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F.T.S. EXPRESS
Spring 1999-2000  -  Issue 16

Matching Services With Client Needs

Successfully working with children, adolescents and their families with chronic, multiple problems requires a resource that combines a variety of methods and theoretical approaches in a comprehensive multi-service program. As the composition and dynamics of each family situation is unique it requires the creative development of solutions tailored to the specific needs of the individuals and their family. Family Trauma Services offers an assortment of services ranging from outpatient treatment, intensive home-based treatment, partial day treatment and therapeutic foster care placement. This edition of The Express will discuss two aspects of the outpatient services: psychotherapy and psychological assessments. The issue also contains a discussion on the treatment of at-risk youth presented by our director Wayne Parks, MA, CFC, DAPA.

 Outpatient Psychotherapy

One of the most common forms of treatment for individuals and families is psychotherapy. This term, however, covers a wide variety of techniques, modalities, schools of training and types of licensed mental health professionals who perform it. This article will give a brief description of the elements involved. For the sake of brevity this article will touch on only three forms of psychotherapy that bridge the spectrum of treatment. They are: psychodynamic or insight-oriented therapy, cognitive therapy, and behavioral therapy.

Psychodynamic Psychotherapy: Psychodynamic or Insight-oriented psychotherapy focuses on the whole person and tends to work less on specific problems of the moment and more on, the inner world, and underlying issues precipitating the behaviors. Therapy sessions are typically once or twice a week, and specific problems may be dealt with more directly than in more intensive forms of therapy such as psychoanalysis. The goal, however, is healing through self-awareness. Insight-oriented psychotherapy helps the individual become aware of the connection between earlier events and their effect upon current problems. The hope is that by understanding underlying patterns you can influence the quality of your current life functioning.

Cognitive Therapy

Cognitive therapy focuses on helping the person to change the assumptions, mind-sets and patterns of attention which lead to problems. The goal is to resolve difficulties by correcting distortions of thoughts and feelings. Its focus is primarily on current difficulties rather than past events.

Behavioral Therapy

Behavioral therapy uses a variety of re-education and re-training techniques to modify behavior patterns that are causing distress or problems in daily living. The focus of behavioral therapy is almost solely present concerns and problems.

  Psychological Assessment

What Are The Types of Tests?

Psychologists test individuals in four principle areas:

1. Abilities: These tests identify the basic skills needed to perform various tasks. Areas assessed include the ability to use verbal and visual information.
2. Achievement: These tests identify how well a client has learned tasks, either through formal schooling or individual scholarship. Tests can cover a broad range of materials including reading. writing, and mathematics.
3. Psychological Functioning: Tests of psychological functioning identify the characteristics that make each person unique. They reveal the individual manner that people use to approach situations, and how someone uses emotion and thought to problem solve.
4. Neuropsychological Functioning:Neuropsychological tests examine the basic functions of the brain, including memory, attention, concentration, and capacity for learning.

For What Purposes Are Assessments Used?

The four types of tests are used in different combinations, depending on the presenting problem, the age of the person being assessed, and the skills and training of the assessor.
Examples of areas that are often assessed include:

1. Educational: Children and adolescents are often referred for testing due to academic difficulties, such as slow learning or eligibility for gifted and talented programs.
2. Mental Health: Individuals often seek evaluation to understand and clarify their current functioning or that of their children. Therapists can seek assessment for their clients to help redirect treatment, identify areas for further work, and clarify the clinical diagnosis
3. Forensic: These assessments are used during court proceedings. Assessment helps the court understand the individual's capabilities and how those capabilities can affect actions. Assessment can be used to clarify issues in a custody dispute.
4. Neuropsychological: Physicians usually request neuropsychological testing when someone has a neurological complaint. For example, testing helps assess intellectual and memory functioning after a head injury or during the progression of Alzheimer's disease.

What Are Common Questions For Seeking Testing?

1. Educational - Does my child have a learning disability?
   Why does my child have problems in school?
   Why do my child's teachers complain that he cannot pay attention in class?
   What does my child need to maximize her ability to learn?
   Is my child eligible for a gifted and talented program?
2. Mental Health - I am not getting very far in therapy.
   What do I need to work on to make progress?
   My doctors tell me that I am depressed. Is this so?
   Why does my mood seem to shift so frequently?
   Why is my child's behavior so hard for me to manage?
3. Forensic - Is a parent capable of making decisions regarding their child's care?
   Is a person the right parent for custody of the child?
4. Neuropsychological - I know that my mind is not working right, although my doctors tell me there is nothing wrong. Can I find out how I am doing?

My distractibility and poor memory have gotten progressively worse over the past five years.

What's going on?

What Can I Expect During Testing?

Duration of testing can vary from one-and-a-half to six hours. depending on the question being asked or the complexity of the case. Most testing can be done during a single day. It can also take place over several days within a two week period of time.   A feedback session is typically scheduled one week after testing is completed. The psychologist goes through the test results with the client and/or parents, discussing the findings and answering any questions. A copy of the report is usually given to the individual receiving the testing, as well as their primary care physician and/or referring doctor.

Final Note

Psychological assessment can clarify an individual's problems accurately and rapidly. This can lead to a more specific, effective, and efficient treatment.

Ronald D. Matthews, Ph.D., is a consulting clinician atFamily Trauma Services. He is a licensed clinical psychologist who has been in practice for over 30 years.   Dr. Matthew's particular interest is in forensic assessment and assessment of children. He also specializes in individual and family treatment for adolescents and children.

 I BELIEVE WE CAN FLY

OUR YOUTH ARE AT RISK

Our society and sense of community have dramatically changed since the 1950's. The significant presenting teenage life stress issues of the 50's were premarital sex/pregnancy, paternal separation/divorce, and alcohol experimentation. However, for some reason, today our society continues to exert tremendous energy in trying to stuff the complexities of today's life circumstances into the social and political paradigms of the 50's. And really when I speak of "our society," I am speaking of our federal government, our state government, our county governments.

I say again, our children are at-risk!

Let's try a little guided imagery.

Close your eyes, relax, breath deeply..............

1. Picture with your mind's eye the typical American family of the 1950's, hold on to that image.
2. Let's try a mental split screen.
3. Now picture the typical American family of today; is there a difference?
4. Picture the extended family supports of the 50's; what did that support system look like?
5. Now picture the extended family system of today; again, is there a difference?

I wish we had the time for each one of you to share these images with us today. I profoundly believe that the essence of our at-risk dilemma today can be found in how we and our government leaders experience these images.

In addition, our families are at-risk!

Our youth-serving agencies are at-risk! To illustrate this, the Youth Services Coalition sponsors an annual networking meeting where public and private providers are invited to come and present their various programs and services. At last year's meeting, I was personally overwhelmed, on a gut emotional level, by the number of vital youth-serving agencies that stood up and reported that because of significant funding cuts they would only be able to provide limited services; or in far too many cases they would no longer be able to provide any services at all.

OUR YOUTH-SERVING AGENCIES ARE AT-RISK.

We, as effective youth advocates, are at risk. Today we are working with youth who are presenting with the most serious psychiatric, psychological and psychosocial problems that have ever been experienced in the modern world. And for a great many of us, we are left at mid-day with a feeling somewhat like we would have had if we were digging a swimming pool with a tablespoon.........a feeling I experienced as a child. I will never forget that when I was 5 years old my grandmother used to provide day care for my 5 year old best friend Rickey and me. At that time, there was no community swimming pool, so Rickey and I took on the challenge of building the neighborhood pool.  We borrowed two tablespoons from my grandmother's kitchen and set out to the backyard to dig out our neighborhood swimming pool. We worked diligently for days until one day a heavy rain came causing the soil to erode and fill in our little hole. All our little 5 year old efforts seemed in vain. In retrospect, I think that Rickey and I realized three things at the time:

1. That our task was considerably larger than we could accomplish with our available resources namely tablespoons.
2. That our enthusiasm had significantly waned because we weren't experiencing any satisfaction from our efforts and we were becoming demoralized by how quickly our minimal gains were being eroded.
3. And that nobody else really believed that we could be successful at what we were trying to accomplish. Some 40 years later, I am distressed to report that often times at the mid-day hour, my staff and I are left with many of those same feelings. We, as youth advocates, are at-risk.

The children we see today fall into essentially three categories. Now these aren't rigid clinical categories because in fact most of the children we see today have multiple presenting problems and carry multiple diagnoses, but I still believe they can generally be viewed in three categories:

There are those young people who exhibit physiopathologic disorders which are organic and neurologically-based; ADHD, seizure disorders, and schizo affective disorders. These youth can't help their presenting behaviors even if they wanted to.

Secondly, there are youth with psychopathologic disorders. Theses youth can display angry, destructive, aggressive and violent behaviors, as well as depression and suicidal ideation. These young people are so overwhelmed by their feelings, that acting-out becomes a coping mechanism. To act-out actually temporarily medicates those intense feelings.

And the third group of young people are those with sociopathologic disorders. These young people don't want to change their behavior because their behavior has been normalized for them within their community and peer structure. The behaviors protect them--these kids are survivors.

Now, let's examine each of these groups a little closer to see if there are any common threads:

An alarming number of the youth presenting with physiopathologic disorders are children that have a history of in-vitro child abuse by virtue of their biological mother's alcohol, drug or tobacco abuse, or insufficient prenatal care. Inadequate prenatal care as the result of lack of concern should in and of itself constitute prenatal child abuse.

The youth with psychopathologic disorders have long histories of early childhood physical, emotional and sexual abuse. In many cases these youth repeatedly witness the abuse of a primary care giver. A one year old child can experience intense trauma after witnessing the abuse of his/her mother, not necessarily because the abuse is in itself so violent, but more because they fear that their basic needs will never again be met. I heard a clinician once refer to this as "the fear of losing the bottle."

Youth presenting with sociopathologic disorders are thought to be the most treatment challenged of them all, and in addition, they are the most rapidly growing group of identified at-risk youth. They are oppositional, defiant, conduct disordered, gang involved, violent and aggressive, and are involved with criminal behavior and chronic truancy. These young people are significantly behaviorally challenged in the home, school and in the community and have adapted a maladaptive behavioral response to a dysfunctional or abnormal life reality. But the bottom line is that this is the reality of their life experience, and I'll tell you, you're going to have a difficult time convincing Carlos of the benefits of walking the "straight and narrow path" when his life expectancy and advocation opportunities are slim to none. Malcolm will have a difficult time accepting that street corner drug trafficking is less inviting than experiencing constant rejection at the employment offices of some fast food establishment.

Let me reassert ----- today we are working with a youth population who is presenting with the most serious set of problems ever faced by our society. We, as effective youth advocates, are at-risk.

Well, now that I have presented this negative assessment of our situation, what do we do? I had entertained the notion of speaking this morning on the topic of "a new paradigm for a new millennium." However, after giving that subject considerable thought, I realized that my suggested approach to this problem is not new at all. It is as old as man's sense of society itself; it just doesn't get used very much anymore. 

You see, if we assess the common thread that weaves through each of the three categories of youth that we described, what we find as the etiology is a systemic lack of genuine compassion in our society. Webster defines society as "living associated with others-companionship." In the 1950's there were far more "we the people" than there were "those people." 

And in that social order it proved much easier to live associated with one another, whether the association was direct we-to-we or an indirect we-to-those people. Today, "those people" of every race, culture, economic and ethnic group have staked irreversible claim to be an equal part of the "we the people" group. 

And therefore, as an association of people who share genuine companionship, we are compelled to find genuine compassion for one another. This is the new paradigm for the coming millennium. 

Our service delivery approach must include genuine affection, respect, trust, affirmation - love, if you will. We must provide role modeling, mentoring and apprenticeship. 

And in addition to the sophisticated therapeutic techniques we utilize, we must infuse these qualities into the family systems that we serve. 

Some of us will say, "well, that is what we do." I know that is what some of us do. 

So, consider that I am just validating those of us who do; maybe, suggesting to those of us who don't, and kind of reminding those of us who forgot. 

Our post traumatic stress disordered youth don't know respect. You see they haven't been respected physically or emotionally. 

They don't do respect. Our attachment disordered kids don't know affection. They have never been loved. They don't do affection. Our gangbangers don't know trust. Their trust has been systemically violated. They don't do trust. You see, their attitudes are a bi-product of the mixed messages of some of our political leaders. For example, some political leaders, on one hand, suggest that there is value and a sanctity of life from the time of conception. 

On the other hand, however, by their legislative votes in eliminating child advocacy programs, cutting funds for education, and eliminating youth recreation programs, they are in essence saying to our youth, "we stand up for your right to be born, but once you're here --- good luck, you are on your own now." 

When we cut teachers, counselors and social workers, we send clear messages to young people about how much we value and support them developmentally. You see, the great social dilemma that we face is the fact that our society continues to be single-mindedly driven toward realizing tremendous technological advancement, amassing great wealth, and insuring an abundant quantity of life. 

However, in order to attempt to remain associated with our society's mission, an overwhelming percentage of our fortunate two parent families are forced to sacrifice the hands-on role of a full-time parent, protector and supporter. An even more compelling factor of this dilemma is our single-parent families, already decimated by the fact that the social and emotional cards of life have been stacked against them, are left with little or no resources to cope. Our society has to step in and mediate this situation by compensating and thus filling the void of support for our children. 

The bottom line is our children need to know that they will be physically and emotionally supported, and developmentally they need to know that the safety net of support is complete and unconditional.  Einstein once said something to the effect of, "No problem can be resolved by the same thinking that created it." We, as youth serving workers, must become political advocates for our young people. I would assert that we're at a critical juncture in the development of our society and that our very future may well be based on our ability to take a different view of the complex issues facing us. We are approaching the year 2000. 

As a society, as with most of us physically, we will never again comfortably fit into the clothing we wore in the 1950's ---- we have grown and we have changed. But I pray that the one thing that hasn't changed is our capacity to support the genuine affection of one another. 

We are social creatures. We need one another. As individuals, we should never feel unwanted, devalued, disrespected or violated. We need affection in our homes and respect and appreciation in our communities, governments and institutions. The children we serve need to know that by our affirming them and by our role modeling that they in fact can achieve. 

Sometimes at the mid- day hour, we may experience that swimming pool/tablespoon feeling, but we should all be eternally thankful that at the close of the day when we press our heads against our pillows, that no matter how stress filled or frustrating our day was ----we know in our hearts that we made a positive contribution to the life of some young person today. We helped some young person, some family or some parent see that they can achieve.

My eight year old nephew Frankie shared this song with me once and I believe it captures what I wish would be the cathartic experience of each of the young people that we work with.
 

 "I Believe I Can Fly"

Verse I

I used to think that I could not go on
And life was nothing but an awful song
But now I know the meaning of true love
I'm leaning on the everlasting arms
If I can see it
Then I can do it
If I just believe it
There's nothing to it

Chorus

I believe I can fly
I believe I can touch the sky
I think about it every night and day
Spread my wings and fly away
I believe I can soar
I see me running through that open door
I believe I can fly, I believe I can fly, I believe I can fly

Verse 2

See I was on the verge of breaking down
Sometimes silence can seem so loud
There are miracles in life I must achieve
But first I know it starts inside of me
If I can see it
Then I can be it
If I just believe it
There's nothing to it

Chorus

Verse 3

'Cause I believe in me
If I can see it
Then I can do it
If I just believe it
There's nothing to it

Chorus

Licensed Programs Maryland

• Outpatient Services
• Partial Day Treatment
• Treatment Foster Care
• Intensive Home-based Services
• Outpatient Mental Health Services
• Psychiatric Rehabilitation Services

Services Available

• Medication Management
• Psychological Assessments
• Psychiatric Evaluations
• Home-based Family Counseling
• Home-based Mentoring

Ongoing Groups

• Adolescent Sex Offender (ASO)
• ASO Cognitive Low Functioning
• Aftercare/Transitions Group
• Children's Posttraumatic Stress
• Adolescent's Posttraumatic Stress

Upcoming Groups

• ADHD Social Skills
• Ages: 6-8, 8-10, 10-12

Openings available in most groups

Call 703-549-4000 for details

FTS ANNOUNCEMENTS

FTS To Provide Family Focused  Service Coordination To Montgomery County

FTS was a warded a contract by Montgomery County to provide family focused coordination of services. Clients for this specialized services program will be referred by the Montgomery County Child Welfare System.. Services are scheduled to begin on May 1, 1999-2000

F.T.S. Awarded Family Preservation Contract in P.G. County

Prince George's County recently granted a contract to Family Trauma Services to provide Intensive Family Preservation Services to families who have a child at imminent risk of being removed, from the home, transitioning back into the home, or who have volunteered to receive services. The goals of this service will be to improve family functioning, to reduce the need for out-of-home placement and to keep all family members safe. Services will begin May 1, 1999-2000. For more information about this service or other services FTS provides in Maryland please contact Peter Steinberg at 301-386-9022
 

F.T.S. IS APPROVED TO PROVIDE MEDICAID INTENSIVE IN-HOME SERVICES IN FAIRFAX COUNTY

Family Trauma Services was awarded a contract in Fairfax County to provide intensive in-home services under Medicaid. Services are provided for a minimum of 5 hours per week for 26 weeks. Interventions offered include:

• Crisis Treatment
• Individual Counseling
• Family Counseling
• Life/Parenting/Communication Skills
• Case Management
• Coordination With Other Services
• 24 Hour Emergency Response

Please contact Laurie Rosser, LCSW at 703-549-4000for more details

F.T.S. Is Looking for A Few Good Counselors

Family Trauma Services (FTS) is a unique combination of mental health services spanning the diverse needs of families, children and adolescents. FTS is a private mental health agency with licensed programs for outpatient mental health services, intensive home-based services, partial day treatment and treatment foster care placement.

THE FOLLOWING POSITIONS ARE AVAILABLE:

Licensed Therapists

VA & MD licensed clinicians needed to provide center-based counseling to children and adolescents. Experience with adolescent sex offenders preferred.

Home-based Counselors

Masters and bachelor level counselors needed to provide home-based services to at risk youth and families in VA & MD. Bi-lingual an asset.

Fax resume with cover letter to (301) 567-6198

Therapeutic Foster Care Homes

Family Trauma Services Inc. is a licensed child placing agency providing comprehensive mental health services to children, adolescents and families.

F.T.S. provides extensive support and training as well as financial compensation

For more information call

301-567-6195 now!          Children are waiting

 

Social Skills Groups for Children and Adolescents

Ten week, ninety-minute social skills groups for children and adolescents to address various developmental and behavioral concerns.

Topics Include:

• Friendship-Making Skills
• Identifying and Dealing with Feelings
• Cooperation and Team Building
• Frustration Tolerance and Anger Management
• Problem Solving
• Empathy and Understanding Others
• Stress Management and Relaxation
• Separations and Endings

Concurrent Parent Group

A free parent support group is included at the same time offering parenting and associated films and information as well as a discussion group addressing specific parental concerns and topics addressed in the social skills group.

For information and registration contact Wayne Parks at (301) 567--6195

Treatment Foster Care Program

Family Trauma Services's Treatment Foster Care Program was developed to provide a healthy living environment for children and adolescents whose needs have not been met in their own families or for children and adolescents who require an out-of-home placement due to other circumstances. Treatment Foster Parents receive ongoing in-service training and support focusing on behavioral management, coping and accessing community resources. In addition, the Family Trauma Service's Treatment Foster Care Program provides families with in-home counseling as well as clinic-based services with a range of services available, including the availability of psychiatric assessments, medication evaluations, psychological testing, individual psychotherapy, group psychotherapy, parent support groups, in-home family counseling, mentoring, and academic tutoring.

For More information Contact Wayne Parks at Tel: (301) 567-6195 Fax: (301) 567-6198