Visits: Planned, Purposeful and Progressive Rose Wentz [email protected] 206 323-4394.

VisitsVisits::

Planned, Purposeful and Planned, Purposeful and Progressive Progressive

Rose WentzRose [email protected]

206 323-4394206 323-4394

mailto:[email protected]

Definition of Visits

All types of visits (birth parents, siblings, extended families, even pets)

All types of contact (face to face, phone, letters) and all levels of supervisionUnsupervisedObserved/MonitoredSupervisedTherapeutic

Federal Laws

Adoption and Safe Families ActVisits are an indicator that the ASFA reviews

have shown to improve the outcomes for children

Permanency Safety Well-Being

Visits has been legally defined to be required to meet Reasonable/Active Efforts through appellate court decisions

The primary purpose of Visits are?

A. To assess a parent’s ability to safely parent their child;

B. To meet the child’s developmental needs;

C. To be an incentive to encourage the parent to attend treatment;

D. To determine the final permanency plan.

Goal of Visits The visit allows the child to be safe and

that it is held in the most natural and home-like location possible.

Children and parents may feel discomfort before, during or after a visit. A child should not be traumatized by visits.

In some cases “visits” that do not require face to face contact may be necessary to ensure the child’s safety.

Children are more resilient when they have multiple healthy connections.Resiliency is the key to surviving trauma.

Research Visits are associated with shorter placements

and higher rates of reunification Worker contact with parents increases their

participation in visits Worker encouragement of parent and non-office

locations increase parental attendance Child’s reactions are the NORM Regularly scheduled visits increase parental

attendance

Research Visits cause parents, caregivers and

workers to face their issues and thereby adults often have reactions to visits

Be sure adult reactions/conflicts do not interfere with visits

It is rare that having NO contact with a parent is in the best interest of a child

Children will have contact with parents even after adoption or years of separation

Best Practice Standards Written – case records and court orders Include all parties in the planning Make the visit as normal as possible Consistency in location, time, place, people involved Within 48 hours of initial placement Phone call shortly after initial removal Homelike location At least weekly At least one hour in length Overnight visits before returning a child home Sibling visits must occur regularly if not living together Caseworker observers at least one visit each month

Four Steps to Developing a Planned, Purposeful and Progressive Visitation Plan1. Child Development and Parenting Skills2. Type of Abuse or Abuse

• Level of Supervision

3. Time in Care (Concurrent Planning)1. Initial Placement2. Reasonable Efforts3. Final Permanency Decision4. Post Permanency

4. Other Factors

Child DevelopmentStep One

• The FIRST and PRIMARY purpose is to meet the child’s needs.

• Children have many different types of developmental needs: educational, emotional, medical, moral, social and cultural.

• If meeting the needs of the adults is in conflict always use the child’s need to determine your plan.

• Over 50% of children in foster care have developmental delays.

• The goal is to help a child move towards the next developmental milestones.

• All children are initially traumatized by the separation from his/her parent. Visits should help a child handle the trauma and catch up on delays.

Frequency, Activities, Locations, and Items for a visit

• How frequently should a child of this age visit with his/her parent?

• List the activities that can occur that will enhance parent/child attachment

• List the locations that the visits can occur. What location would be best?

• List activities that can occur when face to face visits are not possible

• List things the child may want to bring or have at a visit (transitional object)

From the child’s perspective

Child Development - InfancyChild Development - Infancy

Trust vs. Mistrust StageTrust vs. Mistrust Stage

Do not understand changeDo not understand change Attachment is criticalAttachment is critical Communication limitedCommunication limited Interferes with developmentInterferes with development Adults must cope for childAdults must cope for child Separation is immediate and Separation is immediate and

permanentpermanent

Child Development - ToddlerChild Development - Toddler

Autonomy vs. Shame/Doubt Autonomy vs. Shame/Doubt StageStage

Regression and FearRegression and Fear They control the world They control the world Forms attachments to othersForms attachments to others Adults must cope for the childAdults must cope for the child May see foster care as punishmentMay see foster care as punishment Must be helped to learn new homeMust be helped to learn new home Days = permanencyDays = permanency

Child Development - PreschoolerChild Development - Preschooler

Identify and Power StageIdentify and Power Stage

Magical thinkingMagical thinking Does not understand cause Does not understand cause

and effect and effect Forms attachments to adults Forms attachments to adults

and other childrenand other children Needs help copingNeeds help coping Self blame – Acting Out FearsSelf blame – Acting Out Fears Weeks = permanencyWeeks = permanency

Child Development – School AgeChild Development – School Age

Industry versus Industry versus Inferiority StageInferiority Stage

A concrete worldA concrete world Months are permanentMonths are permanent Self esteem tied to Self esteem tied to

familyfamily Foster child is “different”Foster child is “different” Compare parentsCompare parents Friends are importantFriends are important Perception may be Perception may be

distorteddistorted Needs to know “rules”Needs to know “rules”

Child Development - AdolescentChild Development - Adolescent

Identify versus Identify Identify versus Identify Diffusion StageDiffusion Stage

Adult understandingAdult understanding Decision makingDecision making Adults as role modelsAdults as role models Emotional and body changesEmotional and body changes Moral developmentMoral development Future, emancipationFuture, emancipation Ambivalence about familyAmbivalence about family Help with conflictsHelp with conflicts

Attachment and BondsAttachment and Bonds Secure attachmentSecure attachment: an exclusive attachment made between : an exclusive attachment made between

children and their contingent, sensitive caregivers, who provide children and their contingent, sensitive caregivers, who provide nurture, comfort, buffering, shared exploration, and help. Parents nurture, comfort, buffering, shared exploration, and help. Parents represent a secure base for exploration. represent a secure base for exploration.

Examples of secure attachment from a child’s point of view are:Examples of secure attachment from a child’s point of view are:• My parents come back. They are reliable.My parents come back. They are reliable.• I can depend on my parents and people whom they entrust to educate and I can depend on my parents and people whom they entrust to educate and

spend time with me.spend time with me.• I want to please my parents most of the time.I want to please my parents most of the time.• I am rewarded for being competent, for my curiosity, and for my positive I am rewarded for being competent, for my curiosity, and for my positive

states.states.• I can get help with psychologically overwhelming events and feelings.I can get help with psychologically overwhelming events and feelings.• Parents teach me how to cope with problems and to solve them.Parents teach me how to cope with problems and to solve them.• Intimacy is enjoyable.Intimacy is enjoyable.

BondsBonds: Close relationships which tend to be formed with teachers, : Close relationships which tend to be formed with teachers, friends, and others who have shared experiences and emotions.friends, and others who have shared experiences and emotions.

(Gray, 2007)(Gray, 2007)

Attachment and BondingAttachment and Bonding

Child feels discomfort

Child expresses discomfort

Parent comforts child (need is met)

Child feels comfortable

Arousal Relaxation Cycle

Ways to Encourage AttachmentWays to Encourage Attachment Responding to Arousal/Relaxation CycleResponding to Arousal/Relaxation Cycle

Using child’s tantrum to encourage attachmentUsing child’s tantrum to encourage attachment Responding to child when he is physically illResponding to child when he is physically ill Helping child express and cope with feelingsHelping child express and cope with feelings Share child’s excitement about her achievementShare child’s excitement about her achievement

Initiating Positive InteractionInitiating Positive Interaction Making affectionate overtures; hugs, kisses, physical closenessMaking affectionate overtures; hugs, kisses, physical closeness Reading and playing games with the childReading and playing games with the child Helping child with homeworkHelping child with homework Going to fun events togetherGoing to fun events together Saying, “I love you”Saying, “I love you” Teaching the child about extended family and cultureTeaching the child about extended family and culture

Claiming BehaviorsClaiming Behaviors Encouraging the child to call parents “mom” and “dad”Encouraging the child to call parents “mom” and “dad” Hanging pictures of child in the houseHanging pictures of child in the house Including child in family ritualsIncluding child in family rituals Buying clothesBuying clothes Involving in religious or rite of passage eventsInvolving in religious or rite of passage events

Children’s Reaction to Children’s Reaction to Grief and LossGrief and Loss

Separation is always traumaticSeparation is always traumatic Child’s reaction will vary according to her Child’s reaction will vary according to her

current attachmentscurrent attachments Uncertainty hampers a child’s ability to Uncertainty hampers a child’s ability to

copecope Children who are in trauma stop or regress Children who are in trauma stop or regress

on their developmental taskson their developmental tasks There are no set patterns of reactionsThere are no set patterns of reactions Yearning is a dominate characteristicYearning is a dominate characteristic

Stages of Grief and LossStages of Grief and Loss

ShockShock DenialDenial Anger Anger ProtestProtest BargainingBargaining DepressionDepression ResolutionResolution

Elements of a Visitation Plan

PurposeFrequencyLengthLocationWho attends ActivitiesSupervisionResponsibilitiesWhat to have at the visits

Impact of Separation ChartIssue Implications Visit planning strategies

SCHOOL

AGE

The child will compare one parent to another.

The child may talk about what the “other” parent does or does not do.

Let the parent know that this is normal. Let the child talk about without assuming that he

prefers one person over the other. Never talk negatively about the other

parent/caregiver. Don’t push a child to provide information about

the other parent(s).

The child can develop new attachments and turn to adults to meet his/her needs.

Child will call caregivers mom and dad.

If given permission, the child may be able to establish relationships with caregivers without feeling disloyal to own parents.

Child may bond with other children she who are a part of the new family.

Allow the child to determine what names/titles are used; what to call foster parents, step-parents, other children in the home, etc.

Prepare the parent for this normal reaction and that this shows that the child is healthy and normal.

Adults should give positive support of each other’s role. Disagreements should be handled without placing the child in the middle.

Keep child in contact with caregivers and others in the home when the child moves to another home.

Child will have intense emotions and may not know how to handle them.

Anger, sometimes quite intense, is expressed as both an honest reaction to what is happening to him/her and as an externalizing attempt to cope with his/her pain, sadness, and helplessness.

Allow the child ways to express her emotions in a safe manner.

Let her know it is OK to have these emotions. Parent should admit to things he/she did that lead

to the child having these feelings. Do not be defensive or tell child not to feel that way.

The loss of siblings, peer group and friends may be almost as traumatic as the loss of parents.

Making new friends may be difficult.

The child may be embarrassed and self-conscious about “foster child” status.

Children who lose too many relationships may refuse to form new friendships.

Keep siblings together whenever possible.

When possible allow the child to attend the same school.

If not possible, ensure the child can maintain contact with friends.

Encourage the child to make friends but acknowledge to the child that it is normal to be afraid that this may cause more lose.

Have the child get involved in activities and hobbies.

Parents and caregivers work to maintain these connections.

Have the child develop a scrapbook to save pictures, letters and stories of the people in their life.

Developing a Visitation Plan

Child Development/Parenting skills

Type of Abuse Time in Care Other Factors Other Factors Other Factors

Purpose

FrequencyLength

Location

Activities

Supervision level

Who attends

ResponsibilitiesWhat to have at visit

Documentation

Child Development/Parenting skills

INFANTS

TYPE OF ABUSE

TIME IN CARE Other Factors

Purpose Meet child’s developmental needs and maintain connections

FrequencyLength

2 to 5 per weekLong enough for parent to feed, change diapers, play – 60 minutes minimumMeets child schedule

Location Home or homelike environmentAllows for caring of babyHave items that calms baby; blanket, pacifier, toyCommunity, doctor appts.

.

Activities Parent meets child’s needs; crying, eating, sleepingPlay on floor or eye levelMusic, read book, talk to babyBonding activities

Supervision level Lack of communication and self protection means that supervision level should be higher than same situation with older children.

Who attends Birth parents & siblings together or separate, Other key people with emotional attachment


Bring food, toys, diapers and comfort items. Have adult who child feels safe with (could be foster parent) help with all transitions.

.

Documentation Normal documentationDo not allow parents to talk to supervisor of visit during the visit – focus on the baby

Progressive Visitation

Visits usually start as supervised visits with many restrictions on location, activities, etc.

When the parent and child are successfully interacting during visits, the plan should allow for ONE element to be changed at a time. Example: Lengthen the visit or change the location of the visit. Do not change both at the same time.

The goal is to slowly increase the parent’s responsibility and move towards unsupervised visits in the parent’s home while safely testing the parent’s ability.

One change allows for accurate assessment of success or failure. The goal is to always have a safe and successful visit for the child.

When there is a failure or repeated problems go back to the last success visit plan and determine what will make the visit more successful. Try to only change one element at a time even when there has been a problem.

Reward and Punishment

Visits are NEVER to be used as a reward or punishment for the parent or the child. Research shows that doing this does not lead to parents

attending treatment. Children will get the message that relationships are based on

having good behaviors and thereby are conditional.This includes things like:

If you are clean and sober (pass UA) then you get to have a visit.

If you follow the rules of the house you get to have a visit. When you complete your treatment you will get to have more

visits. If you make your husband move out of the house then you can

have unsupervised visits.

Visitation plans are based on behaviors AT the visit!

Roles and Responsibilities

BIRTH PARENTSOCIAL WORKER - person

responsible to develop planCAREGIVER OF CHILDCHILD/YOUTHSUPERVISOR OF VISITTRANSPORTER

TIMES

Before

During

After

Back of Visitation Plan Matrix

CherRitaListen to her experience as it relates to

her having visits and contact with her family.

What could have been done to make her experience better and to maintain her connections with her birth family?

Types of Abuse – Step Two

The second purpose of visits is to provide the parents with an opportunity to learn new parenting skills or demonstrate safe parenting skills. – REASONABLE/ACTIVE EFFORTS Legal requirements

Skills can be taught during visits or be learned from service providers, family or community.

Visits are one of the few ways of assessing the parent’s FUTURE protective capacities.

The case plan must state the minimum sufficient level of care.

Pages 18

Levels of Supervision – all casesA continuum to ensure safety while allowing the

most normal family interactions possible.

FACTORS IN MAKING THE DECISION Age of child (ability of the child to self protect) Type of abuse that the child experienced Parent’s history of family violence Potential for abduction of the child Emotional reactions of the child Where the visit will occur Who will be at the visit Progress parent is making to improve parenting skills Parental issues such as addiction and mental illness

Have agreed upon community Definitions for the levels of supervision.

Therapeutic Visits

Professional conducts visit to address clinical needs Sex abuse and extreme forms of

other abuse Parent who is rejecting the child Child who has extreme fear of

parent Teaching medical or therapeutic

care of child

Supervised VisitsTrained person is within sight and

sound of child

If the parent is: Abusive during visits Inappropriate behaviors by parent Parent who has not started treatmentWhen child is: Afraid of parent

Observed Visits

An objective party is involved or location provides protection Parent is in treatment but has

not completed his/her program

Child expressing discomfort about being left alone

Parent had consistently meet standards during supervised visits

Unsupervised VisitsNo or limited controls needed

Parent has consistently meet standards during observed visits

Parent has made progress in treatment program and/or has a safety plan

Child has a safety plan Unplanned drop-ins might occur

Purpose Child Development/Parenting skills

INFANTS

Type of AbuseNEGLECT

Time in CareREASONABLE

EFFORTS1 TO 12 MONTHS*

Other FactorsFAMILY CULTURE

Other FactorsDRUG ADDICTION

FrequencyLength

Meet child’s developmental needs and maintain connections

Assess, observe and teach safe parenting skills

Teach parenting skills and observe improved parenting

Maintain and strengthen child’s connection with culture, tradition and religion

Protect child from inappropriate or unsafe parenting

Location 2 to 5 per weekLong enough for parent to feed, change diapers, play – 60 minutes minimumMeets child schedule

Long enough to practice parenting skills, usually this will take more than 1 hourIncrease time with increased skills of parents

At least once a week At least one hour Increasing in length and frequency as family gets closer to reunification

If child does not have contact with cultural community through parent visits or caregiver this type of “visit” should be added to case plan

As soon as possible – do not wait until parent is in treatment to begin visits.At time of day parent is least likely to be intoxicated.

Activities Home or homelike environmentAllows for caring of babyHave items that calms baby; blanket, pacifier, toyCommunity, doctor appts.

Optimal: In parent’s home unless the location is unsafe.Home like environment; foster or relative home, home-center

Birth family home whenever possible or home of relative and foster parentsCommunity locationsAgency office least desirable

In family or relative’s homeIn community locations with cultural significanceIn language of the family

Neutral location where drugs would not be available – as homelike as possible

Supervi-sion level

Parent meets child’s needs; crying, eating, sleepingPlay on floor or eye levelMusic, read book, talk to babyBonding activities

Practice the skills that lead to neglect; feeding, supervision, preparing for school, Learn to understand child’s needs and feelings

Modeling/teaching of parenting skillsReactions to visits should be decreasing

Sharing family history, storiesTeaching family traditions; holidays, cooking, games, hobbiesReligious events and learning

Bonding and attachment activities especially for young children.Later activities that maybe triggers for parent.

Who attends

Lack of communication and self protection means that supervision level should be higher than same situation with older children.

Depends on level of neglect. Severe neglect requires high level of supervision until parent demonstrates improved skillsUsually monitoring is enough

Decreasing level of supervision as parenting skills increase, level may vary depending on who attends

Use family and people the family knows whenever possible to supervise visits and teach parenting skills, that person can speak the family’s language

Therapeutic or supervision until treatment counselor approvesUA does NOT indicate the level of safety or whether a visit should occur


Birth parents & siblings together or separate, Other key people with emotional attachment

Birth parent(s) or others in caregiver role, siblingsLater include entire family doing normal family activities

All the people the child would live with if reunification occurs.Sibling even if the child will not live with him/her, extended familyNon-custodial parents

Parents, siblings, extended family, fictive kin, anyone the family identifies as important in the child’s life

Non-addicted parent can be observer of visit if he/she shows ability to make safe decisionsHave a safety plan

Documentation


Bring items to practice parenting skills; cooking, homework, toys, bathing, napping

Social worker should observe visit at least once every 2 months Clear case plan connection with visit activities, Family involved in planning visit

Bring information, pictures, reading materials, and other items to teach family culture

No drugs or alcoholSet clear rules and enforce them – Relapse planEveryone knows warning signs

Purpose Normal documentationDo not allow parents to talk to supervisor of visit during the visit – focus on the baby

Normal documentation Be very specific as to parents progress; strengths and problemsTeach observers how to document visit

Normal documentation Normal documentation

Initial Placement First Day to 30 days in care

Do a visit ASAP no later than 48 hours Placement should not feel like a punishment Expect reactions Confirm that each other is OK Bring child’s belongings Supervised In family home Do not forget fathers, siblings, and others

child have an emotional attachment

Reasonable Efforts2 months to 12 months

Child placed with Resource Family – relationship between families

Teaching and demonstrating parenting skills – based on type of abuse

Decreasing supervision Increasing length and parenting

responsibility Behavior/reactions should be decreasing Change ONE item at a time Observation and feedback from Social

Worker – 2X monthly

Final Permanency Decision12 to 15 months Overnight if reunification Limiting if adoption/guardianship Connections NEVER stop Reactions to permanent plan may occur Relationship between families so

connections can continue Prepare child if he must say “Good-bye” Maintain connections with siblings,

friends, school, ethnic group, religion

Post PermanencyFrom PP through Life

Child want us to help them maintain connections

Children will look for lost family - and often move in

Siblings is most critical group Right to know family and history Help the adults handle their

uncomfortableness Life books Complete information in case record and

with child’s legal family


INFANTS






FrequencyLength
















Supervi-sion level






Who attends












Documentation









Culturally appropriate visits All Families have a culture Children cannot be raised in a culturally neutral

manner Ask the family about their culture and family values There are many different and successful ways to

raise a childWhat is something that can be done by

a parent on a visit to teach a child their family’s culture?

Domestic Violence

Children are impacted by domestic violence even if they do not suffer direct physical harm

Children suffer brain trauma by living in a family that has domestic violence

Professionals must be careful not to blame the victim parent or punish the parent for not leaving his/her battering partner

Special safety precautions must be implemented in these cases

Children of Incarcerated and Hospitalized Parents

These children have the need and right to visit their parents.

Visits should not be limited, restricted or non-existent just because of the parent’s living situation.

Children need to maintain and/or resolve their relationship with this parent, even if the parent will be in prison for years or may never be able to care for the child.

How To Have A Safe Visit With Addicted Parents Have a visitation plan that specifically addresses

what is allowed and not allowed. List behaviors that are unsafe or not allowed State the process of what will occur if parent violates

visitation rules Safety plan - Have a method for the parent to ask for

help or ask questions that does not embarrass the parent in front of their child. This plan would include:

resources for the addicted parent to call for help at any time,

resources for an older child to call for help if the parent is not providing safe care, and

family and community members who regularly check on the well-being of the parent and child.

ADDICTION The level of supervision is related to safety and NOT to

the progress of drug treatment! Parents who are sober and/or have completed drug

treatment but who cannot maintain safe parenting during visits should NOT be allowed to have their visits progress towards reunification.

Recovery can occur without formal addiction treatment.

Parents who have not completed treatment but consistently maintain sobriety should not be denied a chance to reunify.

Mental Illness

Work with parent and therapist to determine how the parent’s illness might impact visits: Indicators of problems Medication – how it may affect parent Treatment plan Safety plan for parent and child

Older child should be informed of illness

Special Needs of Child

Obtain full evaluation of children Work with treatment provider to determine the

child’s developmental age Develop a plan to help the caregivers help the child

achieve developmental milestones Have the parent involved in treatment and decisions Use the child’s true developmental age when

developing the visitation plan

Non-Abusive Parent

What are your fears about this parent? List an issue on a post it note. Pass the note to the next table. What would you do to address those fears?

Special Needs of Parent Work with parent and treatment provider to learn about the

parent’s ability Develop a visitation plan that allows the parent to truly be

involved Ensure that services to the parent will enable him to develop new

skills (parenting classes in correct language) Older children should be informed of their parent’s special need Help parent develop a support system that will ensure safe

parenting if the child is returned


INFANTS






FrequencyLength
















Supervi-sion level






Who attends












Documentation









Evidence Based Practices1. Parent Child Interaction Therapy (PCIT)

2. The Incredible Years

3. Triple P-Positive Parenting Program

4. Motivational Interviewing (MI)

5. Trauma Focused-Cognitive Behavioral Therapy (TF-CBT)

www.childwelfare.govhttp://www.cachildwelfareclearinghouse.org/

Visitation Resources

• Information Gateway – www.childwelfare.gov

• National Resource Center for Family Centered Practice and Permanency Planning – www.nrcfcppp.org

• CA Clearinghouse on Evidence Based Practices http://www.cachildwelfareclearinghouse.org/

http://www.childwelfare.gov/

http://www.nrcfcppp.org/

http://www.cachildwelfareclearinghouse.org/

Closing

• Thank you for dedication to children and families

• Complete your evaluations

Remember to develop visitation plans based on what the child wants and needs.

Visits: Planned, Purposeful and Progressive Rose Wentz [email protected] 206 323-4394.

Documents

Transcript of Visits: Planned, Purposeful and Progressive Rose Wentz [email protected] 206 323-4394.