help4yourfamily

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Who’s Who in the World of Mental Health

Mental Health Awareness Ribbon

Mental Health Awareness Ribbon (Photo credit: Wikipedia)

Written by, Kate Oliver, MSW, LCSW-C

In the field of mental health, you will come across many titles for professionals.  It can be confusing to understand what the differences are.  Here is a quick primer to walk you through the different types of helping professionals in the mental health field.

Social Workers- We typically have a Master’s Degree followed by a few years of supervision with a mandatory test to obtain a license.  Each state has different standards for Social Workers and it is a good idea to check what a license means in your state.  In my state, Maryland, in order to have my clinical license I needed to complete my Master’s in Social Work, then have a minimum of two years and 1500 hours of supervised work time.  After that I needed to pass my licensure exam.  In my state there are also Social Workers that have other certifications that mean they do not have as much training or experience, and or that they declined to take or did not pass the licensing exam meaning they still must be supervised by someone trained to supervise Social Workers. The lens Clinical social workers use when working with clients is typically to look at a person in the context of their environment to see what environmental stressors a client has and to work with a client to see how we can help them better manage within the system they live in.  Social Workers do not prescribe medication

Psychologists have a doctoral degree.  They also are required to take an exam following their degree and need to be supervised during and after school for a period of time before practicing without being supervised.  Psychologists tend to look at patients (Social Workers call them clients, psychologists call them patients) through more of a medical model i.e.- in what ways is this person not functioning?  What are the symptoms…let’s treat the symptoms.  Psychologists do not prescribe medication.

Professional Counselors have varying ways to describe themselves, Licensed Family Counselors, or Licensed Marriage and Family Counselors.  Like Social Workers, Professional Counselors have Master’s Degrees with supervision and testing following their Graduate Degrees, however their Master’s is in Counseling rather than Social Work and they are more likely to be trained in methods akin to a Psychologist, and/or have specific training for their license such as specialization in Marriage and Family work rather than working with individuals.  They do not prescribe medication.

Pastoral Counselors have a Master’s or Doctoral degree in Pastoral Counseling.  They come to counseling with a spiritual perspective often related to a specific religion and will bring in religious and mental health elements into their work with a client.  They do not prescribe medication.

Psychiatrists are trained medical doctors.  Psychiatrists have been through a full medical training with all the tests involved with becoming a doctor but, just as a Pediatrician specializes in working with children, Psychiatrists specialized in mental health.  They most definitely tend to see patients through the medical model and do prescribe medication.  Psychiatrists often meet with patients for about 30 minutes and do medication monitoring.  I would highly recommend that anyone seeing a Psychiatrist also see a Psychologist or Social Worker as it is unlikely you will be getting any talk therapy with a Psychiatrist.

Mental health providers may be found in many different places, schools, hospitals, and in private practice.  They may provide individual, group, couples or family therapy, or a combienation of all of those.  No one group of practitioners has been found to be more successful in treatment than any other group.  However, there is one factor that increases the effectiveness of treatment across mental health provider types.  It will probably come as no big surprise that regardless of training background or methodology, the strength of the relationship between a client/patient and the provider  is the number one predictor for success in treatment.  So, if you see someone a few times, and the chemistry is just not there, it is probably time to switch to another provider.

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May 25, 2012 Posted by | thinking about therapy? | , , , , , , , | 5 Comments

It’s Not Just Strangers: Protecting Young Children from Abuse- Part I

child abuse

child abuse (Photo credit: Southworth Sailor)

I hate to break this to you in case you didn’t already know it but strangers are not the main cause of harm to children.  While we talk to children about “stranger danger,” as parents, we sometimes fail to talk to them about ways to protect themselves from people they come across in their daily lives who may be harmful to them.  Statistically, children are much more likely to be harmed by someone they know.  In cases of sexual abuse, for example, 90% of child victims know the perpetrator in some way^.  In 1994, Dr. Gene Abel, conducted a study of 453 pedophiles.  In total, those pedophiles admitted to over 67,000 victims, averaging out to 148 victims per perpetrator^^.  In my own experience, I have seen that most perpetrators have multiple victims and that sexual abuse is much less likely to be reported and prosecuted in the United States.  In this post, I am focusing on sexual abuse since that is the most under-reported of the abuses, however, you can use many of the same rules for neglect and physical abuse.  Rather than encouraging fear, I would like to tell you some ways you can prepare your children in case anyone ever does try to inappropriately touch or discipline them.  In my next post, I will tell you about signs you can look for to prevent abuse before it occurs.

Tips for teaching your young children about abuse prevention:

1.  Talk with your young child about the rules about private parts, namely that: private parts are the parts covered by your bathing suit; the only people who can touch private parts are parents when you are taking a bath or helping to change a diaper or going potty, and doctors during an exam.

2. Define other types of abuse as well: if someone hits you and leaves a mark, or does not take care of you when they are supposed to- like a babysitter who would leave a child home alone, then come back before the parents get home.  Tell your child that no one has permission to hit them even if they say they do, and that no one is supposed to leave them home alone.

3.  Teach children that if anyone tries to do anything you have just taught them is abusive they should: 1. say no, 2. get away, 3.  tell someone (list a few people it is okay to tell).

4.  Teach kids that people who would try to touch private parts, or hit, or neglect kids can be tricky.  If someone says they are going to hurt someone else if you tell something, don’t be tricked!  Tell!

5.  Teach children to listen to the “uh oh” feeling.  If anyone they know gives them an “uh oh” feeling (usually you feel it in your tummy, throat or head) then instruct your child to tell you as soon as possible.

6.  If you see your child acting strange around another adults and it makes you uncomfortable, when they are away from that person, gently bring up that you noticed they seemed different and get curious about why that might be.

7.  Encourage your child to build a vocabulary for feelings and talk about feelings in your family.  If you have difficulty with this, remember our affirmation for last week was: My children give me constant opportunities to learn and grow.  See, you have a learning, growing opportunity right here.

8.  Keep an open dialogue with children about okay and not okay touches.  Allow your child to speak up if they do not want to hug or kiss someone and back them up if they say or use body language to show that they do not want someone touching them.  Give them alternatives to help them problem solve like a fist bump, a high-five, or a hand shake, or if you find yourself witnessing your child being uncomfortable with a person trying to touch them, you can say something like, “Jake’s not quite ready for a hug, how about a high-five?”

Watch the language and tone that you use during your conversations with kids about this topic.  Children can misinterpret a very serious parent for an angry parent and feel like they are in trouble if you take the conversation too seriously. Keep the conversation light.  Remember Mr. Rogers from Mr. Roger’s Neighborhood?  If you don’t remember him, think of a gentle teacher you have met and emulate them.  Just like talking to kids about “stranger danger” this is not a one-time conversation.  Check in periodically with kids about what they would do if anyone ever tried to touch them.

Do you have questions about protecting your children from abuse?  Please feel free to ask them in the comments section.

^http://www.childhelp.org/pages/statistics

^^http://www.cpiu.us/statistics-2/

 

May 16, 2012 Posted by | child development, help for parents, keeping children safe | , , , , , , | 2 Comments

When your inner critic hurts your relationship with your children

Written by Kate Oliver, LCSW-C

We all have an inner critic.  Some of us have several.  You know, that voice in your head that just feels like it is part of you?  It’s the one that tells you that you did it wrong again, you are not working hard enough to fix your child’s problem, and reminds you of all the times you tried and failed to get items knocked off your “to do” list.  If you are not fully familiar with your inner critic, the next time you are upset about something, take a moment to listen to your thought process.  What are the thoughts floating through your head at that moment?  Our inner critic can be harsh…and sneaky.  We don’t even know it’s there, it feels so much a part of us.

I’ve heard our inner critic (or critics) referred to as “the committee.”

Committee

Committee (Photo credit: Editor B)

I love this because it is so true.  Think about the act of going to the grocery store and passing through the cookie aisle.  The committee gets activated!  You hear one part of your committee saying, “Get the cookies you like, you deserve it!”  Another part of your committee chimes in, “Yeah, your butt loves those cookies so much it will hold onto them all the way through summer.”  Then the internal negotiator pipes up, “Maybe there is a new, healthy cookie out that you could try.  Or, if you get the individual packs, you won’t eat the whole thing in two days and you can enjoy your cookies over the next few days, a little at a time.”  Of course then the critic chimes in, “Fat chance…get it?  Fat chance?  Haha.”  And so on.  Even after making a temporary decision to leave the aisle, or put the cookies into the cart, your mind wanders back as you continue through the store, either feeling like you should take the cookies out of the cart, or wondering if you will pass by other cookies and if you will be able to pass them over too.  Is it just me?  I don’t think so, maybe for you it’s not cookies, maybe it’s picking the right birthday card for a friend, or what job to take, the email you are sending to a friend, etc.

When the committee gets involved, we can all empathize with the wish someone stated to me once when he said he wanted to put them on a bus and send them away for the weekend.  Since that is not possible, what is the alternative?  I have one that may surprise you.  Think about loving them.  That’s right, envelop each part of your committee with love and thank it for working so hard on your behalf.  Right now I imagine there are quite a few people reading this who will argue that there is a part of them that is just plain wrong, that it is a part they would like to eliminate completely and that the focus should be on eliminating the “bad” parts.  If you are saying that, here is my question to you…how is that working for you?  I’m guessing that has not been so successful or you would not still be reading this post.   I might suggest that telling them to go away hasn’t been working so well so far.

If you want to try something new, take a moment to reflect on what it is each member of your committee is trying to say to you.  Try to listen to one at a time.  Are they trying to convey important information about your health, safety, or emotional well-being?  Is your committee chiming in about ways to keep yourself or your family safe?  Is it reminding you of something you need to know right now?  I promise you that even the most seemingly destructive parts of you are trying to help you in some way.   When you figure out the message, imagine yourself giving that part of you a hug and thanking it for it’s input, like you would a friend that just told you something that was really hard to say.  Make sure it knows you got the message and that you will take it into consideration.  Often times these parts of us, our committee, can be like any other team meeting where, if people feel like their important message is not being heard they just repeat it over and over again, saying it louder and louder, until people finally take notice.  Your committee may be doing this now.

Remember, listening to your committee does not mean that you will do exactly what they say, but, just like your children, if you take time to really listen to them, and they feel heard, they are more likely to listen when you tell them no, feel good when you agree, and feel less and less like they need to yell to be heard.

If it is confusing when I say to listen to your committee then listen to yourself, since your committee is part of you, that is understandable.  What I mean is, your committee members are all aspects of who you are.  At your core is you.  The you who knows what you really need, the you who is connected to all the love you feel for yourself and others, the you that does not need to judge anyone else, and is the same you that is connected to a higher, spiritual purpose.  Some people call it their higher self.  We all have this, it is the part that tells us we can do this, forgives us our imperfections, and that finds creative ways to solve any issues.  Take a few moments each day to connect with your committee, then to connect with your core, or higher self.  If you worry about fitting this into your daily routine, remember, thinking is free and can be done anywhere.  Even people with young children can take a few minutes a day to sit when the kids are in bed or are eerily quiet in the next room to check in with their inner dialogue.  The process of getting to know yourself and find peace within does not happen in one day, rather, it happens in increments over time.  It takes a lifetime, which is okay, because you have that long to do it.

A word of caution, your committee may try to tell you that doing this is too difficult and to stop or you won’t like what happens next!  Should you hear that warning from your committee, I would urge you to find a therapist to help you navigate the murky waters of your inner workings.  Over time you will find that the process of getting to know yourself can be like finding a long, lost friend that you have been missing desperately for a long time.

Doing this exercise is especially important for parents because, I hate to tell you, our inner dialogue shows to our children whether we like it or not and becomes their inner dialogue.  The best thing we can do for them is to clean up our inner space and be infinitely loving to ourselves so that our children may follow our example.

There are guides for this type of work as well. Self-Therapy: A Step-By-Step Guide to Creating Wholeness and Healing Your Inner Child Using IFS, A New, Cutting-Edge Psychotherapy, 2nd Edition by Jay Earley (Jan 27, 2012) is one such book.  It is available on Amazon and if you click on the Amazon widget link at the top right of this screen you can find out more about it.  Please read my disclaimer page.

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May 9, 2012 Posted by | help for parents, parent support/ self improvement | , , , , , , , , | 6 Comments

Talking with Robert Holden

Robert Holden Ph.D

Robert Holden Ph.D (Photo credit: Wikipedia)

Written by, Kate Oliver, LCSW-C

On Thursday of this week I decided to try calling into one of my favorite radio shows, Robert Holden’s Shift Happens.  It comes on at 1pm EST.  Every Thursday is the day I stay home from the office and try to get enough done around my house so that my family and I can have a weekend free from running errands and picking up the house.  I always listen to Hay House Radio using my phone app as I clean.  If you don’t know about Hay House Radio, it is a station dedicated completely to positive radio programming.  I love listening to Dr. Holden because he is always gentle and kind to everyone he speaks to and has a wonderful way of helping people to look at things in a different way.

I’ve had an unusual amount of anxiety lately, really since I started this blog.  While I have taught other mental health professionals and parents in educational seminars, I’ve never publicly shared my writing until now and I have been feeling, well…vulnerable.  So, I called into the show, anticipating a busy signal.  How surprised was I when the phone rang and someone asked me what my reason was for calling before putting me back on hold?  Umm, pretty surprised.  I am so grateful for the time I had on hold so that I could gather my thoughts.  Then, just after the commercial break, I heard Dr. Holden announcing…me!  What a wonderful, effortless surprise :).

I know most people hate public speaking.  I actually love it.  I know I have good, worthwhile information to share and I love being with people as we all gain knowledge together.  When I am in front of an audience, I can see people responding and adjust accordingly.  But with this blogging thing, it’s like I’m putting my baby out into the world and it’s difficult for me to see how people are responding.   When speaking in front of an in-person audience, I also know who is there (no one I know personally) and it is easy for me, in a professional setting, to shrug off criticism.  I know what I am saying some people will respond to and some will not.  Remember, I work with children with difficulties with attachment.  I probably hear a few times a week that I am wearing the wrong clothes, have a weird look on my face, don’t have the right games in my office, and that I am just plain wrong.  I usually find it pretty amusing since I know that criticism is more reflective of where my client is and if we stick with it, we will get to the other side to figure out where the defensiveness is coming from.

While speaking to Dr. Holden, I realized it was not so much the people I don’t know reading my blog, but more the people I do know.  It’s funny the things we worry about.  Mostly I was worried about people I know personally changing their opinions of me, or my blog causing conflict with people I love.  Everyone else, if you like it, wonderful!  If you don’t, I sincerely wish you luck in finding a site that better suits your needs.

The most surprising part of the call for me was toward the end when Dr. Holden suggested that if I am worried about critique from people I know and am most connected to, the concern I focused on in my call (no perfectionist tendencies here), that I must begin to be the most loving, least critical person I can be.  I had a little inner battle about that one.  “No, wait!” my insides wanted to cry, “I’m not critical of others!  In fact, I am one of the least critical people I know!  I pride myself on being non-judgemental!”  But then, after the call it clicked.  I am loving and non-judgemental to many, many people with one major exception.  You know the exception, right?  Yup, it’s me.  I have a tendency to save my major criticisms for me.  Don’t we all?  I mean, when we are yelling at our children, isn’t part of it that we are berating ourselves for our perceived lack?  Our inability to get them to eat what we want them to eat, the anger over the clutter or mess in our homes taking over that we can’t seem to keep under control, or feeling like we do not know how to address an undesireable behavior?  It is on the days when we are harshest to ourselves that we are the most harsh with our children.  I realized from that call, (thank you Dr. Holden) that I need to be less critical to everyone.

Let this be a reminder to us that we all, even the experts, need reminders to be gentle, kind and loving to ourselves.  Thank you to all of the people who have contacted me since hearing me on the call.  It has warmed my heart and I welcome building continuing relationships with you.  I hope that I can also take part in helping to you be kinder and gentler to yourselves as you continue your own journey as parents, no matter the age of your children.

You can listen to the show here: http://www.hayhouseradio.com/listenagain.php?latest=true&archive_link_type=link_mp3&archive_id=9401&show_id=180&episode_id=8697

This archive is available for only the next few days for free then it will go into the permanent archives and will cost money.

If I remember correctly, my call was the second after the break at the half way mark.  You can buy Dr. Holden’s book Shift Happens, on Amazon by clicking on the Amazon widget on the top right of this page.  I do not receive any financial compensation for this post or for any referrals to Hay House, or Dr. Holden however I do receive a nominal fee for purchases from Amazon if you click on the link on this page.  I only recommend products I believe in strongly.

May 5, 2012 Posted by | help for parents, parent support/ self improvement | , , , , , , , , , | 3 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

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

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

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

   

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