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. 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. The FRM is GPS.
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But A beginning, a middle and an end...ing. Well, Sort of.
If you think about it, you could say that the basic process of anything is that there is a beginning, a middle and an end. But technically, there is a pre-beginning (what is going on before something actually starts or takes place), the actual "beginning", the middle (where arguably most of the work is done, or gets lost), and then the identified ending. However, after anything ends, there's also the residual, or lasting effects, of that process. The goal for any of us who use any sort of process is to gain as much as we can while we are "in it", and ideally continue to reap the benefits of the process long after its been "finished." With the FRM, we hope for children and families to do just that. Know the process, own the process, live the process. But before the process, I want you to understand what lead to the "beginning." We spend time helping the child/family see the dynamics or circumstances that lead up to the start of official intervention and services. We help service providers understand that journey as well. When you have a basic visualization of the journey you are going to go on, you are probably more likely to enjoy the process, rather than fret and worry, wasting valuable time and energy anticipating dangers or concerns ahead. You can be aware of the road your on, and even take in the sights as you go. We help the children and family understand the process- after all, if you don't fully understand the process, how can you fully engage in it? In a rushed and imperfect world, we are often too busy to "get right to it", whether we are the consumers or the providers, and valuable foundation work is frequently skipped, glossed over, or ineffectively communicated. By using a visual model, analogies, metaphors, stories, and more, we strive to equip the family's and service providers with useful language and tools to do their work. The end. Just kidding... :) This is only the the prequel I'm glad you stopped by to visit! Feel free to come in, take off your shoes, and stay awhile.
This first post is to let you know why this site exists and why this work is so important to me and why it should be for those in the trenches doing the work with our children and families. It's all about keeping the focus on the family. Family, no matter how it is defined (and I'll come back to that in a future post) is the reason we are here. Family is the very beginning of our identify, our foundation of support (or lack thereof), and the unit in which we rely on most often for a variety of types of support along our life's journey in reaching developmental tasks and milestones. However, no family operates the same, times are always changing, and the developments in our healthcare, our nation, and our world continue to have an external force in how our families are shaped and function. And many, if not all, families experience periods of crises or cycles of dysfunction at some point in their life, some of which require the assistance of Behavioral Health Intervention and maybe even Residential Treatment. There is no "normal" family. As I once heard, "...normal is a setting on a washing machine." There also is no manual for perfect parenting- if there was I am certain it would exist by the now. Residential Treatment, and intensive emotional and behavioral health intervention, is designed to serve a time limited purpose along the continuum of care and service delivery. The goal is to help the family unit (however it may be defined) establish or re establish equilibrium as soon as clinically possible. This is why the FRM was created. A guiding principal in my work with families is to normalize the fact that no matter how a family started, what strengths it does or does not have, and however a family is operating does not, and will not, define them as a unit. It is simply a piece of the thread that is used to weave the family's own unique narrative fabric. The goal in our work is to honor where they are at, where they desire to be, and help serve as a deliberate and supportive guiding light back toward safety and balance. While many of the families that require intensive therapeutic intervention face serious and grave issues, I always try to stress to the children, families, and providers involved that a sense of hope and optimism must prevail. Dysfunction is a disruption in equilibrium or homeostasis, and any living organism or system can become unbalanced. It can become unsafe, unproductive, disorganized, and chaotic. It can become unwell, toxic, dangerous, and stuck. We have a very critical choice to make when we work with families or when we are that family: we can choose to see all that is wrong and pass judgment and remain stuck doing the same things that do not help resolve our instability, or we can see all the opportunity that lies before us and yet to be discovered through this unique circumstance. We can choose to create a new lens for the family unit to thrive, not just survive. Crisis is both a threat and opportunity. As providers and as members of our own families, we cannot lose sight that we have the power to choose. And so if you are working with a family who has come to the attention and need of emotional and behavioral family support and that is what has lead you here to this site, or you are that family in need of help and guidance, its critical to know that where ever you are is not where you need to stay. There is a path. Let me show you the way! |
AuthorKelly Bako is a Licensed Clinician, Clinical Supervisor, Performance Coach, and Educator. ArchivesCategories |