Module 1: Strategies

Residential transformation centers on shifting the primary focus from youth behavioral improvement within the program to partnering with youth and families to build and/or strengthen the skills needed by both the youth and their family members, including siblings, for long-term success at home and in the community. This shift is critical, as youth improvement in the residential milieu is often short-lived, especially when there is a lack of focus on partnering with and preparing families through work with them in their homes and communities, designed to support a youth’s successful reunification.

Identify the foundations of organizational transformation to create a road map. BBI identifies the following areas as critical to residential transformation specific to successful family engagement. To achieve successful transformation, organizations can place primary focus on these areas:

• shorter lengths of stay (i.e. less than six months)
• smaller residential programs close to the family’s home and community
• a primary focus on successful family reunification for every youth
• urgency toward ensuring permanency for youth with no identified family
• promotion of youth and family voice, choice, and roles
• cultural and linguistic competence
• strength-based, individualized, trauma-informed/trauma-responsive, and skill-building approaches with youth and families
• prevention, reduction and elimination of restraint, seclusion, and other coercive procedures
• strong partnerships with community programs and supports
• clinical excellence and skills in engaging, supporting, partnering with, and skill building with families and youth
• measuring post-discharge outcomes and impact as central to true transformation.

Develop a strategic plan geared toward authentic and successful family engagement, partnerships, supports, and skill building, with specific action steps for each area. Transformation-focused strategic plans convey the mission and values of the organization, including:

• hiring multiple, diverse Family/Parent Partners
• providing workforce training, supervision, coaching, and mentoring centered on family engagement, partnerships, supports, and skill building
• stressing cultural and linguistic competence in all family activities.

Family-driven strategic plans emphasize the foundational areas listed above, including focusing on ensuring permanency and successful family reunification, stressing family and sibling support and involvement, and shifting practice to center on strengthening families and supporting them at home and in the community.

Hire diverse Family/Parent Partners and integrate them throughout the organization. Integrate family perspectives throughout the organization by hiring Family/Parent Partners. Train them to occupy leadership roles, including on the organization’s board, and support them with effective mentoring and supervision.

Look closely at language⎯ensure that all program documentation conveys a culturally and linguistically competent family-driven stance. To align with transformation goals, the program’s mission statement, website, brochures, program manuals, hiring and employment materials, and other documentation clearly articulate a commitment toward culturally and linguistically competent family engagement and partnership. This documentation avoids references to “family dysfunction” and “home visits,” as families should not be blamed, and children do not “visit” their homes⎯they are guests in the residential program and live at home. Home and community involvement become the expectation.

Review all program practices to ensure a primary focus on supporting and strengthening families. Examples of such program practices include requiring staff to connect with families at least daily, especially to provide positive updates; encouraging youth to contact their families multiple times per day; and ensuring that youth have easy access to calling a family member if they are upset or sad and/or to share good news.

Address the attitudes and practices of residential staff. To ensure respect and authentic collaboration with families, staff need to believe and truly buy into the importance of strengthening families to support long-term success and permanency for youth. Successful organizations carefully hire new staff who are enthusiastic about working with families, including within their homes and communities. Successful organizations hire staff who represent the ethnicities and cultures of the families served and speak the languages of the families served. These organizations also make clear that staff who cannot align with this vision should seek employment elsewhere.

Emphasize outreach to families and maintain close contact. Staff responsibilities include comprehensive outreach to family members, including siblings[. When residential organizations focus on family engagement, staff are in frequent contact with families by phone, via email and video platforms, and in person.

Demonstrate cultural and linguistic competence and commit to equity, diversity, and inclusion  (CLC/EDI) throughout the organization. To promote inclusivity and cultural responsiveness, it is important to hire culturally diverse staff in all disciplines, and especially at the leadership levels of an organization. This includes emphasizing staff training and ongoing coaching in CLC/EDI. For instance, successful organizations teach and support staff in effectively communicating with families about their cultural values and traditions and in incorporating these values and traditions into residential daily practices.

Prior to and during admission, ensure that families feel welcomed, valued, and understood. Staff can demonstrate empathy by understanding that, by the time a child comes to a residential program, family members are often exhausted and feeling hopeless and/or guilty about a child’s behavioral/emotional challenges. Staff can express concern for all members of the household. The first contact families have with the organization should be “welcoming, respectful, culturally and linguistically competent, and sensitive to the issues and challenges the family is facing”.

Provide families with written program materials on the family’s important role within the residential intervention. At pre-admission, provide family members with written materials (in their spoken language) describing their important role and their centrality to all decision-making processes. Materials can describe how families will be full partners in treatment and support interventions for themselves and their child.

Offer culturally responsive education, training, and skill building for family members. To foster long-term success, provide frequent opportunities for parents to receive education and skill-building opportunities relevant to their needs and goals.

Consider clinical promising, best, and evidence-based practices that emphasize family engagement, partnerships, skill building and support. Many programs develop their own promising and/or best practices; others use formal models such as functional family therapy, motivational interviewing, or multi-systemic therapy, which emphasize the family when working with youth. Clinical principles of family engagement that are important for staff to learn and are built into program practices include working from respect, building balanced alliances, focusing on the concerns of both the youth and the family, maintaining a focus on strengths, being empathetic, and providing hope.

Ensure that family members are equal members of the Child and Family Team: Family members are vital members of the Child and Family Team/treatment team/family team conferencing. Organizations that focus on engaging families do not hold team meetings unless families are present. Family schedules determine when meetings are held, and ideally, meetings should be held in a community location convenient to the family⎯preferably in their home. A number of residential programs have two or three staff go to the family’s home for the team meetings and have other staff join the meetings virtually. Ideally, a Family/Parent Partner can support a family in preparing for each meeting. If a Family/Parent Partner is not available, then a clinical or direct-care staff member who has a strong relationship with the family can be assigned to be the support person, ensuring family preparedness and full expression of the family’s voice and recommendations throughout each team meeting. Decisions are not made without family input and agreement.

With the key goal of successful reunification, restructure services toward skill-focused family treatment and support, and support families in the home as much as possible. With the key goal of successfully reuniting the family at home as quickly as possible, organizational transformation must include ensuring that skills developed through a residential intervention align with the skills needed for youth and families to succeed together at home. To achieve this, organizations shift to providing clinical and support services in the home and community as much as possible.