6.7 Ensuring the Child's Well-being

All casework planning must involve consideration of the domains that contribute to the child's well-being: physical needs, family/attachment, safety, socialization, cultural and spiritual, emotional/psychological, health, education and vocational, and legal. The caseworker must advocate for and manage services to ensure the child's needs are met in each of these domains. In addition, the caseworker must manage the relationships with the school, the child, the foster parents and the parents, keeping all team members fully informed and involved.

Casework with children in care may be the most demanding and rewarding responsibility any caseworker can have. Most children who are placed are angry, frightened and confused, regardless of their age or the reason for placement. No matter how the child handles these feelings - whether through rage, withdrawal or something in between, recognizing and directly addressing these feelings with the child is an essential part of casework throughout the life of the case.

The caseworker has three major responsibilities to a child in care: (1) to make sure the child is safe, (2) to assure the child's well-being and (3) to achieve permanency for the child at the earliest possible time. Caseworkers meet well-being responsibilities by ensuring the child's individual educational, health, psychological and emotional needs are met. Meeting the child's individual needs requires that the caseworker know and understand each child for whom he or she is responsible. Frequent, predictable contacts not only provide the caseworker with critical information, they provide the child with assurance that s/he has not been forgotten; that s/he has an advocate in "the system" and that s/he is important.

Important casework tasks with children include placement selection, visitation, supervision and activities related to maintaining the child's well-being, accomplished through visits, advocacy and case management. Perhaps the most important casework activity is to engage the child, involve the child in planning when appropriate and help him/her develop trusting relationships.

6.7.1 Caseworker Visits with the Child

Caseworkers must visit with children at least twice per month, one of which must be in the caregiver's home for the first 30 days of care, thereafter visits must occur monthly. Visits may be more frequent when circumstances warrant; for example, the child has developmental or emotional needs that require frequent monitoring, the child has recently been placed in the home or the case has recently been opened. Frequent visits with the child are essential to establish trust and rapport with the child, to enhance the child's sense of emotional security and to ensure the child's safety, permanency and well-being. Visits enable the caseworker to assess the safety, security and progress of the child in the caregiver's home. They allow for observation of the caregiver-child interaction that is vital to assessing the appropriateness of the placement. Visits also demonstrate support for the caregiver and prevent unnecessary placement disruptions.

Visits with the child and attending to his or her needs forms the basis for a professional relationship that can sustain a child through his or her stay in the child welfare system.

During visits with the child, the worker must:

· assess the nature and quality of the child's relationship to the caregivers and others in the caregivers' home by talking with the child, caregiver; and others; and by observing the child's interactions in the home

· help the child address separation and loss issues by talking with the child in a sensitive manner about these issues; helping him/her identify his/her feelings; allowing him/her to vent their feelings and being aware of how these feelings may be acted out in the home

· help the child understand the reasons for continued placement by appropriately talking about how the birth parents are doing and keeping the child informed about birth parents' progress

· talk with the child about his/her sibling(s) in order to better facilitate sibling communication and interaction

· continuously assess the status of the child by observation and interaction with the child and caregiver

· talk with the child and/or caregiver or make necessary referrals to help the child with any problems which may arise.

Questions for the Caseworker to Consider:

Observe the house for any obvious hazards. Is there adequate supervision? Is the facility safe? Is the child engaging in and benefiting from appropriate activities such as independent living?

Workers can use the following guide when they visit the children/youth on their caseloads. Although not all the topics will be relevant to every child, the guide presents important discussion items that workers need to keep in mind during visits.

A. Family History ( to be provided with respect to confidentiality and as

age appropriate)

1. Reason for family's involvement with DCFS

2. Youth's role in their birth family

a) Discussion of the birth order (oldest, youngest) and the youth's role

b) Relationship with their birth parents

c) Relationship with siblings

Significant relationships with other adults

3. Provide children with updates about their parent(s)/case progress

4. Discuss as appropriate, how their siblings are doing if they are placed elsewhere

B. Adjustment in the Foster Home

1. Review of the youth's placement history and special needs; successful adjustments and identified concerns and areas requiring assistance and supervision.

2. Youth's understanding of their need for foster placement.

3. Discussion of youth's interest, likes and dislikes.

4. Identify some things that help to make them feel comfortable, such as stories at bedtime, favorite toys, pictures, belongings, favorite foods, meals, etc?

5. Do they understand the rules in the home?

6. Are they experiencing any difficulties in the home?

7. Youth's relationship with foster parents and other family members including names or titles to be called.

8. Who can they call if they have problems and cannot reach the worker?

C. School

1. Discuss youth's attendance in school

2. Discuss youth's progress in school.

3. What are their favorite subjects?

4. What subjects do they struggle in?

5. Who helps them with their homework or do they need help with their homework?

6. How do they get along with their teachers and peers?

7. Are there safety issues at school?

D. Visitation (as age appropriate and as it relates to the comprehensive family service plan)

1. Frequency, time, length and identified location.

2. Transportation arrangement.

3. Type of visitation; supervised or unsupervised

4. What does the youth like or dislike about their visits?

5. How are visits going with their siblings?

6. What do they like or dislike about their sibling visits?

7. If needed, discuss concerns regarding the lack of visitation and any problems or changes that need to occur.

E. Court Issues

1. Date of the next court hearing.

2. Purpose of the hearing.

3. Discuss the role of the GAL and how to contact their lawyer.

4. What is the youth's role in court and how should they participate?

5. Recommendations proposed for the next court hearing by DCFS.

6. Anticipated outcome vs. judges decision.

F. ACR Participation

1. Explanation of ACR process, discussion of permanency goal, and the importance of the youth's involvement/attendance.

2. Detailed discussion of what they youth needs to do to support their identified goal, such as return home, or independence.

3. Review the youth's current plan and development of a new plan.

G. Activities and Services

1. Discussion of current or past activities and opportunities to continue.

2. Youth's participation in therapeutic services; counseling, therapy, medical assessments, and dental appointments.

H. Cultural/Religious Issues

1.Explore youth's cultural needs; language, skin and hair care; dietary needs.

Discuss the youth's religious preference and expectations/wish to attend and or participate in church or temple activities.

6.7.2 Physical Needs

The worker needs to be attentive to the child's physical needs in the caregiver's home. The worker should explore whether the child has adequate space, clothing, storage as well as equipment such as a crib, high chair, playpen and other essential items. Relative homes may need additional funds to purchase infant care equipment, beds, dressers, and other items. Prior to reunification the worker should assist the birth parents to plan for the child's homecoming by ensuring that there is adequate space, clothing ,toys, food and other necessities for the child and, if necessary, acess Norman funds to secure adequate housing and furnishings.

Tasks related to physical needs that a caseworker must complete:

· Ensure the child's room is comfortable and adequate

· Ensure that the child has space to call their own and has adequate storage space

· Ensure that the child has adequate clothing and appropriate toys, books and other recreational items

· Ask the caregiver whether he/she has all the equipment and furnishings they need to care for the child. If not, explore funding to assist the caregiver in obtaining necessary items.

· Explore with the birth parents whether they have the necessary housing, furnishings, toys, clothing and other necessary items prior to reunification

6.7.3 Family/Attachment

The importance of the child's connectedness to his/her family cannot be emphasized enough. It is imperative that the caseworker continually assess whether the child has sufficient contact with his/her family to nurture and strengthen his/her connectedness to the birth family. Parent-child and sibling visitation must occur frequently to maintain family relationships. The worker should explore with the caregiver opportunities to include the parents in recreational and parenting activities with the child such as family celebrations, athletic events, school events, doctor's appointments, etc.

Tasks related to family/attachment that the worker must complete:

· Ensure sufficient visitation (parents, siblings, extended family members) to maintain family connectedness.

· Explore opportunities to include the birth parents in the child's activities.

· Encourage the caregiver to remind the child of family birthdays, Mother's Day, Father's Day, and other family related events.

· Encourage the caregiver to assist the child in keeping their Lifebook current

· Seek input from the child and frequently discuss the child's perception of the situation of the parents.

· Assist the child in understanding and establishing appropriate age and role behaviors within their family.

· Help the caregiver understand the child's need fo4 connectedness with their family despite the child's experience of maltreatment.

6.7.4 Safety

Because children who are abused, neglected or dependent are at a higher risk of developmental delays as well as psychological and emotional problems, it is necessary for caseworkers to frequently assess the child's safety. If there are any emotional or behavioral concerns that are identified through ongoing involvement and assessment of the child, safety and crisis planning must be considered. Concerns may show themselves through runaway behavior, suicidal ideation, aggression and threats of aggression, fighting, school problems, withdrawal, etc. Crisis and safety planning must be proactive. At the first suggestion of placement disruption proactive planning must begin, using supports such as the System of Care (SOC) .

Safety related tasks the caseworker must complete:

· Know and monitor behaviors and patterns of behaviors in the home, school and other settings through regular contact with the foster parents, school personnel and other supports.

· Make referrals for supports such as placement stabilization whenever there are hints of disruption of the placement.

· Make Screening Assessment and Support Services (SASS) referrals whenever there are indications that the child might be a danger to self or others, i.e. suicidal or homicidal behaviors

· Consult with supervisor and DCFS clinical staff for additional guidance.

· If a child requires psychiatric hospitalization, the worker must follow the psychiatric hospitalization protocol as enumerated in Policy Guide 96.5, Statewide Psychiatric Hospitalizations and Discharge Planning (following Procedures 327).

Questions for the Caseworker to Consider

Are there behaviors exhibited by the child that indicate a need for additional supports for the child and/or foster family? What are the behaviors and risks that are present? What are the supports necessary to minimize the risks? Should SASS be involved? What will it take to maintain this child in this placement while assuring his/her safety?

6.7.5 Socialization

Too often children who come into care become stigmatized in the community or are not given the opportunity for social and recreational activities that other children receive. Children need opportunities to participate in regular activities with other children in their community. What the child likes to do, with whom, where, etc. is information the caseworker needs to obtain from the child and caregiver. Whenever possible, the child's sibling(s) and friends should be included in the child's activities. Social and recreational activities help children learn team work, and how to appropriately interact with other children. They provide a means to develop gross motor skills, physical strength and athletic competency. Finally, physical activity enhances self-esteem and is often helpful in treating depression and other conditions.

Socialization -related tasks:

· Explore the child's interests and strengths by asking and observing the child; discuss current or past involvement in activites and opportunities to continue

· Provide the child opportunities to participate in extracurricular activities such as scouting, music and dance lessons, team sports, etc.

· Work with the Child and Family Team and community resources to arrange enrollment, transportation, etc. for the child's activities.

· Observe youth's relationships with peers

Questions for the Caseworker to Consider:

What interests does the child have for extracurricular activities? Inquire about the safety of the activity. Is the activity adequately supervised? Is the coach or facilitator adequately trained and emotionally healthy? What are the available activities in the community? What arrangements need to be made for transportation to and from the activities?

6.7.6 Cultural and Spiritual

The cultural and spiritual needs and interests of the child must be addressed. The caseworker and caregiver must make efforts to provide the child with opportunities to participate in cultural activities that will facilitate the child's positive identity with his/her culture. In addition, the child must be afforded opportunities to attend a church in his/her preferred religious denomination or affiliation and attend church activities.

Cultural and Spiritual tasks a caseworker must explore:

· Explore the substitute caregiver's comfort level or understanding of the youth's cultural needs; i.e., language, skin and hair care, dietary needs

· Discuss the youth's religious preference and caregiver's expectations about church/ temple/mosque attendance.

Questions for the Caseworker to Consider

What are the child's religious preferences? What are the parent's? How will these preferences be accommodated while the child is in care? What are the child's cultural needs and how will they be met?

6.7.7 Emotional/Psychological

Children who are abused, neglected or dependent are at greater risk of developing psychological/emotional problems. Early intervention and attention to a child's emotional well-being is critical to the child's development and the achievement of permanency.

Emotional/Psychological tasks a caseworker must complete:

· Talk with the caregiver about the child's psychological/emotional status; explore how the child expresses his/her feelings, how the child manages stress.

· Ensure that screenings through the Integrative Assessment system are conducted. If further assessments are recommended, ensure that referrals have been made and follow-up on any necessary treatment.

· Identify psychological/emotional risk (e.g. dramatic or sudden mood shifts, reported sleep or eating disorders or changes, difficulty with relationships, child's talking about suicide, etc.) through frequent visits with the child and an understanding of the child's and family's mental health history.

· Outside the presence of the caregiver, obtain information such as (but not limited to) how the child is feeling about the placement, about visits with parents and siblings, other children in the home, how the child is functioning at home and schooland how the child manages stress.

· Consult with supervisor as to whether the child should be referred for a psychological or psychiatric evaluation or therapy (if not already done through the Integrative Assessment system).

· If the child has had a specialty assessment, read the assessment and incorporate the recommendations into the comprehensive familyservice plan.

· If the child is taking psychotropic medication, ensure that the medication is being administered correctly and that the caregiver (and child, as appropriate) understands the side effects.

· Consult the child welfare nurse specialist if there are any questions with regard to psychotropic medication, alternative treatments or therapies, etc.

· Consult the supervisor or DCFS clinical staff if there are any questions with regard to diagnosis, unusual behavior, sexually inappropriate behavior, etc.

· Monitor the effectiveness of treatment by discussing child's progress and treatment with the therapist and obtaining regular written updates.

· Discuss the caregiver's role in supporting/maintaining the child's mental health.

Questions for the Caseworker to Consider:

Is the child on medication? What is it? What is the dosage schedule? Has the child been taking the medication as prescribed? Does the caregiver understand how the medication is to be administered and what the side effects are? Does the caregiver or child report any side effects from the medication? Does the child have difficulty taking the medication? Does the child see a therapist? Has the therapist submitted a report? Are there any attachment or separation issues? Is the child homesick? How are the child's reactions to visits (if any) being addressed? What connections are there between the parent and child? How does the child deal with new relationships? Is there any unusual behavior (aggression, sexual acting out, etc)? How does the child get along with others in the home? Any indicators of substance abuse?

6.7.7a Developmental

Human growth and development is based on mastery of stages. In normal human development, mastery of one stage is required before the individual can go on to the next. Because of abuse, neglect, biological and social circumstances, many children in care are behind developmentally. The earlier developmental delays are addressed, the more likely the child will become a self-sufficient, successful adult. See Appendix A for Developmental Chart. Caseworkers shall also review Appendix B, Seven Deadly Sins of Childhood: Advising Parents About Difficult Developmental Phases by Barton D. Schmitt, M.D.

Development-related tasks a caseworker must complete:

· Ensure that a screening has been conducted through the Integrative Assessment system. If a further assessment is recommended, make necessary referrals and follow-up on necessary services.

· Observe the child's developmental progress during all home visits and assess whether child is meeting developmental milestones

· Make timely referrals to DCFS nurse (or if not immediately available, refer to the child's primary physician) for any child who is at significant risk of developmental concerns, such as substance-exposed infants and children, infants with low birth weight, etc. Referral may include a 0-3 assessment and early childhood assessments through the local school district (3 years and older). Consultation with a DCFS nurse can provide information regarding management of developmental concerns.

· Follow the Services for DCFS Substance Affected Families protocol, Section XIV, "Cases Involving Substance-Exposed Infants" (Procedures 302, Subpart B)

· Refer to the supervisor, clinical staff and/or the child welfare nurse specialist any time developmental concerns surface.

· Make referrals to Division of Specialized Services to Children, Office of Rehabilitative Services, independent service coordination agencies, etc. to make a determination of eligibility for specialized resources and funding. Explore other special interest agencies (e.g. Easter Seals, United Cerebral Palsy, etc.) for resources and supports for the child and family. Explore (with eligibility staff and supervisor) Supplemental Security Income.

· When a child appears likely to be in need of adult guardianship under the Guardianship and Advocacy Commission, begin planning and make referrals to an independent service coordination agency when the child is 17-1/2 years old.

All children move along a developmental continuum throughout their stay in care. Workers must continually assess the child's progress along this continuum by observation of the child and by communication with caregivers and other professionals involved with the child. Caseworkers must ensure that activities and services are in place which support continued growth and development. This is true for the newborn as well as the adolescent preparing for independence.

Questions for a Caseworker to Consider:

Is the child achieving developmental milestones within normal limits? Is there anything unusual in the child's behavior that may suggest a developmental issue? What is being done about any observable delays?

7.6.7b Substance Abuse

Substance abuse is known to be an inter-generational problem. Children whose families have a history of substance abuse are at high risk for developing an addiction. The care giver and worker must be attentive to behaviors that may indicate substance abuse on the part ogf the child/youth. Some of these behaviors include school problems, inability to stay on task, jittery, constantly needs direction or re-direction, personality changes, change of friends and drug paraphernalia. Early assessment and intervention is imperative if a substance abuse problem becomes apparent.

Substance abuse related tasks a caseworker must complete:

· Immediately refer the child/youth for a substance abuse assessment

· Follow the recommendations of the assessment which may include inpatient treatment, outpatient counseling or other services

· Include the recommendations on the child's comprehensive family service plan

· Ensure that the caregiver is given adequate support to maintain the child/youth in the home

· Determine whether the child/youth is using substances to self-medicate because of another underlying condition such as depression or sex abuse

6.7.7c Mental Health

Children who are abused, neglected or dependent are at greater risk of developing behavioral problems. Often these children grow-up in homes without structure or discipline. Or are subjected to high amounts of stress at a young age. Early intervention and attention to a child's behavior is critical to the child'sent and the achievement of permanency.

Mental health related tasks which a caseworker must complete:

· Talk with the caregiver about the child's behavior; discuss child's adjustment to the placement and the youth's understanding of their need for placement.

· Identify problematic behaviors (e.g., attention deficit, hyperactivity, aggressiveness, withdrawn, lack of attachment or willingness to go with strangers) through frequent visits with the child and an understanding of the child's and family's mental health history.

· Outside the prescence of the caregiver, obtain information such as (but not limited to) how the child is feeling about the placement, about the visits with parents and sblings, other children in the home, how the child is functioning at home and school.

· Consult with supervisor as to whether the child should be referred for a psychological or psychiatric evaluation or therapy (if not already done through the Integrative Assessment system).

· If the child has had a specialty assessment, read the assessment and incorporate the recommendations into the comprehensive family service plan..

· If the child is taking psychotropic medication, ensure that the medication is being administered correctly and that the caregiver (and child, if appropriate) understands the side effects.

· Consult the child welfare nurse specialist if there are any questions with regard to psychotropic medication, alternative treatments or therapies, etc.

· Consult the supervisor or DCFS clinical staff if there are any questions with regard to diagnosis, unusal behavior, sexually inappropriate behavior, etc.

Monitor the effectiveness of treatment by discussing child's progress and treatment with the therapist and obtain regular written updates.

6.7.8 Health

A child's physical health impacts their emotional health, their development and all other areas of their life. The caseworker should be aware of any health concerns the child may have and inquire into the child's health at every visit. If a child is at risk for any health problems - for example, a child who just returned from being a runaway status - a physical exam should be scheduled. The worker is responsible for ensuring the child's health needs are met.

Health-related tasks a caseworker must complete:

· Ensure that the child has a medical card and that it has been given to the caregiver as well as the Health Passport; ensure that the caregiver is familiar with Healthworks and how to use the medical card.

· Talk with the caregiver about the child's health or any medical problems and give the caregiver the Health Passport.

· Ensure that the child receives an initial physical within 24 hours of the child's entry into care

· Obtain a comprehensive medical examination within 21 days of the placement; ensure child has a primary Healthworks physician and sees the physician at age appropriate times. Discuss any chronic or acute medical needs with the caregiver.

· If the child is on medication, ensure that the medication is being administered as prescribed and that side effects are clearly understood by the caregiver

· Ensure that an annual physical and dental is completed and all recommended follow-up care is completed in a timely manner.

· Ensure that immunizations are current and documented.

· Ensure annual hearing and vision screenings take place.

· Provide age-appropriate health education including information regarding sexually transmitted diseases (STD), family planning or the child's special health care needs.

· Access the child welfare nurse specialist for any necessary consultation (example: medically complex children, questions regarding medication, diagnosis and treatment, alternative therapies).

· Consult with DCFS clinical staff regarding any medical or health-related concerns

· Follow the Services for DCFS Substance Affected Families protocol, Section XIV, "Cases Involving Substance-Exposed Infants" (Procedures 302, Subpart B)

Questions for the Caseworker to Consider:

Has the annual physical and dental been done? Has follow-up been completed on any recommendations made? Have hearing and vision screenings been done? Has the Substance Affected Families protocol been observed? Is the child involved in any alternative medical procedures or therapies? If the child is taking medication, are there any symptoms that suggest side effects? Have immunizations been updated and the Health Passport filled out?

6.7.9 Education and Vocational

Education is one of most important areas of service to every child. Studies show that children who have been abused, neglected or are dependent are at higher risk of academic failure (including both pre-school and school-age children). Academic success is linked to adult success and self-sufficiency and therefore is an essential life domain for consideration regarding the child's well-being and permanency. The caregiver is the designated educational advocate for purposes of special education. The caregiver and caseworker need to work cooperatively toward ensuring the child's educational success. Because the caregiver may have more contact with the school, he/she should be consulted about the child's educational program and progress. Both need to talk frequently to teachers when the child has difficulties in school; joint problem solving and planning should be the rule rather than the exception. Education is a major service that impacts on a child's life. Success or failure in school carries lifetime consequences. Thus, ensuring that the child's educational needs are met must be given high priority.

Education-related tasks a caseworker must complete:

· Reference and follow Rule 314

· Ensure the child is in pre-school or an early intervention program if needed; assist caregiver in enrolling child in school

· Complete the education screen and update it every six months

· Conduct a 0-5 developmental screen

· If the child is in special education, discuss with caregiver his/her role as educational advocate for the child

· Ensure the child has appropriate educational testing

· Attend all educational staffings

· Review the child's grades and report card quarterly. Meet with teachers twice a year (or more frequently if needed). Discuss with teacher and caregiver child's relationships with peers and teachers

· Ensure the child is enrolled in and participating in the appropriate educational placement

· Advocate for and manage the child's educational services

· Facilitate thorough discussions with the Child and Family Team regarding the child's education and ensure that the team includes the child's educators.

· If education issues arise, consult with the regional educational liaisons.

Questions for the Caseworker to Consider:

Is the child enrolled in school or pre-school? Have there been teacher's conferences? Is the child at grade level? Does s/he have friends at school? What is the quality of those friendships? What is his/her view of school? Is this a new school for the child? How well is the child adjusting to the school? Does the child have homework? How much? Who helps? Does the child need tutoring or other supportive services? Is the child progressing academically? Is the child involved in school-sponsored extracurricular activities? Is testing needed?

6.7.10 Legal

The worker needs to determine whether the child/youth has a history of involvement with the delinquency system or the Department of Corrections or is a minor requiring authoritative intervention (MRIA)

Legal-related tasks that a caseworker must complete:

· Determine whether the child/youth is on probation and, if so the conditions of probation; determine whether the child/youth is cooperating with probation and whether he/she has ever violated probation.

· Attend court dates in delinquency court.