Module 5: Special Topic Area – Effective Aftercare Strategies

MODULE 5: Working with Families in their Homes and Communities

Strategies:

To develop successful aftercare approaches that foster long-term success, residential leaders commit to residential intervention as a short-term, permanency-focused, family-focused, youth-guided, trauma-informed, and culturally and linguistically competent intervention. Sustained positive youth and family outcomes post-residential discharge are improved with shorter residential lengths of stay and with significant family involvement and support post the in-program component of the residential intervention.[1] Leaders set the tone by driving an organizational mission of cultural and linguistic competence and permanency for youth and families. Aftercare services and supports are a critical component of residential interventions to ensure post-residential success, aligned with the goal of permanency and lifelong connections for youth.

Consider promising and/or best clinical and support practices, and/or developed models of care, that emphasize working with families in their homes and communities during pre-admission, in-program residential services, and aftercare services. Some programs have developed their own promising and/or best clinical and support practices, practice frameworks, and/or models over time to address the specific needs of the families served. Other programs have chosen specific evidence-based practice models (e.g., multi-systemic therapy, functional family therapy) for their clinical and support practice models during the pre-admission, in-program, and/or aftercare components of the residential intervention. It is critical that, whatever practices, frameworks, and/or models are used by a program, these approaches utilize culturally appropriate approaches that are culturally relevant and sensitive for the youth and families served. Best practice also requires programs to track data carefully and comprehensively and then use the outcome data to inform practice improvement in their pre-admission, in-home, and aftercare practice components ⎯ no matter what model or practices they choose to use.

Begin to develop the discharge plan pre residential admission and ensure that this plan includes a strong aftercare component. Residential providers can begin focusing on discharge planning pre residential admission. Culturally sensitive planning includes a range of aftercare services and supports, based on the individual needs of each youth and family. It is important to identify, starting at pre-admission, specific community services and supports for the youth and family, such as strengthening family connections, identifying school service and support needs, and cultivating and strengthening relationships with natural supports in the community. For youth disconnected from family, this includes the process of family finding and engagement toward permanency. Discharge and aftercare planning include:

• identifying risks that may threaten post-residential success
• determining appropriate services, supports, and youth and family skills needed to address any problems that may threaten success
• putting these services and supports in place throughout the residential intervention.

It is critical that aftercare services and supports are seamlessly integrated with the services and supports offered during the in-program component of the residential intervention.

Ensure that residential staff, including Family/Parent Partners and Youth Partners/Peer Mentors, work in the homes and communities of the youth and families throughout the entire residential intervention, from pre-admission through the in-program component of the residential intervention, to ease the transition to aftercare. Family/Parent Partners and Youth Partners/Peer Mentors ideally represent the ethnicities of the families served, and speak their languages as well. Programs that commit to strategically using diverse and culturally relevant staff, including Family/Parent Partners and Youth Partners/Peer Mentors, can better prepare the youth and family for success post-residential discharge by providing significant work with the families in their homes and communities.

Identify and/or develop community connections for youth throughout the residential intervention and continue and strengthen these connections during the aftercare component. To strengthen community connections, whenever possible during both the in-program and aftercare components of the residential intervention, programs can try to keep the youth in his or her school in the community. Programs can foster participation in activities that match the youth’s talents, strengths, and interests within their home community (e.g., participation on a sports team, religion classes, choir, dance, or music lessons, etc.). Participation in home community activities can also help youth to develop relationships with positive peers ⎯ an important component of long-term success.

Identify and/or develop social support networks for youth and parents throughout the residential intervention, including aftercare. Programs can connect parents to culturally relevant family support groups and Family/Parent Partners in the community. Programs can further support families in identifying informal support groups that can play an important role in their lives throughout the residential intervention and post-discharge. For some family members, it may be a religious or sports group; for others, it may be neighbors and/or a group of old friends. Whatever the chosen supports may be, it is most important to ensure that each parent has access to regular emotional support. It is also critical to develop and strengthen a youth’s relationships with culturally relevant natural supports and community Youth Partners/Peer Mentors and community youth mentors during all residential intervention components, and post-residential discharge. This includes involvement in activities as shared in the previous strategy, as well as peer support groups that meet each youth’s needs and identity (e.g., LGBTQ+ support groups). Families also need support networks that are relevant, such as support groups for families formed by adoption. Potential support networks and groups can be explored pre-admission or very early during the in-residential-program part of the residential interventions with family members. Residential staff then have the responsibility of supporting the development and maintenance of these support networks throughout the residential intervention, including during the aftercare component, so they are fully in place post-residential discharge.

Consider the developmentally appropriate aftercare needs of older adolescents. In addition to partnering with families to build the skills needed to be successful at home, older youth may need assistance developing and practicing the life skills they will need as adults. The primary goal for every youth still needs to be permanency; it is a treatment failure if a youth moves to independent living without a permanent family to support them, celebrate their successes, and just provide a loving family network. At the same time, older youth may benefit from support with employment and educational options post-residential intervention.[2] It is critical for providers to go the extra mile in securing education or employment support, as well as stable and safe housing.[3]

Ensure continuity of care ⎯ keep the same team engaged with the family from pre-admission through aftercare. Youth and families benefit from consistent and culturally relevant service providers who speak their primary language throughout the different residential intervention components (i.e., pre-admission, in-program, aftercare). This requires flexible scheduling for the residential workforce so they can support the family both in the program and at home, based on the family’s needs and schedule. Ideally, the staff who work with each youth and family are the same staff throughout the residential intervention ⎯ from pre-admission through the in-program and aftercare components ⎯ until discharge. When it is not possible for a team member who was part of the in-program component to also support the youth and family during the aftercare component, ensure there is a comprehensive “warm” handoff. For instance, if psychiatric care is needed during aftercare and it is not possible to maintain the same psychiatrist, a direct “doctor-to-doctor” handoff is important to ensure that the community physician is up to date on the family and youth’s needs and current treatment and support plan.[4] Aftercare is the final time for testing the reliability and efficacy of all of the community services and supports that have been put into place.

Continue to emphasize Family/Parent Partners and Youth Partners/Peer Mentors during the aftercare portion of the residential intervention. To ensure that aftercare planning is family-driven and youth-guided, programs can connect each family to a residential program Family/Parent Partner and Youth Partner/Peer Mentor. These peer partners provide services and supports throughout the residential intervention. They provide ongoing support, encouragement, and advocacy rooted in lived experience. Early on during the residential intervention, residential staff will also want to connect families and youth to culturally relevant family and youth support networks and Family/Parent Partners and Youth Partners/Peer Mentors in the community. Residential programs will choose different ways to transition to community peer partners based on whether they hire their own or contract and partner with community family and youth support organizations for these critical positions. These peer partners can support the family and youth in continued success and provide an important perspective to the Child and Family Team regarding the aftercare transition.

Develop a relapse prevention plan prior to residential discharge. The Child and Family Team can work collaboratively to develop a plan, a backup plan, and a backup plan to the backup plan for what to do in the event that the discharge services and supports are not successful in supporting the youth and the family. This includes carefully thinking about the circumstances that can threaten the family’s long-term success, and ensuring that ongoing supports and services, including crisis supports and services, are available to the family.

Work to strengthen and/or build effective partnerships with community organizations that can support the unique needs of each youth and family throughout all components of the residential intervention. Essential partnerships and connections for the family may include clinical supports, respite and crisis services, educational partnerships, religious organizations, medical supports, advocates, community-based services, and oversight agencies.[5] These relationships can be fostered throughout the residential intervention, and strengthened through the aftercare component of the residential intervention.

[1] Walters, U.M. & Petra, C.G.  (2008).  Family-centered residential treatment:  Knowledge, research, and values converge.  Residential Treatment for Children and Youth, 25(1), 1-16.

[2] Stein, M. (2006). Research review: Young people leaving care. Child & Family Social Work, 11, 273–279.

[3] Wade, J. & Dixon, J.  (2006).  Making a home, finding a job: Investigating early housing and employment outcomes for young people leaving care.  Child & Family Social Work, 11, 199-208.

Stein, M.  (2006).  Research review:  Young people leaving care.  Child & Family Social Work, 11, 273-279. Melkman, E.P.  (2017).  Childhood adversity, social support networks and well-being among youth aging out of care:  An exploratory study of mediation.  Child Abuse and Neglect, 72, 85-97.

[4] Ford et al., (2020).  Establishing partnerships to improve aftercare and long-term outcomes for youth and families served through residential interventions (pp. 143-165).  In Caldwell, B., Lieberman, R.E., LeBel, J., & Blau, G.M.  (Eds.).  Transforming residential interventions:  Practical strategies and future directions. New York:  Routledge Press.

[5] Ford et al., forthcoming

Module 5 Working with Families in their Homes and Communities Resources

BBI RESOURCES:

Ford, J., Manners, D., Wang, W., Lieberman, R.E., McMillan, J., & Caldwell, B. (2020). Establishing partnerships to improve aftercare and long-term outcomes for youth and families served through residential interventions. In B. Caldwell, R. Lieberman, J. LeBel, & G.M. Blau (Eds.), Transforming Residential Interventions: Practical Strategies and Future Directions (pp. 143–167). Routledge.

What Residential Leaders Need to Know about Effective Aftercare Practices for Youth Leaving Residential. (Forthcoming 2020, December). Building Bridges Initiative.

Working with Families in their Homes and Communities: A Building Bridges Initiative Tip Sheet for Residential Programs. (Forthcoming). Building Bridges Initiative.