A COMPREHENSIVE SYSTEM OF CARE FOR CHILDREN AND FAMILIES Ken Berrick, Founder and Chief Executive Officer Seneca Center for Children and Families

Seneca Center – Then and Now 1985: One six-bed group home and one special education classroom serving 12 children. 2008: Comprehensive continuum of residential, community-based, and school-based programs serving over 1,600 children and their families each year

Seneca Center—The Early Years Small group home: home-like settings that provide 24-hour care and treatment Professional, well-trained counselors focused on building nurturing relationships with children A therapeutic living environment that emphasizes safety, predictability and engagement Promise of unconditional care: you will be supported every step of the way, no matter how challenging your needs or circumstances

Strengths and Challenges of Residential Care Highly-structured, 24-hour care promotes safety and stability for the children Most children show improvement during their stay in group care However: Staff turnover inhibits consistency of care Contagion effect: troubled children more likely to act out in a group setting Can be difficult to achieve a smooth transition of the child back to family

A New Model: Intensive Treatment Foster Care Combines the best elements of foster family care and residential treatment A nurturing and therapeutic family environment that incorporates individualized and structured treatment for the child Professional foster parents are carefully selected, trained, and supervised Support provided by a therapist and in-home counselors

Challenges of Implementing Wraparound Less control over a child’s behavior Great diversity of needs and issues across families Effectively blending the multiple perspectives and opinions of wraparound team members Finding the right staff to implement wraparound

Service Options to Build a Comprehensive System of Care Out-of-Home Care Family-Based Services Community- and School-Based Services

Out-of-Home Care (1) Therapeutic Group Home Care A more home-like alternative to large congregate care settings 5 to 10 beds in each group home Youth counselors and social workers Children are taught social and independent living skills Children participate in individual, group, and family counseling

Out-of-Home Care (2) Therapeutic Foster Family Care Family-based treatment alternative to group home care Professional, highly-trained foster parents Children and foster parents supported by social workers and youth counselors Children are taught social and independent living skills Children participate in individual, group, and family counseling

Family-Based Services (1) Wraparound Children supported to live with biological family members Wraparound planning team that includes relatives, family friends, other involved individuals, and professional staff The team develops creative solutions to keep children from being placed out of home Services and supports are highly individualized and draw upon family and community strengths

Family-Based Services (2) Multisystemic Therapy Intensive family intervention that maintains youth with parents or relatives Extensive research to support clinical and cost-effectiveness Well-defined treatment techniques that include behavioral parent training and cognitive-behavioral therapy for the youth Therapist works with 4 to 6 families at a time; available on a 24/7 basis Treatment duration of 3 to 5 months

Family-Based Services (3) Functional Family Therapy Intensive family intervention that maintains youth with parents or relatives Extensive research to support clinical and cost- effectiveness Organizes family treatment into specific phases: engagement, behavior change, generalization Therapist works with 6 to 8 families at a time Up to 30 sessions of direct service, spread over 3 to 5 months

School-Based Services (1) Specialized Non-Public Schools Small classrooms of 12 students Each classroom has a teacher, one or more therapists, youth counselors Highly-structured behavioral management system Students participate in individual, group, and family counseling Focus on transitioning students back to public school

School-Based Services (2) Public School-Based Mental Health Services Therapist and youth counselors collaborate with public school teacher Structured behavioral management system Students participate in individual, group and family counseling

Community-Based Services (1) Mobile Response Services Short-term intervention to resolve child crisis in the home, at school, or in other community settings Mobile response team consists of two therapists or one therapist and a youth counselor Team works with family to create a safety plan Up to 30 days of follow-up support to ensure family stability

Community-Based Services (2) Crisis Response Center Facility-based support for adolescents in crisis Designed to help youth whose problems can be resolved in 23 hours or less High staff-to-child ratio of therapists and youth counselors are able to stabilize youth in serious distress Time-limited follow-up services, including case management, short-term individual and family therapy, in-home support, working with individuals in social support network

Developing a Comprehensive System of Care Service needs will vary from child to child, family to family Ensuring that each child and family receives the services they need to address their specific circumstances Determining the right mix and balance of service options

Challenges of Implementing Therapeutic Foster Family Care Recruiting and retaining foster parents to work with troubled children Supporting the foster parents without being too intrusive in their family life Striking an effective balance between the role of foster parents as therapeutic agents and their role as parents in a family home

Wraparound: Restoring Children’s Family and Community Bonds Reunifying the highest-need children with birth family or extended family Family members as partners in service planning and delivery Emphasis on creativity and flexibility to meet child and family needs Engaging the wider community to support the child and family

A New Approach to Residential Care The Oak Grove Center for Family Connections Combining residential care with wraparound to return children to their families and communities Parallel and follow-up community services to reconnect children and family Families are involved in what happens in the residential facility

Supportive Services at School and in the Community Importance of a stable and supportive educational setting Seneca’s non-public schools and public school-based programs Mobile response services: a time-limited intervention to stabilize families in crisis and prevent out-of-home placement Crisis response center: designed to stabilize youth whose issues can be resolved in less than 23 hours

Building a System of Care That Promotes Consistency and Coordination, Rather than Fragmentation of Services

E XAMPLE OF S ENECA C ENTER Evolution from a Small Group Home Provider to a System of Care Agency