Overall, the 81active families during year 5 were most likely to use legal services58% of families (Figure 14). 36% of client families used kinship care case management services, an increase from previous years. Art therapy and support groups involved members of 24% and 12% of families respectively, a lower proportion than in the past. 2% of families received individual counseling, which was available for only a short period during this reporting period.
Of the 4 families included in the detailed
case studies, legal services was the only service received by
all 4 families.
The project attempts to address the many mental health issues experienced by familiesgeneralized anxiety, chronic environmental stress, family dysfunction, compromised communications, impaired self-regulation, compromised coping and depressionthat affect family stability and safety and reduce the likelihood of planning for the future of children. Mental health services are based on an individual treatment plan, developed after a client assessment by the therapist. These treatment plans list goals, outcome indicators, and service methods and are updated quarterly by the therapist. Numerical scores are assigned as a measure of goal attainment. (See section Scaling of Individual Client Goal Attainment, Figures 19 and 20, on pages 4546.)
Services offered at selected times during the year consisted of weekly support therapeutic groups for children and youth provided through a subcontract with Pediatric Care, Inc. In past years, groups for adults were also offered. This year 3 cycles of groups were offered, in winter, spring and summer, down from 4 cycles of time-limited groups in the previous year. Age and gender based groups meet weekly for 10 weeks per cycle. Rites of Passage for teen girls is a psycho-educational group that use both art and group discussion to address growth and developmental issues. Participants in the Life Skills for Girls and Life Skills for Boys learn social skills, problem solving and anger management. The FY 2001 schedule included:
44 clients participated in 10 groups; some clients may participate in more than 1 group during the year. Overall, slightly more than half (54.5%) of the clients enrolled in group therapy completed at least 75% of their group sessions. Enrollment in each therapeutic group ranged from 3 to 6 clients. 27 children received art therapy. Overall, of the 81 families who received Family Ties Project services at least once during the reporting period, 12% and 24% respectively received support group services and art therapy as shown in Figure 14. Children sometimes receive both support group services and art therapy.
In January 2001 the art therapist implemented a new monthly service units reporting system. This system provides her agency, Pediatric Care, Inc., as well as the Family Ties Project with a wealth of data on specific units of service (consultations with other project providers, consultations with case managers, numbers and types of therapy sessions) that may be useful in future allocation of resources. Client specific data are recorded, which can be used to provide a measure of intensity of services. During the 9-month period January through September, she provided a total of 447 art therapy sessions; 58% were 30 to 59 minute sessions; 42% were more than 60 minutes and the remainer were less than 29 minutes. 34% of scheduled sessions (227 + 447 = 674) were cancelled or no shows.
To ensure continuity of care, the project subcontracts with Sasha Bruce Youthwork for kinship care case management. Kinship care transitional case management helps to maintain a continuum of care for families that are caring for affected children, but are no longer eligible for services provided through the HIV service delivery system. Because HIV services eligibility is determined by the family member's diagnosis, once the infected person dies, the uninfected family members may lose their access to services, even though their needs may have increased as a result of the final illness and death.
The project funded kinship case manager located at Sasha Bruce Youthwork coordinates with the family's HIV case manager, if there is one, and assumes sole case management responsibility once the AIDS patient dies. Following an intake and assessment, the kinship case manager develops a family care plan, which typically includes assistance with financial, educational and housing needs, as well as issues of grief/loss, family process, stress, and coping. 29 families or 36% of all families receiving services were involved with kinship case management during this reporting period. Considering the 4 cases in which a parent had recently died, 3 of the families continue to receive a range of services from Sasha Bruce. The fourth family was eligible for HIV-related case management from another agency because the child was HIV+.
Training in parenting and/or caring for HIV-infected and affected
children is available at no charge for biological parents, extended
family members who are caring for children, and foster and adoptive
parents. Occasionally, agency staff members and volunteers also
participate. An
8-hour courseCaring in the Communitycovers HIV transmission, the
spectrum of the disease, confidentiality issues, the role of caregivers
and families, and infection control/universal precautions. Taught
by staff of Project CHAMP of the Children's National Medical Center,
the course offers continuing education credits to certified foster
parents.
Caring in the Community was offered 4 times during the fiscal year (see Figure 10 on page 30). Generally scheduled on Saturdays and located in the community convenient to public transportation. The number of trainees ranged from 3 to 11. In total, 28 persons completed the training. Although a number of steps were taken to ensure attendance, only 60% of those who registered in advance actually participated. No participant feedback or other assessment data were collected.
A caregivers retreat was organized by Sasha Bruce Youthwork in Spring 2001. 14 participants completed assessment feedback forms. Responses to both the closed response and open-ended questions indicated that the retreat exposed participants to new ways of thinking about caregiving and expanded their repertoire of parenting skills.
Life planning legal services include completion of the child medical consent form, child custody issues, last will and testament, living wills, durable powers of attorney for health care and for financial affairs, instructions for disposition of bodily remains, and entitlement applications and appeals.
The project funded attorneya UDC School of Law professoreducates parents and caregivers about their life planning legal options, prepares the appropriate legal documents, provides court representation, and assists with other legal matters as needed to increase family stability. She supervises and is assisted by 10-12 second and third-year students per semester. Second semester second year students can be certified for court representation, therefore these students can and do represent clients before the court as necessary.
Figure 15 shows the types, volume and current/last known status of the 380 (255 at end of first 4 year period) legal non-custody cases opened over the 5 years of the project period. This includes 125 new cases opened during the reporting period. It is important to note that a client family will typically have more than a single case, and cases are closed and new ones opened for the same family over time. Therefore the 125 new cases may consist of the 65 cases of the 16 newly enrolled families in addition to new cases opened for previously enrolled families. Consistent with the project's mandate, the majority of cases involve life planning. SSI and other entitlements constitute about 25% of all cases. 23% involve wills, probate and advance directives. 19% are concerned with medical consent authorizations. Considering the disposition of all 380 cases, 57% have been closed with a favorable outcome, 20% remain open. 8% are nonprogressing and the client withdrew 7% of cases. See Figure 16.
During this reporting period the 16 newly enrolled families generated 65 non-custody cases. The status is shown in Figure 17 and 18. 42% have had a favorable outcome and 49% are still active.
As 1 of its quality improvement measures, the project expects to have a medical consent on file for each child. Clients are encouraged to designate consent during intake in order that the child's medical needs can be taken care of in the event that the parent cannot give consent. This often serves as an entry into discussion of other permanency issues. As of September 30, 2001, 13 of the 38 new child enrollees, 34%, had a medical consent on file.
Of the 4 recently deceased clients whose records were reviewed for this report,
medical consent forms were on file at the project office for 2 families. 1 had
been signed within 2 months of enrollment, the other approximately 18 months
after enrollment. Consent forms for a third family were on file in the UDC School
of Law HIV clinic. This family first came to the attention of the project through
a direct referral to UDC a few days before the mother's death, when apparently
the forms were completed.
The fourth family, for which no medical consent forms were found in the records,
was know to the project for nearly 3 years prior to the mother's death.
