help4yourfamily

Create the family you want to have

End the Hassle! Tell kids what they deserve.

Hey Dad..!

Hey Dad..! (Photo credit: Wikipedia)

Today’s parenting tip that I have for you is so simple but it could change so many of the more frustrating conversations you have with your children.  Are you ready?  When your children are hounding you about doing something you don’t think is a good idea, instead of saying no and negotiating back and forth about when they can, how much, why not, etc. try framing the issue in terms of what they deserve.  You know how this usually goes. You tell your child they can’t do something or they have to do something and they start to argue and negotiate.  Why can’t I?  All the other kids do!  You’re mean! Until you wonder if it was really important in the first place, or their arguments become so darned sophisticated that they have convinced you to go against your better judgement in regard to their health and safety.  Telling your kids what they deserve can end some of that and help you to keep focused on the main goal, the health and safety of your children.  It looks like this:

Example 1:

Kid: Mom, the other kids in my class don’t have to sit in a booster car seat any more! (feel free to imagine this as a whine)

Mom: You deserve to be as safe as possible and the booster keeps you safe.

Example 2:

Kid: Why can’t I have another cookie?  I only had a few!

Mom: You deserve to be healthy, let’s give your body the food it deserves.

Example 3:

Kid: Hey Dad, can I go to Joe’s party this weekend?

Dad: Will there be adults present?

Kid: But Dad!  You don’t trust me?!  I never get to do anything!

Dad: You deserve to be safe.

Framing your decisions this way will not save you from eye-rolls, huffing and puffing, or pouting all together.  Nothing saves you from those things completely, but it may shorten some of the duration.  It also saves some of the mental gymnastics for you.  For every arguement they come up with about the same issue, you can stop and ponder for a moment, then repeat how much you feel as though they really deserve to be safe, healthy, free from hurtful relationship or friendships, etc.  After all, it is difficult to argue back with someone telling you how important you are over and over.  Also, remember that our internal self talk is shaped by the way we were spoken to by our parents. Wouldn’t you prefer that your child’s self talk as they grow be “I deserve to eat healthy foods” over “don’t eat that, it’s bad for you?”

April 30, 2012 Posted by | discipline, help for parents | , , , , , , | 10 Comments

getting insurance to finance specialized therapy

No matter how you feel about the whole health insurance debate in the United States, I think most of us can agree that dealing with insurance companies can be confusing and frustrating.  It can almost seem like the insurance companies have their own special language and code words.  If you have a child in need of specialized therapy, or you are in need of therapy yourself, going through your insurance can seem really daunting and to add to the difficulty,  many specialists no longer deal with insurance.  My hope is that this post will help you navigate the way US insurance companies work so that you can get services paid for (even if they are out-of-network).

Do not let your insurance’s first response, where they say they are not funding an out of network provider, or they say they will but will only pay 20%, throw you off.  You still have options, they just aren’t going to tell you what they are.  Let’s start with a quick primer on insurance “lingo” you need to know:

in-network providers– are providers covered by your insurance company.  If you are going to an in-network provider your insurance company has an agreement with your provider so that they are likely to pay most of the bill except for your regular co-pay.

out-of-network providers– are providers your insurance company does not have an agreement with.  If you are calling your insurance company and they say the provider you are calling about is out-of-network, you will want to ask if you have out-of-network benefits on your plan.  If they say no- do not panic- you have options!

usual customary rate (UCR)- is the rate your insurance customarily agrees to pay for a given service.  When your insurance says they will pay 70% of the UCR that means they will pay 70% of what they normally agree to for that service- which is often different from what the specialist charges.  If your insurance says they cover a percentage of the UCR, ask them what the UCR is for the service you are getting.  If they say $80 and they cover 70% of the UCR, that means they will reimburse you or the therapist $56 and you would be responsible for the remainder of the UCR if you are seeing an in-network provider, or the remainder of the provider’s fee for out of network providers.

Now that you know these terms. give your insurance a call and see what they have to say about the provider you want to see.  Remember to also ask if you have a deductible and how much of your deductible has been covered.  Other insurances have a rate that changes, for example, they pay 20% for sessions 1-5, 40% for session 6-30 and 70% for sessions 31 and above.  Don’t worry, I’ll summarize at the end so you can get all the questions together.

So, what do you do if your insurance company tells you your chosen specialist is not covered? 

Gather the information that makes your provider special.  Do they have special skills and training to help your child that other providers do not have?  My clients that call would tell their insurance I have specialized training in trauma, attachment and adoption- if they are bringing their children for one or all of those reasons- pick only the issues that pertain to you and your child.  Ask your insurance if they have anyone in-network that provides that same level of expertise.  Your insurance is required to find someone with comparable skills within a reasonable distance of your home who has the specialized skills you require.  If they do not, they are required to offer to pay their UCR to your specialist.  If you have a willing specialist, with just a short conversation with your insurance, they can negotiate a rate for services.  I have done this several times now.

To summarize, the questions for your insurance are:

1.  Is (name of the provider) in-network for my plan?

2.  Do I need authorization?- asking the question starts the process if you need it.

3.  If my provider is out-of-network, do you have an in-network provider with the same skills and availability within reasonable distance from my house?

4.  If you do not have anyone in-network, could you offer the provider a single case agreement?

5.  What is my deductible?

6.  What is the reimbursement for this service?

7.  If they mention UCR, what is the UCR?

Remember, if they say they have an in-network provider with the same skills as your specialist, make sure to follow up and call that specialist to make sure they are taking clients because if they are not, you can call the insurance back to report and they need to find someone else or offer a single case agreement.

In case you understand better with a flow chart, I have included one of those below as well.  If you have further questions or would like clarification, please ask in a comment.  This stuff is confusing and someone else probably has the same question!

insurance questions flow chart

April 27, 2012 Posted by | health insurance, thinking about therapy? | , , , , , , , , | 1 Comment

Teaching young children about “stranger danger”

Street photography - photograph of a child wat...

Street photography – photograph of a child watching children play on the grounds of Arts College at Osmania University, Hyderabad, AP – India. (Photo credit: Wikipedia)

I am writing this post in response to a post by GorillaParenting’s post, “Stranger Danger- Gorilla Parenting- Fail!”  I will re-blog it so you can see the quick video of (I assume) the writer’s daughter answering the question, “What do you do if a stranger tries to give you a piece of candy?”  Her answer is, “Say thank you.”  While this is very cute, it also raises a question posed by the blogger- how do we teach our children who is safe and who is not?

Most of us grew up hearing about stranger danger and about never talking to strangers, etc. but I think it is time for a new conversation about this topic that first acknowledges that this is a much more complex issue than we give it credit for.  We know that it is important in our lives to talk to strangers for many things.  After all, on the first day of school, your child’s new teacher is often a stranger to them but of course you want them to talk to the teacher.  At the same time, we want them to be able to identify and get away from anyone who has an intent to harm them.  So, how does one teach a young child who is and is not safe?  Here are a few tips.

1.  “Stranger Danger lessons” grow and change over a lifetime and are not a one time event.  Start this conversation with your young child by asking them if they know what strangers are, followed up by a question about what strangers look like.  You might be surprised by the response you get.  Many children know that strangers are people you do not know, but then if you ask what they look like, children sometimes feel they can give a pretty good description.  This is your opportunity to begin teaching your child about strangers and how to tell if someone is a “safe” stranger or not.  Every child will stay away from a scary guy in a dark cape hanging out in an alley- we know that, it’s the person who would try to lure your child away with kindness that we worry about.  And, of course, there is a healthy balance to be made here because we do not want children to be frightened.  I coach my own children to speak to strangers that are “helping strangers” like someone who works at the store, a police officer or firefighter.  I also tell them if they are ever lost or need help to look for a parent who has children with them that are the same age as my child.  After all, a parent with same age children is most likely to empathize with the needs of my child and to help them to get the help they need.

2.  Come up with some rules for your child about who is and is not a stranger.  When does someone become an acquaintance and does that mean you can go into their home or with them in a car?  In one of your ongoing conversations with your child, fit this in.  What do you need to know about a person for them not to be a stranger anymore?  I often would say you need to know their first and last names, where they live or work, and your mom or dad has to say they are no longer a stranger.  Even if someone is not a stranger, you can talk about whether they are okay to go with and make sure your child always knows to tell you before they go with someone.  Many families also have a code word that they use with kids so that if something ever happened where, say, the normal person was not there to get them off the bus after school, the parent would send someone to pick the child up and that person would share the code word so the child knows they are safe.

3.  Make a playful guessing game with your child when you go to the park and ask them who is a “safe” stranger and who is an “unsafe” stranger.  This will give you an opportunity to teach your child to listen to their own instincts about who is safe to talk to and what it is okay to talk to them about, and to teach them that people who look good, are not always what they appear to be.  Any stranger that tries to give a child something or tries to have a child go with them without checking with their parents or having the kids check with their parents is not okay.   You can also talk with kids about listening to the “uh oh” feeling we get around people sometimes in their tummy, heart or throat.  Tell them to check with you first before talking to a stranger (you can come up with a signal like a head nod to say it is okay also).  After a child talks to the stranger, ask them how it felt.  You can ask them if that person would have been okay to go with to check on their lost puppy (hint- the answer is always “no,” or, “only if I check with you (the parent) first.”   If kids get an “uh oh” feeling about a stranger, talk about why they think that is- was the person not listening about your child’s personal space body language (were they in your space bubble?).  Was the person asking intrusive, personal questions? Acknowledge how these things can be disturbing and help kids figure out how to address them with adults in a respectful way.

When talking to your young child about strangers, I would be sure to try to keep the conversation on the lighter, playful side since we do not want to scare them, but to also playfully fit in little tests of their knowledge.  Children love it when they know the answers to questions.  Remember too, that children love it when they know the rules about things, and, even more, they love rituals.  Create a ritual where each time you go to the park, you remind them of the rules on the way, stay on the mulched area, ask me before you run to the bathroom by yourself, ask the owner before you pet their dog, and never go anywhere with anyone or accept anything from anyone without asking first.  When they are tired of you saying the rules every time, you can make it a guessing game and they can tell you the rules.  When they consistently tell you the rules every time, they have got it and you have done the best you can do on this one.

What’s funny is that I don’t think that original video that prompted this post is a “fail” at all.  My guess, by looking at the body language of the child is that what actually happened is mom and dad thought they were asking the child about stranger danger but what the child imagined in her safe, secure little world was that a stranger presented her with candy with mom or dad watching and giving a nod, then she takes it.  So, what do you do then?  Say thank you, of course!

The real problem is that the people who most often harm children are not strangers.  Look for future posts about how to help children feel confident enough to protect themselves if someone they know ever tries to cross a boundary.

April 25, 2012 Posted by | child development, help for parents, keeping children safe | , , , , , , , , | 9 Comments

Is Chimpanzee good for your child to see if they are adopted or have lost a parent?

See description on File:Chimpanzee mom and bab...

See description on File:Chimpanzee mom and baby.jpg. I cropped it slightly to remove the original black frame. (Photo credit: Wikipedia)

Written by Kate Oliver, LCSW-C

Just from watching the commercials, we can easily see that  the new Disney movie, Chimpanzee, is going to be all about adoption.  While it is predictable that the movie will have warm fuzzy messages about adoption overall, if you have an adopted child, or any child who has lost a parent through divorce, abandonment, death, etc. it is a good idea to take a moment to consider whether this is a good movie for your child.  Of course we know all children are different and only you can decide what is right for your child so please do not use my post as a replacement for your own judgment since obviously you know your child way better than I do.  Also, spoiler alert, you will know all about the movie by the time I’m done with the post.  My hope is to attempt to address the adoption related issues in the movie so you can make the best decision for you and your family and to be ready for any conversations or feelings it might bring up for your child (and you).

First, let me say, the movie was pretty entertaining for the children seven and up in our group, the youngest (5) got bored half way through and I saw several younger children leave during the movie.  The parents were thoroughly entertained and there were quite a few “aww’s” and chuckles throughout.

The movie starts in an idealic world where little monkeys are taken care of by mommies (no mention of daddies).  Little Oscar and his mom, Esha, are the focus.  Children who were not taken care of by their first mommies or whose first mommies have left them in some way may have some feelings about the portrayal of moms in this part as the idea of mommies taking care of babies is presented as the only way things can go.  I can see how a child who feels bad about having a mommy who did not take care of them might be triggered if they carry residual feelings of guilt or believe it was their fault their birth mother did not take care of them.  Additionally, the mention of dads is not just downplayed, it is completely non-existant in this part of the movie.

Soon, the idealic world of the chimps is threatened by another group of chimpanzees who want to take over their territory.  Esha keeps Oscar safe during a particularly scary time when this group attacks and the movie continues to highlight Oscar’s reliance on his mother and her role in keeping him safe, fed and protected.  Sadly, the other group of monkeys attacks a second time and it is during this attack that Esha and Oscar are separated and Esha disappears forever with the assumption being that only death could keep her away.  It continues to be quite heartbreaking as we see Oscar get harshly rejected by several other female chimpanzees who already have children (triggering for children who have been in multiple foster care placements).  During this time, Oscar tries, and fails, to find his mother.  Obviously, no one is able to explain to him where she is and he is left to fend for himself.  Oscar is sad and lonely and experiences difficulty finding food and caretaking.  Do I need to point out the many opportunities for adopted children and/or children who have a parent that is not in their lives will have to identify strongly with this section of the movie?

After suffering for an intense ten minutes or more during the movie, Oscar begins to follow the alpha male, Freddy.  He begins gently befriending Freddy (there is a good conversation to be had about shadowing adults and learning from thier modeling behaviors here).  Freddy, who it was earlier emphasized in the movie, had no interest in the younger chimps, slowly also begins turning toward Oscar and teaching him to get food.  Over time, their friendship grows and, in a particularly heartwarming scene, Freddy grooms Oscar and lets him ride on his back.

During this portion of the movie, there is no mention of moms and, knowing that I see children with attachment disorder in my practice who work pretty hard to come between their parents and who often punish the mom and complian to the dad (because moms are scary for them since they represent the original abandoning mom), I can see this particular part of the movie reinforcing that behavior a bit.  Additonally, I can see how children who have struggled to bond with an adoptive parent would be triggered to wonder what it is about them that caused them to be first rejected or abandoned by other parents if that is their emotional experience.  Those children who struggled to bond with an adoptive parent may also wonder why it is so easy for Oscar (no internal loyalty struggle here, also no negative behaviors from Oscar) to bond with Freddy and just what must be wrong with them that they have difficulty bonding.

While Freddy and Oscar are bonding, however, trouble lurks nearby, the narrator, Tim Allen, says that while Freddy and Oscar have been building their relationship, Freddy has neglected to protect his area and the other chimpazee group is closing in for another attack.  Freddy senses this and begins to do some team building again.  Oscar feels ignored by his new dad and we see him again feeling lonely because he does not understand why Freddy is turning away from him to take care of other chimps.  This made me think about moms or dads taking care of new babies or other siblings and the triggers that has for many of my adopted children, not to mention kids in step-parent families.

I can see this movie being especially nice for single and/or adoptive dads as it reinforces that dads always protect their children even if they didn’t always know how to parent at first.  I can also see it being an issue for moms and other primary, nurturing caregivers (including dads) who, like I said before, have a child that uses them as a representation of all abandoning people in their lives, and for children who did not have a mother that took good enough care of them before entering an adoptive family.  I would also recommend it for children who are able to articulate their feelings about adoption, parental loss, etc. over children who are still unable, or unwilling to discuss those issues.  Ultimately, it is up to parents to decide what is right for their children.  Either way, in the end, the movie has a happy ending where Freddy and Oscar get to be together and Freddy focuses on Oscar again.

I see multiple opportunities for parents to bring up good conversations for kids about: whether Esha’s disapperance was Oscar’s fault; how Oscar must have felt when the other mom’s rejected him; how Oscar befriended Freddy and whether they loved each other right away; how dads and other parents protect children even though sometimes it is hard to see how (like when they go to work or pay attention to other kids); and why Oscar had an easier time of bonding with Freddy (because his first mom was good at teaching him how to love other chimps).

Have you taken your child to see this movie?  What did you think?  Did I miss anything?  I would love to hear how the experience was for your child.

April 23, 2012 Posted by | attachment, resources/ book reviews | , , , , , , , , , | 2 Comments

Qualities of good programs to prevent child abuse

PEARL HARBOR (April 23, 2010) Mara MacDonald, ...

PEARL HARBOR (April 23, 2010) Mara MacDonald, from the Navy New Parent Support Home Visitation Program, leads a group of new mothers and their babies in an infant massage class. The program is administered by the Navy Region Hawaii Fleet & Family Support Center and assists new parents and expecting parents with home visits, information on parenting, referrals, support groups and nurturing skills. (U.S. Navy photo by Mass Communication Specialist 1st Class Jason Swink/Released) (Photo credit: Wikipedia)

In my final post (for now) about programs to prevent child abuse, I thought I would highlight some qualities of programs I have seen that effectively work to prevent child abuse. As a reminder, my original start to this series of posts was a question posed on another blog about how we can prevent child abuse and child deaths.

1.  The first quality any program providing aid to people who could use parenting help is compassion/ empathy.  I know this may seem like a no-brainer, but some programs I have seen seem to leave this element out.  No one wants to go to a program to hear how awful they are, thus confirming their internal fear that they are, in fact, awful.  A compassionate program understands that all parents experience fear, that we are all doing the best we can, and that none of us have children thinking we are looking forward to messing them up as much as possible.  Acknowledging this over and over is an important part of any program seeking to help parents.

2.  Normalizing getting help is an incredibly important part of any program seeing to end child abuse.  Highlighting the diversity of parents, race, class, and gender, who seek help is also incredibly helpful.  This is, in my opinion, best achieved by having mentors that have completed the same or a similar program and are a representation of the general client population of the program.  For example, if this is a program aimed toward parents experiencing postpartum depression, you would want a parent mentor or group leader who has experienced this and is regularly available to participants.

3.  Good programs focus on the importance of parents in a child’s life.  For regular followers of my posts, you know I had to mention attachment :).  But seriously, the cornerstone of a good program that prevents child abuse absolutely needs to highlight the impact parents have on their children.  I think people sometimes think it is a given that parents know how important they are to their children, but for people struggling with parenting- perhaps people whose parents were not ideal either- I find that many of these parents feel disempowered to make change in their child’s life.  A good program reminds a parent of just how important they are.

4.  The final quality I would like to highlight is that a good program helps people to build a supportive community.  Good programs build communities so that if the program is ever unavailable, the learning and growing continues among the members of the community.

Some good programs I know of in my area are:

The Healthy Families program where parents are met in the hospital by someone from the program and are given support if they request it.  Support can include getting help with access to services or forming a group of other new parents in the community.  While there are healthy families programs all over the country, you can find the one near me here: http://www.hopkinsmedicine.org/howard_county_general_hospital/services/mothers_and_babies/healthy_families/index.html

The National Family Resiliency Center (NFRC) is a center for families experiencing a family transition and for parents where there is any need for co-parenting agreements.  NFRC has been a national leader in helping court systems to recognize that when parents separate it is important to keep in mind the best interests of the child.  They provide individual, couples, group counseling for parents and children, reunification and collaborative divorce services as well as very good classes for parents and children who are experiencing the transition process.  Additionally, NFRC helps parents who would like to have co-parent agreements and low-conflict divorce.  One way they do this is with an on-line program, www.familyconnex.org to help parents make decisions that are in the best interests of the children.  Here is the link to NFRC’s website: www.nfrchelp.org

The Infants and Toddlers program, which is part of the educational system but may go by different names in other states, identifies infants who may have developmental delays and helps parents by offering resources for children birth-5 years with the combination of services they might need to get them school ready.  You can find them here: http://marylandpublicschools.org/MSDE/divisions/earlyinterv/infant_toddlers/about/message.htm

There are many more, but these programs I mentioned in particular, although they target different populations, offer the combination of qualities important for a program aiming to prevent child abuse.  While they might not even directly target child abuse, they are organizations that can recognize and report possible abuse, and that may help to prevent it in the first place though education and service.

What do you think?  Do you know of any good programs that have been effective in your area in preventing abuse?  I would love to hear about them.  Also, did I miss any qualities of effective programs to help parents?

April 20, 2012 Posted by | help for parents, social services | , , , , , , , , , | Leave a comment

Laugh and your family laughs with you

One of the funniest kids I've met while travel...

Written by, Kate Oliver, LCSW-C

After a couple of days of heavy posts, it’s time to lighten the mood.  I’ll post about good programs tomorrow like I said I would, but for now, let’s talk about bringing a little light and levity to our everyday life with our children.  Sometimes, all you can do is laugh…or cry.  I would encourage you to laugh.  Sure, I could tell you about all the research that tells you that laughter is, indeed, the best medicine for many situations, but you can easily look that up, or you can just trust me on this one.  Laugh more.  Build humor into your family system.  Make sure that your children understand your humor (even if they do not like it).  Most importantly, teach your children to laugh at themselves by laughing at yourself.  My younger daughter does an impression of my husband when he is telling her to clean up that is hilarious.  We all laugh, then we clean up.

This morning, when I grumbled at my older daughter to rinse her mouth after brushing her teeth (who doesn’t rinse after you went to the trouble of brushing!?) because I’m tired of paying an extra car payments worth of money every time we go to the dentist, I went up to the bathroom after she went to school and found a post-it note she put up in the bathroom to remind herself to rinse:

In case you can’t read that, it said “RINSE OR DIE!”

Parenting does not have to be a series of serious teaching lessons all put together.  It can be easy to forget this. You can teach, love, learn and grow with fun and laughter.  Have a child that asks obvious questions all the time?  Find a code word, like “marshmallows” that tells them they are asking a question they already know the answer to and use it whenever they ask nonsense questions.

Kid:  “What’s for dinner (while they are staring at you cooking a hamburger)”

Parent: “Marshmallows.”

Kid: “When are we going to get there?” (on a trip they have been on 100 times).

Parent: “When we pass the sign with the marshmallows on it.”

Kid: “Do I have to do my homework?”

Parent: “Just do it until you get to the part about the marshmallows.”

Marshmallow Nightmares!!

Marshmallow Nightmares!! (Photo credit: katerha)

It might drive them crazy, but it keeps you a little more sane while you focus on a fun way to fit more marshmallows into your life.

Laugh together over silly jokes or silly things they say.  Make sure you are laughing with not at.  No one like to feel like people are laughing at them but laughing together as a family brings your family closer and reminds us why we brought these “no-rent paying, mess making little people,”  as my husband likes to say, into your home in the first place.

How do you laugh with your family?  Please fell free to share a funny story that makes you smile 🙂

April 19, 2012 Posted by | help for parents, Parenting | , , , , , | 16 Comments

The Problem with Social Services- part II

Mother holds Child

Mother holds Child (Photo credit: Wikipedia)

In my post yesterday, I outlined some of the problems with the implementation of Social Services.  Today, I will be discussing support for CPS and social workers in general.  You can see from what you read already that in many ways workers are bound to the law of their area for decision-making purposes.  I am certain that every CPS worker you will ever speak to has a child, or several children, that they wish they could have removed because they could see the train wreck coming.  Similarly, they will also have a child they were sad to remove, and parents that surprise them with their resiliency, cruelty, etc.  Just when you think you’ve seen it all, they have seen more.  Yet, how much do we hear about CPS workers, or any social workers, for that matter getting recognition for the difficult work they do?  In many ways CPS workers are damned if they do and damned if they don’t in most situations.  The cases that get highlighted are the extremes where children were taken from the home with little apparent reason or children that were not removed from the home who died.  There are almost always people who are upset with the decisions of the workers- people who feel neglect or abuse is occurring get angry because they  want CPS workers to be more proactive, and people who feel the parents are doing the best they can, or have a right to parent however they see fit even if it borders on abuse want CPS workers to mind their own business.   I do not mean to make any excuses over children improperly removed or children who are left in the home who suffer further abuse or fatality but I do want to say that with the high caseloads expected of caseworkers, the low-level of support and the high burnout rate of workers, mistakes are bound to happen.  While I’m mentioning this, another potential area for legal changes could be mandating a particular number of children on a workers caseload just like school districts have a student; teacher ratio.

In addition to having incredibly difficult jobs and little public understanding of their role, CPS workers do this with very little financial support.  While I was not working as a CPS worker, after earning my master’s degree and going to work in a treatment facility for abused children, I got very little compensation.  By comparison, my sister, who was getting her undergraduate degree in computer science, made more at her internship than I was making at my job.  I left that job five years later, with many tears on my part because I did love my work and I was in a supportive atmosphere.  The final straw for me was after I had two children and my husband and I were in a Home Depot one day where two employees happened to be comparing paychecks while we were checking out.  One of them mentioned how much money he was making an hour and I realized I was making only a dollar an hour more than he was.  Even though my husband works hard, we do need my paycheck and I realized I needed to earn more money to justify being away from my babies.   The average income of a full-time CPS worker is about 30-35,000 which is in the high range for social workers outside of private practice.  If you compare what social workers and teachers do, we can make many of the same arguments about being expected to purchase materials in excess of what is provided and work hours outside of paid time, etc.  Yet teachers have the support of the public.  When’s the last time you saw a discount for social workers to get into a museum or social worker night at the pizza place?  I’m guessing never.

My point is not to whine, my point is to say that one thing we could really use is some marketing.  Right now the cons of getting involved in child welfare in general outweigh the pros for anyone who relies on their paycheck to put food on the table.  If I had a dollar for every time in my master’s program I was told we were not in social work for the money, I would be rich.  Bottom line, we need to support the intent of social services- to protect children and prevent child abuse, to advertise the opportunities that social services can help struggling parents with, and to better compensate and support our workers so we attract the best of the best.  As part of a larger marketing campaign, we need to educate people about the current role of social services (while taking responsibility for past mistakes), focusing on people of color, immigrants and the very poor as in the past the United States has improperly targeted these groups and there is, in my opinion understandably, a generation of people who carry the fear that their children will be taken should they seek assistance or raise a question to anyone about how to be a better parent.

While you may believe that focusing on CPS is missing the point of supporting child abuse prevention, I believe it is very pertinent to the discussion.  According to PBS’s Frontline website, only about 60% of the cases referred to CPS are actually found to need further investigation, however, even without finding a child has been abused, often the local Department of Social Services can offer families help in signing up for programs that include child care, food and medical assistance, and parenting classes.   A 2002 report for the Urban Institute says that about $20 million was spent that year on child welfare services.  Compare this to the Humane Society’s $160 million budget to protect animals.  I have nothing against animals (I’m actually a vegetarian) but seriously?  This is shameful!  People will give money all day long to protect animals, but when it comes to children, for the most part, people do not want to hear about it, talk about it or think about it.  I think too, we assume services are out there and available when really, they are not as available as we would like to think.  De-stigmatizing aid and  increasing wages to hire the best workers would dramatically change the impact of Social Services in preventing child abuse.

Tomorrow, I will highlight what I believe to be the cornerstones of a good child abuse prevention program.

April 18, 2012 Posted by | social services | , , , , , , | Leave a comment

Here is the blog I was referring to in my post earlier today.

daniellesstory

Figure 1 The doll was one of a few ragged  items sent with my daughter from the foster home in 2001

I am “Danielle’s” adoptive mother,  I was at the doctor’s office one morning while my mother in law was babysitting her; at the time, she was only eleven years old.  In the waiting room,  I picked up the newspaper and read the headlines: “Woman Admits to Killing Her Son”. It was an article about the confession– there were intimate details about Wendy’s life and the murder of her two-year old son. Initially, I thought it was an article about some stranger in a faraway place. As I read on, it became evident that this was MY daughter’s birth mom! This was how I discovered the details about Danielle’s previous family. I was shocked and saddened by the information!

December 20, 2010 President Obama signs the S.3817 the “CAPTA Reauthorization…

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April 17, 2012 Posted by | attachment disorder, social services | 1 Comment

The Problem with Social Services- from a Social Worker’s Perspective- part I

Length of stay in U.S. foster care

Length of stay in U.S. foster care (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

I am writing this post in response to another post by Daniellesstory (I will repost so you can see it if you missed it) asking how it is that we might mobilize to make our children safer. Part of her concern was their safety when they have been entrusted to the care of social services.  I would highly recommend you read her post about her experiences with her adopted daughter and social services and her questions about how to enact meaningful legislation that would really help children rather than serve as “nice words” saying we support a safe and healthy childhood for every child.  I realize that her blog is not asking solely about Social Services but since most of the children that I see in my practice have had some interaction with social services, this is actually an issue that comes up a lot and I will focus on them for this post.  If you are interested in finding out more about my own work history that informs my thoughts here, you can read my longer professional biography on the website www.attachmentdisordermaryland.com- you will find me in the “about us” section.  While there are many aspects of Social Services we could talk about, in this post, I am going to stick with ways to change the ability of Social Services to protect children.

The issues, as I see them, are three-fold, implementation, support and funding.  I will speak to implementation first.  Right now, the individual states are in charge of the Departments of Social Services (they are not even all called that- but they all serve the same function) and within the states, sometimes Social Services are run by the counties and cities within the state.  Each area decides for example, the level of education required to call someone a social worker and that can very within a state.  In my state, Maryland, the county I live in has Child Protective Service (CPS) workers that are all Master’s level educated, while in Baltimore City, the Master’s level educated people are not in the field, they are supervising the workers in the field who may have an AA or undergraduate degree.  It’s easy to see how a CPS worker with an AA would have a different skill set for helping, coping with burnout etc. from a Master’s level worker.

Additionally, different states have different laws about the implementation of protective services.  In Maryland we have a law that states that Social Services must respond to an abuse report where a child may be in danger within 24 hours.  That law and a law requiring workers to see any child who is a ward of the state routinely was the result of a child death while the child was in care and a subsequent re-haul of the system (via the Maryland state legislature).  We also have a “mandatory reporter” law where people that routinely work with children, such as people in the school system, health care workers, social workers, etc.  are required to report any suspicion of abuse.  Other states have other laws governing (or not governing) social services.  Consequently, when we talk about protecting children, we really must look to the laws of the state.  In the daniellesstory post, the author suggested a lawsuit.  I would suggest laws are easier changed by speaking to politicians about actual measures they can take.  It is not my intent at all to minimize or excuse the awful things that happened to that author’s daughter or her daughter’s biological brother, only to better explain where the gaps and disservice comes from.

The question I think I get most often from people first bringing in their traumatized children to me has to do with why social workers do or do not remove children from a home.  Here’s the deal… when we have a legal system that presumes innocence until guilt is proven, we create a reactive rather than proactive society.  This means that social workers cannot just waltz into a home and remove children unless they have concerns that the child is in iminate harm of abuse.  Each state has different laws about what constitutes abuse or neglect.  In my state abuse means that a person left a physical mark on a child, used a child in a sexually exploitative manner, neglected to meet a child’s basic needs for health and welfare by not dressing them appropriately for the weather, neglecting to follow through on medical recommendations involving health issues, etc.  Also included in my state’s laws related to abuse is mental harm- wherein a child has been emotionally abused by a parent, however, I do not know of a single case where a child has been removed for this alone.  To break this down into the parts people seem most interested in, no, you cannot remove a child solely because they have drug addicted or alcoholic parent, or their house is messy all the time (unless the mess creates certain harm to the child), or because you think they are overly punative and mean.  Children can be removed if the parents are drug abusers who have taken the child in the car while they were driving drunk or high, the mess in the house constitutes danger to a child, or the punative, mean nature of the parent translates into actual physical harm to the child.  Because of the reactive nature of our system, children cannot be removed before harm is done.  Child Protective Service (CPS) workers are trained to work to keep children in the home since we do not have a large pool of willing foster parents who are excited to take children into their home.  Kinship care (where a child is placed with a relative) is the next step, and foster care is the last resort  a worker looks for.  Again, implementation of these decisions over whether a child stays or does not stay will have a lot to do with the training and support given to people in local departments and can vary widely.

In 1997, Congress enacted a law making a timeline where social services are required to work toward reunification of the child with their parent, except for some extreme cases, for 15 months.  After those months are completed, they are to switch to permanency planning where they work toward the termination of parental rights so a child is free to be adopted.  This law is in effect to avoid having children lingering in care for years and years while the system waits for a child’s parent to get it together.  The belief behind the law is that children are best served by being in a family.  Because this is a federal law- it is the same in every state.

As I mentioned before, not all states have the same laws and you definitely want to look up the laws in your individual state.  The laws directly impact the way services are implemented so if you are looking for a different implementation of services, I would suggest you look at the wording of the laws about what constitutes abuse, who is a mandatory reporter and what they would be required to report, and look at the timeline for services for a child outside of the federal timeline like how quickly a child needs to be seen etc.  I would not try to change the law to be pro-active (removing children before harm is done), not only is it asking to change a fundamental principle of our legal system, it is a slippery slope.   Take, for example, when people say you should need a license to be a parent.  Who would implement that law?  Who would decide who gets to be a parent?  What would the requirements be? When you look at it that way, you can see this is not a road we want to go down.  We can’t even agree if a grown woman should be allowed to have birth control covered by her insurance for goodness sake- how in the world would anyone begin to decide who would get the parenting license, etc?  I would also point out that I have met many parents who are “licensed”- they are foster parents and while they are required to take classes and pass basic requirements, they continue to have the same spectrum of parenting ability as the general population- anywhere from abhorrent to fantastic.  To conclude this portion, I would say that the laws generally protect parents to raise children in the ways we see fit with limits set for the minimum standard of care and the maximum amount of physical force and exploitation.  Within those parameters, we are all free to “mess up” our children as much as we would like and the system does not get to take them.

Tomorrow, I am going to post about two other issues, support for Social Workers and others who aid in protecting children and barriers to prevention.

What do you think would be a good law to implement to protect children?

April 17, 2012 Posted by | social services | , , , , , , , | 3 Comments

Finding a therapist for a traumatized and/or attachment disordered child

Some elementary school counselors use books an...

Some elementary school counselors use books and other media to help their counseling (Photo credit: Wikipedia)

As therapist who specializes in both trauma and attachment disorders, I can tell you it is important if you are searching for a therapist for one or both of these issues, that you find the right therapist for your child.  Doing so will save you a lot of money and aggravation and is more likely to speed the healing time for your child.  To start, look at my post on  finding the right therapist for you or your child (you can find the link at the bottom of this post).  With these particular children, and probably people with other specialized issues as well, there are further steps you would want to take to ensure that you have the right person.  I see the steps for this particular issue as follows:

1.  Figure out if your child has “only” trauma, or has trauma with attachment related issues.  Here is the distinction, a child with trauma without attachment disturbance usually experienced a one time occurence, or something that happened over a relatively short period of time and was quickly identified.  Trauma with attachment related issues is trauma that also impacts a child’s ability to bond with their caregivers in a healthy way, for example abuse or neglect by a primary caregiver or ongoing abuse or neglect that a child did not disclose.  If you feel as though your child’s trust in adults to provide care for them has been altered significantly, you will want to see someone with knowledge of attachment related issues.  To clarify this distinction, a teenager carrying on a short-term, secret relationship with a much older adult that they thought was younger or who was tricked into a situation where they kept a secret because they were breaking the rules when they were traumatized does not fall into this category of attachment disturbance.  It is within reason to anticipate that teenagers will try to stretch or break the rules and it does not signify a break in a child’s core ability to trust that their parents will care for them.  A teenager whose step sibling was abusing them for an extended period of time whenever their sibling came to stay at the home does fall under the category of possible attachment disturbance.  The difference is the primary caregivers were around at the time of the trauma and did not know to stop it, while in the first example, the teen was doing an activity it would be reasonable to assume is developmentally expected but someone took advantage of them inappropriately.  When in doubt, I would see someone who specializes in both trauma and attachment.   If you find that there is an attachment related issue for your child’s situation, I would always make sure to take the child to a therapist that understands attachment because in order to work on attachment disorders or disturbance, you must know about trauma since the two go hand in hand.

2.  Once you have determined whether you are looking for a therapist with trauma training or whether you need someone with an attachment and trauma focus, follow the steps from my first post on finding a therapist and ask these additional questions.

  • What is your training in attachment and trauma?
  • What recent trainings have you attended or conducted that relate to attachment and/or trauma?
  • How do you conduct your sessions?

The answers to these questions, if you are talking to the correct therapist, should indicate that the person stays actively engaged in seeking training for attachment and trauma related issues.  Additionally, an attachment specialist will indicate to you that you will be in the room for most, if not all, of the time that your child is in therapy with them.  Attachment oriented therapy is significantly different in that a therapist focuses much more on your relationship with your child rather than their relationship with your child.  In traditional therapy including therapy for singular trauma, you would take your child to see the therapist, you might check in with the therapist at the beginning or the end, then your child would see the therapist alone for the majority of the session.

While traditional therapy is effective with many children, for children with attachment disturbance, it can actually damage a child’s relationship with their parent.  I have seen this happen, since a child with attachment disturbance has a tendency to reject caregivers, and, while they are alone with a therapist they may talk to their therapist about how terrible and difficult their parents are.  The therapist and child will bond over this and the therapist shakes their head in disbelief, meanwhile they may be overlooking a parent who is really trying their hardest to meet the child’s needs while reinforcing for the child that the caregivers in their lives are, in fact, inadequate.  Remember, children with attachment disturbance see adults as unsafe on some level and tend to fit them into these categories.  A skilled attachment therapist will spot when a child is doing this and help them to retrain their system of trust by teaching them how to find trustworthy adults and by training the adults in their lives to be trustworthy in the way the child needs them to be.  To learn more about attachment disturbance you can see my post linked below “What is attachment disorder?”

**A note to providers- I understand that you have seen parents who are, in fact, inadequate.  For this post, I am assuming that a parent who cares enough to read this post is adequate because they are involved and caring enough to research this issue.

Stay tuned for my post on getting specialized treatment for your child- the things insurance companies won’t tell you that can help you get your child’s treatment paid for.

April 16, 2012 Posted by | attachment, attachment disorder, health insurance, help for parents, thinking about therapy? | , , , , , , | 8 Comments

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