Components & Processes
The Parent Therapy Program offers comprehensive treatment foster services based on a multifactor therapeutic framework. The program is intended to help the Child achieve competencies within the dimensions of development that support the successful transition into adulthood and to assist them in achieving positive adaptation and good outcome in spite of adversity. The program is an amalgam of many components and processes functioning to understand the Child’s needs, plan and execute strategies to meet their needs, monitor the outcome, and evaluate the individual case management process and program logic model. A general overview of the core program components and processes are outlined below.
Quinte Children’s Homes Parent Therapy Model
is structured around 9 key developmental competencies that support successful transition into Adulthood:
- Family: The Child will have the opportunity to live in a stable home environment;
- Health: The Child will be healthy and safe and avoid risk-taking behaviour;
- Social Presentation: The Child will demonstrate good social skills;
- Community & Social Relationships: The Child will be supported by and participates their community;
- Identity: The Child has a positive view of themselves and cultural/community/spiritual awareness
- Emotional/Behavioural Development: The Child will experience emotional well being and the capacity to cope with everyday life;
- Education/ Employment: The Child will be successful in their academic and/or vocational activities;
- Self-care: The Child will make a successful transition to higher levels of inter-dependence until reaching full adult maturity.
- Resiliency: The Child will have the strength and resources to face adversity (i.e., demonstrate Resilience);
The objectives of the Foster Plan of Care are based on the 9 competencies described above. The Foster Plan of Care is developed and implemented by the Treatment Team. The initial Foster Plan of Care is developed within the first 30 days of the client’s admission. Foster Plan of Care progress reviews occur at 3 months and 6 months from the date of admission and then every 3 to 6 months thereafter depending upon the client’s treatment level. The Plan focuses on specific, measurable goals and includes comprehensive practitioner and client tasks/strategies, as well as specified timeframes for goal completion.
As part of each Foster Plan of Care progress review, previous goals are rated as to the degree to which the client achieved or met the goal. Similarly, each task/strategy is rated for frequency of use and effectiveness. The ratings help determine which goals and strategies are successful for the client and which goals and strategies need to remain on the upcoming Foster Plan of Care. The review also indicates which objectives might be pursued in future Foster Plans of Care and new goals are added accordingly.
The Foster Plan of Care ratings, along with Risk, Needs and Strengths ratings, form the core of our outcome measures.
Quinte Children’s Homes Parent Therapists:
Parent Therapists are the primary vehicle of treatment and development for the children and youth living in their homes. They are at once, both a Parent and a Therapist. As a parent they provide the physical necessities for the Child/Youth; they create, manage and provide a nurturing, supportive and structured environment. They value and strive for consistency and stability in family routines, and they facilitate family cohesion. As a therapist, they take a lead role in addressing treatment needs. They recognize and take advantage of therapeutic and teachable moments. Intentionality, knowledge of psychosocial development, and practical therapeutic skills in the areas of behavioural management, brief solution focused therapy and cognitive behavioural therapies are the focus of their clinical training.
Quinte Children’s Homes Treatment Management Team:
The treatment management team is a multidisciplinary team that includes the Parent Therapist, Program Supervisor, Clinical Coordinator, Children’s Services Worker, the Child/Youth’s parent (when appropriate) and other treatment professionals, such as our Psychiatrist, Psychologist, Dietician, or Social Worker when necessary. This team uses the information gathered at admission (e.g., history; needs assessment; strength assessment; risk assessment) as well as ongoing progress reports provided to our Clinical Director to prioritise treatment issues, and develop, implement and monitor the client’s treatment plan.
Quinte Children’s Homes Child & Youth Workers:
The Child & Youth Workers operate as supports to the Parent Therapy program. These well-qualified and highly trained staff assist with program delivery, transportation, respite, and risk management.
Specialized Treatment Services
Although Parent Therapists are the primary treatment vehicle, most of our clients require other specialized treatment services. These may include psychiatric consultation and monitoring of psychotropic medications; psychological assessments; and specialized therapies such as Art/Play therapy, or formalised cognitive behavioural and solution focussed therapy. Stevenson, Waplak & Associates, manages clinical consultation and treatment services. Nutritional and dietary counselling for eating disorders is also available and managed by the BridgeCross program.
A specialized academic program for clients who are unable to manage a community school placement is available through Applewood Academy for Progressive Learning. The Applewood program delivers individualized day treatment and academics within a structured and safe environment. The program can accommodate long-term students as well as short-term students, the latter requiring specific interventions to aid in their return to a community school. Applewood is a Ministry of Education licensed school that focuses primarily on elementary grades 1-8. However, we often work with the local school boards to obtain and deliver secondary school subjects.
Community Based Supports and Services:
Quinte Children’s Homes recognizes that a wide variety of services are available in the community that clients may benefit from. Quinte Children’s Homes’ Policies and Procedures in this area reflect the goal of meeting our clients’ and families’ individual and unique needs by accessing appropriate community-based services that are not offered in the context of our program. When a client presents with needs more suited through accessing of services outside of the organization, Quinte Children’s Homes will advocate for the client’s right to access such services.
Quinte Children’s Homes believes the primary treatment objective is establishing a stable and sustainable family environment for each client. Creating a stable environment requires a caring, nurturing and patient Parent Therapist family, along with the necessary supportive program components and specialized services. Sustainability refers to the program’s costs and efficiencies. Many of our clients pose an exceptional risk and have considerable needs upon admission into our program. While our Parent Therapists set about the crucial task of establishing stable attachments with the Child/Youth, they require considerable supportive services such as staffing, clinical consultation, supervision, and possibly specialized training. Additionally, a Child with high needs requires specialized clinical services such as psychiatry, psychological assessment, individual and group counselling, medical treatments, and academic/day programming.
Often a Child’s placement is selected precisely because these specialized services are available, but once the Child stabilizes and their risk and need are reduced, there are cost prohibitions, which compel the Child’s removal from the placement, as the specialized services are no longer required, and the costs no longer justifiable. In some instances this situation leads to the dilemma of potentially destabilizing a Child because they have been successful in reducing their level of risk and need. In other cases, the Child successfully re-integrates into a less restrictive environment but when problems re-emerge and/or modulate as a result of their transition into a new developmental stage, e.g., adolescence or adulthood, the services are unavailable or difficult to obtain and coordinate, often leading to a placement breakdown and re-placement into a more intrusive setting.
To effectively manage stable and sustainable placements, Quinte Children’s Homes employs a system of treatment levels. A Child’s treatment level is determined by the Risk-Need Assessments occurring at the 30 day Foster Plan of Care, the 6 month Foster Plan of Care and every 6 months thereafter. The Child is categorised into one of five treatment levels based on the findings of the Risk-Need Assessments. The lowest treatment level (Level I) is reserved for adolescents who are receiving maintenance and support while in transition to independent living. The most comprehensive treatment level (Level V) addresses Children with serious mental health and safety issues, severe behaviour problems, and psychiatric symptomology. Throughout all five treatment levels, the Child remains within the same Parent Therapist family. As there is progress in the Child’s risk and need, and increased attachment to the Parent Therapist family, intensive support services and specialized treatment services are reduced while the Parent Therapy placement remains stable. Conversely, if during transitional periods, assessment scores reveal increase risk and needs, then more intensive supports and clinical services are employed and the Child’s treatment level is elevated.
Treatment levels contain the following program support and specialized treatment services:
Level V: Very High Risk
- QCH Parent Therapist Support Services: 5 hours per month of supervision, consultation, supportive counselling, and specialised training
- Staffing: 8 hours per week for one to one direct client programming and direct client supervision
- Clinical services: 6.5 hours per week including assessments, individual and group therapies, specialised therapies including art & play therapy.
- Psychiatry: available for consultation, diagnosis, monitoring psychotropic medications
- Education/day programming: available as needed through
Applewood Academy for Progressive Learning
Level IV: High Risk
- QCH supervision: 3 hours per month of supervision, consultation, supportive counselling, and specialised training
- Staffing: 6 hours per week for one to one direct client programming and direct client supervision
- Clinical services: 5.8 hours per month including assessments, individual and group therapies, specialised therapies including art & play therapy
- Psychiatry: yes available for consultation, diagnosis, monitoring psychotropic medications
- Education/day programming: yes – available as needed through Applewood Academy for Progressive Learning
Level III: Moderate Risk
- QCH supervision: 2 hours per week of supervision, consultation, supportive counselling
- Staffing: 4 hours per week
- Clinical services: 4 hours per month including assessments, individual and group therapies, specialised therapies including art & play therapy
- Psychiatry: Yes – available for consultation, diagnosis, monitoring psychotropic medications
- Education/day programming: Yes – available up to 2 days per month through
Applewood Academy for Progressive Learning
Level II: Low Risk
- QCH Supervision: 1 hour per month of supervision, consultation, supportive counselling
- Staffing: 1 hour per week
- Clinical services: 1 hour per month
- Psychiatry: supported through community resources
- Education/day programming: supported through community resources
Level I: Transition to Independence
- QCH Supervision: 2 hours per month
- Staffing: none available
- Clinical services: supported through community resources
- Psychiatry: supported through community resources
- Education/day programming: supported through community resources
The Needs Assessment
is completed on admission by the Child’s Children’s Services Worker or the Adult most involved with the Child. This assessment consists of 103 items and evaluates the Child’s psychosocial history and areas of difficulty. The Needs Assessment and the Indictors of Success are completed upon admission and annually thereafter. The results used to establish Foster Plan of Care goals and monitor outcomes.
The Strength Assessment
is based on the 40 Developmental Assets associated with successful progress into adulthood. Where a client possesses a particular asset, it may be incorporated as a strategy to achieve a particular goal. Where an asset is underdeveloped or absent, establishing a particular strength may be the goal.
The Risk Assessment
is based on objective, psychometrically sound tools and related to the populations we serve. Different client populations may receive a different combination of the tests listed below.
The Risk component uses a multi-gate method which measures Threshold A) premorbid conditions which measure the health & safety domain and; Threshold B) catalytic factors which measure the Child’s and family’s ability to cope. Both the premorbid risk factors and the catalytic risk factors are predictive of escalating problems and adverse outcomes across the life span.
Threshold A: The Health and Safety domain is measured by:
- Children’s Global Assessment Scale (CGAS)
- Conners’ Global Index
- SA-45 or FAB-C
- The Children Autism Rating Scale (CARS)
- The Level of Assistance (LA)
The central belief of the tests at Threshold A is that a Child’s health and safety is compromised by one of five fairly distinct and uncorrelated conditions: (1) chronic behaviour problems, (2) an inability to function at home, in school or in the community, (3) the presence of high levels of anxiety, worries, depression and disquieting thoughts, (4) evidence of autistic symptoms and (5) the presence of medical & or physical conditions requiring direct intervention for the Child to function at the most basic level.
Threshold B: The Child/Youth’s or the family’s ability to cope is measured by:
- The Child Objective Stressors Checklist
- The QRS-F
- A sociodemographic checklist
- Parental Bonding Instrument
- Vineland Adaptive Behaviour Scale (VABS)
The central belief behind the second threshold is that the probability that the Child will get worse without intervention is determined by a combination of (1) The Child’s current stress levels, (2) The Parent figure’s current stress levels, (3) The accumulation of very stressful events and adverse conditions from early life, (4) The quality of the Child’s attachment to his or her primary care givers; and (5) The Child’s acquisition of basic skills in communication, socialization, daily living and motor development compared his peers.
No Child will receive all of the tests under each threshold. At a minimum each Child will be given one test per threshold. In most cases, a Child will be given 2 tests in each Threshold and the highest (or greatest risk score) is the result used in the classification of risk according to the following rules:
- Very High Risk = both thresholds in the high risk zone
- High Risk = combination of high and moderate risk across both thresholds
- Moderate Risk = both thresholds in the medium zone or a combination of high-low across the 2 thresholds
- Low Risk = both thresholds in the low risk zone or a combination of moderate-low across the 2 thresholds
The Risk of Restraint Assessment
is another multi-gate assessment that evaluates the risk of injury in a restraint and the probability of the Child requiring a restraint. The first threshold – risk of injury – evaluates the risk of injury to the client involved in a restraint based on such factors as medical/health issues, medication, and psychiatric symptomology. The second threshold -probability of a restraint -evaluates the likelihood that a Child will engage in imminent risk behaviours requiring a restraint based on such factors as past history of restraints, severity of behavioural and emotional problems, and level of functioning. The degree of risk of restraint (High, Moderate, Low) is discussed with the Child and/or their guardian and where necessary, specific crisis interventions are modified to minimise both the probability of a restraint and the risk of injury to everyone involved.
The outcomes for the Child are measured in two ways:
- By changes in the individual scores on the Risk-Needs Assessments; Strength Assessment; Academic Achievement; and the Indicators of Success. The Risk assessment is completed every 6 months prior to the next scheduled Foster Plan of Care. Needs and Strength Assessments, Academic Reviews, and Indictors of Success are completed annually as part of the Child’s Annual Case Review.
- By observing changes in the Foster Plan of Care, i.e., the meeting of goals and the effectives of the tasks and strategies employed in accomplishing the goals. These outcome measures are noted at each plan of care and reviewed annually as part of the Child’s Annual Case Review.
Outcome reports are reviewed with the Treatment Team and used to guide the Child’s treatment plan.