New Caregiver Onboarding

Video 30 Day Session: Foundations Presentation

Transcript of video:

hello and welcome my name is sha C

Madison I'm the foster care manager for

the

S the objectives for this training is to

understand the flow of a child

protective case get a greater

understanding of the reasons for

involvement what it means and how to

prepare for accepting a new

placement the roles and responsibilities

of individuals you may interact with

throughout the life of a

case and to go into details and provide

you better insight into what we call

parenting

time dcyf Central intake receives more

than 20,000 reports of suspected child

abuse and neglect annually as well as

referrals for children in need of

services reports of abuse and neglect

concerns are confidential and can be

made

Anonymous there are three specific

options when you make a report of

concern you can identify yourself as

disclosure

allowed disclosure not allowed and

Anonymous the difference between those

three options is with regards to your

continued activity within the assessment

and the family's ability to know who

called for assessment

allowed below is the liit the most Comm

of ass for disclosure not allowed when

an assessment is called that information

the family but place it on file chart

goes over the typical would only be

aware of we're going to take a closer

look at these if we proceeded with a

court case we may start an inhome case

the third option is to be

100% and not leave any if we complete an

assessment and we determine that there

are sa concern understand if you call in

a report anonymously you will not be

notified anything that happens during

that assessment for disclosure allowed

disclosure not

allowed we

you updated and share with conclusion of

that assessment think about where things

in your house

belong your first night

together if you do not get those two

pieces of paper on the first night be

sure

to you will hear from a roadmap to

reification

special the following individuals are

ones in which you will have frequent

contact

with when a child comes into State

custody we do our

best going to

court you are typically

Video 60 Day Session: Streamlining Healthcare One Consent at a Time

Transcript of video:

hi everyone and Welcome to our Healthcare presentation streamlining Healthcare one consent at a time the

focus is going to be navigating consents and processes for healthcare needs within our foster care system my name is

Danielle I am the nurse for the burin and Littleton district offices and I've been with the state for approximately

four years and this is Lisa who she's going to introduce herself everyone my name is Lisa Dyer so

like Danielle said um I also work in the Foster Care Health Program I'm out of

the conquer district office and I started back in November of

2022 and what we're going to do is just briefly talk to you about how this came to be and then we're going to go through

and review some slides with you that we hope you find helpful and can reference back later for questions that might come

up relating to healthcare needs for the kids in your care so how this came to be we realized that there was a need to

collaborate better between the Foster Care Program nurses and the foster care parents and caregivers we realized that

there were a lot of uh moments of lack of awareness on what to sign what you can sign what you can't sign and we

realize there's actually a lot of caregivers who don't realize that there are nurses in every district office so

we wanted to go through this to hopefully help make that a little bit more smooth for you and it'll allow you

to see who the nurse is in the office you're working with so that way you can go back and ask questions for healthcare

needs for the kids in your care if things come up and you're not so sure um who to

ask yeah and it's going to be kind of informal um so Danielle and I you know

we're going to go through each slide and one of us will be talking about it but don't be surprised if you hear from both

of us because we're going to kind of go back and forth throughout the presentation um just to make sure that

we cover everything and we're thorough and give you as much information as we can throughout the presentation

all right so our learning objectives are

going to be familiarizing yourself with a foster care health program and the nurse consultant role increasing

knowledge of the role of the caregiver relating to healthcare needs recognizing the difference between custody and

guardianship and understanding the processes for medication consents Surgical consents and other Medical

Dental needs some important words and

definitions that we thought we would like to share with you are on this slide DCF has tons of different acronyms and

different abbreviations that we use these are the ones that come up the most often within our Rule and we referen

them throughout the PowerPoint so I wanted to have a slide on here for everyone to see that way you can look at

this later if you're not sure what it is that we're talking

about so we kind of wanted to go through a scenario um just and give you some questions just

so that um you can kind of gauge maybe where your understanding is now and then

once we go through all of this we hope that um you'll be able to judge if you've been able to learn anything new

um versus like if you were to make a decision today with this scenario versus um with new information would you do

anything different moving forward and our hope is the answer will be yes as we

move forward um so let's say you're caring for a four-year-old boy who is in

the custody of DCF and he wakes up one morning and he has a fever of 100.4 and

a cough so you decide that you need to take him to your local urgent care to be seen uh at the check-in the receptionist

asks you to sign a few forms and these forms include their patient privacy Bill

of Rights which is basically um covering uh our hippoc consense um they'll give

you a consent to treat and permission to Bill insurance so with that being said let's

think about these three questions as we move through and give you information throughout this

presentation so what should you bring with you to this appointment which of the above three

forms are you legally allowed to sign and who should be notified of the Urgent

Care visit so we're not going to answer them right now but just keep those in the back of your mind and think about them

as we move

forward so now we're going to kind of get into some of the information so we're going to start with

um what is the role of the nurse consultant so we wear a lot of different

hats um within our position within DCF so first and foremost our job is

really to ensure that all of the healthcare needs are being being met for the children in in

care so one of those things involves um something we call an initial

comprehensive exam or you may hear the term ice thrown around and that's what that's referring

to and what that is is once a child is removed there's uh DCF policy

1651 that states that for any child in out of home placement they need to have

an initial comprehensive exam and there's certain time frames that need to be met so for a child that's under the

age of two they need to have an exam done within 30 days oh I'm sorry if

they're under the age of two it needs to be done within 48 hours and if they're

over the age of two it needs to be done within 30 days and the goal is always

for them to be seen with their own PCP whenever possible because they have that history and

uh records and are familiar with that child as with a lot of things there can

be caveats or exceptions so let's say there's like a newborn that we've for whatever reason

needed to put into placement prior to them being discharged from the

hospital so if they were to go straight from the hospital into care um like into

your home they would typically get a full assessment

um by the discharging provider on the day of discharge and that would meet this requirement because they're going

they're getting that full physical exam and they're going right from the hospital into your care without going

home to um their biological parent so that would meet that requirement for

that exam but also um when being discharged from like a ncu or special

care it's the typical standard of care care for infants to also then be seen

within 48 hours for followup with their PCP where they're also going to get

additional followup so they wouldn't then need an additional um initial comprehensive

exam another um thing that would meet this

requirement as well would be something called a cap exam and that cap stands

for a child advocacy protect Protection Program and these type of of

exams happen in um a clinic and they can be

recommended for many different reasons um when significant abuse and neglect

and Trauma are suspected and these exams

are thorough they can include urine hair talk screens and uh full history and

physical and if they have one of these um complete thorough cap exams this can

count for uh initial comprehensive exam so if

one of these does take place then most likely a child would not need an

additional ICE exam depending on timing and history of

the case and involvement we may or may not know ahead of time if the child's behind in their medical needs um if we

have this information a lot lot of times we try to get like a two for one in other words if they're going for this

initial comprehensive exam we can try and count it as like a catch-up Wild Child appointment so you're not then

having to go back within you know a week couple days whatever the situation may be to also then also have a well child

check for example sometimes it works sometimes it doesn't um but we are

trying to get them caught back up on their medical needs so if they've also had an initial comprehens of exam and we

do find out they are behind and need well child checks you may be asked to have to take them back to another

appointment that does seem closely timed with an ice exam and that is just so

that you understand they are two different types of appointments so they may still need both of those and the

expectation would be that you would have to bring them to those because they do need

those I think that's a good overview Lisa and I think it's a good reminder that we're talking about a lot of

information throughout these slides and we don't expect you to remember all of this that is why this is part of the

role of the nurse we are here to help you with this so we're we're the ones who are going to help you figure out if

that visit they just had an Urgent Care can count for an ice exam or if that cap visit counts for a nice exam so not

anything you guys have to figure out on your own just I want to throw that in there because I don't want anyone to feel

overwhelmed but there's so many good like moving pieces to this that it's just a good reminder

that that's why we're here and that's why we're doing this

exactly well child checks and initial comprehensive exams another really uh important part of Children's Medical

Care is their dental care and um we want to make sure that they're getting that

taken care of as well um so they're at a minimum needing to have

at least two cleanings uh a year so that would be like their every every six months they really should be starting to

have oral assessments done during that their first year um especially once that first tooth erupts and typically that

can be done in their pcp's office up until around age one and then we should

be looking to get them established with a dental provider in the community so

they can have that ongoing followup for those older children um it may be

recommended if they have a lot of dental carries or cavities that they have

additional cleanings um a lot of times there can be push back from insurance where they get

a denial saying they're not eligible for additional cleanings and if that's happening and the recommendation is

being made that they should have additional cleanings please reach out to the nurses and your offices because they

can help you with that because we can go and assist with you know reaching out to

get those additional cleanings um with their with their New Hampshire Medicaid and get that covered

and then also um children that have had dental surgery are automatically eligible for additional cleanings they

can get a cleaning every three months for a year following um dental surgery and it's not mandatory but it's

highly recommended really want to make sure that the surgery has a chance to

heal and that we're able to help help that by keeping those teeth clean and

healthy especially in that year following that dental surgery and then um just when it comes

to orthodontia and wisdom teeth that is a big thing especially with our

pre-teens and teenagers and um just if it's being recommended for the children

in that age range um it's really best just to kind of let us know as soon as possible and get us those forms

especially for the guardianship kids it can be a really lengthy process um so

just letting you guys know that ahead of time it's not us it's just the process it takes with New Hampshire Medicaid and

it can even be a long process for the the custody youth um just because of

going through New Hampshire Medicaid um so just working with us and getting us those forms and just keeping the social

worker and the nurse and the parents and everyone involved so that we can help you whenever questions come up is I

guess really the key point to take away when it comes to that and we recognize that sometimes

it's hard to get people in for dental appointments I know that we have a lot of issues with that in the North Country

there's just a lack of resources some waiting lists are longer than the six-month window that we're talking

about we're going to work with you and we're just going to do the best we can with what we have and sometimes that may

involve having to have kids seen outside of the area where you live sometimes we have to have kids travel to an office

that would take them a little bit sooner so again something that we will work with you on but I wanted to just put that plugin too because I know that it's

a lengthy process for a lot of things including sometimes just the basic

appointment So Lisa mentioned the well child visits a little bit when she was talking about the comp exams and the big

thing with this is we're making sure that all the kids that are within our care are being seen annually for their

Wellness visits and then babies sometimes obviously get seen sooner so those ones are getting seen multiple

times in that first year we're just ensuring that those visits are happening following up with the providers and just

making sure that the kids are remaining healthy and we're also making sure that their immunizations are up to date we're

not going to get into any specifics about immunizations today because really that could be a whole presentation in itself but I just wanted to put in here

that we are following this as well and these are all things that we would want you to let us know about so if they have

a wellness visit they have immunizations done please let the nurse and social worker know so we can keep track of

it and then another big part of our role is medication oversight we're going to talk about this a little more specific

in a future slide but I just wanted to put a plugin that this is a New Hampshire state law House Bill 120 and

you'll see it referred as hb20 and this is to monitor medications for children and out of home placements

so the placement provider which would be you as the caregiver and the social worker should be reviewing every month

when they when the visits happen the monthly visits happen with your social worker all the medications that the kids

are on the doses the changes of medication side effects such and we'll talk about that a little bit more just a

little bit all right so as we move forward

we're going to go through some terms and we just wanted to kind of lay them out here before we get started just so that

um you're familiar with them and we use a lot of terms um in the world of foster

care and DCF and they can be really confusing um sometimes they're used

interchangeably uh when they shouldn't be and that can also add to confusion so we just wanted to go through um some of

the legal terms and what they actually mean just to kind of help with some of

that understanding which also will help you guys to understand your role as well

so legal supervision um just refers to like an inhome case and that dcyf is

monitoring so the children are still living in the home with their parents and then protective supervision DCF has

removed the child from their home for concerns for child safety um there's no

official finding of abuse or neglect yet so this is um before going um before

there's been a trial but there so there could be a child in your home placed

with you and they just haven't gone um and had their trial yet um so you may

hear the word adjudication thrown around and that's what that means that's so it's pre-trial it we haven't had a

judication hearing yet um and then legal custody uh dcyf is the legal custodian

of the child so there has been a finding of abuse or neglect um so that post-

trial so that means they've gone to adjudication and that determination has been made so then their that child would

be considered to um be in legal custody of DCF and then we have

guardianship so DCF has been granted guardianship of the child so essentially

DCF is the parental figure for that child and guardianship can take on

different looks depending on many factors so when in doubt ask before

signing something and this I know it says it for guardianship but when in

doubt ask about anything for signing I think I don't think we can say that enough um but for sure just ask

um let's see here just trying to think Danielle do you have anything um that

you can think to add on to that yeah I think I think the big thing is legal

custody versus guardianship I feel like are the two that you as the caregiver probably are going to hear the most and

I just want to make sure it's clear that legal custody does not mean a parents

rights are terminated guardianship does not mean a parents rights are terminated it really depends on where we're at in

the case legal custody simply means that DCF has some ability to intervene if

needed if the parent was not doing something that they needed to do or there was concerns for delaying care

such things as that and then guardianship we can have guardianship of kids and be the parent figure but the

parents still retain their parental rights it could be a situation where maybe you can't find the parent at the moment or maybe the parent is even in a

detox facility where we can't get a hold of them but this child might need something medically there's a lot of different reasons why we might have

guardianship so just keep in mind that we know it's confusing we're trying to explain it here and even saying all of

this is probably confusing to you as you're hearing it but just feel free to ask ask the social worker ask us we will

help to the best of our ability to clear that up for you whatever question you might have yeah and just as we move

through the slides I think for the purpose of like this presentation and the information that we're sharing when

a child is in your home protective supervision and legal custody as far as

like what you can and can't sign those really work together as the same for you

guys so the the parents have medical decisionmaking so they're the ones

signing for things um so that's really I think the key is those

two together mean essentially Your Role is the same for

children in um both protective supervision and legal custody so um just kind of think about it um like that is

your role is is the same um as far as the parents having um their medical

decision- making and then as far as guardianship goes whether parents still

have their rights and it's temporary or not DCF is the one that's the the signing figure in that moment and so

just just that kind of breaks it down as at least simple simply enough for you to

know where your role is and kind of who would be the signing person for that um but again if you forget or it's

confusing um because we still get confused you just just ask yeah

absolutely and I do think we have a future slide coming up that'll talk a little bit more about what you can and can't sign as far as medical um so we'll

get into that in just a minute so medical authorizations this is

a very busy slide and if you remember nothing else from the slide I would say the most important thing to read off of

the slide are the things in bold so medical authorizations are needed for children in placement to seek routine

and emergency medical dental mental health care and the other bolded item being placement provider which is you

should always have a copy of this medical authorization so like we were just talking about custody versus

guardianship it gets very confusing but for a medical authorization if this is a

custody situation the parents are the ones who are signing these so this would be a form that the parent has signed

giving permission for the child to have those routine and emergency needs met if this is a kid in our guardianship then

it would be a form that has the dcyf administration signing off on it and those typically have a gold seal at the

bottom because it's an official document for the State of New Hampshire and just a side note for these forms some of them

will say that covid has been approved some of them won't say Co at all and we're not getting into specific with

covid vaccine but we just thought it'd be important to mention that for specifically a kid in custody if there

is no mention of covid vaccine on there we cannot be giving a covid vaccine

during a medical visit and dcyf does not even have the ability to override that

for a custody situation because this is still an emergency use only type medication type vaccine so just kind of

to throw it in there for guardianship typically you will see it on there especially where the window is month and

up but if the guardianship medo does not have any Co language again we can't be

doing anything with covid vaccines unless we have it in writing on these

forms now for the copy that you should get this should really ideally be given

to you when the child is first placed with you we know that that doesn't always happen but you should be getting it fairly soon in the beginning and we

would want you to bring this form with with you to all the visits that you go to even though we try to send them via

fax to all the facilities the PCP the dental provider sometimes faxes don't go through so it's always good for you to

have a hard copy to bring with you just in case and you should also bring the placement letter that you get at the

time of the child being placed with you this is that two-page document that has your information on the front saying

that DCF has whichever legal relationship with a child they're placed in your home with your name phone number

address the second page has a whole bunch of different contact numbers it has the do supervisor the social worker

um it just kind of gives you a little bit more info on who to reach out to and it also has the after hours phone number

so if you were bringing a child on like a Saturday to the emergency room for something and you needed to call and

talk to someone directly from DCF you'd have to call that emergency um after hours number because there is somebody

available 247 if needed so having that form with you is just good in case you

need that number so you're not trying to chase that down

okay so here is a slide just on custody and guardianship um just to break it down a little bit more and just to give

a little bit more clarity so DCF custody we have on the

left-and side and DCF guardianship on the right and we have it laid out just so you can kind of

see uh like compare the the two roles and um who can sign what so on the

custody side that just means that the parents retain their parental rights and

that parents should be the one signing um consents that are needed for the child parents are um the ones that need

to be in agreement um and consenting for all medical dental and surgical

needs and um parents are the ones that need to be in agreement and consenting

for medications prescribed for um their child and then on the guardianship side

um DCF would be the one um acting as the parent on behalf of the child uh ad DCF

administrators would be the ones that would be signing off on all um medical

dental and Surgical consents and then also um DCF administrators um they need to be the

ones to approve all Behavioral Health medication requests

and then just wanted to touch on kind of what is and isn't your role as um a care

provider and I think we've mentioned it quite a few times but we totally

understand how confusing it could be um to be in your shoes um we throw a lot of

services at you a lot of people um a lot of information just even in this

presentation um and without you guys these kids wouldn't have a you know a

safe and stable environment so we need you and we appreciate you guys um they

need you for that safe and stable environment um we you know you guys are

providing that loving and nurturing home and environment for them and you're there to help the children and and

meeting their needs um you're there for them you know in their day in and day out um so you're helping them with their

healthare their education their emotional well-being so I mean essentially you're

their Advocate um we aren't going over prudent parenting um I know that is um

something that's covered during your your initial um licensing training um

so those are the things that you should be following and um if you have questions regarding any of that

definitely reach out to your social worker um to go over stuff like that but those are the things that

really that's that's kind of the expectation of um your role as the care

provider for the children um think really though as long

as the children are in in your home you don't really have any legal authority over the child if they're in custody the

parents still have really that legal decision making and then if they're in guardianship then GCF administrators

really have um that legal Authority for for signing and consenting to things um

so we as their care provider you really can't be consenting to um Behavioral

Health medications or to any like Medical Dental or surgical treatments so we just wanted to take a

moment to go over um over that um so like a couple of

examples uh like you really shouldn't be signed ing releases uh for forms for

receiving or transferring medical records that really should be coming through um the nurse or the social

worker if we're finding that you're at an appointment and they're they're stating that you know they haven't

received medical records in the office maybe it was a new specialist appointment that you're attending and

you find out that maybe some records didn't make it over you can ask them to reach out to

the social worker or the nurse or um you can do that as well after the appointment and we can help facilitate

that information getting where it needs to be but we really wouldn't want you to be signing those release of

information uh forms

exactly so for medication monitoring we talked about this a little bit earlier I said we'd revisit it and here it is so

House Bill 120 hb20 this is a New Hampshire state law that went into effect January 1 of 23

and it requires the nurses to have oversight of all Behavioral Health medications for children and out of home

placements so again this is specific to behavioral health medications so we need

to know about new medications meds that are being changed discontinued if there

are any side effects to any of their medications and these Behavioral Health medications have to be approved prior to

a child starting on them so for DCF guardianship kids DCF nurses need to get

a form sent to us that talks about what the request is and we'll show you that in a few minutes too but we have to go

through and approve it before the kid can start on it the same way if it was a custody child if it's a custody child

the parents have to be in agreement and approve that Med before the provider should be starting it and this is only

specific to the behavioral health narcotic type meds this doesn't apply to a child who has a seizure disorder blood

pressure meds antibiotics anything that's kind of routine and to stabilize them with whatever medical need they

have those ones we would want to know about because we need to keep track of meds but we don't need to give permission prior to the child starting

on it so I just think that's really important to separate out what we do need to approve in advance and what we

don't so we're going to go through consent processes and hopefully explain things a little bit more about

that all right so we're going to break down the medication consent process into um the two different roles so first

we're going to talk about custody and then we'll follow it up with the guardianship role just because they do look different so the first first one

we're going to talk about is custody uh and the role um with regard to medication consents so um with custody

the parent are Guardian so not someone from DCF would be the person to approve

um that medic that um medication so again like Danielle mentioned on previously on the previous slide that

doesn't include like starting an antibiotic or eardrop or some kind of like lotion for a rash or something like

that um if you take a child to an appointment and that's you know they were sick and they need um a medication

like an antibiotic or something like that that's covered under your medo for routine um Medical Care and so we'd want

to know that because we'd also want to let the parent know that hey they were sick and they had to start on something but um this is really talking about

getting that approval from the parents for these Behavioral Health medications

um so there's no official request form that's needed the doctor is just going to if the parent's not at the

appointment the doctor's going to need to call and speak with the parent to get that

permission uh the social worker and the nurse should be informed of any um

additions or changes to um these Behavioral Health medications though just um because we do need to keep track

of it and then also if there are any kind of reactions or side effects that are

occurring or that you're seeing uh please let the nurse and the social

worker know and then a lot of times with these Behavioral Health medications

there can be additional things that are needed uh some of these medications require uh routine Labs whether that's

you know every three months or once a year uh vitals to be taken or sleep logs

to be done um so that's just something to know and may ask for your your help

and keep track of those things along the way and then

um we do have something called or ordinary medical care or OMC we haven't touched on it just yet but in it's

basically a law that um exists to ensure there's no delay in care and it's really

for emergency use only and it really should be temporary and like a one-time

use it's not really for ongoing use and what this covers is situations where if

a parent is you know missing um we can't reach them there is this ordinary

Medical Care law that exists um to help us but really we need to be doing our

due diligence um the social worker and DCF as a whole to make every effort

including and this includes the doctor needing to make a phone call trying to email whatever way that we can reach out

to these parents we especially with concerns to behavioral health medications we really need to be doing our due diligence to reach these parents

to get their consent to start um a behavioral health medication

um before we are looking to OMC

um it does exist like I said but we really want to be giving parents a chance

um because it is really for emergency use um so we want to do that first and

then if we feel like the child's mental health is in such a way

that this is of the utmost importance uh that it needs to be done and we can't

delay then we do have this that we can use and then we need to address any

ongoing issue um and possibly look at what might need what steps might need to

be taken whether that's guardianship or something else down the road um to take care of this so that it's not used

ongoing to address that need for that child um for their ongoing medical

needs uh and just as a side note OMC um can't be used for things like um covid

vaccines um because like Danielle mentioned earlier uh the covid vaccine for Pediatrics is still listed as

emergency use only so we wouldn't be using it um to Grant permission for

something like that exactly

and then for guardianship we have a form 1653 which will take a peek out here in a second on the next slide um that we

provide to the the prescribing doctor of the medication so that they can fill it

out because the state of New Hampshire as Leal Guardian will need to approve the medication prior to the start of the

medication or um a dose change um so

it's one of the priority roles of the nurse um we get this form it's a multi-step process and um a lot of times

there's many steps that are involved um and we will make sure that Labs vital

sleep logs like there's a lot of things that go into this that we help to facilitate and follow along um in our

role as the nurse in the office when it comes to the behavioral health medications and the form 1653 when it's

a guardianship child so just know if there's a request coming through and you're not hearing

back like within the same day or even the next day sometimes this could be why because of all the steps involved

sometimes it takes us a little bit to gather everything that we need in order to be able to approve the

meds yeah so this is just there's multiple pages to this form this just happens to

be in the front page um in case you see it um this is what it looks like um this is a blank one this is what we send out

to if it's the PCP um it could be um their psych um

psychiatrist it could be um a therapist that also is prescribing a medication um

so this is what it would look like and we'd have to have this form filled out

and we also asked for a progress note to be accompanied by it and we go through

this and we make sure that everything is in place and then we start processing it

and um and go from there and a lot of people don't realize this but even this

would even be filled out for something like um an ADHD medication that is considered a behavioral health

medication um which a lot of kids are on that so

just you know a tidbit of information for you guys this that type of medication would fall under this um and

it would still have to go through those same steps if they were a iians ship child

exactly so surgical consents very similar to what least it was just talking about with how the medication

consent process works so for a child in DCF custody the parents need to be aware and approve prior to the procedure

happening we can use OMC ordinary medical care if it's an emergency type situation where a child needs like an

appendectomy or something and let's say we can't get a hold of the parents but the child needs to have this done or

it's detrimental to their health we could sign under ordinary Medical Care to be able to cover that once we have

that legal custody status which is after the adjudication like we talked about earlier so that would be kind of when we

can use that for surgery we would not be able to use OMC for something that's a routine not necessary such as like a

circumcision unless there's a medical reason for it because it's usually considered cosmetic so we can't typically sign under ordinary medical

care for something such as that and then for Guardian ship kids the state of New Hampshire as Le Guardian needs to

approve the surgeries prior so again letting the nurse know as soon as possible that a child's going to need any type of surgery is super helpful

because this is also a multi-step process and we have to be able to arrange for the surgical consents the

anesthesia consents sometimes these are written forms sometimes they're verbal so there's just a lot of things that we

have to be able to coordinate so the sooner we know the better so that way we're not in the last moments before the

procedure and not having all these things done because we don't want to delay any of the kids having procedures done that they need to have done and a

side note dental procedures that have nitrous oxide are considered a procedure that needs the same kind of consent

process as surgeries so if we have a child who is a DCF custody child they

went in for their cleaning their cleaning says they need to have additional work done under nitrous oxide in a custody situation the parents do

have to give permission prior to that happening for a guardianship child DCF needs to give that permission so just

remembering that there there are certain things that need to be talked about with

us prior to them having care done and a lot of dental offices I feel like are very good about reaching out to us

because they treat it as a procedure as well but I think it's just important that we talk about it here with you guys

as the caregivers because it gets

confusing all right so back to our scenario now that we've thrown all this

information at you and your brain is m we're going to go through this scenario and see if you can pull out any of that

information now um and see if you would do anything different in this

scenario then what you may have done for those of you that have you know are

seasoned care providers and have taken care of um children in your home before

maybe you've done something differently and you may change your mind and move

forward differently now having listened to some of the information that we've shared um so we'll just go through the

scenario again real quick and see see how you do um so you're again caring for

this four-year-old boy who um is in DCF custody and he wakes up sick with an

elevated fever and a cough and you take him to the local urgent care and at

check-in the receptionist asks for a few forms so um they are asking you to sign

this patiency privacy rights uh consent a treat and a permission to Bill

insurance so question one what should you bring to this

appointment so as we talked about hopefully you guys remember and if you don't that's why we're doing this again

but you would want to bring obviously the child because you want them to be seen you would want to bring the medical

authorization that you should have a copy of and that placement letter that has all the phone numbers for contacting

people after hours because as you can see this is a Saturday morning the offices are not open so if you needed to

reach anybody through DCF you'd have to call that after hours number

exactly all right so which of the above three forms are you legally allowed to

sign so interestingly enough the only one that you cannot sign is the consent

for treatment so as we talked about earlier consent for treatment has to be by the parent or dcf's Guardian

depending on what the statuses legally for that child the difference between that in the permission to Bill insurance

and the hipa Privacy rights is that those are acknowledgements those are not consenting to anything so when they

present you with the hipa compliance and they're asking you to sign they're just asking you to sign acknowledging that

you have been provided the patient privacy rights that you've been provided that information that they're not going to share information without being

allowed to legally and they're binded to do that legally and for the permission to Bill insurance it's still an

acknowledgement that the insurance is going to be built so neither of those are consenting to anything but a consent

for treatment would be consenting to something so hopefully that makes a little bit more sense now that we've talked about all of the differences at

length but if not remember you can reach out to your nurse at any point and we can talk to you about this again or if

you have questions about it you're not sure that you should be signing it just ask us and then we can talk with you

more about this yep so ideally in this situation because it's a Saturday morning they um really

should be trying to reach the parent um for that to consent a treat

get a verbal and if they can't reach the parent then because you knew what to

bring for question one and you brought that um the uh placement letter with you you

have those phone numbers for the person to call that's on call 24 hours a day and they be able to consent to treat

over the phone um and that's how you would work with that you know that situation and where you can't sign for

the consent to treat um and then the third question who should be notified of the Urgent Care

visit so as Lisa was just talking about you would want to contact the parent if

this is a custody child the parent should know that the kid's being seen even if the office that you bring them

to doesn't need them to verbally like they don't need to reach out to the parent verbally they take your medical authorization and say that covers things

you should let the parent know and if you're not comfortable doing that you should let the social worker know who can let the parent know because we want

to make sure that the parents are being included in on all of these things because they still have those medical decision ability for their child and it

is still their child so they should be aware of what's going on and you would want to let dcyf know if we're the

guardian by letting the social worker know or like we said calling that after hours number if there's something that

urgently needs to be addressed prior to Monday when the offices are back

open so this slide here just goes over the answers to the questions that we just talked about we wanted to do this

as a reference for later so that way any of you who are currently watching this could screenshot this if you wanted to

take a picture with your phone it just might be helpful for you to have later which is why question two on here has

the after hours number and bold because we wanted to make sure that we're providing you as much information as we

could so we want to thank you all for

listening in on this presentation we know that this is a lot of information we're hoping that it helps to streamline

some of the questions or maybe things you weren't sure about before we're hoping that this helped answer some of those questions and we are going to be

working on creating a Q&A that we can eventually send out to everyone we're presenting this content at different

conferences as well so hopefully we can send something out with additional questions that maybe we didn't cover we

realize that there's probably still a ton of questions that we couldn't answer here but we are limited by what we could

present today we couldn't talk all day long even though I'm sure Lis and I would love to do that so there will be

things that we probably didn't get into specifics on so that's why we want you to reach out if you have questions and

if you have any questions specific to the content in this presentation please reach out to myself or Lisa as we're the

ones who kind of created this you can also reach out to the nurses in your office and the next few slides we're

going to go through I'll leave it there for a few seconds so that if you are taking a picture or what not you're able to see it but we listed out all of the

nurses for the state and what office they're out of so that way you can look for the nurse specific to your office that you would want to reach out to

anything else you want to add Lisa before I move through the content of the contacts no definitely I mean thank you

guys for everything that you do and um definitely I mean we just look forward

to working with all of you guys and hearing from you and your questions and um just twin and doubt reach out for

sure we know it's a lot and um you guys are giving a lot and doing a lot so thank you so much yeah thank you we

couldn't do what we're doing without you so please remember that so we'll go through the slides like

I said I'll just keep them up for a little bit just in case you are trying to take a picture of them I'm assuming

that this PowerPoint will also be available to you to reference whenever you need to so you'll be able to pull up this info as well

and then this slide is all of the nurse managers that cover the state and it breaks down which is they're responsible

for again thank you all for listening in with us please reach out if you have any questions and we hope that this

presentation was helpful to you we'd love to have feedback um from you so please reach out if there's anything you'd like us to add for a future

presentation or maybe even topics that would be helpful for you we're happy to take that info back to our team and work

on that for you yep thank you

Video 60 Day Session: Sensory Strategies for New Caregivers

Transcript of video:

good morning or good afternoon or good evening whatever time you're watching this thank you for joining me my name is

Charity Bell my pronouns are she her hers and I'm delighted to be with you for this next 45 minutes or so to talk

about sensory strategies for humans and we all interact with humans but as

foster parents we're going to be interacting with humans whose needs might be slightly different slightly

more complex and we have to think about how we fit those needs into our our own

or our family's current way of moving through the world a little bit about me I've been a

foster parent now for 25 years um I do a lot of work around the impact of

perception on the brain and caregiving and and the ways in which we interact with one another and one of the things

I'm most fascinated by is how different sensory strategies impact behavior and

impact perception of the environment around us so with that being said I look forward to spending a little bit of time

talking to you about sensory strategies for humans first I want you to imagine with

me I want you to take a deep breath settle into your seat close your eyes or

just lower your gaze if that feels better and I want you to imagine what it

would be like if one day someone came to your

house and told you you need needed to leave right

now what would you want to take with you you can pack a small bag but nothing

else you may not be going with the other people you love they may be

separated you've packed those items and now you're walking out the door with a

stranger and that stranger puts you in the car and tells you that you're going to stay in in foster

care you may not know what foster care is or you may know what foster care is

either way how would you feel what would you be thinking what

would you want to know you arrive at this new house and

the door opens and people come out to greet you what would you want to know

about them what would you be looking for what would you remember from what they

told you and what would you not remember evening comes it's getting dark

outside what would you want to know they've served a

meal what would be important to you about that meal you go to

bed they say good night what are the things that you might be thinking about

during the night both the emotional things and just the logistical

things coming into foster care is extraordinarily

complex come back to the the group open your eyes whatever it is you do but one

of the things we want to do is to settle ourselves into the perspective of the foster child or the

people around us it's very easy for us to see things from our own perspective we dwell in it every day however looking

at things from the perspective of of another person is one of the most powerful actions we can take whether

it's interacting with relatives or friends or family members colleagues at

work or children in foster

care I love this quote because it's one of those basic things that most people

look around and go yeah that's true that's how home works and what we know is that for children in foster care this

very basic conception of what home is is disrupted one of the things we know is

when a child goes into foster care when they go back home everything will be different if they go back home but the

likelihood is that if they're not able to go back home they may never see those things or interact with those things

again it makes sense that the children we interact with even the youth we interact with and when I say children I

mean everybody up to teenagers one of the things we know is that we often

overestimate the emotional maturity of the children we interact with especially

if they happen to be bigger in size a little bit more verbal we overestimate

what they're able to comprehend but also we overestimate what they're able to cope with home is wherever you leave

everything you love and never question that it will be there when you return in many ways when we look at it

that way foster children are homeless when people are Fe feeling

overwhelmed and out of sorts and lost it impacts the way they respond to the

world around them you know this for yourself when you're having a bad day anything can be the thing that pushes

you over the edge I mean I drink a lot of Dunkin' Donuts I don't know why but I

drink a lot of Dunkin Donuts even though I know that there's like a 50/50 chance that the coffee that I order exactly the

same way every single time a large iced coffee with cream three Sweet and Low

and coconut and vanilla shots will taste different every single time sometimes

it's great sometimes it's pond water and there are days when I drink

the pond water and I think H well there it is it's not the end of the world but there are other days when the traffic is

bad and the kids are loud and the boss is emailing where that drink is the

thing that just feels like it ruins my whole day and I'm irritable and upset it's about perspective we're going to be

looking at things from the from the perspective of the children who come into our

home day-to-day life is planned for well-regulated neurotypical non-traumatized securely

attached humans there are so many times as someone who experienced foster care

myself growing up and aged out of foster care without being connected permanently legally to a family where the things

that people say the things they talk about um I happen to be recording this at a time when a holiday is coming up

and people are talking about their family traditions I don't have family traditions there's no one in my life

right now who knew me before I was 13 years old I have no idea what happened before that so just the day-to-day

activities that happen the understanding that if you need a ride someplace you'll have it if you need a note card for a

presentation you can get it at home day-to-day life is planned for well-regulated kids

and that's really important for us to understand because we know that we do

not care for kids who are well well regulated so if we understand that then

what we have to pay attention to is that day-to-day life may need to be altered

for our kids to be able to make it through comfortably how are our kids different

they've experienced loss they experienced distrust and they should could experience distrust one of the

things I talk about is the fact that when someone has been burnt by a stove

it makes sense for them to be very careful around a stove and if someone came up and got burnt by their stove

every single day and didn't change how they interacted with that stove we would

worry about that person we would think they've been burnt six times now and they're still sticking their hand right

in the oven well if you're someone for whom relationships have been

painful wouldn't it make sense to avoid them it's our job to prove to these kids

that in fact we're not going to burn them and we may need to do that by

standing through or or working through a lot of times where kids act like they've

been burned accuse us for being burned until they're able to recognize that that's not happening anymore they have

fear issues they have sleeping habits issues the number of times that I have encountered 7-year-olds 8-year-olds

9-year-olds 12 yearolds who have never slept alone in a room some of whom have never slept alone

in a bed there nighttime may be a time when things in their house got loud and

people got angry they may be hypervigilant during the night and they experience anxiety whether clinically

diagnosed or simply a part of moving through life in a way that may feel so chaotic so we know that our kids

experience the the world differently we need to assume that additional supports are needed so one of

the things I kind of see people do sometimes is say well we're just going to see how it goes and then if so and so

needs more supports We'll add those in that's a hard thing to do because in

order for you to see that that child needs to fail in some ways so in order

for your child to see that your child oh we really do need to give her a schedule for the morning you find that out

because the child struggles during the morning it's so much easier to add in the

additional supports assume they're needed and then pull them back as you go

so one of the things I would say is that when kids first get to your house provide some structure provide a lot

more information than you think they might need and then you can back out as you get to know them a little bit

better so here's how we see the process a child gets to your home they get

settled they become a part of the daytoday and then they go to reunification or

permanency that's the process from our point of view however the process from a

child's point of view looks

different the first thing the child experiences is removal from family from relatives and from previous placement

their Journey Begins with trauma they get to your house and they need to go through grieving and loss and

and move through things and understand you it's like moving to a whole new culture and move to

acceptance they get settled but they have to get through being different they're a foster child in a house where

there may be no other foster kids in a family where there may be no other foster kids they have visits and those

visits are enjoyable and and needed and important but they're also hard we say

goodbye over and over they cope with trauma and they also see people have lives that they do not one of the things

I remember most vividly from my experiences in living with families that were not my own was how angry I was at

how safe and easy their life seemed it was amazing to me I was 10 before I

realized that people's lives look different from mine and when I first realized it I felt so betrayed I was so

upset that I did not get to have this kind of day-to-day life and I will say

that in my anger I acted out I disrupted things I I I I ruined things because I

just felt so frustrated by the ease and how I had never experienced that before jealousy is

intense then they become part of that day-to- day but there's always a piece in the back of their head for the vast

majority of our kids because we know that reunification is the goal for most of our kids where they're thinking about

that fact of what is the next Next Step what is the next step they're either going to be

reunified or go to a kinship placement or go on for adoption which means that

they lose you or they go home they stay with you excuse me or

they stay with you which means they lose the other parts of their family and if you are not very careful about expanding

the circle of people that care for that child by including biological family as

far as is safe that loss is very real and they need to go through that loss

and grief and acceptance again the process looks different from the point

of view of the children in your home one of the things I have never ever

forgotten is that um I was interacting with a foster child who had come with

her family to a support group and she was newly in the home and I asked her at

the end of the evening who she sorry it still makes me tear up who she was there

with and she said I don't know their names she'd been with the family for

over a week and she didn't know anybody's name she said the kids call them mom and dad they call each other

honey I don't know what their names are it stuck with me this idea that that

we overestimate what they take in and we way overestimate the questions that they

feel safe asking and so I went and found out and I spoke to the parents and I

asked them to remind the child wear name tags but what we actually ended up doing

this was a child who was eight or nine and old enough to read is doing pictures of everybody in the family including

extended relatives who came often and putting it on the fridge with the name

some of the nicknames that person was called and then the relationship to the family and that was a very helpful tool

for this child who I can't imagine what it felt like to just be wandering around and they'd be like oh Tom is coming over

later I don't know who Tom is who are you going home with I don't know their

names when we look at things from the perspective of the children in our home it becomes clear that we should be

surprised when they are not out of sorts not when they are so General strategies sensory

strategies start from the very beginning before the child even enters your home a

clear introduction to you in your home creating written or visual routines depending on the age of the child and

what they're able to take in mirroring communication about identity and next steps that means everybody in your home

uses the same language when your mom is able to keep you safe when your

grandmother gets all the paperwork that she needs to get to for the social worker we can go to next steps when your

social worker comes back we'll know a little bit more and we share that with everybody else so that we all have the

same language a visual calendar is really important kids like to know

what's coming up securely attached kids may feel comfortable with not

necessarily knowing what's going to happen tomorrow not necessarily knowing what's happening for the weekend however kids who are insecurely

attached and kids who have regular events in their lives that are distressing like visits or social worker

interactions or things like that they deserve to be able to look at a calendar and begin to prepare themselves know

when those things are happening and then regular check-ins and reminders how are you doing is there anything you need

help with can I remind you what tomorrow looks like all of these things will

allow us to be seen as a source of safety and a source of information for

the kids in our ha and that will lower the overall level of distress they feel

and begin to allow them to work within your family in a way that feels comfortable for

everyone I want us to think a little bit about the escalation cycle because this is an important piece of looking at the

way kids come into our home one of the things we want to look at is the Baseline the basine is when someone is

engaged in an activity that they enjoy that they feel successful at that and

that they they feel comfortable doing it's incompatible with escalation so if

I'm sitting comfortably on the couch and reading a book it's unlikely that I'm also about to run around and hit someone

the ways in which we get to know our foster kids allow us to offer them Baseline activities a place where you

feel safe and comfortable activities that you can engage in that you enjoy and that you feel good doing and also

permission to do those things so we want to get that in place as quickly as possible and then we pay attention to

the triggers um we often look at Behavior independent of triggers I will tell you hang hungry angry lonely tired

good Lord bored um looking for those triggers is often far more successful

than punishing a child for responding to triggers offer people something to drink

something to eat an activity and a nap you'd be amazed at how far you get and that's all ages myself included if you

see me and I seem irritable feel free to offer me a snack and a nap you'd be amazed at what a difference it

makes then we look at how we get to crisis and then deescalation those focusing on calming strategies don't

rehashing the incident and you may want to we'll give you the the packet of this so you can look at this more often but

the most important piece of this is the caregiver response if the caregiver

escalates as well everything moves faster up the curve caregivers must modulate their own

responses if you don't control your own response if you don't model calm behavior and you don't use

non-threatening body language you make things worse it's that simple I don't expect

you to be Saints I do expect you to practice good self-care and we'll talk about that so you're at your own

Baseline understand when you need help understand when you need an additional person if there's not an additional

adult in your life figure out ways to add those people in good self-care is one of the most important

things about being a foster parent I can't emphasize it

enough trauma truth um people recreate what is familiar to them if a child is

familiar with chaos in their home and suddenly they're placed in a safe environment free of chaos she will seek

and provoke The Familiar stress in the new environment to keep safe it makes me so sad but what we know

is that kids don't necessarily believe that things are going to stay non-chaotic and in their mind triggering

the chaos as opposed to waiting to see when it's going to start you know if someone told you at some point over the

next 24 hours I'm going to punch you and you couldn't get away from that

punch you knew it was coming would you rather spend the 24 hours waiting for

someone to punch you or would you rather they just did it right then and got it over with and it was

done I'm hoping you're saying I'm thinking you're saying that you'd rather just get it over with because it doesn't

make sense to carry that anxiety and that burden you know it's going to happen let's just get it over with many

of our kids feel the same way I've had kids say to me so I know you're going to

yell at me eventually just do it that's not how I interact with people

and I'm sorry that that's been your experience in the past but that's just not what I do and I want you to know

that there's not many situations in which I would yell and the situations in which I would yell are safety situations

if you're running towards the road if something else is happening you're going to hear me

yell those are the times that that's appropriate but I think it's important to understand that kids are just waiting

for the shoe to drop many times so how do you help I've told you

so much about what the challenges are but now I want to tell you that you are enormously powerful in this cycle the

first thing we're going to do is identify the challenges it's almost like being a nature Observer um a friend of

mine has the amazing job of working in a zoo no idea um I would love to work in a

zoo and she works in a zoo and she was working with um a a a a primate that was

soon to give birth and her job was to note every five minutes what that animal

was doing you know every five minutes Gathering snacks sitting quietly moving

to the side interacting with another animal and by doing that they could identify very early signs of changes or

distress in many ways what we do as foster parents is the same we're

assessing behaviors we're looking for deviations we're looking for triggers we're looking for times and events and

and situations that prevent present challenges so the first thing we're going to do is identify the challenges

when do they happen what's the SI the situation what's the

stimulus what what is happening for that kid when they begin to struggle because that's how we know how to choose a

solution and there may be many tries with Solutions and then look back and

try again so the first thing we're going to do is identify this cannot be random the

strategies that we choose cannot be random so we need to try certain things and I will say you know one of the

things we know about sensory diets we can all benefit from a sensory diet you can Google sensory diet there's tons of

great videos I'm not worried that you're going to be able to find information but what we know is that states of being

states of feeling have opposite and equal responses that help calm those states of

being we know that when we feel anxious I know for myself I don't know what fixes you I actually hear that there are

people who when they feel really stressed and anxious go for a run that sounds that is literally the

worst possible thing that'll be further punishment that is not my choice I always say I don't know what you need

when you're anxious but if you tell me I'll try to give it to you if you want to go for a run I'll find your shoes for

me I want to cuddle up with a book I want a cup of tea I want to be in a space that feels

safe so we know we can add things in we have lots of kids who love fidgets who

love weighted blankets who want to take a hot bath one of the things I often do with kids is a hot bath and a cold

popsicle somehow that combination of warm water and the cold in the mouth

calms all the sensory stuff down and there's a scientific reason that works but we don't need to know we just need

to know it works um music or white noise bouncing or jumping the number of manyi

trampolines we've gone through in my house over the 25 years of fostering it's

uncountable um I I don't know how they do it but many kids in my house jump on the trampoline while they watch their

show in the evening helps them calm down dimmed lights oral motor so kids who

were chewing on things kids who are biting can put things in there um meal options bold favor flavors spicy flavors

I have a kid who when they really really struggle they eat really spicy chips like those ones that burn your mouth I

said why are you eating those and he said I don't know it just makes me feel better it calms me down again that is

not the answer for me I would need so many Tums I'd have to buy stock in the company but for him that's what he

needed and he was able to figure that out and I had a lifetime supp L of those hideous chips in my cabinet so when he

needed them he could go get them one of the other things I want to

talk about is the idea of trust trust is earned it's not given the moment a child

walks through the door remember we talked a little bit about the the idea of the hot

stove unfortunately many kids in foster care have been burnt multiple times by

multiple different PE people including some foster parents for some of them it doesn't make sense for them to

trust us immediately and I would will often say out loud to kids who are older and able to comprehend Hey listen I know

it might be hard for you to trust me I want to earn your trust I want you to

know that I don't often make promises because I don't want to fail you so what

I'm going to tell you is what I believe is going to happen but we also know that

I'm not the boss of everything that's going on and things may change I also want you to know that I'm a safe person

I don't hit I really don't yell very often unless it's a safety issue you can

come to me and tell me things if you break something you can tell me we'll figure it out together what I want you

to know the most is that I want to know when you begin to struggle when you're

in an irritable mood when things are starting to feel uncomfortable cuz I want to help you get back to a space

where you feel safe before things get out of control let's talk let's figure this out

but also I hope you'll let me prove that I can be trusted and when you feel like I've done

something that makes me untrustworthy I hope you'll tell me this is not a magic potion you know

it's not a a a fairy tale where the child then goes oh my beloved caregiver

thank you so much I I've had kids tell me to blank off but providing the

message is really important but more important is standing standing strong in

that message apologizing when we do things incorrectly taking responsibility

for our actions being honest being open being approachable trust is

earned and then trust is given so what we want to do is then explain to the

child how they can move through our family and earn trust as well well you know she may

not want to share that toy with you because she's not totally comfortable because last time you had her toy you

broke it I'm wondering if you want to show her by playing with your own toys

or loaning her one of your toys that you can be trusted with that toy now that

that was a a thing that happened when you were in a a different place and now you're more safe help them learn how to

gain Trust and then we just repeat that cycle over and over and over again it's like any

relationship we prove our trust to one another in the tiny moments and in the

huge moments every single day one of the things it's hard for us to recognize

sometimes especially if you're new to fostering and you've had children that have been in your home since since birth

or since early in their lives they have that secure attachment and often they

have a true they want to please you because

they love you they care about you and your responses matter to them that's not

always the case with children in foster care they don't know you they don't love

you and gaining your approval is not necessarily the first thing in their in

their heads trying to figure out what the heck just happened and stay safe is the first

thing and I often think of this and please don't ever think that I'm comparing children in foster care to

animals in a shelter because I'm not I was a child in foster care

um but I often think of the way that that we are so carefully taught um I

don't know if any of you have ever adopted a Shelter Pet but it's not easy to do um you have to kind of go through

the paperwork similar to what you might have done you have to have interviews and things like that but we are so they

are so clear and aggressive I have friends who work at at animal rescues and they're so intense about saying to

the family you may not judge this Animal by how it acts in the first week in the

first month even the first couple months in your home if you're going to get rid of this

animal because it doesn't act the way you think it should in the first three months we will not give you an animal

think about that the shelters tell us that when an

animal comes to your home they may need three months or more to be able to

settle in many of those animals have experienced loss and neglect and Trauma

and the animal rescue folks are trauma informed enough to know that we need you

to commit to things being challenging that dog might poop in the house and

that dog might go hide and that dog might cringe when you come near it and it might wake up during the night it

might do all sorts of things that are not what you got a dog for and yet they're telling you in no

uncertain terms ride it out we think it'll be worth it what we know is that

in three months maybe a little bit more maybe less

that creature will show itself to be what it actually is when it's not afraid when

it's not overwhelmed so one of the things I really hope that we'll pay attention to is this idea that are

expectations should absolutely be for the first several weeks it's intense

this person is learning a whole new way in your home and the better job you do

of creating routines of community ating of responding with compassion and

understanding the faster that that initial time frame will

pass but never forgetting that they have reason to not trust and we have work to

do to earn

trust one of the things I pay attention to is how carefully we can stick to

schedules in our home when a child arrives for the first time we want to make sure that over that next week or so

things are as predictable as they can possibly be we're not shifting things up that's not the time you know the first

three days that a child is in your home is not the time to say to yourself oh you know what I said this morning that

we were going to get McDonald's for dinner but instead I think I'll make a pot

roast try not to shift things try not to sh share share things around remember

we're building trust we build trust by making a promise and keeping a promise and making a promise and keeping a

promise and making a promise and keeping a promise if you tell a child you're going to pick them up at three be there

at five minutes of three that's how trust begins I am so

enamored of the pile the the of the power of ritual excuse me I put rituals

in my day-to-day life for myself but I put rituals into the day-to-day life of my children as well it might be that in

the morning when I wake a kid up I spend one or two minutes sitting on the side of their bed we talk about their night

we talk about their dreams we talk about the day we get things ready I've had

other kids where we've had a self-esteem chant I'm I'm powerful and I'm hopeful

and I'm strong whatever they want it to be other times we've done top to bottom

check where that kid is really anxious about not not having everything they need to have so every day we start from

the very top did you brush your hair do you have your glasses did you brush your teeth did you put on deodorant do you

have a shirt on that gets Giggles clean underwear pants socks shoes do you have

your bag do you have your math homework from yesterday do you have your lunch so that that child leaves not feeling the

anxiety of perhaps having forgotten something but NOS we did it top to bottom you're good we did it top to

bottom you're good you may also have a car snack I

work with many families that have car snacks so what they do when they get in the car is the kids will all eat some Cheerios or something like that while

they listen to a m to music or to a book on tape audio books are amazing for

filling time in cars and times when people may escalate they may be nervous some people do familiar audio books I

will say I my son listens to the same Audi book every single night um actually

he has a couple he listens to the Martian which was a movie with Matt Damon that you may have seen but there's a book of it um so he listens to that

book he might listen to ready player one but he listens to the same book over and over again and sometimes I can hear him

saying the the the passages out loud with the book that's what he likes that's what he

enjoys you may when you get home ritual after school is really important um or

reconnect ing rituals after daycare Etc getting everybody back together you may do a dance party everybody may be

overwhelmed and intense and things like that you might all gather with a snack and do a book on CH on T on tape or you

may do something that is completely separate you may a friend of mine does activity boxes so each kid she has four

kids in her home each kid has an activity box that she puts a snack a

book a a music player something else and everybody takes 15 minutes on their own

because all of her kids have experienced trauma all of her kids have experienced loss getting back to the house is

intense and she has found that if everybody takes 15 minutes when they get

home to be calm wrap yourself in a weighted blanket or a cozy blanket or

sit with the cat or whatever you need to do and then at the end of the 15 minutes she Rings a soft Bell and people move

into their day that's the strategy she put in place you may need to do a onetoone check-in with each person

you'll figure out what works and then in the evening evenings can be very challenging for people um a lot of

sadness can come up in the evening a lot of things that have been held back or people just break they've been holding

on to it all day long and then when bedtime comes everything

explodes pay attention to that soft jammies alone time together time morning

planning talking about best worst time on a trampoline time with a weighted

blanket you'll figure it out but if you're like every evening is chaos then I'm going to say I'm so sorry

to hear that what are you doing what is your current strategy because you have

to keep trying new things but once you establish a ritual keep doing it do it

over and over again and then if you have to break the ritual announ it hey guys I

want you to know that we usually do our 15 minutes by ourselves when we get home from school to school each day but today

Joey has a doctor's appointment so when we get out of school we're not going to go straight home we're all going to go

to Joey's doctor's appointment and after that we're going to go to

McDonald's just advertise it in advance the surprised is not

helpful identify challenges as opposed to disparaging the child not he's

aggressive but in the morning he can really be intense sometimes he lashes

out if everybody goes to put their shoes on at the same time he can punch people if they touch his

shoes that's a much easier thing to strategize around we're not going to say

she can't play with other kids let's talk about the times that she has been successful playing with other kids or

let's talk about what happen s right when she stops being able to play with other kids that's where our strategies

come from I have lots and lots of kids who can do parallel play if everybody

has their own um tray of stuff but cannot share if

you put one thing of crayons in the center that is going to end disastrously every single time if everybody has their

own thing of crayons you're good to go so paying attention to the challenges

allows you to insert strategies not necessarily she's a mess after of a visit I hate visits every

time she comes home she's a mess visits are integral to the foster

care process and sometimes they go well and sometimes they don't go well and

sometimes when they go well they still don't feel like they go well they're saying goodbye to somebody every single

time and one of the things that I would love to try and help people figure out is how to do therapeutic visits but for

now now there are times when it's going to be hard so we're not just going to say she's a disaster after every visit

we're going to try and figure out what she needs so one day when she gets home from a visit you may try being ready

with her favorite book and something to eat and something to drink and her blanket so she can sit quietly if that

doesn't work you might be ready with the blanket on the couch and the book and you sit together if that doesn't work

you might stop at a park on the way home so she can run around around for a little while identify challenges and then try a

strategy I don't try a strategy just once I often try it three times unless it's clearly a disaster it may take even

more so sometimes I'll be like I don't know might be getting better if you

think it might be working keep doing it it's not going to be immediate I wish I could give you miracles I wish I could

give you a magic wand I wish for a magic wand all the time sometimes I go into my kitchen when it's a mess and I go bing

bing bing just to see if I might be magic but I'm

not we have to do the work I will say though for myself when

things are really really challenging knowing that I'm trying some strategies makes me feel a little bit more in

control and a little bit more hopeful when you're identifying

Solutions we're looking at a few different strategies can we avoid this

you know can can we avoid all the kids gathering at the end of the hallway to put their shoes on can we avoid sharing

crayons what can we avoid let's mitigate it can we can we make it easier can we

make it quieter can we make it less intense how can we kind of put things in that'll soften this experience can we

insert the opposite if things are really noisy when this kid is doing this they

struggle can we insert quiet or can can we prepare the child for situations that

they struggle with um forecasting preparing often kids do really well I've

had kids who've done really well with little cards that they can keep with them that show them each thing that's

going to happen during the day I had kid for the longest time I would print out

everything that was going to happen during the day every class they were going to everything else and they would X them off as they happened and it made

them feel more in control and sometimes they text me they'd be like four more things I can do four more things I like

you're you've got this you can do four more things and sometimes they text me and say four more things I cannot do

four more things and I'd say you know go to the guidance office give me a call let's

figure out what those four things are and let's figure out where we get through preparing them and offering them

strategies is the kindest thing and I will tell you that kid is now 25 years old and he still uses that

strategy and he's working and he's out in the world and things like that so what we're actually doing is preparing

people for life then we have to implement those

strategies and that is is hard to do sometimes because it's extra work if it

wasn't extra work you'd already be doing it so waking up 10 minutes earlier and running around the house and pjs for

five minutes or bouncing for 5 minutes means you may have to get that kid up 10 minutes earlier which may throw off your

entire schedule ual first of all don't set up strategies

that you can't keep going with um you know don't set up a strategy that says every morning the whole family is going

to wake up together we're going to get dressed we're going to go for a lovely walk around the neighborhood while we

discuss current events don't do that unless you are one

of those amazing families that actually can do that don't do that set up strategies that you can

maintain do that audio book or music in the car but then set it up and do it

every time or providing calming options in advance of a challenging situation

keep a sensory box with you keep snacks with you keep you know I I will tell you

the amount of crap that I C around especially in the times when I was taking sibling groups or teen moms or

things like that it was ridiculous I had a sensory box for each kid I had snack boxes for each kid it was easier to just

pull them out but it was also easier to teach that kid I would have kids come to me and be like I need a squishy I need a

squishy if I'm going to sit for longer I need a squishy that's awesome if you can

identify what helps you you are ready for the world I'm not going to lie to you many adults I know are still trying

to figure that out but then we have to have access to them and then we can evaluate and try

again older kids can help if you approach them when they're calm

we do this weird thing where we try to ask people what went wrong while it's still going wrong why are you acting

this way why are you so upset what happened they don't know it's still happening they're still overwhelmed

they're still upset they're still angry and then we do this other thing where we think well it's over now let's not bring

it up but in fact what what we know in our

heads is that planning for Hard Times happens when things are

quiet that's why we plan for emergencies that's why we do fire drills so we want

to kind of do emotional fire drills sometimes we're not going to go through all the challenges we want to say Hey

you know let's think about this you went to school you had a hard day Joe said something you didn't like all those

other things what are some of the things that you could do what are some of the things that I should have in the car or

two days ago Jack took took a toy away from you and you did great what do you

think you was happening that you did so well ask questions how did it feel when

this happened did you know in advance were you feeling irritable and angry beforehand all of kids some say to me

sometimes listen I was having a bad morning and then you asked me that and that was it well then what I need you to do is

start communicating with me if you're having a hard time let's fix it at the beginning you know not for nothing

although this isn't totally true but the time to bring your car to the mechanic is when you hear a funny noise not when

the engine dies I'm saying that as I'm know that I'm hearing a funny noise in my car and

I haven't brought it in yet but we do want to intervene early and then we want to ask the kids

themselves what could have helped what could I have done differently what could they have done differently what could

you have done differently what might have helped talking about hard times is how

we learn how to handle them

the other thing I want to think about is volitional versus non-volitional Behavior so one of the things we know is

that kids who've experienced trauma kids who are highly anxious um kids who have

ADHD kids who have autism all sorts of things it causes them to react before

they're able to develop a response so we see here my beloved Buddy the elf and

Buddy the elf knows that that Jack in the Box is going to come out it's going to startle him

but he still responds non-volitional which means without choosing to or

without him being able to control it by getting scared and if we told him

no matter what you do you may not get scared I don't know if he could do that

volitional behavior is the behavior that we choose non-volitional Behavior

child doing this intentionally is an important thing and to be honest with ourselves sometimes we

attribute intention he likes it when I'm like this he's doing it to push my

buttons let's step back a little bit and make sure that we're really looking at it from the child's point of view our

perception and their perception are very

different disrupted nervous systems love routine they love love routine they love

predictability um this is something that you should have available in your home

you should kind of be able to identify your own schedule your own bedtime routines your own beforetime routines

and you can do this for any age as a family this is what we do I can help you

with this the goal is for you to be ready and waiting or to be downstairs to

get something to eat at 7:20 what does that mean you need to do before that and how can I help you that'

be for an older child for a younger child you want to kind of display the whole piece I've had kids who really for

some reason I had a family that called me and they were like he won't go back upstairs to brush his

teeth he comes downstairs we eat breakfast he needs to go back upstairs to brush his teeth and he will not go

back upstairs to brush his teeth and I asked like so what is the goal what is the task you're trying to

get accomplished and they said we want him to brush his teeth his teeth have been neglected and I said do you have a

sink downstairs and they said yes and I said try having him brush his teeth downstairs tomorrow and they did and he

would why wouldn't he go back upstairs I don't know and I don't necessarily need to

know what I need to identify is that the goal is not to have the child obey me

when I say go upstairs the goal is to have the child brush their teeth and

there are multiple ways to get to that end point so once you figure out what your goals are you can put in place some

strategies figure out what works but predictability o disrupted nervous

systems love ritual and routine predictability the the same thing over

and over again the same book the same story I had kids who I had to say the

same I would say okay everybody's here everybody's ready does everybody

have their shoes their lunch their bag their hat and then if it was summertime

they'd say we don't need hats all right everybody look around

does anybody see someone that doesn't have everything they need all right all

good and they would yell all good and we'd go to the car and the times when we were running late and I tried to skip

that were not all good and I finally realized that the three minutes that I

put into that ritual were much better spent than the 10 minutes I spent trying to drag a kid

out of the car because everyone didn't say all good disrupted nervous systems love

routine if you call me and I'm happy to have you call me um if you call me and

you say this is what's happening and I ask you what you've tried and you say well we just keep telling him he needs

to do it I'm going to refer you back to this quote you have to be flexible

Foster parenting is the essence of having to be flexible try something new

try something different reach out to someone else for ideas it's really hard to see new ideas it's hard for me too

when I'm in it when I'm struggling and overwhelmed I don't just rely on my own Noggin I'll call another foster parent

I'll call a friend and say I'm stuck this mom and I are at loggerheads

she doesn't trust me I'm frustrated every interaction we have ends badly I

need help and it's been amazing how much

people have been able to help me and sometimes they'll say things and I'll think why didn't I think of that it's

really hard to think of how to get out of the crisis when you're in the crisis let's just remind ourselves of that the

number of times that I have been irritable with people and mean because I'm hungry but I never thought of eating

somebody else would be like shouldn't you get a snack and I'm like oh even the simplest answers don't come

to us when we're the one in the problem if you're not trying a strategy

nothing's going to change it's not magic you can't just keep fighting through it you have to try something

identify a couple challenges don't try to fix everything at once pick the things that are most disruptive and work

on those and success breeds success sometimes we'll see the morning routine get handled and then all of a sudden the

afternoon routine is okay success breeds

success it's really hard to not take it personally it's really hard to not feel

disrespected to not feel ignored to not

feel like you're not kids aren't aren't giving you your

due especially if you have other children in your home who have been securely attached and who do respect you

and do trust you and do provide you with that it's not about you when a child's

being defiant they are being defiant to every other time they got burnt they're

being defiant to the fact that they had to leave their home they're being defying to the fact that they will never

see those Spider-Man sheets again it's not about you and when you

take it personally you reduce your ability to be helpful it actually reduces your access

to thoughtful responses so one of the first things I'm going to do if you call me and tell me the child is

disrespectful I'm going to ask you disrespectful to who this is a child in crisis this is a

child in trauma and it is almost never about you now if you're doing something

to elicit that then let's figure that out but most of the time people are just working through stuff you know the

person at the Dunkin Donuts who is you know a little snarky a little unkind a

little mean it's not about you they're just having a bad day and you happen to be near them I often say people are

having a bad day near you and you get to decide whether you make it about

you it's not about you you as a foster parent as a human

but as a foster parent you you take on an additional responsibility to model self-care take breaks ask for time out

find other Foster families you can swap kids with them you can all play together engage your family members and Friends

plan self-care during visits the one thing I'll often see is people will use visit times to get work done and get

stuff done and maybe you don't have to maybe you can take an hour during that time to relax do something for yourself

engage in a quiet activity with your with the other children that are in your home and things like that take breaks

the number of times that I have said to the kid I want to talk to you about this but this is not a good time for me to

talk to you about it so I'm going to take five minutes and I'm going to come back in five minutes everything is okay

you're safe I'm safe I just need to make my brain slow down so that I can

think I've said to older kids you know what I'm I'm really upset right now I'm going to go take 10 minutes because it's

my responsib ability to keep myself in control so that we can work through this

and I can't do that right now I've also called friends and said you know what if you could come over any time today for

an hour I just need to go lock myself in my bedroom and watch two episodes of the

office I'm really lucky I have friends who will do that I hope you do too and I

will say priming them in advance is a good way to do that

that we all have a self-created sensory diet so your homework right now is to

figure about the things that you have built into your sensory life that work for you I get up before anybody else in

my family I go upstairs I feed the cat I make a cup of tea I do that no matter

who's in my home if the baby has to be fed at 5:30 in the morning that means that I may have to to get up at 5: to do

that but I am not an enjoyable person to be around without my cup of tea I also

know that when I get home and everything feels chaotic I get distressed unless

I've taken a few minutes so there's a pond about 10 minutes from my house I often stop at the pond look out at the

water kind of put away the stuff from work in my brain and get ready for dealing with everything at

home knowing what you need knowing what you've put in place place and then knowing that some of those things may

get disrupted or shifted what do you need to do you might need to divide and conquer if you're kids need a quiet

getting ready time in the morning and your foster child is excitable you might need to figure out how to do that you

might need to say okay I'm going to get our foster child ready over here while my kids get over ready over here if

you're parenting on your own other things might happen you might ask someone to come over for a little while and help you and then we want to just

make sure that we're included we're making space for and adding in what we

need you know that piece where you know especially for families who are taking in like school age foster kids there

might be a time where you say good night to the school age foster kids and then you might go to the other kids' rooms

and settle in with them a little bit so figuring out how people get individual time I am a big one for taking kids in

the car with me um I happen to be parenting with someone else now I parented as a single parent for the

first night N9 years and now I parent with someone else and so that was a big thing for me now if I have multiple kids

in my home then we're going to switch off who goes for a ride with me sometimes I'll be like yeah so and so seems off I'm going to go put gas in the

car hey come with me I'm gonna go to the gas station you know you come with me so getting some one-on-one time adding that

stuff in things that came naturally in the past you may need to do deliberately now I would love for you as an

individual or as a family to figure out what are the things that you've put in place what are the ways that you care

for yourself what are the ways that you go about your day that make you feel secure that make you feel safe that make

you feel comfortable so you'll get this this form

and these packets so I'll I'll I hope that you'll take some time to do

that this is hard but amazing work I've done a lot of things in my

life I was actually a peace score volunteer and I don't know if you know but the peace score motto is the

toughest job you'll ever love and I enjoyed being a peace score volunteer and it was really

hard fostering is the toughest job I've ever loved I love that I know that there are

people in distress and I can help them I'd be thrilled if there was no need for foster parents but I'm not sure we're

ever going to get there so for now now it is my honor and my privilege to be a

part of helping people move through chaos move through hard times in a way

that demonstrates that there is safety in the world there is comfort in the world and whether you stay with me for a

week or you stay with me for a year I know that that child has grown that

child has learned things um when I first started I fostered Little People

medically little people and these little people would leave and I would be so sad

and a social worker said to me that what a child learns when they're with you is what love looks

like what safety looks like and even though they're going to leave they're

leaving with the ability to identify in the next person what that looks like it

may not be the same soft voice it may not be the same cuddling it may not be

the same laughter but they'll recognize that those are the things that indicate

love I will tell you for myself I watched my foster

parents to learn what safety looked like to learn what a good marriage looked

like to learn what healthy parenting looked like and I use those lessons

every single day I may not have been able to stay with them for long I may not have been adopted by them but the

lessons they taught me last and they mattered and they're important I would not be here if it

wasn't for them you are providing an extraordinary gift whether you Foster one or two

children whether you adopt or whether you do this for the Long Haul the work you do is important we're here to

support you other foster parents and the agency itself thank you so much take

really good care of yourself and I look forward to talking to you

again

Video 90 Day Session: Working with DCYF to Achieve Reunification

Transcript of video:

i never thought that oh me i would never

get my kids taken away i don't beat them

i don't you know use drugs in front of

them i always thought that it was okay

if i used in the basement and they

didn't see me

after many many warnings ultimately

they

removed our kids because

i got arrested

you know she was like i'm sorry but

you know it's time to

remove the children you know

and i had to go downstairs and

tell my 11 year old daughter that

um i'm sorry honey but they are taking

you and it was like she looked at me

like

she

kind of knew i mean she was 11 too i

think she just

knew that

it was gonna happen

it's difficult to

not be

angry

all the time because i don't have you

know we didn't have control over any of

it you know um

and i didn't realize that the only

control we did have was to just let go

and let them help us

um it took months and months of fighting

you know and

i feel like if we just accepted that

help right away

i don't think it would have taken a year

and a half for us to get them back

ashley was incredible she was amazing

with the kids

the kids loved her

it took hannah

a little bit of time to like start you

know trust her

ashley

she just made me feel

comfortable

you know with the whole thing

she made me feel like

i could do this

she really wanted all of us together

again

and um i i really don't think

that i would have

done this

if it weren't for her i i really don't

like i could

i could cry because

[Music]

i was um

we were just really really

blessed to have her

one two

one my husband and i needed to get

treatment we couldn't stay clean too so

then we ended up at a silver living

place for three months um and we were

going to court on the phone

without dcyf

i think i would have been dead dead or

in jail i think my husband would have

been dead or in jail i think that they

changed my life

they changed my family in so many ways

my daughter

the conversation came up and and she

looked at me and she said

if

this didn't happen

i don't i don't know where i would have

been

she also said that she was grateful that

it did happen

i mean

you you wouldn't think that a kid would

say

oh i'm glad that

i went to foster care

you know um

you know she said that like

i have my mom now

dcyf just wants to help they just want

to help you work with your children

better they want to

help you get your children back they

don't want to keep them from you

which i always

that's what i thought

um

so that's what made me fight them

and

when i finally just accepted the help

that's when i realized

what they were actually trying to do for

me and

it changed my life

[Music]

you