ARKANSAS FAMILY SUPPORT PROVIDERS IN A SYSTEM OF CARE TRAINING MANUAL ARKANSAS FEDERATION OF FAMILIES FOR CHILDRENS MENTAL HEALTH

ACTION FOR KIDS ARKANSAS FAMILY & YOUTH ASSISTANCE NETWORK This training manual was developed by the Arkansas Federation of Families for Childrens Mental Health, ACTION for Kids, and Arkansas Family and Youth Assistance Network. System of Care sites for Arkansas can utilize this resource to train and orient individuals providing support to families of children with behavioral health challenges. The information and examples in the manual are intended to be used as technical assistance tools for individuals who perform the variety of functions which are involved in supporting families. Arkansas Federation of Families for Childrens Mental Health Pamela Marshall, Executive Director P.O. Box 56667 Little Rock, Arkansas 72215 Action For Kids System of Care Bonnie White, CEO Mid-South Health Systems, Inc. & Counseling Services of Eastern Arkansas 2707 Browns Lane Jonesboro, Arkansas 72401 Arkansas Family & Youth Assistance Network Arkansas Department of Behavioral Health Services

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Developed by: Editor: Pamela Marshall, Executive Director Arkansas Federation of Families for Childrens Mental Health Assistant Editor: Martha Lewis, Craighead County Parent Technical Editor: Laura Butler, M.S., LPE In partnership with youth and families from Craighead, Lee, Mississippi, and Phillips Counties: Ashley Solis-Youth, Craighead County James Bragg-Family Support, ACTION for Kids Virginia Done-Parent, Mississippi County Kendrick Done-Youth, Mississippi County Syreeta Tucker-Youth Support, ACTION for Kids Porcher Wilson-Franks-Parent, Lee County Charlotte Wade-Family Support, ACTION for Kids Catherine Dowd-Family Support, Phillips County Eartic Kendall-Parent, Phillips County Maobe Obwacha-Youth, Phillips County Hadyn Huckabee-Childrens Services Director, Mid-South Health Systems Lori Poston-Positive Behavior Intervention and Supports, ACTION for Kids Andria Sims-Director of Marketing and Education, Counseling Services of Eastern Arkansas Permission to copy this manual, at no cost, is granted with proper acknowledgement given to the Arkansas Federation of Families for Children's Mental Health, Action for Kids and Arkansas Family & Youth Assistance Network. This document may be downloaded from the Arkansas Federation of Families for Children's Mental Health website at www.affcmh.org. Funding for this manual was provided by The Child, Adolescent and Family Branch, Center for Mental Health Services, Substance Abuse Mental Health Services Administration, U.S. Department of Health and Human Services, and Arkansas Department of Health and Human Services Division of Behavioral Health

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Table of Contents Chapter Introduction Title ........................................................................................Page ................................................................................................3 What Is Family Support? .....................................................5 What is Family Driven? .........................................................6 Chapter 1. Chapter 2. Chapter 3. Chapter 4. Chapter 5. Chapter 6 Chapter 7. Chapter 8. Chapter 9. Glossary Appendix Theoretical Knowledge ..........................................................7 System of Care Experience ....................................................26 Family Support Skills ............................................................55 Knowledge of Laws and Policy ............................................66 Cultural Competence .............................................................87 Communication Skills...........................................................99 Organizational Skills ..............................................................114 Advocacy Skills .....................................................................122 Values ....................................................................................128 ................................................................................................138 ................................................................................................145

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Introduction History Only a few decades ago, Americans lived in neighborhoods with their extended families and friends. Parents received information, advice, help, and support from religious groups, volunteer organizations, and schools. They counted on businesses, parks and recreational facilities, and transportation systems for additional support. During the 1970s, families became more mobile, mothers entered the workforce, family structures changed dramatically and young families were less likely to live near their extended families. Greater numbers of working parents and varied work schedules interrupted old rhythms of neighborhood life. It became difficult for parents to connect with each other and to build friendships. As traditional sources of help disappeared, people came together in their communities to recreate what they needed. The early family support programs emerged in middle class communities in the 1970s. They arose from loose associations of neighbors providing advice and support to each other. The programs started in a variety of contexts - neighborhood clubs, community groups, groups of families with special needs, preschool programs, Parent Teacher Associations (PTA) and social service agencies. From those groups of families with special needs emerged parents of children with behavioral health needs. Historically these families have been blamed for their childrens mental health disabilities. The term blamed and shamed refers to the way some providers treated families. Many providers blamed parents for their childs negative behaviors and as a result caused parents to feel very ashamed. The practice of labeling families of children with mental health needs as dysfunctional added another layer of blame onto the family. The service system was fragmented, and there was no easy access to the limited services that were offered. In 1982, Jane Knitzer released Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services. This book exposed the truth about the state of mental health care in America and spoke to the need to see families as part of the solution and not as the problem. Progress began in small pockets across the United States. A training called Families as Allies was developed at the Research and Training Center at Portland State University to promote collaboration between parents raising children with mental health needs and the professionals serving them. In 1988 Portland State Universitys Research and Training Center held the Next Steps conference, where it was decided that parents needed to come together in an organized way to address the lack of support and services for children with mental health challenges and their families.

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Synergy between the Next Steps conference, a small number of advocates, and several successful local family-run organizations resulted in the formation of the National Federation of Families for Childrens Mental Health in 1989. In 1992 the Federation received its first grant and hired its first executive director. With a number of other successes in place, the Federation was funded in 2000 by the Federal Child, Adolescent and Family Branch of the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a definition for family involvement to help clarify the goals for providing family support in system of care initiatives. What Is Family Support? Family support seeks to strengthen and empower families and communities so they can foster the optimal development of children, youth and adult family members. To accomplish this, family support advocates a fundamentally different societal response to the challenges impacting children, youth and their families. These families, despite all barriers, are trying to do the most important job in America - raising our next generation of learners, workers and citizens. Thus, family support programs are unified under one essential concept - helping parents deal with the day to day difficulties of child rearing. Programs combine current knowledge about child development, family systems and community impact on families to develop more effective ways to promote healthy child development. Today, family support represents thousands of community-based programs dedicated to supporting families in their efforts to raise healthy children. Family support is not a particular set of programs and services. Nor is it the building that houses the services or the staff that work with families. Rather family support involves a commitment to change all services by making them available to all families (not just those at risk) and emphasizing prevention (not crisis intervention). There are three key aspects to family support: Family Support is a set of beliefs and an approach to strengthening and empowering families so that they foster the development of children and youth and adult family members. Family Support is a shift in how agencies and organizations do their work and interact with families and communities. Family support beliefs guide and shape health, education, and human service systems and organizations to be more preventive, community-based, culturally competent, flexible, family-driven, strengths-based, and comprehensive. Family Support is a type of grassroots, community-based program that provides resources for families. These programs have proliferated in neighborhoods across the country since the early 1970s. They continue to refine their practices and inform the field about quality in family support services.

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Definition of Family-Driven Care The working definition which continues to evolve for systems of care provides: Family driven means families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, State, tribe, territory, and nation. This includes: Choosing culturally and linguistically competent supports, services, and providers; Setting goals; Designing, implementing, and evaluating programs; Monitoring outcomes; and Partnering in funding decisions. Guiding Principles of Family-Driven Care 1. Families and youth are given accurate, understandable, and complete information necessary to set goals and to make choices for improved planning for individual children and their families. 2. Families and youth, providers and administrators embrace the concept of sharing decision-making and responsibility for outcomes. 3. All children, youth, and families have a biological, adoptive, foster, or surrogate family voice advocating on their behalf and may appoint them as substitute drivers at anytime. 4. Families and family-run organizations engage in peer support activities to reduce isolation, gather and disseminate accurate information, and strengthen the family voice. 5. Families and family-run organizations provide direction for decisions that impact funding for services, treatments, and supports and allow families and youth to have choices. 6. Providers take the initiative to change practice from provider driven to family driven. 7. Administrators allocate staff, training, support, and resources to make family-driven practice work at the point where services and supports are delivered to children, youth, and families and where family- and youth-run organizations are funded and sustained. 8. Community attitude change efforts focus on removing barriers and discrimination created by stigma. 9. Communities embrace, value, and celebrate the diverse cultures of their children, youth, and families and work to eliminate mental health disparities. 10. Everyone who connects with children, youth, and families continually advances his/her own cultural and linguistic responsiveness as the population served changes.

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Chapter 1: Theoretical Knowledge Introduction Many families need a starting point to know when to seek help for their child. The information provided in this chapter can provide a family support worker with information to help the family start their path toward making informed decisions and feeling empowered about their childs mental health needs. Many times when a family seeks professional help for mental health treatment, they are not ready to have a conversation about their childs symptoms, treatment options or the positives and negatives regarding medication. Not being able to effectively communicate their needs, a family can feel overwhelmed and essentially lost in dealing with their childs mental and emotional health. This is not a good starting point for a family who may be at their breaking point. The goal of this chapter is to allow a support worker to help the family view their childs mental and emotional health needs from a different perspective and be better prepared to manage and advocate for their child. Having a new outlook on their situation can reduce the familys anxiety and get the family on a path of hope. This chapter will begin by reviewing childhood developmental stages and provide information on what to expect at each stage of development. It will also provide resources on knowing when to seek help if the family is concerned about their childs development. Secondly, this chapter will give examples of the emotional and behavioral disorders that are most commonly diagnosed in children and adolescents and the symptoms that accompany those diagnoses. Finally, this chapter will walk a worker through the steps in selecting an effective treatment plan and provide an overview of commonly prescribed medications. UNDERSTANDING CHILDHOOD AND ADOLESCENT DEVELOPMENTAL STAGES Research shows that parents or guardians of young children have a low knowledge of child development, including basic concepts about what their children should know or how they should act. As a family support provider, you may encounter a mother who is worried about her childs behavior and/or wondering if her child is reaching appropriate growth and development milestones on time. A lack of understanding of a childs development can cause a variety of problems for families. For example, the mother of an 18 month old child expecting her son to sit still for a doctors appointment might cause unnecessary frustration and/or may lead the mother to question her own ability to parent even though children at that age are normally curious and like to wander around. Furthermore, parents or guardians may misinterpret a childs appropriate behavior as being disobedient which may delay full growth in that stage if the parent responds inappropriately. An example would be a mother of a 3 year old interpreting her child rummaging through items around the house as intentionally being defiant and responding with harsh discipline or withdrawal of affection. Although a lack of knowledge about childhood development may cause unnecessary grief in a home, many families begin to truly get worried once their child enters extended daycare or preschool. Negative comments from teachers and, in some cases, removal from centers can

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begin the journey into seeking mental health treatment; however, early intervention and detection can prepare the family and help them feel empowered to start the process with a healthcare professional. Therefore, this section will offer developmental tools that will provide a framework for families to begin a dialogue with teachers, nurses, primary care physicians and mental health professionals about how to best support healthy social and emotional development in their child from infancy to the teen years. Development stages for children can be broken down into four categories: Infancy, Early Childhood, Middle Childhood and Adolescents. Although every child is uniquely different with their own strengths and abilities each child faces their own social and emotional challenges in each stage of development. Below is a snapshot of each stage of development and important areas to consider within each stage: I. Infancy a. Feeding b. Sleeping c. Crying and Comforting d. Discovering Self and Others e. Becoming a Family Early Childhood a. Eating and Sleeping b. Self-Care and Toileting c. Developing the Self: Personality, Emotions and Independence d. Family e. Building Friendships Middle Childhood a. The Emerging Self b. Growing and Changing c. Respecting Self and Others d. Family e. Building Friendships f. School Relationships Adolescents a. Feelings b. Friends and Family c. Preventing Injuries and Risky Behavior d. Body Image and Eating Behaviors e. Sex and Sexuality

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For deeper understanding of what each of these stages represents we have included in the appendix of this manual developmental tools from Bright Futures. These tools are titled, What to Expect and When to Seek Help. Written in a family-friendly language, Bright Futures developmental tools can provide a context for families to know more about important milestones in relation to their childs age and stage of development. Also, available online only, Bright Futures Family Tip Sheets divide the four developmental stages (Infancy, Early Childhood, Middle Childhood and Adolescents) into easy-to-read sheets designed to help families promote

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the health and well-being of their children with information on topics such as social development, child care, safety, eating and physical activity. Although the Bright Futures Family Tip Sheets are copyrighted, we encourage you to download the tip sheets and make multiple copies for your use and free distribution. These resources are available at the following website: http://www.brightfutures.org/tools/index.html http://www.brightfutures.org/TipSheets/index.html Another resource that will promote early identification and intervention is the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service under Medicaids comprehensive and preventive child health program for individuals under the age of 21. EPSDT became legislation in 1989 and includes periodic screening, vision, dental, and hearing services. In addition, Section 1905(r)(5) of the Social Security Act (the Act) requires that any medically necessary health care service listed at Section 1905(a) of the Act be provided to an EPSDT recipient even if the service is not available under the State's Medicaid plan to the rest of the Medicaid population. The EPSDT program consists of two mutually supportive, operational components: (1) assuring the availability and accessibility of required health care resources and (2) helping Medicaid recipients and their parents or guardians effectively use these resources. These components enable agencies to manage a child health program of prevention and treatment, inform families of the benefits of prevention and health services, and help them and the families they serve use health resources, including their own talents and knowledge, effectively and efficiently. It also enables the agencies to assess the child's health needs through initial and periodic examinations and evaluations, and to assure the health problems found are diagnosed and treated early before they become more complex and their treatment more costly. The EPSDT benefit must include the following services: 1.) Screening Services 2.) Diagnosis 3.) Treatment Screening Services -- Screening services must include all of the following services: Comprehensive health and developmental history -- (including assessment of both physical and mental health development); Comprehensive unclothed physical exam; Appropriate immunizations -- (according to the schedule established by the Advisory Committee on Immunization Practices (ACIP) for pediatric vaccines);

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Laboratory tests States must identify as statewide screening requirements the minimum laboratory tests or analyses to be performed by medical providers for particular age or population groups: Lead Toxicity Screening - All children are considered at risk and must be screened for lead poisoning. Centers for Medicare and Medicaid Services (CMS) requires that all children receive a screening blood lead test at 12 months and 24 months of age. Children between the ages of 36 months and 72 months of age must receive a screening blood lead test if they have not been previously screened for lead poisoning. A blood lead test must be used when screening Medicaid-eligible children. A blood lead test result equal to or greater than 10 ug/dl obtained by capillary specimen (fingerstick) must be confirmed using a venous blood sample; Health Education -- Health education is a required component of screening services and includes anticipatory guidance. At the outset, the physical and/or dental screening provides the initial context for providing health education. Health education and counseling to both parents (or guardians) and children is required and is designed to assist in understanding what to expect in terms of the child's development and to provide information about the benefits of healthy lifestyles and practices, as well as accident and disease prevention; Vision Services -- At a minimum, these must include diagnosis and treatment for defects in vision, including eyeglasses. Vision services must be provided according to a distinct periodicity schedule developed by the state and at other intervals as medically necessary; Dental Services -- At a minimum, these services include relief of pain and infections, restoration of teeth and maintenance of dental health. Dental services may not be limited to emergency services. Although an oral screening may be part of a physical examination, it does not substitute for examination through direct referral to a dentist. A direct dental referral is required for every child in accordance with the periodicity schedule developed by the state and at other intervals as medically necessary. The law as amended by the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) requires that dental services (including initial direct referral to a dentist) conform to the state periodicity schedule which must be established after consultation with recognized dental organizations involved in child health care; Hearing Services -- At a minimum, these services include diagnosis and treatment for defects in hearing, including hearing aids; and Other Necessary Health Care States must provide other necessary health care, diagnosis services, treatment, and other measure described in section 1905(a) of the Act to correct or ameliorate (reduce) defects, and physical and mental illnesses and conditions discovered by the screening services. At this time, a mental health screening is not a part of the mandatory services provided by EPSDT. In the State of Arkansas, these services are available to Medicaid eligible families and provided at least one time per year by a Primary Care Physician or PCP. If the family has concerns about the behavioral health status of their child they may request a mental health screening in connection with this visit. In order to obtain services from a mental health professional to get more information leading to a possible diagnosis, there must be a referral

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from the PCP. The family support worker should encourage the family to schedule the EPSDT screening when there are concerns and ask for a mental health screening and a referral. Individual families who are uninsured or underinsured by virtue of having limited private insurance coverage should be encouraged to apply for Medicaid or other public resources to ensure access to the EPSDT services for their child. A discussion of insurance coverage and access to services will occur in a later chapter. Diagnosis When a screening examination indicates the need for further evaluation of an individual's health, the PCP should make a referral to specialty providers to provide diagnostic services. The referral should be made without delay and follow-up should be provided to make sure that the recipient receives a complete diagnostic evaluation. If the recipient is receiving care from a continuing care provider, a PCP who is also qualified to perform the evaluation needed, diagnosis may be part of the screening and examination process. Treatment -- Health care must be made available for treatment or other measures to correct or ameliorate (reduce) defects and physical and mental illnesses or conditions discovered by the screening services. As a family support provider, you will want to be familiar with services provided under the EPSDT. A thorough screening process can rule out important health concerns for the family. It may also eliminate unnecessarily involving the family in other services. An example would be a child referred to mental health services because of inattention or social withdrawal in a school setting when in fact the childs condition is due to a hearing problem. For more information of EPSDT and its services please visit this website address: http://www.cms.hhs.gov/MedicaidEarlyPeriodicScrn/ UNDERSTANDING SYMPTOMS AND TYPES OF MENTAL HEALTH DISORDERS IN CHILDREN AND ADOLESCENTS Many families begin their journey into seeking mental health treatment when they notice a change in their childs behavior, attitude or mood. These changes are not only obvious to the parent; many times other family members, teachers and peers bring up the changes they see in the child/youth. Some of the most common signs and symptoms that are cited include: Aggressiveness (verbal and physical) Academic difficulties Hyperactivity Impulsivity Poor social skills Sadness Frequent disobedience Risk-taking behavior

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Irritability or grumpiness A lack of interest in usually enjoyable activities Concerns about sexual identity Substance abuse Suicidal thoughts Many times, the excessive and inappropriate use of professional jargon or special professional language gets in the way of effective communication between the family and a health care professional. Below is a list of definitions revolving around many of the problem behaviors noted above and other terms associated with symptoms and behaviors. Behaviors and Symptoms: Aggression: Words and action that are perceived to be threatening to others. Anxiety: Exaggerated or inappropriate responses to the perception of internal or external dangers. Also includes excessive apprehension toward new people, places or things; or in some cases excessive apprehension toward people, places or things who or which they have previously encountered. Conduct Problems: Behaviors that are characterized by acting out. These behaviors range from annoying, minor oppositional behavior (yelling, temper tantrums) to more serious types of antisocial behavior (aggression, physical destruction, stealing). Depression: A type of mood disorder characterized by low or irritable mood or loss of interest or pleasure in almost all activities over a period of time. Emotional Health: The well-being and appropriate expressions of ones emotions. Externalizing Disorder: Disorders that are expressed visibly to others and can be characterized by aggression, behavioral acting-out, hyperactivity, and conduct disorder. Hyperactivity: A disorder in which children are overactive and impulsive (acts without thinking). Inattention: Inability to focus and concentrate on a particular person or task. Internalizing Disorders: Disorders that are expressed within the individual and focus on clinically problematic affective and emotional states, such as anxiety or depression. Mental Health: How people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explore choices. This includes handling stress, relating to other people, and making decisions. Post-Traumatic Stress Disorder: A psychiatric illness that can occur following a traumatic event in which there was threat of injury or death to an individual or someone else. The main symptom associated with PTSD is anxiety and avoidance of anything or anyone associated with the event. Outcomes: The results of a specific mental health care service, usually phrased in terms of child and family gains (e.g., improved school performance, improved family communication). Prognosis: Prediction by a health professional regarding a persons diagnosed condition and chances for recovery.

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Assessment When talking to a health-care professional it is very important for the family and youth to describe all of the symptoms the youth is experiencing. This is important because the health-care professional needs to have the most accurate picture of the present situation. It is also important to be able to explain the history of these symptoms, including how long they have been occurring and how often they occur. It might be a good idea to write these ideas down prior to a visit with a health-care professional. Remember, as a family support provider, you must encourage the family to view themselves as equal partners in assessing the extent of their childs mental health needs. When families are empowered in this process, a more accurate diagnosis will likely be made. As stated in the section on EPSDT, a referral from the childs PCP is required to access mental health services. Before an assessment with a mental health provider can take place, the family must know who their PCP is and must have visited him or her about their childs possible need for specialized services. In Arkansas the process by which a family and a mental health provider assess a childs mental health is called a diagnostic assessment. A diagnostic assessment is an evaluation intended to collect more detailed information about a child such as how the child functions at home, in school and the community. There are times when a screening would take place before a diagnostic assessment. This usually happens in an emergency situation or an unscheduled visit to a mental health provider. A screening is a shorter evaluation that gets right to the immediate concern and/or emergency. When/if concerns are identified; a more in-depth assessment will be done. The diagnostic assessment sequence may occur as follows: Family decides to seek mental health care Family schedules EPSDT screening to include mental health Family obtains PCP referral to preferred mental health provider Family schedules initial diagnostic assessment In a diagnostic assessment questions often revolve around the following areas: Mental health (history and current situation) Family relationships Family history Living arrangements School performance Community involvement Cultural strengths (faith preferences, family traditions and values) Substance use or abuse Physical health Financial factors Employment Sexual Activity - 13 -

In Arkansas, diagnostic assessments are provided by a licensed mental health professional that is trained in gathering relevant information pertaining to the mental and emotional health of your child. The following is a list of mental health professional titles and a brief description of their discipline. Mental Health Titles Licensed Master Social Worker (LMSW): A social worker who helps individuals deal with a variety of mental health and daily living problems to improve overall functioning. A LMSW has a master's degree in social work and has studied sociology, growth and development, mental health theory and practice, human behavior/social environment, psychology, and research methods. Licensed Clinical Social Worker (LCSW): A person who meets the same requirements as a LMSW with at least 2 years post-graduate experience, 2000 hours of clinical supervision with an LCSW, and has passed the LCSW Examination. Licensed Associate Counselor (LAC): A person charged with assessment and treatment of mental health who has received a Master's Degree in primarily professional counseling. Licensed Professional Counselor (LPC): A person who meets the same requirements as an LAC with at least three years of supervised experience and has passed the LPC Examination. Psychiatrist (MD): A physician who completed both medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness. Psychologist (PhD or PsyD): A professional with a doctoral degree in psychology who specializes in psychological testing, assessment and therapy. Licensed Psychological Examiner (LPE): A person who has received a Master's Degree in psychology who specializes in psychological testing, assessment, and treating mental illness. If an LPE does not have Independent status (LPE-I), he/she must receive ongoing supervision by a Psychologist. Case Manager: An individual who organizes and coordinates services and supports for children with mental health problems and their families. (Alternate terms: care coordinator, advocate, and facilitator.) This person is not a mental health professional and therefore cannot perform a diagnostic assessment. Websites to verify that your mental health profession is licensed in the state of Arkansas: For persons with an LMSW or LCSW, visit http://www.arkansas.gov/swlb/. For persons with an LAC or LPC, visit http://www.arcounseling.org/. For Psychologists and Licensed Psychological Examiners, visit http://www.state.ar.us/abep/. To confirm that a physician is licensed to practice in the state of Arkansas, visit http://www.armedicalboard.org.

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After the assessment, the mental health professional should be able to provide you with a provisional diagnosis or diagnoses (the plural form of diagnosis). The mental health professional may need to refer you to a psychiatric evaluation. A psychiatric evaluation will be provided by a medical doctor, likely a psychiatrist. A psychiatric evaluation is very similar to the diagnostic assessment but the diagnosis (or diagnoses) will have the backing of a board certified physician, which may be required by your reimbursement source. It is important for families to take the same stance with the physician as they did with the mental health professional and that is to view themselves as an equal partner in the process of determining the extent of their childs mental and emotional health. The psychiatric evaluation sequence may occur as follows: Family and child attend and participate in diagnostic assessment by mental health professional. Mental health professional explains the necessity of referring child for a psychiatric evaluation by a physician or psychiatrist. Family schedules psychiatric evaluation to occur within 45 days of having diagnostic assessment. There are four main categories of diagnoses that are very common among children and youth who seek mental health treatment. Under each major category there are specific diagnoses that your child may have. It is important to understand that the term Not Otherwise Specified (NOS) is commonly used in the initial diagnosis of a child or adolescent. This category includes disorders with significant features of the diagnosis but the symptoms do not meet specific diagnostic criteria. This could be due to the duration of the symptoms or not having the certain number of behavioral symptoms to qualify for the diagnosis. For example, for a diagnosis of ADHD, there has to be 6 or more symptoms of hyperactivity and/or inattention lasting longer than six months to qualify for the full diagnosis of ADHD. A mental health professional may use the NOS category as an initial diagnosis as he or she gathers more information and allows for the child or adolescent to be evaluated by the psychiatrist. They include the following: I. Disruptive Behavior Disorders Attention-Deficit/ Hyperactivity Disorder Attention-Deficit/Hyperactivity Disorder, NOS Oppositional Defiant Disorder Conduct Disorder Disruptive Behavior Disorder, NOS Depressive Disorders Major Depression Depression, NOS Dysthymic Disorder Bipolar Disorders Mood Disorder, NOS Anxiety Disorders Post Traumatic Stress Disorder (PTSD) Generalized Anxiety Disorder

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IV.

Panic Disorder Obsessive-Compulsive Disorder Social Anxiety Disorder Phobias Anxiety Disorder, NOS Pervasive Developmental Disorders Autistic Disorder Asperger's Disorder Pervasive Development Disorder, NOS

While not a disorder, there is emerging work on a variety of sexual identity conditions which are currently designated as LGBTQI2-S by the Substance Abuse and Mental Health Services Administration (SAMHSA). The acronym references the following categories: Lesbian Gay Bisexual Transgender (pre/post-operative) Questioning Intersexed Two-spirit The categories are defined as follows: Lesbian: Females who are emotionally and sexually attracted to, and may partner with, females only. Gay: Males who are emotionally and sexually attracted to, and may partner with, males only. Gay is also an overarching term used to refer to a broad array of sexual orientation identities other than heterosexual. Bi-sexual: Individuals who are emotionally and sexually attracted to, and may partner with, both males and females. Transgender (pre/post-operative): Individuals who express a gender identity different from their birth-assigned gender. Questioning: Refers to individuals who are uncertain about their sexual orientation and/or gender identity. Inter-sexed: Refers to individuals with medically defined biological attributes that are not exclusively male or female; frequently assigned a gender at birth, which may differ from their gender identity later in life. Two-spirit: A culture-specific general identity for Native Americans (American Indians and Alaska Natives) with homosexual or transgendered identities. Traditionally a role-based definition, two-spirit individuals are perceived to bridge different sectors of society (e.g., the male-female dichotomy, and the Spirit and natural worlds).

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Other Terms: Youth also may use other terms to describe their sexual orientation and gender identity, such as homosexual, queer, gender queer, non-gendered, and asexual. Some youth may not identify a word that describes their sexual orientation, and others may view their gender as fluid and even changing over time. Some youth may avoid gender specific pronouns. Poirier, J. M., Francis, S. K., Williams-Washington, K., Goode, T. D., & Jackson, V. H. (2008). Practice Brief 1: Providing Services and Supports for Youth who are Lesbian, Gay, Bisexual, Transgender, Questioning, Intersex or Two Spirit. Washington, DC: National Center for Cultural Competence, Georgetown University Center for Child and Human Development. For more information on these conditions and other mental health disorders please visit the following websites: http://www.apa.org/ and http://www.nimh.nih.gov/health/topics/ Another essential part of the diagnostic process that is critical to the family is the idea behind the term Serious Emotional Disturbance (SED). This is a term introduced by the federal government in 1993 to describe psychiatric conditions severe enough to warrant public intervention through state block grants or other forms of public support. This term was expected to serve the same purpose as the term Serious Mental Illness (SMI) for adults. What is most important to remember about SED is that it is the key to access important mental health services in Arkansas. When discussing the term SED to the family, the best way to describe it is in terms of how the youth is functioning in all the youths life domains (home, school and community). It is critical to explain that the term SED is not tied to a specific diagnosis, but that the symptoms of his or her diagnosis substantially interfere with or limit their child from achieving or maintaining one or more developmentally appropriate social, behavioral, cognitive, communicative or adaptive skills. Furthermore, children will often show symptoms of more than one disorder and may possibly be given more than one diagnosis. It is also important to understand that many of these disorders create other symptoms that do not warrant an entirely separate diagnosis. For instance, a child who has ADHD may get sad often because of the challenges he/she faces in consistently making friends at school; however, an additional diagnosis of depression may not be completely suitable. The sadness or depression would have to impact the childs life in a way that would impair the childs functioning at home and in the school before another diagnosis would be considered. It is important to keep in mind that the family must provide the health-care professional with all the information they can. He or she will let the family know whether or not these additional symptoms would call for a separate diagnosis. In the case where a child is given two or more diagnoses, it is referred to as comorbidity. If the diagnoses involve a substance use or abuse disorder and a mental health disorder, it is referred to as co-occurring. If the diagnoses involve a developmental disability and a mental health disorder, it is referred to as dual diagnosis. Many older adolescents have multiple disorders at the same time, creating the need for a team of providers that understand how to treat all the conditions the child and family are facing.

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Although getting to an accurate diagnosis (or diagnoses) is critical for developing the most appropriate treatment, it is essential that the family and the health-care professional do not use the diagnosis as a label for the child and realize that his or her mental health condition is not their sole identity. To learn more about how to reduce stigma for children and their families, please visit the following websites: http://www.ffcmh.org/, http://www.nami.org/, http://www.stopstigma.samhsa.gov/, and http://www.whatadifference.samhsa.gov/ Furthermore, Arkansas offers a variety of support resources and many national resources are available as set out below: American Academy of Child & Adolescent Psychiatry 3615 Wisconsin Avenue, NW Washington, D.C. 20016-3007 202-966-7300 http://www.aacap.org Arkansas211.org Services that Arkansans will be able to access through 2-1-1 include: Food pantries, Meals on Wheels, clothing closets, shelters, rent and utility assistance. Health insurance programs, medical-information lines, Medicaid and Medicare, ARKids First. Maternal health, counseling and support-group services, drug-and-alcohol intervention and rehabilitation. Child care, after-school programs, Head Start, family-resource centers, mentoring and tutoring, recreational programs and protective services. Adult day care, respite care, home health care and transportation. Job training, transportation and education programs. Volunteer opportunities and donations. CHADD National Office 8181 Professional Place - Suite 150 Landover, MD 20785 Tel: 301-306-7070 / Fax: 301-306-7090 www.chadd.org National Resource Center on AD/HD 800-233-4050 Arkansas Federation of Families for Childrens Mental Health PO Box 56667 Little Rock, AR. 72215 501-374-7218 Email: pammarshall7218@sbcglobal.net National Federation: www.ffcmh.org

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Division of Behavioral Health Services 305 South Palm Street Little Rock, Arkansas 72205 Telephone: (501) 686-9175 http://www.arkansas.gov/dhhs/dmhs/ CAASP COORDINATORS Regional CASSP Coordinators: If you know a child or adolescent who might benefit from multi-agency, wrap-around services, call the Regional CASSP Coordinator who serves your county. Community Counseling Services, Inc. (Clark, Garland, Hot Spring, Montgomery, Pike) Catheryn Luna (501) 624-7111 PO Box 6399, Hot Springs, AR 71902 Catherynl@hsccs.org Counseling Associates, Inc. (Pope, Yell, Johnson, Faulkner, Conway, Perry) Lee Roberson Koone (501) 354-1561 #8 Hospital Drive, Morrilton, AR 72110 lee@caiinc.org Counseling Clinic, Inc. (Saline) Mike King (501) 315-4224 307 E. Sevier, Benton, AR 72015 mking@cc-inc.org Counseling Services of Eastern AR (Cross, Crittenden, Lee, Monroe, Phillips, St. Francis) Lynn Fernon (870) 630-3805 4451 N. Washington, Forrest City, AR 72335 dfermpm@mshs.org Delta Counseling Associates, Inc. (Ashley, Bradley, Chicot, Desha, Drew) Stacey Davis (870) 367-2461 PO Box 820, Monticello, AR 71657-0820 s.davis@deltacounseling.org LR Community Mental Health Center (Little Rock and South Pulaski) [Centers for Youth and Families Cookie Higgins (501) 666-8686 (extension 3503) PO Box 251970, Little Rock, AR 72225-1970 chiggins@ cfyf.org Mid-South Health System, Inc. (Clay, Craighead, Greene, Lawrence, Mississippi, Poinsett, Randolph) Derek Spiegel (870) 972-4029 2707 Browns Lane, Jonesboro, AR 72401 dspiegel@mshs.org Professional Counseling Associates (Lonoke, Prairie, North Pulaski-including North Little Rock) Erica Jenkins (501) 221-1843 650 S. Shackelford Rd, Suite 217, Little Rock, AR 72221 erica.jenkins@pca-ar.org Health Resources of Arkansas (Cleburne, Fulton, Independence, Izard, Jackson, Sharp, Stone, Van Buren, White, Woodruff) Staci Ringwald (870) 793-8925 PO Box 2578, Batesville, AR 72503 sringwald@hra-health.org

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Ozark Counseling Services, Inc. (Baxter, Boone, Marion, Newton, Searcy) Dianne Martaus (870) 425-5395 PO Box 812, Yellville, AR 72687 ocs@yellville.net Ozark Guidance Center, Inc. (Benton, Carroll, Madison, Washington) Vicky Strange (479) 750-1903 614 E. Emma, Suite 203, Springdale, AR 72764 rcstrange@aol.com South AR Regional Health Center (Calhoun, Columbia, Dallas, Nevada, Ouachita, Union) Al Lachut (870) 862-7921 715 N. College, El Dorado, AR 71730 alachut@sarhc.org Southeast AR Behavioral Healthcare Systems, Inc. (Arkansas, Cleveland, Grant, Jefferson, Lincoln) Sharon Cagle (870) 673-1633 121 Commercial Dr. B, Stuttgart, AR 72160 sharon@sabhs.com Bessie Lancelin P.O. Box 1019 Pine Bluff, AR 71613 (870) 534-1834 Becky@sabhs.org Southwest AR Counseling and Mental Health Center, Inc. (Hempstead, Howard, Miller, Lafayette, Little River, Sevier) Danny Stanley (870) 773-4655 2904 Arkansas Blvd., Texarkana, AR 71854 dstanley@swacmhc.com Western AR Counseling and Guidance Center (Crawford, Franklin, Polk, Logan, Sebastian, Scott) Becky Young (479) 452-6650 PO Box 11818, Fort Smith, AR 72913 becky_young@wacgc.org Mental Health America in Northwest Arkansas P.O. Box 4714 Fayetteville, AR 72702 Phone: 479-571-3024 Email: marymartin7@gmail.com NAMI Arkansas 1012 Autumn Road, Suite 1 Little Rock, AR 72211 nami-ar@nami.org National NAMI: www.nami.org UNDERSTANDING METHODS OF TREATMENT FOR CHILDRENS MENTAL HEALTH, INCLUDING TYPES OF THERAPY AND MEDICATION After all the assessments, evaluations and diagnosis (or diagnoses), a master treatment plan is developed. This treatment plan outlines goals and objectives that the youth, family and mental health provider will work toward in order to reach the desired outcome. The treatment decided upon by the youth, family and mental health provider should reflect the symptoms that were

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presented, the diagnosis, and what the youth, family and provider think would work best for everyone involved. Many times the family does not know what interventions are available and how effective they are with certain diagnoses. Furthermore, it is critical for the parent to state what has worked and what has not worked in the past with their child. The more the parent realizes they are the expert in terms of their childs likes, dislikes, mood swings and triggers, the better the treatment planning process will go. Without this critical stance from the parent or guardian, the family may become too dependent on the mental health provider in determining the best possible intervention(s) and the parent or guardian may become disengaged in their childs mental health treatment, reducing the chance for the best possible outcome. The most effective treatment plans include having everyone agree on how best to motivate, monitor and model desired change and help the youth avoid the triggers and behaviors that might lead back to the problem behaviors. Choosing the Right Intervention Treatment interventions can be broken down into two broad categories: Practice-Based Evidence and Evidence-Based Practice. Practice-Based Evidence Practice-Based Evidence is a term to describe a broad range of treatment interventions that families and providers believe can help the youth and their family, but generally have not gone through repeated studies by clinical researchers. These interventions are delivered according to the family and communitys cultural values and standards of care. An example of practice-based evidence would be wraparound. Wraparound is a planning process that allows a series of steps to help children and their families become informed and empowered in getting their needs met. The wraparound process also helps make sure children and youth grow up in their homes and communities. The planning process brings people together from different parts of the whole familys life including traditional, natural, and social supports. With the help from a facilitator or coordinator trained in the principles of wraparound, the family is able to develop a cross agency plan with their multiple service providers and supports using a strengths-based approach in every intervention. The reason wraparound is considered practice-based evidence is because the research remains undeveloped in comparison to other child and adolescent interventions, but significant outcomes in the lives of multi-agency youth support wraparounds effectiveness. For more information on wraparound see Chapter 2. Evidence-Based Practice Evidence-Based Practice is a term to describe a broad range of treatment interventions that have undergone a series of standardized clinical research trials and have been shown to be effective with different groups of people who are similar in terms of their diagnoses and often are of the same age, race/ethnicity and gender. A very common example of a research trial involves youth who have the same symptoms or diagnoses and are from similar backgrounds. The youth are divided into two groups, and one group receives the treatment being studied while the other group does not. The outcomes for the two groups are compared to see whether the outcomes for the group receiving treatment are significantly better. The study is then repeated to see if the

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same results occur. An example of an evidence-based intervention would be parent management training. This is an intervention that will revolve around videotaping and/or observing a parent interact with their child. The mental health professional will provide feedback and coaching through a family therapy session or immediate feedback via a bug-in-the-ear system. One specific type of parent management training is called Parent-Child Interaction Therapy. It is considered an evidence-based intervention because when it has been replicated using the same standardized approach, the outcomes have been better for the families who received the intervention than for the families who did not receive the intervention. Resources for Evidence Based Services The Hawaii State Department of Healths Biennial Report, is a widely cited report in the field of childrens mental health and is endorsed by a variety of system of care communities across the nation. Their research involves examining psychosocial, psychopharmacologic (drugs or medications) and case management treatments, interventions and services that research has shown to be most effective in addressing severe behavioral and emotional challenges of children and youth. The State of Hawaii has produced two grids that summarize the report and provide an overview of evidence-based interventions and evidence-based medications that are used to treat mental and emotional health problems in children and adolescents. These charts are available for viewing at the following web address. Evidence Based Services Committee. 2004 Biennial Report. Summary of Effective Interventions for Youth with. Behavioral and Emotional Needs ...hawaii.gov/health/mental-health/camhd/library/pdf/ebs/ebs011.pdf Medications which are commonly prescribed for behavioral health interventions and their applications are set out below. http://en.wikipedia.org/wiki/List_of_psychiatric_medications

A Abilify - antipsychotic used to treat schizophrenia, bipolar disorder, and agitation Adderall - stimulant used to treat Attention Deficit Hyperactivity Disorder Ambien - used as a sleep aid Antabuse - used to treat alcohol addiction Aricept - used to slow the progression of dementia Ativan - an anti -anxiety medication of the benzodiazepine class often used to help with panic attacks or during detoxification from alcohol or other drugs B BuSpar - an anti -anxiety medication C Celexa - an antidepressant of the SSRI class (Selective serotonin reuptake inhibitor) Clozaril - an antipsychotic

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Concerta - used to treat ADD/ADHD Cymbalta - an antidepressant of the SSNRI (Selective Serotonin and Norepinephrine Reuptake Inhibitor) class, similar to Effexor D Depakote - a mood stabilizer used to treat bipolar disorder, sometimes called an antimanic medication

E Effexor - an antidepressant of the SSNRI (or SNRI) class Elavil - a tricyclic antidepressant (TCA), less commonly used these days Eskalith - a type of Lithium, which is a mood stabilizer used to treat bipolar disorder G Gabitril - a mood stabilizer Geodon - an antipsychotic H Haldol - an antipsychotic I Imipramine - a tricyclic antidepressant (TCA) which is sometimes used to treat bulimia, panic disorder, or related disorders Inderal - a beta blocker alternatively known as propranolol used for acute anxiety K Keppra - an anticonvulsant drug which is sometimes used as a mood stabilizer Klonopin - antianxiety medication of the benzodiazepine class L Lamictal - a mood stabilizer of the anticonvulsant class Lexapro - an antidepressant Librium - antianxiety medication of the benzodiazepine class Lithobid - a type of Lithium, which is a mood stabilizer used to treat bipolar disorder Loxitane - an antipsychotic, today rarely used Lunesta - a sleep aid

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Luvox - an antidepressant of the SSRI class, often used to treat Obsessive-compulsive disorder M Mellaril - an antipsychotic, today rarely used N Namenda - used to slow the progression of Alzheimer's Dementia Navane - an antipsychotic, today rarely used Neurontin - an anticonvulsant (anti -seizure medication) which is sometimes used as a mood stabilizer or to treat chronic pain, particularly diabetic neuropathy P Paxil - an SSRI antidepressant, used frequently to treat depression and anxiety disorders Prolixin - an antipsychotic Prozac - an SSRI antidepressant,benzodiazepine class R Remeron - an antidepressant which is often used as a sleep aid Reminyl - used to slow the progression of Alzheimer's Dementia Restoril - a sleep aid of the benzodiazepine class ReVia - alternatively known as Naltrexone Risperdal - an antipsychotic Ritalin - a stimulant used to treat ADHD/ADD S Serax - anti -anxiety medication of the benzodiazepine class, often used to help during detoxification from alcohol or other drugs of abuse Seroquel - an antipsychotic, sometimes is used as a sleep aid Serzone Stelazine - an older antipsychotic, today rarely used Strattera - a non -stimulant medication used to treat ADD/ADHD T Topamax - a mood stabilizer, also used for migraine headaches Thorazine - an older antipsychotic, today rarely used because of the high occurrence of serious side effects Trazodone - a tricyclic antidepressant (TCA), most typically used now as a sleep aid Trileptal - a mood stabilizer used to treat bipolar disorder

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Trazodone- a tetracyclic antidepressant not a tricyclic antidepressant V Valium - anti-anxiety medication of the benzodiazepine class Vistaril - an antihistamine for the treatment of itches and irritations, an antiemetic, as a weak analgesic, an opioid potentiator, and as an anxiolytic.

W Wellbutrin - an antidepressant of the NDRI class Norepinephrine and Dopamine Reuptake Inhibitor, structurally identical to Zyban, a stop -smoking aid X Xanax - an antianxiety medication of the benzodiazepine class

Z Zoloft - an antidepressant of the SSRI class Selective Serotonin Reuptake Inhibitor Zyprexa - an antipsychotic medication used in the treatment of schizophrenia, schizoaffective disorder, bipolar disorder, and various types of dementia Retrieved from "http://en.wikipedia.org/wiki/List_of_psychotropic_medications"

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Chapter 2: System of Care Expertise INTRODUCTION State level agencies play a major role in the development of policies and decision making for families and children in the state of Arkansas. Working with families in a supportive role requires knowledge about what is available and how to assist families to access needed services. In this chapter, we will explore the source of authority to govern our System of Care, what is available through the various State agencies, the role of local agencies, and the wraparound approach to care and where to look for resources. SYSTEM OF CARE AUTHORITY AND STRUCTURE Act 1593 was signed into law on April 11, 2007. The Act to Ensure Better Utilization & Coordination of the States Behavioral Health Care Resources Devoted to Serving Children, Youth & Their Families directed the Arkansas Department of Human Services (DHS), under the advisement of a newly created Childrens Behavioral Health Commission, to: (1) Ensure that children, youth and their families are full partners in all aspects of the system of care; (2) Revise Medicaid rules and regulations to increase quality, accountability and appropriateness of Medicaid reimbursed behavioral health care services; (3) Define a standardized screening and assessment process designed to provide early identification of conditions that require behavioral health care services; and, (4) Develop an outcomes-based data system to support an improved system of tracking, accountability and decision-making. The Arkansas Childrens Behavioral Health Care Commission, formed in 2007, and is charged by statute with making short-and-long term recommendations to DHS and the legislature to develop a System of Care for childrens behavioral health in Arkansas. The System of Care approach: Is family driven and child-centered; Supports and purchases evidenced-based practices; Provides customized, community-based services when possible; Offers the least restrictive care; Utilizes a team approach to treatment decisions across local providers, stakeholders, and experts to address service needs; and Promotes evidence-based standards that guide services and public expenditures. Representatives of families/youth, community partners, service providers, and state agency leaders were invited to serve on the Arkansas Childrens Behavioral Health Care Commission. All Commission meeting are open to the public. Meeting times, dates and locations can be found at www.arsoc.org or by calling the Division of Behavioral Health Services (DBHS) at 501-6821001.

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THE ROLE OF CHILD SERVING AGENCIES IN ARKANSAS A. Arkansas Department of Health and Human Services The DHS is the largest state agency with more than 7,500 employees working in all 75 counties. Every county has at least one local office where citizens can apply for any of the services the department offers. Some counties, depending on their size, have more than one office. DHS employees work in ten 10 major divisions and five support offices to provide services to citizens of the state. DHS provides services to more than 700,000 Arkansans each year. DHS is involved in virtually every facet of life in the state. DHS staff oversees the regulation of nursing home and childcare facilities. DHS is also responsible for finding adoptive families for foster children, protecting abused and neglected children, funding the home-delivery of meals for the elderly and operating the juvenile justice system. DHS oversees services to blind Arkansans and helps develop volunteer programs, which have a profound impact at the community level. The department also protects elderly Arkansans from abuse and neglect and operates human development centers across the state, which serves the developmentally disabled. Furthermore, DHS provides mental health services to nearly 60,000 people each year through its system of community mental health care centers. DHS provides the following services: Children's Services Child Abuse Hotline 1-800-482-5964; TDD 1-800-843-6349 Adoption (501) 682-8462 or 1-888-736-2820. Adoption is available to children in DHHS/DCFS custody who cannot be reunited with their birth/legal parent. A childs safety, health, and wellbeing are paramount in making decisions about adoption. Recruitment, retention, preparation, and assessment of families and placement of children are provided. Services are also provided after a child is placed with an adoptive family and are available after finalization. The adoption program is focused on finding families for older children, children of color, large sibling groups, and/or children with disabilities. ARKids First 888-474-8275 (English) 800-482-8988 (Spanish). ARKids First provides health insurance to children who otherwise might not get medical care. The program offers two coverage options. ARKids A offers low-income children a comprehensive benefits package. ARKids B provides limited coverage for slightly higher income families. ARKids B requires a small co-pay for most services. Behavioral Treatment Services (501) 682-8441. The Behavioral Treatment Unit provides technical and financial assistance to local county offices requiring assistance in locating and/or funding out-of-home placements for children in the custody of DHS who are experiencing emotional and/or behavioral problems. The Division of Children and Family Services (DCFS) provides these placements through contracts with private providers or Medicaid providers. Services purchased are as follows: therapeutic foster care, residential treatment, comprehensive - 27 -

residential treatment, emergency shelter, case management and specialized foster care placements for developmentally delayed children and sexual offender treatment programs. Chafee Foster Care Independence Program (501) 682-8453. This program provides basic lifeskills training and educational assistance to Foster Care youth age 14 through 20. Foster Family Home Program (501) 682-1569. Foster families are an integral (very important) part of the DCFS delivery system. Foster families provide an essential substitute family-life experience to children for whom DCFS has been given responsibility by the court. Foster parents serve as substitute parents or a decision is reached to free the child to form new family ties with relatives or an adoptive family. Relatives may be considered for approval as kinship foster homes for children who are in the custody of the state. Family Resource Centers (501) 682-9049 A Family Resource Center is a community-based organization that determines the needs of families in the community and provides or coordinates services that enable families to be safe and healthy. Family Treatment Program for Incest Offenders (501) 682-9049. Specialized treatment for adult and adolescent incest offenders is a cognitive-behavioral prevention approach. Adult men and women who have molested their children require specialized sex offender specific treatment, not generic mental health services, and this program provides for that treatment. Family Treatment Program for Non-Offending Caretakers of Child Sexual Abuse Victims (501) 682-9049. Treatment for Non-Offending Caretakers of Child Sexual Abuse Victims is a group therapy service. Skilled professionals focus on group sessions dealing with guilt, betrayal and loss, victimization, expressing emotions, education about the system, skill building, and empowering caretakers/parents to make better choices while sustaining the family unit to stay together. Human Services Worker in the Schools Initiative (501) 682-9049. The School-based Human Services Worker Initiative is a collaborative effort between DCFS and local school districts. The Initiative is designed to help children and families by promoting the well- being of families. This program supports the communitys capacity to produce children who are healthy. Parenting Education (501) 682-9049. This program provides a mixture of didactic, discussion, and experimental methods to teach participants anger control, behavior management, child development, and self-esteem, all of which are essential for effective parenting. Groups run for 6-8 weeks. Respite Care Services (501) 682-9049. Respite Care Services provide continuous out-of-home care for children in special situations. Services are intended to sustain the foster family, adoptive family, or biological family and to maintain the childs placement in the home by providing time-limited and temporary relief to the family from the ongoing responsibility of daily care.

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Family Services General Medicaid Eligibility Categories (Information about any of the services listed below is available in Spanish by calling 800-482-8988) /ARKids First/ 888-474-8275 (English) 800-482-8988 (Spanish). ARKids First provides health insurance to children who otherwise might not get medical care. The program offers two coverage options. ARKids A offers low-income children a comprehensive benefits package. ARKids B provides limited coverage for slightly higher income families. ARKids B requires a small co-pay for most services. Commodity Distribution Program 1-800-467-3663. This program processes and distributes raw commodities donated by the U.S. Department of Agriculture to schools and other eligible recipient agencies in Arkansas that participate in the National School Lunch Program and Summer Food Service Program. Community Services Block Grant Program/ 1-501-682-8719. The Community Services Block Grant Program provides funds to support services and activities that are designed to assist lowincome families to become self-sufficient. Services are administered through the 16 Community Action Agencies across the state. Disaster Services 1-800-482-8988. This program provides financial assistance to families affected by state and federally declared disasters that meet income and other criteria. Emergency Food Assistance Program 1-800-467-3663. This program distributes commodities to food banks, soup kitchens, shelters and other nonprofit agencies. Donated foods are also made available for Disaster Assistance. Emergency Shelter Grants Program 1-501-682-8723. The Emergency Shelter Grants Program assists local communities in helping to improve the quality of life for the homeless by providing grants for minor renovations (home improvements), rehabilitation or conversion of buildings for the homeless, funds for payments of certain operating and maintenance expenses, funds for social services expenses, and homeless prevention efforts. Food Stamp Program 1-800-482-8988 The Food Stamp Program provides food assistance to eligible households to cover a portion of an eligible households food budget. Benefits are distributed through Electronic Benefits Transfer (EBT). In addition to food assistance, the program provides food stamp recipients with nutrition education, employment & training, and work experience. Low-Income Home Energy Assistance Program 1-501-682-8726. The Low-Income Home Energy Assistance Program provides financial assistance to approximately 60,000 households each year to help them meet the costs of home energy. It also offers weatherization services (items to help heat or cool homes and make them more energy efficient) and case management activities designed to encourage households to reduce their energy costs and need for financial assistance. Medicaid 1-800-482-8988 for information on eligibility and enrollment. Call 1-800-482-5431 for information on services covered by Medicaid. Medicaid reimburses health care providers for covered medical services provided to eligible needy individuals in certain categories. Eligibility - 29 -

is determined based on income, resources, Arkansas residency, and other requirements. Covered services also vary among categories. Categories are summarized below under two headings, Aged, Blind & Disabled Categories and Children & Family Categories. Medicaid Aged, Blind and Disabled Categories: Individuals aged 65 and older who meet income; resource and other requirements are eligible for full Medicaid coverage. Individuals who are determined blind or disabled individuals based on Social Security Administration criteria who meet income, resource and other requirements are eligible for full Medicaid coverage. Medicare Savings Program provides limited coverage to supplement Medicare recipients. Coverage varies based on income, ranging from payment of the Medicare premiums, deductibles and co-insurance for low-income individuals to paying only a portion of the Medicare Part B premium for individuals with higher incomes. Long Term Care - Individuals who are residents of nursing homes may qualify for Medicaid if the care in the facility is medically necessary and they meet income, resource and other criteria. ElderChoices covers individuals age 65 and older who would be eligible if they were in a nursing facility, but choose to remain at home. Alternatives for Adults with Physical Disabilities covers individuals who are physically disabled and between the ages of 21 and 65 who would be eligible for Medicaid if they were in a nursing facility, but choose to remain at home. DDS Alternative Community Services covers individuals of any age who are determined to be developmentally disabled, who would be eligible for Medicaid if they were in a nursing facility, but choose to remain at home. Working Disabled provides full coverage to disabled individuals who are working. Individuals with lower income pay the normal Medicaid co-pays. Individuals with higher income pay higher co-pays. Medicaid Children & Family Categories: Needy children under age 19 who meet income, resource and other requirements are eligible for full Medicaid coverage under the ARKids program. A parent or other caretaker relative of children under age 18 with an absent, disabled or unemployed parent who meet income, resource and other requirements is eligible for full Medicaid coverage. Needy pregnant women who meet income, resource and other requirements are eligible for full Medicaid coverage. Pregnant women with income up to 200% of Federal Poverty Level may be eligible for limited coverage if they meet certain income, resource and other criteria, including prenatal, delivery, postpartum and conditions which may complicate the pregnancy. Coverage

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continues through the pregnancy and until the end of the month that the 60th day postpartum falls. Family Planning provides limited coverage that includes family planning services only to women of childbearing age and who also meet income, resources and other criteria. Refugee Resettlement Program 1-800-482-8988. This program assists newly arrived eligible refugees in assimilating (adjusting to the differences) to the American way of life. The program offers financial and medical services to eligible refugees for up to five years. Transitional Employment Assistance (TEA) 1-800-482-8988. TEA is a time-limited assistance program to help needy families with children become more responsible for their own support and less dependent on public assistance. In addition to monthly cash assistance, employment-related services are provided to parents, including job-readiness activities, transportation assistance, childcare assistance, and other supportive services so that the parent can engage in work or education and training activities. Weatherization Assistance Program 1-501-682-8722. This program installs energy conservation materials and appliances in the homes of 1300 low-income families annually to lower the utility bills. Materials generally installed include insulation, duct sealing, weather-stripping and caulking doors and windows, replacement of broken windows, and health and safety measures that are required prior to weatherization. Family Services for Persons with Developmental Disabilities Alternative Community Services (Home and Community Based) (501) 730-9987 Alternative Community Services Waiver is a Medicaid funded program that offers an array of services to persons with developmental disabilities in their homes and communities. Adults and children with various health and social needs may be eligible for a variety of support services, modifications to the home, or specialized medical supplies. Childrens Medical Services (CMS) (501) 682-2277. This program serves children with chronic illness, handicapping conditions, or special health care needs. An application for assistance can be made at any DHS County Office or at Arkansas Childrens Hospital. CMS determines financial and medical eligibility. CMS nurses, social workers, and medical secretaries housed in 22 community-based offices provide resource and referral information. They also offer case management and assistance in paying for limited eligible services. Developmental Day Treatment Clinic Services/ (870) 268-2241. Developmental Day Treatment Clinic Services (DDTCS) provide Medicaid-funded, clinic-based services to approximately 7,500 adults and children with developmental disabilities. The core services include Early Intervention and/or preschool services for children birth to five years of age. Core services also include adult development for persons age 21 and above (or age 18 if person has a high school diploma).

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Early Childhood Program 1-800-643-8258. The Early Childhood Program assists in provision and coordination of services to over 2,500 children ages three to six years with a diagnosis of developmental disability or developmental delay. The program also offers center-based rehabilitative services to children ages three to five years. Services are provided as a result of a multi-disciplinary team (a group from different agencies and with different skills) decision in accordance with a program plan. First Connections Infant and Toddler Program 1-800-643-8258. The First Connections Program oversees provision and coordination of services to over 3,000 infants and toddlers with a developmental disability or a developmental delay and to their families annually. Service Specialists assist families in accessing local services and in funding services that are not otherwise available. Eligible infants and toddlers age birth to 36 months and their families may access an array of sixteen services. Services are provided as a result of a multi-disciplinary team decision and service plan. Integrated Supports (501) 682-7845. Integrated Supports offer a variety of services to children and adults, based on individual needs, and are provided by local Division of Developmental Disabilities (DDS) community providers. These are services that enable people to remain in their communities and reduce the need for institutionalization. Licensure of Community Program Providers (501) 682-8697. Community Providers who serve people with developmental disabilities are licensed or certified by the Division of Developmental Disabilities (DDS) Licensure Unit. Programs are reviewed periodically to determine compliance with minimum standards. Service concerns are investigated by this unit as needed. Services Coordination for Persons with Developmental Disability/Delay (501) 682-8678. Local DHS staff provides assistance to approximately 6,000 adults and children with developmental disability or developmental delay and their families. These staff conduct information intake, make eligibility determinations, provide case coordination, make service referrals, secure crisis intervention, assist individuals as they make life-changing transitions, and conduct follow-along with persons regarding further needs. State Operated Residential Services (501)-682-8678. Human Development Centers located in Alexander, Arkadelphia, Booneville, Conway, Jonesboro, and Warren provide services to persons with developmental disabilities and/or mental retardation. Services include residential, habilitation/rehabilitation, medical, social work, occupational, physical, and speech therapies, psychology, and community development and outreach services. Alexander Human Development Center, Alexander, Arkansas 501/ 847-3506 Arkadelphia Human Development Center, Arkadelphia, Arkansas 870/ 246-8011 Booneville Human Development Center, Booneville, Arkansas 479/ 675-2121 Conway Human Development Center, Conway, Arkansas 501/ 329-6851 Jonesboro Human Development Center, Jonesboro, Arkansas 870/ 932-5231 Southeast Arkansas Human Development Center, Warren, Arkansas 870/ 226-6774.

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Contracted Residential Services (501) 682-8678. Individuals with developmental disabilities may receive an array of individualized services in the community at one of thirty smaller private residential facilities. These services include education, therapies, and medical care. Juvenile Offenders Services Alternative Residential Services 501-682-1927. These programs provide services for juveniles whose emotional or behavioral problems are best served through licensed professional services. These programs include sex offender treatment, therapeutic group homes, and psychiatric placement and counseling. Community Based Programs 501-683-2664. Wide arrays of residential and non-residential services are available for at-risk juveniles. Services include aftercare, electronic monitoring, emergency residential services, intensive supervision and tracking, restitution, day services, and prevention services. Compliance Unit 501-682-9643. The Division serves the juveniles of Arkansas who have either come in contact with the judicial system or are in danger of coming in contact with the judicial system. To accomplish this end, the Division of Youth Services (DYS) contracts with a wide variety of service providers to address the divergent needs of these juveniles. The Audit and Compliance Unit monitors each service provider that the Division contracts with for compliance with the contract performance indicators and quality of life issues. Contracted Youth Services Center 501-682-9800. This facility at Alexander serves a population of both male and female juveniles committed to the Division of youth services on felony and misdemeanor offenses. The intake and holding population includes juveniles who are sex offenders, juveniles requiring psychiatric intervention and juveniles with serious behavior problems. They are housed here until appropriate placement is available. Contracted Serious Offender Programs 501-683-2670. These programs serve the most serious juvenile offenders and provide such services as education, social skills development, structured work projects, and life skills development. These programs for male offenders are located at Colt, Harrisburg, Mansfield, Lewisville and Dermott. A program for female offenders is located at Mansfield. Diagnosis and Evaluation 501-682-1966. Juvenile courts in Arkansas adjudicate juveniles to the DHS Division of Youth Services. The diagnosis and evaluation process for each juvenile coming into the system includes a comprehensive evaluation of medical, psychological, social history, needs assessment, and education. This process determines the most appropriate placement for each juvenile. Juvenile Delinquency Prevention Programs 501-682-1708. These federally funded programs provide support for local delinquency prevention initiatives with a focus upon targeted populations identified by the U.S. Justice Department.

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B. Arkansas Department of Education The purpose of the Arkansas Department of Education is to provide the highest quality leadership, service, and support to school districts and schools in order that they may provide equitable, quality education for all students in Arkansas public schools. There are numerous programs provided for children and youth with behavioral health needs, but access to services varies from school to school in many cases. Empowered and educated parents/caregivers are the key to obtaining appropriate services for children and youth. Listed below are resources for parents available from the Department of Education: Center for Effective Parenting/Arkansas State PIRC, www.parenting-ed.org The Parent Institute, www.parent-institute.com AR Division of Child Care, www.state.ar.us/childcare ADE Special Education, http://arksped.k12.ar.us/ SEDL Southwest Educational Development Laboratory. www.sedl.org PTA National Parent Teacher Association, www.pta.org PTI/ADC Parent Training and Information/AR Disability Coalition, www.adcpti.org Education Fast Facts School Districts School Year Students Students Eligible for Free and Reduced Lunches Student Attendance Graduation Rate Per Student Foundation Funding Teachers Teachers Completely Certified Teachers with Master's Degrees Teachers - Professional Development Hours Required Teachers - Average Salary Schools Number of schools, as of Jan. 20, 2009: Elementary Schools Middle Schools/Junior High Schools High Schools C. Arkansas Department of Health A variety of services for families are provided by the Health units including immunizations for children and youth , health related training opportunities, and prevention training and information related to issues impacting public health such as tobacco cessation (ending tobacco use); healthy eating; and drug and alcohol abuse prevention. Two other programs are of note: - 34 579 214 299

245 178 days 465,000 54% 94.3% 76% $5,789 34,000 99% 34% 60 $45,000

Arkansas' Special Supplemental Nutrition Program for Women, Infants and Children (WIC) The purpose of the Arkansas WIC Program is to improve the nutrition of eligible pregnant, breastfeeding and postpartum women, infants and young children during periods of critical growth. The Program provides food instruments for specific foods that participants redeem at local grocery stores, nutrition education, and referral to other services. Applications and other information about WIC can be obtained from any local county health unit between the hours of 8:00 a.m. and 4:30 p.m. Monday through Friday or by contacting the State WIC Office at 501661-2473 or 1-800-235-0002. The State WIC Office can also be reached via fax at 501-661-2004 or 501-661-2271 or by e-mail to wic.program@arkansas.gov. Arkansas Hometown Health Improvement Through a strategic planning initiative, the Arkansas Department of Health determined that in order to solve todays health problems, cooperative action and creative solutions at the local level would be required. The health of the community is a shared responsibility of many entities. Hometown Health Improvement brings together a wide range of people and organizations including consumers, business leaders, health care providers, elected officials, religious leaders, and educators to identify community health problems and develop and implement ways to solve them. Hometown Health Improvement is a locally owned and locally controlled initiative that stresses: collaboration, coalition building, community health assessment, prioritization of health issues, and the development and implementation of community health strategies that are locally designed and sustained. D. State Level Support Organizations While not state agencies, there are two other organizations at the State level available to provide information and certain types of support to families. The Arkansas Disability Rights Center provides advocacy, including legal services when necessary, for families of children with disabilities who are encountering barriers to appropriate services. Arkansas Disability Rights Center 1100 N. University, Suite 201 Little Rock, AR 72292 501-296-1775 v/tty Fax 501-296-1779 Toll free (800) 482-1174 v/tty www.arkdisabilityrights.org

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Arkansas Advocates for Children and Families' mission is to ensure that all children and their families have the resources and opportunities they need to lead healthy and productive lives and to realize their full potential. The organization focuses on many areas impacting children and provide reasoned and researched policy briefs, KidsCount data and legislative updates. Arkansas Advocates for Children and Families Union Station, Suite 306 1400 West Markham Little Rock, AR 72201 Phone 501.371.9678 - Fax 501.371.9681 http://www.aradvocates.org/ THE ROLE OF LOCAL AGENCIES SERVING CHILDREN Child serving agencies on the local level play a large part in the system of care philosophy. While the state level agencies play a large part in policy development and decision making that impacts youth and their families, the local level is where the policies and discussions are put into action and services are delivered. The local agencies and representatives are with whom the youth and families interact personally, with whom the families forge or develop relationships and work with in the trenches to affect change for their children and youth. Some examples of these agencies include: local DCFS offices, Juvenile Justice, Division of Disability Services, child support enforcement, community-based youth programs, schools, local chapters of the Federation of Families for Childrens Mental Health, National Alliance on Mental Illness, Hometown Health Coalitions, Disability Rights groups, mentoring programs, youth programs through local universities, Big Brothers/Big Sisters, YMCA, faith-based organizations, and many other community-based programs. These agencies are also responsible to communicate with their state-level counterparts regarding unaddressed needs, gaps in service, and barriers to provision of access to care. The need for interagency collaboration is paramount and proven. The following information resulted from a research study published in a monograph about interagency collaboration. Hodges, S, Nesman, T and Hernandez, M. (1999). Promising practices: Building collaboration in systems of care. Systems of Care: Promising Practices in Childrens Mental Health, 1998 Series, Volume VI. Washington, D.C.: Center for Effective Collaboration and Practice, American Institutes For Research. Nine sites who participated in this study worked to actively build collaborative processes into their service delivery systems. Even though there were differences in the mandate, funding and structure among child-serving agencies, these sites found the benefits of collaboration far outweigh the investment it requires in time and energy. They found that collaboration helps bridge the complexities of their work, and allowed them to be more responsive and effective. As one respondent commented, "Partnerships arent a luxury, theyre essential because the problems are too big and too complex." They found that when child-serving agencies focus on the needs of children and families that the agencies share more similarities than differences. As another respondent - 36 -

observed, "the bottom lineis that there is no distinction; the needs of children and families [in different agencies] are not significantly different." They also found that collaboration produces results. Not only are relationships improved among child-serving agencies, but the services they offer are more individualized, less restrictive and anchored in their community. Another respondent, commenting on a documented 48 percent reduction in out-of-home placements that is attributed to their collaborative efforts, made the observation, "Collaboration works for kids and families. And it is cost effective." Although the sites in this study spoke of their efforts to build interagency collaboration, many referenced "true collaboration" as their real mission. True collaboration is distinguished from collaboration based on rules and mandates that exists in name only. The sites described true collaboration as embodying: role clarity for families and service providers; interdependence (working together) and shared responsibility among collaborating partners; striving for vision-driven solutions; and a focus on the whole child in the context of the childs family and community. As you will see in the material describing the phases and activities of wraparound, true collaboration consistent with the principals of wraparound is the goal of your work. When a collaborative is not in place in your area, some suggested steps include: 1. Involve the agencies who are providing services to the youth/family in a meeting. It is helpful to communicate the purpose of the meeting, which should include identifying strengths of youth/family, identifying common goals for the youth/family, and developing a working relationship among all of the agencies and the youth and family. Some agencies may be Juvenile Justice, DCFS, DDS, education, mental health, or community based agencies (YMCA, Parks and Recreation). 2. Look at the resources available from each agency represented, along with the familys natural resources (relatives, church family, neighbors, and support groups). Discuss ways to braid resources to benefit the youth and family. Look at how braiding or blending resources may save money overall. 3. Encourage the team to evolve as the strengths/needs of the family and youth change. Look to include new people or agencies as new interests emerge, or as a way to meet needs of the family and/or youth. An example might be inviting a local bike shop owner to be part of a team for a youth whose strength or interest is repairing or building bikes. 4. Make sure that those who are involved in the team have a purpose or role on the team. Each person should leave a meeting with a specific task to help this youth and family succeed.

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Developing Wraparound teams to help youth and families typically begin this way. Currently Arkansas has the Child and Adolescent Services System Program (CASSP), a system which develops teams to provide multi-agency plans of service (MAPS) for a child or youth and their family who have needs that cannot be met through existing services of those agencies involved with the child or youth. As the CASSP system in Arkansas and the Systems of Care efforts are further developed, families in Arkansas should have access to persons trained in providing Wraparound services through the Community Mental Health Centers across the state. This contact information is provided in Chapter One of this manual. THE WRAPAROUND APPROACH TO CARE Wraparound is a planning process that allows a series of steps to help children and their families become informed and empowered in getting their needs met. The wraparound process also helps make sure children and youth grow up in their homes and communities. The planning process brings people together from different parts of the whole familys life including traditional supports and, most importantly, from natural and social supports. With the help from a facilitator or coordinator trained in the principles of wraparound, the family is able to develop a cross agency plan with their multiple service providers and supports using a strength-based approach in every intervention. The 10 Principles of Wraparound (from National Wraparound Initiatives The Wraparound Process Users Guide) 1.Family voice and choice. Family and youth/child perspectives are intentionally elicited and prioritized during all phases of the wraparound process. Planning is grounded in family members perspectives, and the team strives to provide options and choices such that the plan reflects family values and preferences. 2.Team based. The wraparound team consists of individuals agreed upon by the family and committed to them through informal, formal, and community support and service relationships. 3.Natural supports. The team actively seeks out and encourages the full participation of team members drawn from family members networks of interpersonal and community relationships. The wraparound plan reflects activities and interventions that draw on sources of natural support. 4.Collaboration. Team members work cooperatively and share responsibility for developing, implementing, monitoring, and evaluating a single wraparound plan. The plan reflects a blending of team members perspectives, mandates, and resources. The plan guides and coordinates each team members work towards meeting the teams goals. 5.Community-based. The wraparound team implements service and support strategies that take place in the most inclusive, most responsive, most accessible, and least restrictive settings possible; and that safely promote child and family integration into home and community life.

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6.Culturally competent. The wraparound process demonstrates respect for and builds on the values, preferences, beliefs, culture, and identity of the child/youth and family, and their community. 7.Individualized. To achieve the goals laid out in the wraparound plan, the team develops and implements a customized set of strategies, supports, and services. 8.Strengths based. The wraparound process and the wraparound plan identify, build on, and enhance the capabilities, knowledge, skills, and assets of the child and family, their community, and other team members. 9.Persistence. Despite challenges, the team persists in working toward the goals included in the wraparound plan until the team reaches agreement that a formal wraparound process is no longer required. 10. Outcome based. The team ties the goals and strategies of the wraparound plan to observable or measurable indicators of success, monitors progress in terms of these indicators, and revises the plan accordingly. The role of the family support partner on a wraparound team in connection with these 10 principles was described by Penn, M., & Osher, T. W. (2007). The Application of the Ten Principles of the Wraparound Process to the Role of Family Partners on Wraparound Teams. Portland, OR: National Wraparound Initiative, Portland State University. The Family Partner implements each principle as follows: Family voice and choice Coaching, educating, supporting and encouraging family members to use their own voice to express their views clearly and to make informed choices are the very essence of the role of the Family Partner. The Family Partner actively ensures that the familys own voice drives the wraparound process and their wraparound plan. The Family Partner helps to create a safe environment in which families may express their needs and views or vent frustration. The Family Partner can help the family discover and learn ways to describe negative experiences and express their fears and anxieties to the team in ways that promote communication. The Family Partner makes a special effort to ensure the familys point of viewnot the Family Partnersis heard by the team. The Family Partner is sensitive to the fact that perspectives of individual family members may differ and that conflicts may need to be addressed by all parties to achieve the consensus necessary for the team process to move forward. The Family Partner has a responsibility to educate the other team members on the significance of family voice and choice and how their own practice and behavior can create an environment where families feel safe using their voice and expressing their choices. When a family member feels unable or unwilling to talk about an issue, they may ask that the Family Partner (or someone else) be their spokesperson. In such cases the Family Partner encourages the family member to find a way to express themselves before accepting responsibility of being a temporarily designated spokesperson. When doing this, the Family Partner invests as much time as is necessary to

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develop a complete understanding of the familys perspective. When family members specifically ask the Family Partner to speak on their behalf, the Family Partner always makes sure the family member is present and confirms what is communicated. Team based The Family Partner coaches the family through an ongoing process of discovery and inquiry about possible team members to make sure they are connecting with individuals or agencies who can meet their needs. As a result, the family is prepared to make informed choices about team membership and understand why some team members are mandated by systems working with the family. The Family Partner helps the family understand how to influence the building of their team. Family Partners use their knowledge of the schools, communities, services, and neighborhoods to help the family identify friends, neighbors, relatives, providers, and others from their culture and community who could serve on their team. The Family Partner coaches the family through the process of deciding who they want to have on their wraparound team. The Family Partner helps the family understand why some team members are assigned by agencies without consulting them. The Family Partner helps the family recognize what each of these individuals could contribute as well as the advantages and possible challenges that might arise from their participation on the team. Natural supports The Family Partner helps families understand how natural supports can contribute to the overall success of their wraparound plan and help the family identify natural supports they want to bring onto their team and incorporate into their wraparound plan. The Family Partner encourages the family to bring their natural supports to the wraparound process. However, they must also respect the familys choice to withhold information about natural supports if they so wish. The Family Partner helps the family to develop and discover natural supports already present in their lives, as well as opportunities to develop new supportive relationships in their community. The Family Partner describes the wealth of resources they have identified in the community (for example, sports teams, scouts, and religious groups) and helps the family see the possible benefits of involving some of these resources on the wraparound team and the negatives of not involving them. The Family Partner supports family members as a peer throughout the wraparound team process. The Family Partner gives them opportunities to become part of the larger circle of families where they can find support from other parents and caregivers with similar experiences who have faced similar challenges and overcome them. Family Partners connect families to local family groups and organizations where, through participation in support groups, classes or other events, they have the opportunity to develop relationships with individuals who can serve as natural supports on a team or independently. Once the family has developed its own network of informal peer support they may feel they have the confidence to participate in the wraparound team without the support of a Family Partner, however, at the familys request, the Family Partner could rejoin their team at any time.

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Collaboration It is the Family Partners role to model, coach and encourage the process of collaboration. Doing so will help families become empowered in the present and over time to work successfully with diverse individuals and providers as it relates to the needs of their child. In addition, the Family Partner is a collaborative advocate, helping the family to understand the mandates and perspective of other members of the team. The Family Partner helps to make sure the individual familys perspective is at the forefront of all team discussions by strategizing with the family members about how they can deliver their own messages clearly and with the desired impact. Seasoned Family Partners report that this is the principle that tests their skills most. There are two parts to this challenge. First, it requires keeping their own views in check, respecting the familys culture, aligning themselves with the family, and using their own voice to support the familys choices. Second, the Family Partner must also remain engaged in strategic and mutually respectful partnerships with the wraparound facilitator and other team members. The Family Partner helps ensure that Family Voice and Choice is driving the wraparound team and plan as all team members work collaboratively. Community based It is the Family Partners role to explain why the wraparound process focuses on communitybased living and services for children and youth. The Family Partner helps the family understand the philosophy behind this principle and consider how it could be applied to their own situation. Regardless of their own views, the Family Partner strives to understand the reasons behind the familys placement preferences and helps the rest of the team understand what the family thinks is best for their child. The Family Partner informs the family about supports, services, and placements available in their community and helps them frame questions they might want to ask specific providers or agencies. The Family Partner helps families and their teams implement practical strategies for getting access to whatever it will take to successfully transition home or stay in the community. The Family Partner encourages thinking beyond the customary services and supports. The Family Partner helps the family clearly express the why behind their choices (including critical needs still to be addressed) to the rest of the team. The Family Partner also helps the family understand why others on the team might make a different recommendation and works towards blending the best from each team members perspective and expertise into the familys plan. Culturally competent The Family Partners recognize and value differences among families, ethnic and cultural groups, and communities. Delivering culturally competent services begins with discovering what is important to the family. Each family has its own unique culture, as do any groups with whom the family identifies. This influences how the family approaches the tasks of daily living (for example, food, dress, work, school, spiritual beliefs and practices). This cultural context can also direct how a family faces the challenges of raising children. Families work in different ways, have different resources at their disposal and achieve differing degrees of success at meeting the needs of all their members. Family Partners draw on their own experience of raising and loving a child with emotional or behavioral issues and being a parent as they work with the family

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and its whole team to discover the familys values, priorities, and preferences. Family Partners can use their own experiences to illustrate cultural intelligence, to guide discussions about cultural needs, and to help the family and their team develop a relationship. The Family Partner makes sure that the culture of the family, as they define it, is respected and the plan is grounded in the familys ethnic and cultural background in wraparound in the manner the family feels it is culturally relevant for them. Implementing this principle can be facilitated by assigning a Family Partner who comes from the same or a similar community as the family engaged in the wraparound team. A communitys wraparound initiative should recruit Family Partners who represent the diversity of families served through the wraparound effort, as well as individuals with varied kinds of parenting experience (such as single parents, gay or lesbian parents, grandparents, or adoptive parents). Individualized The Family Partner helps the family ensure the plan is customized to meet their unique needs and is related to their values, history, and traditions. The family must feel that the plan is theirs and is tailored to their daily schedule, transportation requirements, and other specific conditions. The Family Partner helps the family form a better vision of what it would look like to be doing okay. The family can then identify their needs and goals to make sure the plan addresses the whole family not just a single individual. With coaching from the Family Partner, the family develops the skills and confidence to present these to the team and realize their vision. Family Partners draw on their own experience of negotiating services and supports for their own children to help the team understand how, regardless of system mandates, each child and family have different needs. Family Partners can help the team understand how strategies used to meet one familys needs may need to be different from those effective for other families that have similar goals and needs. Strengths based Family Partners, like all members of the team, should model a strengths based approach in all their interactions with the family. Family Partners spend time with families in their home and community; they can observe how each family copes with simple and complex tasks in their daily life. Family Partners use these observations to help families get in touch with their strengths, their childs strengths, and the positive features of their community. Family Partners help families realize how their strengths (for example their resilience) may help address their needs. By sharing their own familys journey, Family Partners describe the process of discovering strengths, thereby showing other families how they can acquire this strength based skill. A familys view of itself can be compromised by systems that focus on risk factors and diagnosis or pathology. The Family Partner, by sharing their own experience of discovering strengths and assets, helps the family develop new skills and competence and hope for a productive future. The Family Partner helps to coach other team members on always utilizing a strength based approach.

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Persistence The Family Partner helps families find hope and encourages them to persist through difficulties to find solutions that work for them. The Family Partner works creatively with the family and their team to make sure that care does not cease when barriers and challenges are encountered. Using identified strengths, they vigilantly ensure that any undesired or unachieved outcomes are recognized by the team as a deficiency in the plan - and are not seen as the failure of the family or a particular team member. These strengths are used to promptly change the plan when something is not working as anticipated. The Family Partner helps the team discover how the plan should be modified to ensure the family will get everything they need to succeed. Ideally the Family Partner should be committed to remaining with the family as long as (and no longer than) the family needs or desires. The Family Partner supports the family through self-advocacy. Phasing out the Family Partner should be a gradual process as families expand their role. Outcome based The Family Partner ensures that indicators of success are not wholly or totally driven by providers or systems goals for the family, but include the familys expression of what success will look like from their perspective. The Family Partner plays an active role in ensuring that the familys vision of a positive future is the basis for indicators of progress in terms of these indicators, and revises the plan when progress is not being achieved. In addition, a familys success often is defined by the extent to which they have become self-empowered advocates. The Family Partner can play a key role in documenting the degree to which, and the specific ways in which, the family has moved along this path. Where wraparound teams are conducting assessments and collecting evaluation data, the Family Partner understands and is able to share this information with the family so that they can assess practices and progress and modify their plan to improve outcomes. Wraparound practice has been researched extensively and a group of leaders in the implementation of the process released a detailed description of the phases and activities for the system of care field. This process included youth and families who have participated in the process as service recipients, facilitators and trainers. Participants came from a wide range of implementation sites with incredible local variation. Many of the cited authors are contributing to the research base which has established wraparound as practice based evidence. These participants and the research community were able to reach consensus that the stages and phases described below are common to all high quality wraparound work. In addition to the published work cited below a group of family advisors has worked to further clarify the role of the family support worker engaged as a part of the wraparound team. The third draft of this material is currently in circulation for comment by these advisors and we have been granted permission to include this role of the family support worker into our work.

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THE ROLE OF THE FAMILY SUPPORT WORKER IN WRAPAROUND The wraparound process involves a team approach to developing a plan driven by the family and guided by the youth to address both the strengths and needs they bring to the wraparound table. The process has been studied by a broad collaborative of experts with extensive history and experience in the development of systems of care. The work of these family, youth and professional experts has resulted in a consensus document, Walker, J. S., Bruns, E. J., VanDenBerg, J. D., Rast, J., Osher, T. W., Miles, P., Adams, J., & National Wraparound Initiative Advisory Group (2004). Phases and activities of the wraparound process. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Childrens Mental Health, Portland State University., which provides guidance to anyone seeking to develop a system of care using a wraparound process. In addition, the family advisors to this group are in the process of developing a companion document which describes in detail the activities of the family support provider in the activities of wraparound during each of these phases. Penn, M., & Osher, T. W. (2008 working draft 1, permission granted) The FAMILY PARTNER ROLE IN THE PHASES AND ACTIVITIES OF THE WRAPAROUND PROCESS. Portland, OR: National Wraparound Initiative, Portland State University. The Family Partner Role in the initial phase of the wraparound process is included in the work below. The full description of the Family Partner role through the four phases is located in a chart in Appendix 1 to this manual. Phases and Activities of the Wraparound Process PHASE 1: Engagement and team preparation During this phase, the groundwork for trust and shared vision among the family and wraparound team members is established, so people are prepared to come to meetings and collaborate. The tone is set for teamwork and team interactions that are consistent with the wraparound principles, particularly through the initial conversations about strengths, needs, and culture. In addition, this phase provides an opportunity to begin to shift the familys orientation to one in which they understand they are an integral part of the process and their preferences are prioritized. The activities of this phase should be completed relatively quickly (within 1-2 weeks if possible), so that the team can begin meeting and establish ownership of the process as quickly as possible. The family partner role The family partner has a collaborative relationship with the wraparound facilitator. Together they establish mechanisms to keep each other informed, make sure the family partner knows when new families are enrolled, as well as when and where team meetings will occur, and ensure all newly enrolled families have the opportunity to draw support from a family partner if they choose.

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HOW A FAMILY PARTNER SUPPORTS THE PROCESS The family partner helps the family understand wraparound as a positive opportunity to get what they need and to also feel comfortable with getting engaged in the wraparound process. The family partner encourages and models commitment, demonstrates respect for the familys culture, builds trust with the family, and eases their fears. This is an interpersonal process. The family partner gets to know the family by meeting with family members (sometimes with the wraparound facilitator) in locations and at times the family feels comfortable. The family partner explains wraparound from a family perspective, including the role of the family partner, sharing personal experiences as examples when appropriate. Together they explore the extent to which the family feels comfortable advocating for their child and family and how much coaching and support they will want from a family partner. The family partner gives the family helpful written materials such as family organization newsletters and brochures and a copy of The Wraparound Process Users Guide: A Handbook for Families. The family partner reviews the guide with them and answers questions about what a wraparound team is and how it is created and functions. The family partner invites the family to support groups and other organized family activities in the community and encourages them to attend.

ACTIVITIES

NOTES This orientation to wraparound should be brief and clear, and should avoid the use of jargon, so as not to overwhelm family members. At this stage, the focus is on providing enough information so that the family and youth can make an informed choice regarding participation in the wraparound process. For some families, alternatives to wraparound may be very limited and/or nonparticipation in wraparound may bring negative consequences (as when wraparound is court ordered); however, this does not prevent families/youth from making an informed choice to participate based on knowledge of the wraparound process.

1.1a. Orient the family and youth to wraparound. In face-to-face conversations, the facilitator explains the wraparound philosophy and process to family members and describes who will be involved and the nature of family and youth/child participation. Facilitator answers questions and addresses concerns. Facilitator describes alternatives to wraparound and asks family and youth if they choose to participate in wraparound. Facilitator describes types of supports available to family and youth as they participate on teams (e.g., family/youth may want coaching so they can feel more comfortable and/or effective in [partnering with other team members) alternatives and/or the consequences of non-participation.

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GOAL 1.1: To orient the family and youth to the wraparound process. 1.1. Orient the family and youth. ACTIVITY TO REACH GOAL 1.1. 1.1. a. Orient the family and youth to wraparound. In face-to-face conversations, the facilitator explains the wraparound philosophy and process to family members and describes who will be involved and the nature of family and youth/child participation. Facilitator answers questions and addresses concerns. Facilitator describes alternatives to wraparound and asks family and youth if they choose to participate in wraparound. Facilitator describes types of supports available to family and youth as they participate on teams (e.g., family/youth may want coaching so they can feel more comfortable and/or effective in partnering with other team members). This orientation to wraparound should be brief and clear, and should avoid the use of jargon, so as not to overwhelm family members. At this stage, the focus is on providing enough information so that the family and youth can make an informed choice regarding participation in the wraparound process. For some families, alternatives to wraparound may be very limited and/or non-participation in wraparound may bring negative consequences (as when wraparound is court ordered); however, this does not prevent families/youth from making an informed choice to participate based on knowledge of the alternatives and/or the consequences of nonparticipation. ACTIVITY TO REACH GOAL 1.1. 1.1.b. Address ethical and legal considerations. The facilitator reviews all consent and release forms with the family and youth, answers questions, and explains options and their consequences. Facilitator discusses relevant legal and ethical issues (e.g., mandatory reporting), informs family of their rights, and obtains necessary consents and release forms before the first team meeting. GOAL 1.2: To address pressing needs and concerns so that the family and team can give their attention to the wraparound process. 1.2. Stabilize crises. ACTIVITY TO REACH GOAL 1.2. 1.2 a. Ask family and youth about immediate crisis concerns Facilitator elicits or seeks information from the family and youth about immediate safety issues, current crises, or crises that they anticipate might happen in the very near future. These may include crises stemming from a lack of basic needs (e.g., food, shelter, utilities such as heat or electricity). The goal of this activity is to quickly address the most pressing concerns. The whole team engages in proactive and future-oriented crisis/safety planning during this phase. As with other activities in this phase, the goal is to do no more than necessary prior to convening the team, so that the facilitator does not come to be viewed as the primary service provider and so that team as a whole can feel ownership for the plan and the process.

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ACTIVITY TO REACH GOAL 1.2. 1.2. b. Elicit information from agency representatives and potential team members about immediate crises or potential crises. Facilitator elicits information from the referring source and other knowledgeable people about pressing crisis and safety concerns. Information about previous crises and their resolution can be useful in planning a response in 1.2 c. ACTIVITY TO REACH GOAL 1.2. 1.2. c. If immediate response is necessary, formulate a response for immediate intervention and/or stabilization. Facilitator and family reach agreement about whether concerns require immediate attention and, if so, work to formulate a response that will provide immediate relief while also allowing the process of team building to move ahead. This response should describe clear, specific steps to accomplish stabilization. GOAL 1.3: To explore individual and family strengths, needs, culture, and vision and to use these to develop a document that will serve as the starting point for planning. 1.3. Facilitate conversations with family and youth/child. ACTIVITY TO MEET GOAL 1.3. 1.3. a. Facilitator meets with the youth/child and family to hear about their experiences; gather their perspective on their individual and collective strengths, needs, elements of culture, and long term goals and vision. Facilitator helps family to identify potential team members and asks family to talk about needs and preferences for meeting arrangements (location, time, supports needed such as child care, translation). Family members should be encouraged to consider these topics broadly and to use these to develop long-term goals or vision. ACTIVITY TO MEET GOAL 1.3. 1.3. b. Facilitator prepares a strength based summary document using the information from the initial conversations that summarizes information about family strengths, needs and vision. The family then reviews and approves the document. GOAL 1.4: To gain the participation of team members who care about and can aid the youth/child and family, and to set the stage for their active and collaborative participation on the team in a manner consistent with the wraparound principles. 1.4 Engage other team members. ACTIVITY TO MEET GOAL 1.4. 1.4. a. Facilitator, together with family members if they so choose, approaches potential team members, hopefully identified by the family, who care about and can aid the youth. It is not the duty of the family or youth to recruit team members but eliciting recommendations from them increases the potential for creation of successful teams. Facilitator asks the potential members if they will participate, seeks their perspective on the familys strengths and needs, describes the wraparound process and orients them to their roles and responsibilities as members of the team.

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GOAL 1.5: To ensure necessary procedures are undertaken to ensure a successful process. 1.5. Make necessary arrangements. ACTIVITY TO MEET GOAL 1.5. 1.5. a. Facilitator integrates all the information gathered from all sources and arranges a location, time and supports as needed for all team members. Facilitator prepares materials for distribution to team members. PHASE 2: Initial plan development During this phase, team trust and mutual respect are built while the team creates an initial plan of care using a high-quality planning process that reflects the wraparound principles. In particular, youth and family should feel, during this phase, that they are heard, that the needs chosen are ones they want to work on, and that the options chosen have a reasonable chance of helping them meet these needs. This phase should be completed during one or two meetings that take place within 1-2 weeks; a rapid time frame intended to promote team cohesion and shared responsibility toward achieving the teams mission or overarching goal. GOAL 2.1: To create an initial plan using a high quality team process that reflects multiple perspectives and build trust and shared vision consistent with the principles of wraparound. 2.1. Develop an initial plan of care. ACTIVITY TO MEET GOAL 2.1. 2.1. a. Facilitator guides the team in a discussion of ground rules and how they will operate during team meetings. Confidentiality, mandatory reporting and any other legal requirements must be included in this discussion. Attention should be given to creating a blame free, safe environment for youth and family as well as all other team members. Facilitator records ground rules in team documents which will be distributed to all members. ACTIVITY TO MEET GOAL 2.1. 2.1. b. Facilitator describes and documents strengths from the summary document prepared before the meeting and asks for additional strengths including those brought by team members. ACTIVITY TO MEET GOAL 2.1. 2.1. c. Create team mission. Facilitator reviews youth and familys vision and leads team in setting a team mission, introducing idea that this is the overarching goal that will guide the team through phases and, ultimately, through transition from formal wraparound. ACTIVITY TO MEET GOAL 2.1. 2.1. d. Describe and prioritize needs/goals. Facilitator guides the team in reviewing needs previously identified and adding to the list. Needs are prioritized with key attention given to the youth and family view of what is most important, what they will work on first and tied to achievement of the team mission.

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ACTIVITY TO MEET GOAL 2.1. 2.1. e. Determine goals and outcome indicators for each goal. Facilitator guides the team in discussion of specific goals or outcomes that will represent success in meeting the needs. The team will discuss how the outcome will be assessed, what measures will show progress and how often the team will measure the progress. ACTIVITY TO MEET GOAL 2.1. 2.1. f. Select strategies. Facilitator guides the team in an open ended and creative process which generates multiple options for reaching the identified goals. Each option is then evaluated by discussing how likely it is to reach the goal, the degree to which it is community based, how it builds on the strengths within the team and how consistent it is with the family culture and values. Attention should be given to whether or how the formal systems supports are evidence based. ACTIVITY TO MEET GOAL 2.1. 2.1. g. Assign action steps. Team members agree to take responsibility for each action step connected with the strategies selected and agree to a time frame for performing their actions. Attention should be given to ensuring that each team member has an assignment and that no member is assigned too many tasks. Goal 2.2: To identify potential problems and crises and create an effective and specific prevention and response plan consistent with the principals of wraparound. 2.2. Develop crisis/safety plan.

ACTIVITY TO MEET GOAL 2.2. 2.2.a. Determine potential serious risks. Facilitator guides the team in a discussion of how to maintain safety for all family members and things that could go wrong followed by decision making on what will happen to prevent the problem. Each team member should have a role and assignment in both the prevention plan and what should occur should a crisis occur. PHASE 3: Implementation During this phase, the initial wraparound plan is implemented, progress and successes are continually reviewed, and changes are made to the plan and then implemented, all while maintaining or building team cohesiveness and mutual respect. The activities of this phase are repeated until the teams mission is achieved and formal wraparound is no longer needed. GOAL 3.1: To implement the initial plan of care, monitoring completion of action steps and strategies and their success in meeting need and achieving outcomes in a manner consistent with the wraparound principles. 3.1. Implement the plan.

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ACTIVITY TO MEET GOAL 3.1. 3.1 a. Implement action steps for each strategy. For each strategy in the wraparound plan, team members undertake action steps for which they are responsible. Facilitator aids completion of action steps by checking in and following up with team members; educating providers and other system and community representatives about wraparound as needed; and identifying and obtaining necessary resources. The level of need for educating providers and other system and community representatives about wraparound varies considerably from one community to another. Where communities are new to the type of collaboration required by wraparound, getting provider buy in can be very difficult and time consuming for facilitators. Agencies implementing wraparound should be aware of these demands and be prepared to devote sufficient time, resources, and support to this need. ACTIVITY TO MEET GOAL 3.1. 3.1. b. Track progress on action steps. Team monitors progress on the action steps for each strategy in the plan, tracking information about the timeliness of completion of responsibilities assigned to each team member, fidelity to the plan, and the completion of the requirements of any particular intervention. Using the timelines associated with the action steps, the team tracks progress. When steps do not occur, teams can profit from examining the reasons why not. For example, teams may find that the person responsible needs additional support or resources to carry out the action step, or, alternatively, that different actions are necessary. ACTIVITY TO MEET GOAL 3.1. 3.1. c. Evaluate success of strategies. Using the outcomes/indicators associated with each need, the facilitator guides the team in evaluating whether selected strategies are helping team meet the youth and familys needs. Evaluation should happen at regular intervals. Exactly how frequently may be determined by program policies and/or the nature of the needs/goals. The process of evaluation should also help the team maintain focus on the big picture defined by the teams mission by continually questioning if these strategies, by meeting needs, are helping achieve the mission. ACTIVITY TO MEET GOAL 3.1. 3.1. d. Celebrate successes. The facilitator encourages the team to acknowledge and celebrate successes, such as when progress has been made on action steps, when outcomes or indicators of success have been achieved, or when positive events or achievements occur. Acknowledging success is one way of maintaining a focus on the strengths and capacity of the team and its members. Successes do not have to be big, nor do they necessarily have to result directly from the team plan. Some teams make recognition of whats going right a part of each meeting. GOAL 3.2: To use a high quality team process to ensure that the wraparound plan is continually revisited and updated to respond to the successes of initial strategies and the need for new strategies. 3.2. Revisit and update the plan.

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ACTIVITY TO MEET GOAL 3.2. 3.2. a. Consider new strategies as needed. When the team determines that strategies for meeting needs are not working, or when new needs are prioritized, the team engages in a process to consider new strategies and set new action steps. GOAL 3.3: To maintain awareness of team members' satisfaction with and buy-in to the process, and take steps to maintain or build team cohesiveness and trust.. 3.3. Maintain/build team cohesiveness and trust. ACTIVITY TO MEET GOAL 3.3. 3.3. a. Maintain awareness of team members' satisfaction and buy-in. Facilitator makes use of available information (e.g., informal chats, team feedback, surveysif available) to assess team members satisfaction with and commitment to the team process and plan, and shares this information with the team as appropriate. Facilitator welcomes and orients new team members who may be added to the team as the process unfolds. Many teams maintain formal or informal processes for addressing team member engagement or buy in, e.g. periodic surveys or an end-of-meeting wrap-up activity. In addition, youth and family members should be frequently consulted about their satisfaction with the teams work and whether they believe it is achieving progress toward their long-term vision, especially after major strategizing sessions. In general, however, this focus on assessing the process of teamwork should not take priority over the overall evaluation that is keyed to meeting identified needs and achieving the team mission. ACTIVITY TO MEET GOAL 3.3. 3.3. b. Address issues of team cohesiveness and trust. Making use of available information, facilitator helps team maintain cohesiveness and satisfaction (e.g., by continually educating team membersincluding new team members about wraparound principles and activities, and/or by guiding team in procedures to understand and manage disagreement, conflict, or dissatisfaction). Discord often arises when a team member feels the work is not addressing their determination of what is the real need for the family. It is important to achieve consensus about needs and mission in the first place, since shared goals are essential to maintaining team cohesiveness over time. GOAL 3.4: Complete necessary documentation and logistics. 3.4. Complete necessary documentation and logistics. ACTIVITY TO MEET GOAL 3.4 3.4.a. Facilitator maintains/updates the plan and maintains and distributes meeting minutes. Team documentation should record completion of action steps, team attendance, use of formal and informal services and supports, and costs or expenditures. Facilitator documents results of reviews of progress, successes, and changes to the team and plan. Facilitator guides team in revising meeting logistics as necessary and distributes documentation to team members. Phase 4: Transition During this phase, plans are made for a purposeful transition out of formal

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wraparound to a mix of formal and natural supports in the community (and, if appropriate, to services and supports in the adult system). The focus on transition is continual during the wraparound process, and the preparation for transition is apparent even during the initial engagement activities. GOAL 4.1: To plan a purposeful transition out of formal wraparound in a way that is consistent with the wraparound principles and that supports the youth and family in maintaining the positive outcomes achieved in the process. 4.1. Plan for cessation of formal wraparound. ACTIVITY TO MEET GOAL 4.1. 4.1. a. Create a transition plan. Facilitator guides the team in focusing on the transition from wraparound, reviewing strengths and needs and identifying services and supports to meet needs that will persist past formal wraparound. Preparation for transition begins early in the wraparound process, but intensifies as team meets needs and moves towards achieving the mission. While formal supports and services may be needed post-transition, the team is attentive to the need for developing a sustainable system of supports that is not dependent on formal wraparound. ACTIVITY TO MEET GOAL 4.1. 4.1. b. Create a post-transition crisis management plan. Facilitator guides the team in creating post-wraparound crisis management plan that includes action steps, specific responsibilities, and communication protocols. Planning may include rehearsing responses to crises and creating linkage to post-wraparound crisis resources. This activity will likely include identification of access points and entitlements for formal services that may be used following formal wraparound. ACTIVITY TO MEET GOAL 4.1. 4.1. c. Modify wraparound process to reflect transition. New members may be added to the team to reflect identified post-transition strategies, services, and supports. The team discusses responses to potential future situations, including crises, and negotiates the nature of each team members post-wraparound participation with the team/family. Formal wraparound team meetings reduce in frequency and ultimately cease. GOAL 4.2: To ensure that the cessation of formal wraparound is conducted in a way that celebrates successes and frames transition proactively and positively. 4.2. Create a commencement. ACTIVITY TO MEET GOAL 4.2. 4.2. a. Document the team's work. Facilitator guides team in creating a document that describes the strengths of the youth/child, family, and team members, and lessons learned about strategies that worked well and those that did not work so well. Team participates in preparing/reviewing necessary final reports (e.g., to court or participating providers, where necessary). This creates a package of information that can be useful in the future.

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ACTIVITY TO MEET GOAL 4.2. 4.2. b. Celebrate success. Facilitator encourages team to create and/or participate in a culturally appropriate commencement or graduation celebration that is meaningful to the youth/child, family, and team, and that recognizes their accomplishments. This activity may be considered optional. Youth/child and family should feel that they are ready to transition from formal wraparound, and it is important that graduation is not constructed by systems primarily as a way to get families out of services. GOAL 4.3: To ensure that the family is continuing to experience success after wraparound and to provide support if necessary. 4.3. Follow-up with the family. ACTIVITY TO MEET GOAL 4.3. 4.3. a. Check in with family. Facilitator leads team in creating a procedure for checking in with the youth and family periodically after commencement. If new needs have emerged that require a formal response, facilitator and/or other team members may aid the family in accessing appropriate services, possibly including a reconvening of the wraparound team. The check-in procedure can be done impersonally (e.g., through questionnaires) or through contact initiated at agreed-upon intervals either by the youth or family, or by another team member. KNOWLEDGEABLE ABOUT RESOURCES AND HOW TO ACCESS THEM. Many of the resources will depend on the local community. The first step a family support worker should take is to engage in development of a resource guide though exploration of the community. This activity will also provide the opportunity for a personal interaction and begin the creation of a personal relationship. The process of collaboration begins in this way. Throughout this chapter a number of resources have been provided and many other helpful sources are set out below: The Wraparound Process Users Guide: A Handbook for Families, from The National Wraparound Initiative. Miles, P., Bruns, E.J., Osher, T.W., Walker, J.S., & National Wraparound Initiative Advisory Group (2006). The Wraparound Process Users Guide: A Handbook for Families. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Childrens Mental Health, Portland State University. The Substance Abuse and Mental Health Services Administration website for Systems of Care: http://www.systemsofcare.samhsa.gov/ Considering a Private Residential Treatment Program for a Troubled Teen? Questions for Parents and Guardians to Ask, Federal Trade Commission, Bureau of Consumer Protection, Division of Consumer and Business Ethics; July 2008

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The Government Accountability Offices (GAO) Report to Congress: Residential Treatment Programs: Concerns Regarding Abuse and Death to Certain Programs for Trouble Youth, October 2007 The US Department of Health and Human Services, Centers for Disease Control and Preventions list of state mental health agencies - www.cdc.gov/mentalhealth/state_orgs.htm The US Department of State Fact Sheet: Behavior Modification Facilitieshttp://travel.state.gov/travel/tips/brochures/brochures_1220.html Your State Attorney General - www.naag.org The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) - http://astart.fmhi.usf.edu http://mentalhealth.samhsa.gov/cmhs/childrenscampaign/1998execsum6.asp Some websites for the entities mentioned above are: http://www.ymca.net/programs/ http://www.bbbsi.org/programs/ http://www.state.ar.us/dhs/sgDD.html http://www.state.ar.us/dhs/chilnfam/

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Chapter 3: Family Support Skills Introduction The role of a family support provider in a system of care is often all- consuming. The family support provider becomes the go-to person when families need more information, someone to act as a sounding board and someone to provide support throughout the phases of the helpseeking process. Families are often confused by the maze of steps necessary to get the help they need and may come to the table with negative experiences from working with systems in the past. Family support providers must be able to assist the families to understand the system of care, wraparound or other processes. The worker needs to help the family feel safe, clarify issues, become a self- advocate, and consider and discuss alternatives without letting past anger interfere with the process. The family support provider needs to do all this without actually giving advice or being judgmental while also inspiring hope for a better outcome. This chapter will provide information about some of the key skills needed to perform this task. DEMONSTRATES ABILITY TO LISTEN TO FAMILY MEMBER/CAREGIVER, INTERPRET INFORMATION AND IDENTIFY THE PRESENTING PROBLEM Listening is the most basic and important communication skill a family support provider will need. To be a good listener, you must: Pay close attention to what is being said. Really want to understand the speakers message. Portray an open attitude. To be an active listener, you must: Give the speaker feedback to indicate that you understand what is being said. Express your acceptance of the speakers feelings. Be aware of what is being non-verbally communicated. To be an empathetic listener, you must: Try to see the situation through the speakers eyes. Set aside your own opinions and feelings. Accept the speakers feelings without making judgments. In order to listen, you must stop talking. You put the parent at ease and encourage them to speak by being interested and showing it. Once you have established rapport, some other tips include: Ask appropriate questions. Avoid close ended questions.

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Center around concerns of the parent, not your own. Empathize with the parent. Have a desire to be helpful and to hear what is being said. Show you understand feelings. Dont let yourself be consumed emotionally, but have compassion. Put aside your own views. Be alert for your own negative feelings. Listen carefully until the parent is finished. Provide feedback; avoid negative feedback. Refrain from advice or criticism. Be patient and allow plenty of time. Avoid premature conclusions and interpretations. Be comfortable with pauses or openings in the conversation. Tips to communicate with Families Take things slowly. Be a good listener, not an advice-giver. Allow the parent to express emotions and feelings freely. Be empathetic. Listen without making the problem yours. A number of challenges and barriers limit early communications between a family support provider and the family. Keeping these in mind will help the family support provider maintain patience to listen and persistence in asking the questions necessary to assist the parent in narrowing the problems and clarifying what they see as a good solution. It is often not easy to receive help It can be difficult to submit to the influence of a helper. Help can be a threat to selfesteem and independence. It is not easy to trust a stranger and be open with that person. It is not easy to see ones problem clearly at first. Sometimes problems seem too large, too overwhelming or too unique to solve easily. People in crisis may be distraught or disconnected. Respect the individuality of the Parent Support them in their choices or decisions, even if you do not agree with them. Encourage parents to use coping strategies that have worked for them in the past.

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Determine the familys personal space needs, personality and temperament and let each family member take the lead (for example, some people are huggers, some are not; some very talkative, some very quiet). Encourage the person to be as independent as possible, but give support and assistance when events appear overwhelming. Help the families recognize and build on personal strengths. Recognize, honor and support cultural and spiritual preferences, which may be different from your own. Your help will be most useful if it shows caring, warmth, and encouragement. An individual will be more likely to accept your help if you: Respond to needs the person has identified. Share the responsibility for meeting needs and solving problems with the person. Your help will be more effective if you: Make clear to the person that he or she has the right to make the decision about whether or not to accept what you offer. Do not imply that anything is wrong with needing your help. Respond to the persons view of his or her problem or need. Encourage the person to use personal support networks and do not attempt to replace those networks with professional support. Your help will be more beneficial if: You encourage people to acquire the knowledge and skills that foster independence. The person experiences immediate success in solving a problem or meeting a need. The person sees improvement and feels responsible for bringing it about. DEMONSTRATES ABILITY TO ASSIST THE FAMILY TO CLARIFY THE ISSUES AND DISCUSS ALTERNATIVES WITHOUT GIVING ADVICE OR BEING JUDGMENTAL According to the Quest Parent Liaison Training tool, Q.U.E.S.T. (Quality, Understanding, Educational, Supportive Team), Childrens Special Health Services Care Coordination, Training Tools for Parent Liaisons Developed by; Linda Pippins, Adm. CSHS, Angela Myers, CSHS Statewide Parent Consultant and Esther McGee, CSHS Statewide Parent Training Coordinator, JanuaryDecember 2006, www.familyvoices.org, family support providers must be aware of the stressors that families face. They need to understand that when new information is introduced to some families, they may shut it out because of the emotional stress they are dealing with and their fear of the unknown (Quest, 2006, pg. 10). When helping families research areas

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of their treatment, family support providers should consider what the parent wants to learn, not what the family support provider thinks they should learn (Quest, 2006, pg. 10). Family support providers can assist families to develop questions that they can take with them to a therapy session or when they have an appointment to see the doctor. Family support providers can have parents practice listing questions they want to ask at a meeting and role playing can be used to assist the families become comfortable in certain situations (Quest 2006 pg. 20). When helping families gather information to clarify issues or find alternatives, the following key questions should be asked and answered (Parent to Parent pg. 45): What is the problem? Who has the power to resolve the problem? What is the chain of command in the organization/agency? How could this problem be resolved? The following five steps of the problem solving process can be used when assisting families (Parent to Parent pg. 46). Step 1: What is the problem? Use active listening and ask how, what, and why questions to help the speaker articulate the issue. Step 2: Why do you think the problem exists? This helps the family support provider bring out underlying issues and enables the person to provide a personal perspective on the problem. Step 3: What have you tried? This helps determine what has already been done. Step 4: Has it worked? What happens when you say (or do) that? This is an important follow-up question to Step 3. Step 5: What are some other ways of solving the problem? Drawing on what has been discussed in Steps 3 and 4, you can help families search for new, creative solutions. A family support provider is just that, a provider of support, an advocate. An advocate is one who supports or speaks in favor of another, one who pleads for another (Parent to Parent, p. 45). In addition to being an active listener, the family support provider is also a researcher. The families look to family support workers to help them obtain information about their treatment, diagnosis, medications, where to find certain resources, etc. It is also important not to do all the work for the parent. Family support providers are to support the families and give them the tools to eventually become independent. BUILDS TRUST AND PROVIDES SUPPORT AND EMPATHY During the initial meeting with family support providers and people on the outside, families are often wary and unwilling to disclose information. According to the Merriam-Webster Online Dictionary, trust is defined as a charge or duty imposed in faith or confidence or as a condition of some relationship. Building trust takes time and does not happen overnight. Families stated that the things that helped them build trust with their family support providers were that they were consistent, showed them they were interested in helping them with their problems, and were

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honest and up front with them. They provided them with information and assisted with educating them about their childs illness and services that are available to them and their family. Family support providers also showed the family members empathy. According to the MerriamWebster Online Dictionary, empathy is the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another, of either the past or present, without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner. Empathy can be shown in the form of nonverbal cues such as nodding your head or saying phrases such as I understand or Ive been through that. When building trust with families, remember that it takes time. Showing genuine interest in their life and being empathetic are keys to providing support to families. ABLE TO DE-ESCALATE A CRISIS SITUATION When emotions are high, conflicts often arise and family support providers need to be able to defuse or de-escalate tense situations. Family support providers have been, and sometimes may still be, where the parents are in terms of similar experiences. Being able to analyze conflict gives the family support provider a better understanding of and ability to do what is needed to calm all parties down. According to the Therapeutic Alternatives in Crisis Training (TACT) there are three types of agitation: mild, moderate and extreme. Mild agitation includes pacing, swearing, loud vocal tones, demanding and changes in normal behavior. The individual is often guarded, has a reddened face and yells or swears. Moderate agitation is when an individual is defiant, threatening, has clinched hands (fists), and seems irrational. Extreme agitation is when an individual is acting out. He/she is a danger to self and others, suicidal or self harming, homicidal (harms others), or may destroy property in a manner risking the safety of themselves and others. The Educational Service District 101 in Spokane, Washington provided their staff with a training titled Threat to your personal Safety: Using Verbal De-Escalation (De-escalation Training. http://webscripts.esd101.net/safety/workers_comp_Powerpoint.aspx). The following tactics are outlined to assist in de-escalation of a situation: Simply listening Distracting the other person Re-focusing the other person on something positive Changing the subject Use humor (sparingly) to lighten the mood (be very careful with this!) Motivating the other person (especially useful with students) Empathizing with the other person Giving choices Setting limits During this process, barriers, or things that may hurt the flow of communication between the family support provider and family member, can keep the meanings of what is being said from being heard by all parties. Some barriers include:

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Pre-judging Not listening Criticizing Name calling Arguing Threatening Using positive statements such as Please tell me more or I want to help you can help the families involved feel at ease when they know that you are there to help them and you are listening and care about what they are saying. The following steps can be used when a family support provider is trying to de-escalate a situation: Listen actively and with empathy. Try to put yourself in their position and understand what made them feel the way they feel. Give the situation your full attention and avoid any distractions. Rephrase important messages when needed to make sure everyone is clear on what was said and nothing will be misinterpreted. Remove outsiders from the room. If other people are present that are not directly involved with the problem, politely ask them to leave the room. They tend to take the roles of cheerleaders or additional victims. Be in tune with what your body is saying. Body language and non-verbal communication can sometime give people the wrong impression. Things like crossing your arms over you chest can make you appear to have removed yourself from the situation or pointing your finger can seem like someone is being accused or threatened. This topic is covered in-depth in chapter six. Respect each other's personal space. You do not want to appear that you are going to restrain or attack someone, this may escalate this situation. Keep your hands visible and do not touch a person who may appear to be agitated. Stay far enough away so that an agitated person cannot hit, kick or grab you. Watch the tone of your voice. Try to keep your voice tone and volume even. Speak in a slow soothing tone and always be respectful using words as please and thank you. Seek assistance. As soon as you see the situation taking a turn in a negative direction, send for help. This other person will be able to help you with the situation by offering solutions, being a witness, and providing for a safer environment. Document what happened. Follow any documentation procedures that are set up by your company/agency. This will provide information if the situation between the same individuals occurs again. Often, minor situations can lead to major ones. The following should be kept in mind after the crisis to address the conflict that led to the crisis situation (Cain, 1997). 1. Family members should keep their focus on what can be done in the future. Remember, Whats done is done.

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2. Each person should take turn speaking. Listen carefully to the facts, and to the other persons feelings. 3. Resist the urge to bring more issues into the discussion. Remember, you can take up another issue later. 4. Personal attacks and blame will only distract from solving the problem. Remember, the problem is your enemy, not each other. 5. Have families be prepared to describe their feelings only and their impression of the facts of the situation. They should remember not to speak for or about others. When all parties have calmed down enough and things are talked through rationally, the reasons for the conflict and how to come to a solution should be clear. If there is an incident where the family support provider cannot assist with de-escalating the conflict, then it is time to seek the assistance of others (care coordinator, therapist, supervisor, etc). UNDERSTANDS WHEN TO CONSULT WITH OTHERS There will be times when situations arise that require the family support provider to seek others for assistance. No one knows all the answers to the questions which will arise in supporting a family and it is absolutely necessary for a support provider to be comfortable with the statement, I dont know, but we can find the answers. Organizations may provide training on specific procedures that need to be followed when a crisis situation arises. There may be formal training on other situations where the family support provider cannot assist the family due to policy or procedures. If you are working with any organization and there is no formal process for dealing with crisis or other similar situations, this should be one of the first things you help to develop. If a process cannot be formally developed, ask for permission, from the parent and the person to whom you choose to report, to discuss things that make you uncomfortable or where you are unsure. This could be a therapist, care coordinator or program supervisor. In essence, know your boundaries. As a family support provider, you are expected to keep confidential any and all information given to you by the individuals with whom you work. Keeping information confidential is an integral part of the trust you establish with an individual. Do not share information with neighbors, friends, or family members. Even if you do not use a persons name, situations often are obvious and people can be easily identified. Always ask permission from the families before speaking to professionals or anyone else involved with their child. Any information shared with a family support provider will probably be given with the unexpressed assumption that it will remain between the family and the provider. This unwritten and unspoken contract must always be honored. The family support provider must realize that, even so, information regarding the safety of a family member may be shared with the

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appropriate supervisor and this exception to the rule of confidentiality must be made clear to the family at the beginning of the support relationship. This is the most effective way to avoid a breach of trust and ensure safety for everyone involved in the support relationship. UNDERSTANDS BOUNDARIES AND LIMITS OF ABILITY AND REFERS TO PROFESSIONS WHEN NEEDED. As previously stated, the role of the family support provider is very important to the families. Families will come to family support providers for advice and guidance. The development of the family support provider and family relationship tends to evolve over time. It is important for a family support provider and families to know boundaries. How far is too far to take a relationship? Can a family support provider and family members become friends? These are important questions that need to be considered and openly discussed before the lines between a family support provider and a family member become blurred. Warning signs that a parent needs more than a family support provider can provide include: Being stuck or obsessed with an idea or emotion; unable to move on in life (i.e., doctors are cruel, life is terrible, always angry or sad); little or no forward movement. Continued isolation, lack of support or willingness to look for support (choosing to stay away from others or wanting to be alone), lack of problem-solving skills, stuck on a purely emotional level, or just stressed out. Burned out all of the time. (Stress and burn out occasionally are not uncommon) Talking about giving up (it seems hopeless, useless, whats the point). (The occasional feeling of hopelessness is not uncommon) Talking about hurting others or hurting themselves; (these are cries for help; ask if they have a plan to do so). Strangely irrational (somewhat bizarre), off-the-wall comments; inability to concentrate. Failure to bond with or attach to the child (lack of affection, speaks in negative terms, as if repulsed by the child); cant make a distinction between the serious emotional and behavioral challenges and the child. There may be times when a family support provider will sense that a family needs more support than the family support provider is able to offer. Trust that if you are feeling uncomfortable about the limit of support you can offer, you must share this with the parent. Explain that what they are asking for is beyond your role. At this time, professional intervention might be helpful to the family and you may be the best person to help the parent gain access to these services. Ask if the person would like professional help; describe the behavior youve noticed (wonder if youd be open to professional help?). Trust your instinct, your gut reaction. Ask for help. Get another opinion. Supporting a parent who feels very hopeless can be a difficult task. Depending upon the intensity of your concerns, the family support provider is encouraged to share concerns with supervisors or clinical directors in their system structure.

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As humans, we have a desire to help those who seek our assistance. It is important to know that there are limits on our ability to help and there will come times that family members will need to be referred to someone else, especially if the boundary lines become crossed or the family needs assistance beyond the family support providers capacity. Remember to always ask permission from the families before speaking to professionals or anyone else involved with their child. You must make it clear that this may be necessary to the family at the beginning of the support relationship. ABLE TO USE NEGOTIATION Negotiation is an excellent skill for both a parent and a family support provider to have. Whenever there is a difference between what the families choose and what the system they are working with is willing to provide, the opportunity for negotiation arises. Linda Tillman, author of Seven Steps to Successful Negotiation, outlines the following seven steps that can be used in successful negotiation: 1. Identify the problem. Each person should state what they seems to be the problem using I Statements. Using I Statements is discussed in depth in Chapter 6. There may need to be some additional discussion on what the problem is so all parties are on the same page. 2. Listen Assertively. In this step, each person states their opinion. It is important to have the other person reflect or restate the persons opinion. This does not mean that you agree with them, restating give the other person the opportunity to be sure they heard the person correctly and clearly. 3. Brainstorm ideas for the solution. During this step, each person throws out ideas. During this idea gathering session, the family support provider should write down the ideas from all parties. Some ideas may work and some may not. It is key that everyone respects all ideas and does not pass judgment, even if they do not agree with them. 4. Pick a solution. Once the brainstorming session is complete and you have run out of ideas, it is now time to discuss each suggestion and pick one of those suggestions together. Telling what is liked and not liked about each suggestion until one appears to be the solution. 5. Make a contract. Contract is another term for a written agreement. It states clearly the solution and makes sure all parties are on the same page. By writing it down, the family support provider will have a document that they will be able to refer back to if the situation arises again. It can be as simple as Johnny will play baseball on Mondays and Wednesdays and play football on Tuesdays and Thursdays. 6. Try out the solution. The try out time should be LIMITED.

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7. Look for problems in the contract. Both parties need to give their view on the way the contract worked. What was GOOD about the contract and what needs CHANGING? Redo the process from the beginning, if necessary. Utilizing these tips can help the families get their needs met and family support providers better navigate sticky situations. This process allows for everyone at the table to have a voice in coming up with a solution to the problem at hand. Negotiation does not define a definite winner or loser, but will allow both parties to feel that they compromised and came up with the best solution for them and their situation. With practice, family support providers can master these seven skills of negotiation and eventually be able to put their own twist on things and find or develop tools that may work better for them and their families. UNDERSTANDS APPROPRIATE USE OF SELF-DISCLOSURE The family support provider is most effective in working directly with families because of their own life experience in parenting a child or youth with similar challenges. The use of that experience helps build the trust bond with family members you serve. The family support provider models success as the family begins to feel that if you did it, then I can do it. Sharing your personal stories of challenge and triumph in caring for your child or youth is called self-disclosure. You share your experience to build an empathic relationship with your families, to illustrate how a process can work and how it can benefit them, to help clarify a question and to help prepare the family you serve to advocate for themselves and other families through telling their own story. Self disclosure is a skill which is used to help the families served build their own skill sets as described above. It should be used in this limited fashion and focused on meeting the needs of the family you serve. Remember, it is not about you. Your methods and outcomes are not shared to tell the family what to do, only to give the family an insight into what is possible. The decisions of the family you serve will be made based on their culture, life style, economic options and support network. Self disclosure is best used to let them see an alternative path to solving a particular difficulty, not as a method of telling the family what they need to do. This remains the work of the family you serve, to decide what is best for their family and be able to tell other what they choose, and if necessary, why. Throughout this chapter a number of resources have been provided and many other helpful sources are set out below: Trust. 2009. In Merriam-Webster Online Dictionary. Retrieved February 5, 2009, from http://www.merriam-webster.com/dictionary/trust Empathy. 2009. In Merriam-Webster Online Dictionary. Retrieved February 5, 2009, from http://www.merriam-webster.com/dictionary/empathy Pippins, L., McGee, E., Myers, A. QUEST-A Parent Liaison Training Tool. January December 2006.

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Cain, Johnnie. 5 Ways to De-escalate a Conflict. Conflict Management. Head Start Bulletin #61. HHS/ACF/ACYF/HSB. 1997. Parent to Parent of Arkansas FFCMH Training Manual (pg. 29-30). (Adapted by Ashley Rentz, certified Parent to Parent Trainer) 2006. Tillman, Linda. Seven Steps to Successful Negotiation. http://www.onlineorganizing.com/NewslettersArticle.asp?newsletter=go&article=266. Date accessed 7/15/2009. http://webscripts.esd101.net/safety/workers_comp_PowerPoint.aspx

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Chapter 4: Knowledge of Laws and Policy Introduction: In order for a system of care to be truly family driven, families not only need to know about their childs mental and emotional health needs, they need to know and get involved in advocacy and policy formation. Many times the barriers that families face are not caused by a single mental health provider, but rather the laws and policies that govern all providers. The same holds true for school districts and other child and family serving agencies. Generally speaking, what drives an agencys rules and policies are the regulations from their funding sources, not the individualized needs of their consumers. Clearly, what can be neglected in a bureaucratic system are the rights of children and families; therefore, it is imperative that families know their rights so they can assert them appropriately and in a timely fashion. The good news is that families can be enlightened into these processes and, ultimately, can become involved. However, before genuine family involvement can happen, there must be a knowledge-base provided to the family. This chapter outlines several important areas for families with high needs children, including special education law, Medicaid eligibility and private insurance, policy development and the legislative process, and information on how to participate in local and state level government. This information provides an opportunity for a family to become less victimized by a system that was established to provide and protect them. Having stated that, it is also important to understand that acquiring this knowledge brings more responsibility to the family; specifically, the responsibility to use this information appropriately and effectively in order to get the family and their childs needs met. The task to educate and coach the family with this information will initially fall on the family support provider. To read about the essential skills needed to be a good family support provider, see chapter 3. UNDERSTANDING SPECIAL EDUCATION LAW Parents of children with disabilities regularly have to conference with teachers and school counselors about their childs behavior. Generally, this is not a good experience for parents who find themselves uninformed about their childs rights in a public school. Because of the overwhelming task of managing a class of many students, a teacher can be distracted from identifying the real needs of a child with a disability. Consequently, a child can get labeled as bad or not wanting to learn. This reality is exactly why parents and guardians of children with mental and emotional health needs are the best advocates when it comes to getting their childrens educational needs meet. The starting point for understanding Special Education Law begins with the Individuals with Disabilities Education Act (IDEA). IDEA began in 1975 when Congress passed the Education for all Handicapped Children Act, which essentially proclaimed that any child with a disability has the right to an education. The first concept for parents to understand when it comes to IDEA is defining what IDEA considers a disability, because having just any disability does not automatically qualify your child for services. IDEA defines a "child with a disability" as a child . . . with mental retardation,

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hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance , orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities; and, who, because of the condition, needs special education and related services. The law also provides other protections for children with special needs such as Section 504 of the Rehabilitation Act of 1973 and the American with Disabilities Act (ADA). These are essentially civil rights acts for individuals with a disability and ensure that reasonable accommodations are provided to students such as a special study area and/or a classroom aid. It is important for families to know that students with disabilities who do not qualify for special education services under the IDEA may qualify for accommodations or modifications under Section 504 and under the ADA. In terms of childrens mental and emotional health conditions, Attention Deficit/Hyperactivity Disorder (ADHD) is considered a disability under Section 504. One acronym that has become very familiar with parents of children with mental health and special education needs is IEP, which stands for Individualized Education Plan. An IEP is mandated under the IDEA law and requires that a school develop one for every student with a disability who is found to meet the federal and state requirements for special education. For the parent or guardian about to embark in the IEP process there are several key considerations including: Assessing the student in all areas related to the suspected disability(ies). Understanding how he or she has access to the general curriculum. Understanding how the disability affects the students learning. Developing individualized goals and objectives that will make the biggest difference for the student. Choosing a placement in the least restrictive environment. When considering the possibility of an IEP for their child, the first thing a parent needs to request from the school is an evaluation performed by a psychologist to identify their childs learning needs. The following are the minimum components of the evaluation: Academic performance Intellectual skills Adaptive behavior and social functioning Social history Communicative abilities or language abilities. If a parent is met with resistance from the school, the parent can contact the Arkansas State Board of Education by visiting them on line at: http://arkansased.org/parents/parents.html. The Arkansas Department of Education can assist the parent in knowing his or her rights and can possibly help the parent access an advocate to help them go through this process. Once the evaluation is complete and eligibility for special education services is determined, the school is required to call or convene an IEP team and develop an appropriate education plan. The IEP should be implemented as soon as possible after the child is determined eligible. The IEP team should include the following: - 67 -

Parent or guardian. Special Education Teacher. Regular education teacher. A representative of the school district who is knowledgeable about the availability of school resources. An individual who has knowledge or special expertise regarding the child. Parents are considered to be full and equal partners in the IEP process. Obviously, parents are crucial members of the team because they have unique knowledge of their child's strengths and needs. Parents need to know they have the right to be involved in meetings that discuss the identification, evaluation, IEP development and educational placement of their children. They also have the right to ask questions, dispute points, and request modifications to the plan. If the IEP is not going as planned, the first step for the parent would be to contact the school counselor, report that the IEP is not working based on parental knowledge or observation, and request another meeting to revise the plan. One very important thing for a parent to remember is that a school can proceed with an IEP meeting without the parent present as long as the school can show they made attempts to make the parent aware of the meeting. According to the law, the school is supposed to do the following to ensure parent participation: 1. 2. 3. 4. Notify the parents early enough that they have an opportunity to attend. Schedule the meeting at a mutually agreed on time and place. Offer alternative means of participation, such as a phone conference. Arrange for an interpreter for parents who are deaf or whose native language is not English.

Wikipedia, http://en.wikipedia.org/wiki/Special_education, provides additional in depth information on this topic. The family support provider can help the family to find information and to become an active and effective advocate for their child. Much of the time, information and effective advocacy will bring about the right result; however, there will be times when the family support provider needs to become a cheerleader for the family to keep them moving forward to assert their rights. The following testimony from a parent highlights this truth. To Whom It May Concern: In 2003 I filed a complaint with the Department of Education in Little Rock, AR with the Special Education Department. My son was diagnosed with ADHD at a very young age and he was placed in special education as a result of this. Anyone who has a child with this ADHD knows about the challenging behavior problems that are associated with the condition. Because my son had problems with his attention and behavior in school he would be severely punished for small things. For example, he was once suspended because the teacher didnt like his facial expression when she addressed him. The last straw for me was when my son was given permission to go to the restroom and as he walked down the hall he passed the assistant principal who began to question my son about his presence in the hallway. He told my son to follow him to the principals

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office where he was eventually accused of being high and searched him for drugs. Even though they found no drugs on my son they proceeded to call the police. When the police arrived they escorted my son out of the building like a criminal in front of his peers. Afterwards, I requested a meeting and I respectfully confronted them about what had happened to my son. I also took them to court because I knew they were not above the law. I was assigned a hearing judge out of Little Rock and after a 2 day hearing I won the case. The violations found by the judge were: An ineffective IEP An ineffective behavioral plan Ineffective program placement Changing placement without providing services After I won the case I composed a legal proposal for the school to follow stating all the changes that needed to occur with my son and when it needed to be put in place. This legal document has followed my son through high school so that his needs are always being met. This is a simple snap shot of what I went though with getting my son the services at the school that he needed. Thank you for allowing me to share my story. I hope to continue to encourage parents to not let their child be denied his or her basic rights to a free and appropriate public education. You are your childs strongest and caring advocate, so fight for their future and make them proud. May God Bless you and your family, James Tony Hollis UNDERSTANDING MEDICAID ELIGIBILITY REQUIREMENTS Medicaid is a joint federal-state program that provides health care coverage for low-income people. Federal Medicaid law provides broad national guidelines on eligibility and definitions of covered services. It establishes the basic rules for the program that all states must follow; however, states have extensive flexibility. For instance, states set the rules for the benefit package, determine which groups of potential eligible individuals will qualify, who may furnish the services and what rates providers will be paid. Medicaid covers children and groups of lowincome parents based on family income; however, individuals with disabilities and the elderly must meet both financial and other criteria. For the purposes of this manual, we will focus on the eligibility and benefits for children in Arkansas. For additional information on this topic see www.bazelon.org, the web site for the Judge David L. Bazelon Center for Mental Health Law. ARKids First Program: In 1997, Congress created the State Childrens Health Insurance Program (SCHIP) to support states' expanding coverage to more low-and moderate-income income children. Arkansas

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version of SCHIP is called ARKids First. ARKids First includes two plans: ARKids First A and ARKids First B. Plan A provides free care for a range of health screening and treatment services. Plan B, for families with slightly higher incomes, provides most of the same benefits, but requires a co-payment for some services, including $10 for routine visits and $5 for prescriptions. What is very important to Arkansas families is recent SCHIP legislation. Unlike traditional Medicaid, SCHIP funds are not guaranteed for every eligible child. Once a state reaches its annual allotment, it cannot receive additional federal funds for that year. Arkansas had not yet reached its full SCHIP cap prior to 2009, but ran the risk of doing so if the SCHIP program was not reauthorized with new funds starting at the beginning of this year. On February 4, 2009, a bill was passed by the Senate renewing and expanding SCHIP and extending critical mental health benefits to millions of recipients for the first time. This legislation renews the SCHIP program for at least four and a half years. Because of this new legislation, Arkansas is taking several steps that will ensure that all children have health insurance. The Arkansas Finish Line Coalition, a growing group of medical professionals, child-serving agencies and advocates, is advancing a three-part plan to reach the goal of covering all children in Arkansas. Enroll children who already qualify for ARKids First but are not currently signed up. Extend health insurance to 12,000 more Arkansas children by raising the family income limit from 200 percent of the federal poverty level to 300 percent. Expand options for additional families who cant afford private insurance by creating a way to buy coverage through ARKids First. To find out more about the Arkansas Finish Line Coalition and how Arkansas is going to cover all children with some form of health insurance, visit their website at www.ARFinishLine.org. To find out more about current statistics regarding health insurance for Arkansas children, visit Arkansas Advocates for Children and Families at their website at www.aradvocates.org. How do I know if my child is eligible for ARKids First? Eligibility is determined by income and the number of people in your family. If your family earns less than the income limits below, your child may be eligible for ARKids First plans A or B.

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How do I apply for my child? Call 1-888-474-8275 or visit www.arkidsfirst.com. Learn about ARKids First and other DHS programs for which your family may qualify at ACCESS Arkansas at https://access.arkansas.gov/Intro.aspx. Visit a Benefit Bank of Arkansas site for help with your application. Sites are located in Hempstead, Izard, Mississippi, Montgomery, Phillips, Pulaski and Washington counties. Call 1-877-375-0790. Visit your Department of Human Services County Office. The array of services covered under Medicaid is broad and more extensive than the benefit packages in a typical insurance plan. Specifically, Medicaid provides specialized services in intensive community mental health services in Arkansas. Those services include, but are not limited to, the following:

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Mental Health Evaluation/Diagnosis Psychological Evaluation Interpretation of Diagnosis Diagnostic Evaluation by Physician Development of Master Treatment Plan Periodic Review of the Master Treatment Plan Individual Psychotherapy Marital/Family Psychotherapy Group Psychotherapy Therapeutic Day/Acute Day Treatment Crisis Intervention Crisis Stabilization Pharmacological Management by Physician Interventions related to a mental health master treatment plan provided to your child in their home, school or community provided by a mental health professional or mental health paraprofessional. A parent who is working with a mental health provider can request a list of the providers array of mental health services to determine the extent to which the provider offers a particular service. The parent can also ask the provider to give them the names and credentials of the individuals providing the service, along with their training and areas of expertise. An important thing to remember is that children are entitled to all services listed in Medicaid law, which generally are more than the services in the state plan. For instance, under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) mandate, children on Medicaid are entitled to any federally authorized Medicaid service. All states must screen Medicaid-eligible children periodically, diagnose any conditions found through a screen and furnish the appropriate, medically necessary treatment to correct or ameliorate deficits and physical and mental illness and conditions discovered by the screening services. For more detailed information on EPSDT, please refer to chapter 1. UNDERSTANDING PRIVATE INSURANCE ISSUES AND APPEALS Although lower-income children enrolled in ARKids First have the highest rates of mental and emotional health problems, it would be a mistake to assume that families who have higher incomes with private insurance coverage do not have children with serious mental health needs. Statistically, mental disorders affect about one in five American children and those numbers do not discriminate between classes. Therefore, parity, which essentially means equality, within private insurance coverage is extremely important. On October 6, 2008, President Bush signed mental health parity into law, addressing this fight to end insurance discrimination against those seeking treatment for mental health and substance use disorders. This historic legislation requires that health insurance equally cover both mental and physical health. This new law will go into effect in January 2010.

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Specifically, the law prohibits unfair coverage with respect to co-payments, coinsurance, deductibles, out-of-pocket expenses, number of covered visits and days of coverage, or other similar restrictions on the scope or length of treatment for mental health or substance abuse. Another important fact is if the plan provides out-of-network coverage for medical/surgical benefits, it must provide the same out-of-network coverage for mental health/substance use disorder benefits. The Mental Health Parity Act of 1996 (MHPA) is a federal law that may apply to two different types of coverage: 1. Large group self-funded group health plans (CMS has jurisdiction over self-funded public sector (non-federal governmental) plans while the Department of Labor (866-4443272) has jurisdiction over private sector self-funded group health plans.); 2. Large group fully insured group health plans. Contact your state's insurance department to find out about whether additional protections apply to your coverage if you are in a fully insured group health plan or have individual market (nonemployment based) health coverage. Medicare and Medicaid are not issuers of health insurance. They are public health plans through which individuals obtain health coverage. Contact your specific Medicare or Medicaid contractor, the State Medicaid Agency, to discuss your level of benefits. Employment-related group health plans that provide benefits through insurance are known as fully insured group health plans. Employment-related group health plans that pay for coverage directly, without purchasing health insurance from an issuer, are called self-funded group health plans. Contact your plan administrator to find out if your group coverage is fully insured or selffunded. The MHPA may prevent your large group health plan from placing annual or lifetime dollar limits on mental health benefits that are lower - less favorable - than annual or lifetime dollar limits for medical and surgical benefits offered under the plan. MHPA does NOT apply to small group health plans or health insurance coverage in the individual (non-employment based) market, but you should check to see if your state law requires mental health parity in such other cases. (Visit www.ncsl.org, on the right hand side of the page enter "mental health parity" then select "State Laws Mandating or Regulating Mental Health Benefits" in order to view State specific information.) MHPA applies to most group health plans with more than 50 workers. According to Federal Standards, MHPA does NOT apply to group health plans sponsored by employers with fewer than 51 workers. For example, if your large group health plan has a $1 million lifetime limit on medical and surgical benefits, it cannot put a $100,000 lifetime limit on mental health benefits. The term "mental health benefits" means benefits for mental health services defined by the health plan or coverage.

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Under current law, large group health plans may impose some restrictions on mental health benefits and still comply with the law. MHPA does not prohibit large group health plans from: Covering mental health services within network only, even though the plan will pay for out of network services for medical/surgical benefits (although with higher out-of-pocket cost to the subscriber); Increasing co-payments or limiting the number of visits for mental health benefits; Imposing limits on the number of covered visits, even if the plan does not impose similar visit limits for medical and surgical benefits; and Having different cost-sharing arrangements, such as higher coinsurance payments for mental health benefits, as compared to medical and surgical benefits. Although the law requires "parity," or equivalence, with regard to dollar limits, MHPA does NOT require large group health plans and their health insurance issuers to include mental health coverage in their benefits package. The law's requirements apply only to large group health plans and their health insurance issuers that include mental health benefits in their benefits packages. Some additional information: A visit limit coupled with a usual, customary, and reasonable (UCR) charge is not the equivalent of an annual or lifetime dollar limit. As a result, it is not a violation of the MHPA requirements. Payments made by the plan on the basis of UCR charges will vary from one case to the next. What is not permitted is a limit on the number of visits, together with a fixed dollar limit per visit, for example, 60 visits annually at $50 per visit (totaling $3,000), unless the medical-surgical coverage is the same. You may be in a network plan that has an annual limit for mental health benefits received out-of-network, with no limits for out-of-network medical and surgical benefits. MHPA allows this as long as there is parity between medical and surgical benefits and mental health benefits received in the network. A large group health plan (or health insurance coverage offered in connection with a group health plan) is not subject to MHPA if the application of its provisions to the plan raises costs by at least 1%. If your large group health plan has separate dollar limits for mental health benefits, the dollar amounts that your plan has for treatment of substance abuse or chemical dependency are NOT counted when adding up the limits for mental health benefits and medical and surgical benefits to determine if there is parity. An example of a coverage provision that violates MHPA is as follows: Your plan has a limit of 60 visits per year for mental health benefits, along with a fixed dollar limit of $50 per visit - a - 74 -

total annual dollar limit of $3,000. It places no similar limits on medical and surgical benefits. MHPA does NOT allow this inequality to exist for large group health plans covered by the law. Note: There are three exceptions to the MHPA requirements: MHPA requirements do not apply to small employers who have between 2 and 50 employees; Large group health plans that can demonstrate that compliance with MHPA increases their cost by at least one percent can notify their beneficiaries that MHPA does not apply to their coverage; and A nonfederal government employer that provides self-funded group health plan coverage to its employees (coverage that is not provided through an insurer) may elect to exempt its plan (opt-out) from the requirements of MHPA and the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) by issuing a notice of opt-out to enrollees at the time of enrollment and on an annual basis thereafter. The employer must also file the opt-out notification with CMS. On October 3, 2008, the President signed the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following: If a group health plan includes medical/surgical benefits and mental health benefits, the financial requirements (e.g., deductibles and co-payments) and treatment limitations (e.g., number of visits or days of coverage) that apply to mental health benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits; If a group health plan includes medical/surgical benefits and substance use disorder benefits, the financial requirements and treatment limitations that apply to substance use disorder benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits; Mental health benefits and substance use disorder benefits may not be subject to any separate cost sharing requirements or treatment limitations that only apply to such benefits; If a group health plan includes medical/surgical benefits and mental health benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network mental health benefits; If a group health plan includes medical/surgical benefits and substance use disorder benefits, and the plan provides for out of network medical/surgical benefits, it must provide for out of network substance use disorder benefits;

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Standards for medical necessity determinations and reasons for any denial of benefits relating to mental health benefits and substance use disorder benefits must be made available upon request to plan participants; The parity requirements for the existing law (regarding annual and lifetime dollar limits) will continue and will be extended to substance use disorder benefits. For more information, visit: http://www.cms.hhs.gov/HealthInsReformforConsume/04_TheMentalHealthParityAct.asp AWARE OF CURRENT POLICY AND LEGISLATION There is an abundance of information about current policies and legislation in Arkansas that affect children with special needs. Unfortunately, what gets in the way of accessing this information for families is a lack of knowledge and feeling overwhelmed by the sheer size of all the terms and knowing the difference between rules, laws, policies and the like. Perhaps the best place to start is by understanding the three branches of government, also known as the Separation of Powers. The normal governance structure in democratic states include the executive (Governor), the legislative (Senate and House of Representatives) and the judicial (Arkansas Supreme Court). The scope of this section will focus primarily on the legislative portion of government, as that is where a parent can become most involved. Some basic terms that will help a parent become more knowledgeable about the legislative process include the following: Bill: A proposed law, introduced during a session for consideration by the legislature, and identified numerically in order of presentation. Act: A bill that was passed by the legislature and enacted into law. Public Law: Constitutional Law: The relationship between the state and individual, and the relationships between different branches of the state, such as the executive, the legislative and the judiciary. Administrative Law: Regulates bureaucratic managerial procedures and defines the powers of administrative agencies. Criminal Law: The term criminal law, sometimes called penal law, refers to any of the various bodies of rules in different jurisdictions, whose common characteristic is the potential for unique and often severe impositions as punishment for failure to comply. Criminal punishment, depending on the offense and jurisdiction, may include execution, loss of liberty, government supervision (parole or probation), or fines.

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Policy: The process of making important decisions that can be understood in a variety of arenas such as political, management, financial, and administrative to reach explicit goals within those arenas. The internet provides a family with a wealth of information that could put them in position to know the ins and outs of a public agencys rules and regulations. For instance, the Administrative Procedures Act, ACA 25-15-201, specifies that states are required to have their agencies, boards and commissions file a copy of their rules and regulations with the Secretary of State. Act 1478 of 2003 requires the Secretary of State to publish all agency rule notices, emergency rules, adopted rules, proposed rules and financial impact statements on the Secretary of State's website. The website that can provide you with that information is: http://www.sos.arkansas.gov/rules_regs.html. Arkansas Advocates for Children and Families provides access to all the bills that were passed in the most recent legislative session. The following is a brief summary of some of the new Arkansas laws that might impact families with children, especially children with mental health needs. For a complete list of bills that were passed and made into laws visit the following website: http://www.aradvocates.org/research/legislation.asp. After School and Summer Programs: SB374 Sponsor: Wilkins General Improvement Fund appropriation bill that appropriates $142,000 to the DHS Division of Child Care and Early Childhood Education for after school programs for low-income and rural school districts. Status: Act 985. SB635 Sponsor: Teague- The Department of Rural Services General Improvement Appropriation. It includes $25,000 for grants to Arkansas Boys and Girls Clubs for construction, maintenance, renovation, equipment, and expenses associated with youth program activities. Status: Act 1097. Child Care and Early Childhood Education: SB252 Sponsor: D. Johnson An act to ensure the enrollment age in pre-K is consistent with the enrollment criteria for entry into public school; and to ensure that adequate notice is given to preK program providers about the new age requirements. The act sets forth new age requirements for 3- and 4-year-old children to enter pre-K programs. Status: Act 426. SB342 Sponsor: Wilkins Requires child care facilities to prepare and file written plans for emergency procedures to protect children during emergencies. Status: Act 801. SB963 Sponsor: Steele An act to provide child care services for temporary assistance to needy family recipients enrolled in day or evening classes in a two-year college. Status: Act 1485. HB1098 Sponsor: Rep. Webb and Senator D. Johnson Expands the definition of children allowed to enroll in a Kindergarten program to include the following: Children who were enrolled in a state approved pre-K program in 2008-2009 for at least 100 days that year and any subsequent year and who will be 5 years of age no later than September 15 during the year he or she is enrolled in Kindergarten. Status: Act 29.

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Child Welfare: HB1008 Sponsor: R. Green Allowing grandparents and great-grandparents visitation to occur without regard to which parent has physical custody of the child. Status: Act 271. HB1633 Sponsor: Reep An act to clarify the authority of foster parents and preadoptive parents regarding consent to medical treatment. Status: Act 700. HB1715 Sponsor: Creekmore To expand the list of mandated reporters of suspected abuse or neglect. Status: Act 629. SB350 Sponsor: Key To repeal the kinship foster care program in the Division of Children and Family services of the Department of Human Services. Status: Act 324. SB359 Sponsor: Madison An act to create the Arkansas Foster Youth Transitional Plan. Status: Act 391. SB464 Sponsor: Madison To help ensure the health, safety, and welfare of children by modernizing and updating the law related to child abuse and neglect. Status: Act 749. Education: HB1272 Sponsor: Blount To increase parental involvement in Arkansas public schools. Status: Act 397. HB1450 Sponsor: Reynolds To enhance the safety of children by requiring central registry checks for all public school employees and bus drivers. Status: Act 1173. HB2163 Sponsor: Rainey To increase accountability for achievement gaps in school districts and to provide intervention and support to public school districts to address the severity of achievement gaps. Status: Act 949. SB238 Sponsor: Laverty To ensure students categorized with behavioral disabilities in other states are promptly and adequately placed in the Arkansas public school system. Status: Act 377. SB358 Sponsor: G. Jeffress To allow reasonable accommodation for a student who has difficulty with sensory processing when taking state required tests. Status: Act 1460. SB847 Sponsor: Broadway To allow a student to continue attendance at a nonresident school district in some circumstances. Status: Act 1368. SB943 Sponsor: Elliott To improve parents' access to public school data on achievement gaps and on public school plans to close achievement gaps. Status: Act 1373. Health: HB1204 Sponsor: Reep To increase the tax on cigarettes and certain tobacco products and to modernize the tax on moist snuff. Revenue would fund a host of health programs that stand to

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benefit children and families, including expanded ARKids First, substance abuse services for youth and pregnant women, coordinated school health, a trauma system, community health centers and others. Status: Act 180. HB1700 Sponsor: Moore The ARKids First Improvement Act. This bill would raise family income eligibility for the ARKids First childrens health insurance program from 200 to 250 of the federal poverty level. Status: Act 435. HB2195 Sponsor: Pennartz To amend the Arkansas mental health parity act, 23-99-501 et seq. and to make certain amendments to the act consistent with federal law. Status: Act 1193. Juvenile Justice: HB1057 Sponsor: Hobbs To provide notification of changes to a juvenile safety plan to school principals and assistant principals. Status: Act 334. Tool for reading these summaries: SB: Senate Bill HB: House Bill Sponsor: Last name of elected state official who is sponsoring the bill Laws are also passed on a federal level (national level) and are equally important to children and families. As stated earlier in this chapter, Medicaid is a joint federal-state program which means that both federal and state government can administer certain rules and regulations. On the federal side, they govern wider aspects of Medicaid such as definitions and usage of certain covered services. Recently, several US Senators, with one being from Arkansas (Blanche Lincoln), have reintroduced the Medicaid Services Restoration Act (S.1217). This legislation was first introduced in Congress in response to a series of extremely restrictive Medicaid regulations. This legislation clarifies and protects vital Medicaid services for vulnerable populations such as children and youth involved in our nations child welfare and foster care systems, individuals with disabilities, and children and adults with mental illness. A summary of what this legislation would do includes the following: Create a new service category to finance therapeutic foster care (TFC) for children with serious mental and emotional disturbances. TFC is the least restrictive form of out-ofhome placement for children with serious mental disorders, and would keep children in their home community. Trained surrogate parents provide a structured, therapeutic environment where children receive intensive individualized Medicaid psychiatric rehabilitation services and learn coping skills and how to manage the symptoms of their illness. Allow states to use bundled rates to pay for services through the rehabilitation option instead of, as CMS insists, accounting and billing for services in 15-minute increments. Although not specifically described in the rehabilitation regulation, this denial of payment through daily rates, case rates and similar arrangements severely restricts providers ability to provide evidence-based practices like assertive community treatment and multi-systemic therapy. The legislation would also permit efficient and reasonable

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payment methodologies under the case management and targeted case management option. Authorize Medicaid to pay for physical health care for children who are placed in a 24hour psychiatric hospital or psychiatric residential treatment center that provides Medicaid psychiatric inpatient services for children under 21. This change addresses CMS claims that Medicaid law applies only to mental health services provided to children in these facilities, contradicting Medicaids EPSDT requirement that a Medicaid-eligible child receive all medically necessary services under a state plan. Codify the Olmstead case management standard that permits 180 days of intensive case management services for Medicaid beneficiaries with disabilities who are transitioning from institutions to the community. Authorize states to assign case managers to individual Medicaid beneficiaries, including multiple case managers. UNDERSTANDS THE LEGISLATIVE PROCESS AND HOW TO EDUCATE POLICY MAKERS As stated previously in this chapter, parents and caregivers of children with mental and emotional health problems need to know how policy and legislation is made so they might have an opportunity to play an active role. The first thing to realize is that our state representatives and senators work for the citizens in their districts. A quote from Abraham Lincolns Gettysburg Address has been used frequently to describe democracy: By The People, For The People. Fundamental aspects of our government entitles families, caregivers and youth to be involved in the law making process. The first place to start empowering a family who wants to be involved is to cover the basics of the legislative process. Below is a summary of steps in this process with key aspects of each step: The Legislative Process: Step 1: Introduction Only a member of Congress (House or Senate) can introduce the bill for consideration. The Representative or Senator who introduces the bill becomes its "sponsor". Other legislators who support the bill or work on its preparation can ask to be listed as "co-sponsors". Important bills usually have several co-sponsors. A bill or resolution has officially been introduced when it has been assigned a number (H.R. # for House Bills or S. # for Senate Bills), and printed in the Congressional Record by the Government Printing Office. Step 2: Committee Consideration All bills and resolutions are "referred" to one or more House or Senate Committees, according their specific rules.

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Step 3: Committee Action The committee considers the bill in detail. If the committee approves the bill, it moves on in the legislative process. Committees reject bills by simply not acting on them. Bills that fail to get committee action are said to have "died in committee, as many do. Step 4: Subcommittee Review The committee sends some bills to a subcommittee for further study and public hearings. Just about anyone can present testimony at these hearings. Government officials, industry experts, the public, anyone with an interest in the bill can give testimony either in person or in writing. Notice of these hearings, as well as instructions for presenting testimony, is officially published in the Federal Register. Step 5: Mark Up If the subcommittee decides to report (recommend) a bill back to the full committee for approval, they may first make changes and amendments to it. This process is called "Mark Up." If the subcommittee votes not to report a bill to the full committee, the bill dies right there. Step 6: Committee Action -- Reporting a Bill The full committee now reviews the deliberations and recommendations of the subcommittee. The committee may now conduct further review, hold more public hearings, or simply vote on the report from the subcommittee. If the bill is to go forward, the full committee prepares and votes on its final recommendations to the House or Senate. Once a bill has successfully passed this stage, it is said to have been "ordered reported" or simply "reported." Step 7: Publication of Committee Report Once a bill has been reported (See Step 6 ), a report about the bill is written and published. The report will include the purpose of the bill, its impact on existing laws, budgetary considerations, and any new taxes or tax increases that will be required by the bill. The report also typically contains transcripts from public hearings on the bill, as well as the opinions of the committee for and against the proposed bill. Step 8: Floor Action -- Legislative Calendar The bill will now be placed on the legislative calendar of the House or Senate and scheduled (in chronological order) for "floor action" or debate before the full membership. Step 9: Debate Debate for and against the bill proceeds before the full House and Senate according to strict rules of consideration and debate. Step 10: Voting Once debate has ended and any amendments to the bill have been approved, the full membership will vote for or against the bill. Step 11: Bill Referred to Other Chamber Bills approved by one chamber of Congress (House or Senate) are now sent to the other chamber

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where they will follow pretty much the same track of committee to debate to vote. The other chamber may approve, reject, ignore, or amend the bill. Step 12: Conference Committee If the second chamber to consider a bill changes it significantly, a "conference committee" made up of members of both chambers will be formed. The conference committee works to reconcile differences between the Senate and House versions of the bill. If the committee cannot agree, the bill simply dies. If the committee does agree on a compromise version of the bill, they prepare a report detailing the changes they have proposed. Both the House and Senate must approve the report of the conference committee and the bill will be sent back to them for further work. Step 13: Final Action Enrollment Once both the House and Senate have approved the bill in identical form, it becomes "Enrolled and sent to the President of the United States. The President may sign the bill into law. The President can also take no action on the bill for ten days while Congress is in session and the bill will automatically become law. If the President is opposed to the bill, he can "veto" it. If he takes no action on the bill for ten days after Congress has adjourned their second session, the bill dies. This action is called a "pocket veto". Step 14: Overriding the Veto Congress can attempt to "override" a governor or president veto of a bill and force it into law, but doing so requires a 2/3 vote by a quorum of members in both the House and Senate. Another helpful tool for families to get a better understanding of how a bill becomes a law is provided in this useful maze:

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http://www.soskids.arkansas.gov/pdfs-09/bill-becomes-law-maze.pdf

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Once a parent or guardian understands the basics of law- making, it may become time to get him or her thinking about how to make the best impact on the process. First, in order to truly empower a parent or guardian to get involved, a family support provider must adhere to essential skills that have been covered in chapter 3. A parent does not need to be thrust into this type of arena without basic readiness such as confidence in knowing the subject that they are wanting to impact, confidence in his or her ability to speak in front of others and a well organized course of action. Once those basic skills are in place, there are a series of specific things a parent or guardian can do to get their hands dirty in political lobbying. A good summary of suggestions that will help a parent get involved is titled: The Basics of Lobbying The Arkansas General Assembly and is provided by the Arkansas Advocates for Children and Families. The Basics of Lobbying the Arkansas General Assembly 1. Learn the basics! It is important to learn the basics about the legislative process, especially how a bill becomes a law. An easy to read presentation about how a bill becomes a law is available at http://www.soskids.arkansas.gov/pdfs09/btlhandoutpdf.pdf. 2. Start Now! Do not wait until the session begins in 2011 to begin preparing. The decisionmaking process for many issues, especially big budgetary issues, has already begun. The Legislature begins holding budget hearings in the fall prior to a legislative session. 3. Do your homework! Prior to your initial meeting with a legislator, know what the problem is and the specific Arkansas law that needs to be changed. You can research Arkansas law at http://www.soskids.arkansas.gov/pdfs-09/btlhandoutpdf.pdf. It is always helpful if you can identify model legislation or existing legislation in other states that address your issue. If you cant identify potential legislation, tell your legislator that you need help in drafting the legislation. Legislators can ask staff from the Bureau of Legislative Research to help draft the legislation. 4. Find your legislator! Find a friendly legislator, preferably an influential one, to carry your legislation during the session. A good place to start is with the representative or senator from your own district or one that has a reputation of being good on your issues. If you dont know which legislative district you live in, contact your County Clerks Office. 5. Bring your friends to the party! Form a coalition or group that will support your legislation. Legislators are more likely to listen and support your bill if you can show others support it, especially constituents from his district or members of an established group that he respects. 6. Show me the money! Identify how much your proposal will cost and how it can be funded. If your bill will require new money to implement, it is important to identify possible sources of funding. As a general rule, bills that dont require new money (especially new state money) are more likely to get funded. If your bill involves a tax issue, ask your legislator to request a revenue impact statement from the Department of Finance & Administration prior to the session. 7. Know your opposition! Identify who is likely to support or oppose your bill and their reasons for doing so. This includes the members of the House and Senate committees that will consider your bill, members of both Chambers, and other lobbyists. Also, anticipate possible arguments against your bill and counter-arguments that support you.

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8. Honesty is a must! Always be honest with legislators. If you dont know the answer to a question about your bill, be honest about it. If a legislator asks who will be opposing your bill and why, be honest about it. You will lose credibility with a legislator if he feels you are misleading him. Remember, credibility is a long-term relationship. 9. Be supportive! Be willing to help your legislator with the bill in any way possible (within reason of course). If he asks you to do some research on an issue pertaining to the bill, you should oblige him. If he asks you to be ready to testify on the bill, you must be willing to attend committee hearings. A good practice is to prepare a 1-page fact sheet about your bill, including the reasons for supporting your bill. 10. Follow through! Even if a legislator agrees to carry your bill, dont expect your bill will be at the top of his agenda and he will take care of it. Some legislators are asked to carry as many as 50 or 60 bills and cant devote full attention to any one bill. You can track the status of your bill at http://www.arkleg.state.ar.us. You must follow-up with your legislator regularly until action is completed on your bill. 11. Lobby! Lobby! Lobby! Be prepared to lobby on behalf of your bill. Even if an influential legislator is carrying your bill, he may need your help in convincing other legislators to support it. 12. Brevity is always better! Once the session starts, the time demands on most legislators are overwhelming. If you will be lobbying legislators, develop a 2-3 minute pitch on why they should support your bill. Any written materials you prepare must be short, preferably no more than 1-2 pages. Legislators do not have the time to read long reports, especially once the session begins. 13. Todays opposition may be tomorrows allies! Dont burn your bridges with a legislator on one issue. Dont bad mouth a legislator because he disagrees with you. A legislator who doesnt support you today on one issue may support you later on another. Remember, reasonable people can agree to respectfully disagree! * Prepared by Rich Huddleston, Arkansas Advocates for Children & Families. Another resource for families who want to get involved in policy development is a State Advocacy Tool Kit. You may download one at http://www.aacap.org/cs/root/legislative_action/state_advocacy_toolkit. ABLE TO PARTICIPATE IN LOCAL AND STATE POLICY DEVELOPMENT Once a family becomes more comfortable with the legislative process, they may be able to make an even bigger impact at a local level. If a parent wants to make an impact in their community, he or she may have several options, depending on what type of need the parents, guardian or youth have. Perhaps the first step a family can take in knowing their citys leaders and governmental structure is through the Arkansas Municipal League. Their website is http://www.arml.org/ . The Arkansas Municipal League is an instrumentality of municipal governments from throughout Arkansas made up of voluntary cities and towns and was founded in 1934. It has three major purposes: to act as the official representative of Arkansas cities and towns before the state and federal governments; to provide a clearinghouse for information and answers; and, - 85 -

to offer a forum for discussion and sharing of mutual concerns. On the Municipal Leagues website, a parent or guardian will first find the link to the Local Government Portal. http://local.arkansas.gov/index.php. This will take the parent to a map of the state of Arkansas. There the parent will click on their county and find a list of all the cities and towns in that county. Once a city or town is chosen, the website provides you with an exhaustive list of city leaders including the mayor, police chief, fire chief, parks and recreational director, and every city council member. There is also a list of all the school districts in each city or town. Overall, it is very important for a family support provider to build strong relationships with their community leaders to see where they stand on issues, especially issues impacting vulnerable children and families. For example, a parent may want to know what areas of interest the citys parks and recreation director has. This individual is leading the citys agenda on issues such as where youth spend their time after school and during the summer, how accessible these places are and their plans for promoting safety in those places of recreation. If a parent finds out that what is on the citys agenda does not fall in line with what he or she feels are major concerns, there is always the option to rally other non-traditional leaders in the community. Obviously, these types of leaders differ in each community according to the communitys history and culture. An effective way to gain knowledge of a communitys culture is by attending town meetings and visiting with people who have lived in that community a long time. In most cases, getting any leverage within a community starts with who you know and not what you know. This reality makes family involvement a real possibility, as many community organizations are open to families such as churches, school board meetings, and city council meetings.

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Chapter 5: CULTURAL COMPETENCE Introduction For all families, culture plays a critical role in the goals parents set for their children. Understanding a familys culture can help Family Support Providers better serve them. When offering parenting advice, it is important that Family Support Providers remember that healthy child development can follow many paths. Cultural competence is a developmental process that evolves over an extended period, with individuals and organizations being at various levels along a continuum, according to the National Center for Cultural Competence (NCCC) at Georgetown University. The National Center also states that culturally competent organizations: have a defined set of values and principles, and demonstrate behaviors, attitudes, policies and structures that enable them to work effectively cross-culturally, have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge and (5) adapt to diversity and the cultural contexts of the communities they serve, and incorporate the above in all aspects of policy making, administration, practice, service delivery and involve systematically consumers, key stakeholders and communities. But what does Cultural Competence mean to families? Why is it important to develop an understanding of various cultures and belief systems? Efforts to increase cultural competence among all who work with families are necessary in developing a culturally competent System of Care. Culture affects all parts of family life how family members respond to each other and those outside of their family; how families receive information and assistance from agencies; how families communicate with those outside of their family. Typically, those in child-serving agencies move along the continuum of cultural competence, as described by the NCCC. The 6 points along this continuum are: 1. Cultural Destructiveness 2. Cultural Incapacity 3. Cultural Blindness 4. Cultural Pre-Competence 5. Cultural Competence 6. Cultural Proficiency Cross TL, Bazron BJ, Dennis KW, Isaacs MR (1999). Toward a Culturally Competent System of Care, Volume 1. National Institute of Mental Health, Child and Adolescent Service System Program (CASSP) Technical Assistance Center, Georgetown University Child Development Center. Cultural competence is a work in progress. Understanding what is different from us is not easy, but we can learn to respect and be sensitive to those different from us. The guiding principles of Systems of Care state that Children with emotional disturbances should receive - 87 -

services without regard to race, religion, national origin, sex, physical disability, or other characteristics and services should be sensitive and responsive to cultural differences and special needs. It is the responsibility of anyone working with youth and families to strive to become more culturally aware and competent, to better ourselves and to better serve those with whom we work. DEMONSTRATES RESPECT FOR FAMILIES/CAREGIVERS FROM DIVERSE CULTURAL, RELIGIOUS, SOCIO-ECONOMIC, EDUCATIONAL, RACIAL, ETHNIC AND PROFESSIONAL BACKGROUNDS, AND PERSONS OF ALL AGES AND LIFESTYLE PREFERENCES For all families, culture plays a critical role in the goals parents set for their children. Understanding a familys culture can help Family Support Providers better serve them. What is Culture? Culture is not just ethnicity, race or religion. Culture is seen in any group that shares a history and belief system that affects how they function. It is important to distinguish societal culture and home culture. Societal culture is made up of the things in society that express the groups value system (educational systems, medical systems, political systems, religious systems, the media, etc.). As Family Support Providers, you may work in the agencies in society which may make it difficult to see that views different from your own are okay. Home culture is made up of the values of the immediate family. Sometimes, home culture can conflict with the societal culture. An example is the cultural practice of arranged marriage. It can be hard for families to maintain their home culture with their children (e.g., values, behaviors, ceremonies), while also combining them with the society around them (e.g., schools, doctors, and clubs). The process of combining and balancing the two cultures can be hard for families who are coming in contact with new agencies and value systems. Cultural values can usually be divided into independence or interdependence. The U.S. culture commonly stresses values of independence while non-Western cultures focus more on interdependence. The most important goal of raising independent children is for them to take care of themselves and act on their own personal choices. On the other hand, the primary goal of raising interdependent children is for them to be part of a larger system of relationships to depend on others for well-being. A range of both independence and interdependence can be seen in any family or culture. Parents are usually adjusting each value according to the particular goal they are trying to achieve for their children. The following information regarding the impact of culture on parenting comes from: Culture and Parenting: A Guide for Delivering Parenting Curriculums to Diverse Families, (2006) University of California Cooperative Extension; Lenna L. Ontai, Ann Mastergeorge, Families with Young Children Workgroup - University of California, Davis Communication -Research finds that:

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Communication is important for teaching children about essential cultural and social information. Cultures that focus on developing independence in children tend to communicate about the physical world, such as using objects, and other topics that prepare children for school. Independent cultures emphasize outward expression using words or gestures like pointing to an object and saying the name to teach infants new words or learning games by listening to or reading the instructions. Cultures that focus on developing interdependence in children use communication to develop childrens social knowledge, such as how objects relate to one another. Interdependent cultures use more non-verbal and subtle expression such as learning games through observation or using touch, gaze, posture, and facial expressions to express meaning. Some interdependent cultures do not speak directly to infants and toddler but rather speak around them. Children raised in these environments tend to speak later than other children but catch up quickly. Discipline - Research finds that: Cultures that focus on developing independence in children value parenting strategies that provide structure while being available, involved, warm, and sensitive. Examples are using time outs or explaining why hitting is wrong. Children are encouraged to think about their behavior and learn about limits. Cultures that focus on developing interdependence in children use strategies such as shaming to exert control over childrens behavior rather than giving choices and time to think. These strategies encourage respect for elders and authority figures. Parenting strategies can be different in different situations. Time-out and explanations are most effective in middle-class environments where misbehavior is not life-threatening and time and resources are available. In high-risk environments, misbehavior can result in more serious consequences (dense traffic, unsafe environments outside the home). In these contexts, more controlled discipline strategies tend to be more effective and valued. Discipline strategies can be tightly linked to cultural values and traditions. In cultures where respect for elders is important, shaming is seen as an effective way to promote this important value. Parent-Child Emotional Bonding -Research finds that: Parents and children of all cultures share a deep, emotional connection called attachment. This bond is expressed through behaviors that may vary across cultures. Interdependent cultures tend to use more behaviors to bond with their children. Independent cultures tend to use verbal exchanges such as I love you along with touch. Attachment to parents help children feel safe in the world and in their later relationships with others as adults. In many cultures like the U.S., building a strong, emotional connection to infants begins at the time of conception with behaviors like talking to the womb, family delivery rooms, and encouraging breast feeding as a bonding activity.

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In cultures with high infant mortality rates, bonding between parents and children is commonly delayed until that childs survival is more certain. In cultures with large extended families or close communities, parents may encourage children to bond with multiple people. Family Structure and Roles -Research finds that: Different cultures define family in different ways. Some include extended family members (i.e. aunts, uncles, cousins, second cousins, etc.) or close family friends in the decision making and day-to-day functioning of the family. In cultures that focus on developing interdependence, all members are responsible for all children in the community, not just their own. This helps to build connections between individuals. Having an extended family system can help to increase the chances of survival for children in environments where survival rates are low. Having an extended network that feels jointly responsible for all the children in the community can decrease childrens misbehavior. Children in interdependent cultures are seen as part of a larger family system rather than as an individual. The family system is the highest authority. In independent cultures the core family unit is usually the authority when it comes to decisions about parenting and child rearing. Gender Role Development -Research finds that: Children receive messages about their gender from the time of birth and begin to form a gender identity by the age of 2. Parents often treat boys and girls differently. For example, girls may be held more tightly than boys and boys may be given more freedom than girls. Cultural expectations for girls and boys drive gender socialization behaviors. For example, in the U.S., girls tend to be encouraged to express emotion while boys are encouraged to be less emotionally expressive. Values placed on gender roles vary greatly across cultures and across individual families. In the U.S., gender equality is valued by many. In other cultures, gender differences are highly valued. Immigrant families may experience conflict when their gender expectations conflict with U.S. culture and their children begin to challenge traditional gender roles. This conflict can affect childrens developing sense of self and ethnic identity. Play -Research finds that: Children use play to learn about and explore new skills, roles and values important in their culture. Cultures that focus on developing independence in children encourage one-to-one (dyadic) play that is child-focused such as stacking blocks and babbling with infants. Cultures that focus on developing interdependence in children encourage large group play where many different people are involved and tend to use more observation and mimicking of normal routines.

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Games in independent cultures tend to have winners and losers more than in interdependent cultures that have games that rely on cooperation. Sleeping Arrangements -Research finds that: Sleeping arrangements for infants vary widely from family to family and across cultures. Interdependent cultures and families regularly use co-sleeping (where one or two parents sleep with the infant). As many as two-thirds of cultures in the world sleep together as a family (i.e. the family bed). Co-sleeping arrangements help the parent-child bond, have lower SIDS cases, tend to breastfeed longer and have extended mother/child sleep cycles. Parents rolling over onto a child and suffocating from bedding structures are concerns with co-sleeping. Independent cultures believe that separate sleeping arrangements help children develop independence, and maintain parental privacy. Families who sleep separately in the U.S. tend to have fewer reported marital difficulties than those who co-sleep. There is some concern over abuse issues in co-sleeping families. There is no research evidence that there are higher abuse rates in co-sleeping families. UNDERSTANDS THE IMPORTANCE OF CULTURAL, RACIAL, SOCIAL AND BEHAVIORAL FACTORS IN SUPPORTING FAMILIES/CAREGIVERS CARING FOR CHILDREN WITH BEHAVIORAL HEALTH NEEDS In this section, we will be talking about understanding the importance of cultural, racial, social, and behavioral factors in supporting families/caregivers caring for children with behavioral health needs. Families of all cultures want what is best for their children and families, but when the behavior of their child is different from what is familiar, it can become scary to those observing from the side lines. Remember that your cultural background shapes the way you look at a family and you will need to step back from time to time to get a clear picture of the culture of others. There are 7 areas of culture that we will be looking at in this section: communication, discipline, parent-child emotional bonding, family structure and roles, gender role development, play and sleep arrangements. 1. Communication- All children will learn to communicate the way their family will understand them, beginning with crying. All mothers know the difference between their childs hungry cry and their Im wet cry simply by the difference in the tone of the cry. As a baby grows he/she will learn by listening and watching their parents. Most families teach a baby by starting with simple words such as mama, dada, no-no, and byebye. Many families teach children by showing them something then saying the name until the child can say the word. During this period of time, we begin to teach our children about our family cultures and values. For example, we may begin by taking them to church and teaching them how to sit quietly during the service. Lets face it, this is a wonderful time of learning that we share with our children. 2. Discipline- Take a moment and think about how your culture, society and family structure has shaped you ideas on discipline. Different cultures have different views on what type of behavior is desirable. Many families in middle- class America use the time-

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out method or give their children opportunities to make choices before jumping in and spanking them because they live in a safe environment and they can take the time to teach children without worry of outside dangers. When you look at families that have lived in areas where the environment is dangerous, they may tend to be more strict than you. This doesnt necessarily mean they are wrong in their approach, they are just different and we must respect them. 3. Parent-child emotional bonding-Bonding with your child is a very personal issue and can be done in many different ways. In the United States, we place great importance on bonding and begin as early as the first trimester of pregnancy by talking to the baby or placing ear phones on the tummy and playing music for the baby. Bonding is also encouraged by family delivery rooms or having the baby room- in with mom while they are in the hospital. In some cultures, infant mortality rates are so high that bonding doesnt happen until families are sure the child will survive. Regardless of culture, bonding is important for families and should be taught and encouraged even if the child is no longer an infant. 4. Family structure and roles-Not all families look like yours or mine! Be respectful of the differences you will encounter. Just because they are different does not mean they are wrong. Some families do not include outsiders in the decision- making process within the family unit, such as aunt, uncles, grandparents, which is very common in the United States. Some cultures consider the unborn child as the child of the parents until birth; at that time, the child belongs to the community or tribe. You should support all family structures and roles and help incorporate new roles that are safe for the children. 5. Gender Roles and Development-Ladies, remember when you were a kid and your parents gave you a doll and your brother a truck and all you really wanted was to play with that little truck; and men, do you remember vice versa? That is gender identity in the making. Parents often treat boys and girls differently, giving boys more freedom and holding girls more tightly. In the US, gender equality is highly valued, thanks to the Womens Suffragette movement of the early 1900s. 6. Play-Play should be fun regardless of what we are trying to teach our children. Children learn in many different ways. They learn from helping do simple chores such as sweeping the floor, folding clothes or dusting the furniture. In a culture where education is highly valued, children may need to engage in learning games that incorporate counting or language skills. Children will learn if you keep learning fun! 7. Sleeping Arrangements-Family and cultural roles play a major part in whether or not a baby sleeps with parents. Some families feel that both mother and child will have a better sleep cycle if the baby sleeps with mom and dad, while other cultures feel the baby will become more independent if the baby sleeps in his or her own room. Regardless of where the baby sleeps, we must make sure that the baby is safe.

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DEVELOPS AND ADAPTS APPROACHES TO REACH OUT TO DIVERSE FAMILIES/CAREGIVERS. The following information is adapted from: Culture and Parenting: A Guide for Delivering Parenting Curriculums to Diverse Families, (2006) University of California Cooperative Extension; Lenna L. Ontai, Ann Mastergeorge, Families with Young Children Workgroup - University of California, Davis Tips for the field: Parents vary on how much they use verbal and non-verbal communication with their children. They may be more comfortable using different kinds of communication strategies in different situations. Encouraging parents to use more outward expressions with their children can help children to be prepared for school settings where verbal communication is valued. Some parents may overlook talking directly to pre-verbal infants and toddler. Encouraging parents to speak directly to infants and toddlers will help to avoid language delays. The use of more internal forms of expression such as facial expressions can help children learn to pay attention to others feelings and emotions. This will help prepare them for social interaction. Understanding parents goals for their childrens behavior is important. Time-out strategies can help children develop thinking skills. Taking more control over childrens behaviors and choices can help children learn to respect authority figures and rules. Families from interdependent cultures may use other relatives or networks to discipline their children. It is important to be aware of the existence of these types of important familial and social ties when working with parents. Helping parents to understand their own goals for their discipline behaviors can help them to try other strategies that may be more effective. Parents may not like certain types of discipline strategies that go against their value systems. Childrens safety and well-being must always be considered. While some strategies may be tied to cultural values, it is important to watch for cases of emotional and physical abuse. Understanding the underlying parental goals and the meaning behind their behaviors with their infants and children is critical to helping parents from all types of families build and maintain a strong bond with their children. Children can bond with multiple caregivers who they see on a regular basis and provide warm and consistent care. This can help children learn to build relationships with others. Some parents can feel guilty or uncomfortable with behaviors that encourage their child to be more independent such as going to pre-school or sleeping in their own bed. Supporting behaviors that help parents feel bonded to their children is important. The term family can have different meanings to different people depending on their background. It is important to acknowledge and support important roles played by extended family members or close family friends.

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There are increasing numbers of non-traditional family units (e.g. single parents, samesex partners, grandparents as parents). Extended family members can be important sources of support for children and parents living in non-traditional family units. Some roles played by family members may not be typical for U.S. culture. For some families, it may be expected that the oldest sibling give up extracurricular activities to take primary care of the younger children. It is important to understand the goal of parents and the family when addressing these roles. Playing an important role in the family such as caregiver or provider can increase adolescents sense of self-esteem even though they may be giving up other activities. Involving extended family can help parents to feel more supported and gives children multiple sources of support in their development. Understanding the historical cultural background of gender expectations is important to help families both maintain their cultural heritage and traditions, while helping to integrate the expectations of U.S. culture in their goals for their children. It can be hard to understand valuing various views on gender roles. It is important to realize that appropriate behaviors can be strongly connected to traditional gender roles in other cultures. First and second generation children from immigrant families often challenge traditional gender roles held by their parents. This can be the cause of tension and stress for parents. Supporting parents in their efforts to maintain their cultural traditions while helping them identify with their childrens experiences in the U.S. culture is important. How to resolve the inconsistency between traditional gender roles and those valued by the U.S. may not be obvious to some parents. Helping parents with strategies that allow children to explore new gender roles that dont entirely conflict with traditional roles can be helpful (e.g. activities with groups of friends instead of dating, considering non-contact sports such as gymnastics or dancing for girls). Routine activities such as folding clothes or sweeping can be play for children. These types of play activities help to build motor control while also letting children explore normal routines in their environment. Some parents may feel uncomfortable with some play activities like competitive sports or face-to-face play. These activities are not consistent with some cultural values such as children should learn to work together with many different people. Play may be valued differently by families with different cultural values. It is important to understand parents underlying goals for their children. Consideration of parents underlying goals in raising their children should be kept in mind when suggesting new activities for children. For example, in families where academic performance is highly valued, children may benefit from activities that incorporate counting, reading or problem solving skills. Sleeping arrangements can impact a family dramatically. Parents may feel guilty with their child in a separate room or experience marital problems when the child shares their bed. Understanding parents goals for their children and supporting the behaviors toward those goals are important. Co-sleeping arrangements may be tied to interdependent cultural values such as dependence and reliance on elders. Self-reliance and ability to self-soothe are less important in these cultures.

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Families who co-sleep should be encouraged to make their bed safe for their child. Appropriate information on steps they can take is available from doctors and hospitals. There are many patterns of parenting behaviors. We all have our own opinions about what is good parenting and these opinions are okay. When working with families, it is important to consider how your background influences your views. We may not agree with all the behaviors that are being expressed by families with whom we work; however, it is important to take the time to understand what motivates these behaviors. Parents have various goals for their children and these goals influence the decisions they make in their parenting. Understanding the role culture assumes in shaping these goals will allow you to relate to families from their perspective. Ultimately, parents respond to people who understand and respect their goals for their children and their parenting. In the end, we all want the best for children. When beginning work with diverse populations, it is a good idea to use a tool similar to the following checklist , as presented by Ontia, et. al. to develop increased awareness of ones own thoughts and feelings about persons of a culture differing from their own. Self-Awareness Checklist: Do you understand how culture influences communication between parents and children? see how the culture, society and family structure that you live in has shaped your views on appropriate parent-child communication patterns? understand how independent and interdependent values shape communication patterns? consider alternative communication behaviors that families may use? consider the underlying cultural goals that motivate various communication patterns? support parents who use alternative communication patterns (that are safe for the child) and help parents incorporate new communication behaviors into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of multiple parent-child communication patterns? Do you understand how culture influences discipline practices? see how the culture, society and family structure that you live in has shaped your views on appropriate parent-child communication patterns? understand how independent and interdependent values shape communication patterns? consider alternative communication behaviors that families may use? consider the underlying cultural goals that motivate various discipline behaviors? support parents in alternative discipline behaviors (that are safe for the child) and help parents incorporate new discipline behaviors into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of multiple discipline strategies? Do you understand how culture influences bonding behaviors? see how the culture, society and family structure that you live in shapes your views on appropriate bonding behaviors? understand how independent and interdependent values shape bonding behaviors?

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consider alternative bonding strategies families may use? consider cultural goals that motivate various bonding behaviors? support parents in alternative bonding behaviors (that are safe for the child) and help families incorporate new bonding strategies into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of various bonding strategies? Do you understand how culture influences family roles? see how the culture, society and family structure that you live in shapes your views on family roles? understand how independent and interdependent values shape family roles? consider alternative structures and roles families may have? consider underlying cultural goals that motivate family roles? support parents in alternative family roles (that are safe for the child) and help parents incorporate new family roles into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of multiple family roles? Do you understand how culture influences gender socialization behaviors? see how the culture, society and family structure that you live in shapes your views on appropriate gender socialization behaviors? understand how independent and interdependent values shape gender socialization behaviors? consider alternative gender socialization strategies families may use? consider the underlying cultural goals that motivate various gender socialization behaviors? support parents in alternative gender socialization behaviors (that are safe for the child) and help parents incorporate new gender socialization behaviors into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of multiple gender socialization strategies? Do you understand how culture influences play behavior? see how the culture, society and family structure that you live in shapes your views on appropriate play behavior? understand how independent and interdependent values shape play behaviors? consider alternative play behaviors families may use? consider the underlying cultural goals that motivate other play behaviors? support parents in alternative play behaviors (that are safe for the child) and to help parents incorporate new play behaviors into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of multiple play behaviors? Do you understand how culture influences sleeping arrangements? see how the culture, society and family structure that you live in shapes your views on appropriate sleeping arrangements? understand how independent and interdependent values shape sleeping arrangements? consider various sleeping arrangements families may use?

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consider the underlying cultural goals that motivate other sleeping arrangements? support parents in alternative sleeping arrangements (that are safe for the child) and help parents incorporate new sleeping arrangements into their existing cultural framework? teach your classes (support group or trainings) from a perspective that is accepting and appreciative of multiple sleeping arrangements? A number of individual or self assessments are available. The resource cited below provides an analysis of why a family support provider should engage in self assessment to improve the quality of service they provide. http://www.tapartnership.org/docs/clcRoleofSelfAssessment.pdf Institutional Cultural Competence Institutional cultural incompetence is described as Differential access to the goods, services and opportunities of society by ethnicity or race, according to information from the 2000 US Census. Examples include housing, education, employment, income, medical facilities, information, and resources. Cultural Incapacity within organizations may affect hiring practices, allocation of resources to various ethnic groups, or even messages that some ethnic/minority groups are not welcome or valued. It may also affect and lower expectations that agencies/professionals have for some cultural or ethnic groups. -National Center for Cultural Competence, Georgetown University Center for Child and Human Development. As noted above, they provide some qualities of organizations that demonstrate cultural awareness: systems/organizations create mission statements that articulate values of cultural competence for the organization, implement policies and procedures that integrate cultural and linguistic competence in all aspects of the organization, and develop strategies to ensure consumer and community participation in planning, delivery and evaluation of the organizations function. As we explore the impact of institutional cultural incompetence, we can see how youth in the child- serving system can be affected by lack of understanding or sensitivity to ones cultural needs. Structural (or Institutional) Racism is defined as: ..Institutional or structural racism is the social, economic, educational, and political forces or policies that operate to foster discriminatory outcomes or give preferences to members of one group over others (NASW, 2007). ..Structure for allocating social privileges; perpetuates racial group inequities (NASW, 2006). ..Deeply rooted aspects of American institutions, ideology, and culture that, intentionally or otherwise, maintain and reproduce a racial order that privileges whiteness. (Lawrence, Aspen

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Institute, 2001) -National Association of Social Workers, Social Work Speaks, NASW Policy Statements, Seventh Edition, 2006-2009. Examples of Structural Racism in Society The perception of Americans who feel they have received poor quality medical treatment or care in past 5 years because of their racial or ethnic background: Whites 1% African Americans 23% Hispanics 21% Or - because of their accent or how well they speak English: Whites 2% Hispanics 21% (Joycelyn Elders, MD: From Sharecropper's Daughter to Surgeon General of the United States of America, Harper Collins (1996.)) Or the denial rate for home mortgage loans is much higher for Latinos and African Americans than for whites-The costs of borrowing are higher for low-income and families of color (Technical Assistance Partnership Cultural and Linguistic Competence Action Team power point presentation, October 2008 http://www.tapartnership.org/events/webinars/webinarArchives/searchByDate.php?id=topic3#20 0809 -Differences in credit constraints by race and ethnicity persist, indicating discrimination in the credit industry (Center for American Progress, 2007) http://www.tapartnership.org/events/webinars/webinarArchives/searchByDate.php?id=topic3#20 0809 While children of color represent approximately 33 percent of all children in the United States, they are 55 percent of the foster care population. African American children face the gravest disparities; they are 15 percent of the child population, yet 38 percent of the foster care population. The Pew Commission, 2004

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Chapter Six: Communication Skills Introduction There are ten components in this chapter that will be addressed and will ultimately assist the family support providers in their role. Topics such as active listening, empathy, group facilitation and using technology to communicate will be highlighted. Family support providers new to their roles may not have certain communication skills that are needed to assist families in crisis. With practice, these skills can be learned and tailored to fit that particular family support providers style when working with families. Family support providers must remember that each family is different and they must develop and tailor their communication techniques to fit the family; what works for one family may not work for another. ABLE TO ACTIVELY LISTEN TO OTHERS In the article The Importance of Effective Communication (http://web.cba.neu.edu/~ewertheim/interper/commun.htm#feedback1), the authors point out that skills in communication involve a number of specific strengths. The first strength we will discuss involves listening skills. When confronted with a problem situation: Listen openly and with empathy toward the other person; Judge the content, not the messenger or delivery; comprehend before you judge; Use multiple techniques to fully comprehend (ask, repeat, rephrase, etc.); Maintain an active body state; fight distractions; Ask the other person for as much detail as he/she can provide; paraphrase what the other is saying to make sure you understand it; Respond in an interested way that shows you understand the problem and the concern; Attend to non-verbal cues, body language, not just words; listen between the lines; Ask the other for his views or suggestions; State your position openly; be specific, not global; Communicate your feelings, but don't act them out (e.g. tell a person that his behavior really upsets you; don't get angry); Be descriptive, not evaluative-describe objectively, your reactions, and possible consequences; Be validating, not invalidating ("You wouldn't understand"); acknowledge others uniqueness, importance; Be conjunctive, not disjunctive (not "I want to discuss this regardless of what you want to discuss"); Don't totally control conversation; acknowledge what was said; Own up: use "I", not "They"... not "I've heard you are uncooperative"; Don't react to emotional words, but interpret their purpose; Practice supportive listening, not one way listening. A major source of problems in communication is defensiveness. Effective communicators are aware that defensiveness is a typical response in a tense situation, especially when negative

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information or criticism is involved. Be aware that defensiveness is common, particularly with people in a help- seeking position when they are dealing with a problem. Try to make adjustments to compensate for the likely defensiveness. Realize that when people feel threatened, they will try to protect themselves; this is natural. This defensiveness can take the form of aggression, anger, competitiveness, or avoidance, among other responses. A skillful listener is aware of the potential for defensiveness and makes needed adjustment. He or she is aware that self-protection is necessary and avoids making the other person spend energy defending him or her self. In addition, a supportive and effective listener does the following: Stops talking: Asks the other person for as much detail as he/she can provide; asks for other's views and suggestions; Looks at the person, listens openly and with empathy; is clear about his position; is patient; Listens and responds in an interested way that shows they understand the problem and the other's concern; Is validating, not invalidating ("You wouldn't understand"); acknowledges other's uniqueness, importance; Checks for understanding; paraphrases; asks questions for clarification; Doesn't control conversations; acknowledges what was said; lets the other finish before responding; Focuses on the problem, not the person; is descriptive and specific, not evaluative; focuses on content, not delivery or emotion; Attends to emotional as well as cognitive messages (e.g., anger); is aware of non-verbal cues, body language, etc.; listens between the lines; Reacts to the message, not the person, delivery or emotion; Makes sure to comprehend before they judge; asks questions; Uses many techniques to fully comprehend; Stays in an active body state to aid listening; Fights distractions; (If appropriate, takes notes); decides on specific follow-up actions and specific follow- up dates. Many times, the problem may not be ineffective listening, but not getting enough relevant information. The defensiveness mentioned above and the stressors a family may be facing interferes and limits the ability of the family to provide the answers you need to be an effective helper. This is the time when effective questions are needed.

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There are two major categories for questions: closed-ended and open-ended. A closed-ended question is a form of question which can normally be answered using a simple "yes" or "no", a specific simple piece of information, or a selection from multiple choices. Example: Do you have dinner with your children? This type of question does not require the family member to go into great detail. Open-ended questions require more than a yes or no answer. http://en.wikipedia.org/wiki/Open-ended_question. They are used to help the speaker to come up with his or her own answers so the speaker can broaden and clarify his or her message and you can better understand it. Example: What did you and your family have for dinner? Openended questions require more details. Questioning skills help the family support provider assist the family in clarifying issues and narrowing options to arrive at their preferred solutions to the problems they may be facing. Listening, remaining neutral and asking questions are all important to this process. NONVERBAL SKILLS Family support providers can let family members know they are listening though nonverbal communication, including certain body language signals. According to helpguide.org, nonverbal communication, information conveyed through facial expressions, body language, pace, intensity and tone of voice gives you a powerful means for self expression. Nonverbal Communication: The Hidden Language of Emotional Intelligence (http://www.helpguide.org/mental/eq6_nonverbal_communication.htm), provided by Helpguide.org has the following table that outlines the most important nonverbal cues. Nonverbal Communication: The Most Important Nonverbal Cues Eye contact The visual sense is dominant for most people, and therefore especially important in nonverbal communication. Is this source of contact missing, too intense or just right? Facial Universal facial expressions signify anger, fear, sadness, joy and disgust. What is the expression face you show? Is it mask-like and unexpressive, or emotionally present and filled with interest? Tone of voice The sound of your voice conveys your moment to moment emotional experience. What is the resonant sound of your voice? Does your voice project warmth, confidence and delight, or is it strained and blocked? Posture Your postureincluding the pose, stance and bearing of the way you sit, slouch, stand, lean, bend, hold and move your body in space-affects the way people perceive you. Does your body look stiff and immobile, or relaxed? Are shoulders tense and raised, or slightly sloped? Is your abdomen tight, or is there a little roundness to your belly that indicates your breathing is relaxed? Touch Finger pressure, grip and hugs should feel good to you and the other person. What feels good is relative; some prefer strong pressure, others prefer light pressure. Do you know the difference between what you like, and what other people like? Intensity A reflection of the amount of energy you project is considered your intensity. Again, this has as much to do with what feels good to the other person as what you personally prefer. Are you flat or so cool you seem disinterested, or are you over the top and melodramatic? Timing and Your ability to be a good listener and communicate interest and involvement in pace impacted by timing and pace. What happens when someone you care about makes an

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Nonverbal Communication: The Most Important Nonverbal Cues important statement? Does a response not necessarily verbal come too quickly, or too slowly? Is there an easy flow of information back and forth? Sounds that Sounds such as ahhh, ummm, ohhh, uttered with congruent eye and facial gestures, convey communicate understanding and emotional connection. More than words, these sounds understanding are the language of interest, understanding and compassion. Do you indicate with sincere utterances that you are attending to the other person? Family support providers can also use clarifying questions to keep the families talking. This type of question keeps the family member engaged in the conversation, focused on the topic being discussed, and allows them to clarify unclear statements. Some examples of those types question are: Can you tell me more about that? What do you mean by ___________? The body language of the family support provider during these conversations is also important. Family support providers should practice having an open and inviting posture when speaking with families. With your body language, "you're constantly saying either, "Welcome, I'm open for business," or, "Go away, I'm closed for business." According to Nicholas Boothman "How To Connect in Business in 90 Seconds or Less" (June 3, 2002), you may be showing that you are an opportunity or a threat; a friend or a foe; confident or uncomfortable; telling the truth or spouting lies". The following are a few examples of good body and bad body language. Good Body Language Relaxed appearance Eye contact Leaning forward Nodding your head Erect posture Bad Body Language Arms folded across chest Avoiding eye contact Body pushed back from table Twirling your hair Slumped posture

With time, family support providers will become more and more comfortable around the families with whom they are working. Nonverbal communication, including body language, is an important tool to know and have when working with families. Keeping the families engaged in the process is a critical role of a family support provider. In addition to being skilled in nonverbal skills, being able to verbally communicate with families is critical. The next section, Communication Using I Messages, goes in depth about using the word I and its importance. COMMUNICATES USING I MESSAGES When speaking to someone, it is important to express ourselves so the other party understands our point of view and what is being said. Many times, family support providers rely on their own experiences to assist families with issues they may be having. During this time, it is - 102 -

important to use I messages when speaking with someone about your own situation. I messages are also important when a situation becomes tense. According to Mary Novack, Understanding Conflict: Communication Using I Statements (learningstore.uwex.edu/pdf/B3870-02.PDF) using I messages helps us take responsibility for how we feel. When speaking about personal experiences or expressing yourself during an argument, it is important to begin each sentence with the word I. According to Novack the anatomy of an I statement is comprised of three parts: the feeling, what happened, and why it matters. The following are examples of using the feeling component of using I messages: I am tired I am happy I am overwhelmed The next component of using I messages is to tell what happened. The following are examples of using the what happened component: because I was working alone because I received an A on my report .because the kids wont go to sleep The third and final component of using I messages is to tell why it matters. The following are examples of using the why it matters component: it seemed that no one wanted to help me. and I worked really hard on it. and I need to get up early in the morning. The following are all three components put together: I am tired because I was working alone and it seemed that no one wanted to help me. I am happy because I received an A my report and I worked really hard on it. I am overwhelmed because the kids wont go to sleep and I need to get up early in the morning. These phrases allow the person/people that are listening to truly understand your point of view. It allows you to put what is happening to you into words and helps you learn how to assert yourself and your feelings that will ultimately get you the things you want and need. Using I messages helps the person speaking become assertive. According to Being Assertive: A Self Help Guide (http://www.moodjuice.scot.nhs.uk/assertiveness.asp.), being assertive is the ability to stand up for ourselves and say how we feel when we feel we need to. It includes: Expressing you own opinion and feelings; Saying no without feeling guilty;

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Setting your own priorities (i.e. choosing how you spend your time); Asking for what you want; Being able to take responsible risks; Choosing not to assert yourself at times. Being assertive does not come easily for some people. Some have a fear of being criticized by other or fear people of authority. Being assertive also requires practice. The following steps can be used to strengthen assertiveness skills (Being Assertive, moodjuice.com): Keep what you want to say clear and to the point. Avoid long explanations. Look at the other person, stand (or sit) upright and keep a calm tone of voice. There's no need to apologize if you feel you are in the right. Be polite, but firm. Try to relax, rather than becoming angry. It is important to remember that being assertive does not mean being bossy or manipulative. It is about being able to speak up for yourself and letting your voice be heard. This is something that family support providers can help families learn to do. ABILITY TO RESPOND WITH EMPATHY Empathy is the capability to share and understand another's emotions and feelings. It is often characterized as the ability to "put oneself into another's shoes," Empathy does not necessarily imply compassion, sympathy, or empathic concern because this capacity can be present in context of compassionate or cruel behavior. http://en.wikipedia.org/wiki/Empathy Empathy can be in the form of nonverbal cues such as nodding your head or saying phrases such as I understand or Ive been through that. Family Support Providers must show empathy and good listening skills when working with families in and out of crisis situations. Showing empathy is important when families are going through difficult times or having trouble making changes. When providing feedback to families, Family Support Providers must ensure they are being nonjudgmental, avoid making moral or value judgments, and exhibit genuine empathy. SOLICITS INPUT FROM OTHERS Being able to go to other people when a situation is either unfamiliar or too complicated is essential for Family Support Providers. It is in no way a bad thing. Another persons area of expertise may be in an area where the Family Support Provider has limited knowledge. Seeking their input and assistance with certain matters is smart and can help the Family Support Providers build their knowledge base.

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According to the website that outlines The Importance of Effective Communication (http://web.cba.neu.edu/~ewertheim/interper/commun.htm#feedback1), there are a number of situations when you need to solicit good information from others. When you are approached by a family member with a problem you cannot handle or a situation arises that you cannot manage, you need to seek information from others. When asking other for their input or help it is important to remember the following: Do not let pride get in the way of you helping someone in need. This is not considered begging. Remember that the person can only say yes or no, and if they say no, move on to the next person; it is not the end of the world. There is nothing to be ashamed of when asking others for their help or input. When an emergency arises, asking for help should come naturally. Asking for help or input is a great tool for family support providers to have. Peer to peer interaction is an excellent way to learn new skills. It is also an excellent way to become an expert in areas that you are unfamiliar with by learning from other experts. The key thing is to remember when soliciting input is that everyone has their own, and often differing, points of view. It is always important to respect that. RESPECTS OTHERS POINTS OF VIEW We are all diverse; in our beliefs, in our lifestyles, in our opinions. It is important to realize that everyone will not believe what you believe, nor have the same point of view as you. Respecting others' points of view and differences is important when dealing with different types of families. No one family is alike. They may differ on cultural levels, education levels, income levels and your role as the Family Support Provider is to respect those differences even though they are not you own. The article Respecting other beliefs from Ehow.com (http://www.ehow.com/how_4675371_respect-other-peoples-beliefs.html) outlines the following six steps that will assist you in respecting others' beliefs and points of views. Step 1: Always think before speaking. How often have we hurt others by the careless words we said? When talking to someone who obviously doesnt share your point of view, be very careful in responding to him. Be polite in your conversation and maintain eye contact. Step 2: Empathize with the other person. One of the best ways to show respect to others and their beliefs is to practice empathy. Put yourself in the other's shoes and for a while feel how it is to be the person to whom you are talking. Ask yourself the question, How different would it be if I live in this persons world? By doing that, you will be more sensitive to his feelings and will develop more understanding as to why the other person thinks and acts as he does. Step 3: Do not criticize other peoples beliefs that are different from yours. The fastest way to lose a friend is to criticize what he thinks is right or holds dear in his heart. This is also a sure way to gain enemies. When you tell someone that his religion is wrong or his idea about how to - 105 -

succeed is dumb, dont expect the person to seek your company. Build bridges instead of walls by genuinely appreciating the good that you see in others and showing respect to their ideas, no matter how different their beliefs are from yours. Step 4:Dont push your beliefs. Sure, you can try to convince others what you think and believe in a particular area, but dont expect them to be your follower. Show respect by letting them decide on their own. You will be respected in return and it will be more likely that they will reconsider what you shared with them. Step 5: Understand that everyone you meet is unique. Individuals of the same culture dont always share the same point of view and beliefs so it is much more likely that those who hail from other cultures with different background, values, experiences, norms, environment, tradition, and religion will differ. Mix them together and what you have is a web of complicated personalities who want to let their beliefs be known and heard! Show respect to what others think by respecting who they are and where they came from. Step 6: Listen to what others have to say, even if you dont agree. The best way to show respect to others' beliefs is to listen to what they share. You will be surprised what new things youll learn from them. Likewise, you will not only get better in your listening skills, you will also gain their trust and respect! Following these six steps will assist you in being able to help families to the best of your ability. You will become approachable to them and they will learn to trust you and respect your input and assistance in their lives. ORGANIZES IDEAS AND COMMUNICATES EFFECTIVELY IN WRITING Family Support Providers will be speaking and writing constantly, so it is important for them to have/learn good writing and speaking skills. This can be done through training, education, and practice. Writing is a skill that only improves with practice. The more you write, the better you become at it. Ehow.com outlines the following five steps to improve writing skills and technique in the article How to Write Well: The Basics (http://www.ehow.com/how_4878629_write-wellbasics.html. date accessed 4/10/09). Step Increase Your Vocabulary Description This does not involve reading the dictionary everyday. Doing things such as crossword puzzles and playing board games like scrabble are great ways in increase your vocabulary. If Internet access is available, sign up for a Word of the Day service. They are typically free and will send a word to your email each day. Once you get your word and the definition, try to use it in a sentence throughout the day.

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Read

Take a Writing Class

Write. Write. Write.

Get Feedback from Other about Your Writing Skills

Reading not only enhances writing skills but it also promotes creative thinking. Reading also provides writers with some of the best examples of proper grammar use. The key to reading is to find something or a type of book that you enjoy reading. Many community colleges in the areas have adult education centers where they offer classes such as English and Writing to the public, either free or for a small fee. This will get you used to writing notes and letters. Practice is key, regardless how mundane it is. You can do this by keeping a personal journal and writing about your day. Look for opportunities to write and dont get frustrated if you get stuck. As you practice, it will get easier. Have a trusted friend, co-worker, or family member read your work and give you feedback on your writing skills. Have them point out areas in which you excel and areas that need improving.

When you are ready to begin writing a document, there are three steps you should take: Prewriting, Writing, and Revising. The first step, Prewriting, gives you the opportunity to figure out who your audience is and what you want to tell them. During this stage, you want to anticipate their reaction to your document to get an idea of who will agree with you and who will not. You will also pinpoint the right words and tone to use that will get your message across to the audience. The second step, Writing, gives you the opportunity to research, organize, and actually write the message. During the research component, you gather any background information you feel is relevant to the topic. Once the information is collected, now it is time to organize it. Determine what information you want to go where to see if it flows logically. Once the information is organized, now it is time to write it. You can do this first either on paper or at the computer, whichever method makes you comfortable. The third and final step, Revising, gives you the opportunity to make sure your document is clear to you and the reader, is readable, proofread for errors and evaluate for effectiveness. During this step, you may want to rearrange the organizational structure of your document to increase the effectiveness. Proofreading for grammatical errors, spelling and punctuation, and format are extremely important. Writing is another one of those skills that requires practice. The saying practice makes perfect holds true for writing as well as speaking. - 107 -

DEMONSTRATES ABILITY TO FACILITATE A GROUP Family Support Providers must have the ability to organize a group of people together for specific things such as meetings. When a family support provider is called upon to facilitate a group, a new skill may come into effect, leadership. According to Jeff E Brooks-Harris and Kevin G. Shollenberger Group Facilitation for Student Leaders, (http://www2.hawaii.edu/~jharris/facilitation.html), leadership is the process of assisting a group to realize its common goals, vision and dreams. During the facilitation process, the role of the family support provider is to promote interactive learning within the group. Many times, the topics being covered by the facilitator may be new to families, so being able to give in-depth and detailed knowledge that is understandable on many educational levels is important. There are several settings where group facilitation skills can be used. They are: meetings; presentations; group discussions; parent meetings; family nights. How people learn during the group facilitation process is important for family support providers to know. David Kolb Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall (1984) described a model of experiential learning that provides a useful way to think about leadership and group facilitation. Kolb described four ways that people learn, which he referred to as concrete experience, reflective observation, abstract conceptualization, and active experimentation. Imaginative Learners are oriented toward concrete experience and reflective observation. They have strengths in imaginative ability and awareness of meaning and values. Imaginative learners learn best when they are given the opportunity for personal involvement and interpersonal interaction. Analytic Learners are oriented toward abstract conceptualization and reflective observation. They have strengths in inductive reasoning and creating theoretical models. Analytic learners like to learn about theories, facts, concepts, and data and often excel in traditional educational settings. Common Sense Learners are oriented toward abstract conceptualization and active experimentation. They have strengths in problem solving and decision making. They want to put learning to immediate practical use. Common Sense learners want to be involved in hands-on learning that involves experimenting with new knowledge. Dynamic Learners are oriented toward concrete experience and active experimentation. They have strengths related to carrying out plans, taking action, and getting involved with new experiences. Dynamic learners may be anxious to know how to apply new learning and will want to put ideas into action.

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There are four group facilitation skills that were originally identified and described according to Brooks-Harris, J. E. & S. R. Stock-Ward (in press). Workshops: Designing and facilitating experiential learning by Thousand Oaks, CA: Sage Publications. These skills are: Engaging Facilitation Skills invite members to be a part of a group. They encourage a member to feel included and valued within the group context. Engaging skills are used to create curiosity, interest and energy. Informing Facilitation Skills are used to provide a group with information from outside the group and to help the group learn about itself. These skills include teaching factual information and allowing group members to gain new knowledge. Involving Facilitation Skills encourage positive interaction and learning between group members. These skills create an opportunity for active experimentation and encourage learning by practice and allow group members to put new knowledge to practical use. Planning Facilitation Skills focus on planning for the future and applying learning from the group to other contexts. These skills encourage members to work together to make specific plans to accomplish group or individual goals. Planning skills prepare group members to move from active experimentation within the group to concrete experience beyond the group. The following are some tips that a group facilitator can use to help with facilitation: Tell a story about yourself. By sharing, you are opening up to the group and letting them know that it is okay for them to share as well. You are building trust and a rapport with the group. Role play. This is an excellent way to teach and learn new behavior. Group members can play someone else in roles to explore the situation. Use feedback. During the meeting or at the conclusion ask the participants for feedback. This will give you a chance to improve your skills. Make them laugh. Using appropriate humor also helps build rapport within the group. It makes everyone comfortable and the participants will begin to put their guards down, relax and become more comfortable with you. If you are new to presenting or group facilitation, you may be able to learn additional skills by seeking out a mentor or additional training at your local community college or adult education center. Like all the other skills in this chapter, group facilitation requires practice also. By starting with a small group of people you will be able to work your way up to presenting before a larger group. DEMONSTRATES ABILITY TO PRESENT BEFORE A GROUP One of the most difficult things to do for most people is presenting before a group of their peers. During this time, stage fright and panic may begin to set in and the presenter may freeze up. The only way to combat this is to learn ways to effectively present before a group and to practice presenting. Find an audience of family and friends and practice your presentation. This will allow you to become comfortable speaking in front of people thus building your confidence.

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Practicing will also give you the opportunity to get feedback before the actual presentation. This will give you the opportunity to make changes or additions to your presentation. Before the actual presentation takes place, the presenter must prepare. Two important steps in presenting is to know what you are presenting about, your topic, and know who you are presenting to, your audience. Often, Family Support Providers are called upon to facilitate group discussion among families or to give input during meetings with peers. Both audiences are different and have different needs. It is important to be able to distinguish between the two. According to Mary Ellen Guffey Essentials of Business Communication 7th edition (2007, 346), there are four types of audiences: friendly, neutral, uninterested, and hostile. The table below breaks down each audience. Audience Members Friendly (they like you and your topic). Neutral (they are calm, rational, and their minds are made up but they think they are objective). Uninterested (they have short attention spans; they may be there against their will). Hostile (they want to take charge or to ridicule the speaker; they may be defensive, emotional). It is important to find ways to relate the topic to the needs of the audience and how the topic can appeal to them. Gaining their attention is the first hurdle you must overcome. The following table provides techniques for gaining and keeping audience attention (Guffey, 348). Technique Drama Description Open by telling an emotionally moving story about yourself that relates to the topic. This shows the audience that you have lived what you are presenting . Before you begin, command the attention of the audience and take in the listeners. Make eye contact with as many people as you can. Do not hide behind the podium or lectern. Leave it whenever possible. Try to move toward the audience, in between aisles. Keep listeners active and involved with questions peppered into your presentation. Have a few cheap prizes with you that can be given out as prizes such as stress balls or pens. If you ask a question and receive a correct answer, then pass out prizes. That will keep your audience interested because everyone likes to win something. Give your audience something to look at besides you. PowerPoint presentations are good for this. Having concrete examples of things in your presentation that you can pass around is good, too.

Eye Contact Movement Questions

Gimmicks

Visuals

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Organizing your presentation is key. It should consist of three components: Introduction, Body, and Conclusion. Your introduction captures the audiences attention, gets them involved, and identifies the speaker. The body of your presentation establishes the main points of the presentation. This is where the meat of the presentation is and an in-depth look at the subject is discussed. If you are doing a short presentation (about 20 minutes), the body of the presentation should be limited to two to four points (3 is good). Each point should be developed with adequate, but no excessive, explanations and details. It should be kept simple so the audience will not become confused. The conclusion of the presentation is where the main points are summarized. Important facts are highlighted again and the audience is given a chance to ask questions, have discussion, and provide you with feedback. This is also the chance for you to exit the audience gracefully; do not end with thats it. Look for a creative way to summarize your presentation that leaves a lasting impression. DEMONSTRATES ABILITY TO EFFECTIVELY USE TECHNOLOGY TO COMMUNICATE As each day passes, new ways to communicate with people are developed and discovered. Technology has evolved from the days when telegraphs were sent. Today, technology makes communicating with someone who is in another part of the city, state, and country easy and in a timely manner. Tools such as mobile telephones, computers with Internet, and electronic mail are all technologies that families can use to communicate with their Family Support Provider, therapist, doctor, etc. Family support providers may need to learn new skills when using some technologies. In many agencies, electronic mail, or email, is now becoming the universal tool to communicate with coworkers. If a family support provider is unfamiliar with the tools that agency is using, training may be available. Family Support Providers should not be afraid to ask for assistance with things with which t they are unfamiliar. Classes at local community colleges on subjects such as Computer Fundamentals can help Family Support Providers become more comfortable with using computers and the programs that come with them. Employers may offer educational assistance to staff that express interest in attending a class to receive additional training. Assisting families to research information about their diagnosis or medication will likely lead that Family Support Provider to the Internet. According to What is the Internet from centerpan.org (www.centerspan.org/tutorial/net.htm. date accessed 2/12/09), the internet is a worldwide collection of computer networks, cooperating with each other to exchange data using common software standards. Through telephone wires and satellite links, Internet users can share information in a variety of forms. By using the Internet, the Family Support Provider can tap into medical resources such as WebMD to get information about diagnosis and medications. State and local agencies have websites that contain information about their services that the families may need. The amount of information that can be gathered from the Internet is infinite. Once a family support provider is able to effectively communicate using various technologies, they will be able to provide the families with more services more quickly. Knowing where to go to get certain information is vital in their jobs.

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Access to these advances in technology is a barrier to the families that are not able to afford them. Although the affordability of computers and mobile phones is making progress, families often have to choose between paying the electric bill and buying a cell phone. Families may also be skeptical of adding another bill to their already stretched household budget. The Universal Service Administrative Company (USAC) has established a fund to ensure that quality telecommunications services are available to low income customers at affordable rates, according to www.lifelinesupport.org. In 1997, the Federal Communications Commission established rules to govern the Lifeline and Link Up programs. Lifeline is a government program that offers qualified low income households a discount on their monthly telephone bill. Each state has its own guidelines to qualify. In the state of Arkansas, there are nineteen companies that offer customers this service including AT&T and Alltel. For example, through Alltel (now Verizon), a family can save up to $13.29 on their basic monthly bill. The program only allows for one wireless or landline telephone per household. Another program that can help families stay connected is Link Up. Link Up helps households reduce the cost of initiating telephone service. This program pays some of the cost of connecting local telephone services to your home or activating wireless phone services. Information regarding qualifications and the application procedure can be found at http://www.lifelinesupport.org. Throughout this chapter a number of resources have been provided and many other helpful sources are set out below: www.lifelinesupport.org. date access 2/19/2009. What is the Internet? www.centerspan.org/tutorial/net.htm. date accessed 2/12/09 Guffey, Mary Ellen. Essentials of Business Communication. 7th edition. 2007. How to Write Well (The Basics). http://www.ehow.com/how_4878629_write-well-basics.html. date accessed 4/10/09. Importance of Effective Communication. http://web.cba.neu.edu/~ewertheim/interper/commun.htm#feedback1. Respecting other beliefs. http://www.ehow.com/how_4675371_respect-other-peoplesbeliefs.html date accessed 4/10/09. Being Assertive: A Self Help Guide. http://www.moodjuice.scot.nhs.uk/assertiveness.asp. Accessed 6/6/09. Novak, Mary. Understanding Conflict: Communication Using I Statements. learningstore.uwex.edu/pdf/B3870-02.PDF

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Brooks-Harris, Jeff E. and Kevin G. Shollenberger. Group Facilitation for Student Leaders. http://www2.hawaii.edu/~jharris/facilitation.html. Date accessed: 6/8/2009 Workshops: Designing and facilitating experiential learning by J. E. Brooks-Harris & S. R. Stock-Ward (in press). Thousand Oaks, CA: Sage Publications. Nonverbal Communication: The Hidden Language of Emotional Intelligence. Retrieved February 3, 2009 from the helpguid.org website. http://www.helpguide.org/mental/eq6_nonverbal_communication.htm Boothman, Nicholas "How To Connect in Business in 90 Seconds or Less". Workman Publishing Company (June 3, 2002) Body Language: Managing without Words. By Vadim Kotelnikov, Founder, Ten3 BUSINESS eCOACH, 1000ventures.com. http://www.1000ventures.com/business_guide/crosscuttings/body_language.html. Date accessed 6/29/2009.

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Chapter 7: Organizational Skills Introduction Parents of children with mental and emotional health problems can be overwhelmed with problems and worries concerning their child. With that being a reality for many parents, it is easy to see how organization may not be a priority; therefore, being organized is one of the basic or fundamental skills a family support provider must possess if he or she is going to truly influence a familys situation in a positive way. Also, for a family to be truly empowered or be an effective advocate for their child and ultimately succeed, they must possess their own organizational skills to keep the progress or momentum from their wraparound experience going in a positive direction. For a family support provider, having the relevant life experiences and a passion for creating change will take you only so far. The familys voice needs to have a planned course of action in order for the voice to carry any weight in a professional world. One way to describe the role of a family support provider is that of a coach who is there to help the family get a clear picture of where they are and where they want to be. In the beginning of that relationship, an emphasis on organization can be overlooked because the family is often in crisis. When this is the case, the family support provider may feel the need to move right into helping the family stabilize, which is generally the right move. Once the family is stabilized, its important that organization comes back into focus. As stated, empowering the family to be their own most reliable resource is critical for long term success. This ideal can only come into reality when a family feels they have the right information, resources and a sense of direction. With so many complex issues going on during wraparound, it is easy to forget about the importance of organizational skills when working with families. Clearly, organizational skills would be beneficial with so much going on, but many times, its the simple things about becoming organized that get missed. Perhaps it is due to the lack of definition or vagueness of what it means to be organized and exactly how being organized plays out in a family support providers role. Therefore, the goal of this chapter is to help clarify what is meant by organizational skills within the context of providing family support in a system of care. To accomplish this, we will begin by helping the family think about their current situation, analyze and interpret information they can obtain, and lead them to problem solving and making informed decisions to reach the desired outcome. One approach that will be taken in this chapter will be to identify a hypothetical problem a family might face in a system of care (i.e. lack of after- school options for at- risk youth) and then identify and summarize the basic organizational skills that are necessary to help the family meet their particular need. We will also look at the importance of staying organized in the wraparound process. The chapter will conclude with the necessary steps to accomplish a family- run event or training. ABILITY TO THINK, ANALYZE AND SUMMARIZE INFORMATION Although a family is extremely aware of all the chaos surrounding their lives, it would be wrong to assume they see their problems in terms of unmet needs. Your family support skills with communication can help the family begin to see the problem as one of unmet needs. Once a family sees their childs challenges as unmet needs they can begin to organize information to

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move toward getting that need met. The family and youth must be engaged in the process of taking steps to meet their own need, so make sure that they have tasks and assignments in the plan that is developed. This is the first step to empowering the family. The example of an unmet need that will be used in this chapter is the need for recreational activity among a positive peer group during after- school hours. The scenario or circumstance in this example includes the following information: The family support provider is working with a single parent who recently moved into a new neighborhood. She works full time and feels burned out. Her 13 year old daughter is energetic and charming, but lacks good judgment in making friends. The arguments in the home have increased drastically and the mother has noticed a change in her daughters tone and overall attitude toward life. The mother strongly senses that she is being negatively influenced by peers in their neighborhood and wants her daughter to have something positive to do after school hours to avoid as much interaction with the older neighborhood peers. Obviously, the first thing to help the family identify is what after-school activity may be interesting to their child. This information should naturally come through the wraparound process through a list of the youths strengths and interests. Its important not to overlook this important step because just identifying an after-school activity will not completely meet the unmet need of the youth. Likely, the first real step in getting organized in this scenario is the ability to research what is already available in the community. A common role for a family support provider is to play the private investigator that helps the family look for what is already occurring in their neighborhood, childs school or community-at-large. To carry out this task effectively, the family support provider must be organized with their material in a way that summarizes the information. One way to accomplish this is to develop a resource manual. The following is a list of possible resources that might help a family support provider get started in this task: Information from the local Chamber of Commerce Existing programs at the local community centers Existing Boys and Girls Clubs Big Brothers and Big Sisters Programs YMCA Programs Karate and other forms of martial arts Organized sports programs offered by the city Faith-based initiatives 4-H or County Extension Programs Schools or Community Colleges Elks, Masons or other fraternal organizations When developing a resource manual, its critical that the manual itself is developed in an orderly or structured manner that summarizes major areas of need. For instance, the manual will need to be broken down into categories, such as shelter, food, places that aid in utilities and other community resources, like recreational activities and other after-school and summer programs. - 115 -

These are just some examples of categories. A resource manual will be simple to read and include information easily understood by all educational level. The resources will match the uniqueness of what each community has to offer. The common organizational aspects of the manual will include using a three ring binder, a table of contents and the use of page breakers with color coded headings. When needed resources such as after-school activities are not available in a community, the family support provider needs to have a plan of action to help research ways to either create an after-school activity or collaborate with another group to create this resource. This is a larger undertaking and will require a greater deal of organization. Below are some tips for getting organized so that this task can be effective and have direction. Planning: Day planners are the primary tool for organized people. A calendar may be used if a day planner is not available or more comfortable for the family. If you are setting appointments with city officials, you do not want to miss that appointment or be late. Having a day planner also helps you budget your time on other appointments, as well. Besides helping you remember items on your schedule, day planners also provide a means of tracking. This allows you to go back and look up when you contacted someone or when you spoke at a civic group and indicate the outcome. Model the skill of using the day planner or calendar with the family and youth. Practice with the by checking with them regularly until the habit develops. If you are working in a system with resources to support such a purchase, provide each family and youth with a day planner or calendar which they can use to track their own team activities. Time Management: In order to have a more organized, balanced work style, you need more time. Unfortunately, we cannot control how many hours are in a day, so a family support provider must utilize their time wisely. This can be done by figuring what needs to be accomplished and then setting a suitable amount of time in which to do it. This is critical in our scenario of trying to acquire or establish resources for the family because there are so many players involved and steps to complete in order from first to last. A critical thing to remember about time management is that saved time accumulates. Saving a few seconds here or there will eventually add up to hours and possibly days. Another good technique for time management is to note when things are supposed to be completed and develop a system which gives you a reminder that something is due in a month, then two weeks, then one week. Rather than having to do everything in a panic, you can use the flexible time in your schedule to keep projects on track. A Place for Everything and Everything in Its Place: As an organized family support provider, you will come to realize that it is always easier to put something in its designated place rather than just set it down for now. Find a home for each item you possess and return it to its home after each use. A family support provider will eventually be flooded with material that can help lead them to accomplish tasks such as establishing needed resources for families, but if that material doesnt have a home and the family support provider doesnt know where it is, and then it only collects dust.

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Use a Filing System: Once and for all, create a filing system that works based on your style and way of work. I can be as simple as keeping papers in a box by date or involve filing by category, medical information in one place and financial information in another. Just remember, if you just put something down for now, you will have the second and third step of actually remembering where it is and that it actually has a place. Because of this, a family support provider needs to file things for his or herself. Organize those files under categories you develop and use folders with labels. These are some simple steps in helping a family support provider take on major tasks such as identifying and/or creating resources within their communities. Even with some of the basic organizational skills in place, though, a family support provider can still potentially become overwhelmed with all the information and the daunting tasks of creating things that dont exist in communities. Here are a few other suggestions that may be helpful in this type of undertaking: Break the larger portions of the task down into small, chronological steps. What absolutely needs to happen first when faced with this challenge? After that, what comes second? And so on. Simply schedule these steps into your day using your day planner. Keep only the supplies you need on a daily basis on top of your work area. Otherwise, you will be distracted and may get sidetracked on something else. Be clear when communicating to individuals within the community exactly why you are contacting them and what you need from them. Also, be especially clear when leaving a message on an answering machine. You may want to write down a prepared statement if you feel you are going to have to leave a message with someone before they call you back. This way, you are more likely to get a full and appropriate response. Keep a file index (a master list of names) of all the key community resource people or agency contacts that become helpful and include their full name, agency, position, phone number, fax number and email address. When you couple a family support provider's enthusiasm with his or her inexperience, there may be times when he or she overestimates or underestimates the time it takes to perform certain tasks, especially when the responsibilities involve multitasking with multiple people. Its also important that a family support provider know the obstacles that lead to disorganization. The following are a few of those stumbling blocks: Procrastination: Many people wait for the problem to disappear on its own or wait for someone else to do it. A family support provider must realize that families are counting on them to follow through. It doesnt mean they have to do everything, but he or she needs to model reliability and dependability to the families with whom they are working. Interruptions: Interruptions or distractions can reduce the motivation to follow through on a time schedule. Some interruptions are inevitable and can be handled without disturbing a schedule. It takes discipline and putting forth the time to get well organized to handle those unpredictable moments. Setting Wrong Priorities: When faced with the task of organizing or rallying a community to address gaps in services or programs for at- risk youth, a family support provider must know what his or her priorities are. A family support provider cannot just

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rely on or gravitate to whom or to what he or she is comfortable. Set a clear course of action with clear goals and objectives. Do not indulge or waste time in an activity that is just interesting to you and not really important to your overall task. ABLE TO INTERPRET INFORMATION AND TO PROBLEM-SOLVE AND MAKE DECISIONS In order to set up an effective organizational model, one must understand the process of communication. Communication is key in understanding where a family is and what their needs are. Interpreting information and being able to problem- solve and to make decisions begin with a simple process: Listening. Surveys show that miscommunication in any setting has high costs, including lowered productivity, increased client turnover, and higher stress for all involved. Most people want to be heard, but rarely make the effort to listen to others. Effective, thoughtful listening can help avoid troubled communications that lead to such unwanted outcomes as lost respect, misunderstandings, and ultimately, disorganization. Basic organizational skills allow for a level playing field where families and family support providers share a common ground to air concerns and issues and even to discuss intervention ideas. Without this foundation, effective problem- solving may never occur. All wraparound models involve team-based decision-making and problem-solving. Without proper organization in wraparound, a team can wander in circles which will lead to poor outcomes and/or burnout from the youth and family participating. Fortunately, there are some wonderful resources on wraparound that help the family know what to expect and how they can genuinely participate. For more information on the wraparound process, see chapter 2. For national sources of information on wraparound, visit your library or other computer resources to view the following: National Federation of Families for Childrens Mental Health www.ffcmh.org The National Wraparound Initiative www.rtc.pdx.edu/nwi Systems of Care The U.S. Substance Abuse and Mental Health Services Administration www.systemsofcare.samhsa.gov Although there are many resources, wraparound demands an organized approach that is unique to each system of care community, lead agency and family culture. One challenge the states System of Care Pilot Project, ACTION for Kids, had in wraparound was keeping the families engaged and informed of where they were in the wraparound process. Families seemed to never know when they had completed a phase and were moving into another phase, and for those who were progressing, there was no way of knowing for sure that the family was truly ready for graduation and transition. There are several national fidelity models or tools to measure the wraparound process available for cooperative agreements, state initiatives, communities and agencies to use that grade whether or not wraparound is occurring reliably and is conforming to the core principles; however, for a family support provider and the entire wraparound team, it is essential that there

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are organizational steps in place to keep the whole team in position to problem- solve and make the right decisions. A tracking form to accomplish this was developed by ACTION for Kids and is included in this manual. We incorporated several different wraparound tools along with our own experiences to create this organizational tool. ABLE TO PLAN AND ORGANIZE A TRAINING OR EVENT Effectively planning a training or event is a necessary skill for a family support provider; however, getting families to come together is not easy to do initially. Fact is most parents of children with mental or emotional health problems are overwhelmed and tired. Motivation by family members is likely an obstacle a family support provider will face as he or she begins to approach this type of task. Perhaps the first question a family support provider may ask his or herself is why would a parent want to meet in the first place? In using the previous scenario to establish an after- school program in a rural community, a family support provider may have a head start in getting to this question. Once a family support provider has identified an unmet need with a family, he or she is likely on the way to having a family genuinely buy in to rallying for this type of community resource. The next step is to decide what type of event you are going to plan to start this ball rolling. Questions the family support provider need to ponder are: What kind of event would create the greatest awareness of this problem? Who would be the most appropriate guest speaker(s) to present at this event? Who needs to be present at this event (i.e. target audience)? Where does the event need to take place? What day of the week will I get the greatest attendance considering the culture of the town? What time would the meeting need to be in order to get the widest range of participants? How will this event be funded? How can I effectively market this event to the target audience? What will the invitations look like and how will I get them out? Once details for the event are in place, the family support provider needs to think about how the event will be family- friendly and supportive of family input. By including the ideas of families, after-school programs that are eventually established in the community will see higher participation and improved program outcomes. Family ideas and feedback can be sought regarding how the program operates, when and where it may operate, and what the activities will be for the youth. Below is list of activities ideas that a family support provider can do to ensure genuine family feedback: Have several parent suggestion boxes available. 1. Conduct an informal survey.

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2. Host a parent forum or discussion group strictly for parents to meet one another and discuss their concerns. This may be done prior to the event with all the community stakeholders and carried out afterwards, as well. 3. At the rally, strike up conversations with parents that focus on them. Important things a family support provider needs to remember when planning an event is how they can engage the family in the planning itself. Planning an event can have multiple purposes, such as developing a parent's confidence in their ability to organize and plan. Its also important to realize the importance of linking the parent to certain individuals in the community and other organizations while planning is taking place. Finally, there are several other key organizational parts to event planning including: Making a checklist A checklist provides a step-by-step guide to organizing and executing a special event. Be as specific as possible. Creating a budget The objective is to provide event planners with a financial blueprint. The budget should be specific, and include revenue or fundraising opportunities (sponsorship, ticket sales, donations, concession sales), as well as expenses (printing, permits, insurance, speakers, food, supplies, security). Always considering the logistics With many activities going on simultaneously, there are many details to be checked. Major areas to consider and plan for include: size of space or building used, utility support needed, setup (tables and chairs, tents, portable toilets, parking, signage) coordination, cleanup, emergency plans, transportation, and public services such as police and fire departments. Planning for publicity Promoting a special event takes creative thinking balanced with practicality. The primary objective is to publicize the event, but secondary objectives should be considered. o o o o Are you trying to: inform, educate or entertain? Increase awareness or attendance of the event? Build a base support from a specific audience? Facilitate good community relations?

Brainstorm all the available media, including marquees or billboards which may be available to the public, school newsletters, church announcements, and cable and commercial stations. Make a detailed list with names of whom to contact and when.

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Evaluating the event Take time to evaluate right after the event while the details are fresh. You may want to consider having a questionnaire for participants to complete. Some general evaluative criteria include: o Did the event fulfill its goals and objectives? Why or why not? o Identify what worked and what needs fine-tuning. Which vendors should be used again? o What items were missing on the checklist? o Was the event well attended? o Was informal and formal feedback about the event positive? o Given all that went into staging, was it worth doing? Keep sign in sheets so you can contact people with questionnaires to get their opinion on the event.

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CHAPTER 8: Advocacy Introduction The American Heritage Dictionary of the English Language, Fourth Edition, defines advocacy as The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support. Advocacy can take many forms. For this chapter, there will be two specific types of advocacy described case advocacy and systems advocacy. Sometimes this advocacy is needed with agencies, but often it is in the educational system. Here are a few numbers that show the need for families and caregivers to become advocates for our youth in Education: 74% of children who are unsuccessful readers in the third grade are still unsuccessful readers in the ninth grade. (Journal of Child Neurology, January, 1995) Only 52% of students identified with learning disabilities will actually graduate with a high school diploma. Learning disabled students drop out of high school at more than twice the rate of their non-disabled peers. (Congressional Quarterly Researcher, December, 1993) At least 50% of juvenile delinquents have undiagnosed, untreated learning disabilities. (National Center for State Courts and the Educational Testing Service, 1977) 31% of adolescents with learning disabilities will be arrested within five years of leaving high school. (National Transition Longitudinal Study, 1991) Up to 60% of adolescents who receive treatment for substance abuse disorders have learning disabilities (Hazelden Foundation, Minnesota, 1992) 62% of learning disabled students were unemployed one year after graduation. (National Longitudinal Transition Study, 1991) From Emotions to Advocacy: The Parents' Journey by Pamela Wright, MA, MSW http://www.wrightslaw.com/advoc/articles/Emotions.html

This chapter will explore the core competency of advocacy, and how Family Service Providers can serve as advocates. Please keep in mind that advocacy is not about the person who is doing the advocating. It is about that youth or family whom they serve. It is about helping that youth, family or caregiver develop the skills needed to be heard by others service providers, educators, or policy-makers. Those in the role of Family Service Provider will benefit from self-awareness to better understand their own feelings about the issues facing the youth/families they are serving. Having someone to talk to can help Family Service Providers to feel supported and remain objective about the families they are serving. Some specific skills are necessary for those in the role of advocate. Some of these skills are: 1. Knowledge of the subject about which you are advocating

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2. Ability to communicate clearly with others 3. Ability to help others find a common goal or cause, and to work together for that goal or cause 4. Ability to control your emotions to get your point across

UNDERSTANDS THE ROLE OF ADVOCACY TO INFLUENCE CHANGE When the role of an advocate is described, several words come to mind. Supporter, ally or partner, and helper are just a few. Marie Sherrett, a long-time advocate for autism-related groups, describes the role of self-advocacy for children in special education: Advocacy opens new doors so children may become part of the community. Advocacy knocks down barriers and prepares children for independence. *www.wrightslaw.com/info/advo.parent.sherrett.htm What skills does someone need to advocate for others? Here are some ideas: 1. Be organized! 2. Make a list of the unmet needs or the problems facing the youth/family with whom you are working. 3. Research laws/policies and understand how they impact this situation. 4. Keep good documentation of your contact with the youth/family, research you do, facts of the case or situation; also document the outcomes/goals for this situation. 5. Make a list of your allies and/or resources. Also consider the barriers or walls you may encounter during your advocacy. 6. Think about possible outcomes, both positive and negative. Consider what the family can/cannot live with related to outcomes. 7. Have plan B! Know what your next move will be if your first plan doesnt work out as you hope. 8. As you will hear in Section C of this chapter, remember that this is about the youth/family, not you! 9. Make sure you keep key partners informed of the progress/status of the case. 10. Be respectful of the youth/family. Understand their needs related to culture and work to incorporate those needs into your actions. DEMONSTRATES UNDERSTANDING OF THE DIFFERENCES BETWEEN CASE ADVOCACY AND SYSTEMS ADVOCACY This section will attempt to describe the difference between case, or individual advocacy and systems advocacy. One source defines individual advocacy or case advocacy, as Action on behalf of, for, and most importantly with an individual; focuses on providing training, information, referral and intervention to, and with, individuals. An effective individual advocate seeks to help people develop knowledge and skills for effective future advocacy activities. www.trcil.org/advocacy.htm

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This same source defines systems advocacy as: Working to create broad based change within a system, agency, community, etc. implementing strategies to increase availability and accessibility of services and resources, creating equal opportunities for large numbers of people with disabilities. Systems advocacy activities may include speaking out on issues, laws, benefits, and/or practices that affect many people with disabilities; community organizing, or making legislative contracts, lobbying, presenting testimony, filing petitions, etc. Many times, parents or others become involved in individual advocacy for their child or other person they know. As they become involved, this becomes a passion to help others who face similar struggles and issues. Families come to rely on others who have dealt with similar problems, and can find support and encouragement in each other. As Family Service Providers, this is commonly seen families can connect when there is common ground, and can feel comfort and support from people who have walked in their shoes, often more easily than from professionals. For system advocacy there are several resources available to help better understand the legislative process as it is important in advocacy on the systemic level. One is Seven Keys for Effective Legislative Advocacy, written by Dennis M. Byars. A second resource is The State Advocacy Toolkit, a document produced in 2007 by a national coalition made up of National Alliance for Mental Illness (NAMI), Mental Health America (MHA), Federation of Families for Childrens Mental Health (FFCMH), and other organizations. This document contains Tips on Effective State Legislative Advocacy, which helps readers understand the legislative process and what steps to take when functioning in an advocacy role to impact proposed legislation. Both documents stress the need to understand the legislative process for bills, which is well outlined in Chapter 4 of this manual. An important part of advocacy on the state or systems level is building relationships and communicating effectively with legislators. Some of the suggestions offered include: Share personal stories Family and personal stories are powerful and are often remembered. These stories tend to have a deep impact on how a legislator feels about an issue or bill, particularly during oral or spoken testimony. It is important to keep your stories brief (less than two minutes) and tied to pending legislation and policy issues or budgets. Identify constituency Constituents are given top priority by legislators. In a communications with legislators, advocates should identify themselves as a constituent whenever applicable. Increase contacts The more calls, letters and emails that a legislator receives on an issue, the more likely they are to act on that issue (drafting legislation, pushing for a hearing, casting a vote, etc.). To increase the number of contacts to a legislator, advocates often form coalitions with organizations that have similar interests. This may lead legislators to be more confident in supporting the coalitions cause. Repetition The number of times that a legislator hears about an issue, from the time they are elected to office until they leave office, plays a key role in whether they favor a cause or issue. Therefore, it is important that advocates communicate on a consistent basis with their legislators and keep them updated and informed about an issue during all

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stages of the legislative process. Advocates should craft key messages and consider asking friends and family to help in contacting legislators on important issues. Keep materials brief, straightforward, and simple When sharing printed materials with a legislator, try to keep it to a one-page, and bulleted fact sheet that reinforce key points on the issue. Clearly communicate what you are asking for Whether it is support for a bill or asking a committee chair to hold a hearing or move a bill be clear on the action you want taken. Stay informed Advocates should keep their legislators informed about their issues and how they want the legislator to vote, if there is an impending vote. On the flip side, advocates should also stay informed on where their legislators stand on issues, the actions they have taken, and any debates they have participated in on the issue. If legislators know their constituents are watching, they are more likely to vote in favor of the issues that matter most to their constituents. Follow up Advocates can never thank a legislator enough for supporting their cause, especially since they get pushed and pulled in many directions. It is essential for advocates to thank legislators when they are supportive of their issue by voting in favor of it, taking a public stance on it, or promoting the issue during a debate or speech. If a legislator is not supportive, a relationship can still be formed providing education and resources on issues; the relationship that is established as a result will likely be beneficial when in the future the issue comes up again. *Adapted from The State Advocacy Toolkit referenced above Contacting legislators about important issues can take several forms. When contacting your legislator by phone, remember to make the most of your time. Remember plan or script your message, so that it is brief and to the point, logical and contains the important parts. Use complete terms (No abbreviations), identify the specific bill, and state your position and how you want the legislator to vote. If you are sending a letter or e-mail, try to send it before a decision has been made or before a public hearing. Make sure your letter is one page, brief but containing major points to be made. If sending an e-mail, format it like a letter. If you cite statistics, use only one or two main facts (and be sure they are accurate). If needed, attach supporting documents rather than write everything in your letter. Try not to use a form letter where many are allowed to sign the same letter but personalize letters with the same key message. UTILIZES ROLE OF AN ADVOCATE FOR THE BENEFIT OF A CHILD, A FAMILY/CAREGIVER OR THE SYSTEM AND NOT FOR SELF What is an advocate? According to Websters Dictionary an Advocate is one who speaks or writes in support of another or a cause.

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There are several types of advocacy which include self advocacy, individual advocacy, systems advocacy and parents. The goal of self advocacy is to achieve change in ones own life by advocating for change in your own life. You will stand up for self; protect your rights or the rights of your child or family member. Individual advocacy is action on behalf of, for, and most importantly with an individual. An individual advocate will educate, train, and advise on both an individual level and a systems level. System advocacy usually requires a large group of people working a long time to make broad system changes. System advocates may have to speak out on issues, work to change laws, or change agency policies, for the benefit of disabled persons. They may have to contact legislators, lobby, or present testimony (tell their story). Parents are natural advocates. You know your child better than anyone else. Parents feed, cloth, and raise their child. Parents send their children to school. When a child or family has a problem the parent is the one to guide the child or family and advocate for them with the school, juvenile justice system, mental health system or the Department of Child and Family Services. As a parent of a child with a disability you have to stand up for your child or they will fall through the cracks of whatever system they are involved with. Regardless of which type of advocate you are you must educate yourself on the issues you want changed. The Family Voices Network of Erie County, New York describes the role of advocates on their website: The advocates roles is not to tell the parents/family what to do but to find out from the family what is it they need to meet their families needs. They work with the family to understand their strengths and goals and to help the family achieve their goals. The primary role of a family advocate is: 1. Provide education to the family member but also the system 2. To help identify the strength and needs of families 3. To be a mediator between the system and the family by helping to educate the system on the needs of the family. 4. Or help the family understand the different roles of the difference agencies are within the system and how they affect the family. *www.familyvoicesnetwork.org/en

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BUILDS POSITIVE RELATIONSHIPS WITH COMMUNITY AND SYSTEMS PARTNERS Learn to play the game with community partners, school personnel, juvenile justice, and mental health professionals. Learn to speak their language, learn how their system works, and learn how they think! The more educated you are about who you are working with the more they will respect you as a parent/caregiver. You must also learn about your family members disability. You cannot effectively advocate if you dont know what you are talking about. If you feel you are in over your head then find someone who knows the systems you are working with to help you. Within the state of Arkansas you can contact Arkansas Disability Rights Center for help and guidance. When advocating for yourself or a family member you must try to not become emotional, and remember to be polite when working with others. If you lose your cool then you lose the game. Dont expect that you will be welcomed in with open arms at the beginning and some may never welcome you but dont give up!! Educate community partners about the disability you are dealing with and listen when they educate you regarding their system. Dont be afraid to ask questions but be prepared to not always get the answer you want. Helpful hints for effective advocacy: Do not assume that the person you are working with will tell you all of your rights. Keep a paper trail Every request must be in writing. Send a copy to everyone involved with your child, keep a copy for yourself. Start a notebook Have a pen and paper handy Provide the community partner with an information sheet about the disability you are dealing with Keep a current list of medications and side effects Learn the rules of the game Plan and prepare for meetings Negotiate solutions DO NOT BECOME EMOTIONAL. Pretend you are advocating for someone elses child. This is hard but can be done. If all else fails, tape record the meeting. The person you are working with will start playing fair when they know you are serious about your child.

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Chapter 9: Values Introduction The word values can have many meanings. Values can be used when referring to a musical note, when referring to a number, when referring to something of monetary worth. In this chapter, the term values refers to the ideals, customs, institutions, etc., of a society toward which the people of the group have an affective regard. These values may be positive, as cleanliness, freedom, or education, or negative, as cruelty, crime, or blasphemy or speaking against someones religious beliefs, according to Dictionary.com When our writing team of youth and families got together, they brainstormed on a set of values they thought were important from the family and youth perspective. Those values are: 1. Honesty 2. Integrity 3. Competency 4. Efficiency 5. Loyalty 6. Patience 7. Dedication 8. Inner harmony (balance) 9. Respectful of others 10. Involvement 11. Growth 12. Creativity 13. Resourcefulness In this chapter, several of these values, and others, will be covered. Whether the family or family support provider is working with community partners or others, these values are important to the success of program participants.

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DEMONSTRATES RESPECT FOR THE DIGNITY AND INDIVIDUAL DIFFERENCES OF EACH FAMILY/CAREGIVER AND THE RIGHTS OF FAMILIES/CAREGIVERS TO MAKE DECISIONS FOR THEIR CHILDREN The term respect means to be mindful, to pay attention, to show consideration, to avoid intruding upon and to avoid violating. Imagine a world in which nothing is respected. Without respect, little or nothing would be of value, including ourselves or our relationships. No one would have a sense of empowerment in society, nothing would have meaning and disorder would prevail. There are many active ways to demonstrate our respect for our children and families. One example, allow someone to complete what they are saying uninterrupted. The state and its institutions are legally and morally obligated to meet the basic needs of people. According to the Universal Declaration of Human Rights (1948) (http://www.un.org/en/documents/udhr/), All human beings are born free and equal in dignity and rights. It is hard to define the word right, but easier to give examples for rights. For example, you have the right to free speech or religions. These are important rights guaranteed by laws. Family support providers need to know that a caregiver has rights and ensure that the knowledge is shared. If your child needs or receives behavioral health service family support providers need to know that a caregiver has three basic rights that protect and support their decisions in behavioral health system. Children's Rights: The Rights of Children and Their Families Who Need or are Receiving Community Services is a publication from Ohio that outlines the three basic rights your youth and family should know: 1. Know and understand important information about services and treatment, before you have to make any decisions. 2. To participate in making decisions about services and treatment. 3. Complain about services or treatment if you feel your childs rights or your rights are being restricted or violated. Family support providers will interact with families of various cultural backgrounds. As stated in Chapter 5, Culture is not just ethnicity, race or religion. Culture is seen in any group that shares a history and belief system that affects how they function. It is important to distinguish societal culture and home culture. Each familys life is different and their interactions as a family will different from the next family and even the family of a family support provider. Respecting this difference is important once the hat of family support provider is put on. According to Culture and Parenting: A Guide for Delivering Parenting Curriculums to Diverse Families, (2006) University of California Cooperative Extension; Lenna L. Ontai, Ann Mastergeorge, Families with Young Children Workgroup - University of California, Davis, there are seven areas of behaviors that can differ among cultures:

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1. 2. 3. 4. 5. 6. 7.

Communication Discipline Parent-Child Emotional Bonding Family Structure and Roles Gender Role Development Play Sleeping Arrangements

For a more in-depth look at each of these behaviors, please refer to Chapter 5: Cultural Competence. Family support providers often assist families with many things. Often, they take reference from their own lives to give those families additional information. But family support providers must remember that the final decision is the families and you should be supportive of their decision regardless if you are in agreement or not. Family support providers, acting as advocates for families, often are asked to speak for the family. When doing so, it is important to seek the permission from the family first. Many cultures stand behind the saying, what goes on in this house, stays in this house. Families are leery or reluctant about putting their business in the streets even if the street is a work related session. Once you have the familys permission, make sure you tell their story as accurately as possible. You can take it a step further and assist the family in writing their story down and sharing it in written form to ensure there will be no mistakes. It may take time for the family support provider to earn the respect and trust of their families. But if honesty, communication, and follow through are a part of the equation during the relationship building process, the family support provider will be off to a great start where their families are concerned. ESTABLISHES PARTNERSHIPS WITH PROVIDERS, POLICYMAKERS, ADMINISTRATORS AND OTHER ADVOCACY ORGANIZATIONS TO IMPROVE SYSTEMS OF CARE A partnership is defined as a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal, according to The American Heritage Dictionary of the English Language, 4th ed. When developing partnerships where the goal is to assist families in need, many different agencies and organization will be at the table. These agencies will work together for a common goal and will be able to rely and call on one another when the need arises. Each family support provider has a different style. What it looks like to develop partnerships varies by group, but the end result should be the same. Strong alliances with those in the community that influence policy or hold positions of authority are key to the support structure of a family support provider. These relationships provide a blueprint to assisting families in crisis or when situation arise. These partnerships can be with the court system, Department of Health and Human Services, local churches, or anyone that may assist the family support provider with

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helping families receive services. There are also advocacy organizations that advocate for the improved treatment of people with mental illness. There are several advocacy organizations but the following two have established local roots in several states: National Alliance on Mental Illness and National Federation of Families for Childrens Mental Health. Family support providers should become familiar with advocacy organizations that are available to those with mental illnesses. The National Alliance on Mental Illness, NAMI, is an organization dedicated to improving the lives of individuals and families affected by mental illness (http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_NAMI/About_NAMI.h tm). NAMI has a state organization in all 50 states as well as in Puerto Rico and the District of Columbia. There are also more than 1,200 local affiliates spanning all 50 states, D.C. and Puerto Rico. NAMI offers a number of programs and services including: Awareness and Support: A Pathway to Recovery Education: The Face and Voice of Mental Illness Advocacy: A Respected Force Through their local and state offices NAMIs education program offers value information to the communities. NAMI offers a number of peer education and training programs and services for consumers, family members, providers, and the general public. NAMI's education and support programs provide accurate information, valuable insight, and the opportunity to engage in support networks (http://www.nami.org/template.cfm?section=Education_Training_and_Peer_Support_Center). Another useful advocacy organization is the National Federation of Families for Childrens Mental Health, NFFCMH. The NFFCMH is a national family-run organization linking more than 120 chapters and state organizations focused on the issues of children and youth with emotional, behavioral, or mental health needs and their families (http://www.ffcmh.org/whoweare/history.html). The National Federation of Families for Childrens Mental Health organization is currently assisting states in the development of local Federation of Families chapter. For more information about state chapters of Federation of Families, visit their website at http://www.ffcmh.org/whoweare/chaptersandstateorgs/chaptersandstateorgs.html. The National Federation of Families for Childrens Mental Health offers high quality trainings which have been developed through thorough and inclusive processes with continuous quality improvement feedback loops at every step. Their trainings are comprehensive, outcome-focused and may be tailored to your communitys requests and their certified trainers are chosen because they are experienced family leaders from across the country. Family support providers should assist families to learn as much as they can about their illness. Encouraging families to seek knowledge about subject areas they do not know empowers them to take the drivers seat in their childs treatment. The following are a few examples of how a family support provider partnered with an agency in their community to help a family in need.

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Example 1: A parents lights were about to be cut off and the family support provider called the light company and explained that ACTION for Kids will assist the family with payment if the light company would wait a few days so the agency could get the payment processed. The light company agreed and the familys lights were not cut off. Example 2: A family support provider went to court with a client because the client was about to be placed in a residential treatment facility. The family support provider explained to the judge that the clients grandmother is no longer able to properly care for the client and the family support provider asked the judge if the child could live with her aunt. The judge approved the request with a two month test period to see if things would work out and to see if the child would adjust ok. The arrangement has worked out and the client is currently been doing well with this arrangement. DEMONSTRATES RESPONSIBILITY TO ASSIST FAMILIES/CAREGIVERS WITH UNDERSTANDABLE, COMPLETE ACCURATE INFORMATION Family support provider has a responsibility to help the family become more responsible by taking the driver seat and not the back seat in their child care. Family support providers will also help in any area such as gathering information about the child illness to educate the family. The skilled family support provider strives to present the information in a manner which the family understands and in a way they can best learn. For example a family may find learning from video presentations better than large amounts of written material. Many newer books are available as books on tape. Large print materials on various subjects can be obtained through public libraries. Much of the information needed can be requested in alternate formats for individuals with visual or hearing impairments. The skilled family support provider will develop knowledge about the capacity to obtain different language translations of materials depending on the languages present in your local community. Charlotte Wade, Family Support Provider for ACTION for Kids and a member of this writing team, describes how she assisted a family. I have a family who has a child with Bipolar disorder. I told them about some things that I dealt with from my personal experience with a family member who suffers with Bipolar Disorder. I explained to the family that the first thing you must do is to try to be understanding of what the person is going through, have empathy. I also told them they have to make sure to give the medication on schedule to help regulate their childs mood. This use of the personal experiences helps deepen the understanding of the additional material you may provide for their learning. Family support providers also have the privilege of going to conferences and bring back information that helps the family deal with their childs illness. For an example, a family support provider with ACTION for Kids attended a workshop at a conference in Washington and brought

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back information that was used to help a family member who has a child that suffers with Bipolar Disorder. The presenters at the workshop encouraged those with bipolar disorder to journal as a way of keeping up with that triggers manic moods. The journaling can also help families keep records of their appointments and things that are discussed. They are then encouraged to be proactive and try to solve a problem before contacting a family support provider; this will hopefully teach them independence instead of becoming dependent on the presence of the family support provider. Another resource that families have access to are their mental health professionals: therapists and psychiatrists. These individuals have a wealth of information and can easily help the family navigate any territory they feel is confusing or not understandable. During appointments with the staff, families should ask them to explain terms or thing they do not understand. Families should also take notes during the session so they can refer back to them if necessary or to conduct further research about what was discussed during the appointment. They can also provide families with additional information by giving them pamphlets or brochures that provide more specific information. DEMONSTRATES COMMITMENT TO EMPOWER FAMILIES/CAREGIVERS, THROUGH SUPPORT, TRAINING, AND EDUCATION Oprah Winfrey states, I think education is power. I think that being able to communicate with people is power. One of my main goals on the planet is to encourage people to empower themselves. When families are first introduced to the mental health system, there are large amounts of information that they are given. Everything from medications to diagnosis, this information can be overwhelming and intimidating. This is where the family support providers role in the families lives is critical, they provide the family with the necessary support they will need throughout the treatment of their loved one. The family support provider has been there, they have walked in the shoes of the families. They know what the family is going though and they have the tools, resources, and experience to help these families navigate the waters. Family Support Provider should develop a type of resource book that outlines all the resources in their community. The book should be a comprehensive look of the area and includes those agencies that may assist the families if needed. Some agencies to include are: Department of Health and Human Service o Medicaid o Nutritional Assistance (EBT) Department of Child and Family Service Housing and Urban Development Department of Child Support Enforcement Local churches and civic groups that offer assistance to families in need

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Local utility office Public Library Schools Social Security This list is just a starting point. Your communities may offer a variety of agencies that assist the community. The book should also include a section for online resources. Although many families may not have access to a computer or internet, the local library may have these resources available. Some sites to include in the resource book include: Mental Health America: nmha.org National Alliance on Mental Illness: nami.org Mental Help: mentalhelp.net National Institute on Mental Health: http://www.nimh.nih.gov/index.shtml When developing the book, it is good to make a contact at each agency if possible, include their name, title, phone, and fax and email address. This will give you someone to ask for instead of just calling the office. This person can direct you to the person who can help you if they cannot. Family support providers also become knowledgeable of training resources for families and where they can receive additional assistance. Local community colleges and libraries offer classes that teach those new to certain technologies like Introduction to Computers and how to use the internet to research should also be included in the resource book. On the internet, there is so much information available it can be overwhelming for families. By typing Attention Deficit Hyperactivity Disorder into a Google search box yielded 2,110,000 results. By educating yourself on how to use the internet, families can begin to whittle those 2.1 million results down to those that apply to them. In addition to community colleges and libraries, some community mental health centers offer free training opportunities for families to learn more about their issues. Family support providers can host Family Night that serves as a form of support group for families living with mental illnesses. These events can feature a speaker that will come and discuss a certain topic with the families. Families should mention to their family support provider the types of things they would like to know more about so they can arrange that topic to be discussed at Family Night events. Family support providers should also remember to seek information and trainings from their local chapters of Federation of Families and the National Alliance on Mental Illness. These organizations often offer peer to peer training activities where families are training families. By using their experience, family support providers can help the families learn more about what challenges they may face. The family support providers job is not to do the work for them but provide them with the tools to do the work themselves with assistance.

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DEMONSTRATES ACCOUNTABILITY TO FAMILIES, THE COMMUNITY, AND TO FUNDERS Accountability is a concept in ethics with several meanings. It is often used synonymously with such concepts as responsibility, answerability, enforcement, blameworthiness, liability and other terms associated with the expectation of account-giving. Accountability can be outlined as "A is accountable to B when A is obliged or required to inform B about As (past or future) actions and decisions, to justify them, and to suffer punishment in the case of misconduct. "In leadership roles, accountability is the acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance and implementation within the scope of the role or employment position and encompassing the obligation to report, explain and be answerable for resulting consequences. Retrieved from Wikipedia, http://en.wikipedia.org/wiki/Accountability The family support provider performs a variety of activities to show accountability to all levels of the system. Some examples are: Accountability To Families: Following through with what you say you are going to do. Assisting with finding the resources you need to solve your problems. Providing transportation or access to transportation assistance to get things you need done. Talking to people and introducing me to people who help will provide me with support in the future. Providing home visits to see to the parents needs and how they are doing to reduce isolation. Explaining the paperwork presented to the family in a way that they understand what they are signing. Accountability to the Community: Building relationships with community resource providers like the housing authority, the utility providers and the phone company. Helping families he or she serves get budget counseling to remain in their home and keep services. Providing speakers from different areas for informing the families she serves (fire department; police; IEP information from the special education department) at family support groups). Having support groups for parents to share experiences about how they handle common problems. This opportunity encourages caregivers to put their heads together and learn from each other. Developing games or other activities or babysitting services for the youth to provide respite for the caregiver during their support times. Offer other training opportunities to the families they serve. - 135 -

Offering mentors and tutors for youth who need additional supports. Providing meals or access to meals during family support times. Accountability to funder: Completing all necessary documentation to report time spent and activities to the funding source in timely fashion. Family support providers are at their best when they strive to be a person who fits the following definition of accountability: People who are truly accountable expand their view of organizational responsibility. At all levels, accountable people do what they can to get done what needs to get done, no matter where in the organization they have to go. They NEVER say, "It's not my job." They also hold themselves accountable for making relationships work - they don't say, "Well, I'll go halfway if they will." They take 100% responsibility for making any relationship work. A person with the core quality of accountability: Takes the initiative to get things done Is not afraid to hold himself accountable Is willing to cross departmental boundaries to help with a meaningful project Takes personal responsibility for organizational success http://en.wikipedia.org/wiki/Leadership_Character_Model Throughout this chapter a number of resources have been provided and many other helpful sources are set out below: values. (n.d.). Dictionary.com Unabridged (v 1.1). Retrieved July 22, 2009, from Dictionary.com website: http://dictionary.reference.com/browse/values Universal Declaration of Human Rights (1948) (http://www.un.org/en/documents/udhr/) Children's Rights: The Rights of Children and Their Families Who Need or are Receiving Community Services (http://olrs.ohio.gov/ASP/ChildrensRights.asp) Culture and Parenting: A Guide for Delivering Parenting Curriculums to Diverse Families, (2006) University of California Cooperative Extension; Lenna L. Ontai, Ann Mastergeorge, Families with Young Children Workgroup - University of California, Davis partnership. (n.d.). The American Heritage Dictionary of the English Language, Fourth Edition. Retrieved July 22, 2009, from Dictionary.com website: http://dictionary.reference.com/browse/partnership National Alliance on Mental Illness http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_NAMI/About_NAMI.ht m - 136 -

http://www.nami.org/template.cfm?section=Education_Training_and_Peer_Support_Center Federation of Families for Childrens Mental Health http://www.ffcmh.org/whoweare/history.html http://www.quotes.ubr.com/subject-quotes/e/empowerment-quotes.aspx http://en.wikipedia.org/wiki/Leadership_Character_Model http://en.wikipedia.org/wiki/Accountability Mental Health America: http://www.nmha.org Mental Help: http://www.mentalhelp.net National Institute on Mental Health: http://www.nimh.nih.gov/index.shtml

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GLOSSARY

A Abilify - antipsychotic used to treat schizophrenia, bipolar disorder, and agitation ADHD- Attention Deficits/Hyperactivity Disorder Adderall - stimulant used to treat Attention Deficit Hyperactivity Disorder Advocate-1 : one that pleads the cause of another; specifically : one that pleads the cause of another before a tribunal or judicial court 2 : one that defends or maintains a cause or proposal 3 : one that supports or promotes the interests of another Aggression- Words and action that are deemed to be threatening to others. Ambien - used as a sleep aid Ameliorate- to make better or more tolerable Antabuse - used to treat alcohol addiction Anxiety - Exaggerated or inappropriate responses to the perception of internal or external dangers. Also includes excessive apprehension toward new people, places or things; or in some cases excessive apprehension toward people, places or things in which they have previously encountered. Assessment-1 : the action or an instance of assessing : APPRAISAL 2 : the amount assessed Aricept - used to slow the progression of dementia Ativan - an anti -anxiety medication of the benzodiazepine class often used to help with panic attacks or during detoxification from alcohol or other drugs B BuSpar - an anti -anxiety medication C Case Manager - An individual who organizes and coordinates services and supports for children with mental health problems and their families. (Alternate terms: care coordinator, advocate, and facilitator.) This person is not a mental health professional and therefore cannot perform a diagnostic assessment. Conduct Problems - Behaviors that are characterized by acting out, ranging from annoying, minor oppositional behavior (yelling, temper tantrums) to more serious types of antisocial behavior (aggression, physical destruction, stealing). Celexa - an antidepressant of the SSRI class (Selective serotonin reuptake inhibitor Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) website (www.chadd.org). Clozaril - an antipsychotic

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Collaborative-1 : to work jointly with others or together especially in an intellectual endeavor 2 : to cooperate with or willingly assist an enemy of one's country and especially an occupying force 3 : to cooperate with an agency or instrumentality with which one is not immediately connected Cognitive-1 : of, relating to, being, or involving conscious thinking, reasoning, or remembering) <cognitive impairment>intellectual activity (as thinking, reasoning, or remembering) <cognitive impairment> Concerta - used to treat ADD/ADHD Cultural competence - Help that is sensitive and responsive to cultural differences. Caregivers are aware of the impact of culture and possess skills to help provide services that respond appropriately to a person's unique cultural differences, including race and ethnicity, national origin, religion, age, gender, sexual orientation, or physical disability. They also adapt their skills to fit a family's values and customs Cymbalta - an antidepressant of the SSNRI (Selective Serotonin and Norepinephrine Reuptake Inhibitor) class, similar to Effexor D DBHS- Arkansas Department of Behavioral Health Depression - A type of mood disorder characterized by low or irritable mood or loss of interest or pleasure in almost all activities over a period of time. Depakote - a mood stabilizer used to treat bipolar disorder, sometimes called an antimanic depression.

DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition): An official manual of mental health problems developed by the American Psychiatric Association. Psychiatrists, psychologists, social workers, and other health and mental health care providers use this reference book to understand and diagnose mental health problems. Insurance companies and health care providers also use the terms and explanations in this book when discussing mental health problems. E Emotional Health - The well-being and appropriate expressions of ones emotions. Externalizing Disorder - Disorders that are expressed visibly to others and can be characterized by aggression, behavioral acting-out, hyperactivity, and conduct disorder. EPSDT- Early and Periodic Screening Diagnostic and Treatment Effexor - an antidepressant of the SSNRI (or SNRI) class Elavil - a tricyclic antidepressant (TCA), less commonly used these days

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Empathy- the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner Empower-1 : to give official authority or legal power to <empowered her attorney to act on her behalf. Evidence Based Practice (also known as EBP) -Following the definition offered by the Institute of Medicine (2001), evidence-based practice is the blending of the best research evidence with clinical expertise and consumer values. It can also be thought of as service approaches, interventions or practices that have consistent scientific evidence showing that they improve consumer outcomes. F Facilitator - one that facilitates; especially : one that helps to bring about an outcome (as learning, productivity, or communication) by providing indirect or unobtrusive assistance, guidance, or supervision <the workshop's facilitator kept discussion flowing smoothly> Family-centered services -Help designed to meet the specific needs of each individual child and family. Children and families should not be expected to fit into services that do not meet their needs. Also see appropriate services, coordinated services, wraparound services, and cultural competence. Family support services - Help designed to keep the family together, while coping with mental health problems that affect them. These services may include consumer information workshops, in-home supports, family therapy, parenting training, crisis services, and respite care. Family Support Worker - The role of a family support provider in a system of care is often all consuming. The family support provider becomes the go-to person when families need more information, someone to act as a sounding board and someone to provide support throughout the phases of the help seeking process G Gabitril - a mood stabilizer Geodon - an antipsychotic H Haldol - an antipsychotic Hyperactivity - A disorder in which children are overactive and impulsive (acts without thinking). I Inattention - Inability to focus and concentrate on a particular person or task.

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Internalizing Disorders - Disorders expressed within the individual and focused on clinically problematic affective and emotional state, such as anxiety or depression. Imipramine - a tricyclic antidepressant (TCA) which is sometimes used to treat bulimia, panic disorder, or related disorders Impulsivity - arising from an impulse <an impulsive decision> b : prone to act on impulse <an impulsive young man> Inderal - a beta blocker alternatively known as propranolol used for acute anxiety Intervention - to come in or between by way of hindrance or modification <intervene to stop a fight> b : to interfere with the outcome or course especially of a condition or process (as to prevent harm or improve functioning) K Keppra - an anticonvulsant drug which is sometimes used as a mood stabilizer Klonopin - anti-anxiety medication of the benzodiazepine class L Licensed Master Social Worker (LMSW): The same as a LCSW without at least 2 years post-graduate experience, 2000 hours of clinical supervision with a LCSW and the passing of the LCSW Exam. Licensed Professional Counselor (LPC): A person with an advanced degree in mental health or other social services charged with assessment and treatment of mental health. Licensed Associate Counselor (LAC): Same as a LPC. Lamictal - a mood stabilizer of the anticonvulsant class Lexapro - an antidepressant Librium - anxiety medication of the benzodiazepine class Lithobid - a type of Lithium, which is a mood stabilizer used to treat bipolar disorder Loxitane - an antipsychotic, today rarely used Lunesta - a sleep aid Luvox - an antidepressant of the SSRI class, often used to treat Obsessive-compulsive disorder M Mellaril - an antipsychotic, today rarely used Mental health -How a person thinks, feels, and acts when faced with life's situations. Mental health is how people look at themselves, their lives, and the other people in their lives; evaluate their challenges and problems; and explore choices. This includes handling stress, relating to other people, and making decisions. Mental health problems -Mental health problems are real. They affect one's thoughts, body, feelings, and behavior. Mental health problems are not just a passing phase. They can be severe, seriously interfere with a person's life, and even cause a person to become

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disabled. Mental health problems include depression, bipolar disorder (manic-depressive illness), attention-deficit/ hyperactivity disorder, anxiety disorders, eating disorders, schizophrenia, and conduct disorder. Mental disorders - Another term used for mental health problems. Mental illnesses -This term is usually used to refer to severe mental health problems in adults. N NAMI- National Alliance on Mental Illness. NFFCMH- National Federation of Families for Childrens Mental Health NOS -Not Otherwise Specified Navane - an antipsychotic, today rarely used Neurontin - an anticonvulsant (anti -seizure medication) which is sometimes used as a mood stabilizer or to treat chronic pain, particularly diabetic neuropathy O Outcomes - The results of a specific mental health care service, usually phrased in terms of child and family gains (e.g., improved school performance, improved family communication). P Plan of care - A treatment plan especially designed for each child and family, based on individual strengths and needs. The caregiver(s) develop(s) the plan with input from the family. The plan establishes goals and details appropriate treatment and services to meet the special needs of the child and family. Post-Traumatic Stress Disorder - A psychiatric illness that can occur following a traumatic event in which there was threat of injury or death to you or someone else. The main symptom associated with PTSD is anxiety and avoidance of anything or anyone associated with the event. Prognosis - Prediction by a health professional regarding a persons diagnosed condition and chances for recovery. Psychiatrist (MD)- A physician who completed both medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness. Psychologist (PhD or PsyD) - A professional with a doctoral degree in psychology who specializes in psychological testing, assessment and therapy. PTSD - anxiety and avoidance of anything or anyone associated with the event. PCP- Primary Care Physician Paxil - an SSRI antidepressant, used frequently to treat depression and anxiety disorders

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Prolixin - an antipsychotic Prozac - an SSRI antidepressant,benzodiazepine class R Remeron - an antidepressant which is often used as a sleep aid Reminyl - used to slow the progression of Alzheimer's Dementia Residential treatment centers -Facilities that provide treatment 24 hours a day and can usually serve more than 12 young people at a time. Children with serious emotional disturbances receive constant supervision and care. Treatment may include individual, group, and family therapy; behavior therapy; special education; recreation therapy; and medical services. Residential treatment is usually more long-term than inpatient hospitalization. Centers are also known as therapeutic group homes. Respite care -A service that provides a break for parents who have a child with a serious emotional disturbance. Trained parents or counselors take care of the child for a brief period of time to give families relief from the strain of caring for the child. This type of care can be provided in the home or in another location. Some parents may need this help every week. Restoril - a sleep aid of the benzodiazepine class ReVia - alternatively known as Naltrexone Risperdal - an antipsychotic Ritalin - a stimulant used to treat ADHD/ADD S SED- Serious Emotional Disturbance- youth - Diagnosable disorders in children and adolescents that severely disrupt their daily functioning in the home, school, or community. Serious emotional disturbances affect one in 10 young people. These disorders include depression, attention-deficit/hyperactivity, anxiety disorders, conduct disorder, and eating disorders. SMI- Serious Mental Illness-adult Serax - anti -anxiety medication of the benzodiazepine class, often used to help during detoxification from alcohol or other drugs of abuse Seroquel - an antipsychotic, sometimes is used as a sleep aid SCHIP - State Childrens Health Insurance Program Stelazine - an older antipsychotic, today rarely used Strattera - a non -stimulant medication used to treat ADD/ADHD T TFC - therapeutic foster care Topamax - a mood stabilizer, also used for migraine headaches Thorazine - an older antipsychotic, today rarely used because of the high occurrence of serious side effects

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Trazodone - a tricyclic antidepressant (TCA), most typically used now as a sleep aid Trileptal - a mood stabilizer used to treat bipolar disorder V Vistaril - an antihistamine for the treatment of itches and irritations, an antiemetic, as a weak analgesic, an opioid potentiator, and as an anxiolytic.

W Wellbutrin - an antidepressant of the NDRI class Norepinephrine and Dopamine Reuptake Inhibitor, structurally identical to Zyban, a stop -smoking aid X Xanax - an anti-anxiety medication of the benzodiazepine class Z Zoloft - an antidepressant in the treatment of schizophrenia, schizoaffective disorder, bipolar disorder an antidepressant of the SSRI class.

Merriam-Webster Online Dictionary, www.merriam-webster.com SAMHSA's National Mental Health Information Center http://mentalhealth.samhsa.gov/child

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APPENDIX I- BRIGHT FUTURES

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B R I G H T

F U T U R E S

F A M I L Y

T I P

S H E E T S

Infancy
(011 Months)

The Future Starts Here

In your babys life, infancy is a time of exciting physical and emotional growth. Your baby will triple in weight, grow many inches, and learn how to sit up and stand. He may even take his first steps. Emotionally, he will develop bonds of love and trust with the people around him. The ways you nurture him now lay the foundation for him to grow into a selfconfident, active toddler.

Parents and Health Professionals: Partners for a Healthy Baby

Health professionals like your babys doctors and nurses are your partners in keeping your infant healthy. Each of you brings something special to the effort. Health professionals know about child health care, growth, and development. You have the day-to-day experience that makes you an expert on your baby. You are also the best person to make sure your baby gets the kinds of care she needs. This tip sheet will help you think about some of the most important health issues during infancy.

Health Professional Visits During Infancy

Because your baby is changing so fast, your health professional will want to see her at the following ages for regular checkups: Newborn Within the first week 1 month 2 months 4 months 6 months 9 months you to ask any questions or discuss concerns. At these visits, your baby will get a physical exam. Your health professional may check her hearing and vision or do other screening tests. Your baby may also be immunized against some of these diseases: Hepatitis B Diphtheria, tetanus, pertussis (DTaP) H. influenzae type b (Hib) Polio (IPV) Pneumococcal conjugate (PCV)

These visits are important. They give your health professional a chance to make sure your baby is healthy and growing well. They are also a time for

Social Development
During early infancy, you and your baby are developing a strong, loving bond. By 2 months, your baby knows your voice and shows he enjoys your attention. You will also begin to see his unique personality. Make sure that the way you deal with him fits with his personality. For example, an active baby may want lots of active playtime. A calm baby may prefer quiet cuddling. The way you cuddle and play together is the basis for his future social development. It helps him learn what to expect and how to act with other people. Here are some ways to be sure he learns to feel good about himself and other people:

Things to Discuss with Your Health Professional

Ways to help older brothers and sisters play safely with the baby. Concerns about the way your baby acts around you or others.

Eating
Your baby will learn a lot about eating and drinking in her first year. Breastfeeding or drinking from a bottle comes first. Then, sometime between 4 and 6 months, your baby will be ready to start eating solid foods. Shell learn how to chew and swallow, drink from a cup, and feed herself. A whole new world of tastes, textures, and skills will open up. You can do a lot to help her eat well.

Encourage Your Baby to Feel Good About Himself

Praise your baby and give him lots of loving attention. Spend time together, holding, cuddling, and rocking him gently. Talk, sing, and read with him every day. Even though he cant talk yet, your baby learns by listening to you. Notice the way your baby moves, cries, and smiles. Your loving response helps him know that he is well cared for.

Encourage Good Feelings Within the Family

Do things together as a family. Encourage older brothers and sisters to spend time with the baby. Encourage family members to show affection for the baby and each other.

Start Out Well

Breastmilk is best for your new baby. Breastmilk is easy to digest and has just the right nutrients. It can also help prevent some infections. A nurse, doctor, or breastfeeding consultant can answer your questions and help you get started. If you choose to bottlefeed your baby, be sure to feed her formula that is iron fortified. When you feed her, hold her so that she is partly sitting. Do not warm breastmilk, formula, or baby foods in a microwave oven. The milk or food may overheat and burn your babys mouth. Stop feeding your baby when she seems full. Youll know shes had enough when she turns her head away from the nipple, closes her mouth, or seems to lose interest in sucking.
Responds to parents faces and voices Can lift head briefly when lying down Can sleep 34 hours at a time; stays awake 1 hour or more Can be comforted by being held or talked to Coos and talks back Pays attention to voices and sounds Smiles in response to attention Can lift head, neck, and upper chest

Encourage Your Baby to Enjoy Other People

Find safe, fun ways for your baby to spend time with other adults and children. Think about joining a parent-baby play group. Around 79 months of age, your baby may seem afraid of strangers or get upset whenever you leave. Its a natural step in his development. It shows that he is learning to know the difference between family members and other people.

My Baby Is Changing!

Responds to sounds Responds to parents faces and voices Moves arms and legs Sees color and has fully developed hearing

1 Week

1 Month
2 Infancy

2 Months

Introduce Solid Foods When Your Baby Is Ready

When your baby has good control of her head and neck and can sit up with support, she is ready to try solid foods. This happens around 46 months. Start out with iron-fortified rice cereal. If your baby has no problems with this, then slowly add other foods. After introducing a new food, wait a week before you add the next one. This gives you a chance to see whether your baby has a problem with the food. Make sure that all foods are soft or pured. Dont give your baby hard, small foods like peanuts or whole grapes, or large chunks of meat or vegetables. Such foods can get stuck in your babys tiny throat and make her choke. Dont give your baby honey until she is a year old. It can cause food poisoning in infants. Keep giving your baby breastmilk or iron-fortified formula for the first year. This milk is still her major source of nutrition.

Oral Health
Its never too soon to start taking care of your babys gums and teeth. With regular cleaning, your baby will have a beautiful and healthy smile right from the start.

Take Care of Gums and Teeth

Even before your babys first tooth appears, you can clean his gums. Gently wipe them after each feeding with a clean, damp washcloth. After teeth appear, clean them gently with a soft infant toothbrush. Use just waternot toothpaste!

Make Teething Easier

Teething begins anytime between 6 and 12 months. During teething, babies drool a lot and want to chew on things. Sometimes they fuss or cry if it hurts. They may even have a fever. To ease the pain, try giving him a cold teething ring to chew on.

Prevent Tooth Decay

Never put your baby to bed with a bottle of milk or juice. The sugar in these drinks stays in his mouth and can lead to tooth decay. At about 6 months, begin encouraging your baby to drink from a cup rather than a bottle. Your own saliva can pass bacteria from your mouth to your babys, so make sure you brush and floss regularly. Dont put your babys pacifier in your mouth before you give it to him. Dont eat out of a common dish with your baby or use the same spoon or fork.

Things to Discuss with Your Health Professional

Concerns about your babys weight. What to do if your baby has colic, seems allergic, or has problems with any solid foods. What to do if you have any difficulties with breastfeeding or bottlefeeding. Whether to give your baby vitamin D supplements if youre breastfeeding.
Babbles and coos Rolls over from front to back Controls head well Reaches for and bats at objects

Things to Discuss with Your Dentist or Health Professional

How to relieve teething symptoms. Whether your baby needs fluoride supplements. When and how to help your baby stop sucking his thumb or using a pacifier.

Says dada Sits with support Is interested in toys Smiles, laughs, squeals May have first tooth

Responds to own name Crawls and stands with help Understands a few words Shows anxiety with strangers Plays peek-a-boo, pat-acake

4 Months

6 Months
3 Infancy

9 Months

Safety
Now that you have a baby, look around your house with new eyes. Ask yourself what you need to do to make your home a safe place to raise a child. Think about your daily routines, like changing diapers, cooking, and driving, and consider ways to make them safer, too.

Find out which hospitals are covered by your insurance. Ask about financial assistance if needed. Take a first-aid and infant CPR course.

Things to Discuss with Your Health Professional

A plan for dealing with medical emergencies, injuries, or poisonings. Guidelines for knowing when to go to the emergency room. The hospitals and clinics your health professional works with. Ways to get in touch with your health professional after office hours.

Plan Ahead
Know when to go to the emergency room. Know where the closest one is and how to get there quickly. Keep the number of a poison control center near the phone. Remove guns from the home or keep them unloaded and locked up.

Making Sure Your Child Is Safe

Prevent Injuries
Use a car safety seat in the back seat every time your child rides in the car. Carefully attach the car seat to the back seat according to the manufacturers directions. Never place your babys safety seat in the front seat of a vehicle with a passenger air bag. The back seat is the safest place for children of any age to ride. Always put your baby to sleep on her back to reduce the risk of sudden infant death syndrome (SIDS). Think back to sleep to help you remember. Do not put blankets, comforters, pillows, or toys in the crib. They could cover her face if she rolls over. Keep her room temperature comfortable but not too warm. Check that the bars of her crib are less than 2 3/8 inches (about the width of a playing card) apart. The space between the mattress and the crib frame should be less than two fingers wide. When your baby is in the crib, always keep the sides of the crib all the way up. Never leave your baby unattended when she is awake. Put a safety gate at the top of stairs. Close the latches on all windows. Keep sharp objects like scissors, letter openers, pens, and knitting needles in a safe place. Keep medications, household cleaners, and poisons locked up. Make sure your baby cant get at electrical wires, outlets, or appliances. Practice water safety. Put a fence around any pools. Empty buckets, baby pools, and bathtubs right after use. Never place your baby in a walker. It wont help her learn to walk and it can be unsafe because she can tip over, fall out, fall downstairs, or get to dangerous places. Keep cigarettes, lighters, ashtrays, and matches out of sight and out of reach. Set the temperature of your household water heater below 120F. Before you put your baby in the bath, put your wrist in the water to make sure its not too hot. When you take your baby outside, keep her out of direct sunlight. Dont use sunscreen until shes 6 months old. But put a brimmed hat on her head. Put a hood on the stroller or use an umbrella to shade her from the sun. Install smoke alarms in your home. Check them regularly to make sure they work.

Prevent Choking
Do not allow your baby to play with things that can cover his nose and face. Plastic bags and balloons can be very dangerous! Keep objects that your baby could swallow, like buttons, coins, and marbles, out of reach. Cut food into small pieces.

Prevent Burns
Keep your baby away from hot stoves, fireplaces, grills, heaters, irons, and hair dryers. Turn pot handles toward the back of the stove.

4 Infancy

Physical Activity
During infancy, your baby develops many new physical skills. As she learns to control her body movements, she becomes stronger and more active. Before long, she will be able to hold up her head, sit up, roll over, crawl, stand, and even take a few steps. Shell also be able to point, hold a toy, and feed herself. Your baby needs lots of opportunities to play with you, with food, and with toys to help her develop these important skills.

Child Care and Learning

Whether you are going to work or school, or just going to the store, there will be times when you need someone to watch your baby. It is important to find someone that both you and your baby like. Finding the right babysitter, child caregiver, or child care center can take time, but its worth it to know your child is in good hands.

Choose Child Care Carefully

Plan ahead. Have a caregiver or child care center lined up before you actually need it. Choose a caregiver or child care center that can give your baby the loving attention he needs and wants. Pick babysitters you trust. Make sure they are old enough to care for a baby. Tell your sitter how to reach you. Give her clear instructions on what to do in case of an emergency. Write these instructions and post them someplace easy to find, like the refrigerator.

Help Your Baby Be Active

Play with your baby. Find ways to rock, bounce, and sway her gently. This will help her learn to control her head and body and build her strength. Never shake your baby. Shaking your baby can cause serious injury or death. Help her play with toys. Give her a rattle to shake, blocks to stack or knock over, a stuffed animal to reach for. These games help your baby develop muscle control. Find games that encourage her to move rather than to sit and watch.

Watch Your Baby Learn to Crawl and Walk

Your baby may begin to crawl between 7 and 10 months. Make the area safe, then encourage her to explore. It will help her strengthen her muscles. When your baby can stand and move around the room by holding onto furniture, shes almost ready to walk. Shell soon be walking without help.

Help Your Baby Adjust to Child Care

Spend a few minutes with your baby at the child care center or caregivers home. Help him settle in before you leave. Build a friendly and trusting relationship with the caregiver. This will make it easier for you to discuss any problems or concerns about your baby. It will help your baby feel more comfortable, too.

Things to Discuss with Your Health Professional

Questions or concerns about your babys development. Any problems your baby has with physical activities.

Help Your Baby Learn

Every day, take advantage of learning opportunities. Talk, read, and play together. Take short trips and outings around the neighborhood. Celebrate special occasions. These will help prepare your baby for future learning.

Things to Discuss with Your Health Professional

How to know if your baby is happy or unhappy in his child care program. Whether there are any hearing or vision problems that might keep him from learning.

5 Infancy

Choosing the Right Child Care

Step 1: Interview caregivers.
Call and ask about:
cost and financial assistance how many children are cared for size of the adult staff meals and food they provide their license, accreditation, and certification How do they handle childrens emergencies and illnesses?

Step 3: Make the decision.

Ask yourself:
Will my child be happy and secure? Can the caregiver meet my childs needs? Do the caregivers values agree with mine? Is this child care suitable and affordable? Do I feel good about choosing this caregiver?

Visit and look for:

a good relationship between staff and children happy, active children a clean, safe center, inside and out a variety of toys and learning materials

Step 2: Check references.

Talk with other parents who use the center and ask:
Is the caregiver always reliable? Is their child happy there? Does the caregiver seem to respect their values and culture? Would they recommend the caregiver?

Step 4: Stay involved.

Be sure to:
make time to talk with your caregiver every day talk with your caregiver about issues and concerns ask about your childs growth and development

Ask them:
Are parents allowed to visit their child during the day? How do they discipline young children in their care?

Source: U.S. Department of Health and Human Services, Administration for Children and Families, Child Care Bureau. Four Steps to Selecting a Child Care Provider. Administration for Children and Families Web site. Available at http://www.acf.dhhs.gov/programs/ ccb/faq/4steps.htm. Accessed April 22, 1999. 2001 For information about Bright Futures, please contact (703) 524-7802 or e-mail brightfutures@ncemch.org. Visit our Web site at www.brightfutures.org.

Compliments of Pfizer Inc.

B R I G H T

F U T U R E S

F A M I L Y

T I P

S H E E T S

Early Childhood
(14 Years)

The World Opens Up

Early childhood is a time of big changes for your child. At age 1, hes still a baby in many ways. By age 4, hes ready for preschool! In these few years, your childs world will open up. Hell begin to focus on adults and playmates outside of the family. His thinking abilities will grow, and hell be able to use his imagination in play. Your toddlers growing size, strength, and energy will change him into a running, jumping, climbing kid. Hes beginning to have a sense of himself as a separate person. Hell want to explore, be active, and show his independence. This is what early childhood is all about.

Parents and Health Professionals: Partners for a Healthy Child

Health professionals are your partners in keeping your child healthy. Each of you brings something special to the effort. Health professionals know about child health care, growth, and development. You have the day-to-day experience that makes you an expert on your child. You are also the best person to make sure your child gets the kinds of care she needs. This tip sheet will help you think about some of the most important health issues in early childhood.

Health Professional Visits During Early Childhood

Your health professional will want to see your child for regular checkups at these ages: 1 year 2 years 15 months 3 years 18 months 4 years These visits are important. They give your health professional a chance to make sure your child is healthy and growing well. They also are a time for you to ask any questions or discuss your concerns. At these visits, your child will get a physical exam; hearing, vision, or other screening tests; and one or more of the following immunizations: Hepatitis B Diphtheria, tetanus, pertussis (DTaP) H. influenzae type b (Hib) Polio (IPV) Pneumococcal conjugate (PCV) Measles, mumps, rubella (MMR) Varicella (Var) or chicken pox Hepatitis A (in selected areas)

Social Development
Social development is how your child grows in confidence, independence, and good feelings about herself. Youll see these qualities in the way she feels about people and acts around them. Your child is beginning to discover a whole new world of people and things to enjoy. Helping her develop socially will create a strong foundation for later development. Here are some ways to help:

Eating
Toddlers learn about foods by looking, touching, and tasting. As they get older, children explore new foods by talking about them, helping to shop and cook, and sharing mealtimes with the family. You may notice that your childs growth and weight gain will slow down, compared to when he was a baby. He might eat a lot one day but not much the next. Hell also show his new independence in choosing which foods to eat. During these years, your child may seem to become a fussy eater. The foods he likes and dislikes might even change from day to day.

Encourage Your Child to Feel Good About Herself and Others

Praise your child every day. Encourage her to explore and try new things. Provide safe places for her to do this. Within limits, let your child make simple choices. For example, which shirt to wear or which fruit to eat. Be consistent and clear about which behaviors are okay or not okay. Use discipline to teach and protect your child, not to punish her or make her feel bad about herself. Try timeouts, setting limits, and gentle restraint.

Build Healthy Food Habits

Offer a variety of healthy foods, such as grains, fruits, vegetables, meats, and dairy products. Let your child choose what to eat and how much. Let your child feed himself. It will be messy but hell learn a lot. Give him cups, bowls, and spoons that are easy to use. Dont give hard, small foods. Small foods like nuts, raisins, meat chunks, and whole grapes can get stuck in his throat. If you have a child care provider, make sure she also serves a variety of healthy foods.

Encourage Good Feelings Within the Family

Encourage family members to show affection for each other. Do lots of things together as a family. Spend special time alone with each child.

Encourage Your Child to Enjoy Other People

Join a parent-child play group. Take your child to community activities. Encourage friendships with other children.

Things to Discuss with Your Health Professional

Your childs progress in weaning from breast or bottle to cup. Any problems your child has with eating or drinking. Questions or concerns about your childs growth and development.

Things to Discuss with Your Health Professional

How to help your child express anger and other feelings in acceptable ways. Signs that will tell you whether she is ready for preschool.

My Child Is Changing!

Begins to take steps and talk Waves bye-bye Plays pat-a-cake and peek-a-boo Says a few words plus mama and dada

Feeds self with fingers Listens to a story Drinks from a cup Understands simple commands

Uses a spoon and cup Uses two-word phrases Throws a ball Kisses and shows affection

1 Year

15 Months
2 Early Childhood

18 Months

Oral Health
The good habits your child learns now can last a lifetime. Good habits include brushing, flossing, seeing a dentist regularly, and protecting teeth from injury.

What to do if your child hurts her mouth or breaks a tooth. How to help your child stop sucking her thumb.

Prevent Tooth Decay

Teach your child to drink from a cup instead of a bottle. If she sucks from a bottle for a long time, the sugar from the milk or juice stays in her mouth too long. The sugar can lead to tooth decay. Water in a bottle is okay. It has no sugar and wont hurt her teeth. Take your child to the dentist for her first visit when shes about 1 year old. Until she is 2, clean her teeth twice a day with a small, soft toothbrush. Use just water, not toothpaste. When shes 2, begin putting a little toothpaste on her toothbrush. Use a fluoridated toothpaste, and just a pea-size amount. Teach your child to brush her own teeth at age 3. Watch to make sure she brushes correctly and spits out the toothpaste. Your own saliva can pass bacteria from your mouth to your childs, so make sure you brush and floss regularly. Dont eat out of a common dish with your child or use the same spoon or fork.

Physical Activity
Keeping active isnt a problem for most toddlers and young children. Theyre always on the go! There are lots of ways to channel this energy in positive ways.

Build Healthy Habits for a Lifetime

Try to find physical activities that are fun for the whole family. Let your child play as long as he has energy and interest. High energy may come in spurts. Limit the amount of time your child watches TV and plays video or computer games. Be a role model. Be physically active yourself. Look for community programs that encourage physical activity.

Protect the Teeth and Mouth from Injury

Use the safety tips in the box on page 4 to help protect your childs teeth from injury.

Things to Discuss with Your Dentist or Health Professional

How often to bring your child to the dentist. Whether your child needs fluoride supplements to protect her teeth. When and how to floss your childs teeth.

Things to Discuss with Your Health Professional

The kinds of activities your child should be able to do. Physical activities that are especially hard for your child.

Can go up and down stairs one at a time Can kick a ball Can stack blocks Imitates adults

Rides a tricycle Knows name, age, sex Copies a circle and a cross Dresses self

Can sing a song Knows reality from fantasy Talks about daily activities and experiences Can hop, jump on one foot

2 Years

3 Years
3 Early Childhood

4 Years

Safety
Now that your child can move fast, has lots of energy, and likes to explore, you need to be extra careful about her safety. Plan ahead. Think about things you can do to prevent injuries and know what to do if she gets hurt.

Plan Ahead
Know when to go to the emergency room. Know where the closest one is and how to get there quickly. Keep the number of a poison control center near your phone. Find out which hospitals are covered by your insurance. Ask about financial assistance if needed. Take a class to learn first aid and child CPR. Every once in a while, do a safety check of your home and child care facility.

Things to Discuss with Your Health Professional

A plan for dealing with medical emergencies, injuries, or poisonings. The hospitals and clinics your health professional works with. Ways to get in touch with your health professional after office hours.

Keeping Your Child Safe at Home and at Play

Prevent Injuries
Put your child in a car safety seat every time he rides in the car. Attach the car seat according to the manufacturers directions. Be sure that the seat is the right size and type for your childs age and weight. The back seat is the safest place for a child to ride. Young children should never sit in the front seat of a car with airbags. Never leave your child alone on a changing table or other high place. Keep safety gates on stairs and close the latches on windows. Keep sharp objects, such as scissors and pens, in a safe place. Lock up medications, household cleaners, and poisons. Make sure your child cant get at electrical wires, outlets, or appliances. Remove guns from the home or keep them unloaded and locked up. Keep your child away from lawn mowers, overhead garage doors, and electric tools. Teach your child street and playground safety. Warn him not to chase balls into the street. Practice water safety. Teach your child to swim. Empty buckets, childrens pools, and bathtubs right after use. Put a fence around any pools. Check playgrounds for safety. Look for things like sharp edges, splinters, and broken equipment. Find playgrounds with soft surfaces like wood chips or grass. irons, and hair dryers. Turn pot handles toward the back of the stove. Keep cigarettes, lighters, ashtrays, and matches out of sight and out of reach. Set temperature of household water heater below 120F. Before your child gets in the bath, put your wrist in the water to make sure it is not too hot. Limit the time your child spends in the sun. Put sunscreen (at least SPF 15) on your child before he goes outside. Install smoke alarms and check them regularly.

Prevent Choking
Dont allow your child to play with things that can cover his nose and face, like plastic bags or balloons. Keep your child away from small, hard objects that he could swallow. For example, keep buttons, coins, or marbles out of reach.

Prevent Burns
Keep your child away from hot stoves, fireplaces, grills, heaters,

4 Early Childhood

Child Care and Education

Young children need lots of attention and chances to play and learn. Choose child care that gives these to your child. The home or child care center where your child spends his day should be safe and caring. It should have toys, books, and activities that encourage learning.

Choose Child Care Carefully

Take time to research your child care options carefully. The chart on page 6 can help you choose high-quality child care. Be just as careful when you hire a babysitter for the evening. Pick a mature person who can give your child the loving attention he needs and wants.

Make Sure the Care Is Right for Your Child

Every so often, make a surprise visit to your child care provider. Is the staff caring and gentle with your child? Does your child play well with the other children? Look around the center and think about safety and health issues. Are toys with small parts out of reach of toddlers? Is the center clean? Make sure your child is happy there. Does he look forward to going? Does he talk cheerfully about his day?

Help Your Child Learn

Every day, take advantage of learning opportunities. Talk, read, play, and visit friends together. Go on short trips and neighborhood outings.

Things to Discuss with Your Health Professional

Warning signs that show that your child is unhappy in a child care program. Any problems with hearing, vision, or speech that might affect learning.

5 Early Childhood

Choosing the Right Child Care

Step 1: Interview caregivers.
Call and ask about:
cost and financial assistance how many children are cared for size of the adult staff meals and food they provide their license, accreditation, and certification

Step 3: Make the decision.

Ask yourself:
Will my child be happy and secure? Can the caregiver meet my childs needs? Do the caregivers values agree with mine? How do they handle childrens emergencies and illnesses? Is this child care suitable and affordable? Do I feel good about choosing this caregiver?

Visit and look for:

a good relationship between staff and children happy, active children a clean, safe center, inside and out a variety of toys and learning materials

Step 2: Check references.

Talk with other parents who use the center and ask:
Is the caregiver always reliable? Is their child happy there? Does the caregiver seem to respect their values and culture? Would they recommend the caregiver?

Step 4: Stay involved.

Be sure to:
make time to talk with your caregiver every day talk with your caregiver about issues and concerns ask about your childs growth and development

Ask them:
Are parents allowed to visit their child during the day? How do they discipline young children in their care?

Source: U.S. Department of Health and Human Services, Administration for Children and Families, Child Care Bureau. Four Steps to Selecting a Child Care Provider. Administration for Children and Families Web site. Available at http://www.acf.dhhs.gov/programs/ ccb/faq/4steps.htm. Accessed April 22, 1999. 2001 For information about Bright Futures, please contact (703) 524-7802 or e-mail brightfutures@ncemch.org. Visit our Web site at www.brightfutures.org.

Compliments of Pfizer Inc.

B R I G H T

F U T U R E S

F A M I L Y

T I P

S H E E T S

Middle Childhood
(510 Years)

Venturing Beyond the Family

From the ages of 5 through 10, your child begins to move from the close and familiar world of family to the larger world of school and friends. At the beginning of this period, your child will make the big jump into kindergarten. By the end, shell be looking forward to junior high school. Her growing physical, mental, and social skills will help her develop confidence in her abilities. This new feeling of Yes! I can do it! will show in her school work, sports and other activities, jobs around the house, and relationships. This feeling is allimportant to a healthy childhood and, later, to a healthy adolescence.

Parents and Health Professionals: Partners for a Healthy Child

Health professionals like your doctor or nurse are your partners in keeping your child healthy. Each of you brings something special to the effort. Health professionals know about child health care, growth, and development. You have the day-to-day experience that makes you an expert on your child. You are also the best person to make sure your child gets the kind of care she needs. This tip sheet will help you think about some of the most important health issues of middle childhood.

Health Professional Visits During Middle Childhood

Your health professional will want to see your child for regular checkups at these ages: 5 years 6 years 8 years 10 years child a chance to ask questions and talk directly with him. Your child will get a physical exam and hearing, vision, or other screening tests. Also, before your child enters school (sometime between the ages of 4 and 6), he should get the following immunizations: Diphtheria, tetanus, pertussis (DTaP) Polio (IPV) Measles, mumps, rubella (MMR) Hepatitis A (in selected areas)

These visits are important. They give your health professional a chance to make sure your child is healthy and growing well. They are also a time for you to ask any questions or discuss concerns. At these visits, your health professional will begin to give your

Social Development
Social development is how your child grows in confidence, independence, and positive feelings about himself. Its also the ways in which he acts with other people. During these years, your child begins to develop a sense of who he is, what he can do, and how he fits in. Friends become very important. He develops ideas about right and wrong and personal responsibility. Heres how you can help your child grow in positive ways:

Spend special time alone with each child in the family. Try to let your children solve their own arguments. But dont allow them to hit or hurt each other in any way.

Help Your Child Feel Good About Others

Help your child learn how to get along and work well with others. Encourage him to become more aware of other peoples lives, strengths, problems, and needs. Talk about ways he might want to help out. Go with your child to school, community, or faithbased activities.

Help Your Child Feel Good About Himself

Show affection. Praise your childs efforts and achievements. Spend time together. Do things you both enjoy, like reading, being physically active, or going to museums. Encourage your child to talk to you about school, friends, and things that happen during the day. Encourage a sense of responsibility. Give him household jobs that he is able to do. For example, ask your 5-year-old to help you set the table. Ask your 10year-old to take out the trash. Be clear about behavior that is okay and not okay. Dont change the rules (bedtime, chores) from day to day. Use discipline to teach and protect your child, not to punish him or make him feel bad about himself. For example, use time outs or take away time from the computer, Internet, video games, or TV.

Things to Discuss with Your Health Professional

How your child expresses his anger and resolves conflicts. Signs of low self-esteem or depression. How your child is doing in school.

Encourage Good Feelings Within the Family

Encourage family members to show affection and respect for each other. Do lots of things together as a family.

My Child Is Changing!
During infancy and early childhood, children change quickly and in many ways. In middle childhood, your child will still be changing. Here are some ways your child will change by the end of this period.

Mental Changes
Rapid development of mental skills. Greater ability to describe experiences and to talk about thoughts and feelings. Change in thinking ability from being self-centered to being able to think about others. Children also become able to understand cause and effect.

Emotional/Social Changes
A growing independence from parents and family. A strong sense of right and wrong. A beginning awareness of the future. A growing understanding about ones place in the larger world. A greater emphasis on friendships and teamwork. A growing desire to be liked and accepted by friends.

Physical Changes
Steady growth in size, strength, and coordination. Breast development and menstruation around age 10 in some girls.

2 Middle Childhood

Eating
By now, your child has learned how to eat and drink by herself. She is beginning to make her own choices about what goes on her plate and in her cup or glass. She is also starting to eat away from home at school and friends houses. This means you will have less control over what she eats. This is a good time to teach her the importance of healthy eating and how to choose healthy foods on her own.

Encourage Healthy Eating at Home

Prepare nutritious meals with breads, cereals, and grains; fruits and vegetables; chicken, fish, and lean meats; and low-fat dairy products. Encourage everyone in the family to have healthy eating habits. Eat meals together as often as you can. Start your childs day off right with a good breakfast. For a balanced meal, include bread or cereal, milk, and fruit. Keep nutritious snacks in the house. Limit foods that are high in fat or sugar, like candy, potato chips, and soft drinks. These foods are high in calories but dont offer much nutrition.

Encourage Healthy Eating Away from Home

Be sure your child eats a nutritious breakfast or lunch at school. Pack a balanced breakfast or lunch or use the school meal program. Fast foods like french fries, burgers, soda, and pizza are high in fat or sugar. Encourage her to choose these foods less often and in smaller portions.

Things to Discuss with Your Health Professional

Your childs weight gain. Possible food allergies.

3 Middle Childhood

Oral Health
During this period, your child will lose many of his baby teeth. Permanent teeth will grow in their place. He will have these teeth for the rest of his life, so he needs to protect them from decay and injury.

Physical Activity
Your child isnt growing as fast now as when she was a young child. Still, during these years, she will become much taller, stronger, and more coordinated. Any fun, safe physical activity is good for your child. Many children enjoy physical education classes at school, afterschool sports programs, and playing in the neighborhood with friends. Here are some ways to help your child stay physically active.

Prevent Tooth Decay

Be sure your child brushes his teeth twice a day. Have him use a pea-size amount of fluoridated toothpaste. Take him to the dentist every 6 months or as often as your dentist or health professional recommends. Talk with your child about smoking and tobacco. Discuss how smoking cigarettes or chewing tobacco can cause oral disease, cancer, and other conditions.

Build Healthy Habits for a Lifetime

Make physical activity fun. Encourage your child to try lots of different physical activities. Soccer, biking, gymnastics, walking, and swimming are just a few. Everyday tasks are also forms of physical activity. Encourage your child to walk the dog, rake up and play in a pile of leaves, wash the car, and join in neighborhood clean-up events. Limit the amount of time your child watches TV, plays video or computer games, and uses the Internet. Be active with your child. Plan physically active family outings, like hikes and bike rides. Be physically active yourself. Be a role model.

Protect the Teeth and Mouth from Injury

Teach your child ways to protect his teeth. For example, he should wear a mouth guard for sports, a safety belt in cars, and a helmet when he bikes, ice skates, or roller skates.

Things to Discuss with Your Dentist or Health Professional

How to deal with thumb sucking. When and how to teach your child to floss his teeth. Whether your child needs fluoride supplements. What to do if your child hurts his mouth or breaks a tooth. Whether your child might need braces. Whether your child should get dental sealants. Sealants are a thin plastic coating that covers the molars, the big teeth used for chewing. Sealants keep food and bacteria from getting trapped in the molars where they can cause decay.Physical Activity

Things to Discuss with Your Health Professional

The right amount of physical activity for your child. Difficulties with any physical activities. Concerns about physical activity if your child has special needs.

4 Middle Childhood

Education
School will be one of the most important parts of your childs life. Shell have a world of things to discover. She will learn to read and write, add, subtract, and multiply. Shell be introduced to history, geography, and science. Your child is more likely to enjoy learning and do well in school if you show that you believe education is important. Your praise for what she can do will help her feel good about herself.

as you drive. Talk together about nature and science when youre outside. Talk to her about school. Know how she feels about it. Does she look forward to going? Is she making friends? Does she enjoy her subjects?

Things to Discuss with Your Health Professional

Difficulties in school that may be related to vision, hearing, or other health problems or behaviors that may interfere with learning. Concerns about school progress. If your child has special needs, how the health professional can support you in getting special educational services or adaptive equipment.

Get Off to a Good Start

Prepare your child. Tour the school together. Meet your childs teacher and talk about the things your child will learn in the classroom. If you can, have your child meet some of her classmates before school starts. Once school starts, stay in touch with the teacher. Attend parent-teacher conferences. Talk to the teacher about any concerns or questions. Tell the teacher about your childs feelings about school, too.

Sexual Development
During these years, your child becomes more aware of his own body. If he has brothers or sisters, he will be curious about the differences he sees. Your childs sexual curiosity is normal. Puberty, with all its physical changes, starts toward the end of middle childhood. As your child nears 8 to 10 years of age, prepare your daughter for menstruation and your son for wet dreams. Let them know that these are expected and natural. Help your child feel comfortable with his body and his physical changes: Avoid using slang words or street language for parts of the body. Using the correct words shows respect for the body. Explain that certain parts of the body (those normally covered by a bathing suit) are private. He should not be touched by anyone in places that make him feel uncomfortable. Encourage your child to ask you questions. Answer his questions frankly, in ways he can understand. Get books for your child that answer some of his questions. A librarian can help you find books that are written at the right level. If your child receives any type of family life or sex education at school or in the community, discuss with him what hes learning.

Be Active in Your Childs School Life

Try to attend school plays, concerts, team games, and other special events. Join the school parent-teacher association (PTA) and participate in PTA-sponsored activities. Encourage your child to join clubs or activities, like the chess club, the science club, or a school play.

Help Your Child Learn

Set aside a special time and place for your child to do her school work every day. Go over her homework. Help her if she has questions. Make learning part of everyday life. You can do simple math together in the grocery store or read street signs

Start sharing your values and attitudes about sex. Explain why its important to delay sexual behavior. Explore your childs understanding of sexually transmitted diseases, such as HIV/AIDS and hepatitis.

5 Middle Childhood

Safety
From ages 5 to 10, children are starting to become more active and independent. This means that you will need to set clear rules for safe behavior. As your child gets older, take time to talk about safety rules and the reasons behind them. Around age 10 some children are tempted to try tobacco, alcohol, inhalants, or illegal drugs. Helping your child learn to say NO is a good beginning. Its a good idea to talk to him and tell him how you feel. Here are some ways to keep your child from harm: Use a car safety seat until he can sit upright against the back seat and bend his knees over the edge of the seat. When he is ready to use a seat belt, make sure it has both shoulder and lap straps. Remove guns from the home or keep them unloaded and locked up. Install smoke alarms. Check them regularly to make sure they work. Lock away medications, household cleaners, poisons, and matches.

Get to and from School Safely

Walk with your child to school or have him walk with a friend or neighbor. Work out a safe route. If he takes the bus, make sure that the bus stop is in a safe place. Remind your child never to talk with strangers or get into a car with them.

Plan Ahead
Be sure that your child wears a bike helmet whenever he rides a bike. Talk about the importance of wearing protective gear, such as a mouth guard, helmet, and knee and wrist pads, when he plays sports. Teach your child to swim and make sure he follows water safety rules. Safety rules include: no swimming alone, no rough horseplay, no running near a pool, and no diving into the shallow end. Limit the time your child spends in the sun. Make sure he puts on sunscreen before he goes outside. Have him use sunscreen with a rating of at least SPF 15. Know when to go to an emergency room. Know where the closest one is and how to get there quickly. Find out which hospitals are covered by your insurance. Ask about financial assistance if needed. Keep the number of a poison control center near the phone. Take a first-aid and child CPR course. Every once in a while, do a safety check on your home.

Be Active Safely
Teach your child how to cross the street safely by obeying these safety rules: Obey traffic signs and signals, cross only if the light is green, cross only at a corner or crosswalk, and look both ways for people and cars. Explain the danger of chasing balls and running into the street. Teach your child biking rules, including using hand signals before turning.

Things to Discuss with Your Health Professional

A plan for dealing with emergencies, injuries, or poisonings. Ways to reach your health professional after office hours. Community safety programs.

Be Safe at Other Times

Never place your child in the front seat of a car that has a passenger-side air bag. The back seat is the safest place for him to ride.

Compliments of Pfizer Inc.

2001 For information about Bright Futures, please contact (703) 524-7802 or e-mail brightfutures@ncemch.org. Visit our Web site at www.brightfutures.org.

B R I G H T

F U T U R E S

F A M I L Y

T I P

S H E E T S

Adolescence
(1121 Years)

A Journey from Childhood to Adult Life

Between the ages of 11 and 21, your adolescent will change in many ways. He will grow physically, mentally, emotionally, and socially. As he goes through this period, he will begin to make his own choices about many things, such as studying, working, friends and family, sports, driving, sex, drinking, and smoking. It will be important for you to help him learn how to make wise choices.

Adolescents, Parents, and Health Professionals: Partners for Health

Until now, youve been responsible for your childs health. You established relationships with health care providers and took him to doctors appointments. Now that he is an adolescent, he needs to be more involved in his own health care. Each of you brings something special to his health care. Your adolescent is the one experiencing physical and emotional changes. The health professional knows about health care and development. And you have guided your childs health and development throughout his life.

Health Professional Visits During Adolescence

Your health professional will want to see your adolescent for regular checkups once a year between the ages of 11 and 21. You can use annual school, sports, or camp physicals for these visits. These visits are important. They give your health professional a chance to make sure your adolescent is healthy and developing as she should. They are a time for you to ask questions or discuss concerns. And they are a time when your adolescent can talk privately and confidentially with the health professional. At these visits, your adolescent will get a physical exam and screening tests, such as those for hearing, vision, blood pressure, tuberculosis, and sexually transmitted diseases (if she is sexually active). Also, she may get one or more of the following immunizations: Hepatitis B* Diphtheria, tetanus (Td) Measles, mumps, rubella (MMR)* Varicella (Var) or chicken pox* Hepatitis A (in selected areas)
* If previously recommended doses were missed or were given earlier than recommended.

Social Development
Social development is your adolescents growth in confidence, independence, and positive feelings about herself. It is also the way she interacts with others. Here are some issues to think about as she grows and changes.

Encourage Good Feelings Within the Family

Spend time together doing things you enjoy, like playing board games and cooking. Understand that your adolescent may be unwilling to participate in family activities. As she tries to become more independent, she may challenge your authority. Be flexible in making and enforcing rules. Adjust your rules as she grows in independence and responsibility. Share responsibility for the family by giving your adolescent household chores. For example, ask your 12-year-old to help wash the dishes. Or ask your 18-year-old to shop for groceries.

Help Your Adolescent Feel Good About Herself

Show affection. Praise her efforts and achievements. Respect her need for privacy. Teach her how to deal with stress. Encourage her to set reasonable but challenging goals. Emphasize the importance of school. Show interest in her school activities. Decide together when she is ready to do certain things on her own.

Help Your Adolescent Feel Good About Others

Show her how to get along and work well with others. Encourage her to get involved in group activities, such as studying with classmates, playing sports, or participating in after-school activities. Spend time together volunteering. Look for opportunities at local schools, libraries, hospitals, or nursing homes. Talk with her about how to choose friends and have good relationships. Explore ways to help her deal with peer pressure.

Things to Discuss with Your Health Professional

Concerns your adolescent may have in making or keeping friends. Ways to help your adolescent cope with her anger and resolve conflicts without violence. Signs that she is feeling sad or nervous, or that things are just not going right.

The Stages of Adolescence

Young adolescents are concerned with their appearance and the ways their bodies are changing. Many are reassured to learn that everyones body matures at a different pace. Early Adolescence (ages 11 to 14) Physical change is the main event of this period. Your adolescents hormone levels will rise, bringing about the changes of puberty. Girls develop pubic hair and breasts, and begin to menstruate. In boys, the testicles grow and wet dreams begin. Face and pubic hair appears and their voices deepens. Both boys and girls may develop acne. Middle Adolescence (ages 15 to 17) Girls usually complete puberty earlier than boys. Most will be physically mature by now. Boys may still be maturing physically. During these years, boys rapidly gain muscle mass, strength, and height, and usually finish the development of sexual characteristics. Late Adolescence (ages 18 to 21) During these years, your adolescent will complete most of his physical development. He may start taking responsibility for his own health. He will develop the capacity for emotional intimacy, and will focus on achieving independence and creating a sense of identity as an adult.

2 Adolescence

Safety
Adolescence is a time when young people experiment with new behaviors. Trying new things helps them develop good judgment. It helps them learn to respect limits. But sometimes they make mistakes or misjudge a situation. So its important to talk about ways to stay safe.

Help him plan ahead for uncomfortable situations. Discuss what he can do if he is in a group where someone is using drugs, under pressure to have sex, or offered a ride from someone who has been drinking. Remove guns from the home, or keep guns unloaded and locked up.

Plan Ahead for Safety

Make sure your adolescent has the names and phone numbers of people to call in case of emergency. Explain what to do if theres a fire or accident in your home. When your adolescent goes out, ask where he is going, with whom, and when he will be back. Discuss what he is planning to do. Ask him to call you if his plans change. Discuss his ideas for settling conflicts without violence. Explore safe, constructive ways to express anger. Remove guns from the home or keep them unloaded and locked up. Talk together about the dangers of drugs, tobacco, alcohol, and risky sexual activity. Talking about them shows him that you care and want to help him make good decisions. (See box Talking to Your Adolescent About Hard Issues.)

Adolescents and Cars: Tips to Reduce Risks

Agree on rules for when and where he can use the car. Make an agreement about who can ride with him. Be firm about safe driving rules. For example, be sure that he wears a safety belt and obeys speed limits and traffic lights. Insist that he never drink and drive. Be a role model. Follow these safe driving practices, too. Start discussing safe driving long before he gets his drivers license.

Things to Discuss with Your Health Professional

A plan for handling emergencies or injuries. Community alcohol, tobacco, and other drug prevention and treatment programs. Sexual maturity; contraception; prevention of sexually transmitted diseases; abstinence; and other issues related to sexuality.

3 Adolescence

Talking to Your Adolescent About Hard Issues

Before your child enters adolescence, begin talking with him about drugs, drinking, smoking, and sexual development. Continue your talks as he moves through adolescence. Ask him what he knows and thinks about these issues, and share with him your beliefs. Most importantly, listen to what he says and try to answer his questions honestly and directly. It may be hard to talk about these things, but it is very important for your adolescent to feel that he has someone to talk to. If you cant do it, turn to a health professional or another adult you trust to help you. Your adolescent may face a lot of peer pressure to have sex, use drugs, drink, or smoke. Help him find ways to refuse without losing face. Also, discuss the importance of choosing friends who do not act in dangerous or unhealthy ways.

Sexuality
Explain to him that sexual feelings are normal but that having sex should be a wellthought-out decision. He should delay having sex until he and his partner are mature enough to assume responsibility for the consequences of sexual activity. Discuss your beliefs about sex, love, and personal responsibility. Talking about your own experiences can lead to meaningful discussions. Dont feel that talking about these issues will encourage him to have sex. He should know that you are there to guide him if he needs help making choices. Talk about ways to prevent pregnancy and sexually transmitted diseases (STDs), even if you have advised your adolescent to delay sexual activity. Explain that most birth control methods prevent only

pregnancy. Only latex condoms help reduce the risk of both pregnancy and STDs such as HIV. Discuss any confusion or concerns he has about his sexual feelings (for the same sex or opposite sex).

Risky Behaviors
Teach him about the dangers of smoking, alcohol, inhalants, and drugs. Explain how using these can lead to addiction, cancer, heart disease, and motor vehicle crashes. Look for signs of alcohol or drug abuse, such as changes in dress, falling grades, different friends, mood swings, violent behavior, and problems at school or with the law. (These may also be signs of emotional or mental health problems. Talk with your health professional about how to deal with these issues.)

4 Adolescence

Physical Activity
The best activities are those your adolescent enjoys. He may like activities such as walking, running, swimming, or biking. These activities can provide opportunities to socialize. They will also improve your adolescents overall health, self-esteem, and well-being.

Eating
An adolescents rapidly growing body needs more energy and nutrients than before. Eating right is essential for growth and development. It also helps prevent health problems. Your adolescent will eat away from home more often. She will begin to make her own choices about what she eats and drinks. Its a good time to teach her the importance of healthy eating and of choosing nutritious foods on her own.

Healthy Eating at Home

Prepare nutritious meals with breads, cereals, and grains; fruits and vegetables; chicken, fish, and lean meats; and low-fat dairy products. Encourage everyone in the family to have healthy eating habits. Eat meals together as often as you can. Start the day off right. Encourage your adolescent to have a good breakfast.

Build Healthy Habits for a Lifetime

Encourage him to try a variety of sports and physical activities. Team or individual sports are an option. But everyday tasks are also forms of physical activity. He gets exercise when he walks the dog, rakes and plays in the leaves, washes the car, and joins neighborhood clean-up events. Be active. Plan physically active family outings, like hikes and bike rides. Encourage him to exercise for 30 to 60 minutes, at least three times a week. Agree on how much time he may spend watching TV, playing video and computer games, or using the Internet.

Keep nutritious snacks in the house. Avoid buying foods and beverages that are high in fat or sugar, such as candy, chips, or soft drinks.

Healthy Eating Away from Home

Explain the importance of eating three nutritious meals a day. Emphasize that skipping meals is unhealthy. Encourage your adolescent to select a healthy lunch from the school cafeteria. Or pack a balanced lunch. Fast foods like french fries, burgers, soda, and pizza are high in fat or sugar. Encourage your adolescent to choose these foods less often and in smaller portions.

Things to Discuss with Your Health Professional

Physical activities, athletic conditioning, or weight training for your adolescent. Questions about weight gain or loss. Any special health care concerns related to physical activity.

Activity

Things to Discuss with Your Health Professional

Ways to help your adolescent safely control her weight. Possible food allergies. Alternative foods or meal plans, such as vegetarian or vegan diets.

5 Adolescence

Oral Health
Good oral health requires regular visits with the dentist. Your dentist will recommend how often to visit. A team effort is the best way to support good oral health. You, your adolescent, and the dentist form a partnership built on a shared history and trust.

Education
During these years, your adolescent will go from middle/junior high school to high school and then into the adult world. At each stage, she will have much greater independence. School pressures will require her to become more organized and efficient. Your adolescent is more likely to enjoy learning and to do well in school if you show that you believe education is important. Your praise will help her feel good about herself.

Prevent Tooth Decay

Remind your adolescent to brush his teeth twice a day and to floss daily. Encourage him to eat a variety of healthy foods to maintain better oral health. Discourage him from smoking or using chewing tobacco.

School Achievement
Encourage her to become more responsible for her attendance, homework, and course selection. She may be anxious about going from middle/junior high school to high school. Discuss her concerns with her, her teachers, or her health professional. If she feels frustrated with school or is thinking about dropping out, discuss her feelings and options. Encourage her to participate in school activities, such as drama, band, math team, or sports. Show your interest by attending her school plays, concerts, team games, and other special events. Help her begin setting goals for the future. When shes in high school, encourage her to think about college, vocational training, the military, or other career choices.

Protect the Teeth and Mouth from Injury

Teach him to wear a mouth guard for sports. Be sure he wears a helmet when riding a bike or skating. Plan how to handle dental emergencies. Know what to do if he loses or breaks a tooth.

Things to Discuss with Your Dentist or Health Professional

Proper techniques for flossing and brushing. Whether your adolescent might need braces. Whether your adolescent should get dental sealants. A sealant is a thin plastic coating that covers the molars, the big teeth used for chewing. Sealants keep food and bacteria from getting trapped in the molars where they cause decay. Whether the water in your community is fluoridated. Water fluoridation is a safe and effective way to greatly reduce the risk of cavities and tooth decay.

Things to Discuss with Your Health Professional

Problems with vision, hearing, or other health issues that interfere with learning. Behaviors that cause problems at school. Concerns about your adolescents school progress. Getting special educational services or adaptive equipment if your adolescent has special needs.

Compliments of Pfizer Inc.

2001 For information about Bright Futures, please contact (703) 524-7802 or e-mail brightfutures@ncemch.org. Visit our Web site at www.brightfutures.org.

Social & Emotional Development in Infancy

AGES BIRTH12 MONTHS

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

What Parents Want to Know

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark

From the moment of birth, parents want to know: Is my baby OK? Youll ask this question again and again as your baby grows from infant to toddler to teen. All babies are born with different strengths and abilities, and no other baby will develop exactly like yours. Health, personality, and early experiences are important to your babys development; family, community, and cultural traditions also play important roles. For example, feeding and sleeping practices may differ in various cultures. Although each baby is unique, all parents want to help their babies achieve social and emotional milestones such as: Learning to trust and respond to your love and attention Learning to express emotions such as pleasure and distress Learning to smile, coo, and use gestures, sounds, or words to communicate

As parents, you are becoming experts at knowing and meeting your babys needs. This tool can help by providing: A snapshot of what to expect as you and your baby learn and grow together A way to identify your babys strengths and your abilities as parents A starting point for talking with others about your babys development Tips for when, where, and how to seek help If you have questions or concerns about your baby, check it out. Ask a trusted friend, family member, or member of your faith or cultural community; talk with your babys health care or child care provider; or contact your local health department or social service agency. Help is available in your community. See the last page to learn more about services and support for you, your baby, and your family. Finding answers to your questions early will help your baby develop in the healthiest way possible.

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

T
Cite as: Mayer R, Anastasi JM, Clark EM. 2006. What to Expect & When to Seek Help: A Bright Futures Tool to Promote Social and Emotional Development in Infancy. Washington, DC: National Technical Assistance Center for Childrens Mental Health, Georgetown University Center for Child and Human Development, in collaboration with the National Center for Education in Maternal and Child Health. 2006 by Georgetown University Center for Child and Human Development With funding from: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

he What to Expect & When to Seek Help: Bright Futures Developmental Tools for Families and Providers are guided by the following principle: Every child and adolescent deserves to experience joy, have high self-esteem, acquire a sense of efficacy, and believe that she can succeed in life. BRIGHT
FUTURES CHILDRENS HEALTH CHARTER

Beginning the Conversation

Written in family-friendly language, the tools may be used by families and child development professionals in a range of disciplines, including health, education, child care, and family services. Throughout the tools, a strong emphasis is placed on strengths as well as concerns. The information under What to Expect not only offers a guide to healthy development and parenting, but provides information that parents can find reassuring about their childs behavior and their own parenting. The tools provide an opportunity to identify concerns at an early stage. The information under When to Seek Help includes issues that might be addressed with additional information, as well as those that signal the need for further assessments and services. Space is provided for families to write down their concerns as well as to create their own list of community resources and services.

To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools

Based on Bright Futures in Practice: Mental Health, the Bright Futures developmental tools offer a framework for providers and families to begin a conversation together about how best to support healthy social and emotional development in children and teens. The tools are part of a coordinated set of print and Web materials, including the Referral Tool for Providers and the electronic Community Services Locator. The tools gently encourage families who have any questions or concerns about their childs development to check it outand offer a number of tips for when, where, and how to seek help through local, state, or national resources.

Bright Futures: What to Expect & When to Seek Help

Infancy

Feeding
What to Expect
Baby: Birth-3 months Enjoys feeding, feels comfortable and safe (sucks and swallows easily, gains weight, seems content) Gazes at or turns toward parent, nuzzles or cuddles while feeding 3-6 months Sometimes shows more interest in sights and sounds around him than in feeding 6-9 months Explores breast or bottle during feeding; touches, tastes, and plays with different foods; tries to hold feeding spoon 9-12 months Gains more confidence and control during feeding (feeds herself with her fingers, holds and drinks from a cup) Parents: Learn babys hunger cues and respond promptly and lovingly Are sensitive to babys cues when feeding (pause or stop when baby is drowsy, turns head away, or sucks less vigorously) Hold, cuddle, and talk to baby during feedings Keep feeding and sleep schedules somewhat regular to help baby feel secure Encourage baby to touch and taste different foods, feed herself with her fingers, and hold and drink from a cup (9-12 months)

Sleeping
What to Expect
Baby: Usually sleeps after feeding, wakes when hungry (newborn) Settles into a routine of sleep/wake times; takes 2-3 naps during the day, sleeps more at night (3-6 months) Stays awake much of the day, sleeps most of the night (6-12 months) Feels secure with a comforting bedtime routine Gradually adapts to familys sleep patterns Learns self-soothing behaviors (sucking fingers, holding comfort item like soft toy or blanket) to settle down for sleep Parents: Respond to cues that baby is sleepy or overtired; help baby settle down for sleep Create a comforting bedtime routine (spend quiet time cuddling, singing, reading, or softly talking to baby before bedtime) Encourage baby to use self-calming behaviors to fall asleep on his own; offer a comfort object Provide a quiet room and safe sleep setting (always place baby on his back to sleep; avoid loose bedding or spaces that could trap or smother baby)

When to Seek Help

If your baby: Has a hard time calming down at bedtime; needs a lot of help to fall asleep Has trouble settling into a good routine of sleep and wake times Wakes and cries often at night, is not able to fall back to sleep on her own (by 6 months) Or if you, as parents: Have a hard time helping your baby fall asleep or stay asleep Have trouble keeping a regular bedtime routine for your baby (6-12 months) Need ideas for keeping your baby safe in a crib or while sharing a bed Are usually exhausted or upset because you do not get enough sleep Are smoking. drinking, or using drugs while in bed with your baby

When to Seek Help

If your baby: Lacks interest or enthusiasm in feeding Is often fussy or upset during or after feeding Does not cuddle or respond to you during feeding Has poor weight gain or other feeding problems (has trouble sucking and swallowing, or spits up a lot after feeding) Shows no interest in finger-feeding or using a cup (by 12 months) Or if you, as parents: Feel uneasy holding, cuddling, or feeding your baby Are not sure when to feed your baby Think you may be feeding your baby too little or too much Are trying to keep your baby on an exact feeding schedule

Infancy

Bright Futures: What to Expect & When to Seek Help

Crying and Comforting

What to Expect
Baby: Birth-3 Months Cries to express her needs and feelings (hungry, wet, tired, lonely, in discomfort) Can usually be calmed or comforted within a few minutes (by 3 months) May have colic or fussy periods caused by stomach pains or discomfort (1-4 months) 3-6 months Feels calm, content, and secure as his needs are met 6-12 Months Begins to soothe herself some of the time by sucking her fingers or holding a comfort object (soft toy or blanket) Parents: Hold, rock, and softly sing or talk to baby to help comfort him Learn babys different cries, and how best to respond Always respond quickly to cries of distress or discomfort Encourage self-soothing behaviors (offer comfort object or toy, wrap or dress baby so his hands are free and he can suck her fingers)

Allow baby a few minutes to calm down on his own when he is tired or fussy (6-9 months) May feel frustrated if unable to comfort baby despite best efforts

When to Seek Help

If your baby: Does not turn to you for comfort or respond to your efforts to console him Seems fretful and unhappy much of the time Cries for hours at a time and is very hard to calm Is not able to calm himself some of the time (6-12 months) Or if you, as parents: Have a hard time knowing what your babys different cries mean and how you should respond Have concerns that you might spoil your baby if you give him attention every time he cries Allow your baby to cry for a long time without trying to calm her or make her feel better Get upset and feel like shaking or hitting your baby when she cries Need ideas to help your baby learn how to calm herself

Discovering Self and Others

What to Expect
Baby: Newborn-3 months Looks at faces and follows with his eyes (newborn); can maintain eye contact (by 1 month) Smiles and coos in response to others (by 2 months) Shows interest in life around her (sights, sounds, people, pets, movements) 3-6 months Enjoys social play (babbles, giggles, laughs) Delights in playing with his hands and feet Shows range of feelings like joy, surprise, anger, fear (by 5-6 months) 6-9 months Responds to her name, smiles at her image in mirror Plays games like peek-a-boo or pat-a-cake Talks by babbling and trying to imitate sounds Reaches for familiar persons (6 months); may become fearful with strangers (7-9 months)

Bright Futures: What to Expect & When to Seek Help

Infancy
When to Seek Help
If your baby: Does not respond when held or cuddled Seems to shut down (does not smile or make eye contact) Does not coo or make sounds when you talk to him Shows no response to peoples faces or voices Does not react to sound, light, or movement Shows little interest in exploring her surroundings Or if you, as parents: Think your baby is not developing as he should Have concerns because your baby does not seem to be doing things that others her age can do Want ideas for making playtime safe, fun, and creative Are not sure about the kinds of toys or objects your baby should look at and play with Need help making your home safe for your baby to move around and explore

9-12 months Imitates actions (talking on phone, waving bye-bye) Learns that his actions have an effect (drops, dumps, rolls, pushes and pulls toys) Grows more independent (crawls, pulls to stand, may take a few steps) Parents: Hold and cuddle baby; gently and playfully move her arms and legs Provide a variety of sights, sounds, colors, textures (safe toys, rattles, mobiles, crib gyms, music) Talk, sing, read, show pictures to baby; play games such as peek-a-boo with baby Teach baby to imitate sounds, words, movements Learn to be in tune with babys needs and feelings Let baby lead playtime, and respond to her interests Help baby play safely and explore new things Gently encourage baby to try doing things on his own; stay nearby to keep him safe Help baby feel secure in new situations (reassure through touch, eye contact, words)

Becoming A Family
What to Expect
Baby: Newborn-1 month Looks at parents face, maintains eye contact briefly 1-3 months Smiles and coos in response to parents (4-6 weeks) Learns to trust that parents will meet his needs 4-6 months Knows parents face, voice, and touch Laughs and babbles 6-8 months Begins to become aware of strangers Seeks comfort and security from her parents 9-12 months May say da-da or ma-ma Is upset or fearful when parents leave (separation anxiety) Turns to parent after exploring, or when upset and seeking comfort

continued

Infancy
Becoming a Family Continued
Parents: Hold, cuddle, and comfort baby, help baby feel secure and loved May feel overwhelmed or have the baby blues in early weeks; gradually feel more confident as parents Start to read and respond to babys different cries and signals (hunger, sleep, discomfort) Give baby lots of time and attention; talk, sing, read, and play with baby; talk about everyday events, name objects and feelings Celebrate babys achievements Allow baby to explore surroundings, set safe limits Spend special time with each child in the family Encourage older children to play with and help care for baby

Bright Futures: What to Expect & When to Seek Help

Does not seem to know or respond to other family members Has little or no reaction when you leave the room for a while or when you return (at 6 - 9 months) Does not look to you for comfort or security after exploring or when upset Or if you, as parents: Feel very tired, depressed, worried, or overwhelmed, and these feelings do not go away Have trouble knowing when your baby is hungry, sleepy, needs attention, or needs quiet time Do not enjoy spending time with your baby Feel that your babys personality doesnt fit in with the rest of the family Often think that your baby is naughty or bad on purpose Want tips to help older children adjust to baby Face major stresses or changes in your family (job, money, housing, illness)

When to Seek Help

If your baby: Resists your efforts to hold, cuddle, or comfort her, or does not respond Does not coo, babble, or show delight when you talk or play with him

Bright Futures: What to Expect & When to Seek Help

Infancy

NAME __________________________________________________________________________________ AGE ________________________________________

Your Questions and Concerns

Feeding
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Sleeping
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Crying and Comforting

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Discovering Self and Others

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Becoming A Family
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Infancy

Bright Futures: What to Expect & When to Seek Help

Where to Seek Help

If you have questions or concerns about your baby or your parenting, check it out. You may want to talk with your babys health care provider or caregiver, a close friend, or a member of your family or faith community. You can also open doors by locating resources and services in your own community. The toll-free numbers and Web sites listed below are a starting point. Or you can ask for help at your local library or call your local health department, school district, or social services agency listed in the county government section of your phone book.

National Toll-Free Numbers & Web Sites

Health & Wellness (Health Provider; Clinic) Maternal and Child Health Bureau Hotline (800) 311-2229 (800) 504-7081 (Espaol) Child Care & Early Childhood Education Child Care Aware (800) 424-2246 (English and Espaol) www.childcareaware.org www.childcareaware.org/sp (Espaol) Parenting Education Medline Plus www.nlm.nih.gov/medlineplus/parenting.html www.nlm.nih.gov/medlineplus/spanish/parenting.html (Espaol) Early Intervention (Developmental Services) National Dissemination Center for Children with Disabilities (NICHCY) (800) 695-0285 (voice or TDD) www.nichcy.org Mental Health (Community Mental Health Center) National Mental Health Information Center (800) 789-2647 (voice) or (866) 889-2647 (TDD) www.mentalhealth.samhsa.gov Family Support In addition to the resources listed above, you can locate local social services, WIC, financial support, or faith-based programs: Dial 2-1-1 (a telephone network offering community-based information and referrals for services in most states) www.GovBenefits.gov

Your Own Contact List

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

For more resources, see Community Services Locator at www.mchlibrary.info/KnowledgePaths/kp_community.html. To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools 8

Social & Emotional Development in Early Childhood

AGES 14 YEARS

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

What Parents Want to Know

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark

From the moment of birth, parents want to know: Is my baby OK? Youll ask this question again and again as your child grows from toddler to teen. All children are born with different strengths and abilities, and no other child will develop exactly like yours. Health, personality, and early experiences are important to your childs development; family, community, and cultural traditions also play important roles. For example, ideas about how and when to toilet-train a child may differ in various cultures. Although each child is unique, all children face social and emotional challenges in early childhood, including: Learning how to control their emotions and tantrums Testing limits and becoming more independent Learning how to share, take turns, and play with others

As parents, you are becoming experts at knowing and meeting your childs needs. This tool can help by providing: A snapshot of what to expect as you and your child learn and grow together A way to identify your childs strengths and your abilities as parents A starting point for talking with others about your childs development Tips for when, where, and how to seek help If you have questions or concerns about your child, check it out. Ask a trusted friend, family member, or member of your faith or cultural community; talk with your childs health care or child care provider; or contact your local health department or social service agency. Help is available in your community. See the last page to learn more about services and support for you, your child, and your family. Finding answers to your questions early will help your child develop in the healthiest way possible.

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

T
Cite as: Mayer R, Anastasi JM, Clark EM. 2006. What to Expect & When to Seek Help: A Bright Futures Tool to Promote Social and Emotional Development in Early Childhood. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Center for Child and Human Development, in collaboration with the National Center for Education in Maternal and Child Health. 2006 by Georgetown University Center for Child and Human Development With funding from: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

he What to Expect & When to Seek Help: Bright Futures Developmental Tools for Families and Providers are guided by the following principle: Every child and adolescent deserves to experience joy, have high self-esteem, acquire a sense of efficacy, and believe that she can succeed in life. BRIGHT
FUTURES CHILDRENS HEALTH CHARTER

Beginning the Conversation

Written in family-friendly language, the tools may be used by families and child development professionals in a range of disciplines, including health, education, child care, and family services. Throughout the tools, a strong emphasis is placed on strengths as well as concerns. The information under What to Expect not only offers a guide to healthy development and parenting, but provides information that parents can find reassuring about their childs behavior and their own parenting. The tools provide an opportunity to identify concerns at an early stage. The information under When to Seek Help includes issues that might be addressed with additional information, as well as those that signal the need for further assessments and services. Space is provided for families to write down their concerns as well as to create their own list of community resources and services.

To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools

Based on Bright Futures in Practice: Mental Health, the Bright Futures developmental tools offer a framework for providers and families to begin a conversation together about how best to support healthy social and emotional development in children and teens. The tools are part of a coordinated set of print and Web materials, including the Referral Tool for Providers and the electronic Community Services Locator. The tools gently encourage families who have any questions or concerns about their childs development to check it outand offer a number of tips for when, where, and how to seek help through local, state, or national resources.

Bright Futures: What to Expect & When to Seek Help

Early Childhood
When to Seek Help
If your child: Wants to eat all the time and begs for food Refuses to eat or doesnt enjoy mealtimes Has temper tantrums about foods Shows little interest in feeding herself Refuses to go to bed or stay in bed Has trouble falling asleep or staying asleep Has strong nighttime fears or scary dreams Or if you, as parents: Have concerns or power struggles over your childs eating Are trying to force your child to eat certain foods Feel pressured to increase or decrease your childs weight Get upset when your child wont eat or makes a mess when eating Are worried about having enough money to buy food Have a hard time getting your child to fall asleep or stay asleep Need help handling bedtime problems, night waking, or nighttime fears

Eating and Sleeping

What to Expect
Child: Likes to explore new foods, choose what he likes, and feed himself (using fingers first, then child-size spoon; drinks from a cup) Enjoys being part of family mealtimes and table talk Has a regular bedtime routine (cuddles while listening to stories, goes to bed at same time each night) Can usually settle herself down to sleep, may hold a comfort object (soft toy, blanket) Sleeps through the night May have nighttime fears like monsters in the dark Parents: Offer a variety of healthy foods, allow your child to choose what and how much to eat Eat family meals together, keep mealtimes pleasant and unrushed Avoid using food for comfort, reward, or punishment Have a regular bedtime routine, cuddle while reading a bedtime story together Gently help your child learn how to soothe and settle himself for sleep Calm your childs fears, help him feel safe and secure Provide a safe, quiet place for your child to sleep (no loose bedding, waterbeds, or spaces where child could fall or be trapped)

Self-Care and Toileting

What to Expect
Child: Wants to do some things for himself without your help Feels good when she learns to wash her hands and face, brush her teeth, and dress herself (2-4 years) Shows that he is ready to learn how to use the toilet: knows the difference between wet and dry, can pull his pants up and down, gives some sign before wetting or bowel movement, stays dry for 2 hours or more (2 to 2-1/2 years) Parents: Teach your child basic self-care skills (handwashing, toothbrushing, dressing), and help make these routines fun Encourage and praise him as he learns to make choices and grow more independent Support and assist your child if she returns to baby-like behaviors at times of change or stress; avoid shaming or criticizing Wait to begin toilet training until your child seems ready Delay toilet training if major changes occur in family (new baby, home, or child care) Deal with accidents calmly and with acceptance Avoid conflicts or struggles over self-care or toileting continued 3

Early Childhood
Self-Care and Toileting Continued

Bright Futures: What to Expect & When to Seek Help

When to Seek Help

If your child: Shows no interest in learning to wash and dress herself Has made little progress in self-care or toileting (by age 3) Is unable to control his body functions or use the toilet (by age 3) Seems very afraid of using the potty or toilet Goes back to soiling herself after she has learned to use the toilet Holds back or refuses to have bowel movements Or if you, as parents: Find it hard to let your child try doing things for himself Are having struggles with your child over self-care or toileting Worry that your child doesnt seem able to learn how to use the toilet Are pushing too hard (or feeling pressured) to toilet train your child Get very upset or punish your child when accidents occur

Developing the Self: Personality, Emotions, and Independence

What to Expect
Child: Learns to name and express feelings (joy, anger, fear, sadness) Is very curious and loves to explore Is aware of gender Becomes more aware of others feelings Likes the word no and uses it often (even when he means yes) Likes to test limits but accepts them most of the time Finds it hard to control strong emotions like anger and frustration May have temper tantrums Makes some choices (books to read, clothes to wear) Does simple chores (picks up toys, puts dirty clothes in hamper) Feels good about himself, his body, and what he can do (run, jump, climb, throw) (3-4 years) Learns basic skills (drawing, sorting, counting, letters and numbers) that help her feel ready to start school (4 years) Parents: Accept and support your childs developing personality and style Help your child name what shes feeling, talk about your own feelings Praise good behavior and efforts; smile, give hugs Talk with your child about what you do together; help him name what he sees, hears, and does Allow your child to make some choices about snacks, clothing, stories, playtime Give your child freedom and space to explore safely; stay close by Set safe and secure limits Help your child deal with anger and other strong feelings; learn what helps him gain control (holding, calmly talking, distraction) Discipline with gentle restraint, distraction, or time out Expect behavior that matches your childs age and abilities Encourage your child to be kind and helpful

Bright Futures: What to Expect & When to Seek Help

Early Childhood

When to Seek Help

If your child: Has trouble expressing feelings Shows little interest in doing things for himself or trying new skills Seems to be in a world of his own (poor eye contact, repeated body rocking, little interest in people or toys) Is unable to calm down after a few minutes or has extreme temper tantrums Seems very stubborn compared with others his age Gets very frustrated when trying to do simple things that others his age can do Is unable to wait for a few minutes when she wants or needs something (by age 3) Cant seem to focus on or finish activities (3-4 years) Often refuses to do simple things you ask Hits, bites, or punches Destroys toys or other objects Or if you, as parents: Have trouble keeping up with your childs activities or needs Want tips for setting safe limits, simple rules, and following through Expect more than your child seems able to do Have a hard time dealing with your childs anger or your own anger Need tips for dealing with temper tantrums or power struggles

Family
What to Expect
Child: Feels loved and accepted, shows affection, trusts you Wants to please her parents turns to parents for affection and security imitates parents actions (talks on toy phone, combs dolls hair) (2 years) usually cooperates with family routines and simple requests Communicates needs and shares feelings uses mostly sounds and gestures, says about 15-20 words (18 months) links 2-3 words together in simple phrases (more milk) (2 years) speaks in short, mostly clear sentences (me want ball) (3 years) tells lots of stories, asks lots of questions (4 years) Gets along most of the time with siblings, but sometimes fights with them Is learning to share and take turns Can separate easily from her parents for a while (3 years) Parents: Show affection, care, and concern in the family Give lots of smiles and hugs Listen actively to your child and talk together Play creatively together: encourage dress-up and pretend play, allow space and freedom to explore safely, play games and activities that strengthen new skills Praise your childs strengths, skills, and efforts; avoid comparing with other children Look for ways to help your children get along together (fun games or outings) Let your children try to solve conflicts on their own, teach how to be fair; do not allow physical or verbal bullying Spend special time alone with each child (listening, talking, reading, playing) Respond to your childs curiosity; encourage questions Limit TV time; watch shows together and talk about them Help your child learn to take care of himself and to be confident without being aggressive

continued

Early Childhood
Family Continued

Bright Futures: What to Expect & When to Seek Help

When to Seek Help

If your child: Seems withdrawn or doesnt enjoy being part of the family Doesnt seek your love and approval Clings and gets very upset when you leave (at 3-4 years) Tries to physically hurt siblings Often sees violence at home or on TV; shows violent behaviors Never shares toys or takes turns (3-4 years) Or if you, as parents: Find it hard to praise your child or show affection Focus more on your childs negative behaviors Feel alone or have little support (family, friends, neighbors, church) Have trouble setting consistent rules and safe limits Need tips for dealing with fights among your children Are having serious conflicts in your family or other relationships Often argue in front of your child

Parents: Encourage your child to play with other children (siblings, play group, child care, preschool) as a way of learning social behaviors Supervise playtimes and activities Help arrange social play that suits your childs personality (free play or structured, quiet or active, short or long) Encourage your child to tell you about his playmates and the things they like to do together Allow your child to assert herself, but teach her not to hit, bite, or call names Provide safe ways to release built-up energy through physical activities (throwing balls, crashing toy cars, running and jumping) Protect your child from frequent contact with very aggressive playmates Find opportunities for your child to play with boys and girls of other racial, cultural, and economic backgrounds

When to Seek Help

If your child: Seems very shy or fearful with other children Doesnt communicate with other children through short phrases or sentences Plays alone most of the time, doesnt play well with others, or feels left out (3-4 years) Hits, bites, or punches others when angry or frustrated (3-4 years) Refuses to share toys or take turns (3-4 years) Or if you, as parents: Worry that your child is too active or too aggressive with other children Notice that your child is often alone and doesnt play with other children (3-4 years) Get phone calls from preschool or child care teachers with concerns about your childs social behaviors Need tips for encouraging your child to play happily with others

Building Friendships
What to Expect
Child: Plays side-by-side but not directly with other children (1-2 years) Begins playing together and sharing with other children (3 years) Gets along with others in child care or preschool; can name two or more playmates (4 years) Begins simple make-believe play (2 years), then more complex pretend play with friends (3-4 years) Uses language to communicate with playmates uses simple phrases or 2-word sentences (my ball) (2 years) speaks in 4- to 5-word sentences (I go home now) (3 years) talks easily; makes up fantasy stories with friends (4 years)

Bright Futures: What to Expect & When to Seek Help

Early Childhood

NAME __________________________________________________________________________________ AGE ________________________________________

Your Questions and Concerns

Eating & Sleeping
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Self-Care & Toileting

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Developing the Self: Personality, Emotions, and Independence

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Family
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Building Friendships
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Early Childhood

Bright Futures: What to Expect & When to Seek Help

Where to Seek Help

If you have questions or concerns about your child or your parenting, check it out. You may want to talk with your childs health care provider or caregiver, a close friend, or a member of your family or faith community. You can also open doors by locating resources and services in your own community. The toll-free numbers and Web sites listed below are a starting point. Or you can ask for help at your local library or call your local health department, school district, or social services agency listed in the county government section of your phone book.

National Toll-Free Numbers & Web Sites

Health & Wellness (Health Provider; Clinic) Maternal and Child Health Bureau Hotline (800) 311-2229 (800) 504-7081 (Espaol) Child Care & Early Childhood Education Child Care Aware (800) 424-2246 (English and Espaol) www.childcareaware.org www.childcareaware.org/sp (Espaol) Parenting Education Medline Plus www.nlm.nih.gov/medlineplus/parenting.html www.nlm.nih.gov/medlineplus/spanish/parenting.html (Espaol) Early Intervention (Developmental Services) National Dissemination Center for Children with Disabilities (NICHCY) (800) 695-0285 (voice or TDD) www.nichcy.org Mental Health (Community Mental Health Center) National Mental Health Information Center (800) 789-2647 (voice) or (866) 889-2647 (TDD) www.mentalhealth.samhsa.gov Family Support In addition to the resources listed above, you can locate local social services, WIC, financial support, or faith-based programs: Dial 2-1-1 (a telephone network offering community-based information and referrals for services in most states) www.GovBenefits.gov

Your Own Contact List

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

For more resources, see Community Services Locator at www.mchlibrary.info/KnowledgePaths/kp_community.html. To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools 8

Social & Emotional Development in Middle Childhood

AGES 510 YEARS

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

What Parents Want to Know

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark

From kindergarten through middle school, every parent asks one question more than any other: How is my child doing? All children have different strengths and abilities, and no other child will develop exactly like yours. Health, personality, and early experiences are important to your childs development; family, community, and cultural traditions also play important roles. For example, children have fewer limits and become more independent at earlier ages in some cultures than in others. Although each child is different, all children face social and emotional challenges in middle childhood, including: Developing selfesteem and growing more confident Making new friends and meeting new challenges at school Learning to take reasonable risks, to handle failure, and to bounce back

As parents, you are becoming experts at knowing and meeting your growing childs needs. This tool can help by providing: A snapshot of what to expect as you and your child learn and grow together A way to identify your childs strengths and your abilities as parents A starting point for talking with others about your childs development Tips for when, where, and how to seek help If you have questions or concerns about your child, check it out. Ask a trusted friend, family member, or member of your faith or cultural community; talk with your childs health care or after-school care provider; or contact your childs school or your local social service agency. Help is available in your community. See the last page to learn more about services and support for you, your child, and your family. Finding answers to your questions early will help your child develop in the healthiest way possible.

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

T
Cite as: Mayer R, Anastasi JM, Clark EM. 2006. What to Expect & When to Seek Help: A Bright Futures Tool to Promote Social and Emotional Development in Early Childhood. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Center for Child and Human Development, in collaboration with the National Center for Education in Maternal and Child Health. 2006 by Georgetown University Center for Child and Human Development With funding from: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

he What to Expect & When to Seek Help: Bright Futures Developmental Tools for Families and Providers are guided by the following principle: Every child and adolescent deserves to experience joy, have high self-esteem, acquire a sense of efficacy, and believe that she can succeed in life. BRIGHT
FUTURES CHILDRENS HEALTH CHARTER

Beginning the Conversation

Written in family-friendly language, the tools may be used by families and child development professionals in a range of disciplines, including health, education, child care, and family services. Throughout the tools, a strong emphasis is placed on strengths as well as concerns. The information under What to Expect not only offers a guide to healthy development and parenting, but provides information that parents can find reassuring about their childs behavior and their own parenting. The tools provide an opportunity to identify concerns at an early stage. The information under When to Seek Help includes issues that might be addressed with additional information, as well as those that signal the need for further assessments and services. Space is provided for families to write down their concerns as well as to create their own list of community resources and services.

To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools

Based on Bright Futures in Practice: Mental Health, the Bright Futures developmental tools offer a framework for providers and families to begin a conversation together about how best to support healthy social and emotional development in children and teens. The tools are part of a coordinated set of print and Web materials, including the Referral Tool for Providers and the electronic Community Services Locator. The tools gently encourage families who have any questions or concerns about their childs development to check it outand offer a number of tips for when, where, and how to seek help through local, state, or national resources.

Bright Futures: What to Expect & When to Seek Help

Middle Childhood

The Emerging Self

What to Expect
Child: Initiates own ideas and actions (self-starter) Works hard to learn new skills, feels proud and wants to show what he can do Masters skills for success in school (sorting, counting, language skills) Expresses own unique personality in relating to others, handling experiences Has more internal control over impulses, emotions, and behaviors Becomes more independent and responsible in making some choices on her own Shows growing awareness of good and bad (conscience) Parents: Accept childs unique personality Encourage healthy, balanced behavior (e.g., provide social experiences for shy child; calm, structured activities for impulsive or highly active child) Support childs interests, ideas, and activities Model responsible behavior, help child take on new responsibilities Help child balance time for self and time for structured activities Are aware of childs activities inside and outside the home Teach reasonable risks and safe limits Talk with child about the risks of experimenting with tobacco, alcohol, drugs (8-10 years)

Think your child is either too aggressive or too dependent (does whatever someone wants) Need ideas to help your child resist pressures to smoke, drink, or use drugs (8-10 years)

Growing and Changing

What to Expect
Child: Learns to care for her body (bathing, grooming, dressing; healthy foods; physical activity) Feels good about how she looks Has energy and a sense of well-being Takes pride and pleasure in mastering new physical skills Develops gender identity (by 5 years) Is aware of changes that will take place during puberty (8-10 years) Parents: Encourage safe, healthy habits (healthy foods, physical activity, seat belts) Talk with child about sexuality and puberty; offer ageappropriate information, answer questions honestly Reassure child about the positive changes of puberty Talk together about changing body image and how to resist pressures to look perfect (shape, weight, height)
continued

When to Seek Help

If your child: Is often sad, worried, or afraid Clings to you or wants to stay home much of the time Seems very worried about failing or making mistakes Waits to be told what to do, does not express own interests or ideas Avoids new tasks, experiences, and challenges Often seems out-of-control, acts on impulse, makes unhealthy choices Takes unsafe risks (with bike, traffic, play, sports) Shows signs of tobacco, alcohol, or drug use (8-10 years) Or if you, as parents: Find it hard to encourage independence yet set safe limits Are overly protective and afraid to let your child try new things

Middle Childhood
Growing and Changing Continued

Bright Futures: What to Expect & When to Seek Help

When to Seek Help

If your child: Wets the bed Has trouble sleeping or wants to sleep much of the time Lacks basic self-care habits (bathing, brushing teeth, dressing) Returns to baby-like or silly behaviors Shows signs of early sexual development (before age 9) Seems unaware or fearful of puberty and sexuality (ages 9-10) Has a distorted body image (thinks shes fat when shes not) Uses food to self-soothe or escape uncomfortable feelings Or if you, as parents: Worry that your child sleeps or eats too much or too little Notice that your child cant keep up physically with others the same age Are concerned that your child does not speak clearly or communicate well with others Need tips for how to talk with your child about sex or puberty Think your child is overly concerned with weight or body image

Help child overcome fears and cope with stress Share own feelings and stories about facing fears and problems Respect childs growing need for privacy Limit exposure to media violence

When to Seek Help

If your child: Feels that he lacks basic skills or abilities Often says negative things about self or others Has problems dealing with angry feelings Is preoccupied with violent movies, TV, computer games Is aggressive or tries to bully others Or if you, as parents: Worry about how your child views himself Often find yourself criticizing and blaming your child Notice that your child seems preoccupied with violence Have concerns about your childs exposure to abuse (physical, verbal, sexual) Lack confidence or have doubts about your own abilities

Family
What to Expect
Child: Feels loved, accepted and valued in the family Shares feelings and experiences with family members Gets along with brothers and sisters most of the time Shares or takes turns (games, toys, TV, computer) Enjoys being part of the family and doing fun things together Helps out with simple chores, follows family rules Parents: Show love, affection, and respect Set aside time each day to talk and play with child Support and supervise childs activities Praise good behavior, efforts, and accomplishments Have family meals together as often as possible Arrange fun family activities Set reasonable rules and consequences Help child learn how to solve problems with brothers and sisters Teach child to value and celebrate family heritage

Respecting Self & Others

What to Expect
Child: Feels good about himself and his abilities Is able to get over or bounce back from disappointments Learns from mistakes or failures, tries again Respects the rights and feelings of others, has a sense of fairness Has growing ability to understand another persons viewpoint Solves conflicts or problems by talking, not fighting Parents: Talk and listen to child with respect Are good role models (show understanding, kindness, patience) Teach child to accept and respect peoples differences (ethnic, cultural, religious) Handle anger constructively

Bright Futures: What to Expect & When to Seek Help

Middle Childhood

When to Seek Help

If your child: Is often silent or unwilling to share feelings with family Does not want to join in family activities Stays in her room most of the time; often seems sad or sullen Acts angry or disrespectful with family members Refuses to help with chores or follow family routines (bedtime, mealtime) Or if you, as parents: Find it hard to talk with your child or spend time together Often feel upset or angry with your child Feel that your childs personality does not fit in with the family Need help resolving conflicts in your family Are facing major family changes or stresses (divorce, job loss, substance use)

Building Friendships
What to Expect
Child: Has playmates and friends, feels accepted by peers Gets along well with others, enjoys spending time with friends Shares well, takes turns Brings friends home to play, is invited to friends homes Stands up for self when hurt by peers; copes with teasing or taunting Parents: Support healthy friendships (know childs friends and their families, invite friends home) Supervise childs activities Talk with child about friends, school, interests Encourage childs social activities, limit TV time Help child find ways to solve conflicts with friends or playmates Teach child how to be safe near strangers (home, neighborhood, cars, playgrounds) Teach skills to resist peer pressures and to cope with teasing

When to Seek Help

If your child: Does not have playmates or friends Is not willing to share or take turns with others Seems very nervous or shy with others, chooses to be alone much of the time Is aggressive or bullies other children (hits, taunts, calls names) Feels pressured by others to do things he does not want to do Is easily hurt by peers Or if you, as parents: Worry that your child does not get along with others or has trouble keeping friends Notice that your child seems withdrawn or alone much of the time Get calls from other parents or neighbors about your childs behavior Need tips to help your child build good social skills Worry about the types of friends and activities your child chooses Observe that your child seems fearful with familiar adults, or too friendly with strangers

Middle Childhood

Bright Futures: What to Expect & When to Seek Help

School Relationships
What to Expect
Child: Feels good about school Is accepted by classmates and teachers Is included in group activities Joins school clubs, teams, or other school activities Cooperates with school rules and routines Responds positively to guidance from teachers Seeks help when needed Parents: Help child feel confident about school (visit classroom, meet teachers before school starts) Have expectations that match childs abilities Provide help or guidance with school tasks Encourage childs interests in school activities Become involved at school (field trips, PTA) Talk with childs teachers regularly Encourage child to invite classmates home to play

When to Seek Help

If your child: Is worried or fearful about school; refuses to go to school Often has headaches or stomach pains on school mornings Has problems with classmates, teachers, or school work Feels different, rejected, or left out Acts out in class or on the playground Likes to hang out with classmates who get into trouble Gets picked on or bullied at school or play Refuses to follow school rules and routines Loses interest in school (grades, friends, activities) Or if you, as parents: Observe that your child does not have friends or playmates at school Get calls or reports from teachers with concerns about your childs behavior Expect your child to achieve more than she seems able to do Notice a change in your childs school performance, such as a drop in grades

Bright Futures: What to Expect & When to Seek Help

Middle Childhood

NAME __________________________________________________________________________________ AGE ________________________________________

Your Questions and Concerns

The Emerging Self
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Growing and Changing

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Respecting Self & Others

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Family
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Building Friendships
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

School Relationships
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Middle Childhood

Bright Futures: What to Expect & When to Seek Help

Where to Seek Help

If you have questions or concerns about your child or your parenting, check it out. You may want to talk with your childs health care provider, after-school provider, or school counselor. Or check with a close friend or a member of your family or faith community. You can also open doors by locating resources and services in your own community. The toll-free numbers and Web sites listed below are a starting point. Or you can ask for help at your local library or call your local health department, school district, or social services agency listed in the county government section of your phone book.

National Toll-Free Numbers & Web Sites

Health & Wellness (Health Provider; Clinic) Maternal and Child Health Bureau Hotline (800) 311-2229 (800) 504-7081 (Espaol) Parenting Education Medline Plus www.nlm.nih.gov/medlineplus/parenting.html www.nlm.nih.gov/medlineplus/spanish/parenting.html (Espaol) Education & Developmental Services National Dissemination Center for Children with Disabilities (NICHCY) (800) 695-0285 (voice or TDD) www.nichcy.org Mental Health (Community Mental Health Center) National Mental Health Information Center (800) 789-2647 (voice) or (866) 889-2647 (TDD) www.mentalhealth.samhsa.gov Family Support In addition to the resources listed above, you can locate local social services, WIC, financial support, or faith-based programs: Dial 2-1-1 (a telephone network offering community-based information and referrals for services in most states) www.GovBenefits.gov

Your Own Contact List

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

For more resources, see Community Services Locator at www.mchlibrary.info/KnowledgePaths/kp_community.html. To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools 8

Social & Emotional Development in Adolescence

AGES 1121 YEARS

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

What Parents Want to Know

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark

As children become teenagers, parents have lots of questions about how to help their teenand the entire familycope with the dramatic and often confusing changes of adolescence. All teens have different strengths and abilities, and no other teen will develop exactly like yours. Health, personality, friends, and life experiences are important to your teens development; family, community, and cultural traditions also play important roles. For example, teens may start dating at a later age in some cultures. Although each teen is unique, all teens face social and emotional challenges during adolescence. This is a time of dramatic growth, from the early teen years (11-14) through late adolescence (ages 18-21). Major challenges include: Learning to manage feelings and moods Experiencing sexual development and shifts in body image

Learning to be safe and to avoid risky behaviors Becoming more self-directed yet respecting needs of family and friends As your teen is changing and facing new challenges, so are you, as parents. This tool can help by providing: A snapshot of what to expect during this time of transition A way to identify your teens strengths and your abilities as parents A starting point for talking with your teen or with others about adolescence Tips for when, where, and how to seek help If you have questions or concerns about your teen, check it out. Ask a trusted friend, family member, or member of your faith or cultural community; or contact your teens health care provider or school counselor, or your local social service agency. Help is available in your community. See the last page to learn more about services and support for you, your teen, and your family. Finding answers to your questions early will help your teen continue to develop in the healthiest way possible.

What to Expect &When to Seek Help

A Bright Futures Developmental Tool for Families and Providers

T
Cite as: Mayer R, Anastasi JM, Clark EM. 2006. What to Expect & When to Seek Help: A Bright Futures Tool to Promote Social and Emotional Development in Adolescence. Washington, DC: National Technical Assistance Center for Childrens Mental Health, Georgetown University Center for Child and Human Development, in collaboration with the National Center for Education in Maternal and Child Health. 2006 by Georgetown University Center for Child and Human Development With funding from: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

he What to Expect & When to Seek Help: Bright Futures Developmental Tools for Families and Providers are guided by the following principle: Every child and adolescent deserves to experience joy, have high self-esteem, acquire a sense of efficacy, and believe that she can succeed in life. BRIGHT
FUTURES CHILDRENS HEALTH CHARTER

Beginning the Conversation

Written in family-friendly language, the tools may be used by families and child development professionals in a range of disciplines, including health, education, child care, and family services. Throughout the tools, a strong emphasis is placed on strengths as well as concerns. The information under What to Expect not only offers a guide to healthy development and parenting, but provides information that parents can find reassuring about their childs behavior and their own parenting. The tools provide an opportunity to identify concerns at an early stage. The information under When to Seek Help includes issues that might be addressed with additional information, as well as those that signal the need for further assessments and services. Space is provided for families to write down their concerns as well as to create their own list of community resources and services.

To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools

Based on Bright Futures in Practice: Mental Health, the Bright Futures developmental tools offer a framework for providers and families to begin a conversation together about how best to support healthy social and emotional development in children and teens. The tools are part of a coordinated set of print and Web materials, including the Referral Tool for Providers and the electronic Community Services Locator. The tools gently encourage families who have any questions or concerns about their childs development to check it outand offer a number of tips for when, where, and how to seek help through local, state, or national resources.

Bright Futures: What to Expect & When to Seek Help

Adolescence

Feelings
What to Expect
Teen: May have frequent mood swings or changes in feelings (tearful one moment, happy the next) Has better understanding of own emotions and those of others Has positive feelings most of the time Is learning to accept disappointments and overcome failures Understands that sadness and bad feelings are temporary and will pass Usually does well in school or at work Parents: Support teens efforts and praise accomplishments Listen to and talk openly with teen Avoid criticism, judging, nagging Are available for help and advice when needed Help teen resolve conflicts, solve problems Recognize that teens feelings are real; are careful not to minimize or dismiss them Provide opportunities for teen to use own judgment

Is no longer interested in things she used to enjoy Has negative thoughts or opinions of himself Is easily discouraged by disappointments or failures Feels hopeless, unable to make things better Talks about hurting or killing herself; has tried to hurt or kill herself Uses alcohol or drugs to escape negative feelings Has difficulties in school or at work If parents: Have concerns about changes in your teens moods or emotions eating or sleeping habits school achievement work habits Have trouble talking with your teen Frequently have conflicts with your teen Think your teen is abusing alcohol or drugs Are concerned that your teen may drop out of school or quit work Think your teen might try to hurt or kill himself Are worried that your teen might be able to get guns or other weapons

When to Seek Help

If teen: Is sad or depressed, in a bad mood most of the time Seems very worried or anxious Has extreme mood swings Eats or sleeps less (or more) than before

Friends and Family

What to Expect
Teen: Gets along with parents, family, and friends most of the time Listens to parents though often seeming to ignore their guidance or advice Is becoming more independent Sets goals and works towards achieving them Usually dresses and acts like other teens, but gradually develops own taste, sense of style Has one or more best friends and positive relationships with others the same age Respects opinions and values of friends, others Has improved social skills Accepts family rules; completes chores, other responsibilities

continued

Adolescence
Friends and Family Continued
Parents: Respect teens privacy and encourage teens desire for independence Understand teens need to be like other teens or to be influenced by them Tolerate (within reason) teens developing likes and dislikes in clothes, hairstyles, music Continue to offer guidance and support Show interest in teens relationships and activities Establish fair and consistent rules (school, work, curfew, car use, chores) Encourage teens goals, plans for the future (school or career) Plan activities for family and teen to enjoy together

Bright Futures: What to Expect & When to Seek Help

When to Seek Help

If teen: Is disrespectful, defiant, unwilling to compromise Often argues; causes family conflicts Seems overly dependent, unwilling or unable to make own decisions Is alone most of the time; seems happier alone than with others Withdraws from family and friends Ignores family rules (car use, curfew, phone, computer) Is easily influenced by friends who lack good values or who take part in negative or harmful behaviors If parents: Have trouble letting go as your teen becomes more independent Need tips on discipline and setting limits for your teen Feel uncertain about changes in your teens behavior (whats typical, whats not) Are concerned about your teens choice of friends and their influence Often experience stress or conflict in your home Would like to join support or discussion group for parents of teens

Preventing Injuries and Risky Behavior

What to Expect
Teen: Has developed safe and healthy habits (drives safely, uses seat belts, follows speed limits, no drugs and alcohol) Avoids riding in a car with someone who has been drinking or using drugs Knows how to resist peer pressure to smoke, drink, use drugs, speed, or try other risky behaviors Has friends who disapprove of and avoid alcohol and drugs Is able to calm down and handle anger Is assertive without being aggressive Parents: Set a good example (use seat belts and helmets, avoid drinking and driving, manage anger) Host alcohol-free parties for teens; supervise Praise teen for staying away from alcohol and drugs Educate teen about the risks associated with alcohol and drug use (impaired judgment, car crashes, unprotected sex, violent behavior, drowning) Establish rules for safe driving (number of passengers, night driving, speed limits, no alcohol or other drugs) Have rescue plan (teen can call for a ride; parents remove teen from unsafe situations) Have removed guns from the home or stored them safely (unloaded and locked up)

Bright Futures: What to Expect & When to Seek Help

Adolescence

When to Seek Help

If teen: Takes part in harmful behaviors; ignores dangers Often gives in to negative peer pressure Belongs to a gang; takes part in illegal activities Gets angry; loses temper; becomes violent or abusive Bullies or harms others; has been bullied or harmed Carries a weapon (guns, knives) for protection Has an abusive boyfriend or girlfriend Has experienced or witnessed violence in home or neighborhood Is exposed to a lot of violence in movies, videos, television, and music Is experimenting with or is addicted to alcohol, tobacco, or other drugs Seems to have money from unknown sources Drives aggressively, speeds, drinks and drives If parents: Need help identifying signs of alcohol or drug use Are having problems with alcohol or other drugs Fight with your teen much of the time; often lose your temper Feel unsafe in your home or neighborhood Want information about safely disposing of guns or storing them Are afraid your teen might harm you or others Need tips for teaching your teen safe driving habits

Body Image and Eating Behaviors

What to Expect
Teen: Spends a lot of time and effort on physical appearance Is very concerned about body weight, shape, and size Feels very self-conscious, compares physical appearance to other teens or celebrities Will have a growth spurt sometime during adolescence (may be early or late) Generally eats healthy foods and is physically active Begins to develop an identity and self-worth beyond body image and physical appearance Parents: Talk with teen about the physical changes in puberty that affect height, weight, and body shape Encourage teen to join the family for meals, and keep mealtimes relaxed Eat healthy foods and are physically active Avoid critical statements or nagging about eating, weight, or appearance If teen is overweight, encourage weight loss through healthy eating, physical activity, and social support Help teen to identify and value overall strengths (kindness, courage, talents), not just appearance

When to Seek Help

If teen: Show no signs of growth spurt and other physical changes, compared with most teens the same age Is very unhappy about her weight, height, or body image Thinks hes overweight (when hes not), or is afraid of gaining weight Diets excessively, even when not overweight Has poor appetite; eats unhealthy foods or skips meals much of the time Has binge-eating episodes eats unusually large amounts of food lacks control over eating Binge-eats but does not gain weight (may purge through vomiting or laxatives) Refuses to eat in front of others Exercises too much or overtrains for sports Is gaining a lot of weight and has little or no physical activity Uses steroids to build muscles continued 5

Adolescence
Body Image and Eating Behaviors Continued
If parents: Are concerned that your teen is maturing very early (9-10 years) or very late (17 or older) Worry about your teens weight (losing too much or gaining too much weight) Have very strict expectations about family meals Need tips to talk with your teen about healthy body image, good eating habits, and physical activity Need to know more about possible signs of eating disorders like anorexia or bulimia

Bright Futures: What to Expect & When to Seek Help

Sex and Sexuality

What to Expect
Teen: Develops sexually (may be early or late in adolescence) Worries about developing in the same way as other teens Needs time for emotions and reasoning skills to catch up with rapid physical changes May feel pressure to experiment sexually May explore sexuality with same-sex friends Gradually develops sexual identity and sexual orientation (straight, gay, lesbian, or bisexual) Parents: Talk with teen about the sexual development that takes place during puberty Listen to teens concerns and answer questions about sexuality; are clear and respectful Talk about ways to resist sexual pressures Encourage teen to delay sexual activity Explain the risks of sexual activity, such as sexually transmitted diseases (STDs) and teen pregnancy Discuss safe-sex practices (condoms, birth control, limited partners) Encourage teen to talk with health provider or counselor about sexuality and sexual health Are alert to signs of possible sexual abuse or assault Offer clear, easy-to-read materials if teen wants to learn more

When to Seek Help

If teen: Shows no signs of sexual development by mid-teens Is being pressured to have sex Is sexually active or at risk for early sexual activity Acts out sexually (has unsafe sex or a number of sexual partners) Seems upset or worried about sexual orientation Is interested in dating at a young age (11-13 years) If parents: Need tips for talking with your teen about sexuality (values, pressures, safe sex) Have concerns about your teens dating relationships Think your teen is having sex or may become sexually active soon Are worried that your teen may be pregnant or at risk for STDs Think your teen may have been sexually abused or assaulted Want to know how best to support your teens healthy sexual development and sexual orientation

Bright Futures: What to Expect & When to Seek Help

Adolescence

NAME __________________________________________________________________________________ AGE ________________________________________

Your Questions and Concerns

Feelings
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Friends and Family

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Preventing Injuries and Risky Behavior

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Body Image and Eating Behaviors

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Sex and Sexuality

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Adolescence

Bright Futures: What to Expect & When to Seek Help

Where to Seek Help

If you have questions or concerns about your teen or your parenting, check it out. You may want to talk with your teens health care provider or school counselor. Or talk with a close friend, a member of your family or faith community, or other parents of teens. You can also open doors by locating resources and services in your own community. The toll-free numbers and Web sites listed below are a starting point. Or you can ask for help at your local library or call your local health department, school district, or social services agency listed in the county government section of your phone book.

National Toll-Free Numbers & Web Sites

Health & Wellness (Health Provider; Clinic) Maternal and Child Health Bureau Hotline (800) 311-2229 (800) 504-7081 (Espaol) Parenting Education Medline Plus www.nlm.nih.gov/medlineplus/parenting.html www.nlm.nih.gov/medlineplus/spanish/parenting.html (Espaol) Education & Developmental Services National Dissemination Center for Children with Disabilities (NICHCY) (800) 695-0285 (voice or TDD) www.nichcy.org Mental Health (Community Mental Health Center) National Mental Health Information Center (800) 789-2647 (voice) or (866) 889-2647 (TDD) www.mentalhealth.samhsa.gov Family Support In addition to the resources listed above, you can locate local social services, WIC, financial support, or faith-based programs: Dial 2-1-1 (a telephone network offering community-based information and referrals for services in most states) www.GovBenefits.gov

Your Own Contact List

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

For more resources, see Community Services Locator at www.mchlibrary.info/KnowledgePaths/kp_community.html. To learn more about the tools, download a copy, or inquire about training, consultation and technical assistance, visit www.brightfutures.org/tools 8

Social & Emotional Development

Where to Seek Help

A Bright Futures Referral Tool for Providers

Creating a Referral Network

Developmental, behavioral, and family support services are best provided through the coordinated efforts of a variety of professionals, agencies, and other resources. Many providers find it valuable to identify and develop collaborative relationships with other local providers to create a communitybased referral network.

Locating Community-Based Services to Support Children and Families

The first step toward creating an effective network is to identify a broad-based contact and referral list. The listings in this referral tool have been designed specifically for use with the Maternal and Child Health Librarys online knowledge path, Community Services Locator at: http://www.mchlibrary.info/Knowl edgePaths/kp_community.html Presenting current, credible, and accessible sources, the knowledge path provides immediate access to the Web sites of national organizations that list state or local contacts. We also urge you to: Ask families for the names and phone numbers of their primary providers (health care, education, child care, social service). Network with colleagues to identify experienced providers. Talk with professionals who provide other services for children and families in your community. Meet the Special Services/Special Education Director in your school district. This person can provide specific contacts for the child study team, school psychologist, Child Find and early intervention programs, special schools, and other special services available in your school district. Become familiar with the resources available through local faith-based organizations. Contact your local social service agency and police outreach department for lists of domestic violence or abuse hotlines and programs. Ask for help at your local library or check the county government listings in your phone book for social service agencies, childcare, and education resources.

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark Susan Lorenzo, M.L.S. John Richards, M.A., AITP

Where to Seek Help

A Bright Futures Referral Tool for Providers

Your Referral and Contact List

Your referral and contact list might include the following:

Education/Special Needs
Special Services/Special Education Director in your local school district __________________________________________________
________________________________________________________________________________________________________________________

Early Intervention/Child Find Services __________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Health and Wellness

Local Health Department ______________________________________________________________________________________________
________________________________________________________________________________________________________________________

Primary Health Care __________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Oral Health Care ______________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Genetics Services ______________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Childrens Hospitals ____________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Home Health Care ____________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Health Insurance ______________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Poison Control Centers ________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Professional Associations ______________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

A Bright Futures Referral Tool for Providers

Where to Seek Help

Mental Health and Well-Being

Community Mental Health Center ____________________________________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Mental Health Professionals ____________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Family Support/Parenting
Family Support Groups/Parent Organizations __________________________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Child Abuse Prevention and Intervention Services ______________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Community Violence Prevention and Intervention Services ____________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Domestic Violence Prevention and Intervention Services ________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Faith-Based Support Services __________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Marriage and Family Therapists ________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Services for Military Personnel and their Families ______________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Respite Care for Caregivers or Families of Individuals with Disabilities or Other Special Needs ____________________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Where to Seek Help

Child Care/Early Childhood Education

A Bright Futures Referral Tool for Providers

Early Head Start ________________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Head Start ____________________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Local Child Care Resource and Referral Organizations __________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Financial Assistance for Child Care ____________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Other
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Cite as: Mayer R, Anastasi JM, Clark EM, Lorenzo S, Richards JT. 2006. What to Expect & When to Seek Help: A Bright Futures Referral Tool for Providers. Washington, DC: National Technical Assistance Center for Childrens Mental Health, Georgetown University Center for Child and Human Development, in collaboration with the National Center for Education in Maternal and Child Health. 2006 by Georgetown University Center for Child and Human Development With funding from: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

To learn more about the tools, download a copy, or give feedback, visit www.brightfutures.org/tools

Desarrollo Social y Emocional de los Nios Pequeos

EDADES DE 1-4 AOS

Qu se Puede Esperar y Cundo Buscar Ayuda

Una Herramienta de Desarrollo de Bright Futures para Familias y Proveedores

Lo que los padres quieren saber

Desde el nacimiento los padres quieren saber: Mi beb est bien? Usted se preguntar esto una y otra vez segn su nio(a) crece, desde que empieza a caminar hasta la adolescencia.
Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark

Como padres ustedes se estn haciendo expertos en conocer y suplir las necesidades de su nio. Esta herramienta le puede ayudar proveyndole: Una fotografa instantnea de lo que puede esperar segn usted y su nio aprenden y crecen juntos Una manera de identificar las fortalezas de su nio y sus habilidades como padre/madre Un punto de partida para hablar con otros sobre el desarrollo de su nio Consejos sobre cundo, dnde y cmo buscar ayuda. Si usted tiene preguntas o preocupaciones sobre su nio(a), busque. Pregunte a un amigo/a de confianza, un miembro familiar o a un miembro de su comunidad cultural o iglesia; hable con el proveedor de cuidado de salud de su nio o su proveedor de cuido, llame a su departamento de salud local o a la agencia de servicios sociales. Hay ayuda en su comunidad. Vea la ltima pgina para aprender ms sobre los servicios y ayudas disponibles para usted, para su nio y su familia. El encontrar contestaciones a sus preguntas pronto, ayudar a que su nio se desarrolle de la manera ms saludable.

Todos los bebs nacen con diferentes fortalezas y habilidades y ningn otro nio se desarrollar exactamente igual al suyo. La salud, personalidad y experiencias tempranas son importantes para el desarrollo de su nio; la familia, comunidad y tradiciones culturales tambin desempean papeles importantes. Por ejemplo, las ideas de cmo y cundo ensear a un nio a usar el retrete (inodoro o toilet) puede cambiar en diferentes culturas. A pesar de que cada nio es nico, todos los nios enfrentan retos sociales y emocionales cuando son pequeos incluyendo: Aprender a controlar sus emociones y pataletas Poner a prueba sus lmites y hacerse ms independientes Aprender a compartir, esperar su turno y jugar con otros.

Qu se Puede Esperar y Cundo Buscar Ayuda

Una Herramienta de Desarrollo de Bright Futures para Familias y Proveedores

E
Cite como: Mayer R, Anastasi JM, Clark EM. 2006. What to Expect & When to Seek Help: A Bright Futures Tool to Promote Social and Emotional Development in Early Childhood. Washington, DC: National Technical Assistance Center for Children's Mental Health, Georgetown University Center for Child and Human Development, en colaboracin con el National Center for Education in Maternal and Child Health. 2006 por Georgetown University Center for Child and Human Development Con fondos de: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

l documento Qu se Puede Esperar y Cundo Buscar Ayuda: Una Herramienta de Desarrollo para Familias y Proveedores est guiado por el siguiente principio: Todo nio y adolescente merece experimentar gozo, tener una alta auto estima, adquirir un sentimiento de eficacia y creer que l/ella puede ser exitoso(a) en la vida.ESTATUTO DE DE SALUD
INFANTIL DE BRIGHT FUTURES

Comenzando el Dilogo
Las herramientas, escritas en lenguaje apropiado para las familias, pueden ser usadas por familias y profesionales de desarrollo infantil de varias disciplinas incluyendo la salud, educacin, cuido de nios y servicios para familias. A travs de las herramientas se enfatiza igualmente tanto las fortalezas como las preocupaciones. La informacin de Lo que Debe Esperar no slo ofrece una gua para el desarrollo saludable y la crianza, sino que tambin provee informacin que los padres pueden encontrar que los har sentir ms seguros sobre el comportamiento del nio y la crianza. Las herramientas proveen una oportunidad para identificar preocupaciones a edad temprana. La informacin indicada en Cuando Buscar Ayuda incluye situaciones que podran ser manejadas con mayor informacin al igual que situaciones en que hay seales mostrando la necesidad de evaluaciones ms profundas y servicios. Se provee espacio para que las familias escriban sus propias preocupaciones y tambin escriban su propia lista de recursos y servicios comunitarios.

Para conocer ms sobre las herramientas, descargar una copia o preguntar sobre capacitaciones, consulta y asistencia tcnica visite www.brightfutures.org/tools

Basado en Bright Futures en Prctica: Salud Mental, las herramientas de desarrollo de Bright Futures ofrecen un modelo para que los proveedores y familias puedan comenzar el dilogo juntos sobre cmo se puede ayudar a promover el desarrollo social y emocional de los nios y adolescentes. Las herramientas son parte de un conjunto de materiales impresos y en el Internet incluyendo la Herramienta de Referidos para Proveedores y el Localizador Electrnico de Servicios Comunitarios. Las herramientas exhortan a que las familias con preguntas o preocupaciones sobre el desarrollo de su nio busquen y ofrecen una variedad de consejos para cundo, dnde y cmo buscar ayuda a travs de recursos locales, estatales o nacionales.

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Nios Pequeos

Comer y Dormir
Lo que debe esperar
Nio(a): Le gusta explorar alimentos nuevos, escoge lo que le gusta y se alimenta a s mismo (usando primero sus dedos, luego una cuchara para nios; toma de una taza) Disfruta de formar parte de la cena familiar y la conversacin en la mesa Tiene una hora de dormir regular (se acurruca mientras escucha historias, va a dormir a la misma hora todas las noches) Usualmente se puede tranquilizar a s mismo para dormir, puede que tenga un objeto que lo haga sentir mejor (un juguete suave, una sbana) Duerme toda la noche Puede que tenga miedo en la noche a monstruos o a la oscuridad Padres/Madres: Ofrezca una variedad de alimentos, deje que su nio escoja lo que quiere y cunto quiere comer Coma las comidas en familia; haga del momento de comer algo placentero y sin apuros No use la comida como consuelo o para hacerlo sentir mejor; no use la comida como recompensa ni como castigo

Tenga una rutina para la hora de dormir, abrcelo mientras leen una historia juntos Ayude con delicadeza a su nio para que aprenda a calmarse y prepararse para ir a dormir Tranquilice los miedos de su nio, aydelo a sentirse seguro Provea un lugar seguro y tranquilo para que su nio duerma (sin ropa de cama suelta, ni camas de agua o espacios en los que el nio pueda caerse o quedar atrapado)

Cundo buscar ayuda

Si su nio(a): Quiere comer todo el tiempo y suplica por comida Se rehsa a comer y no disfruta de las comidas Tiene ataques de rabia por la comida Muestra poco inters en alimentarse a s mismo Se rehsa a ir a la cama o a permanecer en la cama Tiene problemas para dormir o para mantenerse dormido Tiene demasiado miedo en la noche o sufre de sueos aterradores O si usted, como padre/madre: Tiene preocupaciones o lucha de poder por la comida de su nio Est tratando de forzar a su nio a que coma ciertas cosas Se siente presionado a disminuir o aumentar el peso de su nio Se enfada cuando su beb no quiere comer o hace un desorden cuando come Est preocupado(a) por tener suficiente dinero para comprar comida Pasa mucho trabajo logrando que su nio se duerma o que se mantenga dormido Necesita ayuda para manejar problemas a la hora de dormir, el despertar en la noche o los miedos a la noche

Nios Pequeos

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Aseo y Cuidado Personal

Lo que debe esperar
Nio(a): Quiere hacer algunas cosas por s mismo sin su ayuda Se siente feliz cuando aprende a lavarse las manos y la cara, cepillarse los dientes y vestirse por s mismo (2-4 aos) Muestra que est listo para usar el retrete (toilet); sabe la diferencia entre mojado y seco, puede subirse y bajarse los pantalones, da alguna seal antes de evacuar u orinar, puede mantenerse seco por 2 horas o ms (2 a 2 1/2 aos) Padres/Madres: Ensee a su nio destrezas bsicas de cuidado personal (lavarse las manos, cepillarse los dientes, vestirse) y ayude a convertir estas rutinas en algo divertido Estimule y elogie a su nio mientras aprende a hacer decisiones y se hace ms independiente

Apoye y asista a su nio si regresa a sus comportamientos de beb en algunos momentos de cambio y tensin (estrs); evite avergonzarlo o criticarlo Espere para comenzar a ensearle a usar el bao hasta que su nio parezca estar listo Posponga el ensearle a usar el bao si pasan cambios drsticos en la familia (un Nuevo beb, una nueva casa o un lugar nuevo de cuido) Maneje los accidentes calmadamente y con aceptacin Evite conflictos y luchas acerca del cuidado personal y el aseo

Cundo buscar ayuda

Si su nio(a): No muestra inters en aprender a lavarse y vestirse por s mismo Ha hecho poco avance en el cuidado personal y el aseo (para la edad de 3 aos) No es capaz de controlar sus funciones del cuerpo o de usar el retrete (toilet) (para la edad de 3 aos) Parece tenerle mucho miedo al retrete (toilet) o al retrete de nios Vuelve a ensuciarse encima despus de que haba aprendido a usar el bao Se aguanta o se rehsa a evacuar O si usted como padre/madre: Encuentra que es difcil dejar que su nio trate de hacer cosas por s mismo Est luchando con su nio acerca del cuidado personal y el aseo Se preocupa de que su nio no parezca aprender cmo usar el retrete (toilet) Est empujando demasiado (o siente que lo presionan demasiado) para que su nio aprenda a ir al bao Se enoja mucho o castiga a su nio cuando pasan accidentes

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Nios Pequeos

Desarrollndose a S Mismo: Personalidad, Emociones e Independencia

Lo que debe esperar:
Nio(a): Aprende a mencionar y expresar sentimientos (gozo, enojo, miedo, tristeza) Es muy curioso y le encanta explorar Est consciente del gnero Se da cuenta de los sentimientos de otros Le gusta la palabra no y la usa con frecuencia (hasta cuando quiere decir s) Le gusta probar sus lmites pero los acepta la mayora de las veces Se le hace difcil controlar las emociones fuertes como el coraje y la frustracin Puede tener pataletas Escoge y hace algunas decisiones (libros para leer, ropa que se quiere poner) Hace algunas faenas (recoge los juguetes, pone la ropa sucia en el cesto de ropa sucia) Se siente satisfecho consigo mismo, su cuerpo y lo que puede hacer (correr, brincar, trepar, lanzar) (3-4 aos) Aprende cosas bsicas (dibujar, clasificar, contar, palabras y nmeros) que lo ayudan a prepararse para comenzar la escuela (4 aos) Padres/Madres: Acepte y ayude al desarrollo de la personalidad del nio y su estilo Ayude a que su nio pueda nombrar sus sentimientos, hable de sus propios sentimientos Elogie el buen comportamiento y el esfuerzo, sonra y d abrazos Hable con su nio de lo que hacen juntos, aydelo a nombrar lo que ve, lo que escucha y lo que hace Permita que su nio escoja algunas meriendas, ropa, historias y juegos D a su nio la libertad y el espacio para explorar de una manera segura; mantngase cerca

Establezca lmites seguros Ayude a que su nio maneje el coraje y otros sentimientos fuertes; aprenda lo que lo ayuda a controlarse (abrazarlo, hablarle calmadamente, distraccin) Discipline con restriccin moderada, distraccin o aislamiento Espere un comportamiento que est al nivel de la edad y habilidades de su nio Estimule a que su nio sea bondadoso y que ayude

Cundo buscar ayuda

Si su nio(a): Tiene problemas expresando sus sentimientos Muestra poco inters en hacer cosas por s mismo o en tratar nuevas destrezas Parece estar en su propio mundo (poco contacto visual, mece su cuerpo repetidamente, poco inters en las personas o juguetes) No puede tranquilizarse despus de unos minutos o tiene pataletas extremas Parece ser muy terco comparado con otros nios de su edad Se frustra demasiado cuando trata de hacer cosas sencillas que otros nios de su edad pueden hacer No puede esperar unos minutos cuando quiere o necesita algo (para la edad de 3 aos) No parece poder enfocarse o terminar actividades (3-4 aos) A menudo se rehsa a hacer cosas simples que usted le pide que haga Golpea, muerde o da puetazos Destruye los juguetes u otros objetos O si usted como padre/madre: Tiene problemas manejando las actividades y supliendo las necesidades de su nio Desea consejos de cmo establecer lmites, reglas simples y de cmo seguirlas Espera ms de lo que su nio parece poder hacer Tiene problemas manejando el coraje de su nio o el suyo Necesita consejos para manejar las pataletas o la lucha de poder

Nios Pequeos

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Familia
Lo que debe esperar
Nio(a): Se siente amado y aceptado, demuestra afecto, confa en usted Quiere complacer a sus padres busca a los padres para tener afecto y seguridad imita las acciones de los padres (habla por el telfono de juguete, cepilla el cabello de la mueca) (2 aos) usualmente coopera con la rutina familiar y con pedidos simples Comunica sus necesidades y comparte sus sentimientos usa mayormente sonidos y gestos, dice de 15-20 palabras (18 meses) conecta 2-3 palabras juntas en frases simples (ms leche) (2 aos) habla en oraciones cortas y casi claras (yo quiero bola (3 aos) dice muchas historias, pregunta mucho (4 aos) Se lleva bien con los hermanos(as) la mayor parte de las veces, pero a veces pelea con ellos Est aprendiendo a compartir y a esperar su turno Puede separarse de sus padres fcilmente por un tiempo (3 aos) Padre/madre: Muestre afecto, preocpese y quiera cuidar a su la familia D muchas sonrisas y abrazos Escuche atentamente a su nio y hablen juntos Juegue creativamente: fomente los juegos de pretender, juegos con diferentes vestimentas, d a su nio espacio y libertad para explorar de una manera segura con juegos y actividades que fortalezcan nuevas destrezas Elogie las fortalezas de su nio, sus destrezas y esfuerzos, evite compararlo con otros nios Busque maneras para ayudar a que sus nios se lleven bien juntos (juegos divertidos o salidas) Deje que su nio resuelva conflictos por s mismo, ensele a ser justo, no permita el abuso fsico o verbal Pase tiempo solo con cada nio (escuchando, leyendo, hablando jugando) Responda a la curiosidad de su nio; estimule que le haga preguntas

Limite el tiempo frente al televisor; vean espectculos juntos y hable sobre ellos Ayude a que el nio aprenda a cuidar de s mismo y a tener confianza en s mismo sin volverse agresivo.

Cundo Buscar Ayuda

Si su nio: Parece retrado o no disfruta de ser parte de la familia No busca su amor y apruebo Se aferra a usted y se pone muy triste cuando usted se va (a los 3-4 aos) Trata de herir fsicamente a los hermanitos (as) Ve la violencia frecuentemente en la casa o en la TV, muestra comportamientos violentos Nunca comparte juguetes ni espera su turno (3 a 4 aos) O si usted como padre o madre: Encuentra difcil poder elogiar a su nio y mostrarle afecto Se enfoca ms en los comportamientos negativos de su nio Se siente solo(a) o tiene poca ayuda (familia, amigos, vecinos, iglesia) Tiene problemas estableciendo reglas consistentes y lmites seguros Necesita consejos para manejar las peleas entre sus nios Est teniendo conflictos serios en su familia u otras relaciones Muchas veces discute frente a su nio(a)

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Nios Pequeos
Cundo buscar ayuda
Si su nio(a): Parece ser muy tmido o tiene miedo de otros nios No se comunica con otros nios usando frases y oraciones cortas Juega solo la mayor parte del tiempo, no juega bien con otros o se siente aislado (3-4 aos) Golpea, muerde o da puos a otros cuando est enojado o frustrado (3-4 aos) Se rehsa a compartir juguetes o a esperar su turno (3-4 aos) O si usted como padre/madre: Se preocupa de que su nio es demasiado activo o demasiado agresivo con otros nios Ha visto que su nio est muchas veces solo y no juega con otros nios (3-4 aos) Recibe llamadas de los maestros del cuido o del preescolar porque estn preocupados por el comportamiento social de su nio Necesita consejos de cmo fomentar a que su hijo juegue alegremente con otros

Desarrollando Amistades
Lo que debe esperar
Nio(a): Juega al lado pero no directamente con otros nios (1-2 aos) Empieza a jugar junto a otros y a compartir con otros nios (3 aos) Se lleva bien con otros en el lugar de cuido o en el preescolar; puede mencionar 2 o ms amigos que juegan con l (4 aos) Comienza un juego simple de pretender (simulacin) (2 aos), luego haciendo estos juegos ms complicados con sus amigos (3-4 aos) Usa el lenguaje para comunicarse con los amigos de juego usa frases simples u oraciones de 2 palabras (mi bola) (2 aos) habla en oraciones de 4 a 5 palabras (Yo voy a casa ahora) (3 aos) habla fcilmente: crea historias de fantasa con los amigos (4 aos) Padre/Madre: Estimule a que su nio juegue con otros nios (hermanos, grupos de juego, cuido, preescolar) como una manera de aprender comportamientos sociales Supervise el tiempo de juego y las actividades Ayude a organizar un juego social que est de acuerdo a la personalidad de su nio (juego libre o estructurado, calmado o activo, corto o largo) Fomente a que su nio le diga sobre sus compaeros de juego y las cosas que les gusta hacer juntos Permita que su nio se haga valer, pero ensele a que no muerda, golpee o llame a otros usando un mal nombre Provee una manera segura para descargar la energa suprimida a travs de actividades fsicas (lanzar una bola, chocar carros de juguete, correr, brincar) Proteja a su nio del contacto frecuente con compaeros de juego que son muy agresivos Encuentre oportunidades para que su nio juegue con otros nios y nias de otros grupos raciales, culturales y econmicos

Nios Pequeos

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

NOMBRE ____________________________________________________________________________ EDAD ________________________________________

Preguntas y Preocupaciones
Comer y Dormir
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Aseo y Cuidado Personal

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Desarrollndose a S Mismo: Personalidad, Emociones e Independencia

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Familia
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Desarrollando Amistades
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Nios Pequeos

Dnde buscar ayuda

Si usted tiene preguntas o preocupaciones sobre su nio o su estilo como madre/padre busque. Quizs quiera hablar con el proveedor de cuidado de salud o el proveedor de cuido de su nio, con un amigo(a) cercano o un miembro de su iglesia. Usted tambin puede abrir puertas localizando recursos y servicios en su comunidad. El nmero libre de costo y los sitios en el Internet mencionados en esta pgina son un punto de comienzo. Usted tambin puede buscar ayuda en su biblioteca local o llamar a su departamento de salud local, a su distrito escolar o la agencia de servicios sociales listada en la seccin de gobierno del condado en su gua telefnica.

Nmero Nacional Libre de Costo y Sitios de Internet

Salud y Bienestar (Proveedor de Salud; Clnica) Maternal and Child Health bureau Hotline (Lnea del Departamento de Salud Maternal e Infantil) (800) 311-2229 (800) 504-7081 (Espaol) Cuido de Nios y Educacin de Nios Pequeos Child Care Aware (800) 424-2246 (Ingls y Espaol) www.childcareaware.org www.childcareaware.org/sp (Espaol) Educacin para Padres/Madres Medline Plus www.nlm.nih.gov/medlineplus/parenting.html www.nlm.nih.gov/medlineplus/spanish/parenting.html (Espaol) Intervencin Temprana (Servicios de Desarrollo) National Dissemination Center for Children with Disabilities (NICHCY) (Centro Nacional de Diseminacin para Nios con Incapacidades) (800) 695-0285 (voz o TDD) www.nichcy.org Salud Mental (Centro Comunitario de Salud Mental) National Mental Health Information Center (Centro de Informacin Nacional de Salud Mental) (800) 789-2647 (voz) (866) 889-2647 (TDD) www.mentalhealth.samhsa.gov Apoyo Familiar Adems de los recursos mencionados, usted puede localizar servicios sociales locales, WIC, ayuda econmica o programas de fe: Marque el 2-1-1 (una red telefnica que ofrece informacin comunitaria y referidos a servicios en la mayora de los estados) www.GovBenefits.gov

Su Propia Lista de Contactos

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Para ms recursos vea el Localizador de Servicios Comunitarios en www.mchlibrary.info/knowledgepaths/kp_community.html Para conocer ms sobre las herramientas, descargar una copia o preguntar sobre capacitaciones, consulta y asistencia tcnica visite www.brightfutures.org/tools 9

Desarrollo Emocional y Social en la Adolescencia

EDADES DE 1121 AOS

Qu se Puede Esperar y Cundo Buscar Ayuda

Una Herramienta de Desarrollo de Bright Futures para Familias y Proveedores

Lo que los padres quieren saber

Segn los nios se convierten en adolescentes los padres/madres tienen muchas preguntas sobre cmo ayudar a sus adolescentes (y a la familia completa) para lidiar con los cambios dramticos y muchas veces confusos de la adolescencia. Todos los adolescentes tienen diferentes fortalezas y habilidades y ningn otro adolescente se desarrollar exactamente como el suyo. La salud, personalidad, amigos y experiencias vividas son importantes para el desarrollo de su adolescente; la familia, comunidad y tradiciones culturales tambin desempean un papel importante. Por ejemplo, los adolescentes de otras culturas pueden comenzar a salir en citas amorosas ms tarde en la adolescencia. A pesar de que cada adolescente es nico, todos los adolescentes enfrentan retos sociales y emocionales durante la adolescencia. Este es un momento de crecimiento dramtico, desde la adolescencia temprana (11-14 aos) hasta la adolescencia tarda (edades de 18-21 aos). Los mayores retos incluyen: Aprender a manejar los sentimientos y estados de nimo Experimentar el desarrollo sexual y cambios en la imagen fsica Aprender a estar seguros y evitar los comportamientos de alto riesgo Hacerse una persona ms centrada, respetando las necesidades de amigos y familiares. Segn su adolescente cambia y encuentra nuevos retos, usted tambin los encontrar como padre/madre. Esta herramienta puede ayudarle proveyndole: Una fotografa instantnea de lo que puede esperar durante este periodo de transicin Una manera de identificar las fortalezas de su adolescente y sus habilidades como padre/madre Un punto de partida para hablar con su adolescente o con otros sobre su adolescente Consejos para saber cundo, dnde y cmo buscar ayuda Si usted tiene preguntas o preocupaciones sobre su adolescente, busque. Pregunte a un amigo/a de confianza, un familiar o a un miembro de su comunidad cultural o iglesia; hable con el proveedor de cuidado de salud de su adolescente o consejero escolar, o llame a la agencia local de servicios sociales. Hay ayuda en su comunidad. Vea la ltima pgina para aprender ms sobre los servicios y ayudas disponibles para usted, para su adolescente y su familia. El encontrar contestaciones a sus preguntas pronto, ayudar a que su adolescente se desarrolle de la manera ms saludable.

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark

Qu se Puede Esperar y Cundo Buscar Ayuda

Una Herramienta de Desarrollo de Bright Futures para Familias y Proveedores

E
Cite como: Mayer R, Anastasi JM, Clark EM. 2006. What to Expect & When to Seek Help: A Bright Futures Tool to Promote Social and Emotional Development in Adolescence. Washington, DC: National Technical Assistance Center for Childrens Mental Health, Georgetown University Center for Child and Human Development, en colaboracin con el National Center for Education in Maternal and Child Health. 2006 por Georgetown University Center for Child and Human Development Con fondos de: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

l documento Qu se Puede Esperar y Cundo Buscar Ayuda: Una Herramienta de Desarrollo para Familias y Proveedores est guiado por el siguiente principio: Todo nio y adolescente merece experimentar gozo, tener una alta auto estima, adquirir un sentimiento de eficacia y creer que l/ella puede ser exitoso(a) en la vida.ESTATUTO DE DE SALUD
INFANTIL DE BRIGHT FUTURES

Comenzando el Dilogo
Las herramientas, escritas en lenguaje apropiado para las familias, pueden ser usadas por familias y profesionales de desarrollo infantil de varias disciplinas incluyendo la salud, educacin, cuido de nios y servicios para familias. A travs de las herramientas se enfatiza igualmente tanto las fortalezas como las preocupaciones. La informacin de Lo que Debe Esperar no slo ofrece una gua para el desarrollo saludable y la crianza, sino que tambin provee informacin que los padres pueden encontrar que los har sentir ms seguros sobre el comportamiento del nio y la crianza. Las herramientas proveen una oportunidad para identificar preocupaciones a edad temprana. La informacin indicada en Cuando Buscar Ayuda incluye situaciones que podran ser manejadas con mayor informacin al igual que situaciones en que hay seales mostrando la necesidad de evaluaciones ms profundas y servicios. Se provee espacio para que las familias escriban sus propias preocupaciones y tambin escriban su propia lista de recursos y servicios comunitarios.

Para conocer ms sobre las herramientas, descargar una copia o preguntar sobre capacitaciones, consulta y asistencia tcnica visite www.brightfutures.org/tools

Basado en Bright Futures en Prctica: Salud Mental, las herramientas de desarrollo de Bright Futures ofrecen un modelo para que los proveedores y familias puedan comenzar el dilogo juntos sobre cmo se puede ayudar a promover el desarrollo social y emocional de los nios y adolescentes. Las herramientas son parte de un conjunto de materiales impresos y en el Internet incluyendo la Herramienta de Referidos para Proveedores y el Localizador Electrnico de Servicios Comunitarios. Las herramientas exhortan a que las familias con preguntas o preocupaciones sobre el desarrollo de su nio busquen y ofrecen una variedad de consejos para cundo, dnde y cmo buscar ayuda a travs de recursos locales, estatales o nacionales.

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Adolescencia

Sentimientos
Lo que debe esperar
Adolescente: Puede tener cambios de nimo frecuentes o cambio de sentimientos (llorando por un momento, alegre en otro) Entiende mejor sus propias emociones y las de otros Tiene sentimientos positivos la mayor parte del tiempo Est aprendiendo a aceptar desilusiones y a sobreponerse a sus fracasos Entiende que la tristeza y los malos sentimientos son temporeros y pasarn Usualmente le va bien en la escuela o en el trabajo Padre/Madre: Apoye los esfuerzos de su adolescente y elogie sus logros Escuche y hable abiertamente con su adolescente Evite criticar, juzgar y regaar Est disponible para ayudar y ofrecer consejo cuando sea necesario Ayude a solucionar conflictos y problemas Reconozca que los sentimientos del adolescente son reales, tenga cuidado de no minimizarlos o ignorarlos Provea oportunidades para que su adolescente use su propio criterio

Tiene cambios de nimo extremos Come o duerme menos (o ms) que antes Ya no est interesado en las cosas que disfrutaba antes Tiene sentimientos u opiniones negativas de s mismo Se desanima fcilmente por desilusiones o fracasos Siente que no tiene esperanza, no puede mejorar las cosas Habla de herirse o matarse, ha tratado de herirse o matarse Usa alcohol o drogas para escapar sentimientos negativos Tiene dificultades en la escuela o en el trabajo Si el padre/madre: Se preocupa sobre los cambios en: Los estados de nimo y emociones del adolescente Hbitos alimenticios o de dormir del adolescente Logros escolares del adolescente Hbitos de trabajo del adolescente Tiene problemas hablando con su adolescente Frecuentemente tiene conflictos con su adolescente Piensa que su adolescente abusa del alcohol o las drogas Se preocupa de que su adolescente pueda dejar la escuela o el trabajo Piensa que su adolescente puede tratar de herirse o matarse Est preocupado de que su adolescente pueda obtener pistolas u otras armas de fuego

Cundo buscar ayuda

Si el(la) adolescente: Est triste o deprimido, de mal humor la mayor parte del tiempo Parece estar muy preocupado o ansioso

Amigos y Familia
Lo que debe esperar
Adolescente: Se lleva bien con el padre/madre, la familia y los amigos la mayor parte del tiempo Escucha a su padre/madre aunque muchas veces parece ignorar su direccin o consejo Se est haciendo ms independiente Establece metas y trabaja para lograrlas Usualmente se viste y acta como otros adolescentes, pero gradualmente desarrolla su propio gusto, su propio estilo Tiene uno o ms mejores amigos y relaciones positivas con otros de su misma edad Respeta las opiniones y valores de sus amigos y de otros Mejora sus destrezas sociales Acepta las reglas familiares, termina quehaceres y otras responsabilidades

continuacin

Adolescencia
Amigos y Familia, Continuacin
Padre/Madre: Respete la privacidad de su adolescente y fomente el deseo de su adolescente por independizarse Entienda que los adolescentes necesitan ser como otros adolescentes o ser influenciados por ellos Tolere (dentro de lo razonable) el desarrollo de lo que le gusta y no le gusta a su adolescente concerniente a ropa, estilos de cabello y msica Contine ofreciendo direccin y apoyo Muestre inters en las relaciones del adolescente y sus actividades Establezca reglas justas y consistentes (para la escuela, trabajo, hora de llegada, uso del auto, quehaceres) Fomente a que su adolescente tenga metas y planifique para su futuro (escuela o carrera) Planifique actividades para que la familia y el adolescente disfruten juntos

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Cundo buscar ayuda

Si el(la) adolescente: Es irrespetuoso, desafiante o no quiere llegar a acuerdos Discute frecuentemente; causa conflictos familiares Parece ser demasiado independiente, no quiere o no puede tomar sus propias decisiones Est solo la mayor parte del tiempo, parece estar ms contento solo que con otros Se aparta de la familia y amigos Ignora las reglas familiares (uso del auto, hora de llegada, telfono, computadora) Se influencia fcilmente por los amigos que carecen de buenos valores o que toman parte de comportamientos negativos y dainos Si el padre/madre: Tiene problemas dejando ir segn su adolescente se hace ms independiente Necesita consejos para disciplinar y establecer lmites para su adolescente Se siente inseguro sobre los cambios en el comportamiento de su adolescente (lo que es tpico y lo que no lo es) Se preocupa por los amigos que escoge su adolescente y la influencia que ejercen Muchas veces experimenta estrs (tensin) o conflicto en su hogar Le gustara unirse a un grupo de apoyo o de discusin para padres de adolescentes

Previniendo Heridas y Comportamiento Riesgoso

Lo que debe esperar
Adolescente: Ha desarrollado hbitos seguros y saludables (maneja con precaucin, usa el cinturn de seguridad, sigue los lmites de velocidad, no drogas ni alcohol) Evita estar en un auto manejado por alguien que ha estado bebiendo alcohol o usando drogas Sabe como resistir la presin de sus compaeros para fumar, beber alcohol, usar drogas, velocidad o tratar otro tipo de comportamiento de alto riesgo) Tiene amigos que no estn de acuerdo y evitan el alcohol y las drogas Es capaz de calmarse y controlar el enojo Es asertivo sin ser agresivo Padre/Madre: Ponga un buen ejemplo (use el cinturn de seguridad y los cascos, evite beber alcohol y manejar, controle su coraje) Auspicie fiestas libres de alcohol para adolescentes; supervise Elogie a su adolescente por mantenerse libre de alcohol y drogas Eduque al adolescente sobre los riesgos asociados con el uso del alcohol y las drogas (impedimento del juicio, accidentes de auto, sexo sin proteccin, comportamiento violento, ahogarse)

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Adolescencia
Si el padre/madre: Necesita ayuda identificando los sntomas de uso de alcohol o drogas. Tiene problemas con el alcohol y otras drogas Lucha demasiado con su adolescente; muchas veces pierde el control No se siente seguro en su hogar o en su vecindad Quiere informacin sobre cmo deshacerse de una manera segura de sus pistolas o de cmo guardarlas Tiene miedo de que su adolescente se haga dao o le haga dao a otros Necesita consejos para ensearle a su adolescente hbitos para manejar de una manera segura

Establezca reglas para manejar de manera segura (nmero de pasajeros, lmites de velocidad, no alcohol, no drogas) Tenga un plan de socorro (su adolescente puede llamar para un aventn, padre/madre saque a su adolescente de situaciones peligrosas) Saque las pistolas del hogar o gurdelas en un lugar seguro (sin balas y bajo llave)

Cundo buscar ayuda

Si el(la) adolescente: Toma parte de comportamientos dainos; ignora los peligros Con frecuencia consiente a la presin negativa de sus compaeros Pertenece a una ganga; toma parte de actividades ilegales Se enoja, pierde el control y se pone violento o abusivo Intimida o hace dao a otros; ha sido intimidado o herido Tiene un arma (pistola, cuchillos) para protegerse Tiene un novio(a) abusivo Ha visto o experimentado violencia en el hogar o la comunidad Est expuesto a mucha violencia en pelculas, video, televisin y msica Ha experimentado o es adicto al alcohol, tabaco y otras drogas Parece tener dinero de fuentes desconocidas Maneja agresivamente, excede el lmite de velocidad, bebe bebidas alcohlicas y maneja

Imagen Fsica y Hbitos Alimenticios

Lo que debe esperar
Adolescente: Pasa mucho tiempo y se esfuerza en su apariencia fsica Se preocupa mucho por el peso, la forma y el tamao de su cuerpo Est muy conciente de s mismo, compara su apariencia fsica con otros adolescentes y celebridades Tendr un crecimiento rpido en algn momento de la adolescencia (puede ser temprano o tarde) Generalmente come comidas saludables y est fsicamente activo Comienza a desarrollar una identidad y auto estima ms all de la imagen y apariencia fsica Padre/Madre: Hable con su adolescente sobre los cambios fsicos en la pubertad que afectan el crecimiento, peso y forma del cuerpo Fomente que su adolescente se una a la familia para comer y mantenga relajada la hora de la comida Coma alimentos saludables y est fsicamente activo Evite las crticas y regaos sobre la comida, el peso o la apariencia Si el adolescente est sobre peso, estimule a que baje de peso mediante el consumo de comidas saludables, la actividad fsica y apoyo social Ayude al adolescente a identificar y valorar sus fortalezas (compasin, valor, talento), no solo la apariencia
continuacin

Adolescencia
Imagen Fsica y Hbitos Alimenticios, Continuacin

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Cundo buscar ayuda

Si el(la) adolescente: No muestra seales de crecimiento u otros cambios fsicos comparado a otros adolescentes de su edad Est extremamente insatisfecho con su peso, tamao o imagen fsica Piensa que est sobre peso (cuando no lo est), o tiene miedo de ganar peso Hace demasiadas dietas, aunque no est sobrepeso Tiene poco apetito, come comidas poco saludables o con frecuencia no come una de las tres comidas diarias Tiene episodios de comer exageradamenta usualmente come grandes cantidades de comida le falta control al comer Come sin lmites pero no gana peso (puede ser que se est induciendo el vmito o usando laxantes) Se rehsa a comer frente a otros Hace demasiado ejercicio o entrena demasiado para deportes Est ganando demasiado pero hace poca o ninguna actividad fsica Usa esteroides para desarrollar msculos Si el padre/madre: Se preocupa de que su adolescente est madurando prematuramente (9-10 aos) o demasiado tarde (17 aos o ms) Se preocupa por el peso de su adolescente (pierde mucho peso o gana demasiado peso) Tiene expectativas estrictas sobre las comidas en familia Necesita consejos para hablar con su adolescente sobre una imagen fsica saludable, hbitos alimenticios saludables y actividad fsica Necesita saber ms sobre otros sntomas de desrdenes alimenticios como la anorexia y la bulimia

Gradualmente desarrolla una identidad sexual y una orientacin sexual (heterosexual, homosexual, lesbiana o bisexual) Padre/Madre: Hable con su adolescente sobre el desarrollo sexual que toma lugar durante la pubertad Escuche las preocupaciones del adolescente y conteste las preguntas sobre sexualidad, sea claro y respetuoso Hable de las maneras en que se puede resistir la presin sexual Anime a su adolescente a que demore la actividad sexual Explique los riesgos de la actividad sexual como lo son las enfermedades venreas (transmitidas sexualmente) y el embarazo en la adolescencia Hable de las prcticas del sexo seguro (condones, otros mtodos anticonceptivos, limitacin de parejas) Anime a su adolescente para que hable con su proveedor de servicios de salud o su consejero sobre sexualidad y la salud sexual Est alerta a las seales de posible abuso sexual y violacin Ofrezca materiales claros y fciles de leer si el adolescente quiere aprender ms

Cundo buscar ayuda

Si el(la) adolescente: No muestra seales de desarrollo sexual para la mitad de la adolescencia Est siendo presionado para tener relaciones sexuales Est sexualmente activo o est en riesgo de tener actividad sexual a temprana edad Tiene relaciones sexuales sin proteccin o tiene varias parejas Parece molestarse o estar preocupado por la orientacin sexual Est interesado en salir en citas amorosas a temprana edad (11-13 aos) Si el padre/madre: Necesita consejos para hablar con su adolescente sobre la sexualidad (valores, presin, sexo seguro) Est preocupado con las relaciones amorosas de su adolescente Cree que su adolescente est teniendo relaciones sexuales o las tendr pronto Est preocupado de que su adolescente est embarazada o tenga una enfermedad venrea Cree que su adolescente fue abusado(a) sexualmente o violado(a) Quiere saber cmo puede proveer apoyo a su adolescente para promover un desarrollo sexual saludable y apoyar la orientacin sexual de su adolescente

Sexo y Sexualidad
Lo que debe esperar
Adolescente: Desarrollo sexual (quizs temprano o tarde en la adolescencia) Se preocupa por desarrollarse de la misma manera que los otros adolescentes Necesita tiempo para que las emociones y las destrezas de razonamiento puedan alcanzar los rpidos cambios fsicos Puede sentirse presionado a experimentar sexualmente Podra explorar su sexualidad con amigos del mismo sexo 6

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Adolescencia

NOMBRE ____________________________________________________________________________ EDAD ________________________________________

Preguntas y Preocupaciones
Sentimientos
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Amigos y Familia
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Previniendo Heridas y Comportamiento Riesgoso

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Imagen Fsica y Hbitos Alimenticios

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Sexo y Sexualidad
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Adolescencia

Bright Futures: Qu se Puede Esperar y Cundo Buscar Ayuda

Dnde buscar ayuda

Si usted tiene preguntas o preocupaciones sobre su adolescente o su estilo como madre/padre busque. Quizs quiera hablar con el proveedor de cuidado de salud o con un consejero escolar. Tambin puede hablar con un amigo(a) cercano o un miembro de su iglesia o con otros padres de adolescentes. Usted tambin puede abrir puertas localizando recursos y servicios en su comunidad. Los nmeros libre de costo y los sitios en el Internet mencionados en esta pgina son un punto de comienzo. Usted tambin puede buscar ayuda en su biblioteca local o llamar a su departamento de salud local, a su distrito escolar o la agencia de servicios sociales listada en la seccin de gobierno del condado en su gua telefnica.

Nmero Nacional Libre de Costo y Sitios en el Internet

Salud y Bienestar (Proveedor de Salud; Clnica) Maternal and Child Health Bureau Hotline (Lnea del Departamento de Salud Materna e Infantil) (800) 311-2229 (800) 504-7081 (Espaol) Educacin para Padres/Madres Medline Plus www.nlm.nih.gov/medlineplus/parenting.html www.nlm.nih.gov/medlineplus/spanish/parenting.html (Espaol) Educacin y Servicios de Desarrollo National Dissemination Center for Children with Disabilities (NICHCY) (Centro Nacional de Diseminacin para Nios con Incapacidades) (800) 695-0285 (voz o TDD) www.nichcy.org Salud Mental (Centro Comunitario de Salud Mental) National Mental Health Information Center (Centro de Informacin Nacional de Salud Mental) (800) 789-2647 (voz) o (866) 889-2647 (TDD) www.mentalhealth.samhsa.gov Apoyo Familiar Adems de los recursos mencionados, usted puede localizar servicios sociales locales, ayuda econmica o programas de fe Marque el 2-1-1 (una red telefnica que ofrece informacin comunitaria y referidos a servicios en la mayora de los estados) www.GovBenefits.gov

Su Propia Lista de Contactos

__________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

Para ms recursos vea el Localizador de Servicios Comunitarios en www.mchlibrary.info/knowledgepaths/kp_community.html Para conocer ms sobre las herramientas, descargar una copia o preguntar sobre capacitaciones, consulta y asistencia tcnica visite www.brightfutures.org/tools 8

Desarrollo Emocional y Social

En Dnde Buscar Ayuda

Una Herramienta de Referido de Bright Futures para Proveedores Creando una Red de Referidos
Los servicios de desarrollo, de comportamiento y de apoyo familiar se proveen mejor mediante la coordinacin de esfuerzos de una variedad de profesionales, agencias y otros recursos. Muchos proveedores encuentran que es muy valioso identificar y desarrollar relaciones en colaboracin con otros proveedores locales para crear una red de referidos basado en la comunidad.

Localizando Servicios Basados en la Comunidad para Ayudar a Nios y Familias

El primer paso para crear una red efectiva es identificar una lista amplia de contactos y referidos. La lista en esta herramienta de referido ha sido diseada especficamente para usarse con el camino al conocimiento de la Biblioteca de Salud Maternal e Infantil en el Internet, Localizador de Servicios Comunitarios, en el: http://www.mchlibrary.info/Knowl edgePaths/kp_community.html El camino al conocimiento presenta recursos actuales, crebles y accesibles proveyendo acceso inmediato al lugar en el Internet de organizaciones nacionales, dando informacin de contactos estatales y locales. Tambin le exhortamos a que usted: Pregunte a las familias los nombres y nmeros de telfono de sus proveedores primarios (cuidado de salud, educacin, cuido de nios, servicio social). Desarrolle redes con otros colegas para identificar proveedores con experiencia. Hable con profesionales que proveen otros servicios para nios y familias en su comunidad. Conozca al Director de Servicios Especiales/Educacin Especial en su distrito escolar. Esta persona puede proveer contactos especficos para el equipo de estudio del nio, psiclogos infantiles, Child Find y programas de intervencin temprana, escuelas especiales y otros servicios especiales disponibles en su distrito escolar. Familiarcese con los recursos disponibles a travs de las organizaciones religiosas. Llame a su agencia local de servicios sociales y al departamento de alcance de la polica para una lista de nmeros de telfono de violencia domstica y abuso al igual que informacin de programas disponibles. Pida ayuda en su biblioteca local o vea la gua telefnica en la seccin de gobierno del condado para obtener informacin de agencias de servicios sociales, cuido de nios y recursos educacionales.

Rochelle Mayer, Ed.D. Jeanne Anastasi, M.A. Eileen M. Clark Susan Lorenzo, M.L.S. John Richards, M.A., AITP

En Dnde Buscar Ayuda

Una Herramienta de Referido de Bright Futures para Proveedores

Su Lista de Referidos y Contactos

Su lista de referidos y contactos puede incluir los siguientes:

Educacin/Necesidades Especiales
Director de Servicios Especiales/Educacin Especial en su Distrito Escolar Local __________________________________________
________________________________________________________________________________________________________________________

Intervencin Temprana/Servicios de Child Find ________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Salud y Bienestar
Departamento de Salud Local __________________________________________________________________________________________
________________________________________________________________________________________________________________________

Cuidado de Salud Primario ____________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Cuidado de Salud Oral ________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Servicios Genticos ____________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Hospitales de Nios ____________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Cuidado de Salud a Domicilio __________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Seguro Mdico ________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Centros de Control de Envenenamiento ________________________________________________________________________________

________________________________________________________________________________________________________________________

Redes Profesionales ____________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Una Herramienta de Referido de Bright Futures para Proveedores

En Dnde Buscar Ayuda

Salud Mental y Bienestar

Centro de Salud Mental Comunitario __________________________________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Profesionales de Salud Mental __________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Apoyo Familiar/Clases para Padres y Madres

Grupos de Apoyo Familiar/Organizaciones de Padres y Madres __________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Prevencin de Abuso Infantil y Servicios de Intervencin ______________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Prevencin de Violencia Comunitaria y Servicios de Intervencin ______________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Prevencin de Violencia Domstica y Servicios de Intervencin ________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Servicios de Apoyo en la Comunidad Religiosa __________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Terapia de Parejas y Familias __________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Servicios para el Personal Militar y sus Familias ________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Cuidado de Respiro para los que Cuidan o las Familias de Individuos con Incapacidades u Otras Necesidades Especiales ________________________________________________________
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

En Dnde Buscar Ayuda

Cuido de Nios/Educacin Temprana

Una Herramienta de Referido de Bright Futures para Proveedores

Head Start Anticipado __________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Head Start ____________________________________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Organizaciones de Recursos Locales de Cuido de Nios y Referidos ______________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Ayuda Financiera para Cuido de Nios ________________________________________________________________________________

________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Otro
________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Cite como: Mayer R, Anastasi JM, Clark EM, Lorenzo S, Richards JT. 2006. What to Expect & When to Seek Help: A Bright Futures Referral Tool for Providers. Washington, DC: National Technical Assistance Center for Childrens Mental Health, Georgetown University Center for Child and Human Development, en colaboracin con el National Center for Education in Maternal and Child Health. 2006 por Georgetown University Center for Child and Human Development Con fondos de: Child, Adolescent and Family Branch Center for Mental Health Services Substance Abuse and Mental Health Services Administration

Para aprender ms sobre estas herramientas, descargar una copia, dar su opinin visite www.brightfutures.org/tools

Contents of CD The CD contains three folders that contain the following information: Electronic Copy of the Manuals (Family and Youth) Bright Futures (English and Spanish)