Why Bundled Support is Crucial to Childhood Well-Being
Op-ed by Edward Myers Hayes
When a child cannot live with their parents or bio-family, foster care is an effective healing alternative to congregate care if the foster care intervention can address the child’s trauma and other complex service needs. Most foster care children require individual and family therapy, skills building and coaching, educational support, and medical care. Without precise coordination between the providers of these services, fragmentation and inconsistency become the norm – and the child is negatively affected the most.
Programs have choices. A program can attempt to secure this needed support from other community providers or provide it in-house.
In our bundled treatment model, we take the latter approach. Certainly — given the rates foster care providers are paid and the difficulties of hiring in the current workforce environment — the easier, fiscally safer road is to turn to others rather than do it oneself. However, in our over 20 years of providing treatment foster care — we have found that doing such does not serve our foster children well – it does not help them heal from their pre-existing trauma and build the skills they need to create futures for themselves.
There are many barriers to effectively meeting the needs of children in the foster care system:
- Many community mental health clinics have long waiting lists.
- The insurance children have is not always accepted.
- Community clinic staff turnover can create more disruption in a child’s life.
- Many youths have a fear or do not want to go to a clinic.
- Too many therapists want to continue remote therapy instead of providing in-person therapy. We find that most of our youth do better with an in-person therapist.
As our youth have suffered from inconsistency and contradictory messages throughout their lives, they need a focused, team approach with lots of planning and communication.
- Too many community clinicians aren’t trained in the treatment approach of the foster care program, which can lead to conflicting and sometimes contradictory approaches.
- Even if a clinician is willing to be trained in a particular treatment approach, their caseloads and schedule often do not allow them to attend a treatment team meeting with the foster care provider’s staff.
- Information sharing and communication between these clinicians and the foster care program may be inconsistent.
- In a bundled services approach, we accept that it is our responsibility – without excuses – to provide what a child and their family needs. We have done this by initially using concepts and designs from: Dr. Patty Chamberlain of the Oregon Social Learning Center, Dr. Glenn Saxe of the New York University Child Study Center, Dr. Margaret Blaustein of the Center for Trauma Training. Our over 20 years of experience with accepting youth deemed too high needs for foster care also inform our current model.
Bundling services allows for trauma-sensitive, hands-on, active treatment. Furthermore, it is led by a team with highly defined yet flexible roles that place the child’s needs at its center. In this bundled model, we also provide foster parents a seat at the table and prepare them to be active participants by providing them with:
- Enhanced training, so they understand trauma and treatment.
- Daily contact with the program – either in-person or by phone, so we are reaching out to them and not waiting for them to be in touch.
- 24-hour on-call availability — if needed.
- Our partnership in securing medical specialty appointments, medical transportation, arranging for school needs, and related needs.
These benefits are not optional support add-ons. This is our doing our job right.
For our children, we provide:
- A masters-level Clinician trained in addressing trauma – to provide at-least weekly therapy.
- A Youth Coach to connect at least weekly to mentor or teach life skills.
- A school advocate to push the community school to meet their needs.
- A case planner to quarterback the process.
- Psychiatric and medical support from – in our larger programs – members of our staff or – in our smaller programs – our contracted consultants.
- Assistance in getting a job or enrolling in college.
- Regular time with their bio-family — not just parents but also siblings and their larger family network.
- Assistance in finding and maintaining an apartment for youth who are not returning to their family’s home.
And for the parents or bio-families or permanency resources, our clinicians provide:
- Family therapy to help resolve what is needed for reunification.
- Family time (some call it visitation) as a right – not as an earned privilege. We doom a discharge from being successful if we do not do this.
It goes without saying that there are obstacles to doing this; securing funding is a challenge.
Creating cooperation among different systems is daunting. Finding and supporting tenacious foster parents who won’t request reassignment after their first rocky day with a child requires a unique recruiting and training approach. Retaining and maintaining our teams stretches us. Nevertheless, those we serve need our best – not our reasons for why we could not overcome the obstacles we face. After all, we are always encouraging them to overcome their obstacles. The first step toward success is to model this behavior.
Ultimately, children are served best when we keep families safely and successfully together. In those situations where a removal must happen, a child needs to be treated with care safely, and effectively. Moreover, we must correct the drivers of race, class, poverty, and misogyny, which put so many families at risk. Our bundled approach is the answer to ensure we stay true to the mission of putting children and families first.
