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Clinical ServicesEnterphase Child & Family Services employs a multi-disciplinary, multi-systemic treatment model that includes family, community, Residential Care, Day Treatment, Individual Psychotherapy, group therapy in addition to and in conjunction with psychiatric and psychological treatment. Clinical Support Services:Dr. Anita Halpern, (Clinical Psychologist):Dr. Halpern has been consulting to Enterphase since its formation and provides vital treatment planning, clinical insight, and staff training to the six residential programs in the Durham area. Dr. Halpern supervises the Individual Psychotherapy Program and meets regularly with the therapists and residential staff through supervisions and clinical case conferences to oversee the clinical work. Dr. Halpern administers Treatment Readiness Assessments on all latency aged Enterphase clients within the Durham area programs. She also administers comprehensive psychological and psycho-educational assessments where needed. Janet Morrison, (Psychological Associate):Janet works closely with our Toronto area latency aged coed programs. She assists the residences and day treatment program with clinical supervision in treatment planning and administers Treatment Readiness Assessments on all clients in the residence's. She is invaluable in providing clinical training to staff members through clinical case conferences and she supervises the therapists from the Toronto School of Child Psychotherapy who deal with the children within the homes. Dr. Cynthia Gertsman, (Psychiatrist):Dr. Gertsman is a Child Psychiatrist with a long history of dealing with children in residential treatment settings. Dr. Gertsman provides psychiatric testing and consultation for the Enterphase clients who require it. She also assists in medication reviews, recommendations and monitoring where needed, and works collaboratively with family physicians and specialists involved with our clients. Robert Schoemaker (Clinical Coordinator):In consultation with Dr. Halpern, Dr. Gertsman and Janet Morrison, Robert oversees the treatment planning for all the clients within the residential programs. He is also an individual psychotherapist and carries a case load of Enterphase clients. Robert worked collaboratively with Dr. Halpern and Janet Morrison in creating the agency clinical training workshop Milieu Based Treatment: What it is and What to do. He is also a certified trainer for U.M.A.B. (Understanding and Managing Aggressive Behaviour). Defining Treatment: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 do we mean when we say we do treatment?Children 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 clients have experienced with a view to organizing a treatment plan that will be useful for that child. 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 child. This is treatment. In order to conduct effective treatment, E.C.F.S. staff require any and all background information on clients 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 eight weeks. The purpose of this assessment is to determine whether that client can make use of individual psychotherapy. If it is felt that the child could make use of this intervention, then the child is 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 nine 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 child and predict useful interventions. All of these programs are in schools close to the residence and integration into the mainstream school system, where appropriate, is the long term goal. E.C.F.S. follows certain principles in organizing and implementing treatment plans for our clients. They are as follows:
What do we mean when we say we are a long-term placement?E.C.F.S. does not have pre-established time lines regarding the length of the placement of the children in the residences. Often the children in our programs have experienced a number of placement changes previous to admission. The child can remain within the program as long as it is useful to the youngster. Efforts are made to deliver the message clearly to all involved parties, including the child, that this is the case. Any change of placement would occur only in a planned and informed way, and in a manner which is beneficial for the child. Often a placement change involves moving the client 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 clients returning home, support and parent skills development can be organized previous to, and following, the move. How do we make decisions and who is included in the decision making?All clients within the E.C.F.S. program have a "family team" which is made up of parents (if appropriate), social workers, 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 child 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 child 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 membersThe 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 child's social worker regardless of how that week has gone. All significant incidents are documented as are all Plan of Care meetings. Additional recording includes daily tracking of contacts, appointments and events, as well as the youngster'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. ConclusionIt 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 and other family 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 child 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 resident, 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 resident, their prime worker, and members of the resident's client team. It will lay out for the resident and the home the day to day individualized needs of that resident. 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 resident may have and what resources are available to assist the resident in pursuing these interests and talents. Assisting the resident to develop a self-concept and personal identity away from the "group home" framework and disengaging them from the other residents in the home is the goal here. The Community Team:The community team are members of the local community who are willing to contribute some time to community service with the agency. Members chosen would represent areas of the community such as business, the arts, recreation, mental health, physical health, and any other area found relevant to treatment planning. These members would be called upon to assist in accessing resources that the agency does not have in an effort to hook children into positive activities and services. This might include help in locating part time jobs, finding specialized counseling services and groups, or registering a child for a little known sports or art class. The community team members would attend case reviews only upon invitation and with the proper protocols being followed regarding confidentiality. The members of the Family Team begin to be identified in the initial seven day Plan of Care and the beginnings of a house plan is formed. The Individual House Plan is refined and revised as needed and is reviewed by the family team and recorded on the Case Review and Case Conference Reports. It is encouraged that the resident and prime worker meet once a week to review the plan and reinforce gains made or strategies around areas that may be presenting difficulties. |
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