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Predisposing variables
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Developmental age |
Regarding the transitional age period being especially vulnerable: “It is, and a lot of them, because of the trauma they’ve experienced, their biological age is not necessarily matching their emotional, developmental [age].” [Social worker]
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Psychological resources |
“...They have this history of all these things that happened, and it just feels overwhelming and didn’t go anywhere. Working on specific skills and things, that seems easier to master.” [Social worker]
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Enabling resource variables
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Transportation |
“It is a trek. It is a bus, it is a BARTa, then another bus, and then a taxi, and then a this. And we have some parents that will do it religiously. We have other parents that, it’s rough, it’s a rough trek and they’re not able to do it as much.” [Supervisor]
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Telehealth resources and literacy |
“Then it raises the questions of access to technology and access to the internet service that would, no doubt, be needed. And you know, the technology itself then becoming an obstacle, also...” [Supervisor]
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Privacy |
“I’m less comfortable with people in the same room where I can kick her, and I can tell her different things. I am a little concerned, but not overly so, of the confidentiality of I have someone else listening in who is then going to call up my kid after we get off the phone and berate them for whatever was said, but that could happen anywhere.” [Supervisor] “It could be difficult for bio parents if they don’t have a private space with Wi-Fi. Like if they’re used to going to the library for Wi-Fi or café for Wi-Fi and you need a private space with confidentiality, like quiet, if they’re living in an SROb, something like that, it could be more difficult.” [Social worker]
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Competing needs |
“For this population, just scheduling, they all, they work on the weekends.” [Psychotherapist] “...They would rather just be out in the community, hanging out with each other. They’re not going to want to sit in a therapy session during the three times a year that mom can come and visit in-person.” [Social worker]
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Social support |
“The first thing that came to my mind was helping the young person by having their parent figure involved in their life, helping them feel more sense of connection and permanency. Because what we’re finding is that when our kids have permanent people in their life, they know that person loves them, no matter if they’re there, touching them, or just their person, they tend to do better in outcomes of getting out of foster care, aging out of foster care.” [Case manager] “It benefits them to know that their mom and dad or their aunt or uncle or cousin, whoever that person is, is there, because that’s the person they go to, not us... That’s the person who they talk to, the person who they ask advice to, and when they leave the system, that’s the person who they’re going to count on, other than us.” [Case manager]
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Foster parent involvement |
“...I also have some foster parents who are very experienced, and so they do the visits with the mom at their house and actually show them, ‘Oh, no, this child needs this at this time.’ They show them how to talk to them. Say two children are arguing, then the foster parent would model how the mom should handle the argument, like ask each child what the problem is. I have one foster parent who does great at that, and the mom gets their kids back very soon because they’re working with this foster parent.” [Social worker]
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Incentives |
“In my experience, trying to get parents to do something consistently would be a huge barrier...” [STRTPc staff]. “Unless they were getting something out of it, then they might” [Supervisor]. “Yeah, if its incentive based for the parents, then absolutely. Everything, nowadays, seems it has to be incentive based.” [STRTP staff]
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Enabling provider-related variables
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Provider diversity |
“...I really want to emphasize that having more providers of color would be particularly helpful for a number of our youth.” [Supervisor] “So, if I’m in [one city] and there are no therapists that have history working with LGBTd folks, wouldn’t it be nice for a kid or family or caregiver to be able to connect? And even if that’s not their main source of treatment, but at least to have that person that reflects them whether it looks like them or just reflects them, in general, if it opens up the ability to access more diverse therapists, especially when you’re not in the immediate Bay Area, I think that is a big positive.” [Supervisor]
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Rapport building |
“...It’s kind of more of a synergy that’s created and more camaraderie where all of us, collectively, form relationships where the changes happen over a period of time, consistent interaction, and there’s a level of trust for us, as a staff, and a level of trust for them. And the kids see that teamwork, as well...” [STRTP staff] “...And I think that’s key in how we do engagement, like for families to understand we’re not just another piece of the system, but we’re really here to help them...” [Administrator]
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Telehealth vs office-based care |
“I think it’s great. Teens are attached to their phones. Some parents are attached to their phones. And they’re on it all day, anyway, and I wonder if there would be a higher level of engagement if the therapy was right on their phone. So, like while they’re checking Instagram, they also have access to that support.” [Supervisor] “And I think there’s certain positives to that screen where, for those hard topics for the youth, like the sexual health, reproductive rights, it’s a little bit safer. It’s kind of like how we have youth who do great in that group home setting, but you put them in a family setting, it all falls apart because it’s too intimate. So, for youth who maybe struggle with that intimacy, it sort of puts that barrier to where they’re talking to someone, but they don’t have to really have that intimate, person-to-person contact.” [Supervisor]
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Team-based services |
“ISFCe teams and wraparound teams are like a mini team. They usually have two or three providers that are all assigned to the same youth, doing different things. I think those modalities, generally speaking, are good.” [Supervisor]
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Youth centered |
“Because it seems to make more sense that you make the services youth-based, not placement-based, and we are a very placement-based services, when, if the youth get to keep their team, build their team, build the trust, do the hard work because of the trauma, I think we would see more successes. Versus each placement having their own team. It just makes more sense for the teams to follow the youth, because we have some kids that move a lot, and those are obviously the kids with the highest needs, highest mental health, and so we can’t even get a team in place before they have to move again.” [Supervisor]
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Enabling community-related variables
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Service availability |
“...Because we have kids who have severe mental health and some behavior that comes with it, but then we have kids who have behavior issues, not necessarily the severe mental health, but just some mental health and trauma, and they’re all in the same placements. So, when the kids hit 18, we can start accessing the adult mental health system... but before that, unless they’re a regional centerf, which is different, it’s just a mixed bag in with all the other youth in the group homes, in the STRTPs, and sometimes, that can be a bit exploitive for youth who aren’t able to kind of stand up to people or really not even know what’s going on. And they can definitely be victimized or bullied or asked to do things, and all of a sudden, they’re getting arrested for carrying around alcohol. And you’re like, ‘Why were you carrying around alcohol?’ Because the other youths told them to carry it.” [Supervisor]
“Where we don’t have access to a lot of different modalities. Some of our kids would do great with drama therapy, even still art therapy, drawing, DBTg, different modalities for different diagnoses, and we just throw the run of the mill, we’re going to put you in therapy and don’t really match the youth and their needs and their diagnoses to, I guess, an evidence-based modality that has shown to work.” [Social worker]
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Need variables
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Evaluated health status
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Emotional regulation, trauma, healthy relationships |
“Well, I think, also, there could be a parallel in their emotional regulation. My youths are having trouble day to day, sometimes, regulating how they react to the world, where their parents are probably having a parallel process. So, somehow, kind of going off what you were saying, working with them on small steps on how to, okay, what happens when you get upset?” [Case manager] “I think another topic, if able, to touch on healing. Because I know that, like, detaining or removal, there’s a lot of trauma that came with that from both peoples’ perspective, the parent and the child, and not talking about that, and the parent is working on their case plan or whatever to be ready to have the kid reunified, but that kid has feelings, too. And especially if they’re a teen, probably a lot of feelings. And without that kind of healing work, putting them back into the same place and expecting everything to be fine and moving forward...” [Social worker]
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Substance use, parenting, sex, life skills |
“I would say 80% of the youth that I work with use substances, so that’s definitely at the top there, and managing feelings.” [Social worker] “Especially marijuana, because since it’s legal here, they think it’s okay. They think it’s not bad when it is, for kids.” [Social worker] “One of the things that I would like to see is kind of like pre-counseling, working through some of the living together challenges if they’re going to be potentially moving, because when you have a weekend visit or even a two-week visit, it’s all exciting, you make it lots of fun, but there’s no workup towards what’s everyday life going to look like? What are the rules going to be? Because everybody’s focused on, it’s so exciting, we’re going to go to this restaurant or whatever, I’m going to make your favorite food. So, that would be one thing.” [Supervisor]
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Perceived health status
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Motivation to engage |
“...Willingness to be involved, where they’re multi-stressed families with lots of other demands, and sometimes, as much as they may or may not love their children, it’s one less thing they have to worry about when their kid is in care. I don’t know if that’s true for all families, but I think that can happen. And so, like, it almost feels like sometimes, out of sight, out of mind...” [Administrator] “Give them back when you fix them.” [Supervisor] “Yeah, like, 'It’s your job to take care of this and fix this and we’ll see what we can do when the kid comes back.'” [Administrator] “...A lot of times, the families don’t realize they require some changes and some intervention in terms of their process and approach to whatever the problem that developed.” [STRTP staff]
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