The Front Lines of Children’s Mental Health, Part Two: Home-Based Services

This is part two of a two-part look at mental health services mandated by the settlement of Katie A. v Bonta, a class-action lawsuit brought against the State of California over its lack of community-based mental health services for youths.

Having been removed from his parents’ home six months earlier, eight-year-old Michael didn’t need another disruption in his life.

As described in yesterday’s story, his recent outbursts had pushed Michael’s foster parents to the breaking point. At home and school, he exhibited defiance, his anger and grief coming out in physical and verbal aggression toward his foster parents, sister, and classmates.

His foster parents were on the verge of giving the county notice that they could no longer care for him.

Enter the Fred Finch Youth Center, to which Michael was referred by his county caseworker in an attempt to stabilize his placement and access needed mental health services.

Fred Finch clinician Rogelia Becerra and Michael’s Child and Family Team conducted an assessment and decided that Intensive Home-Based Services (IHBS) would help Michael learn how to function successfully at home and in school. Under the Katie A settlement, IHBS must be provided when it is determined during the assessment phase of ICC (Intensive Care Coordination) that intensive in-home and community-based support is necessary for the ICC plan to be successful.

As the name indicates, Intensive Home-Based Services are not provided in an office setting. They take place in the environments where the child is having difficulty regulating his emotions and controlling his own behavior.

An example, as described by Joslin Herberich, senior director of community mental health programs for Fred Finch’s Oakland office: For an adolescent who is having trouble maintaining a job because of anxiety about getting on a bus, a behavior specialist can go with the teen to the bus stop and coach him or her through the process until the teen is ready to manage independently.

For younger children like Michael, unstructured transition times are often difficult. So Michael’s behavior specialist visited the foster home while dinner was being made, or showed up at school during lunch hour or recess.

Seeing that Michael became aggressive when he felt slighted or left out on the playground, the behavior specialist held sessions with him at recess, and coached him on how to ask classmates to play a game of four-square.

Standing off to the side, the behavior specialist gave nonverbal cues to Michael to help him put into practice with peers the communication skills he was working on.

While Michael met with the behavior specialist, the family partner went into the home to provide support to his foster parents so that they could reinforce the behavioral work Michael was doing, and understand it from within the context of trauma.

“Youth who are removed from their homes are, at a minimum, traumatized by living with families they don’t know,” said Charlotte Moore, senior director of programs at Fred Finch. “Most have experienced trauma prior to the removal. And often this trauma expresses itself in acting out, which can lead to foster parents saying they can’t do it.”

So the behavior specialist helps the child learn to manage their trauma and their feelings, Moore noted, in a way that doesn’t sabotage the placement.

Fred Finch provided Intensive Home-Based Services to Michael and his family over four months. According to Becerra, while the process was not without its challenges, Michael was soon able to problem solve during unstructured times that had previously proven difficult for him to manage without intense conflict.

Over the course of the services, Michael’s placement in the foster home stabilized as his biological parents completed what they needed to do in order to reunify with him and his sister.

With reunification on the horizon, Michael’s Child and Family Team met to create an eco-map, a drawing that would show the formal and informal supports in place for Michael and his family.

“Michael was so happy about it, he wanted to draw his own,” said Becerra.  He and his sister later returned home to their parents.

Child welfare services in California are administered by the counties. As the Chronicle reported recently, people close to the Katie A. settlement have noted uneven progress on both ICC and IHBS; some counties have developed, while others have not.

Young Minds Advocacy Director Patrick Gardner, who was a lead attorney in Katie A., gives San Diego high marks for its progress under the settlement, noting the county’s long commitment to wraparound, an intensive, individualized approach that is family centered and community based. ICC and IHBS are based on the core values of wraparound.

He credits the county’s leadership: Alfredo Aguirre, the current Behavioral Health Director,and Robert Ross, (now CEO of the California Endowment) who served as director of the Health and Human Services Agency for San Diego County from 1993 to 2000.

“They had already made significant investment in this approach,” Gardner said, “and didn’t have as big a distance to go as other counties.”

Melinda Clemmons is a reporter and marketing manager for The Imprint.

Note: The true name of the subject in this story has been changed to protect the child’s identity.

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