1. PROVIDING CLINICAL SERVICES TO HOMELESS CHILDREN IN CHICAGO, ILLINOIS Susan Reyna-Guerrero, LCSW President/CEO

2. ABOUT BEACON THERAPEUTIC Located in Chicago, Illinois Began in 1968 as a Therapeutic Day School Today, a multi service site offering special education services to students 3-21; community mental health clinic and supportive services to homeless children and families.

3. KEY OBJECTIVES OF PRESENTATION Overview an approach to addressing the mental health needs of homeless children Understanding attachment issues as they relate to a homeless child Understanding system building to keep homeless families and homeless children’s issues in the forefront

4. ABOUT BEACON THERAPEUTIC Based on a homeless systems gap, therapeutic day services were developed in 1996 to address the specific mental health needs of homeless 3-5 year olds.

5. AN APPROACH TO MEETING THE MENTAL HEALTH NEEDS OF HOMELESS 3-5 YEAR OLDS LITTLE INTENSIVE OUTPATIENT PROGRAM The program addresses the emotional, behavioral and social needs of homeless children Children are picked up by agency transportation five days a week at their residence (often shelters) and brought on site to Beacon Services include individual as well as group intervention for five hours a day. There is also the opportunity for more in-depth evaluations to occur

6. LITTLE INTENSIVE OUTPATIENT PROGRAM – con’t Parents must participate at a minimum of once a month to provide input into their child’s treatment planning As a means of including the parent more in treatment, an outreach worker provides the bridge between the home community and the day treatment program for the child and family

7. AN APPROACH TO ADDRESSING THE NEEDS OF HOMELESS FAMILIES: SHELTER OUTREACH SERVICES SOS provides Mobile Mental Health Services to 22 homeless shelters in Chicago (Citywide) with over 600 families served each year First in Chicago to respond to the continually increasing numbers of homeless families

8. SERVICE DELIVERY MODEL A multi-disciplinary approach that is inclusive of: Primary therapy and counseling Intensive case management Psychiatric and Psychological services Access to other outreach services Developmental pediatric & well-child evaluations in partnership with University of Chicago Utilizing a wrap around approach

9. WHAT IS A “WRAPAROUND” APPROACH Wraparound is a philosophical approach to delivering services Services are unconditional, continuous and coordinated. Delivers individualized services based on the inherent strengths of the child and family

10. WHAT IS A “WRAPAROUND APPROACH” Services are community-based with the goal of ensuring that children and families succeed in their own natural home community What ensures success in their own community is the family’s ability to identify and access natural supports in that community

11. CLINICAL DEMOGRAPHICS OF HOMELESS CHILDREN 3-6 Unique needs of homeless children ages 3-6 Observation of insecure/indiscriminate attachment to adult figures Children acting out based on the stress placed on children in shelters Children often exhibit a delay in both developmental as well as social functioning Symptoms of children range from oppositional defiant to post traumatic stress symptoms to early signs of depressive symptoms. It is important to note the comorbidity of symptoms versus a singular diagnosis as in older presenting clients

12. CLINICAL DEMOGRAPHIC STUDY OF HOMELESS CHILDREN Based on observations made by the demographics of homeless children, there are a variety of presenting problems that children exhibit (comorbid diagnoses) Problems are systemic Need for a wraparound approach to delivering services

13. ATTACHMENT ISSUES NOTED IN HOMELESS CHILDREN Understanding the foundation for secure attachment: Sensitive, responsive caregiving provided consistently over time by a specific caregiver Primary caregiver is attuned & responsive to child’s cues, state, emotions, needs (Ainsworth)

14. UNDERSTANDING THE FOUNDATION FOR A SECURE ATTACHMENT CONT’D Caregiver’s emotional investment in the child (Howes) All these features are deeply impacted by the family’s homeless state and parent’s availability to ‘parent’ and facilitate a secure attachment

15. TREATMENT PHILOSOPHY Strengths based, culturally sensitive & developmentally focused (for child and parent) are most effective Belief in the resiliency of the child and family and capacity to improve functioning Recognize the myriad of resources that can be mobilized for the benefit of the child and family

16. TREATMENT PHILOSOPHY – con’d Addressing the child’s needs now will have long term impact (impact on future homelessness, early identification of needs….) Homeless mothers’ availability severely impacted by: Mental Health issues/cognitive functioning Traumatic histories (abuse, homelessness… Attachment issues (ghosts in the nursery) Reality of homeless state (inability to cook, parent,….

17. TREATMENT APPROACHES & MODALITIES Reflective practice & supervision Within a milieu setting: recognize and regularly monitor areas of functioning: Problems & positive reinforcement to child strength areas Parent-child psychotherapy Reflective developmental guidance Supporting direct play, caregiving, communication, interaction modeling & coaching Play Therapy – focused attention to child’s developmental needs (gross & fine motor, sp/l…)

18. TREATMENT MODALITIES - cont’d Video scrapbooking, Mommy and Me program, Medical Home Model Psychiatric/psychological assessments and treatment Intensive case management to address the family’s needs for housing, financial support, education/employment, …

19. COALITION BUILDING TO ADDRESS THE NEED OF HOMELESS CHILDREN AND FAMILIES Chicago’s Ten Year Plan to End Homelessness Planning Council (representative of Constituency Groups, Consumers, public/private funders Service Providers Commissions Homeless Families Constituency Group Chicago Alliance to End Homelessness New Initiatives in Chicago