Enterphase Child & Family Services employs a multi-disciplinary, multi-systemic treatment model that involves residential treatment, day treatment, community involvement, psychological assessment, individual psychotherapy, family based interventions including parental skills training, family working sessions and family therapy in addition to psychiatric consultation and medication services.
Enterphase Child & Family Services (E.C.F.S.) is a long-term residential treatment agency. This document is designed for Parents, Social Workers, Placement Workers, and other collateral agency professionals working with Enterphase, and will cover the following areas.
What is “Treatment”?
Persons admitted to E.C.F.S. are typically children who have experienced difficult life circumstances to the degree that these experiences have impacted on their development. As a result, their success in school, in the family and in developing and maintaining meaningful relationships has been impacted. Those of us at E.C.F.S. attempt to understand the circumstances and situations our persons served have experienced with a view to organizing a treatment plan that will be useful for that person. By understanding a child’s life experience and the perceptions that child holds regarding them, we are able to predict and direct interventions that will assist in improving the mental health of the person served. This is treatment.
In order to conduct effective treatment, E.C.F.S. staff require any and all background information on persons served referred to us. No report or documentation is unimportant. Of particular value are previous psychological and psychiatric assessments. E.C.F.S. also conducts what is called a “treatment readiness” assessment on each new placement within approximately 90 days of placement.
The purpose of this assessment is to determine whether that client can make use of individual psychotherapy. If it is felt that the person served could make use of this intervention, then they are assigned to one of the E.C.F.S. individual psychotherapists. As well, more extensive assessments can be organized if assessment findings indicate a need for it.
E.C.F.S. operates several Day Treatment School Programs which work hand in hand with the residential programs to extend the treatment planning into the classroom setting. Accurate and daily communication between the residence and school program is essential to assist the person served and predict useful interventions. All of these programs are in schools close to the residences and integration into the mainstream school system, where and when appropriate, is the long term goal.
E.C.F.S. follows certain principles in organizing and implementing treatment plans for our persons served. They are as follows:
- Appropriate living environment.
E.C.F.S. provides a living atmosphere that is predictable, consistent (in that staff always respond to particular behaviours, but in a way that is appropriate to the child and the situation), non-punitive, safe, and structured.
- Providing corrective/therapeutic experiences.
A corrective experience is “better than before”, promotes further personal development, and broadly fits with social expectations. A therapeutic experience is helping the child work through the negative impact on them (that is, how they think, feel and behave) of their previous experiences.
- Individualized treatment planning.
E.C.F.S. understands that every person is an individual and that it is their subjective “take” on what has happened to them that matters, and has influenced their development. Planning is done with this in mind and after a thorough examination of the client’s background and life experience.
- Modifications of treatment planning – How to do it.
As the treatment strategy is implemented, modifications to the plan are often required. It is important that no decision is taken in isolation. All of our work is based on a team approach, with full communication between all team members. Any intervention implemented is done in a planned and informed way, with the purpose of being helpful to the child. The child must be included and informed of the treatment plan as much as is useful for them so that issues are dealt with and processed using the treatment plan as a frame of reference. Efforts are made to translate the treatment plan into terms the child can use and at a time which is right for the child. Staff, parents, workers and other stakeholders involved in the treatment planning must recognize that putting issues “on the table” and discussing aspects of the child’s treatment can be destabilizing to the child for a time. However, this process is understood to be part of treatment and should not be avoided. Destabilization can look like various things such as: tension and conflict between staff and the person served; escalation of symptomatic behaviour as well as subjective distress on the part of the person served. It can also include a deterioration of the child’s ability to cope at school or in the community for periods of time.
What does “Long-Term Placement” mean?
E.C.F.S. does not have pre-established time lines regarding the length of the placement of the person served in the residences. Often the children in our programs have experienced a number of placement changes previous to admission. The person served can remain within the program as long as it is useful to them. Efforts are made to deliver the message clearly to all involved parties, including the person served, that this is the case. Any change of placement should occur only in a planned and informed way, and in a manner which is beneficial for the person served. Often a placement change involves moving the person served to a less structured environment such as foster or group care. Liaison work with the future care giver is considered essential to the success of the future placement. For those persons served who are returning home, family working sessions and parent skills development can be organized previous to, and following, the move.
How do decisions get made?
All persons served within the E.C.F.S. program have a “client team” which is made up of parents (if appropriate), staff members, social workers, therapists, and any other adult important to the child. This team meets regularly at the Plan of Care meetings. These meetings occur once a month for the first six months of the placement and then once every three months from that point on, unless more frequent meetings are indicated. It is at these meetings that plans for the person served are developed or refined and communicated; as much as possible no changes are made to the plan between these meetings. Only exceptional circumstances would warrant making changes to the treatment plan between meetings. This allows the person served to experience the adults presently looking after him/her as people who can be trusted to do things in a planned and organized way. This, in and of itself, can be a corrective experience.
Responsibilities of all team members
The most important component of treatment is communication. This communication starts at the pre-placement stage with the referring agency providing any and all information and documentation to E.C.F.S. so that effective assessment and planning can occur. E.C.F.S. maintains a minimum of weekly communication with the client’s social worker regardless of how that week has gone. All significant incidents are documented and reviewed at the Plan of Care meetings. Additional recording includes daily tracking of contacts, appointments and events, as well as the client’s reactions to them. With this information patterns, hypotheses and predictions are identified. This information is used at Plan of Care meetings and at clinical case conferences.
Attendance at Plan of Care meetings is very important for E.C.F.S. staff and referring agency social workers. Attendance of referring agency Social Workers at clinical case conferences is essential; the E.C.F.S. consulting psychologist, psychiatrist (if needed) and possibly the child’s therapist are also in attendance. All historical and recently acquired information and tracking is reviewed at these meetings and the treatment plan is formulated and put in place for the future. Decisions regarding school, community activities and contact with family and others are often made at these meetings and the social worker’s input, feedback and consensus is essential.
A clinically-informed decision-making approach provides the framework for helping guide treatment and case management planning, and the formulation of an understanding of clients and their psychological, relational, and developmental needs. Psychological consultation is an integral part of the process that informs and maintains this approach to treating, managing and providing therapeutic care to clients. Psychological consultation occurs in various formats, such as through regular clinical conferences, meetings involving various members of a client’s treatment team, supervision, and as-needs discussions.
It is hoped that through the process outlined above, clear and effective teamwork can be put in place. It is expected, however, that from time to time, difficulties and misunderstandings may occur between E.C.F.S. staff, referring agency workers, family members and other client team members. The staff at E.C.F.S. is very open to discussing these situations as candidly and quickly as possible, thereby avoiding further problems and building the potential for better team work in the future. Maintaining a treatment plan that will benefit the person served is the primary concern of E.C.F.S. and all decision making is geared to this end
The Wraparound Process:
The Wraparound process is an old idea with a few new twists. The “old” idea stems from a past time when family lived close together and the extended family was very involved in the lives of other family members. When problems or difficulties arose with a family member, whether it was in raising the children or raising a barn, the extended family would gather around the family member and “wraparound” the problem. Strengths and resources were assessed and those members who could provide support were identified. A plan was made and responsibilities assigned. From time to time the family would meet and re-assess the progress of the problem resolution. If new problems arose, or changes needed to occur within the plan, it was discussed and new planning took place.
Wraparound today follows these same principles with the change that professionals are added to the equation to help strengthen the family when extended family is not available or willing to become involved. Treatment planning is strength based opposed to problem based. Having non-professionals actively included in the treatment planning helps provide resources not previously accessed and having members of the family or culture present assures that treatment planning is ethnically and culturally appropriate. The Wraparound Process is utilized in all of our residential treatment programs.
The Client Team:
The Client Team consists of the person served, the prime worker, the house supervisor, the social worker and any other individuals (professional and non-professional) considered important in creating and assuring a socially and culturally appropriate Individualized Client Plan. Other team members might include the resident’s parents, the resident’s best friend, other involved relatives or family friends, church and/or cultural leaders, counsellors, probation officers and any other resources which the family might have access to. Ideally, the team should consist of about 6-8 members, half of which are professionals and half non-professionals.
The goal of developing a client team is to assess the family from a strengths perspective and bring these strengths together to create a plan. This plan will reflect future individualized treatment planning for the child.
Individualized House Plans:
This is a plan designed by the person served, their prime worker, and members of the client team. It will lay out for the person served and the home the day to day individualized needs of that client. Items such as shower times and laundry nights will be included as well as issues such as special arrangements needed for school, medication, counseling, room assignments, and morning and evening curfew times. More importantly, the needs of the family will be assessed and plans for aiding the family to meet these needs will be made. Need areas could include the possibility for home visits and how often, the plans for discharge, the plan for reintegration back into the family home or for semi-independent and independent life skills training. The Individualized House Plan should also include any areas of interest or talents the person served may have and what resources are available to assist the person served in pursuing these interests and talents. Assisting the person served to develop a self-concept and personal identity away from the “group home” framework and disengaging them from the other persons served in the home is the goal here.