildandFamilyTeam(CFT)(whichhassimilaritieswithFamilyTeamConferencing(FTC)usedinchildwelfare)wheneveraresidentialinterventionisused.ThisCFTorFTCteamwillbringtogetherindividualswhoengagewiththeyouthandfamilytoassess,plan,anddeliverservicesthatwillguidethecourseoftheintervention

o TheCFTorFTCshouldconsistoftheyouthandfamilyandindividualswhoprovidebothformalandinformalsupportstoafamilyandtheyouth.Supportpersonsmayincludeindividualssuchas:publicagencyrepresentatives,includingthecaseworker;residentialprogramstaff;arepresentativefromtheyouth’stribeorotherculturallyrelevantentity;educationalprofessionals;extendedfamilymembers;friends;coaches;faith-basedconnections;aswellasothersidentifiedasimportantsupportsbytheyouthandfamily.Meetingsshouldbeconductedinthelanguageofpreferenceofthefamilyandatrainedfacilitatorshouldleadthediscussion.TheprimarypurposeofCFTandFTCmeetingsaretomakemeaningfulandthoughtfuldecisionsaboutayouthandafamily,tohelpthefamilyplanforthefuture.Theteamthatcomestogetherprovidesanallianceofsupportforthefamilyandfacilitatesthefamily’sparticipationindecision-makingregardingsafety,permanency,andwellbeingfortheirchildren.Thisprocessismeanttobesolution-focusedandshoulddrawonafamily’shistoryofsolvingproblems,determinetimeswhenthefamilyiscurrentlyabletosolvetheproblem,anddevelopthefamily’svisionfortheirfuture.Childandfamilyteamsdrivethecaseplanningprocessandensurestrengths-basedandsolution-focusedplancontentthat,uponimplementation,facilitatesthefamily’sstabilityandultimatesafedisengagementfromthepublicagency’sinvolvement.

• EnsurethatacomprehensivetreatmentplanisdevelopedbytheCFT/FTCwithinthefirstsevendaysoftheresidentialintervention

• Giveparentstheprimarydecision-makingpowerfortheiryouthandassuretheirstrengthsarerecognizedandvalued.Forolderyouth,supportthefamilyandyouthinsharingthedecision-making

process

Referencedinactionitemsabove:(ACRC,PositionPaper-SecondinSeries,pp.2-4;Blauetal.,2014,pp.15-30)(ChildandFamilyTeamMeetingsNevadaCasePlanningandAssessmentPolicies,p.6)(NorthCarolinaDepartmentofHealthandHumanServices,pp.1-2)StrategiesforEngagingFamiliesFamilyengagementisacriticalgoalforanyorganizationthatworkswithyouth,andthecourtsshouldcloselyevaluateresidentialprogramstoensuretheyarefocusedonengagingfamilies.EngagingandsupportingfamiliesisatthecoreoftheStrengtheningFamiliesapproachtheAnnieE.CaseyFoundationhasembraced(NationalHumanServicesAssembly,FamilyStrengtheningPolicyCenter,2004,p.3).Priortocomingtotheresidentialintervention,familiesmayhavehadanumberofpreviousexperiencesinthesystemwithjudges,probationofficers,childwelfareagencies,mentalhealthworkersorotherresidentialprograms,andnotallmayhavebeenpositive.Thisconcernisofparticularrelevanceforfamiliesfromhistoricallyunderrepresentedandmarginalizedpopulationgroups.Theresidentialprogramneedstoreachoutandshowrespectforfamilies,acknowledgethepotentialcross-culturaltensions,buildanalliancewiththeyouthandfamily,andfocusontheirindividualconcerns.Theprogramalsoneedstodevelopfamilyfriendlypolicies,procedures,andpractices.Thisfocusmustbeonthestrengthsofthefamilyandatthesametimeincorporateempathyandavisionofhope(Blauetal.,2014,pp.39-40).KeyActionItemsbyResidentialPrograms:• Askfamiliesabouttheirgoals,whattheythink,whattheirhopesareforthefuture,what’salready

beentried,whatworkedordidn’twork,andwhy,andcontinuetoaskthesequestionsovertimesoresponsescanbecapturedinongoingassessmentsandintegratedintoon-goingtreatmentplanning

• Treatparents/familymembersasequalpartnersandplanforthemtobeinvolvedinallaspectsoftheyouth’streatmentandsupport,whichshouldbeprovidedinthefamily’shomeandcommunity.Programstaffwillneedtosensitivelyexplorewithparents/familymembershowtheyview

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professionals.Havingprofessionalsviewfamiliesasequalpartnersmaybeanewperspectivethatsomefamilieshavenotyetencountered;itisimportanttoevaluateafamily'sexpectationoftheirowninvolvementandworkgently,withencouragementandpersistence,tosupportfamiliesingainingthestrength,supportsandskillstheyneedtosupporttheirchild

• Providetreatmentandsupportinthefamily’shomeandcommunityandensurelanguage accessforfamilieswhohavelimitedEnglishproficiency(LEP)andforfamilieswithlimitedliteracy

• Keepfamiliesinformedaboutandinvolvedwitheverythingthathappensaroundtheyouth’scareto enablethemtomakeinformeddecisions

• Askthefamiliesaboutimportantculturalfactorsthatshouldbeaddressedduringtheyouth’sstayandinquireabouttheircomfortlevelwiththeresidentialprogramrelatedtotheirculturalidentity

• Trainandsupportallstaffinengagingfamilies,usingbestpracticeandculturallyand linguisticallyappropriateengagementapproachesandfamilyfriendlylanguage

• Usereflectivesupervisionandcoachingtohelpstafflearntheseskillsandidentify/addressbias• Assureyouthareabletospendtimeathome(thisisnotaprivilegeorrestrictedforany

behavioralissues),beginningfromthefirstdayofplacement,withappropriatesupportsfromthe residentialprogramstaffasneeded

• Usefamilypartners(a.k.a.peersupports,parentpartners,parentorfamilyadvocates,familyliaisons,etc.)tosupport,guide,engageandempowerfamilies

• Provideopportunitiestoinvolvefamiliesinthehiringprocessofnewstaffandusethemforfeedbackduringtheperformanceevaluationsofstaff

• Maintainaculturallydiverseworkforcetoassistwiththebuildingoftrust• Reviewagencypolicies,procedures,andculturetoevaluatethenecessityandefficacyofagency

practicesspecifictosuccessfullyengagingandpartneringwithfamilies• Ensurethatgrievanceproceduresaresimpleandwelladvertised.Familiesshouldbeinformed

atintakethattheyhavetherighttomakeformalcomplaintsshouldtheyeverdesiretodoso.Inaddition,proceduresshouldbestraightforwardandeasytocompleteregardlessofafamilymember'sfirstlanguageorliteracylevel.Havingmultiplemethodsforcollectingcomplaintsgivesfamiliesthechoiceinwhatapproachismostmeaningfulandappropriateforthem.Somemethodsincludefillingoutasimplepaperdocument,completingasimpleformviaemail,orspeakingviaphoneorinpersonwithaspecificworker

Referencedinactionitemsabove:(BBI:FindingandEngagingFamiliesforYouthReceivingResidentialInterventions,andStrategiesforProviders;Blau,et.al.2014,p.26)

KeyQuestionsfortheCourtstoAskAboutInvolvingFamilies:

1. Isatleastoneidentifiedfamilymembercurrentlyengagedintheyouth’scare,activelyparticipatingintreatmentplanningwithdecisionmakingpower,andspendingtimewiththeyouthintheirhome?

2. Ifnofamilymemberisengaged,whatstepswillbeusedtoengagethefamilyandsupporttheyouthtospendtimewiththeirfamilyatleastweeklyintheirhome/community?

3. HasaChildandFamilyTeamorFamilyTeamConferencingbeencreatedtohelpguidethecourseoftreatmentduringtheresidentialinterventionandwasacomprehensiveplandevelopedwithinthefirst7days?

4. Isfamilytreatmentandsupportoccurringinthefamily’shome,howoftendoesitoccur,whatapproachisbeingused?

5. Arefamiliesbeinginformedandactivelyengagedwitheverythingthathappensaroundtheyouth’scaretoenablethemtomakeinformeddecisions?

6. Istheprogressoftheyouthandfamilyregularlyreviewed,andistheplanchangedifprogressisnotoccurring?

7. Havefamilypartnersbeenmadeavailabletoengage,guide,supportandhelpempowerthefamilyandyouth?

8. Haverelevantculturalandcross-culturalissuesbeenidentifiedandaddressedwiththefamily?

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Engage,SupportandEmpowerYouthAyouthguidedinterventionmeans“thatyoungpeoplehavetherighttobeempowered,educated,andgivenadecisionmakingroleinthecareoftheirownlivesaswellasthepoliciesandproceduresgoverningcareforallyouthinthecommunity,stateandnation.Thisincludesgivingyoungpeopleasustainablevoiceandthenlisteningtothatvoice.Youthguidedorganizationscreatesafeenvironmentsthatenableyoungpeopletogainselfsustainabilityinaccordancewiththeculturesandbeliefswithwhichtheyidentify.Further,ayouthguidedapproachrecognizesthatthereisacontinuumofpowerthatshouldbesharedwithyoungpeoplebasedontheirunderstandingandmaturityinastrengthbasedchangeprocess.Youthguidedorganizationsrecognizethatthisprocessshouldbefunandworthwhile”(YouthMoveNational,2016,para.3).KeyActionItemsbyResidentialPrograms:• Supportstrongyouthvoiceandinputintoestablishingyouthtreatmentgoalsandeducational

plans,aswellasanyindividualizedplanthatisspecificallydesignedtohelpandsupportthem.Allpracticeswithintheresidentialprogramshouldfocusonindividualizedandstrengths-basedapproaches,versusstandardizedapproaches(e.g.asetofprogramrulesthatarethesameforallyouthintheprogram;pointsandlevelsystems;thesamebehaviormanagementapproachesforallyouth,etc.).Assureyouthinputiscontinuallygatheredovertimeandisusedtodevelopprograming,includingactivitiesintheirhomecommunities,andtoaddressanyyouthconcerns

• Provideyouthwithopportunitiestoconnectandinteractwitharangeofsupportivepeoplewhomtheyhaveidentified(e.g.friends/pro-socialpeers;extendedfamilymembers;favoritecoachesorteachersfromtheirhomecommunity)throughouttheirresidentialintervention,especiallyinpositivesettingsintheirhomecommunities

• Assureopportunitiestoparticipateintheoperationoftheresidentialprogramareprovidedtoyouth.Examplesofhowtoaccomplishthisinclude:formingameaningfulyouthadvisorycommittee;beingpartofanexternaladvocacygroup;participatinginthestaffhiringprocess;participatinginstafforientationandtrainingprograms;reviewingagencypoliciesandproceduresincludingintakeprocesses,qualityassurancereviews,etc.

• Useyouthadvocates,whoarepaidindividuals,typicallybetween18and25yearsofagewhodrawupontheirownexperiencestobringadifferentperspectiveaboutbeinginasimilartypeofsetting,andtoperformactivities(e.g.participatingintheintakeprocesses,facilitatingconversationsbetweenyouthandstaff,preparingyouthforimportantmeetings,assistinginthedevelopmentofactivitiesandcommunityoutreach,providingsupporttoayouthpost-discharge,havinginputintoagencydecisions/practices,andpromotingyouthempowerment)

• Promoteyouthempowermentbyprovidingappropriatedevelopmentalfreedom,trainingandsupporttoyouth,allowingthemtolearnfromtheirownmistakes,andencouragingthemtovaluetheirstrengths

• Includefamiliesnotonlywiththetreatmentplan,butwithactivitiestheiryouthmaybeinvolvedinduringtheresidentialintervention

• Supportyouthinexploringtheirculturalidentitiesandenhancingpositivecross-culturalinteraction.Developmentally,youtharetryingtounderstandtheiridentities,includinghowtheyidentifyracially,ethnically,sexually,religiously,etc.Forsome,theirmentalhealthandbehavioralchallengescouldbeexacerbatedbyconcernsregardingtheirculturalidentity.Thisisincreasinglytruewhenayouth'sfamilyand/orcommunityisnotaffirmingofoneormoreaspectsoftheyouth'sculturalidentity.Staffshouldbetrainedinhowtoidentifyredflagswhenthesesituationsoccurandensurethatprovidersarecompetentinaddressinghealthyculturalidentityformationinyouth

• Valueyouthcontributionsbysharingthepowertomakedecisionswithyouth,respectingtheirjudgment,andrecognizingandunderstandingwhattheyouthhastooffer

Referencedinactionitemsabove:(Blauetal.,2014,pp.34-44)

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1. ProvideCulturallyandLinguisticallyCompetentServicesProvidingculturallyandlinguisticallycompetent(CLC)servicesiscriticaltoachievepositiveoutcomesforyouthandfamilieswhoreceivearesidentialintervention(BBIGuide:CulturalandLinguisticCompetence,p.6).AstheU.S.populationcontinuestogrowinculturaldiversity,especiallyamongchildren,residentialprogramscanexpecttoexperienceabroadrangeofcultures.Therehasalsobeenanotableincreaseinthedisproportionalityofyouthofcolorplacedinresidentialprograms.Culturaldiversityincludesavarietyoffactorsincludingaperson’srace,ethnicity,nationalorigin,socioeconomicclass,sexualorientation,genderidentity,genderexpression,faithcommunity,primarylanguage,uniquefamilycultureandgeographicalcommunity(Blauetal.,2014,p.61).Culturalcompetence,“requiresaclearlydefined,congruentsetofvaluesandprinciples,and(to)demonstratebehavior,attitudes,policies,structures,andpracticethatenable[providers]toworkeffectivelycross-culturally”(NCCCwebsiteadaptedfromCross,Bazron,Dennis&Isaacs,1989,para.2).Attheindividuallevel,culturalcompetencerequiresthattheindividualacknowledgeculturaldifferences,understandhis/herownculture,engageinself-assessment,acquireculturalknowledgeandviewbehaviorwithinaculturalcontext.Attheorganizationallevel,itrequiresthattheorganizationvaluediversity,conductself-assessment,managethedynamicsofdifference,institutionalizeculturalknowledgeandadapttodiversity(Cross,Bazron,Dennis,&Isaacs,1989).“Linguisticcompetenceisthecapacityofanorganizationanditspersonneltocommunicateeffectively,andconveyinformationinamannerthatiseasilyunderstoodbydiverseaudiencesincludingpersonsoflimitedEnglishproficiency,thosewhohavelowliteracyskillsorarenotliterate,individualswithdisabilities,andthosewhoaredeaforhardofhearing”(Goode,2010,p.21).Eachoftheseculturalandlinguisticfactorscaninfluenceayouthandfamilies’attitudesandbehaviorsintheirinteractionswithresidentialstaffandpeers.Aculturallyandlinguisticallycompetentprogramcreatesanorganizationalculturethatacknowledgesandtakesintoaccounttheculturalvalues,norms,practices,worldview,traditions,routines,andperspectivesofyouth,familiesandstaff.Itcreatesaninfrastructuretofacilitateeffectivecross-culturalpracticethatbecomesvisibleinmissionstatements,policiesandprocedures,organizationalstructures,programmaticpractices,staffbehaviorandattitudes.KeyActionItemsbyResidentialPrograms:• Ensurethepresenceofadiverse,preparedandculturallyandlinguisticallycompetent

workforceatalllevelsofanorganization.Thediversityshouldreflecttheculturaldiversityofyouthandfamiliesbeingserved.Staffshouldrecognizeandunderstandtheuniqueoperationalfamilycultureofeachfamilyservedwithinthecontextoflargersocio-culturalcontexts

KeyQuestionsfortheCourtstoAskAboutInvolvingYouth:1. Doyouth(duringtheresidentialintervention)haveanactiveroleinestablishingtheirtreatment

goals,educationalplans,andcontinuingtoengageinactivitiesthatmatchtheirindividualstrengthsandtalentsintheirhomecommunities?

2. Duringtheresidentialinterventiondoyouthhaveopportunitiestogivemeaningfulinputintoprogrampractices,andbuildtheirsenseofempowermentanddecisionmakingskills?

3. Areyouthallowedtoattendpublicschoolwhenappropriate,aswellasspendtimeinthecommunity(preferablytheyouth'shomecommunity)developingprosocialpeersthroughpositiveactivitiesandevents?

4. Areyouthencouragedtoexploretheirculturalidentitiestowardsapositivesenseofselfandpro-socialapproachestocross-culturaltensions?

5. Areyouthadvocatesmadeavailabletoengage,guide,support,andhelpempowertheyouthintheprogram?

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• Createlivingenvironmentsthatreflectdiversityinthedifferentcultures,ethnicities,sexualorientations,andgenderidentitiesoftheyouthandfamiliesservedaswellasthegreatercommunityatlarge.Thiscanbeaccomplishedthroughprovidingavarietyoffoodsservedatmeals,decorations,magazines,brochures,andpostersthatreflectthevariousculturesoftheyouthandfamilyserved.Inaddition,arrangementsforsafe,all-genderbathrooms,showers,andsleepingroomsshouldbeprovidedforyouthforwhoidentifyastransgenderorgender-nonconforming

• Respondtothespiritualityandvariousreligioustraditionsoftheyouthbyofferingthemopportunitiestoengageintheirreligiouspractices,preferablyintheirhomecommunity.Agenciesneedtoaccommodateforreligiousholidaysanddietaryrequirements,aswellasprovideappropriatespaceforprayer,meditation,andotherspiritualpractices.Theprogramshoulddowhateverittakestoensurethatallreligiousholidaysarecelebratedathomewithfamilyoraccordingtothefamilywishes

• Reviewpoliciesandproceduresannually,andmissionandvisionstatementseverythreeyears,toensuretheyincorporatetheprinciplesofculturalandlinguisticcompetencyandarefamilyfriendly

• Challengeandsupportstafftoaddresstheirconsciousandunconsciousbiases,stereotypes,andprejudicestolimittheimpactofbiasinservicedelivery.Agenciescanincorporatebiastestinginstaffself-evaluationproceduresinanon-punitivemannertoencourageprofessionalgrowtharoundpersonalbiases.Inaddition,trainingsandworkshopsthatinvolveparticipantself-reflectionofstereotypesandprejudicescanbeincludedasmandatorystaffdevelopment

• Keepyouthandfamiliesemotionallyandphysicallysaferegardlessoftheirculturalidentity.Programsneedtoprovidestaffguidanceonhowtoaddressbias,stereotypes,andprejudicesexpressedbyyouthandfamilies

• Engageandeducatetheleadershipandboardsofdirectorsandensurethatorganizationalgovernanceembracesandsupportsculturalandlinguisticcompetence

Referencedinactionitemsabove:(Blauetal.,2014,pp.61-77)

ProvideTrauma-InformedCareTheword“trauma”isoftenusedtorefertoaneventthatisperceivedasscary,dangerous,orviolent,andthatcanhappentoanyone.Aneventcanbetraumaticwhenwefaceorwitnessanimmediatethreattoourselvesortoalovedone,oftenfollowedbyseriousinjuryorharm.Thisdangercancomefromoutsideofthefamily(e.g.anaturaldisaster,caraccident,schoolshooting,orcommunityviolence)orfromwithinthefamily(e.g.aseriousinjury,domesticviolence,physicalorsexualabuse,ortheunexpecteddeathofalovedone)(NationalChildTraumaticStressNetwork,2016,p.1).Exposuretotraumaticexperiencescanhaveadramaticimpactonmentalhealth,physicalhealth,interpersonalrelationships,andevenlifeexpectancy.Residentialprogramsthataretrauma-informedrecognizethewidespreadimpactoftrauma

KeyQuestionsfortheCourtstoAskAboutCulturalandLinguisticCompetence:1. Howareanyissuesofbias,prejudiceorstereotypesaddressedtoensuretheydonotinhibitthe

necessarytherapeuticworkwithyouthandfamilies?2. Istheresidentialprogramabletomeetthelinguisticneedsofalloftheyouthandfamilieseither

directlyorthroughinterpreterservicesthattheyouthandfamilyfindhelpful?3. Doestheresidentialprogram’sworkforcereflectthediversityofyouthbeingreferredfortreatment

atalllevelsoftheorganization?4. Doyouthhavetheopportunitytoengageinreligiouspracticesrepresentativeoftheirfaithorbeliefs

intheirhomecommunitieswithouthavingtomeetprogrammaticrequirements(otherthanpossiblyararesituationofsafety)toattend?

5. Doallresidentialprogramstaff,boardmembersandexecutiveleadershipreceivetraining,supervision,andmentoringspecificallytoimprovetheirculturalandlinguisticcompetence?

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onyouth,staff,andfamilymembersandhavedevelopedtheknowledgeandunderstandingforpotentialpathsofhealingwhileintegratingthisknowledgeintotheirenvironments,policies,practices,andtrainingoftheworkforce(Blauetal.,2014,pp.78-91).KeyActionItemsbyResidentialPrograms:• Conducttraumaassessmentsforbothyouthandfamiliesasastandardpartoftheadmissions

processsinceamajorityofyouthcomingintoaresidentialinterventionhaveexperiencedsomeformoftraumaintheirlives.Includeinquiryabouttraumathatislinkedtoculturalidentity,suchashistoricaltraumaorbullyingrelatedtosexualorientation,orgenderidentity

• Assuremedicalcareforallyouthisprovided,andcontinuesinacoordinatedfashionwiththeircommunityhealthcareproviders,recognizingthatyouthoftenhaveuniquehealthneedsexacerbatedbytraumaandlackofconsistenthealthcare.Itispreferredthatallmedicalcareoccurwithprovidersintheyouth’shomecommunity,andwithwhomthefamilyalreadyhasarelationship,ortheprogramshouldworkwiththefamilytoestablishrelationshipswithneededmedicalprofessionalswhotheywillcontinuetoseepost-residentialservices

• Trainallstafftoachieveacommonunderstandingoftrauma,theneurosciencebehindtrauma,andtheimpacttraumahasontheyouththeyservesotheycanbetterunderstandthatmanybehaviorsthatyouthdisplaycanberelatedtothetraumaticexperiencesofyouth

• Adoptacultureandlanguageofcollaborationandempowerment,notaculturewherestaffviewthemselvesasagentsofcontrol.Atrauma-informedmindsetassumesthat“undesirablebehavior”isaresultofunmetneedsandthatthereis“nosuchthingasabadchild.”Staffshouldunderstandthatyoutharedoingthebesttheycan;andiftheyarenotdoingwell,thereisareasonrelatedtohowwelltheyareabletothinkaboutandprocesstheirimmediatecircumstances.Anagencyshouldadaptthevalueofunconditionalcarearoundprovidingforunmetneeds

• Createtrauma-informedenvironmentsthatfosterhealing,minimizeunitdisruptions,provideopportunitiesforpassivesupervision,allowforprivacyanddignity,provideoff-unittherapyspacesandofferaccesstotheoutdoors.Ensurestaffknowandunderstandyouthtriggersandwarningsigns,andsupporttheminfindingstrategiestorelaxandstaycalm

• Diligentlypursuetheuseofestablishedbestpracticestosupporttheneedsofyouthandfamilies.Itisimportanttonotethatmostevidence-basedtreatmentmodelsweredevelopedforutilizationinthecommunity;thesetreatmentmodalitiesideallyshouldoccurinthefamily’shomesandthecommunityratherthanintheresidentialprogram.Residentialisaninterventionwithoutanevidencebaseandcomparativedataandsustainedpositiveoutcomesarelimited

Referencedinactionitemsabove:(Blauetal.,2014,p.83-91;ACRC,PositionPaper-EighthinSeries,2010,p.3)

LinkResidentialProgrammingwiththeHomeCommunitiesoftheYouthandFamiliesResidentialinterventionsarecriticalcomponentsoflocalcoordinatedsystemsofcareforchildrenandfamilies(ACRC,PositionPaper-FirstinSeries,2005,p.1)andneedtoinvolvefamiliesandcommunityasnonnegotiablepartnersforlong-termsuccess.Topreserveallfamilyandpro-socialcommunity

KeyQuestionsfortheCourtstoAskAboutTrauma-InformedCareEnvironments:

1. Howhastheresidentialprogramadoptedatraumainformedapproachtocare?2. Havetraumaassessmentsbeenconductedwiththeyouthandfamily,andsharedwiththeresidential

programstaffworkingdirectlywiththeyouthandfamily?3. Isthestafftrainedintrauma-informedcareanddotheyhavewrittenplansavailabletothemonhow

toengageandinteractwitheachindividualyouthandfamily?4. Hastheresidentialprogramaddressedtheemotionalandmedicalneedsofyouthintheirhome

communities,maintainingfamily-identifiedmentalhealthandmedicalprofessionalsandsupports?

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connections,residentialinterventionsshouldbeofferedatalocationasneartoayouth’shomeaspossible.Thisallowsfamilyconnectionsandinteractionstobemaintainedwhileallowingtheyouthtoremainconnectedtopeersandactivitiesinthecommunityastheyandtheirfamilymembersareacquiringnewskillstosuccessfullyreunite.Thisalsoallowstheyouthtospendtimewithfamilymembersmultipletimesperweek,andforstafftoworkwithfamiliesintheirhomesandcommunities,whicharepracticesthatcorrelatewithpositiveoutcomespost-residentialdischarge.Evenwhentheresidentialprogramisnotclosetohome(i.e.furtherthanonetooneandahalfhoursaway),connectionswithanumberoffamilymemberswhoareimportanttothechild,inadditiontotheprimarycaregiver(e.g.grandparents;siblings;cousins;aunts)canbemaintainedthroughtheuseoftechnologyandfrequentin-personcontact(theidealbeingdailyormultipletimesdailyformostyouth).Thereisnoevidencethatplacingchildrenfarawayfromhome(i.e.morethanoneandahalfhoursaway)iscorrelatedwithsuccessfullong-termoutcomes.Infact,toachievesuccessfullong-termoutcomesincreasedtimeworkingwiththefamiliesintheirhomesandcommunitiesisnecessary(Blauetal.,2014,p.96).KeyActionItemsbyResidentialPrograms:• Usearangeofpracticestosupportreunificationthatincludefrequentandvariousformsof

communicationbetweenyouthandfamilymembersdaily• Ensureyouthspendmeaningfultimeathomeand/orintheirhomecommunityatleastonce

weekly(preferablymorethanonce),andstaffarerequiredtobeworkingwithfamiliesintheirhomesandcommunities;thisincludeshavingplanningmeetingsinthefamily’shomeorcommunity,ratherthanintheresidentialprogram

• Ensureayouthisplacednomorethanonetooneandahalfhoursfromtheirhome(ideallycloser)andthatregularinteractionsoccurwiththefamilyintheirhomeandcommunityandthatstaffhelpfamiliestocoordinatetransportationandvisitationlogistics

• Maintaindailycontactwhenthereisavalidreasontoserveyouthfurtherthanoneandahalfhoursfromtheirhomeandcommunity,andkeeptheresidentialinterventiontoasshortaperiodoftimeaspossible,generallylessthanthreemonths

• Workwithfamily’slocalcommunitiestofacilitatetheuseofchildandfamilyteamswiththeactiveparticipationofnaturalsupports(inclusiveofculturallyrelatedsupports),allowforeducationalrelationshipstobemaintained,andforaftercareservicestobeprovidedby,orcoordinatedthrough,theresidentialprogram

PreventSeclusionandRestraintCreatingenvironmentsinresidentialprogramsthataretrauma-informed,andinwhichthereislittleornocoercion,cangoalongwaytowardpreventingaggressionandviolenceandreducingseclusionandrestraints(S/R)toimproveoutcomesforyouth.Residentialprogramsshouldestablishpoliciesandphilosophiesthatpreventtheuseofseclusionandrestraintsorothercoerciveinterventions,aswellastrainstaffininterpersonalapproachesasalternativestoputtinghandsonyouth.Theremaybetimeswhenayouthlosescontrol,orbehaveswithsevereaggression,andinthosemoments,staffmustdecidewhetherputtinghandson,orsecludingayouth,isabsolutelynecessarytomaintainsafety.Trainingand

KeyQuestionsfortheCourtstoAskAboutLinkingResidentialwithCommunity:1. Howfarfromtheyouth’shomeandcommunityistheresidentialprogramlocated(theidealisless

thanonetooneandahalfhoursaway,preferablyevencloser)andwhywasitselected?2. Arethereopportunitiesforyouthtohavedailycontactwiththeirfamily,andtimeathomeatleast

onceperweek,preferablymoreoften?3. Ifdailycontactandweeklytimeathomeisnotoccurring,whatisbeingdonetoensurethiswillhappen

inthenearfuture(i.e.withinthenexttwoweeks)?4. Forfamilieswithfinancialchallenges,hassupportbeenprovidedsothattheirchildcanspendtimeat

homeonaweeklybasisataminimum?

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closesupervisionofstaffintheuseofneurobiologically-informed,trauma-sensitiveapproachesthatidentifyearlywarningsignsandtriggers,andsupportyouthinself-regulationpriortoescalationofbehaviors,isparamount.Emphasisonthesepreventiveapproachesiskeyforprogramsinsignificantlyreducing,andeveneliminating,theuseofseclusionandrestraint.Thereisevidencethattheuseofseclusionandrestraintmayrepeatearliertraumaticexperiencesofhelplessness,andtherebyperpetuateacycleofre-traumatizationforyouth.TheSixCoreStrategies©developedwithsupportfromtheSubstanceAbuseandMentalHealthServicesAdministrationisanevidence-basedresourcetohelpprogramspreventseclusionsandrestraints(ACRC,PositionPaper-TenthinSeries,April2013,pp.2-3).KeyActionItemsbyResidentialPrograms:• Articulateleadership’svision,valuesandprogramexpectationsonS/R,definingwhatis

acceptableandwhatisnotandmodelingthesevalueswithallstaff,youthandfamilies• CollectdataonS/Rincidentsbylivingunit,timeofday,andstaffmember.Thisinformationmustbe

collectedandusedinanon-punitivemannertoestablishbaselinesofuse,setperformanceimprovementgoals,andcontinuallymonitortoinformandimprovepractice.Ensurethatdataarecollectedonyouthfeedbackaboutwhatcouldhavepreventedseclusion/restraint

• Createenvironmentsgroundedwithknowledgeoftraumaincludingitsbiological,neurological,social,andpsychologicaleffects.Agenciesshouldalsogaintheabilitytorecognizethattheseissuesmayalsobepresentinthefamiliesandthestaffthatservetheyouth

o Recognizingthatstaffcanthemselvesbeimpactedbytrauma;createon-goingstrategiestotrain,superviseandsupportthemintheirworkwithyouth

• RecognizesignsofdistressinyouthtohelpreducetheuseofS/Rthroughtheuseoftraumaassessments,detectionofearlywarningsigns,andthedevelopmentofcalming/soothingplansandotherstrategiestohelpyouthself-regulate.Includeknowledgeofculturallyinfluencedsignsofandtriggersofdistress

• UsedebriefingtechniquesaftereveryS/Randincorporatetheknowledgegainedthroughthedebriefingtoinformimprovementsinpractice,policiesandprocedures

• Useacrisismanagementtrainingprogramthatembracesprinciplesoftrauma-informedcare,restraintreductionandelimination,andusingrestraintsasalastresort

Referencedinactionitemsabove:(Blauetal.,2014,pp.113-120)

KeyQuestionsfortheCourtstoAskAboutSeclusionandRestraint(S/R):1. Hastheyoutheverbeensubjectedtoanyphysical,mechanicalorchemicalrestraints?2. HowfrequentlydoS/Roccurintheresidentialprogramandwhatculturallyinformedstepshavethe

programstafftakentopreventandreduceseclusionandrestraint?3. Isthestafftrainedinrecognizingsignsofdistressinyouth,employingtraumatechniquesandthe

preventionandsafeuseofS/R?4. AreallS/Rincidentscomprehensivelydebriefedandalternativesexploredbetweenthestaffinvolved

andtheirsupervisor?5. IsdataonS/Rcollected,analyzedandreviewedbyresidentialprogramleadership,andarethese

findingsusedtoimprovepracticeandoutcomes?

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WorkwithYouthinTransitiontoAdulthoodYouthapproachingtheageoflegaladulthoodfrequentlydonothavesupportsystemsinplacetoallowforasmoothtransitiontoindependencebyage18,andoftenfindthemselvesontheir18thbirthdaylivingontheirown.Residentialprogramscanplayakeyroleinhelpingolderyouthtransitiontoadulthood.Thistransitionisacontinuousprocessofrapidpsychologicalchangethatbeginsacceleratingaroundage16andcancontinueuntilthelate20’s.Thispsychologicaldevelopmentencompassestheareasofcognition(thinking),moralreasoning,socialcognition,sexualorientation,genderidentity,andculturalidentityformation.Whilefamiliestypicallyplayaverycriticalroleinthistransition,somefamiliesfacesignificantchallenges,includingaddiction,poverty,incarcerationand/orintergenerationalmentalhealthchallengeslimitingtheirabilitytoassistwiththistransition.Residentialstaffmustbecomeexpertsinsupportingandpromotingfamilyconnectionswhileatthesametimesupportingtheyouthintheirgrowingindependence(Blauetal.,2014,pp.126-130).KeyActionItemsbyResidentialPrograms:• Supportyouthindeterminingwhomtheyconsiderfamilyandwhatsupportive,safe,andcaring

relationshipslooklike.Everyyouthtransitioningtoindependenceshouldbeconnectedtoatleastone,andpreferablymany,caringadultswhocanprovidesupport

• Teachyouththenecessaryskillstosuccessfullyliveontheirowninthecommunityaswellasfacilitatewellnessroutinesforthemthatcanbeadaptedtotheirlivinginthecommunity.Includestrategiestoconfrontbiasandstereotypesdirectedatthembybothmembersofthepublicingeneralandalsopersonsinrolesofauthority

• Ensureanyjuvenilerecordsaresealed,thosethattheyouthmighthavehadfromthejuvenilejusticesystem

• Usepeermentorstoteachandmodelskillsandoffersupporttotheyouthbothduringandafterdischarge

• Connecttransitioningageyouthtocommunityresourcesthatwillbeneededduringtheresidentialintervention,includingsubstanceabusecounseling,educationalorvocationalservices,physicalhealthproviders,andmentalhealthsupportsandservices

• Assureyouthdonotenduphomelesswhentheytransitiontoindependentlivingbyprovidingstablehousingandsupportspriortodischarge,especiallyincommunitieswherehousingoptionsarelimited

EngageintheInformedUseofPsychotropicMedicationsThepossibilitythatpsychotropicmedicationsmaybeoverprescribedorinappropriatelyprescribedforyouthhasraisedsignificantconcernsacrossthecountryduetotherelativelackofinformationorstudiesontheiruseinyouth(Blauetal.,2014,p.142).AccordingtoACRC,itisimportanttohaveamindsetof“notexpectingpsychotropicmedicationsto‘cure’thecomplexconditionsofchildrenseeninresidentialsettings”butratheronethatprovides“arealisticunderstandingoftheextenttowhichpsychotropicmedicationscanbeexpectedtoreliablyinfluenceyouthoutcomes”(ACRC,PositionPaper-Eleventhin

KeyQuestionsfortheCourtstoAskAboutYouthinTransition:1. Hasastrongconnectionbeenestablishedtoatleastone,andpreferablymany,positive,supportive,

caringandstableadults,whomtheyouthapprovesofandwelcomes?2. Hastheyouthbeentaughtthenecessaryskills(practicinginthecommunityandnotrelyingon

programgroupsorworkbooks)tolivesuccessfullyontheirowninthecommunity?3. Doesayouthtransitioningtoindependencehaveastableplacetolive?4. Haveappropriateeducational/vocationalservices,physicalhealthproviders,substanceusetreatment

andmentalhealthsupportsbeenestablishedpriortodischarge?5. Haveanyjuvenilerecordstheyouthhadfromthejuvenilejusticesystembeensealed?

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Series,January2014,p.2).Medicationdecisionsneedtoincludeanalysisoftheethnopharmacologicalindicatorsthatinfluencethechoiceofmedicationandtheappropriatedosingdecisions(Jackson,M.,1999).

KeyActionItemsbyResidentialPrograms:• Conductanassessmentanddiagnosistoselectmedicationinterventionsthatisbasedonany

priortreatmentattempts,hasinputfromtheyouthandfamily,anddeterminesiftheyouth’ssituationatadmissiondiffersfromwhatisreportedintheclinicalrecord

• Ensuretheprescribingpsychiatristweighsthepotentialbenefitsandrisksofanymedicationclass,dosage,andpolypharmacy(includingethnopsychopharmacologicalimplications)allofwhichcanincreasethelikelihoodofundesirablesideeffects

• Obtaininformedconsentfromallappropriatepartiesandensureitcontainsinformationonbothwhatisknownandunknownaboutanymedicationsprescribed.Consentshouldbegatheredinaculturallyappropriatemannerassomeculturesviewdisagreeingwithprofessionalsasdisrespectful.Culturalbrokersmaybeneededduringtheconsentprocesstoensurethatinformedconsenttrulyhasbeenobtained

• Ensurethatyouthandfamilyvoiceandchoiceisrobust,andeducationforfamiliesandyouthregardingmedicationsiscomprehensiveandongoingthroughouttheresidentialintervention

• Conducton-goingreassessmentsthatoccurateverymeetingoftheChildandFamilyTeam,whichmeasuretheyouth’sprogressinrelationtothetreatmentgoalsanduseamedicationmanagementprocessthatusesthelowesteffectivedoseandfewestnumbersofmedications

• Ensuredischargeplanningandcoordinationwithcommunityprovidersstartsatadmissionandconsidersthecapacityofthecommunityprovidertomanagethemedicationregimeninacommunitysetting

• Evaluatewhetheropposingexplanatorymodelsexisttohelpguidethroughanyclashesinunderstandingofthereasonfortheyouth'schallengesandhowmedicationscanhelp.Ifafamilydoesnotunderstandwellnessandhealththroughthemedicalmodel,thenthisneedstobeaddressed.Successfulapproachestoclashingexplanatorymodelscanincludeencouraginghealingtraditionsofthefamilytocontinuealongsidewesternmedicinalpractices,aslongasthosetraditionsarenotunsafe

Referencedinactionitemsabove:(ACRC,PositionPaper-EleventhinSeries,January2014pp.2-4;Blauetal.,2014,pp.142-150)

KeyQuestionsfortheCourtstoAskAboutYouthinTransition:1. Istheyouthcurrentlyonanypsychotropicmedications,andifso,whichone(s)andwhatdosage,and

whowillbeadministeringthemedicationandmonitoringitseffects?2. Isamedicationmanagementprocessinplacethatusesthelowesteffectivedoseandleastnumberof

medications?3. Doyouthandfamilieshaveanactivevoiceinagreeingtomedications,includinginformedconsentfor

newmedication,orchangesinmedication,anddotheyreceiveextensiveeducationabouttheeffectsofthemedications?

4. Doestheresidentialprogramconducton-goingreassessmentsthatoccurateverymeetingoftheChildandFamilyteam–minimumofmonthly-whichaddresseachyouth’sfrequenttimewithfamilyandtheiropportunitiestoengageinmeaningfulcommunityactivitiesthatmatchtheirinterests/talents?

5. Doestheresidentialprogramhaveverylowrates,orno,restraints,seclusions,policecallsandactsofaggressionthatcanincreaseyouthdysregulation,andcancontributetohigherdosesofmedication?

6. Istheprescribingpsychiatristpartoftheresidentialprogram'streatmentteamorfamiliarwiththeprogram;ishe/sheinvolvedinmonitoringandassessingtheeffectsofmedicationsaswellasprovidingmedicationinformationandeducationtoallpartiesinvolved?

7. Doestheresidentialprogramuseexternalpsychiatricexpertstoreviewprescribingpractices,especiallyforyouthonmultiplemedications?

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CreateOrganizationalCulturesSupportiveofBestPracticesOrganizationalculturesareextremelycomplexandcanbeviewedashavingtwoparts;thevisiblecultureor“thewaywesaywegetthingsdone”andtheinvisibleculture,whichistypically“thewaywereallygetthingsdone."Thevisibleculturetellsushowtheorganizationgetsthingsdonethroughitsmission,vision,sharedvalues,goals,policiesandstructures.Thepartoftheorganizationalculturethatishiddenholdssuchthingsasperceptions,values,norms,traditions,unwrittenrules,feelingsandsharedassumptions(Rick,p.1).Whenanorganization’scultureisprimarilychild-centered,significanteffortsarerequiredbyleaderstotransformtheirculturetoonefocusedonshort-terminterventionsthatsupportpermanencyforyouthandactivelyinvolvefamilies.Whilemuchliteratureexistsaboutorganizationalculturechangethereisnoeasyorsetwaytogoaboutthisprocess.Organizationshaveusedvariousapproachestoaddressintra-agencychangeincludingtheevidence-basedstrategiescontainedintheSixCoreStrategies©(Blauetal.,2014,p.154).KeyActionItemsbyResidentialPrograms:• Assesstheorganizationalcultureandassurethereisabaselineofstandards,processes,and

practicestowhichtheorganizationholdsitselfaccountablearoundtherightsofyouthandfamilies,health,safety,andtreatmentplanning.Externalstandardizedcriteriaexistthroughlicensingandaccreditationrequirementsthatassuresconsistencyinthesevitalcomponentsofcare.Thesestandardsalsocreateabasisuponwhichresidentialprogramscanestablishinternalstandardstoassesstheirperformance

• Incorporateacoresetofbestpracticevalues(e.g.family-driven;youth-guided;culturallyandlinguisticallycompetent)intotheresidentialprogram’sculturethataredefinedandimplementable.Hiringprotocolsandstaffdevelopmentshouldputaprimaryfocusonpracticesthatoperationalizethesevalues,ensuringaworkforcethatishighlytrainedthroughconsistentinternaltrainingprogramsandregular,supportivesupervision

• Assurethereisasafe,nurturing,andwellcaredforfacilitythatiswelcomingandculturallysensitivetotheyouthandfamiliesserved

• Createlanguageandcommunicationthatisrespectful,empoweringandappropriatelyrecognizesgenderdiversityinordertopromotefamilyinvolvementandengagement

• Createtraumainformedenvironmentsthatusenoejectpoliciesandemploythepracticesoutlinedinthisguide,andspecificevidence-basedandpractice-informedapproachesthatsupportsustainedpositiveoutcomespost-dischargeforyouthandfamilies,andnotjustafocusonimprovingyouthbehaviorswhilereceivingresidentialinterventions

Referencedinactionitemsabove:(ACRC,PositionPaper-ThirdinSeries,March2007,p.2;Blauetal.,2014,pp.170-177)

KeyQuestionsfortheCourtstoAskAboutOrganizationalCulture:1. Istheresidentialprogramlicensedbyitsstateauthorityanddotheyholdnationalaccreditation?2. Doestheresidentialprogramprovideregularandconsistenttraining,coachingandsupervisiontoits

staffonbestpracticesinresidentialinterventions(e.g.permanency;engagingfamilies;youthvoiceandchoice)?

3. Doestheresidentialprogramemploytraumainformedcareandusearangeofbestpracticesthatcorrelatewithpositiveoutcomespost-residentialdischarge(i.e.sixmonthstoayear)foryouthandfamiliesversusjustafocusonyouthimprovingbehaviorsbetweenadmissionanddischarge?

4. DoestheresidentialprogramabidebytheNationalStandardsforCulturallyandLinguisticallyAppropriateServicesinHealthandHealthCare?

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FocusonOutcomesItiscriticallyimportantforresidentialprogramstoachievepositive,sustainedoutcomesfortheyouthandfamiliestheyserve.Itisessentialthatresidentialprogramscollect,analyzeandbenchmarkmeaningfuldatatodetermineifthedesiredoutcomesarebeingachieved.Thisdatashouldincludeoutcomedatafocusedonpractice/processindicators,experienceofcaremeasures,organizationalindicators,andfunctionaloutcomes.Thereissubstantialdatatodemonstrateyouthandfamiliescanachievesuccesswhilereceivingaresidentialinterventionasevidencedbyreductionsinreportedorobservedsymptoms.Whilethisisimportant,realsuccesscanonlybeevaluatedbythefunctionaloutcomesthataresustainedwhenyouthreturntotheirfamiliesandcommunities.Thisrequireslonger-termfollow-upbyresidentialprogramsbeginningimmediatelyafterdischargetoensurethingsaregoingwellandcontinuingforatleast24months.Thislong-termsuccessshouldreflectnotonlysymptomimprovementwhileintheresidentialintervention,butalsofunctionalimprovementsintherealworldacrosskeylifedomainsthatarecriticalforyouthtoreachtheirfullpotential(BBITipSheet:EvaluatingandImprovingOutcomesforYouthwhohaveReceivedResidentialServices,pp.1-6).KeyActionItemsbyResidentialPrograms:• Determinewhatoutcomedataisvitaltocollect,developmethodsandfrequencyofcollection,

createoperationaldefinitionsforthedatacollected,benchmarkthedataamongstpeersandfindwaystodisplayandconveythedatatotheirinternalandexternalconstituents,includingfamily

• Ensurethefunctionaldomainsofhome,purpose,community,andhealtharemeasured,astheyarethedomainsmostidentifiedbyyouthandfamilies

o Thedefinitionsofeachare:Home-asafe,stable,supportivelivingenvironment;purpose-meaningfuldailyactivities,suchasajob,school,volunteerism,andpossessingtheindependence,income,andresourcesnecessarytoparticipateinsociety;community-relationshipsandsocialnetworksthatprovidesupport,friendship,andlove;health-sustainedbasicphysicalandbehavioralhealth,andovercomingormanaginghealthchallenges

o Additionaldomainshavingbeensubsequentlyidentifiedthatincluderelationshipstability,access/utilizationofservices,recidivism/readmissionandriskybehavior/safety

• Ensurethatpracticeandprocessindicatorsaremeasuredandevaluatedduringthecourseofaresidentialintervention.Indicatorstobemeasuredandevaluatedincludeareassuchasmedicationmanagement,seclusionandrestraintdata,criticalincidents,injuries,familyparticipationinthemilieu,youthparticipationintreatment,frequencyofparentalcontacts,etc.

• Ensureexperienceofcareismeasuredandquantifiesthesatisfactionofyouth,families,andcommunitymembersregardingtheservicesprovided.Feedbackfromthesegroupsshouldtypicallybemeasuredusinginternallydevelopedand/ornationallynormedinstruments

• Ensureorganizationalindicatorsaremeasuredandreviewperformanceinsuchareasasstaffretention,jobsatisfaction,fiscalperformance,untowardevents,safetyprograms,andworkenvironmentsthatdirectlyimpactthequalityofcare

• Includeanalysisofdisparitiesinoutcomesandexperienceofcarebyrace,ethnicity,sexualorientation,genderidentityorexpression,language,nationalorigin,disability,andfaithcommunity.Basedonfindings,implementcorrectiveactionstopromoteequityincaredeliveryacrossallpopulations

Referencedinactionitemsabove:(ACRC,PositionPaper-FourthinSeries,October2007,p.3;Blauetal.,2014,p.184)

KeyQuestionsfortheCourtstoAskAboutOutcomes:1. Doestheresidentialprogrammeasurelong-termoutcomes(foratleast24months)andusethe

informationcollectedtoinformpractice?2. Isexperienceofcaremeasuredonthesatisfactionofyouth,families,andcommunitymembers

regardingtheservicesprovided?3. Doestheresidentialprogramcollectandanalyzeadditionaldatatoidentifyandaddressdisparities

inoutcomesandexperienceofcare?4. Doestheresidentialprogramsharedatawithexternalconstituentsonitsperformance?

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WhattheResearchTellsUsResearchhasindicatedthatchildrenunder12shouldbeplacedintheleastrestrictive,mostfamily-likesettingspossible,notingitiscriticalthatinfantsandyoungchildrenbeallowedtodevelophealthy,secureattachmentswithadultswhoareconsistentlyavailable.Youngchildrenlivinginresidentialprogramsareatahigherriskfordevelopingphysical,emotionalandbehavioralproblemsthatcanleadtofailureinschool,homelessness,relationshipchallenges,teenpregnancy,unemploymentandincarceration.Theseyoungchildrenarealsolesslikelytobeplacedinapermanenthomethanthosewholiveinfostercare(CongregateCare,ResidentialTreatmentandGroupHomeStateLegislativeEnactments2009-2013,October,2015,pp.1-2).TheUSDepartmentofHealthandHumanServices’Children’sBureaunotesthefollowinginitsarticleontheuseofcongregatecare:“Childdevelopmenttheory,federallegislation,andbestpracticeconfirmwhatweknowintuitively-childrenshouldbeplacedinsettingsthataredevelopmentallyappropriateandleastrestrictive.Foryoungchildren,particularlythoseage12andunder,itisparticularlyimportantfortheirdevelopmentalneedstobemetinfamily-likesettings.Assuch,wewouldexpecttoseeverylowpercentagesofchildrenage12andunderinacongregatecaresetting.Wheretherearechildreninthesesettings,wewouldexpectthemtospendshortamountsoftimeinthatsetting—timefor…andstabilizationthatreadiesthemfortransitiontopermanencyorfamilyfostercare.Children12andyoungercomprisedanunexpectedlyhighpercentage(31%)ofchildrenwhoexperiencedacongregatecaresetting.Thisconcerningpercentageofyoungerchildrenincongregatecareunderscorestheneedforcarefulexaminationofthisspecialgroupofchildren”(U.S.DepartmentofHealth,2015,p.III).BestPracticesWhilerecognizingtheremaybesomeuniquesituationswherearesidentialinterventionisappropriateforchildrenunder12,itisimperativethatresidentialprogramsandplacingagenciesactivelyexplorecommunity-basedalternativesforyoungerchildren.Treatmentandkinshipfostercareareviablealternativestoaresidentialinterventionandkeepchildrenunder12inmorefamilylike,community-basedsettings.Wraparound2,designedtopreventaresidentialintervention,isanapproachusedinmanycommunitieswhilethechildremainslivingintheirhome.Thewraparoundprocesscreatesanindividualizedplan,developedbyachildandfamilyteamwhoknowsthechildbest,thatisneeds-driven,strengths-based,culturally-relevant,andfamily-centered.Thesolutions(bothformalandinformal)arecreatedtomeettheuniqueneedsofeachindividualyouthandfamily.Inadditiontothewraparoundprocess,thereareavarietyofhome-basedservicesthatcanbeusedtopreventaresidentialintervention.Residentialprogramscandevelopteams,madeupofclinicalstaff,parentpartnersandyouthworkerswhoprovideintensiveinterventionsandcoachingwiththeyouthandfamilyintheirhomestopreventremovalofayoungchild,withtheresidentialinterventionavailableforshorttermrespite.Residentialprogramsservingchildrenunder12shouldhaveanactivequalityimprovement/reviewprocessinplacethatmonitorstheneedforacontinuedresidentialintervention.Thisprocessshouldalertthehighestlevelsofleadership,onaweeklybasis,thatafamilyoralternativecommunitybasedlivingresourceisnotyetavailablefortheyouthtotransitiontowithinthenexttwoweeks.Theremustalsobeasenseofurgencycreatedtoassurealleffortsarebeingmadetolocatefamily,ordetermineafamily-likesettingthechildcanmovetointhecommunity.Lengthsofstayoveronemonthforchildrenunder12shouldbeofgraveconcerntoresidentialleaders,andurgentstepsshouldbeputinplaceimmediatelytoaddressthesituation.

2Foradditionalinformationonwraparoundvisit:TheNationalWraparoundInitiativewebsiteathttp://www.nwi.pdx.edu

III. ChildrenUnder12YearsofAgeandTheirFamilies

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InSummaryIfjudgesandlegalpartnersarefurnishedwithinformationaboutwhentousearesidentialintervention,aswellaswhatconstitutesasafe,qualityandeffectiveresidentialintervention,theycanmakebetterplacementdecisions.Thisguidehasattemptedtoaddressthesetwoimportantissues.Whilejudgesmustrelyontheinformationpresentedtotheminthecourt,byusingthequestionspresentedinthisguide,aswellasanyadditionalquestionstheymaydevelopwiththeircommunitystakeholders,theywillhopefullybebetterinformedatallphasesofthejudicialprocessforyouth,andtheirfamilies,receivingaresidentialintervention.Armedwiththisinformation,judgesandlegalpartnershavetheopportunitytoholdstakeholdersinthejuveniledependencysystemaccountableforconductingupfrontassessments,andunderstandingandexploringalternativecommunity-basedoptionsbeforeplacementisconsidered,therebyreducingtheuseofcongregatecare.Andwhenabsolutelynecessary,choosingasafe,qualityandeffectiveresidentialintervention,usingthebestpracticesoutlinedinthisguide,thatcanproducedurable,positiveoutcomesfortheyouthandtheirfamiliesservedintheirjurisdictions.

IV. Closing

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AssociationofChildren’sResidentialCenters,PositionPaper-FirstinSeries:RedefiningtheRoleofResidentialTreatment,atwww.togetherthevoice.org,October2005.

AssociationofChildren’sResidentialCenters,PositionPaper-SecondinSeries:BecomingFamilyDriven,atwww.togetherthevoice.orgAssociationofChildren’sResidentialCenters,PositionPaper-ThirdinSeries:EnsuringthePre-conditionsforTransformation,atwww.togetherthevoice.org,March2007.AssociationofChildren’sResidentialCenters,PositionPaper-FourthinSeries:PerformanceIndicatorsandOutcomes,atwww.togetherthevoice.org,October2007.AssociationofChildren’sResidentialCenters,PositionPaper-EighthinSeries:TraumaInformedCareinResidentialTreatment,atwww.togetherthevoice.org,December2010.AssociationofChildren’sResidentialCenters,PositionPaper-TenthinSeries:CreatingNon-CoerciveEnvironments,atwww.togetherthevoice.org,April2013.AssociationofChildren’sResidentialCenters,PositionPaper-EleventhinSeries:TowardstheRationalUseofPsychotropicMeds,atwww.togetherthevoice.org,January2014.AssociationofChildren’sResidentialCenters,PositionPaper-ThirteenthinSeries:StrategicInterventionstoAdvanceYouthPermanency,atwww.togetherthevoice.org,April2015BBI:CreatingandMaintainingCulturalandLinguisticCompetenceinHumanServiceAgencies:RationaleandRecommendationsforPromisingPracticesathttp://www.buildingbridges4youth.org/sites/default/files/BBIFinalCLCIssueBrief1_25_14(1).pdfBBIGuide:CulturalandLinguisticCompetence:GuidelinesforResidentialPrograms,December2011,atwww.buildingbridges4youth.orgBBITipSheet:EvaluatingandImprovingOutcomesforYouthwhohaveReceivedResidentialServicesatwww.buildingbridges4youth.orgBlau,G.,Caldwell,B.,&Lieberman,R.E.(2014).ResidentialInterventionsforChildren,AdolescentsandFamilies:ABestPracticeGuide.NewYork,NY:Routledge.ChildandFamilyTeamMeetingsNevadaCasePlanningandAssessmentPoliciesClarkCountyDepartmentofFamilyServicesretrievedon1/31/17athttps://www.childwelfare.gov/pubPDFs/NV_CaseManagementTrainingParticipant.pdfCongregateCare,ResidentialTreatmentandGroupHomeStateLegislativeEnactments2009-201310/26/15athttp://www.ncsl.org/research/humanservices/congregate-care-and-group-home-state-legislative-enactments.aspx

V. References

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Cross,T.,Bazron,B.,Dennis,K.&Isaacs,M.(1989).Towardsaculturallycompetentsystemofcare:Amonographoneffectiveservicesforminoritychildrenwhoareseverelyemotionallydisturbed(Vol.1).Washington,DC:NationalTechnicalAssistanceCenterforChildren’sMentalHealth,GeorgetownUniversityChildDevelopmentCenter.Goode,T.D.(2010).AGuideforUsingtheCulturalandLinguisticCompetenceFamilyOrganizationalAssessmentInstrument.Washington,DC:NationalCenterforCulturalCompetence,GeorgetownUniversityCenterforChildandHumanDevelopment.Jackson,M.,Croghan,T.,Melfi,C.&Lewis-Hall,F.(1999).Culturalcompetencyandpsychopharmacology.InCulturalCompetencyinManagedBehavioralHealthcareeditedbyV.JacksonandL.Lopez.(pp187-210).NationalCenterforCulturalCompetence(n.d.)–ConceptualFrameworks/Models,GuidingValuesandPrinciples,adaptedfromCross,Bazron,Dennis&Isaacs,1989,accessed12/1/2016athttp://nccc.georgetown.edu/foundations/frameworks.htmlNationalChildTraumaticStressNetwork–accessed9/27/16at:SourceURL(retrievedon10/31/2016-17:44):http://www.nctsn.org/resources/audiences/parents-caregiversNationalFederationofFamilies,WorkingDefinitionofFamily-DrivenCare,January,2008,athttp://www.ffcmh.org/publications/definition-family-driven-careNationalHumanServicesAssembly,FamilyStrengtheningPolicyCenter,PolicyBriefNo.1,October,2004,p.3athttp://nationalassembly.org/fspc/policybriefs/BriefsByArea75a4.html?CategoryID=103NorthCarolinaDepartmentofHealthandHumanServices,on-linemanuals,December2016pdfview,retrievedon1/31/17athttps://www2.ncdhhs.gov/info/olm/manuals/dss/csm-55/man/CSVII.htm,pp.1-2.Obrochta,C.,Anthony,B.,Armstrong,M.,Kallal,J.,Hust,J.,&Kernan,J.,(2011).Issuebrief:Family-to-familypeersupport:Modelsandevaluation.Atlanta,GA:ICFMacro,OutcomesRoundtableforChildrenandFamiliesOctober,2011.Rick,T.TheIcebergThatSinksOrganizationalChange,PostedbyTorbenRickonJanuary16,2015inChangeManagement,CorporateCultureathttp://www.torbenrick.eu/t/r/jxmU.S.DepartmentofHealthandHumanServicesAdministrationforChildrenandFamiliesAdministrationonChildren,YouthandFamiliesChildren’sBureau,ANationalLookattheUseofCongregateCareinChildWelfareMay13,2015athttps://www.acf.hhs.gov/sites/default/files/cb/cbcongregatecare_brief.pdfWalter,U.,Petr,C.,Family-CenteredResidentialTreatment:Knowledge,Research,andValuesConverge,HaworthPressVol.25(1)(2008).YouthMoveNational,Youth-GuidedDefinition,accessedon12/1/16at:http://www.youthmovenational.org/Pages/youth-leadership-development.html

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ForAdditionalInformationontheHistoryofResidentialgoto:• ACRCPositionPapers• ResidentialInterventionsforChildren,AdolescentsandFamilies:ABestPracticeGuideForAdditionalInformationOnPermanencySee:• ACRCPositionPaper-ThirteenthinSeries:StrategicInterventionstoAdvanceYouthPermanency• TheInitiative&ChildWelfare:ACollaborativePathtoAchievePermanency• BBI:FindingandEngagingFamiliesforYouthReceivingResidentialInterventions:InterviewsandExamples

• BBI:ABuildingBridgesInitiativeGuide:FindingandEngagingFamiliesforYouthReceivingResidentialInterventions:KeyIssues,Tips,andStrategiesforProviders

• InformationonAssessmentTools:o TheChildandAdolescentNeedsandStrengths(CANS)o TheMulti-DimensionalYouthAssessment(MDYA)360o TheTreatmentOutcomePackage(TOP)

ForAdditionalInformationOnFamilyInvolvementSee:• ACRCPositionPaper-SecondinSeries:BecomingFamilyDriven• ACRCPositionPaper-SixthinSeries:FamilyDrivenCare(FamilyMembersSpeak)• BBI:SupportingSiblingsWhenaBrother/SisterisReceivingResidentialInterventions• BBI:EngageUs:AGuideWrittenbyFamiliesforResidentialProvidersForAdditionalInformationOnInvolvementofYouthSee:• ACRCPositionPaper-SeventhinSeries:YouthGuidedTreatment• BBI:TipSheetonDevelopingandSustainingaYouthAdvisoryCouncil• BBI:PeerYouthAdvocatesinResidentialProgramsHandbook• BBI:PromotingYouthEngagement-WhatProvidersShouldKnowForAdditionalInformationOnCulturalandLinguisticCompetenceSee:• BBI:CreatingandMaintainingCulturalandLinguisticCompetenceinHumanServiceAgencies:RationaleandRecommendationsforPromisingPractices

• BBISelfAssessment-PromotingCulturalDiversityandCulturalandLinguisticCompetency• BBI:CulturalandLinguisticCompetence:GuidelinesforResidentialPrograms• NationalStandardsforCulturallyandLinguisticallyAppropriateServicesinHealthandHealthCareForAdditionalInformationOnTrauma-InformedCareSee:• ACRCPositionPaper-EighthinSeries:TraumaInformedCareinResidentialTreatment• ACRCPositionPaper-TenthinSeries:CreatingNon-CoerciveEnvironments• CentersforDiseaseControlandPrevention–ACEsStudyForAdditionalInformationOnLinkingResidentialandCommunitySee:• BBI:FrequentlyAskedQuestionsforCommunityProvidersForAdditionalInformationOnSeclusionandRestraintSee:• ACRCPositionPaper-TenthinSeries:CreatingNon-CoerciveEnvironments• SixCoreStrategies

VI. AdditionalInformation

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ForAdditionalInformationOnYouthinTransitionSee:• TransitiontoAdulthoodandIndependentLivingForAdditionalInformationAbouttheuseofPsychotropicMedicationsSee:• ACRCPositionPaper-EleventhinSeries:TowardstheRationalUseofPsychotropicMedsForAdditionalInformationAboutOrganizationalCultureSee:• ACRCPositionPaper-ThirdinSeries:EnsuringthePre-conditionsforTransformation• ACRCPositionPaper-TwelfthinSeries:EnsuringCompetentResidentialInterventionsforYouthwithDiverseGenderandSexualIdentitiesandExpressions

• SixCoreStrategiesForAdditionalInformationAboutOutcomesSee:• ACRCPositionPaper-FifthinSeries:EvidenceBasedPractices• ACRCPositionPaper-FourthinSeries:PerformanceIndicatorsandOutcomes• ACRCPositionPaper-NinthinSeries:MeasuringFunctionalOutcomes• BBI:BuildingConsensusonResidentialMeasuresforOutcomeandPerformanceMeasures• BBI:EvaluatingandImprovingOutcomesforYouth-ExecutiveSummary• BBI:EvaluatingandImprovingOutcomesforYouthwhohaveReceivedResidentialServices


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