Therapeutic Residential Child Care Services
PROCEDURAL MANUAL
THERAPEUTIC RESIDENTIAL INTERVENTION SERVICES
For
CHILDREN AND ADOLESCENTS
INTRODUCTION
The Multi-Agency Team for Children (MATCH) purchases Therapeutic ResidentialIntervention Services for children and adolescents with severe emotional disturbances. The services are provided to children whose mental health treatment needs are so serious that they require treatment in residential settings or through therapeutic wrap-around services in the children’s homes or with substitute families. These children require specialized services in order to stabilize their emotional problems, keep them and others safe, and progress towards more normal functioning. The types of Therapeutic Residential Intervention Services purchased by MATCH are: Therapeutic Wrap-around, Basic Plus Foster Care, Therapeutic Foster Care, Basic Plus Group Care, Intermediate Residential Care, Therapeutic Wilderness Camps, and Intensive Residential Treatment and Provider Network Services.
PROGRAM DEFINITIONS AND DESCRIPTIONS OF CHILDREN SERVED
THERAPEUTIC WRAP-AROUND SERVICES
Program Definition
Therapeutic wrap-around services provide care, supervision and treatment within a child’s own home or in a substitute family. Services are directed to avoiding residential placement by meeting the child’s treatment and safety needs in the home community, or facilitating the child’s successful return home and reintegration into the community following residential treatment. Family members work as full partners with a well-constructed interdisciplinary team to 1) increase their capacity to provide for the mental health needs of the child, and 2) to identify and use strengths in the home, school, and community to meet the child’s social, emotional, physical and educational needs. Services are provided primarily in the family’s home and there is 24-hour a day availability of staff.
There are four levels of Therapeutic Wrap-around Services – Basic Plus, Special, Exceptional and Extraordinary. The levels differ primarily in the amount and type of interventions needed to support the child and family. The number of levels allows children to step-down through the service as they achieve their goals at the various levels.
A child served through wrap-around services has a mental health diagnosis and substantial problems in one or more areas of life. The child has mental health needs and behaviors that present mild, moderate or serious risk of causing harm to self or others. The child may be exhibiting a combination of multiple problems and/or one or two problems that are significantly interfering with his/her ability to function at home, in school and in the community. The child has a family or substitute family who is willing to act as informed decision-making participants in the child’s treatment process.
A child served at the Basic Plus or Special Level has a mental health diagnosis and mild to moderate emotional and/or behavioral problems. These problems may include anxiety, withdrawal, moodiness, depression, hyperactivity, impulsivity, defiance, and sexual behavior problems. The child may be experiencing school problems and be engaged in pre-delinquent activities. There may be some verbal aggression and difficulty getting along with peers and adults. The levels differ from each other in the intensity and range of the child’s needs and problems.
A child served at the Exceptional orExtraordinary Level has a mental health diagnosis and moderate to serious emotional/behavioral problems. These problems may include high levels of anxiety, depression, hyperactivity, moodiness, withdrawal, and sexual acting out. Other problems may include school suspensions and other school-related problems, delinquent behavior, verbal and some physical aggression towards peers and adults and destruction of property. The levels differ from each other in the intensity and range of the child’s needs and problems.
BASIC PLUS FOSTER CARE
Program Description
Basic Plus Foster Care provides individualized treatment and support services in a family setting. The child lives with a substitute family. Treatment is individualized and the foster home is the primary treatment setting. The programs serve children whose needs fall between traditional foster care and therapeutic foster care. Basic Plus Foster Care parents are especially screened and trained to meet the special needs of the children. They are able to tolerate a child’s challenging behaviors.
Many of the children served in Basic Plus Foster Care are in the custody of the Department of Family and Children Services or are committed to the Department of Juvenile Justice. Where appropriate, Basic Foster Care Plus foster parents must support and enhance the child’s ties to parents, siblings and extended family by encouraging visits and involving the family in decisions about the child, and working as a partner with other professionals to achieve permanency for the child.
Some of the children served at this level are in transition from more restrictive settings. This level of care provides these children with an opportunity to enhance their adaptive skills and generalize what they have learned to the larger community.
Description of Children Served
A child served in Basic Plus Foster Care has a mental health diagnosis and mild to moderate emotional and/or behavioral management problems. The child may exhibit acting out behaviors marked by mild to moderate levels of anxiety, withdrawal, moodiness, depression, hyperactivity, impulsivity, and defiance. Other behaviors and areas of concern may include verbal aggression towards peers and adults, pre-delinquent activity, truancy and other school-related problems, and sexual behavior problems. Many of the children served at this level have substantial histories of abuse and neglect and have experienced multiple out-of-home placements.
THERAPEUTIC FOSTER CARE
Program Definition:
Therapeutic Foster Care provides individualized treatment and support services in a family setting. The child lives with a substitute family in the family’s own home. Social workers, clinical staff and the therapeutic foster parent together work as a treatment team to provide a therapeutic environment designed to help the child achieve increased emotional stability and an improved level of behavioral functioning and social interaction. Many of the children served in therapeutic foster care are in transition from more restrictive treatment settings. This level of care provides these children with an opportunity to enhance their adaptive skills and generalize what they have learned to a non-residential center environment.
There are three levels of Therapeutic Foster Care – Special, Exceptional, and Extraordinary. A child is assigned to a level based on clinical symptoms, functioning, the amount and degree of services the child needs to meet his/her treatment goals, and the support and supervision given to the therapeutic foster parents.
Description of Children Served:
A child appropriately served in Therapeutic Foster Care has a mental health diagnosis and substantial problems in one or more areas of life. A child at this level has mental health needs and behaviors that present a moderate to severe risk of causing harm to self or others and interfere with the child’s ability to function successfully outside of a therapeutic setting, in school and in the community. Despite significant emotional and behavioral problems a child in therapeutic foster care has sufficient interpersonal, adaptive skills and behavior control to participate in community activities and in public school. Although the child is likely to display episodes of aggressive or antisocial behavior, there is a preservation of meaningful social relationships. The child can be maintained safely outside of a residential center.
Many of the children served in therapeutic foster care are in transition from more restrictive settings; they are given opportunities to enhance their adaptive skills and generalize what they have learned to a non-residential environment.
A child served at the Special or Exceptional Level has a mental health diagnosis and moderate to serious problems or occasional major problems in one or more areas of functioning. The child may exhibit acting out behaviors marked by moderate levels of anxiety, withdrawal, moodiness, depression, hyperactivity, impulsivity and defiance. Other behaviors and areas of concern may include serious verbal aggression, occasional outbursts in which the child becomes dangerous to others or self, some destruction of property, school suspensions and other school-related problems, mild delinquent behavior, sexual acting out that responds to supervision and restrictions.
Children served at the Special or Exceptional Level differ from each other in the intensity and range of their problems and in their capacity to relate to and connect with substitute parents.
A child served at the Extraordinary Level has a mental health diagnosis and presents severe emotional and/or behavioral management problems. There are intensive problems in the areas of attention, defiance, oppositional behavior and impulse control. There may be significant verbal aggression with some physically aggressive behaviors towards peers and adults; property destruction may require the replacement of articles in the home and of clothing. There may be episodes of self-abusive and/or suicidal behavior, sexual acting out behavior (including sexually reactive behavior with aggression), run away episodes (brief absences), and delinquent behavior. Despite the severity of the child’s symptoms, he/she has demonstrated some capacity and desire to live in a family and form a connection with adults.
BASIC-PLUS GROUP CARE
Program Description:
Basic-Plus Group Care provides treatment services and supervision to a child in the structured, supportive setting of a group home or residential facility. Programs and services are provided in small, neighborhood-based group homes or campus-based facilities. The child attends school in the community and participates in community-based recreational activities and services. Each child has an individual written service plan that identifies treatment goals and needed services and resources. A mix of services is provided to include counseling, education, recreation, daily living experiences, independent living skills and reunification services.
Description of Children Served:
Basic-Plus Group Care serves those children whose needs fall between traditional group home and intermediate residential care. The services target primarily those children who are involved with the child welfare or juvenile justice systems. A major goal of the program is to stabilize the child’s living arrangement and help the child repair the damage that has been done by previous adverse life experiences. Some of the children are “stepping down” from more structured treatment programs. Basic-Plus Group Care provides these children with additional opportunities to generalize what they have learned at the more restrictive levels of care.
INTERMEDIATE RESIDENTIAL TREATMENT
Program Definition:
Intermediate Residential Treatment provides 24-hour care for a child in a residential facility designed as a therapeutic environment. Programs and services are provided in a wide range of settings, such as neighborhood-based group homes, campus-based facilities, and other self-contained facilities, including secure units. Within these settings, children receive a mix of individualized services, including individual, group and family therapy, psychiatric evaluation, education, activity therapy, occupational therapy, speech and hearing therapies, substance abuse treatment, daily living experiences, independent living skills, reunification and aftercare services.
There are three levels of Intermediate Care – Special, Exceptional and Extraordinary. A child is assigned to the appropriate level based on clinical symptoms, functioning and characteristics and the services that will be needed to improve the child’s ability to succeed in a family or less restrictive living situation, in school, at work and in the community. Each level is designed to serve the child and family. Each level of intermediate care provides children with opportunities for learning that can be generalized to family and community life.
The levels differ primarily in the severity of the children served and the amount of treatment and specialized services that are provided to achieve the desired outcomes for each child.
Description of Children Served:
A child appropriately served in Intermediate Residential Treatment has a mental health diagnosis and substantial problems in one or more areas of life. A child at this level has mental health needs and behaviors that present a moderate to severe risk of causing harm to self or others and interfere with the child’s ability to function successfully at home, in school and in the community. The exhibited behaviors are of at least six months duration. Some of the children served in intermediate care are in transition from a more intensive form of care.
A child served at the Special or Exceptional Level has a mental health diagnosis and moderate to serious emotional/behavioral management problems. Behaviors may include: threats to harm peers/adults, occasional outbursts in which the child becomes dangerous to others or self, deliberate destruction of property, sexual acting out (including promiscuity, sexually-reactive behaviors), self-injurious behavior and/or suicidal intent (with or without an actual attempt), chronic running away (brief absence), pre-delinquent and delinquent behavior and school suspensions and other school-related problems. The child experiences moderate to high levels of anxiety, depression, hyperactivity, moodiness, withdrawal and impulsivity. Children served at the Special and Exceptional Levels differ from each other in the variety and intensity of their emotional and behavioral problems and in their responses to prior therapeutic interventions.
A child served at the Extraordinary Level has a mental health diagnosis and severe emotional/behavioral management problems. Behaviors may include: routine threats to harm peers/adults, occasional outbursts in which the child becomes dangerous to others or self, self-injurious behavior and/or one or more suicide attempts, frequent physical altercations with peers, sexual acting out that is frequent and requires restrictions, destructiveness of property that requires replacement of articles, frequent suspensions that have resulted in expulsion and exclusion from community schools, occasional runaway episodes (prolonged absence), and delinquent behaviors. The child experiences high levels of anxiety, depression, hyperactivity, moodiness, withdrawal and impulsivity.
THERAPEUTIC RESIDENTIAL WILDERNESS CAMPS
Program Definition:
Therapeutic Residential Wilderness Camps provide care, supervision and treatment in an outdoor setting where physical, environmental, athletic and other challenging activities are therapeutically designed to improve the child’s social, emotional, and educational functioning and to teach the child prosocial adaptive skills. Children live in outdoor settings. Therapeutic intervention is encompassed within a unique program milieu and involves physical and psychological challenges, which are implemented by professional and paraprofessional staff under the direct supervision of professional staff. Appropriate professional staffs are employed on a full time, part time or consulting basis (depending upon the size of the program and the needs of the children). Such staffs include a psychiatrist, psychologist, nurse and an adequate number of therapists or social workers to carry out the treatment plan with the children. The camps have on-grounds schools.
There are two levels of Therapeutic Wilderness Camps – Special and Exceptional. A child is assigned to the appropriate level based on clinical symptoms, functioning and characteristics and the services that will be needed to improve the child’s ability to succeed in a family or less restrictive living situation, in school, at work and in the community. Each level is designed to serve the child and family. Each level provides children with opportunities for learning that can be generalized to family and community life.
The levels differ primarily in the severity of the children served and the amount of treatment and specialized services that are provided to achieve the desired outcomes for each child.
Description of Children Served
A child appropriately served in a Therapeutic Residential Wilderness Camp has mental health diagnosis and exhibits substantial problem behaviors in a variety of settings, such as home, school and the community. The child must be of an age and developmental level to participate in and understand the concepts underlying the physical experiences and challenging activities and the purpose of his/her participation in the program.
A child served at the Special Level has a mental health diagnosis and behaviors that present a mild to moderate risk of causing harm to self or others, including depression, withdrawn behaviors, undisciplined behavior, physical fighting, violations of rules at home and at school, truancy, brief but chronic absence from the home and school, lying, stealing recklessness and risk-taking acts. Some of these behaviors may be episodic in nature.
A child served at the Exceptional Level has a mental health diagnosis and behaviors that present a moderate to serious risk of causing harm to self or others, including depression, withdrawn behaviors, undisciplined behavior, physical fighting, chronic violations of rules at home and at school, school suspensions, prolonged absences from home and school, lying, stealing, recklessness and risk-taking acts. A child at this level has demonstrated a consistent pattern of violating social norms and expectations across a variety of settings.
INTENSIVE RESIDENTIAL TREATMENT
Program Definition:
Intensive Residential Treatment provides a highly structured program with 24-hour supervision. Secure programming is available for evaluation and crisis stabilization as needed for children in acute condition of danger to self or others. There are formalized behavior groups and therapeutic interventions, including individual, group and family therapy. Therapies occur more frequently at this level of care in order to achieve stabilization and improve functioning and increase adaptive behaviors. The treatment plan is implemented in all aspects of the child’s daily living routine. Activities and interventions are individually designed with the goal of stabilizing and improving the child’s severe emotional problems. The child has access to community activities, public school participation and other normalizing situations as promptly and fully as is consistent with the treatment plan. There is 24-hour nursing coverage, with social work, psychiatric and psychological support on staff. An on-campus school is available.