Archive from 2014..a literal oratory

Family Reunification Treatment Model Project
 
Rationale for its development
While practicing in a residential treatment center, it became evident that there was not a clear path or understanding on how exactly to successfully reunify families.  There was a basic understanding that the counselors would do the therapy, the direct care workers would care and supervise the child and try to work on modifying their behavior(s) as best as they were minimally trained to do so, the caseworker would assist the family in working the case plan goals and assist in court proceedings, and the family would do:::: Crickets chirping::::. It lead me to wonder if other Treatment Centers and behavioral healthcare agencies had this problem, too?

Parents were expected to show up to team meetings, however at times it was almost naturally assumed that this was what the caregivers or parents were supposed to do, although the parents may not have been explicitly told, let alone told why, or how their participation in their own family’s stabilization could effect the outcome. They were expected to show up for sessions, meetings, and visitations, but there was minimal clarity in their role and their expectations, especially for change.
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There was little common understanding of what each part did, exactly, in the process to achieve the desired outcome, which was reunification, and it appeared only speculative in each case as to what exactly was responsible for the family’s success (or lack thereof) in its ability to stabilize and function again at an improved, non crisis level, family system. Luckily, were are in the era of big data and keeping a bit of my own to reflect and evaluate my own work has helped me to discover some insights. In my own world of the "my child test" theory {If I had to put my child in said program, would I? If the answer is "Yes", stay awesome, if it is "No", keep making it better!}, I simply felt that if there were any ways to improve our services and the services of others, surely there was a reason I was in the work that I was in and caring so deeply about the intimate nature and dynamics of the work.
 
Our work in residential focused primarily on the reunification of emotionally and behaviorally disturbed children and whose family has been disrupted in a single event crisis or had escalated due to chronic crisis level issues and required a social service agency’s intervention in order to keep child and family safe. Thus, about 6 months into the job I began cataloguing my experiences of several elements that I believed to be critical in the outcome(s) of treatment. I began cataloguing: Presenting issue, type of disrupted family (i.e. biological, adopted, foster, kinship placement, permanent custody), core family issues (e.g. Sexual offenses, domestic violence, attachment issues, family trauma, and communication/interaction dysfunctions), and a review of efforts to stabilize (ex: use of the behavioral healthcare continuum). In addition, it occurred to me that while the names and faces changed, the stories rarely did; thus, I began cataloguing variables of these families that I thought were to be of potential importance (age, diagnosis, parent's AoD Hx, Level of Severity of the child's IQ and Mental Illness, the parent/caregiver's mental illness hx, number of placements, and level of parental/caregiver involvement).
 
While conducting my private case studies and my own practice evaluation, I discovered that these families were in a state of crisis which required significant support and levels of intervention due to the escalation and decomposition of the family system. I operate out of a family systems theory practice, and often, it appeared as though our healthcare services and delivery were disjointed in our efforts to serve. Additionally, it appeared as though many of the families required residential level of care intervention due to the disconnected avenues of help that either were not truly collaborative in nature or did not get to the heart of the crisis antecedents: the core family system issue.  Thus, this observation lead to the construction of a model that insists of the connection and collaboration of invested parties, with special attention and respect to how each part in the system contributes to the whole (i.e. outcome) yet is a critical and valued entity of the treatment team. Most importantly, it considered and touted the importance of the parental involvement. If the primary issue was the lack of parental involvement, the team knew right from the start of the core work to be done: assist in establishing a safe, stable, and permanent natural support system.
 
This translates into a multidisciplinary treatment model for traumatized families with presenting issues that have lead to significant crisis levels in the family system. And I say traumatized family and call it a trauma model because trauma work focuses on the real and perceived nature of safety. The difference between grief, loss, and trauma, is that while the three issues may have experienced real or perceived meaningful loss, it becomes traumatic when the person, as a result, no longer feels safe, and instead feels quite vulnerable. Thus, in order to stabilize a traumatized family system where it is highly likely that one, or even all, of the family unit is experiencing unsafe thoughts, attitudes, or behaviors, a comprehensive model should address these relational dynamics across the board for effective outcomes.
 
Reaching a state of crisis level even once can lead to a family system's temporary disequilibrium; however chronic dysfunction can effect the entire family system and subsystem with lasting damage. Therefore, it requires a serious and collaborative method for intervention. This model was created so that a clear (and visual!) understanding of the family reunification process can be well mapped out and understood by all parties. This allows the program to provide the child/family with concise information and informed consent on what would be expected from all the participants in order to achieve the desired outcome. 
 
In the model, interventions are tailored to discovering and explaining the nature of the families’ distress, why it exists, what factors contribute, how the distress/lack of safety can be alleviated or removed, and the steps in which a family can take in order to achieve their desired outcome. It spells out, both in text and with visual aids and even advanced metaphors, the stages a family and treatment team are in and will work toward. The model identifies the individual and group tasks to be achieved, cited along with the clinical and social work rationale, and emphasizes the overarching guiding principle of safety throughout each phase. Families and treatment teams must be safe; physically safe to work with one another effectively, emotionally safe, in order for effectively and productive communication, and of course, protect against any sexually related boundary issues or safety concerns.

Individuals and teams can learn and grow when they feel safe, not when they feel threatened. Thus, without a clear model and understanding of what and how we are working toward the desired outcome, I believe that many a great social and behavioral healthcare worker tries in vain to assist families but fall short for this very reason.
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The FRM is GPS.