Module 5: Strategies

MODULE 5: Working with Families in their Homes and Communities

Strategies:

Shift the organization’s mission, mindset, and culture ⎯ change the goal from a primary focus on youth success in the program/milieu to fostering permanency and long-term success of the family at home and in the community.

Residential leaders set the tone for the organization’s mission ⎯ that of strengthening permanency and long-term post-residential-discharge success. The emphasis on working with families at home then becomes clear, as all services become focused urgently on reuniting the family and doing whatever it takes to support their success ⎯ particularly building and practicing new skills at home and developing community connections that support the family long-term.

Hire the right people for the job: people who match and respect the family’s unique culture and ethnicity and who speak the same language. During the interview process, the organization can clearly articulate that all jobs in the program entail working with families at home and in their communities, and that strengthening permanency and ensuring cultural and linguistic competence are part of the core organizational mission. Ideally, programs endeavor to hire staff who resemble the communities served. This becomes critical when programs ask families to open their homes to clinical and support services. Staff who share cultural and linguistic backgrounds will approach the relationship from a starting point of shared cultural understanding, which can be helpful in establishing trust and rapport.

Develop a multi-disciplinary team, who represent the culture and ethnicities of the families served and speak their language, to provide specific expertise, services, and supports for the family at home and in the community.

These teams often include:

• social workers
• clinicians/therapists
• behavioral specialists
• Family/Parent Partners
• direct care staff.

Each team member provides a different type of in-home support to the family. For instance, clinicians provide in-home therapy and skill-building services in the family’s home. Direct-care staff often become behavioral and emotional support coaches or specialists in the community, also teaching and modeling skills. This requires additional training and mentoring to ensure they have the specific skills needed for working with families in their homes and communities. Staff support the family in building confidence with new strategies and skills when youth are home.

Family/Parent Partners with lived experience often work most effectively with families in the home and community. Family/Parent Partners can have a powerful impact on the lives of families by connecting through the lens of their lived experience. Family/Parent Partners can engage with families in the home by:

• supporting the parent/parents to practice self-care and carve out time to take a breath
• providing peer-to-peer support and connecting with other parents and community resources
• helping the family determine their strengths and needs
• supporting the family to voice their needs and ensure that necessary modifications or additions to the treatment and support plans are put in place, and to use their own voices to articulate the knowledge and support that would be most helpful.

Train staff in how to engage effectively, work with, and support families. In-home and in-home-community work with families requires effective interpersonal and best practice skills for engaging families. Staff become proficient in identifying and supporting each family’s many strengths, even when some families may be in the midst of very challenging times. Staff learn skills and specific practices to support families with complex challenges and needs. Residential leaders experienced in providing in-home work with families note that staff can be easily perceived by families as intrusive or as “snooping” on the home, unless a solid, trusting relationship is established. Training and mentoring of staff address how staff can interact comfortably with the family to strengthen the relationship, while supporting the learning of skills needed for the family to live together successfully at home.

Choose and implement promising, best and/or evidence-based practices for engaging families ⎯ practices that are culturally relevant for the families served and emphasize a home and community focus. Programs often adapt promising and/or best practices that they have learned about or implement or adapt specific evidence-based models (such as multi-systemic therapy, systemic family therapy, functional family therapy (FFT), and motivational interviewing) that have been adapted to the specific cultural and ethnic backgrounds of the families served. Programs are encouraged to:

• Adapt or adopt the chosen promising and/or best practices, or evidence-based models, that emphasize successfully engaging and working with families.
• Have strong training and coaching protocols in the practices or models chosen.
• Ensure that offering and providing families with a range of formal and informal supports that meet their individual needs is as important a part of the program practices offered as any specific promising and/or best practice or evidence-based model. Program staff can get lost in adherence to practices or models and not see the changing needs and challenges families are faced with over time. Continuous listening to the family, flexibility, creativity, and “doing whatever it takes” approaches supersede the use of specific models.
• Include, within the practice array that staff offer to the family, self-care, reaching out for support when needed (including through Family/Parent Partners and Youth Partners/Peer Mentors) and the use of sensory and other self-help tools for self-regulation, soothing, and calming.
• Continuously evaluate fidelity to chosen promising- and/or best-practice, model, or adapted model implementation, through informal and formal family feedback, regular staff meetings to discuss the work, rigorous program evaluation, and use of expert technical assistance.
• Actively and comprehensively use data to inform efficacy of practices, ongoing practice improvement needs, inclusive of long-term outcomes post residential discharge (i.e., 2 to 5 years), family perceptions, feedback and satisfaction, and cultural and linguistic competence.

Adopt a “do whatever it takes” approach.

Provide the support needed by the family to ensure that required child safety conditions are addressed and the child can spend time at home and return home permanently. This type of approach can translate to many different (and sometimes, initially, unusual seeming) activities for staff when programs first undertake a serious focus on working with families in their homes and communities. Successful programs share that their staff have provided assistance with cleaning and organizing; home repairs; purchasing beds and other necessities; connecting to no-cost and/or low-cost resources; supporting different family members with specific needs (e.g., addressing hoarding issues, ensuring nutritious food is the focus of grocery shopping, connecting a parent to substance abuse treatment); and many other types of activities to support youth safely spending regular time with family in the home and progressing toward successful reunification.

Put a major focus on connecting youth with activities and hobbies with prosocial peers in their home communities, versus a primary focus on recreational activities occurring within the residential program and/or with youth from the program. Successful programs put a primary focus on residential recreational staff working with the family and youth to identify youth strengths, interests, and talents and either keep youth involved in home-community activities that match these areas and/or identify new home-school activities and/or groups for the youth to engage in (e.g., playing on a sports team, involvement in religious groups, taking music or dance lessons).

Keep the youth’s schooling consistent. Whenever possible, it is helpful for youth to stay in school within their community. This consistency allows youth to stay connected to their peers and community, and provides residential staff with the opportunity to observe real challenges and needs of the youth and family for the youth to be successful in their home school. Some programs have direct-care staff assigned to work with the youth and the school; these staff become important to and appreciated by the schools.

Do whatever it takes to promote meaningful in-person time between youth and families when families live far from the program. Significantly increased transportation may be needed for staff to work with families in the home frequently. Organizations plan ahead to reallocate dollars for this purpose and are strategic in budgeting to allow for in-home and community-based services for all families on a regular basis. Programs committed to working with families at home to promote successful reunification have had staff drive three to four hours every weekend and/or have regularly flown staff with a youth to the family’s home to ensure youth remain a strong presence in the family and to provide in-home services. Program staff have worked with transportation companies and with community providers to supplement and support getting youth home every weekend when families live more than two hours from the program. Programs have provided gas gift cards to families to meet staff halfway to support youth spending time at home every weekend. Programs have also funded travel for families to visit youth at the program, though contact and work with the family in their own home and community is the greatest priority if programs are to focus on successful long-term outcomes for the family post residential discharge.

Put a strong emphasis on reaching out to, engaging, and partnering with informal and formal community supports and organizations. Families and residential staff work together to identify family needs that can be addressed by formal and informal community supports and to build a comprehensive community support system. These supports include neighbors, friends, religious organizations, and other naturally occurring support systems. Many families also will need an array of formal supports, including mentoring; in-home services; specialized educational supports; formal social services; mental health and/or substance abuse treatments; specialized supports such as LGBTQ+, adoptive, immigration, specialized medical, or hard-of-hearing/deaf groups; advocacy; housing support; referrals to other agencies; etc. Programs build strong relationships with community resources to provide seamless support to the family, during residential interventions and post residential discharge.

Invite and support oversight and cross-agency partners in learning about the importance of youth spending frequent time at home and residential staff working frequently with families in their homes and communities. When partners from child welfare, juvenile justice, probation, the courts, and other residential stakeholder entities understand the research on short-term residential interventions and the urgency of permanency work, the importance of working with families in their homes and communities is better understood and true partnerships with common goals are built. As much as possible, ensure that critical partners participate on Child and Family Teams to promote support for in-home work. When partners are involved in goal setting and decision making, they better understand the plan and the reasoning behind it. This partnership lessens resistance, builds trust, and keeps everyone on the same page. Residential clinical or leadership staff who have built strong partnerships share that they have put tremendous time into providing education and inviting partners to training programs to ensure that residential best-practice work is fully supported.

Consider each family’s individual need when evaluating safety for the child to spend time at home. Safety concerns are critical for both family and staff. Staff can work closely with families to identify their safety concerns at an early stage. For instance, if there has been aggression or violence in the home, families may desire support through in-home clinical work and having direct-care staff stay with the youth during time at home until these issues are successfully addressed.

Assess what increases risk and try to mitigate these risks. Basic safety awareness can go a long way for keeping staff and the family safe. Programs can train staff to consider where to park, privacy issues, and assessing safety risks in the home environment. Training emphasizes practices for staying safe (e.g., notifying others where you are, having a contact should issues arise, assessing and responding to a variety of situations, etc.). The program practices include decision-making tools for when different safety measures are used, including when two staff are needed for working in a home or community.

Provide aftercare to the family after the in-program component of the residential intervention is completed, ideally for at least six to twelve months.

Sarah Drummond, General Mental Health Clinical Director at YDI, discusses essential elements for aftercare programs and important strategies to effectively engage families.

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.