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Family based care?

2015

We are exploring the potential of operating a residential program for families in need. In this program, entire family units would move into a therapeutically supported program for a period of "X" weeks. During their stay, they would participate in a variety of experiential and cultural challenges focusing on building resilience and strength in the family, improving communication, teaching interpersonal skills and more. As we build our model, we have questions about duration of stay and after stay support — which is where we are seeking input.

For duration of stay, do we operate a program where families come in for an undetermined length of time, leaving only when they are ready, or do we establish a set duration of program? If so — what is that duration? Once a family leaves how do we best support them? How do we maintain the delicate balance between supporting and helping, but not being a crutch or "doing for"?. We've examined many programs — some seem very short (days) others seem excessively long (months).

These philosophical questions are challenging to answer, but are core to the formation of a valid and meaningful program. So... in your personal or professional experience — what do you feel a best practice model of care for a program like this would look like?

Thank you!

Andrew Middleton
...

Hi Andrew,

Firstly I would like to congratulate you for such a wonderful program. My understanding of such a program is that it requires at least two weeks excluding weekends.

Regards

Bongani Buthelezi
...

Hi Andrew

What an amazing opportunity for families and for the CYC ractitioners implementing the program. Wonderful idea Andrew!

Regarding the length of stay for families: Why not make this part of the assessment process? Examining the issues within each family unit, the team/family would determine the programs required to meet their needs. Once these programs are determined the length of stay could be figured out. Weekly check ins with the families could ascertain whether or not the programs/strategies are being effective, are other issues surfacing that need to be addressed with additional programs or is the family unit succeeding causing the length of stay to increase/decrease.

Follow up — family members could journal, call the facility for support and attend a weekly support group. Successful families of the program could potentially become supports for newer families and a once monthly family fun day could be arranged — food and games. The games could reinforce the skills engaged in at the facility and awards could be handed out to the families (communication, unity, fun).

You may want to examine:

If the families are living at the facility how will this impact their own housing arrangments? Income assistance, etc. The answers to thes particular family concerns may provide you with parameters.

Good luck Andrew. I know if there is a way to make this happen you will be successful.

Charlene Pickrem
...

Hello Andrew,

A social innovation entrepreneur in progress myself, I am interested in your residential program for families. The first thing that comes to my mind when asked about duration of stay, is that in order to facilitate a therapeutic program with specific goals (family cohesiveness/communication), a shorter time limit, as in 3-5 days, would probably initiate motivation and participation, as well as take into consideration the difficulty of being away from the usual family home and taking care of daily tasks, jobs, pets etc.

I can’t help but imagine that setting up a family for “an undetermined amount of time” may turn into “a crutch”. SMART goals have taught us that time limits help to plan, motivate and be challenged to reach a goal in a particular amount of time. A free spirit by nature, and one who feels much stress bound by time....I have to admit that limits and deadlines absolutely kick me into action and gear and I am much more productive....that’s just me....but....

That’s my two or three cents worth. I wish you all the best with your endeavours! Have you checked out Wood’s Homes in Calgary? Here is the link....

http://www.woodshomes.ca/site/PageServer?pagename=programs_Whole_Family_Treatment

Ally
...

Hello Andrew,

I am very glad to hear that you guys are looking into making a residential program for families in need. From what I have been learning from my classes and practicum placements there is much need for the whole family to undergo therapy together rather than just getting the children/youth the help that they need. If the children/youth are removed from the toxic environment to be fixed and then return to that environment, it is much more likely for a relapse to occur, and they will revert back to their old behaviours.

In regards to how long the family should stay, you have mentioned that you have been looking into having an undetermined length of time or a set amount of time. I have done a practicum in a program that did not have a set period of time, and I am currently doing my practicum in a program that has a set period of 3 months. From my experience, it is my professional opinion that having a set amount of time for the family to stay in a treatment program is more beneficial. I believe this because giving them a schedule and steps that they need to complete within their stay at the facility within a set amount of time gives them more drive and motivation to complete the program. However, when there isn't a set amount of time I have noticed that the clients take their time, procrastinate and push off working through the treatment process. As for your inquiry about how long, I personally feel it would need to be determined by the specific needs of each family, due to the fact that no family is the same nor do they have the same needs. I would suggest looking into how feasible it is to determine the length of time that the family stays based on an evaluation of how much work they need in the areas of experiential and cultural challenges focusing on building resilience and strength in the family, improving communication, teaching interpersonal skills and more. Some families may need to spend more time working on one area than other areas or need to spend more time on all areas than another family.

In regards to helping the family once they leave, how do you best support them, along with keeping the delicate balance between supporting and helping, but not being a crutch. I feel that it is hard for the individuals who have helped the family work through the program to allow the family to use their tools once they have left the program. From what I have learned, there are a couple of different ways to assist the family after they have left. You could have a couple of workers who specifically work with the family after they have left, doing home visits, possibly once a week for about a month or so then making the visits less frequent and eventually not at all. You could also provide the families with outside sources that can assist them once they have completed the program, and let the other resources assist them with the rest of their journey.

Melissa Evans
...

Having worked in a variety of residential, in home and clinic based programs for families I would suggest that if you thought of what you offered and designed it accordingly as a continuum of options this may allow you to be more responsive to what families need. The challenge with starting with a fixed program model, which has actual walls, is this literally and figuratively sets the parameters of thinking about the issue and how they are to be managed.

I remember one "horror" story of a family that was brought into a residents in settings and they literally imploded and required years to regain their own footing. Now this was before the era of CNN and fact checking, but dependent of the truth the story is instructive.

I would echo some other thoughts and in a few others:

Use clearly focused goals and time frames. Open ended horizons can continue to recede into the distance and become illusive.

Explore the Family Conferencing Model generated in New Zealand and embedded in their Child Welfare and Youth Justice legislation since the 1980s. This model achieves a number of objectives. It builds on the strengths and culture of family and kinship networks. It provides a more comprehensive understanding ( assessment) of the family and issues and options. It sets a tone of working with families rather than "doing to" them by acknowledging and utilizing the power within families.

Think of the end goal first, which is families self sufficiency, and work your program backwards from there.

Think in terms of a continuum of options which can link to the developmental journey of families.

Make sure they can bring their pets with them if they do come into the program. Pets are a great indicator of the family health in the moment. Dogs pick up and show the emery level present. Fish not so much.

Good luck.

Rick Kelly
...

Dear Andrew,

It’s great that you are exploring this potential program. A therapeutic residential program for families at risk is such a huge need in our system. As for your question about duration of stay and after support I can really only give advice from what I am learning in my classes and at my practicum placements.

In our classes they teach us about SMART goals and how important it is to have a time frame to accomplish said goals set by the client or program. I know from personal experience I tend to work harder for something when I know there is a deadline. In my professional experience I have been a part of two different programs ranging from three weeks to one year duration. With both programs their goal is to support the client(s) with resources and skills needed to live a successful life after their time is complete. For determining a time frame for your program I would suggest you evaluate the type of skills and tools you are teaching the families and how long it would take to not only teach them but observe these skills being used. Repetition is sometimes the best way to learn a new life skill especially more difficult ones.

As for support after the program my advice would be to create some in home support for the families in their new community. With possibly starting a weekly check in then gradually moving to monthly. This then gives the family time to adjust to being outside of the program but still gives them a safety net and gives you more time to observe the skills being used and if modifications are needed. Again this is all based off of what I have observed from programs during my practicum placement and what I have learnt in my classes. I hope this helps.

Katelyn Morgan
...

Colleagues,

The idea of treatment for families is good and I support it. It comes from the concept of family therapy and the Systems theory that sees a family as a system that should be considered and be treated as a whole. Any intervention should therefore consider how individual members of the family influence one another and how the family as a whole affects individuals.. I suggest bringing intervention to the family? In this way you may also have a broader impact on the surroundings.

My concerns about bringing the whole family into residential care are:

• removing the family from their surrounding and bringing them into residential care will be costly
• Who will take care of their house while they are away on treatment
• Some cultures have extended family so do you envisage bringing extended members as well, the influential granny or uncle who stays with the family?

Lastly I suggest that family residential care should be short and as soon as the family shows signs of being healed they can be reintegrated in their community with regular monitoring and continued support to ensure that they do not regress to old ways.

Mosa Moremi

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