Creating a Family: Talk about Adoption & Foster Care

Home Based Therapy

November 24, 2021 Creating a Family Season 15 Episode 48
Creating a Family: Talk about Adoption & Foster Care
Home Based Therapy
Show Notes Transcript

Have you ever thought that it would be a lot more effective if the therapist could really see your child in action? That's the gist of home-based therapy. We talk with Stephanie Glickman, a licensed clinical social worker at the Clinical Director of the Family Centered Treatment Foundation and an adjunct professor at the University of North Carolina Charlotte's School of Social Work.

In this episode, we cover:

  • What is home-based therapy?
  • Is it family therapy or child therapy?
  • Why is it so effective for families struggling with behavioral issues?
  • What type of issues respond well to in-home therapy?
  • What does the research show about the effectiveness of home-based therapy vs. residential placement?
  • How does in-home therapy work? How often does the therapist come? How long do they stay? How long does it need to continue?
  • What if the child does not act out while the therapist is in the home?
  • Who in the home participates in home-based therapy? Parents? Siblings? Others?
  • Are their confidentiality concerns with this type of therapy?
  • What are some of the advantages and disadvantages to home-based therapy?
  • How does the cost of this therapy compare to office-based therapy?
  • Does Medicaid cover home-based therapy? 
  • How do you find an in-home therapist that is knowledgeable about adoption and fostering and the trauma these kids may have experienced?
  • What are some tips for knowing if you have found a good fit between the therapist and your family?
  • Family Centered Treatment Foundation

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Please pardon the errors, this is an automatic transcription.
0:00  
Welcome, everyone to Creating a Family talk about adoption and foster care. I'm Dawn Davenport. As you know, I am the host of this show. But I'm also the director of Creating a Family dot org. And I want you to make sure you listen to the end of this show, because we're going to be giving you some practical tips. So make sure you listen. Today we're going to be talking about home based therapy. We will be talking with Stephanie Goodman. She is a licensed clinical social worker. And she is the Clinical Director of the Family Center Treatment Foundation. She is also an adjunct graduate professor at UNC Charlotte's School of Social Work. Welcome, Stephanie, to Creating a Family, we are so happy to have you here today.

0:45  
Thank you so much for the invitation. It's a pleasure to be here.

0:48  
This is a topic I am really excited about. I have seen such hope for families, when they have had home based therapy that I'm, I'm really excited to be giving more exposure to it. Because I'm constantly amazed when families are really struggling. And this has not been suggested. So let's start with the obvious what do we mean by home based therapy, I think I have an idea of what it means. But with this opening, It's same as yours.

1:15  
Sure thing? Well, it's basically essentially just the therapy that is provided in the home setting or you know, even if it's children who may be in foster homes, in group homes or residential placements, that there's the availability for the treating practitioner or clinician to meet the child and family where their current living environment is opposed to the kind of the traditional treatment of asking folks to come to an office

1:40  
setting. Gotcha. Now, so is the therapy directed to the family? Or is it child therapy that happens to happen in the child's home, or the family. So

1:51  
you know, I guess, depending on what the referral is for could determine that. So there are some home based services that are geared specifically towards the child. But you know, we've seen just through best practice that when we're able to integrate the parents and caregivers into the process, it really enhances the work, I always use the analogy, it's like you can't just lose weight in your leg, it's got to be a full body. And so, you know, when we're talking about making change in a home environment, you know, the more players that we can have be a part of it, the more successful it is.

2:24  
So with that includes siblings are and grandparents if they're around, or is it primarily just the parents? Yes, siblings,

2:33  
grandparents, you know, we say the family is defined by the individual. And so sometimes that just may be somebody that they're very close with, um, it could be a live in family member, but it does not always necessitate being a biological related person. So you know, if they have just a roommate, or somebody that's also living in the home, or is very close with the child or individual, then they're welcome to invite them into the process.

3:00  
So why is it so effective for families? Or maybe I should ask, is it very effective? I think I'm sure, since you are the Clinical Director of the Family Centered treatment Foundation who practices home based therapy, you're going to agree with me. But is it effective for families struggling with behavioral issues? And if so, why?

3:19  
So, you know, I've I've been doing, I've been involved specifically with Family Center treatment since 2005. And doing everything from the Home Base provision of services to trained nurse supervisor, clinical director, you know, kind of seeing it from all the different levels. And what I can say from my experience is that it's remarkably successful and effective. You know, I think what makes it just have the added the added appeal is that, you know, we're in this setting where, you know, I guess you could say the quote, unquote, like problems or challenges are occurring. Yeah, practitioners are able to experience in real time, you know, how is the caregiver, trying to parent one of five children while there's a dog barking and a cat running through the room? Outside, you know, just being in their environment to really feel the experience firsthand.

4:13  
Hmm, yeah, that makes such good sense to me. Absolutely. Are there some type of issues that respond better than others to in home therapy?

4:23  
I think it really depends on you know, every every individual is so different. And so, you know, there's when we're talking about things related to children specifically, I think having the home environment with the caregivers involved, brings it so much success because we need that parental involvement. You know, it's really challenging to just take a child out of the environment, make some tweaks and then put them back into the same environment. So to be able to have caregivers and older siblings involved, whether it's things from, you know, just kind of ADHD or some behavioral concerns, but we've seeing successes for folks who are on the autism spectrum, when there has been severe cases of abuse, neglect, exposure to domestic violence, to really be able to have that full system involvement has really brought about just that, that collective change. And so we're not only seeing the change and like the quote unquote, like identified client, we're seeing progress for all of us off.

5:26  
Yeah, that is what exactly what I have seen that it seems to, in some ways that parents feel supported, mentored, coached. The if they're open to that it's it's incredibly effective. The child then is, is seeing their parents respond, it seems to almost be a synergistic type relationship.

5:45  
Yes, yes. And it's such a partnership that gets established. And then, you know, it feels very real at the, at the ending of services as they're going through the completion phase. But it's, we've, the parents just feel more equipped, you know, that they feel like I've got it. And because they've been able to practice in their home, again, they weren't kind of just asked to do create things in an office setting, and go back home and try it. They're trying it later with the practitioner present in the home, giving it a shot, some work, some don't, you know, trial and error along the way. But then, when we get through to generalization, the parents really feel that, that they've got it that they've gone through the experiences and

6:25  
that practice, is it's it's a situation where you would normally start people in the office. And then if the more severe cases are the cases that don't respond well to, in office therapy, that you would then move into the home, is that how it generally works? Or do you begin in the home,

6:47  
oftentimes, you know, based on our referral sources, and you know, funding, of course, is always a big piece to this, but

6:54  
we're gonna come to that.

6:58  
So starting the services in the home is actually our primary mode of service delivery is getting to them first, for many of the families we serve, you know, I mean, we're rural, urban, and even frontier. And so there's been times where there's just such such frontier areas where families do not have the resources to come to an office setting. So this may have been one of the first time that somebody has actually come to help their family. And so really trying to make our services as available to the families as possible with breaking down those barriers of simple things like transportation, gas money, how would they get there, the timing of the day, you know, our practitioners are really adept at being able to flex their schedules to match families. And you know, there are times where we may ask families to come to the office. And we always assess throughout treatment, if safety is ever a concern, we may transition to like a community based setting like sometimes renting like a room at a library as long as it's secure, or using offices, if for some reason, the home environment just wasn't safe for a particular reason.

8:09  
Okay. You said something earlier about treating the children where they are, as opposed to removing the child and treating the child separately, and then the child really interesting environment. And that that makes me wonder about in I suspect that research, I'm hoping you know, it does exist, but showing the effectiveness of home based therapy versus residential placement. I realized those are not the two the only two options. But often we do see parents, sadly, often it's when they've reached the end of their rope and they just want the child removed and put in residential placement to give himself some respite. But it is a research that shows the effectiveness from the child's standpoint and from really effecting change in the family dynamics between doing home based therapy versus residential placements.

9:02  
Yeah, so with the, you know, there are plenty of residential placements that do have an effort to integrate families into the process, you know, again, sometimes those barriers of location and getting to and from can be a challenge. But you know, I mean, I think the family component is the most important part, a couple little, you know, just some random numbers to throw out right that I came at least share based on a family center treatment perspective. You know, there was in Maryland, the state of Maryland, back in 2003 through 2007. For every $1 spent on fct, the cost for a child in residential care was $2.29. So you know, there's like one direct thing. We also had some data from North Carolina, between 2017 and 2018. And you know, the average cost for a child in foster care was about $50,000 for a child getting families center treatment was 17,000. So in the length of stay between therapeutic foster care tends to be about 18 months, whereas FCT is from five and a half to six months. So, you know, there's whomever the cost benefits, right, you know, like show in that perspective, so stakeholders, but also for what the families are getting out of that is, you know, less time more intense services. And when it can be preventative instead of reactive is really our best case scenario.

10:30  
Yeah, for all of us. Yes. And when you say FCT are speaking of Family Centered treatment, and and that is the name of the organization, but it also, so you're speaking of your specific home based therapy that is or treatment modules that you use, our system that you use, but I would assume it would be similar to other home based therapies.

10:54  
Yeah, absolutely. And we've seen a trend, you know, I think it's becoming more of a trend, you know, seeing that a lot of things are just kind of becoming more home based, right, even true. shifted it, we're all like UberEATS and DoorDash. You know, yes, coming to the home. And, you know, healthcare is no different. And so I think just to stay current with the times it's a shift that's happening, and it's proving to be really successful.

11:19  
Yeah, I agree with you. Yeah, I everything does seem to be going away from in person we run the creating a family has curriculum for parents support groups, adoptive Foster and kinship parents support groups. And originally, all supported not all but the vast majority of support groups were only in person. And now, I'm almost worried that people that support groups won't go back to it, none will go back to in person. They all seem to be online. So yeah, I'm, I hear you. So but fine with us because our curriculum is based for in person or online. So it doesn't matter. But I, I think there's sometimes there's an advantage to both. Let me pause here for a minute tell you about a free educational resource. Thanks to our partners, the jockey bang Family Foundation, we offer you five free online courses through our online Parent Training Center, you would go to Bitly slash JBf support that is bi T dot L y slash JP F support. And you can see five courses. One example would be parenting tweens and teens. This will equip you with more expert based and trauma informed information. Each course is free, there's a coupon code on that page, I won't even bother to mention it just go to the page Bitly slash JBf support. Alright, so how does in home therapy work? And what I mean is, how often does a therapist come? How long did they stay in the home? How long does it continue? How many months or years or whatever does it continue?

12:57  
There's there's a lot of different models of home based services. So you know, it's it really again, it kind of depends on the specifics, there are some services that may be more similar to like an outpatient therapy, that may just be an hour to maybe a maximum of two hours a week where the practitioner would come to the home. Some services operate on a more intensive level, such as the one that we do, which is more like four to six hours a week. So that can be spread across two days, or maybe spread across four days, again, really trying to target we ask the families, what are the most challenging times in your home, that's when we want to be there to provide a support and help walk, you know, help us go through it together. And then you know, I think traditionally, the length may be anywhere from, you know, they're short term models that might just operate at like two to three months. There's some that operate more like a six month ozone. And then also, you know, when we look at things like ABA therapy, or things that are targeted more towards specific like spectrum disorders, or something that may be something that's much more long standing, like over the course of a couple of years or so.

14:09  
Okay, so it's somewhat depends on the model. But it does sound like that a lot of the models you're talking about are more intense, where you're in the home for longer periods in the 90 minute or that, like a 15 minute session in a therapists office.

14:23  
Correct? Yes, that's the, you know, it's kind of like getting the best bang for your buck, right? Like, if we've got a practice nurse driving a certain distance to get to the family's homes, like let's, let's really make the best use of our time together while we're at the home and really get them practicing. You know, it's more than just a talk therapy, it really becomes, you know, instead of saying the next time you're going over, you know, chores and things like that, like you get to do it like in person with the families and say, Okay, stand up and move over to the couch and, you know, it really gets to become experience. All opposed to just like, let's talk about it.

15:02  
Okay. So, you know, anytime my car is making a funky noise, and I take it in to the mechanic, almost always my car doesn't make too funky noise when I get there. So what happens if my car and my child is like my car, and so the kid doesn't act out, the therapist comes up and the kid is just absolutely perfect, you know, on, you know, showing off doing all the right things behaving exactly like we want this child to behave. But that's not the norm. So what happens then? Or is that really a problem?

15:34  
We see that and have a name for it. So we call that the honeymoon phase. We start working with a family and everything just is so lovely. And we want everybody sitting and you know, every family has a different length that that phase, we actually start to celebrate we do. You know, we do these consultations in team meetings. And as soon as we hear the Oh, guess what I experienced last night, you know, we celebrate that because when a family is able to act, how they typically act in the presence of their therapist, that actually shows a tremendous amount of trust. And so it's like, wow, like they finally trusted enough us enough to see the their their typical way of interacting. And that really gives us a good window. But while we're waiting for that to happen, we just use a lot of scenario like role plays, you know, like, so let's pretend that this thing that happens and do a walkthrough, so they're still starting to practice maybe some different behaviors or learning some new strategies, until we until we see the some of the truth behaviors come out.

16:47  
It let's pretend that when someone asked you to do chores, you don't throw the broom on the floor. Let's just pretend just on the off chance that might happen in somebody else's home. Gotcha. Okay, so you've talked about a lot of the advantages, and there seem to be a lot, are there some disadvantages, and and we're gonna move to cost in a minute. So let's know, let's start with our so what are what could be some of the disadvantages to doing therapy in the home, having a therapist come to the home? Some, you know,

17:21  
we, we asked this a lot. And you know, we always welcome the feedback and help to shift services as needed, you know, some, some family, some caregivers feel just really uncomfortable or unsafe with somebody else coming into their home, either. They're finding, they're operating in some type of like shame or embarrassment, and just feel really uncomfortable. So you know, that could be one disadvantage is we're not trying to, we're not trying to impede or like be nosy in people's business. But we also want to respect and honor you know, their own privacy wishes. So being cognizant of that, you know, on the side of the practitioners who are going out and delivering the service, you know, we have to pay a lot of attention to safety, and ensuring that, you know, home environments in neighborhoods, you know, that we have a really good understanding, what are the pets, what's the pet situation in the home, if we have a practitioner who's afraid of dogs, we need to know that ahead of time. So you know, things like safety in that realm, you know, it's really important for us to, and even, you know, the driving the location pieces can sometimes be a challenge, whether probably becomes one of our biggest challenges, if, you know, the age of the pandemic helped us all shift to virtual platforms, but prior to that, bad weather oftentimes meant a lot of canceled sessions, and missed opportunities to really get some good work done. And so, you know, I think between safety, the distance, and, you know, just kind of helping to preserve people's safety and security and privacy in their home own home, I would say are the biggest ones.

19:00  
Okay, that makes good sense. Do you face sometimes families being embarrassed? Because, you know, the home is messy, or it's, you know, it's rundown, are, it's not the way they would prefer it to look, or they or they feel like they've got to go through a full, you know, a spring cleaning or, you know, that type of thing before the therapist comes in? If this is a problem, what do you do about it?

19:21  
Yeah, we get so many families who the first thing they do upon greeting us is apologize, you know, and we really have to slow down our process to just, again, just kind of honor them and actually spend a lot more time thanking them for allowing us to come into their space and if that means we start in a driveway conversation, we will do that. If that then moves to the front porch, we'll do that as well. You know, really making sure that they feel okay enough to welcome us in and really trying to emphasize that we're not there to pass judgment. We're not there to you know, we're not grading them on their level of funniness and If those are things that are really challenging and bothersome for the whole family system, then it's potentially something that could be worked on in the therapeutic sessions, you know, of how can we create, like a more comfortable space for everybody who's there, if that really is something that they're worried about?

20:18  
Other than just Yeah, that could be better could also just be, oh, you know, I don't have as much money as you my house was probably not as nice as yours, that type of thing.

20:28  
Right, right. And just, you know, we really try to normalize, you know, we're just, we're people helping people, and trying to break down a lot of those hierarchies. And, you know, of course, there's the professional side of it all, but otherwise, you know, we're even encouraging our, for the provision of home based services, you know, also just trying to promote, like, you know, just you don't have to dress like you're walking into a conference to do a presentation, you know, be at the same level, you know, like, just what's going to be more comfortable, instead of carrying in a briefcase full of paperwork, just go meet somebody, for the first time, shake their hand, say hello. You know, it's, it's really just again, just getting to know people to create that initial engagement.

21:15  
I was running a support group one time, and the one of the participants had said she was she didn't want to participate. It was an online group, I should add. And in fact, it was at the very beginning of the pandemic right at the very beginning. And she said she wanted to participate, but she did not want she said, I won't use I don't want my camera and I don't want I don't want people looking at me, and I don't want them looking at my my environment. We said fine, not a problem. And one of my college aged kids was coming home, I think it was, and they had brought I was there were boxes everywhere in my office. There were pictures, hate from someplace else that where it was my office was just a total mess. And I was running the support group. And I was looking for something. And so I show them what was on the ground cuts. I had actually had stacks of paper that had been on the desk, partly my daughter's who had brought him in. And there were other anyway, this, you get the gist, everything was a mess. So I took my computer up and showed them the floor. And all of a sudden, this woman who this is my fourth or fifth meeting, she pops her camera on she goes, I feel pretty comfortable now. She had seen my environment. She was like, okay, yeah. So, yeah. I said, Well, good. I'm glad I've made you feel comfortable. I, on the other hand, feel a little claustrophobic. I'm glad you're feeling really good about this. Alright, now let me ask are there are there conflicts? I mean, when you go to a therapist office, there is a zone of confidentiality, I wonder if that zone doesn't exist when it's in your house. I mean, you may be talking with a therapist when the child may be there. But an older sibling is sitting upstairs in your finger, the older siblings ears are, you know, pinned to the ground to hear? Um, is there is that an issue that arises?

23:09  
It is, and it's something that we talk with families about from the very beginning and pure and like, really just ongoing throughout all of treatment. Because, you know, again, we want to create the safe spaces. So we established very early on, you know, what's the most kind of like, secure private place to have a conversation, some practitioners may even bring like one of the little portable sound machines to place outside of a door, you know, or sometimes it's even sitting out on a back porch or going into a backyard or if we're playing games with a kid, you know, to be able to find that secure location. Even when we've switched to virtual, you know, we've had kids who have done their sessions in the bathroom with the shower running, so it will act as its own white noise for audio to this creative. Curious yours. Yeah. But you know, we're always we're always very aware of that. And we also do things such as having either code words or code non verbals to communicate with each other. So whether we're in person or virtual, you know, if somebody I'm just making one up, but, you know, if somebody like touches their ear, that might mean okay, somebody just entered the room, change the topic. And so, you know, it's, it's another way of creating safety and trust in a therapeutic relationship and understanding that there's no way to secure it 100% of the time, but we're going to have a plan for if and when things get jeopardized. And, you know, it's just ongoing conversation.

24:40  
So this can be done virtually as well.

24:45  
We had to, you know, when when the pandemic hit, and we all we all got locked in. Every one of our provider organizations and the provision of home based therapy across the country really had to make a big pivot. And so There were, you know, there's a few services that needed to maintain in person, but everybody had to get extremely creative. So whether that was social distance sessions in a driveway, whether it had to switch to virtual platform, you know, we just we, we got creative. You know, one of our practitioners had an idea which spread throughout all of our companies was creating these activity boxes, where they would put some items in a box, drop it off at the family's front door, and then any time that they had a virtual session, they would say, Okay, go get your activity box. So we knew that the families had the materials that would be needed for that section. But yeah, it's, it opened up a whole new world. And, you know, we have to admit that it actually has a dual, being able to do the virtual, you know, one of the barriers before was whether in distance, the virtual fix that, aside from when it might cut out some power. Our

26:02  
internet, internet can sometimes be worse, and whether might,

26:06  
you know, and we've had times where, you know, we might have been doing home based sessions where one caregiver was always home with the children. And you know, we've had caregivers where one person might have been like a truck driver might have had a job that was at a different location, and they could never be present during the family session. Well, with the virtual permissions, we were now able to invite them into the sessions and to be present. So it really brought some, some new innovations to how we could keep the system working together, and actually be more inclusive in the process.

26:42  
I could say that I absolutely can I'm such a believer in the in the way online can open up avenues that haven't existed before. On the other hand, I can also see that it might be problematic, if you're going back to my example of let's say, the child refusing to do chores, or something along those lines, which I realized is fairly tame, and probably symptomatic of something larger if you're there for doing therapy. But I could see that, that the actual practicing and going through the motions wouldn't be there online.

27:16  
Yeah, and, you know, we try our best to do that, you know, we'll still, you know, ask the family to set up the camera, you know, or put their computer in a common area. And we can still, you know, guide them and ask them to do some different activities, which, which have actually been really fun and pretty successful. But, you know, it takes everybody a little while to get used to that, again, yeah, how these changes had to come about. But we've had really good feedback, though, from families that they've they've enjoyed having the combination of both.

27:47  
Yeah, as is often the case, the combination of both is probably better than either by themselves. Hey, guys, do us a favor, follow creating a family.org podcast, the one you're listening to here, wherever you prefer to catch your podcasts. That way, you will never miss a week of great content, like today's episode on home based therapy. And you can scroll through our archives Once you subscribe for even more topics related to therapy intervention, choosing a therapist, you name it, we've got tons, we've got 14 years worth of recordings for you to listen to and go through. And you can do that by checking out the archives and by subscribing to creating a family ThoughtWorks podcast. So now let's talk about costs. How does the cost of this therapy compared to office space therapy?

28:39  
You know, when we talk about home based therapy, just as a broad umbrella, you know, it's it all comes down to either what insurances allow what Medicaid allows, you know, and what the specific service is. So, you know, if it's a home based surveys still like kind of more outpatient lens, like just that, like one, maybe two hours a week, it may be comparable to what an office setting might be, you know, Medicaid does cover certain types, certain modalities of home based therapy, you know, but the federal the title for IE plans that have all come through have really made a shift in how we look at home based treatment. You know, I think that there has been more attention now to prevention and helping to preserve families and keep families there. And so we're seeing a surge of more home based services getting authorized, which I'm personally very excited about, because we're catching things before they, they get too bad. Exactly. So that's been really helpful that you know, we're starting to see the money, get the direction in the front end.

29:47  
I'm so glad to hear that. So you may have just answered my question is that family first or family Family First Act and Family First Prevention Services Act? Is that going to allow more I don't know, it'd be the title for money to go towards home based therapies as a way of preventing children from entering foster care.

30:09  
Yes, that's roughly what it's geared to do. So which is which has been great because this means that more families across the nation will have access to a service that they previously may not have had. And again, it's working on more on the preventative side. And so we're catching things early, opposed to be having to do all the cleanup and being reactionary. When things have gotten too too far gone.

30:35  
And that's where when we have the opportunity to recommend it, we recommend it, we're primarily dealing with foster adoptive and kin family. So the child is already in, it's outside of their bio family for most, for the most part of the families that we're dealing with. But they're struggling, obviously. And so we want to encourage, we want to get support to these families, before the parents reached the end of their rope. And it seems like in home therapy, is I mean, sometimes office based therapy is just fine. But for a lot of families, the problems are more complex and just talking and it really is helpful to have somebody in their home, seeing what they're seeing, and also be able to guide them and well, why don't you try this, you know, at that exact moment.

31:23  
Exactly. And that's it, that's the biggest benefit is like we're here, right now, what's happening, let's operate here. And you know, the premise that we always work under is we're not asking families to stop what they're doing and come all sit perfectly, you know, like, let's look, we're not trying to create a mock office within their home, we instead kind of want to insert ourselves into what's already operating in the home. And so, you know, it might be the one kids at the table doing homework and other ones playing on the floor, we've got mom folding some laundry, we've, you know, like there could be a lot of different things happening. And we're able to just be extra hands, extra eyes, extra ears, and to be able to really see in practice and try some new things, just to make those little tweaks. Sometimes it's just the little changes that have the biggest impact. And when the families who practice with their practitioner present, you know, it's just a huge bonus to see did it work? Or did it not?

32:23  
It from a cost standpoint, it can't be as cost efficient, because a therapist sitting in an office, you know, has one hour appointment, 15 minute appointments, 10 minutes in between the follow up to jot down the follow up notes. They could see what six people a day or maybe more, I don't know, maybe less, but still, with home based therapy, you're having to drive get there. So I don't and you're spending longer time. But of course, that would be the same, you could spend a longer time in the office, but just the travel time alone would make it it seems like less cost efficient. On the other hand, it seems to me it would be within on the other hand, if it's more effective, then you save a boatload of money. I don't know, just from the cost standpoint, that's kind of how I would look at it.

33:07  
Yeah, the way that you've described it as perfect, you know, it's really looking at short term versus long term gains, you know, like, kind of day to day perspective. Sure, could more clients be seen, and an office? Yes. But the the, the length of their duration of services may potentially be a lot longer. So, you know, the idea with a lot of home based services is to be able to go in intensely, kind of hit them hard, hit them heavy, right? Like, yeah, some impactful changes, like at a high dose early on, and then we kind of titrate down, but then we're able to the family feels better equipped to then operate without having professionals consistently involved. They kind of stopped being like system or external reliant, and they're able to say, I got this, I can do this, you know, and that's a long standing game that we really love to see. And the the repeater rate or the recidivism rate is extremely low. You know, folks who participate in the home based services and get that intensity level, tend not to come back into services either as frequently or at all or may just need something very less, just a lesser level of services ongoing.

34:24  
This show is brought to you by the support of our partners, one of those partners is adoptions from the heart. Over the past 35 years, they have helped create over 7000 families through domestic infant adoptions. adoptions from the heart can also provide home steady only services. They work with people all throughout the US and they are specifically licensed in Pennsylvania, New Jersey, New York, Delaware, Virginia, and Connecticut. Thank you adoptions from the heart for your support. So how do you find an in home therapist especially One that's knowledgeable about adoption and fostering and the trauma that these kids have experienced.

35:06  
very loaded question.

35:10  
Oh, well,

35:11  
how do we find? Well, one, one place that I consistently promote is just the NC TSN, the National Child Traumatic Stress Network, they are a wealth of resources and knowledge and connections. We're an affiliated partner with them. And, you know, the, again, the expertise and the trauma knowledge within that entire cohort is phenomenal. A lot of it then comes down to, you know, whether it's families checking with their own insurances. First, you know, like, what's available to me what's available in my area? Again, depending on the state, you know, it could be looking at who manages the Medicaid funding, whether it's managed care organizations, you know, is it privately owned? Is it an insurance led, you know, kind of having to see what am I covered by and what's available to me. But with that said, there's oftentimes many grants and you know, like stipend based funding that's available to providers as well. So even if there's not, you know, insurance coverage, we are still able to provide a lot of services that are run through grants, so checking with, you know, state and local county funding or state funding, but really, you know, if you have insurance, that's the first point of entry.

36:30  
Absolutely, and especially if you are, it's a foster child or a child adopted from foster care, you may, you should be having some support, that will be able to fund this, you know, one of the things that we encourage people is to specifically ask for in home treatment, a lot of people don't know that fact, quite a few people don't know that that's an option, that when they're seeking treatment for their child, that they can ask that we think we would benefit from home based therapy, and saying that specifically asking for it will increase your chances of getting it. Again, though, finding someone finding a provider in your area, although the agency who has placed that has placed a child with you should have knowledge of home based therapy in the area, I would think is that is that your experience?

37:19  
Yeah, you know, and one of the things that I think is, you know, that needs to be noted here, too, is just there is a lot of turnover that exists within like the social service, or kind of our so repeated trainings, repeated attendance at collaboratives, or community meetings, you know, the faces change, but oftentimes the organization's and the agencies do not. And so being able to get those personal connections, is so valuable in our field, and, you know, making sure that everybody knows what's out there. You know, when we've gotten Yes, managers coming into the field, it's like, here's what we've got, you know, like, there's a whole array of services out there, and then also being open to checking out like, national organizations like yourselves, like ours, you know, just doing some simple searches, such as, you know, foster parents support or reunification services. And, you know, there's some really great programs and initiatives out there helping to link families, to the services that they're seeking. And, you know, sometimes it is just getting a couple search engine searches going.

38:29  
Absolutely. And let me just give the, we had mentioned the National Child Traumatic Stress Network, we talk about that organization a lot. And so let me just give it the I'm gonna throw out the URL. It's the initials for the name in C TSN, National Child Traumatic Stress network.org. So NCTs n.org. And we'll include it in the notes to this show as well. They are a great organization. And I'm going to give you a moment in just a moment to talk to us more about Family Center treatment Foundation, because that is another great source for finding home based therapy in your area. But before we move to that, I did want to ask you about, you know, what some tips for knowing if you found a good fit between your family or your child and the therapist, especially it seems especially important when somebody is coming into your home. So how do you know? I mean, usually at the point you're having a therapist come in you're you're lacking in confidence at that point, you know, that things are not going as smoothly as you had hoped. So being self empowered to make selection, sometimes it's not where we're at in our head. So what are some tips for knowing if there's a good fit or not?

39:42  
We have a there's one sentence that I always promote to our practitioners and I did say to them, you know, when you're well joined with a family when they start asking When are you coming back? So if you're a you know, if if you're in there and you're building the trust, and if The practitioners are just genuine, and they're respectful. And just that, you know, can chat it up with a little kid can talk with the adults, you know, is really just a good, good listener, a good sounding board, you know, not trying to push agendas, not trying to be too forceful with anything but really able to read and seek feedback from the family. We also promote a lot of in session feedback. So every single one of our sessions, were asking our families, what are you taking away from today? What worked? What didn't? What really stood out? What are you going to try before I come back, you know, just just to gauge like, what's what's stuck, you know, we want to make our time applicable. And we also value the family's times and we value our own time, enough that we want to be like, we want to do what they're finding beneficial and useful. Feedback is a big component. And, you know, when you've got kids and adults saying, oh, when is missed on coming back to our house, we're so excited, then we know we've nailed it.

41:08  
And that's it from a family standpoint, if you're looking forward to another session. That's a good sign.

41:12  
Absolutely. All right. So

41:15  
tell me a little more about the family center treatment Foundation, in general, but also as a source for finding good home based therapy.

41:24  
Sure, so the family centered treatment foundation, so we've been around, we're almost getting our 30 year anniversary in 2020 will be our 30th year, we're very excited. And we actually have a day of giving, that's going to be coming up because one of the things we do in the model is we have like a giveback component, where, you know, we ask families to just have some way of giving back like finding value and demonstrating that all of our families are so worthy and so valuable. And so finding a way that they in some way, share that externally. And so we have, so March 3 will be our Day of Giving. But then you know, the foundation, we have the home based evidence based model called Family Centered treatment, we are listed, as you mentioned, the we've talked about title for you funding in the family for sex. So we are listed as one of the supportive programs that's available out there.

42:20  
And good for you, by the way.

42:22  
Thank you, we appreciate that. In so we provide services, we're in multiple states, our website is just Family Centered treatment.org. And we are coast to coast, we have over 75 sites. So some of our providers have multiple sites. But you know, all of our current states are listed on our website, and we're a four phase model. So you know, we have a roadmap for treatment. So it's not, you know, just going in and doing what we think is going to work. You know, we have specific activities we do in the beginning to really get to know the family, we do a lot of practice based work. So like I mentioned before, like trying things out what worked, what didn't a lot of Sensory Learning to make sure everybody's got different learning styles. So we got to put them all in there. Some are talkers, some are doers. So you know, making sure that we're keeping things as applicable to everybody is possible. And then, you know, we really pride ourselves on our third phase, which is called valuing change in this is where families are internalizing the new ideas, the new behaviors into other areas of their life, because we want to make things long standing for our families, you know, our hope is that they're able to fill their toolboxes and their buckets, enough that even after we've finished services with them, that they just feel well equipped to continue handling it in our numbers show it we've got great success rates, we have amazing family success stories that we tout and celebrate all the time. So we're, you know, it's a it's a model that we're really proud of, we're continuing to grow. We also have a conference coming up in the spring in Charlotte, North Carolina. So just a lot of exciting things happening over the foundation, that we're that we've got some really great families success and good growth that we partner with amazing organizations.

44:17  
And so if a family if just from a practical standpoint, if a family is looking for a home based therapist, that they could go to your website, Family Center treatment.org and see a list of partners or agencies that participate in follow your model.

44:37  
Yes, yep, those are all listed on our website by state and then broken down by provider organizations.

44:43  
Okay, excellent. Well, thank you so much, Stephanie Glickman for being with us today. As I said at the beginning, I think there is such hope for in home therapy and we want to help spread the word to our families to specifically ask for so If they think they can benefit and I think a lot of people can so thank you so much for being with us today to talk with us about this model and to everybody else see you next week

Transcribed by https://otter.ai