NAFI NY PLL, Family Wraparound, Westchester Wraparound

NAFI NYPLL, Family Wraparound, Westchester Wraparound December 14, 2012 Shanon Harris, Home Finding Supervisor-WW/PLL Director Tanya Rodriguez, Clinical Director-WW Tracey Corsiglia, Program Director-WW

Where NAFI Began… • Dr. Yitzhak Bakal founded NAFI in 1974, after feeling that youth improve in community settings, and do worse in institutions. • This philosophy has carried NAFI into 10 different states and more than 90 different programs, serving youth, families, and adults in community-based settings. • Dr. Bakal also instituted his Normative Community Approach in all programs, which empowers the clients and consumers to learn approaches that are useful in building healthy, strong communities wherever they may go.

Where NAFI-NY Began… • 2000-2006 Westchester County began consulting with NAFI to improve the way they provided services to youth and families being served by the Department of Social Services • 2006 NAFI Westchester Wraparound gets approved and begins working with youth placed out of state, to bring them back into their home communities • 2006-Present NAFI WW has worked successfully with over 60 youth with issues ranging from Sexual Offenses and Fire Setting to Truancy and Oppositional Behavior.

Where NAFI-NY Began… • 2008-NAFI NY gets approved for the Family Wraparound program and begins working with youth and families to prevent foster care placements. • 2008-Present Family Wraparound has worked with over -125 families, referred primarily to help the caretaker manage the youth’s behavioral issues. • 2012-NAFI NY gets approved for the Evidence Based Practice of PLL-Parenting with Love and Limits-program, and begins working with youth and families on re-entry-bringing youth back from Residential Treatment Centers. • 2012-Present PLL now also has a contract to work with youth and families to prevent Residential Placements of youth at risk of involvement with family court.

NAFI-NY Mission Statement • NAFI-NY empowers and strengthens youth, families and communities through supportive, innovative programs and strategies that respect individuality and culture.

NAFI-NY Philosophy • We actively use the 10 Principles of Wraparound in all of our Programs: • Family voice and choice (nothing about us without us) • Team based • Natural Supports • Collaborative • Community based • Culturally competent • Individualized • Strengths based • Persistence • Outcome based

NAFI-NY Philosophy • Guiding Principles • The services will be: • Youth centered • Community based • Individualized to the needs and potentials of each youth • Provided in the least restrictive environment • Designed in partnership with the birth families, foster families, and community partners • We commit to • Integrated and coordinated linkages to child and youth serving agencies and programs • Using a strength based approach • Advocating for the rights of our youth • Providing services without regard to race, religion, national origin, sex, sexual orientation, physical disability or other characteristic, and to services that will be sensitive and responsive to cultural difference and special needs • Using financial and staff resources in a flexible manner to meet the changing needs of the youth • The highest standards of accountability by using measured outcomes and systematic documentation.

Who we serve… • All referrals come from the Westchester Department of Social Services (DSS) • We serve the ages of 12-18 • The behaviors and/or diagnoses served are: • Sexual aggression, including juvenile sex offenders • Fire Setting • Psychiatrically fragile-bipolar disorder, schizoaffective disorder, major depressive disorder, ADHD, anxiety disorders, etc. • Developmental Disorders-PDD, Mental Retardation • Medically fragile-brittle diabetes, etc. • Probation involvement

How we do it… • Recruitment/Training/Retention of Staff and Foster Parents • Referral • Psychosocial Assessments, Child Behavior Checklists, University of RI Change Assessment, Family Functioning Assessment, FACES-IV • Matching with FP (WW only) • Pre-Placement (WW only) • Admission • PLL Group Cohort Sessions-6 Parenting Groups (Group Therapy for Parents) • PLL-minimum of 8 family coaching sessions • Strategies-Safety Planning, Behavioral Planning • Community Based Action Team (PLL only) • Benchmark Meetings (PLL only) • Planning for Discharge/Aftercare Plan • Support for Birth Parents

Referrals • All Referrals come from Westchester County Department of Social Services • WW has a ‘no reject-no eject’ policy, and all referrals are considered for and accepted into the program, depending on if a foster parent match is available, if no match is available, the youth is placed on a wait list until a home becomes available. • PLL has very few exclusionary criteria, if a youth is age 10-18 and has a viable discharge resource, they are accepted into the program. Heavy drug use and active psychosis are other exclusionary criteria. PLL will work with youth who are considered sex offenders, however PLL cannot be the primary treatment program.

Referrals • Assessments: • Both WW and PLL make independent assessments of the youth referred to the program, using the ‘referral packet’ only as a guide. • WW will conduct a psychosocial assessment prior to matching a child with a foster parent by interviewing the youth, their biological family (if appropriate) and any staff at the facility where the child is currently placed. • PLL conducts the following assessments on their youth and families at the time of admission: Child Behavior Checklists, University of RI Change Assessment, Family Functioning Assessment, FACES-IV. • PLL conducts a motivational interview within 48-72 hours of receiving a referral, to begin engaging the families.

Referrals • Upon completion of the WW Psychosocial Summary, the document is reviewed during a staff meeting or clinical meeting, where as many staff members participate in discussing the case • During these discussions, we discuss what is needed for the child to succeed: • School • Mental Health • Safety Contracting • After school activities • Level of Supervision • Additional evaluations • Foster Parent Match

Engagement • In WW at the time the foster parent says “Yes” to a match (which is after they have had the opportunity to read the child’s chart and discuss it with WW staff), the child is officially in ‘Pre-Placement’ • Pre-placement is the period of time from when a youth is matched with a foster parent to the time they ‘Step-Down’ into the program • During this time, the foster parent and biological parent (if appropriate) are introduced, before the FP meets the youth, so they can begin working on a shared parenting experience. This helps the reunification process. • After the FP and BP meet, the FP is introduced to the youth, and visits between the FP and youth begin. This starts with visits at the Residential Facility and eventually move to weekend visits at the foster home. • Pre-Placement can take anywhere from a few weeks to six months. On average, WW has a 2 month pre-placement time frame

Engagement • PLL conducts a Motivational Phone Intake and then a Motivational Interview, face to face • The purpose of the intake is to assess the family’s strengths and needs, and to contract with them to accept the program. PLL is voluntary and the family must accept the services of their own accord. • Parents are informed that the program is time limited and are provided with an out line of what the six group sessions entail • During the initial interview, a genogram and eco-map is developed to help the family identify potential barriers that may prevent them from participating. The PLL CM and Clinician are then able to work with them to remove those barriers, ie, child care, transportation, availability, duplication of services.

Engagement • Support for Birth Parents: • Constant Communication • Family Therapy • Engagement in all appointments for their child-doctors, psychiatry, educational • Participation in Summer Barbeque • Family Coaching Sessions • Parent Group Therapy • Individual or Couples Therapy (where appropriate) • Introducing them to their child’s foster parent, giving them a choice • Introducing them to the program first, before their child • Letting them be the experts on their families • Commitment to multiple chances for engagement • Advocacy with other systems-DSS, Substance Abuse Programs, Housing, etc. • Use of community resources for obtaining household items, employment, food

Admission • After the child is admitted to WW, the team (Clinician, CM, FP, BP, DSS) work together to achieve the child’s permanency goal (return to parent, independent living, adoption, adult custodial care) via providing individual and family therapy, concrete services (educational, medical, recreational, independent living skills), planning for discharge from day one, safety planning, providing creative outlets for socialization and developing a sense of community (Mural Projects, Film Projects, Summer Barbeques, Holiday Parties, Educational and Recreational Trips)

Admission • After the child is admitted to PLL, the team (Clinician, CM, CBAT (Community Based Action Team) BP, Youth, Residential Facility, DSS) work together to achieve the goal of reunification. • The Clinician is responsible for facilitating the Parenting Groups (Group Therapy), and family coaching sessions. • The CM is responsible for developing the CBAT and identifying services to ensure the youth’s transition to the community is successful. • Both the Clinician and CM serve as liaisons between DSS and Residential Facilities to increase communication, and ensure that all parties are planning for discharge.

What is a CBAT? • A Community Based Action Team is comprised of professionals in the community that help the family identify services that would be helpful to them when the youth returns home, ie, helping the youth to obtain employment, or to have a mentor at school. Someone in the parent’s ‘village’ can also be in the CBAT, ie, clergy or a family member who may have connections in the community.

The Strategies We Use • For WW we use: • On Call Services • Planned Respite • Planned Hospitalization • Safety Planning • Who • Youth--Birth Parents/Family--Foster Parents--NAFI Staff—DSS--Other Supporters • When • Pre-placement visits (day and/or overnight)—Step Down—Foster Home—Family Visits—School—After School/Extracurricular Activities—As concerns/issues arise • What • Overall safety goals—Responsibility of youth, family and NAFI—Triggers—Interventions—Indicate Supports—Consequences • Why • To help youth and all parties involved feel safe—To help youth with transitions—To help you feel like a participant in their care—To hold all parties accountable for ensuring safety in home and community

The Strategies We Use • In PLL we use: • On Call Services • Behavioral Planning • In PLL, behavioral planning is establishing an Iron Clad Contract between the parent and child regarding rules, consequences, and rewards. • The contract is introduced in the parenting group session and are established during the family coaching sessions.

Planning For Discharge • Discharge Planning is started at the time of Admission • Discharge planning is part of the youth’s on going service planning, and is discussed at least every 6 months during Service Plan Reviews done with DSS, the foster and birth families and the youth • The youth, no matter how old, are a part of the service planning, so they understand, to the best of their ability, that foster care is temporary, and what we do is to get them to achieve their goal

Planning for Discharge • In PLL, while the child remains at the Residential Facility, the following occurs: • Identifying an appropriate school placement • Developing the behavioral contracts and giving the parents and youth an opportunity to test the contracts during planned home visits • Identifying all other services the parent may need, utilizing the CBAT and CM

Planning for Discharge • In WW, we partner with Birth Families to facilitate a discharge home: • From the start of the referral process, WW works with the birth family, where appropriate, to have them get to know the foster family. The foster family then develops their own relationship with the birth family to help them and the child achieve their permanency goal. This entails phone calls, the foster parents being a part of the family visits, inviting birth parents to the foster home (where appropriate) for celebrations (birthdays, holidays).

Tools and Activities • Group Incentives-Food, Raffles, Providing Child Care, Providing Transportation • Use of Video Conferencing (PLL) for family coaching sessions • Parties/Trips-Holiday Party, Summer Barbeque, Kid’s Holiday Party, Movies, Dorney Park, Intrepid • In Home/In The Community Treatment • Individualized Treatment-”Think Outside of the Box” • Flexible schedules for workers • 24 hour on call services • Facilitating Transportation for Birth Parents • Ensuring, as best as possible, that the Birth Parent and Foster Parent meet first • Coordinating with Residential and DSS staff

Challenges • Other agencies and DSS not understanding what Wraparound means • Conflicting philosophies with school districts on appropriate placements • Conflicting philosophies on discharge dates • Conflicting philosophies on how best to help youth with Residential Facilities, Birth Parents, DSS, Schools • Foster Parents not understanding what Wraparound means • Coordination of family coaching sessions with Residential Facilities • Pre-Placement in WW is too long (or, rarely, too short) • DSS not wanting to embrace the risk and try these programs • Staff not understanding the philosophy, not “buying into” the program

Lessons Learned • Develop positive relationships with DSS, Schools, other Agencies, Collaterals from the start of the program-Honoring their philosophies in order to collaborate • Providing education to other system partners • Matching the staff to the program • Full Disclosure with foster parent about what to expect, using real world examples in recruitment and initial trainings • Identifying appropriate referrals for PLL • Self-Care • Use your Gut-in regards to safety issues

Tips • Collaboration • Safety First • Use Your Gut • Out of the Box Thinking • Networking • Be Creative and Innovative • Use a Multi-Disciplinary Team Approach

NAFI NY PLL, Family Wraparound, Westchester Wraparound