G P\ \.--\ ra oo . ~d. ?l ~v d-OD ~ /Sf f1N'~ in this How to Support Adoptions Deciding Whether to Adopt Family Conferencing and You Keeping Your Child Healthy [' spring What Is Permanency? Permanency is a word often used by case managers, foster parents and generally within the child welfare field. But what does it mean according to DFCS policy? The DFCS Social Serv ices Manual describes "early permanency" as "the goal for all children in foster care; that is, every child will be provided with a continuous, lifetime relationship with the parent or, if that is not possible, with a parent substitute." "A sense of belonging helps kids develop and mature," explained Linda Doster, program consultant with the state Foster Care Unit. "DFCS's first preference is that they be reunited with their birth family. Parents need DFCS staff and foster parents to support them in the tough work of making changes so their children can return home. Meanwhile, even with loving foster parents, children can feel they're in between homes, and every month can feel like forever. DFCS policy follows federal and state law, which sets a time limit that if a family can't be safely reunified in 12 to 15 months, children need a different plan - to obtain the most secure, nurturing living arrangement available to them. They need a home they feel will continue." The Five Options The DFCS manual lists federal law's five options for permanency in federal law's order of preference. On a case-by-case basis, DFCS considers which of these five options best meets each child's interests. Topping the list are 1) reunifying children with birth family and 2) adoption, if safe reunification appears impossible within 12-15 months. When reunifi- cation with birth parents is not feasible, adoption can provide the child (both legally and psychologically) with a strong, lasting bond and connection. The third permanency option is guardianship. Sometimes for a child who is unlikely to return home and for whom adoption is not feasible, the court appoints a guardian. Like adoption, guardianship is a legal agreement but is less binding legally. Doster noted, "No more than two percent of Georgia's children in foster care are appointed guardians." Maximizing Wholeness The fourth option is placing children permanently with relatives DFCS deems able to "ensure the child's safety and well-being." When children have relationships with kin, they have the advantage of feeling continuity with their family history and roots. Thus, to bolster all five permanency options, the DFCS manual emphasizes the importance of DFCS staff and foster parents supporting children's positive connections with family members, even if those relationships will be very limited, such as a stepsister sending the child Christmas cards or a grandmother occasionally telephoning. The fifth permanency option is more accurately described as a planned permanent living arrangement, since it provides the least permanency. Only after seriously considering and ruling out the other four permanency options, DFCS will select an arrangement for some children such as "long-term foster care" with a committed family or "emancipation" to prepare children for the transition to independent living. Children need to feel they belong. Foster parents greatly influence children's futures, says Danny Stevens. 2 Ado tions: Foster Parents Are rucial Teammates When a child in foster care is to be adopted, sometimes the foster parents choose to adopt. Foster Parent and Staff \ the child, writing down details like foods the child Ii Development Institutes! likes and things that help when the child is angry However, when not adopting, what is their role in the adoption process and the child's long-term future? "Foster parents are crucial teammates in helping adoptions be more successful," emphasized Danny Stevens, regional adoption coordinator supervisor in the Office of Adoptions in or sad. Such information can greatly speed the process of adoptive parents getting to know the child and helping the child feel at home. Photos Help The 2002 Foster Parent and Staff Development Institutes will offer practical skills and information. As always, fo ster parents and staff associated with DFCS, as well as private providers, are welcome. Athens. "Photos can help adoptive parents connect Foster parents who attend will earn annual with the child's past," said Stevens. "Maybe the parent development training hours and will be child mentions Uncle Joe, and the adoptive par- reimbursed for expenses. Institute registration ents don't have any idea who that is. Uncle Joe brochures will be mailed to foster parents. Foster might not even be a real uncle, but is the foster parents are asked to coordinate their attendance family's neighbor who really took to the child and with their local DFCS. If local DFCS agencies can- whom the child likes a lot. If the foster family took not answer a question about the Institutes (includ- a picture of 'Uncle Joe' and wrote a note on back ing questions about registration, lodging and explaining who he is, the adoptive parents would workshops), call l.800.227.3410; for questions know about that meaningful part of the child's about reimbursement, contact your county DFCS; w or ld. " for all other questions, call 404.657.3454. Sharing Information Photographs can help the child beyond the initial adjustment phase of adoption and even for years to come. When foster parents take pictures for an 11-year-old, perhaps for a scrap book or Life Book, they might not mean a lot at the time. "But in years to come," Stevens noted, "he or she might look at the pictures and think, 'I didn't stay very long with those people and don' t remember them very well, but look at how he has his hand on my shoulder, and look at how she's smiling at me, and look how I'm laughing. There were tough times back then, but it really looks like there was good, too. These people look like they really cared about m e.'" Catch up with the Institute Savannah: .................................. June 28-29 Macon: .................................... August 9-10 Atlanta ................................ September 6-7 Partnerships in "By sharing information, foster parents can help children and adoptive parents adjust to each other," explained Stevens. "For instance, the foster parents might throw birthday parties for all their children's birthdays. If the adoptive parents d on' t know that and don't usually throw parties, they might not sense the child could feel disappointed when his or her birthday comes and there's no party. Of course, the adoptive parents don' t need to copy all the foster family's customs, but knowing about them can help to be more sensitive to the child's thoughts and feelings." Stevens recommends foster parents describe the child's typical day to ad optive p arents. Does the child get dressed for school before or after breakfast? Does the child bathe in the morning or evening? Foster parents can keep a journal about Building Continuity Foster and adoptive parents need to keep in mind children sometimes feel disloyal for caring about more than one set of parents. When foster parents find out about the child's adoptive family and talk enthusiastically about them with the child, the child feels permission to love these new parents. When the child hears foster and adoptive parents talk positively about one another, the child feels more supported by a network of people who care. When the child is adopted, foster parents might write their own address on stamped envelopes, to give with stationary to the child to encourage keeping in touch. Many foster and adoptive parents stay in touch . I SS UE NUMBrn 17 Newsletter Production Supervisor: Jayne Bachman Editorial Committee Members: Kathleen Rinehart and Doris Walker Writer/Editor/Publisher: Dan Corrie Writer: Ellen Corrie Desktop Design: Dara O' Neil Do you like this newsletter? Do you have ideas for how it could be better? Send your comments to: Jayne Bachman DFCS Foster Care Unit, 18-222 Two Peachtree St., NW Atlanta, GA 30303-3142 404.657. 3570 From Fostering to Adopting? Often parents foster a child who becomes available for adoption. You as a foster parent may be both attracted and uncertain about whether to adopt a child yourself. You should consider several key factors in making this tough decision. Love: Love can make the adoption decision easy or very hard. You may have learned to love a child and feel glad to adopt. Yet you can love a child and choose not to have a permanent relationship due to circumstances or your stage of life. When you let go of someone you love, you will need to grant yourself time to grieve. Time: Children do not simply fit into our lives. They require quality time and large quantities of time. Do you have the time to raise a child? Does this child require extra attention due to disabilities or other special needs? Can you imagine a lifetime commitment with this child? Visualizing: Prospective adoptive parents need to visualize a particular child as part of their family. Imagine family photographs over the years. Can you imagine this child as a teenager? How would he or she fit in with other family members and family dreams? Birth families: Adoptive children come with their past. Their genes connect them with their biological family. Many have memories from living with their birth parent(s) and siblings. When you adopt, you will be connected forever with a child's past. Adopted children will likely ask about their birth family, may want contact with them and may want to search for birth family members. Ask yourself if you are ready to honor the child's potential needs for connecting or maintaining connections with his or her past. Current family: Adoption will change everyone in your family. Birth order may be altered (the baby may no longer be the baby). Money will be shared with more children. Time will be re-organized. The decision to adopt is a decision not only for adults, but you should consult with both your children and the child you might adopt. You and a child you adopt will need to live in a network of family and community, so allow close extended family and good friends to express feelings and opinions. Guilt and pressure: Never adopt a child out of guilt or under pressure. The adoption decision is a major life moment for both parents and children. Not every child will fit in every family. This is a time to be assertive about saying no, or you can break many hearts. Do not accept a sibling group if you do not want a sibling group. Follow your heart and your gut. Adoptions should never be "shotgun" adoptions. Adoption is an awe-inspiring decision which should be made with deep reflection and consideration. Then if you adopt, you will know you made your decision with the best available information and a leap of faith and hope. You will begin a life-long journey of challenges and joys. Teaming for Children's Futures: am1 y on erenc1 ng Since 1999, family conferences have been part of DFCS standard procedure throughout Georgia. Family conferencing is a powerful approach to bring change to families and establish teamwork for children, engaging and supporting birth parents or other caregivers for years to come, beyond the time of DFCS involvement. Cobb County DFCS was an early leader in family conferencing in Georgia. pletes and mails them all a standard form we've developed to announce the conference. The form asks them to call us with any questions they might have about the meeting. The case manager also talks to the family, describing how the conference works and answering questions, as well as encouraging them to invite any family or friends they'd like to come. We always invite each child's foster parents." Clockwise fro m upper left: Patricia Dunton, Stephanie Boisiolie, Sabrina W atson "We have a conference for every family with a child entering foster care in Cobb County," described Stephanie Boisjolie, case manager. "We average four conferences a week, but the number can range from two to six. Each conference lasts about 90 minutes to two hours. We used to meet any day of the week but settled on Thursdays, to be easy for regular participants to remember - like people coming from other agencies - so they won't have to consult their calendars all the time. They'd just know Thursdays are always family-conference days here at DFCS." reparing for the Meetin When a child enters foster care, the case manager tries to learn as much information as possible about the parents and people important to the family, including both professionals working with the family (such as a mental health counselor or a women's shelter staff member) and relatives or friends who might be close to or concerned about the family. "We give the secretary the time, date and list of 4 people to invite," Boisjolie described. "She com- The family conference is a key step in developing the family's required 30-day case plan and is scheduled to occur within a few days of the 30day deadline, in part to allow time for completion of the family's required initial assessment, so the contractor coordinating the assessment will be able share pertinent information during the conference. The conference provides an opportunity to bring family connections together who might form a supportive network for the child for years to come. Too often in the past, case managers worked individually with mothers, but Cobb DFCS has discovered how willing many fathers are to come to conferences when invited, even if living away from the mother and children. Recently, one child's maternal grandparents and a great aunt met each other for the first time in the DFCS lobby on their way to the conference. Bringing family members and friends together for the meeting often leads to productive brainstorming about other people who have been or might be important in the child's and parents' lives. Patricia Dunton, a volunteer on Cobb County citizen review panels, attends all conferences, noting, "During the conferences, I often remind parents that the judge makes all final decisions, and everyone in the room is there to support the family in doing the things that will make the judge decide it's safe for their child to come home again. That helps parents see us as working with them, rather than in their minds being 'bad DFCS who took away my kids.' " The meeting begins with everyone introducing themselves. Then the facilitator (the child's foster care case manager) reviews the ground rules, in order to help encourage a mutually respectful, less emotionally charged atmosphere. The ground rules are posted on a bulletin board in large print, easily read from anywhere in the room. See the ground rules listed on this page. "We emphasize the law's time limits, requiring the judge to make sure the child has a safe, permanent home within a year," explained Boisjolie. "It's natural for parents to feel intimidated coming to this room full of people, and we explain the meeting is an opportunity for them to let us know about things they need help with for their children's sake, so we can all think together how to help them meet those needs. It can be empowering to parents to realize this whole room full of people is there to help them." Boisjolie continued, "Next, we ask parents to describe in their own words the circumstances leading to their child going into foster care. The family's child protective services (CPS) investigator is sitting in the room with knowledge of how things happened, so parents usually don't exaggerate the facts to blame DFCS or put themselves in an unrealistically positive light. The CPS worker adds any pertinent information, then leaves the meeting. Sometimes parents see CPS investigators as adversaries, so when he or she leaves, parents usually relax some and look to the rest of us more as helpers." Next, the facilitator invites everyone (including the parents) to name the parents' then the children's strengths, which the facilitator lists on flip chart paper everyone can see. Often parents feel more relaxed and open after this positive recognition from the group. Next, everyone names the parents' then the children's needs. The group then develops the family's case plan. DFCS may begin developing case plans prior to family conferences, based on information gathered during the investigation that clearly indicates family members need to do certain things for the child's safety, for example parents entering a substance abuse treatment program. However, the case plan is fully completed based on the group's discussion during the conference, tailoring case plans to each family's particular strengths and needs, unlike the "one-size-fits-all" case plans too often developed in the past when case managers lacked the help of so many people with know!- GROUND RULES BE RESPECTFUL TO ALL PARTICIPANTS DO NOT PLACE BLAME OR SHAME ONLY ONE PERSON SPEAKS AT A TIME EVERYONE HAS THE OPPORTUNITY TO SPEAK IT IS OK TO DISAGREE SPEAK TO EACH OTHER, NOT ABOUT EACH OTHER EVERYTHING SAID IN THE FAMILY CONFERENCE IS CONFIDENTIAL edge of the family. A recorder takes minutes of the meeting. These and the case plan are later sent to the family and other attendees, along with everyone's name who attended so everyone can remember each other's names. s a Te "Having the foster parent there really helps," remarked Sabrina Watson, social services supervisor. "The birth parents hear them saying good things about the child and can ask them questions like, 'Is he sleeping at night? Is he eating? He really likes this kind of food.' The foster parent is there talking with them and making eye contact, so they get a first-hand sense that this person isn't replacing them, but is taking care of their child during this time. That peace of mind makes it easier for them to cooperate with us." Watson added, "Occasionally, when family members have acted aggressively, maybe during the investigation, we'll take the precaution of having a security guard nearby if needed, maybe waiting outside the door. You might expect we'd encounter more conflict than we do, with some parents having histories of volatile behavior, such as in abuse cases. But usually if a family member becomes upset, we say we understand it's natural for parents to feel emotional while discussing their children. We stop the meeting for a few minutes, to let everyone get a Coke or have a smoke, or whatever. When we come back, everyone is usually much calmer and more focused. We always keep the meeting's tone respectful toward the famil y. " 5 Programs to eep Kids Healthy Preventative care boosts children's health State Health Check 404.463.0183 1.800 .822 .2539 www.health .state.ga.us 6 To help make sure children are as healthy as possible, the Georgia Division of Public Health offers many programs. You as a foster parent or case manager can use these programs with children in foster care. Health Check Health Check is a preventive program offered at all county health departments for children from birth to age 21 who are enrolled in Medicaid or PeachCare. All children in foster care are eligible for Health Check services. It offers screenings for vision, hearing and dental beginning at age 3. Also children can be screened for tuberculosis and exposure to lead. Health Check also provides immunizations. "Health Check exams are 'well-child checkups' to make sure a child is developing appropriately for his or her age, not to treat an illness," explained Gloria Chen, Health Check program manager. "We provide appointments which are scheduled at recommended ages to check on development in a variety of areas, including growth, learning to talk, and becoming physically coordinated. At each visit, we set up an appointment for the next recommended visit. The exam is done by a nurse who spends as much time with the family as needed to understand the child's physical or emotional issues - anything that affects the child's health. The nurse will give advice about whatever issues typically come up for a child of that age. For example, there are different health and safety concerns if a child is 2 versus a teenager." If any problems are suspected or identified, the nurse refers the child to a physician, dentist or whatever specialist is necessary, locating providers who accept Medicaid. The nurse may be able to refer the child to other public health programs that would be helpful to the child. If a child becomes sick between visits, the nurse will also help you with referrals to a doctor. Because children in foster care are more likely to change addresses, Health Check can be helpful in providing continuity because, with proper authorization, the child's records are easily transferred between county health departments. Thus, you especially might want to bring a child to Health Check if the child received check-ups at a health department prior to coming into foster care or is likely to be returned to a home where he or she will receive health care at a health department. Also you can continue to take the child to get wellchild check-ups at the health department while also working with a doctor or other program. "One of the keys to a child's good health is this sort of preventive care," emphasized Barbara Wallace, team leader for Infant and Child Health Services in the Georgia Division of Public Health. She urges foster parents "not to wait for symptoms to get health care for children. Many children in care are especially vulnerable to health problems because of their backgrounds of neglect and/ or abuse. The sooner problems are identified, the easier it is to treat them, and the less likely they will become bigger problems." Children 1st All children in foster care are also eligible for Children 1st, a program which screens children from birth to age 5 who are at risk of developing poor health or have developmental problems. If you have concerns a child may have health or developmental problems which are not being addressed, call the Children 1st state office (1.800.822.2539) or your local health department. They will put you in touch with your local Children 1st coordinator. Before calling, foster parents should discuss doing so with their case manager. "Children 1st will have a nurse complete an assessment of the child in the home to determine what, if any, services are needed," explained Susan Bertonaschi, program coordinator for Children 1st and the state Program for Developmental Health. "The in-home assessment can be helpful because going to a doctor's office may be one more stressful situation for a child who has just come into care. Based on the assessment, Children 1st refers children to community programs, doctors or other therapists. It also provides caregivers with information about any identified health problems." Other Programs Public Health has many other programs which can be useful to foster parents and children. These include programs to provide health counseling to teens, reduce the risk of Sudden Infant Death Syndrome, and screen infants for inherited disorders. Other programs provide many services such as family training, medical services, and therapy to children with special needs. Foster parents can call their local health department to ask what programs the health department nurse would recommend for their child's particular needs. Nutritionists are available at every health department. While every program is not available in every county, most programs are located relatively nearby in each county's public health district. Initial Assessments Two years ago, Georgia's case managers were given a powerful tool with which to help at-risk families and children: initial assessments. For these assessments, a team of professionals gathers abund ant information about children who enter foster care and their families. Getting this information so early in working with a family gives case managers a major boost in understanding and planning how best to help them. "The assessments give us information to know whkh services a child and family need," stated Margaret Dawe, Dekalb County DFCS social services case manager. "We may find that not only the child but a parent has untreated mental health issues, so we know to help them get counseling and an evaluation for medication. The family's assessment helps me know what supports they need to meet their case plan's goals." The assessment's information can lead to needed treatment and better ways of dealing with a child. For example, the assessment might reveal a ch ild's diabetes, which can greatly affect not only the child's health but behavior. The psychologist might advise that the child could need several hours to calm down before talking about a prob- lem. The child's caregivers could greatly benefit from such advice. According to state policy, DFCS agencies should complete a comprehensive child and family assessment within 30 days of a child's coming into care. This should include a medical exam for each child, a psychological exam for each child (or for children under age 6, an evaluation of their development), a general assessment of the family as a whole, as well as gathering each child's educational information. The assessment provides a rich source of information to help tailor a family's case plan to their particular strengths and needs. County DFCS offices contract with private professionals or agencies to do these assessments. Betty Wrights, Foster Care Unit consultant, noted there may be areas of the state that do not yet have enough providers with adequate training to complete the assessments and "we're working now to provide further training because these assessments need to be done to better help the children and families DFCS serves." Margaret Dawe heavily relies on initial assessments. Foster Care Georgi a Depa rtment of Human Resources D ivis ion of Fam ily and Ch ildren Ser v ices Suite 18-222 Two Peachtree Street, NW Atlanta, GA 30303-3180 PRSRTSTD U.S. POSTAGE PAID ATLANTA, GA PERMIT NO. 5823 Get Medicaid Card Quickly! To contact Right from the Start Medicaid 1.800. To fax Medicaid card applications 7 0 To locate Medicaid providers "Getting Medicaid cards should be a top priority when children enter foster care," emphasized Lorraine Ilugbo of the Right from the Start Medicaid Outreach Project (RSM). "Just as we adults want to be covered by insurance in case we suddenly need treatment, children need to be covered." Within 10 days after a child enters care, DFCS case managers should complete the brief, simple application for the child's Medicaid coverage and fax it to RSM. RSM averages two days to process applications. If the case manager calls RSM because the child needs treatment that day, RSM will attempt to speed up the process and fax a temporary Medicaid card that day. Case managers can obtain Medicaid card applications at their DFCS office or by calling RSM at 1.800.809.7276. Prior to submitting the child's application, DFCS is responsible for closing each child out of all prior cases, if a separate case or cases had previously been opened and never closed for the child. Medicaid cards cover a range of treatment, including medical, mental health and dental services. Not all providers accept Medicaid; to locate providers in your area who do, call 1.800.822.2539.