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1 THERAPEUTIC ACCESS: An Innovative Access Program that Expedites Permanency Planning A Partnership Between: Thistletown Regional Centre, Ministry of Children.

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Presentation on theme: "1 THERAPEUTIC ACCESS: An Innovative Access Program that Expedites Permanency Planning A Partnership Between: Thistletown Regional Centre, Ministry of Children."— Presentation transcript:

1 1 THERAPEUTIC ACCESS: An Innovative Access Program that Expedites Permanency Planning A Partnership Between: Thistletown Regional Centre, Ministry of Children & Youth Services, Ontario and The Childrens Aid Society of Toronto

2 2 Therapeutic Access Presenters: Mary Rella Manager of Assessment, Consultation & Training Thistletown Regional Centre Shannon Deacon Therapeutic Access Program Coordinator Childrens Aid Society of Toronto Kathy Duncan Child Welfare Supervisor Childrens Aid Society of Toronto

3 3 Therapeutic Access BACKGROUND….

4 4 Why is Access so Important? Good Access Planning is pivotal to casework success Good Access Planning is pivotal to casework success Well managed access provides opportunities to assess, teach, and correct parenting behaviours Well managed access provides opportunities to assess, teach, and correct parenting behaviours Well managed access allows us to develop early and successful permanency plans for children Well managed access allows us to develop early and successful permanency plans for children Well managed access contributes to placement stability Well managed access contributes to placement stability

5 5 When Access Goes Well… Maintains continuity in a childs relationship to their family Maintains continuity in a childs relationship to their family Contributes to a sense of psychological permanence for the child Contributes to a sense of psychological permanence for the child Assists the child and family in confronting the reality of separation, the reasons for it and the need for caregiving behaviours to change Assists the child and family in confronting the reality of separation, the reasons for it and the need for caregiving behaviours to change

6 6 When Access Goes Well… ( contd ) Assists families to cope more adaptively Assists families to cope more adaptively Provides a time and place to practice new behaviours Provides a time and place to practice new behaviours Provides an opportunity to assess the reasons for deficits in caregiving behaviours Provides an opportunity to assess the reasons for deficits in caregiving behaviours Provides an important transition when reunification is possible Provides an important transition when reunification is possible

7 7 When Access Does NOT Go Well… Promotes confusion for the family Promotes confusion for the family Disrupts continuity in a childs life Disrupts continuity in a childs life Promotes anxiety about the reasons for the separation and the reasons change is necessary Promotes anxiety about the reasons for the separation and the reasons change is necessary Contributes to disagreements between Family and Workers, Workers with Workers, Courts with Workers Contributes to disagreements between Family and Workers, Workers with Workers, Courts with Workers

8 8 When Access Does NOT Go Well… (cont) It continues with little resolution or understanding It continues with little resolution or understanding It goes on forever with poor direction towards decisions It goes on forever with poor direction towards decisions It promotes instability and poor permanency planning, ie. environmental or emotional stability It promotes instability and poor permanency planning, ie. environmental or emotional stability

9 Mary Rella THERAPEUTIC ACCESS Mary Rella, B.A. Psych., Dip. C.S. Psych. INTERFACE Program Thistletown Regional Centre Ministry of Children & Youth Services From Supervising Access to Building Parent Child Relationships

10 Mary Rella Access as an Opportunity for Therapeutic Intervention

11 Mary Rella THERAPEUTIC ACCESS Overview Attachment Informed Attachment Informed Research Based Research Based Interventions with parents are specific and linked to the reasons for historical parenting deficits Interventions with parents are specific and linked to the reasons for historical parenting deficits Risk Reduction Assessment Model Risk Reduction Assessment Model Supervised Access/Semi-Supervised Access Supervised Access/Semi-Supervised Access Partnership between Child Welfare and Childrens Mental Health Partnership between Child Welfare and Childrens Mental Health

12 12 From Supervising Access to Building Parent Child Relationships Productive in the Environment vs Product of Environment Resource-rich Worker Silent Worker Intervention Focused Note Taker

13 Mary Rella INTERVENTIONS Our understanding of the parents perspective is crucial to help them change. Change requires Parents to build a bridge between their reality, i.e., whats wrong with what Im doing and adaptive parenting.

14 Mary Rella Therapeutic Access Assisting parents to cross the bridge by helping to link the caregiving experiences they received to current maladaptive behaviours in parenting Building adaptive parenting skills based on their own understanding that change needs to happen Promoting Secure Attachments

15 Mary Rella Therapeutic Access Interventions Aimed Aimed at helping the parent(s) learn to reduce the risk to their child as defined by Child Welfare Planned and organized by the Child Welfare Team and the Parent

16 Mary Rella Criteria for Therapeutic Access Planned shortly after the child is placed in care or when access is re- evaluated. Included as a part of the Court material with specific criteria that identifies goals and/or process to achieve goals Longer in duration, e.g., 2-4 hours. Focused on learning new strategies and/or practicing more adaptive parenting skills.

17 Mary Rella Criteria for Therapeutic Access (contd) Focused on skill building for the parent and child. For example, the skills can be relational or behavioural. Interventions aimed at increasing skill level and/or demonstrating skill level. Effects of external therapeutic intervention are evident in Access.

18 18 Interview: Caregiving Behaviours Their own childhood experiences Mothering/Fathering Their own childhood experiences Mothering/Fathering Conflicts and how they were resolved Conflicts and how they were resolved Trust Trust Impact on current parenting Impact on current parenting

19 19 Interview as a Blueprint for Change The quality of the caregiving relationship is influenced by the caregivers: The quality of the caregiving relationship is influenced by the caregivers: –Own attachment experience –History and experiences of care as a child –Internal working model and mental representation of the self and others –Defensive strategies

20 Mary Rella Identified Risks to Children Formulation History of Trust: Parent memories of Caregiving behaviours they received Adult Attachment & Key Relationships Attachment: Parent and Child Child and Parent Parent Cues to Act: Dispositional Representations Identifying Risks for Parents Intervention Plan Template Information acquired to create a therapeutic alliance with parent Parenting Model Parenting Behaviours Affecting Parenting Patterns of Parent Child Relationships Parental Acceptance of Responsibility for Change Review Recommendations

21 Mary Rella Structure to Therapeutic Access 1. Saying Hello 2. Playtime/Activity Time: unstructured time 3. Meal/Snack: structured time 4. Preparation for Separation and Planning for Next Visit 5. Debriefing with the Parent

22 22 Patterns of Parent Child Relationships Adults with sensitive caregiving behaviours promote secure attachment relationships Adults with sensitive caregiving behaviours promote secure attachment relationships Inconsistent, rejecting and/or A-typical parenting behaviours promote insecure attachment relationships Inconsistent, rejecting and/or A-typical parenting behaviours promote insecure attachment relationships

23 23 Maladaptive Caregiver Behaviours Unresponsive to childs cues Unresponsive to childs cues Inconsistence in sensitive responses Inconsistence in sensitive responses Parents needs above the childs needs Parents needs above the childs needs Rejecting behaviour Rejecting behaviour Affectively unavailable Affectively unavailable Inability to provide comfort Inability to provide comfort Frightening to or frightened of child Frightening to or frightened of child Dissociative Dissociative Intrusive Behaviours Intrusive Behaviours

24 Mary Rella Correcting Behaviours Parent Focused Parents who are over-involved behaviourally Under-involved emotionally Parents who promote fusion and enmeshment, i.e., unable to separate self from child Unable to read cues from child Unable to respond to cues

25 25 Interventions: Overview Increase sensitive behaviours Increase sensitive behaviours Reduce rejecting behaviours Reduce rejecting behaviours Reduce inconsistencies in parenting behaviours Reduce inconsistencies in parenting behaviours Eliminate frightening, frightened, dissociative, or intrusive behaviours Eliminate frightening, frightened, dissociative, or intrusive behaviours

26 Mary Rella Teaching Parent Containment Containment Contingent Responsivity Contingent Responsivity Emotional Regulation Emotional Regulation Dyadic Regulation Dyadic Regulation Communication of Affective States Communication of Affective States

27 Mary Rella Result: Parents positive affect allows child to be more engaged Joint attention Affective attunement Sensitivity and Responsiveness reads childs cues, responds appropriately

28 Mary Rella Access is One Snapshot in time Involve parent and their personal story Involve parent and their personal story Move away from a Silent Child Protection Worker to an Involved Resource-rich Worker Move away from a Silent Child Protection Worker to an Involved Resource-rich Worker

29 Mary Rella Understand how Parents make meaning of their caregiving behaviours with their children Understand how Parents organize behaviours towards their children Result: Treatment can support and be intervention focused for purpose of change.

30 30 Consider…. If we only focus on Parents current skills and do not correct the behaviours, we run the danger of supporting patterns of inappropriate parenting.

31 CAST Access Goals in Child Welfare Permanency Planning Permanency Planning Understanding of parental limitations, based on historical factors including trauma Understanding of parental limitations, based on historical factors including trauma Assessment of parents capacity to learn, bridged with reducing risk factors Assessment of parents capacity to learn, bridged with reducing risk factors A comprehensive working plan that informs parents and the legal system A comprehensive working plan that informs parents and the legal system

32 Child Parent Access Plan casework plan (risk factors) culture expected activities level of supervision behavioral indicators frequency location safety plan court plan documentation Fully Supervised Semi Supervised Unsupervised Reassessment Fully Supervised Semi Supervised Access Plan Unsupervised Admission Duncan, Dale, Rella 20067

33 33 Childrens Aid Society of Toronto Therapeutic Access Program Initiated in the Fall of 2005, Initiated in the Fall of 2005, initially funded by Society through the Foundations Block Grant, it is now part of the Societys core budget. The Therapeutic Access Program provided service to 120 children in 68 families in 2006/2007, and as of December 2007, the program had received 125 referrals. Of those families who have completed the program, reunification has been the outcome for 49% of the children. For the remaining 51%, other permanent plans have been sought, including placement with Kin and Kith. The program has created new opportunities for collaboration between the Society and various community services, including the Willow Centre, Ontario Early Years Centres, and the Jean Tweed Centre.

34 34 Therapeutic Access at C.A.S.T. Scarborough Branch North Branch Toronto Branch Etobicoke Branch Referrals Therapeutic Access Program Program Manager Coordinator CYW Consultation TrainingINTERFACE Consults

35 CAST The Role of the Therapeutic Access Coordinator (CAST) To assist workers in developing and implementing Therapeutic Access Plans (TAPs) Accepts and coordinates referrals Accepts and coordinates referrals Creates written therapeutic access plans that outline for the parents, the workers, and the court the risk factors identified in the caregivers history and how interventions will be implemented Creates written therapeutic access plans that outline for the parents, the workers, and the court the risk factors identified in the caregivers history and how interventions will be implemented Conducts developmental interview of parents with their child protection workers Conducts developmental interview of parents with their child protection workers Creates the therapeutic alliance necessary to begin caregiving interventions Creates the therapeutic alliance necessary to begin caregiving interventions

36 CAST …Role of the Coordinator Trains front-line workers on the significance of caregiver history and the link to current parenting Trains front-line workers on the significance of caregiver history and the link to current parenting Guides workers to apply clinical interventions specific to each familys identified needs Guides workers to apply clinical interventions specific to each familys identified needs Provides clear and supportive communication to the family about changes required Provides clear and supportive communication to the family about changes required Assists workers in assessment plans Assists workers in assessment plans Provides written summary of progress/concerns which can be provided to the court with recommendations Provides written summary of progress/concerns which can be provided to the court with recommendations

37 37 The Role of the Child & Youth Worker Collaborates with the Coordinator in developing and implementing therapeutic access plans Collaborates with the Coordinator in developing and implementing therapeutic access plans Provides direct teaching to parents on adaptive caregiving Provides direct teaching to parents on adaptive caregiving Contributes feedback to the overall assessment and recommendations Contributes feedback to the overall assessment and recommendations

38 CAST Referral Process Referral form is user-friendly and easily accessible to workers Referral form is user-friendly and easily accessible to workers Includes: Includes: –Child Protection Risk Factors – current and historical –Reasons for referral (Goals to achieve) –Access plans/observations/concerns

39 CAST The Developmental Interview Both Family & Childrens Service Workers must be present with parents Both Family & Childrens Service Workers must be present with parents Goal is to create a Therapeutic Alliance, necessary to implement parenting changes Goal is to create a Therapeutic Alliance, necessary to implement parenting changes Interview of Parents using Key Relationship Questions to assess: Interview of Parents using Key Relationship Questions to assess: History of caregiving experiences and impact on current parenting History of caregiving experiences and impact on current parenting Parents responsibility to change Parents responsibility to change Behaviours affecting parenting Behaviours affecting parenting Parents strengths & limitations Parents strengths & limitations

40 CAST Therapeutic Access Plan Written Plan includes: Written Plan includes: –Risk Factors for Parent, Child & Family –Familys Strengths –Specific learning tasks to address risk factors –Number of planned teaching hours and date for Review Plan can be added to court documents/protection applications Plan can be added to court documents/protection applications

41 CAST Environment of Access Centre Family Friendly – decorative, warm, welcoming Family Friendly – decorative, warm, welcoming 9 Family visiting rooms, including 2 Infant rooms with cribs, change tables, rocking chairs, baths, etc. 9 Family visiting rooms, including 2 Infant rooms with cribs, change tables, rocking chairs, baths, etc. Kitchen with stove, microwave, fridge, plates & utensils and dining table Kitchen with stove, microwave, fridge, plates & utensils and dining table Large open space for unstructured play Large open space for unstructured play Toys for all ages, stored in one room Toys for all ages, stored in one room

42 CAST Implementation of Therapeutic Access Plan Interventions specific to risk factors, applied by worker in the moment Interventions specific to risk factors, applied by worker in the moment Neglect - Practicing Instrumental Tasks – parents to bring all items needed to care for child, such as food, diapers, clothing Neglect - Practicing Instrumental Tasks – parents to bring all items needed to care for child, such as food, diapers, clothing Emotional engagement – pointing out to parents childs cues, teaching attachment rich interactions Emotional engagement – pointing out to parents childs cues, teaching attachment rich interactions Violence/Physical Abuse – parent presenting to child as not scary, identifying physical safety precautions Violence/Physical Abuse – parent presenting to child as not scary, identifying physical safety precautions

43 CAST Review & Recommendations Program duration weeks Program duration weeks Review after 4-6 weeks to assess progress, concerns, modify plans Review after 4-6 weeks to assess progress, concerns, modify plans Written Summary at Completion, provided to the Court: Written Summary at Completion, provided to the Court: –Number of teaching hours completed –Summary of plan/goals –Changes/Progress made and remaining concerns –Recommendations for reunification, permanent removal, or other alternatives

44 CAST Training Clinical Learning Discussions, Ongoing Case Consultation and Direct Support during Access… To teach workers the importance of understanding the parents past caregiving experiences as they relate to their current parenting behaviours To teach workers the importance of understanding the parents past caregiving experiences as they relate to their current parenting behaviours To provide workers with learning opportunities to teach parents more adaptive parenting To provide workers with learning opportunities to teach parents more adaptive parenting To review and implement attachment theory and research To review and implement attachment theory and research

45 45 Future Directions Continuing to understand and implement current research in attachment theory in front-line clinical work Continuing to understand and implement current research in attachment theory in front-line clinical work Helping parents to develop adaptive parenting models that will ensure their newborns can remain in their care despite past CAS interventions with previous children Helping parents to develop adaptive parenting models that will ensure their newborns can remain in their care despite past CAS interventions with previous children Helping front-line workers understand the significance of providing children with developmentally appropriate information about the risks leading to CAS interventions, as well as teaching workers to assist parents to provide the same messages to promote psychological stability for children Helping front-line workers understand the significance of providing children with developmentally appropriate information about the risks leading to CAS interventions, as well as teaching workers to assist parents to provide the same messages to promote psychological stability for children

46 46 For More Information… Mary Rella, Thistletown Regional Centre Mary Rella, Thistletown Regional Centre Tel: Shannon Deacon, Childrens Aid Society of Toronto Shannon Deacon, Childrens Aid Society of Toronto Tel: , ext


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