Carlton Manor, Inc.

Family Support Services (FSS)

The Carlton Manor Inc. Family Support Services Program is a multi-faceted community based program. It is designed to maintain emotionally handicapped(E-H), severely emotionally disturbed (SED) and at-risk children in their family and home environment and to reduce the need for more costly long term mental health hospitalization, juvenile justice commitment and long term residential care. The program aims to preserve families who are experiencing severe family problems and to reduce the need for the out of home placement of their children. In cases where a child has already required an out of home placement, the program strives to reduce the length of the out of home placement and work intensively to reunify, strengthen and preserve the family. The Family Support Services Program strives to develop and enhance the strengths, skills and social capacities of all family members by providing an intensive level of therapeutic and support services through 6-12 primary service months and an additional 6-12 months of
After Care services.

FSS Program History

Throughout the past 18 years in Pinellas County, Carlton Manor Inc. has served the high risk population of severely emotionally disturbed children via our Therapeutic Group Home and After Care programs. A high level of family support and family therapeutic services is provided to all of the children and families we serve. Much of the considerable success we have achieved with emotionally disturbed children is directly attributable to the high quality and quantity of family support and family therapeutic services provided in both the Therapeutic Group Home and After Care program components.

Our efforts to strengthen and build these critical family services especially in the past 3 years has resulted in five new full time staff positions devoted to the provision of family support and family therapeutic services. In an effort to prioritize the development and delivery of therapeutic and support services to at-risk families, Carlton Manor Inc. established the Family Support Services Program as a second major agency program, and separated this service component from the Carlton Manor Inc. Therapeutic Group Home Program.

Many recent studies have demonstrated the critical importance of the family and the quality of a child’s relationship with his/her parents as the primary factor affecting academic achievement and positive social development. An overwhelming majority of the children in these studies have reported that their relationships with their parents and significant others such as grandparents, relatives, teachers and coaches are primary sources of motivation to continue their positive development in the areas of academic, vocational and social skill development and to resist the lure of negative peer influences, substance and alcohol abuse, at-risk sexual behavior and delinquent behavior.

Carlton Manor Inc. firmly believes that working with families and reinforcing the development of their strengths, assets and the natural supports and community resources available to them is the most effective approach towards helping families to build and increase their personal and family relationships, abilities, self esteem and self sufficiency.

A family which has been enabled by social service providers will often become service dependant and lose all hope in their own ability to solve their problems, have little confidence in themselves, be unaware of their strengths and ultimately unable to achieve their true potential. An empowered family can and will face the problems and challenges it’s members face in life and will call upon it’s strengths and resources to identify and implement solutions. It is to this end that Carlton Manor Family Support Services commits it’s human resources.

FSS Program Objectives

The following is a short list of the primary objectives of the Family Support Services Program:

1. Preserve and strengthen families and reduce the indicated need for long term residential placement of their children
2. Support and facilitate positive family development so that families become more nurturing and skilled at fostering the positive development of all children living in the home.
3. Support and facilitate the development of the families’ natural support systems which provide for the ongoing support of all family members.
4. Support and facilitate the development and strengthening of positive parent-child and sibling relationships.
5. Develop and provide youth development activities designed to address and meet the needs of emotionally handicapped and at-risk children especially in the areas of building positive character attributes, enhancing self esteem and self confidence and developing alternative social skills and behaviors.
6. Develop and enhance family empowerment and self sufficiency by identifying, reinforcing and building upon the strengths and assets of all family members.
7. Assist families to utilize their enhanced strengths and assets to identify and implement solutions with which to resolve the problems faced by the family.
8. Develop and implement the necessary educational and intervention strategies which will result in the prevention or marked decrease in child and adolescent aggressive/violent behavior, alcohol and substance abuse and at-risk sexual behavior.

Program Services

The primary program services provided by Carlton Manor’s Family Support Services are: children’s mental health case management, individual and family assessment, brief individual and family therapy, group therapy and parent training, sexual abuse service, mentoring services, psychiatric consultation, family support system development, social enrichment programming and educational programming.

Program Staff

Presently the Program staff consists of a Program Coordinator, 2 Case Managers and 2 In-Home Family Therapists. Each Case Manager and In-Home Family Therapist serve from 12-15 children and their families.

The program also enlists the services of a full-time Sexual Abuse Therapist and volunteer and part-time professional Mentors on a case by case basis. A contracted Child Psychiatrist assesses children on a scheduled basis and provides ongoing consultation and pharmacotherapy services as needed.

Family Support Service staff seek to develop a team approach with families and partner with all family members in developing their individual and family based goals and objectives. Specific needs for clinical services are identified and service schedules are typically developed and implemented on a quarterly basis. Family therapy and Case Management objectives are clearly stated and in addition to the focus on primary treatment issues also include assisting families towards identifying and reinforcing strengths and accessing and developing their natural family support systems.

Service Availability

The Family Support Services Program office is operated at 45 Westwood Terrace North, St. Petersburg, Fl. 33710. The telephone # is (813) 343-3662. The program provides its services seven days per week between the hours of 9am.-8pm.

Carlton Manor provides Family Support Services to families living in Pinellas and Pasco counties with children aged 8-14 at intake, who are identified as E-H, SED or at high risk of aggressive/violent/self injurious behavior, drug and alcohol abuse and at-risk sexual activity.

Referrals are authorized by the State Of Florida, Department Of Children and Families, District Five Alcohol, Drug and Mental Health Program Office, and/or the District Five Family Services Planning Team.

Public Transportation

The program is easily accessible to public transportation. The Central Ave. and Pasadena Blvd. bus stop is approximately fifty yards from the FSS main office. However, an overwhelming majority of the services are provided on-site in the home, school and in the community.

Program Accessibility

The program is specifically designed for children and adolescents aged 8-14 and their families. Carlton Manor will attempt to offer services and meet the needs of any person with special needs or impairments. The program has primarily developed it’s specific capabilities to serve E-H, SED and at-risk children and their families.

Eligibility and Target Populations

Targeted populations are emotionally handicapped, severely emotionally disturbed and at-risk children, ages 8-14 and their families. Family income level is typically below $20,000 per year annually. The program will provide services regardless of race, creed, gender, marital status, individual or family income level or age of the parents and other family members. The programs admission criteria focuses on the child and families willingness to become active partners in developing their goals, objectives and outcome expectations.

Intake Procedures

1. Referrals are accepted from the District 5 Clinical Staffing Team and the Family Service Planning Team under the supervision of the State Of Florida, Department Of Children and Families, District 5 Alcohol, Drug and Mental Health Program Office(ADM).
2. All other inquiries or referrals are directed to ADM for authorized processing
3. When a referral has been made by the CST or FSPT the referral packet is reviewed in depth by the Carlton Manor Family Support Services Program Coordinator and the FSS team.
4. The referral packet must include:
   1. Psychological assessment current within 6 month from the date of referral.
   2. Psychiatric assessment current with 6 months from the date of referral.
   3. Social History current within 6 months from the date of referral.
   4. A determination or recommendation from a qualified Psychiatrist or Psychologist that the child and family are in need of the services provided by the program.
   5. Orders of the Court as it involves delinquent offenses and behaviors.
   6. Orders of the Court as it involves dependant custody of referred child.
   7. A list of all previous treatment interventions and documentation from previous treatment providers.
   8. Medical History current within 6 months from the date of referral.
   9. Educational History current within 6 months from the date of referral.
   10. Full names and addresses and telephone numbers of referring agency, parents, agency workers and significant others involved in referred child's life.

Once the referral packet is reviewed and ascertained to contain all necessary documents, it is accepted and the case is reviewed by the Carlton Manor Family Support Services Program Coordinator and the FSS team to determine eligibility for potential program enrollment based on program enrollment criteria. If the packet does not contain all necessary documents, Carlton Manor will notify ADM or other referring entities and state the need for specific information. The eligibility review will begin once all required information is received.

Entry Criteria

1. Child must be 8 - 14 years of age. Children may be enrolled at 7 years of age if their 7th birthday falls within 6 months of the date of admission.
2. Child must possess a full scale I.Q. of at least 70 based on WISC-R test data current within the past 6 months.
3. Psychiatric and Psychological assessments and DSM III diagnosis must identify emotional and mental health disorders that are typically considered amenable to community based treatment and services.
4. Children with serious mental illness (i.e. Psychosis, Schizophrenia, Manic Depression, Personality Disorder etc.) are not considered amenable to community based treatment provided by the FSS program.
5. Children with organic brain disorders, mental retardation, autism and any other severe organic disorders are not considered amenable to community based treatment provided by the FSS program.
6. Child's behavior patterns must be free of excessive violence and assaultive behaviors which consistently present physical danger to others and indicate the need for a secure placement.
7. Child's behavior patterns must be free of excessive self abuse, self mutilation and/or suicide attempts which consistently demonstrate physical danger to self and the need for a secure placement.
8. Child's behavior patterns must be free of excessive delinquencies and runaways which consistently demonstrate physical danger to self, others and an inability to be treated in a community based program.
9. Child must demonstrate the ability and willingness to accept services and to cooperate with treatment.
10. Child must be able to attend and cooperate with the public school system.
11. Parents or Custodian must demonstrate a strong commitment to both the child's and families growth and development.
12. Parents must be willing to become active partners in the development of individual and family goals, fully participate in family therapy and other service activities provided and/or recommended by the program; provide transportation of their child to and from the all appointments scheduled outside of the home and be responsive to staff requests for their presence, assistance and follow through on recommendations.
13. Custodial agencies must be willing to provide transportation in emergencies; work with program staff to identify and procure other necessary services and be responsive to the programs requests for their presence and assistance when deemed necessary.
14. The child must be physically able to safely participate in a majority of the program and recreational activities provided.

PROGRAM SERVICES:

Intake Assessment

Children and families are referred by the District 5 Clinical Staffing Team and the Family Service Planning Team under the supervision of the District 5 Alcohol Drug and Mental Health Program Office(ADM).The referral packet usually contains all significant background psychological, family history, educational, medical, legal and psychiatric information. The first step in the program Intake Assessment is the review of this packet. Additional information is requested if necessary. A preliminary eligibility determination is made by the Carlton Manor Family Support Services Program Coordinator and the FSS team. The referring entities and the child's parent are notified of the determination within one week of receiving the referral packet.

Following the determination the program sets initial appointments to visit the home, meet the child, parents and other children living in the home and in addition to explaining program philosophy and methodology begins to assess the child and family. The child and family are scheduled to visit the program office and participate in ongoing intake assessment processes. The visit is composed of individual interviews with both the child and the parents, a family interview, introductions to all staff and an exit staffing to determine the child and families willingness to continue in the enrollment process and to further clarify program goals, objectives and services.

Individual and family strengths, assets and presenting problems are discussed during the interview process. The child and family are requested to share their short and long term goals for themselves and for one another. Individual and family assessments are ongoing through out the interview and the child and family leave the program with additional assessment questionnaires to complete.

The FSS Treatment Team evaluates the visit, shares assessment notes and formalizes the acceptance decision. The percentage of referred children and families, accepted into the program has historically been over 95%. The family is notified of the decision and returns to the program for the intake and enrollment conference. The intake conference is designed to develop the outcome objectives and initial short term goals for both child and family. Based on the current population being served and projected service openings, the family is placed on the approved waiting list and assigned a projected start date.

In addition, psychiatric , psychological, educational, vocational and medical consultation is sought from previously and presently involved professionals. The Intake Assessment is completed and documented within 14 days of case start-up disclosing all relevant findings.

The assessment information is utilized by the Treatment Team in the development of Treatment Plans, Case Management Service Plans, long term outcome objectives, short term goals, the strategies necessary to accomplish these goals and objectives and weekly service schedules.

Child and family assessment is an ongoing process throughout the course of the program. The assigned Case Manager focuses the family towards an evaluation of the services and their satisfaction with the program, progress made on goals and objectives and the identification of additional strategies and solutions to foster the continued growth of the child and family each week. The family returns to the program office to engage in a quarterly evaluation of services provided and monthly staffing’s to identify progress made on goals and objectives.

Treatment Planning and Goal Setting

Under the direction of the Program Coordinator the Treatment Plan and Goal Setting process are conducted in order to develop realistic and comprehensive plans for the child, the parents or guardians and the entire family unit.

All involved persons are consulted and are encouraged to provide input into these plans. Those typically involved include the child, the parents or guardians, siblings and other family members, the consulting Psychiatrist and the Carlton Manor Family Support Services Team.

Upon completion of this process the Treatment and Service Plans are documented and reviewed with each contributing member. All contributing members signify their agreement by signing the plans and receive a copy for their personal use.

These plans then become the driving force of the therapeutic process and services. Parents and children review their positive efforts on their goals each day in family meetings and with FSS service staff in scheduled face to face sessions.

Case Management

Case Management services are provided to all children and families enrolled in the Family Support Services program. The Case Manager develops service plans, monitors and evaluates the ongoing efforts of children and families and coordinates facilitates and links the child and family with clinical, educational, vocational, financial and support services as needed. The Case Manager becomes a trustworthy ally to the family and works closely with the family to help them build their natural support system. The Case Manager helps the family advocate for all members of the family and provides consistent feedback, reinforcement and affirmation to children and parents.

Family Therapy

Family therapy is an integral program service. The Family Therapist develops a strong partnership with the family and consistently strives to help family members to develop a solution focused approach to dealing with current problems. The Family Therapist seeks to unite the family in their drive to build their strengths, assets, communication skills, inter-family relationships, family systems and the skills needed to identify and implement solutions to the primary problems they face.

Individual Therapy

The program provides individual therapy to children in the family who demonstrate an outstanding need for this service. Children in treatment are assisted in learning to verbally express their feelings, recover from trauma stemming from abuse, neglect, maltreatment or abandonment, develop enhanced self esteem and confidence, develop and utilize problem solving skills and develop solution focused responses to problems. The program counseling staff adhere to universally prescribed counseling principles and strive to develop a positive and trusting relationship with each child. Carlton Manor staff strongly believe in demonstrating a genuine caring attitude with children and families and regularly utilizing empathy, self disclosure, strong positive reinforcement, affirmation and motivational techniques to facilitate each child’s commitment to personal growth.

Sexual Abuse Therapy

Due to the high number of children we serve who have been sexually abused, the agency employs a full-time, licensed, Sexual Abuse Therapist. Children and families enrolled in the Family Support Service program who are in need of this highly specialized and critical service are provided weekly individual and family sexual abuse therapy until their recovery is complete.

Group Therapy

As scheduled by the Family Support Services Team, groups of children and parents routinely participate in group therapy. These services may occur in the public school setting, on community based outings or on the grounds owned and operated by the agency. A wide variety of recreational, therapeutic, informational, educational and vocational topics and processes are utilized to maximize participation, learning and positive development. Outside professionals are regularly scheduled to provide educational and vocational presentations to our children’s groups. Parent groups convene on a monthly basis. A variety of therapeutic and educational programs are presented by the staff and outside professionals. Parent group programs are based on individual and group needs. The focus of these groups is usually in the areas of parent skill training, the building of natural support systems and promotion of a wide range of community based educational, vocational, therapeutic, social and financial resources available to parents.

Social Enrichment Programming

The program seeks to advance each child’s social and character development by involving children in a variety of community activities and projects. Case Managers consistently seek to encourage parents to link children with available recreational, educational and character building community organizations such as the YWCA, YMCA, Boy and Girls clubs, Boy and Girl Scouts, The Little League and other recreational sports, school sponsored extra curricular activities and agency sponsored community service projects. When children are out of school, program staff often plan group outings and attend special community activities and athletic sporting events. Many of our children have been deprived of such opportunities in the past and they derive an enhanced appreciation of and interest in a variety of the activities they are exposed to through our social enrichment programming.

Educational Programming

The FSS staff work closely with the public school system in an effort to maintain client enrollment and attendance in the public school setting. Prior to entering the program, many of our children could not be controlled in a regular or specialized educational setting and had been placed in half day or home based academic programs. The program ensures each child’s appropriate academic placement in either a mainstream, EH or SED public school program. FSS staff respond to in school client crisis whenever necessary. Coordination with the school system is undertaken to insure effective communications between the school system and the family and to help the family effectively advocate for their children.

Mentoring Services

Many of our children are raised in single parent families or by a single Grand-Parent. In many of these cases the FSS Team recommends the need for MENTORING services. FSS recruits volunteer Mentors and contracts with part-time professional Mentors to help provide role modeling, direction and linking with extracurricular activities when single parents are experiencing significant difficulty meeting the needs of their children.

AfterCare

After Care services are provided for 6 to 12 months following the completion of primary services and are characterized by a significant reduction of services as agreed upon by FSS staff and the family. Case Management, family therapy, individual therapy, sexual abuse therapy and mentoring services are gradually scaled down in proportion to the developing self sufficiency of the family.

Follow-Up

Case follow-up begins once all clinical services are phased out and is characterized by the monthly evaluation of the family by the Case Manager for a period of six months.

Outcome Evaluation

Expected program outcomes are evaluated and reported on a semi-annual basis. Three standardized state-wide outcome assessment tools are utilize to provide periodic and objective outcome data. The CAFAS (Child and Adolescent Functional Assessment)is administered at intake, six months,
twelve months and at discharge following the completion of after care. It measures the individual functional growth of each E-H or SED child.

The CMHOSS (Children’s Mental Health Outcome Scoring Sheet) is administered at intake, six months, twelve months and at discharge following the completion of after care. The CMHOSS measures children’s monthly attendance in school, number of days each month maintained in the home and the community and the number of days spent in a secure setting such as JDC, crisis unit or mental health hospital.

The Family Satisfaction Survey is administered at six months, twelve months and upon discharge from after care. Each family rates the agency through 15 service provision areas. It measures the families satisfaction with the providing agency.

In addition the FSS Program shall undertake other outcome objectives that may be recommended or required by the Juvenile Welfare Board.

Typical Client Process

The FSS Program begins each case with a high intensity of service duration and frequency. Services are decreased in proportion to the growth and self sufficiency of the family. The typical FSS service model is illustrated below.