Youth and Family Center supports emotionally challenged youth

Communities of Care provides a welcoming haven

By Sandra Gray

UMass Medical School Communications

November 04, 2010

Members of the Youth and Family Center’s dedicated staff are (from left) Kijah Clark, Migdalia Velez, Daisy Rivera, Mariana Ferreira, Sarah Golding and Matthew Penniman. Not pictured are Kathy Black, Toni DuBrino Irsfeld and Anthony Wilson.

Imagine a place where kids with severe emotional and behavioral challenges can come and be helped, not judged, a place where their entire family can also get help. Such a place exists: the Youth and Family Center (YFC) in Fitchburg, housed in an old factory that is unprepossessing on the outside, but bright, airy and cheerful inside, a welcoming space decorated entirely by the youth and families who use it.

Administered by UMass Medical School’s Division of Child and Adolescent Psychiatry, the YFC is an accessible destination where youth with Severe Emotional Disturbance (SED)—especially youth at risk of court involvement—and their families are empowered to get the services they need to become active participants in their own treatment, support and recovery.

“Building relationships with youth and families is the first step and the foundation for building a comprehensive system of care for them,” explained Toni DuBrino Irsfeld, MA, the center’s acting director, director of family involvement and training, and instructor in psychiatry. Like many of her colleagues at the center, Irsfeld brings personal as well as professional experience with SED to her oversight of the center’s creation and operation (see sidebar). “Better outcomes are achieved when families, in partnership with professionals, are empowered to act on their child’s behalf. We strive to individualize and tailor services to the specific strengths and needs of the families served.”

Youth and families can access services at the Youth and Family Center via one of two routes: while some youth are referred by juvenile court judges, many simply walk in. “We have many people learn about us through word-of-mouth,” said Migdalia Velez, the parent of a youth with serious emotional and behavioral challenges, and the center’s assistant director and first staff member.

“When we first opened, we immediately got 38 referrals, including 15 court-referred kids who were really struggling,” she recalled. “I’ve been privileged to see the paths many of them took after getting involved with the center and its services, graduating from high school and going on to college. One even made the dean’s list, and three were children bounced from foster home to foster home who got their lives together.”

Central MA Communities of Care Youth and Family Center history, mission and methods

Established in 2006with a six year, $11 million Systems of Care grant from the federal Substance Abuse & Mental Health Services Administration (SAMHSA) to the Massachusetts Executive Office of Health and Human Services, the Youth and Family Center is a program of Central Massachusetts Communities of Care (CoC), directed by Peter Metz, MD, professor of psychiatry and pediatrics at UMMS. Funded by the Systems of Care and several other related grants and contracts, CoC has been a leader in Massachusetts and the country in the implementation of the System of Care, family-driven, youth-guided approach to intensive home and community-based services for youth with Serious Emotional Disturbance and their families.

Serious Emotional Disturbance is a term used by SAMHSA to denote youth who have a diagnosable psychiatric disorder accompanied by substantial functional impairment that has lasted or is expected to last a year or more. CoC is a collaboration of youth with SED and their families; community and state child serving agencies; and the Massachusetts Executive Office of Health and Human Services, under the direction of the Department of Psychiatry’s Division of Child and Adolescent Psychiatry.

With the belief that all youth and their families should receive support within their communities to live happy and productive lives, Communities of Care is dedicated to providing a welcoming environment where youth with complex emotional and behavioral needs and their families know they are not alone, get the help they need to access resources, and feel a sense of hope through community connections and support from others. Communities of Care strives to implement care that is family-driven and youth-guided; culturally competent and strength-based, coordinated, and guided by outcomes that are tracked and measured through an established evaluation process.

Whether through early intervention with youth at risk, or through intensive services for teens who are already court-involved, the Youth and Family Center takes a community-involved, public health approach to behavioral health services. Early intervention and prevention services have included group programming for youth; parenting skill-building; and informational presentations and support groups for caregivers, adoptive parents and parents. Cultural and family events further encourage and strengthen family participation.Groups are also offered beyond the center’s walls, in schools and other community locations. The center space is available to other community-based groups for meetings, further strengthening its local partnerships.

Family care partners and youth coordinators are the hands-on service providers at YFC. “We start by building a team through a collaborative exploration to ensure that the family feels that the team is something they created and takes ownership of. Teams can comprise a combination of natural supports such as family members, friends and important peers to the youth or to the parents, and professional supports such as an important teacher,” explained Sara Golding, one of three family care partners at the center. “That team is a think-tank for brainstorming, where we can look at the family’s needs and address them in a way that makes everyone feel included, invigorated and ready to go.”

Anthony Wilson detailed the role he and two other youth coordinators assume as members of each family’s team. “We connect with youth in three different ways: through groups and activities we run at the center, whether evidence-based or ones that we’ve developed ourselves; through one-on-one work in the Foundations Program; and through programs and activities we bring to schools and the community.” The Foundations Program provides intensive care coordination support to youth with behavioral and emotional challenges and their families who have been referred by the courts either because of a Department of Children and Families Child in Need of Services Petition being filed or because of their potential involvement in the juvenile justice system. Groups include Safe Dates, which promotes safe and healthy teen relationships, and All-Stars, a prevention program designed to delay the onset of drug use and other risky behaviors.

The family walking group is another example of YFC programming that was created by staff to meet an expressed need, one for caregivers to take a break for themselves. “When you’re strained and on the brink of crisis, you need someone to go to,” Velez said. “Our walking group may mean a parent can walk, vent and strategize with someone who’s not at that crisis point.”

A survey conducted one year after the center opened found that family satisfaction was very high. More than 80 percent of caregivers in the program stated they would “absolutely” come back to the program and would recommend the program to others, commenting in particular on the welcoming, non-stigmatizing atmosphere, the wide range of programs available and bilingual services. These same caregivers are much less enthusiastic about other encounters they have had with the “system” in its efforts to respond to the needs of their children.

Caregivers have seen positive and lasting changes in the behaviors, emotions and functioning of their youth, and reported less stress in raising their youth. Youth reported feeling less depressed and anxious, and stronger and more hopeful. Further, they were avoiding behaviors that could get them into trouble with the law. Youth over the age of 16 who have become involved with center activities have a lower dropout rate over the next year than the average of all students at Fitchburg and Gardner high schools, despite their risk for dropping out due to their SED.

Care partners work with the entire family, especially parents, while youth coordinators focus on individual youth, but their work often overlaps. “We all do whatever we can to help each other maximize what the center can do for the community,” said Youth Coordinator Kijah Clark. Sometimes this means addressing basic needs for food, housing, heat and transportation. Staffers have reached out to local food pantries on behalf of families, and helped them apply for benefits they are eligible for but intimidated about getting.

“A lot of the paperwork required to get assistance is complicated,” said Golding, of staffers’ willingness to simply help fill out forms. “Even if you speak English, it can be overwhelming.”

“Families can come in with an issue, any crisis, and staff will work with them right where they’re at,” said Irsfeld. Velez recounted one case in which she was called into court and the mother of the child in trouble was hostile. Velez just gave the woman her card, then left. “She came back,” said Velez. “This parent needed some help in her own life, so building a team for that mom not only addressed her child’s issues, it looked also at what this mom needed to be an effective parent—what steps needed to be taken and who could help. That’s a prime example of team building and getting the right people involved.”

Now 18, the young man in that case still calls Wilson, his youth coordinator, every few weeks. He reports that he is in school, hasn’t been in court for a long time, is starting a job and looking forward to getting his own apartment. “Seeing this progression in maturity and growth in this young person is awesome,” said Wilson.

In this case as with many, Youth and Family Center staffers deal with some of life’s toughest problems—and they love their jobs. “This is work that comes from the heart,” said Velez. “I’ve been privileged to see the paths many of our youth took, seeing them graduate from high school and move on to college. You know you’ve been effective when you’re no longer needed.”

Related link on UMassMedNow:

Positive behavioral interventions help kids succeed