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Thaddius the Large
Jul 5, 2006

It's in the five-hole!


Oh snap, I didnít know this thread existed! Iím a state caseworker in a teen specific unit, and love to talk at length about everything from foster care to juvenile justice to the mental health system and everything in between, so if anyone has general questions about that population Iím happy to chime in, with the usual caveats about region-specific laws and regulations and whatnot. More importantly, yíall providers are goddamn rad and I love you all.

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Thaddius the Large
Jul 5, 2006

It's in the five-hole!


Kodilynn posted:

Anything you have to contribute is certainly welcomed. We're in the second round of authorizations (hopefully to disclosure) on our 3rd attempt at getting a teen (THEY NEED HOMES BUT DELAAAAYS) so i'm very curious about the mental health system and what they do for these teens, as the first two we wanted have been inpatient multiple times for SI among other things. Do the juvenile systems deal or address any of the mental health needs at all? Or are they just holding them and letting it go unchecked?

Turned out our second teen we were attempting to go for decided to sleep with her math teacher, so it ended up on the news and we connected the dots when the photo was released with the name. They ended up labeling her unsafe to be around other children, especially younger, so while I know we're wandering into a forest of behaviors with teens, i'd be curious what kind of stories you have from your area of expertise.

Sorry for the delay, but Iím usually phone posting, which makes trying to offer any kind of a thoughtful response pretty awkward, even beyond my usual rambling, stream of consciousness approach to writing. Mental health services are going to vary immensely by state, everything from what sort of therapeutic offerings are around to how to access them to what may (or may not) be provided versus what you have to seek out. The universal truth is that insurance is god king in deciding what anyone gets, and so at least in my area that means while certain, very basic options are around, they can also be quite generic and limited; basically the most frequent options are weekly outpatient therapy and maybe medication management, if you want any of the frills (skill building, more frequent appointments, more specific or alternative modalities like art or equine therapy, case management, community or home based therapists who arenít limited to an office, etc) it takes a high level of need, a firm diagnosis, will likely be short term (1-6 months).

One of the more common misconceptions Iíve encountered are around mental health placements, because people seem to be of the opinion that if a kid acts out I can just toss them in a group home or a psych ward or whatever. The reality is that in my neck of the woods it breaks down to two avenues, Behavioral Rehabilitative Services and mental health beds. The latter encompasses a variety of options, ranging from transitional housing for 18-21 year olds to home-like residences run by clinical staff, but the common factors are they tend to be very difficult to get into (e.g. actively homicidal or suicidal on a daily basis) and are quick to discharge. The former are much more readily available as they donít require a therapeutic referral, and are instead contracted directly through the state, but are a much lower level of care, and range from the stereotypical foster care group homes to formal programs. The other significant more about BRS is that it is not restrictive and is wholly voluntary, so kids can check themselves out at any time. This obviously make things fun with teenagers in general, let alone those with mental health needs, but I digress, especially as placement issues arenít likely so much what youíll be dealing with.

When a kid is discharged theyíre ideally stepped down the ladder of care (hospital to residential program to intensive community and home based therapy to outpatient therapy) gradually and over the course of weeks or months or however long is therapeutically recommended to ameliorate the concerns. With the pressures that come from insurance and financial folks, whether within the provider organization, the insurer, or whoever else, it means that ideal is rarely aided by systemic forces, and thatís before you take into account that human behavior is a pretty fickle thing, before you take into account mental illness, and oh yeah, these are teenagers, a population known for consistency. The point is I honestly wouldnít interpret too much from repeat hospitalizations, as thereís a ton of factors that could play into it.

The biggest question is probably how you can best assist a teen experiencing significant mental health needs in your role as a placement provider. Everyone on the team can find a specific niche, from caseworker to attorney to CASA to therapist to foster parent, etc, and while many of them are obviously easily defined, a lot of them can vary by personality, so part of this is finding what my old clinician used to refer to as your therapeutic voice. While lessons about attachment disruptions and trauma are important for all foster care kids, when it comes specifically to teens the things I always encourage folks to be mindful of is that being strength based is all the more important; kids always have their own wants, perspective, and desire, and these only get more sophisticated and strong as they age. Whatever mental health symptoms are seen, theyíre likely to have been present for a long time, and as such are fairly engrained, so any sort of change will be difficult, as the kid will have been living with their experiences for longer than younger kids. The good news is theyíre remarkably resilient, and will have developed all the more skills (not always healthy) to address whatever conflict they feel.

Iíve got a number of CSEC involved youth I work with, which can be generally (and not entirely accurately or completely) summed up as child trafficking, and much of the work with these kids turns to a harm reduction model rather than a harm prevention model, accepting that the kid is going to make all sorts of risky, stupid choices even compared to other teens, and the goal is to ensure the kid has access to whatever safety mechanisms you can provide them. The same can be said of teens in general! Obviously having them host an underage oxy-fueled orgy isnít probably a great idea, but working collaboratively to identify specific triggers, coping strategies, and whatnot is a wonderful starting point. Ensuring the kid understands that youíre approaching from a point of mutual respect, safety, and care is how I usually frame things, since while that and the strength-based approach is hardly a guarantee of success, itís a good place to start. The other day I had a foster parent and a kid meet and present each other with a list of their rules for the home, so they could develop a plan together; that kind of obvious and easy example is rare, but they happen! Most of all utilize the kids team, whoever is closest to them is a great resource, as well as their therapist.

When it comes to concerns specifically around sexually acting out, it can mean any number of things, and Iíd be just as cautious to read too much into that too. Sometimes itís a definite issue, sometimes itís a one-off thing that gets blown way out of proportion, usually itís not clear. Talk to folks on the team to get a feel for the specific needs, but common sense applies, ranging from whether the kid requires line of sight supervision around kids to whether you donít want to be alone with them because of what allegations may later come up. Odds are you wonít be privilege to every detail on the kids sexual history, but sex is also likely to be a part of any teens life regardless of their past, so itís gonna be an issue regardless.

On a largely unrelated note, everyone please spay or neuter your teens.

The most reoccurring theme I have around my work is people being surprised at some of the poo poo kids do, from cutting to outright suicide to getting tattoos to stealing cars (or a city bus once, that was awesome) to every drug under the sun to gang poo poo to whatever, and the thing is that while being exposed to it has made me pretty numb and/or cynical, I would also put out there that itís WAY more common and frequent than boomers seem to think, but also nowhere near the screaming panic that people seem to think. By way of example, my uncle volunteers for some charity summer camp thing, and they flipped the hell out when a girl with a history of cutting made some scratches on her arm. Like, yes, thatís not great, but they were thinking she needed to be hospitalized for the foreseeable future. What Iím getting at is a crude sense of humor, thick skin, and a willingness to roll with punches will get you a very long way with teens, unleash your inner 16 year old dirtbag! Donít let the battle scars or rough past scare you off, be honest and thoughtful and nonjudgmental, treat the kid like an adult except with bunch of stupid kids stuff about them, and youíre on your way.

Thaddius the Large
Jul 5, 2006

It's in the five-hole!


tek79 posted:

I'm curious to know if anybody has had any experience with this organization?: https://familypreservation365.com

They seem fringe, and they don't seem all that big or influential but I've got a family member I've reconnected with after a few years who appears to be involved in some way. I'm not saying that some of their concerns aren't valid or shouldn't be considered, but my wife and I are adoptive parents (we have a son who is almost 3, that we've had since his birth) and I'm sort of half expecting I might have to actually defend how our family came to be to this person - as hosed up as that sounds. Their site is pretty meh, but their social media looks like it can be hostile. I just wasn't sure what to make of it. Is this a thing beyond a few fringe nutters?

On another note: I've only ever lurked this thread maybe once or twice. Congrats to everyone, and all the best luck to you and your families!

Without doing any research whatsoever, Iíve had several aggrieved parents start up multiple organizations each, which seemed to all connect into a giant network of people who hate the foster care system; itís never to say there arenít plenty of legitimate critiques to be made, but even beyond how varied policy, procedure, and law are between states, Iím obviously quite leery of any of these groups as even ignoring their specific complaints they tend to be more for personal grievance than a systemic issue. There are plenty of watchdog organizations that are entirely on the level, Iím just hugely cynical about them!

Thaddius the Large
Jul 5, 2006

It's in the five-hole!


Some families are just like that. Iíve got the one kid and canít fathom more, I feel like Iím flustered just handling that much coordination in my life.

Thaddius the Large
Jul 5, 2006

It's in the five-hole!


Kodilynn posted:

Been a couple weeks to wrap my head around it, but our teen is no longer with us by way of her own choices. They decided to go rogue, sneak out, make some poor choices, and end up in police custody. Unfortunately this was a third strike so there isn't a ton we can do since being with us was kind of a last chance to keep her out of the criminal justice system. I'm sure it was self sabotage as it felt like things were going well, but it definitely stinks. Family is kinda reeling and confused still, but we'll kinda see where things go. Don't think we'll be doing this again until our younger daughter graduates and moves out at which point we might just do respite care instead. Ugh.

No fun at all, but donít beat yourself up, Iíve had way too many teens do the same. Even the best foster parents canít take back where the kid has been or all the other influences theyíve got in their lives, the best you can do is try and provide for their needs the best you can and hope they are able to take advantage of it.

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Thaddius the Large
Jul 5, 2006

It's in the five-hole!


Yeah, our response has been to try and stagger people being in the office and maximize working from home, but ultimately stuffís probably just gonna be delayed or missed, weíre making it all up as we go along, thereís nothing approaching a coordinated effort. Particularly determined folks can probably call up some contact they know, a caseworker or certifier or something, and ask to help out, not sure what there is overall though, our unit is pretty much figuring out our needs and resources amongst ourselves.

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