 I should get you... I should get your children's quote. You ready? You all ready? Yeah, I'm going to introduce myself. Some issues? Your audio and your presentation has been displayed everywhere. So, once we can cut the video feed and the audio feed, then we'll get going. Otherwise, you guys will be presenting to everyone, even though they can't all see it. Just give us a few seconds. Let's turn it off. And to continue with the wonderful and invaluable information that we have been receiving through the day and the wonderful and robust discussions, I was asked by Kathy to introduce our next speakers and obedient as I am. I could not refuse the honor. So, I am introducing this afternoon Dr. Connie Almeida. Connie Almeida is a psychologist, specialist in school psychology. Dr. Almeida has also a postdoctoral specialization and developmental disabilities from the University of Massachusetts. Presently, Connie is the director of behavioral health sciences for Fort Bend County. Also with us this afternoon someone who might not need an introduction in our community is Judge Peter Sakai of the 225th District Court, the Bear County Children's Court. An institution in our community, a judge beyond expectations, but not beyond what he sees as his own responsibilities. He champions initiatives and brokers effective implementations to reflect the nurturing impact of the judiciary in a community as it should be. Without further ado, I leave you with these two wonderful speakers. I actually have a microphone here. Sorry. It takes a while to coordinate all this technology. So, I'm Connie Almeida and truly I thank you. You all can hear me, right? Oh, the lights are going. Can you see me? I know you can hear me, but can you see me? Okay, good. I'm a little vertically challenged. That doesn't keep me from... One of the things I'm really thrilled to be here again. I have to tell you a story that actually it was about eight or nine years ago. Judge Pope, who's a district court family court judge in Fort Bend County. And I had the privilege of being invited to San Antonio to meet with Judge Sakai, Judge Garcia, and to observe your children's court. And as far as I know, San Antonio Beer County is still the only county that actually has a specialized children's court. And you actually have a visitation center within your children's court. And you should feel extremely proud of that because what you were doing 10 years ago, we are still trying to develop in other counties. So congratulations on that. And it's interesting because since then we've done a lot of work. And so it's really a privilege to be back here. And I also have to tell you because I feel like I'm one of you because although I work with Harris in Fort Bend Counties, this is a beer county children's court portfolio. So thank you. And it's very sturdy. It's lasted almost 10 years. Connie, we call that marketing. Marketing. Judge Garcia said they're going to give me a red one so that when I go to the other counties, they can see beer counties. Did he get that in the budget? Okay, we'll get you the red one. I think Judge Montemore is blue, right? Okay. And so one of the things, you know, what we're doing is hard work. The cases we work with are complex. The system is complex. And I have a colleague. How many of you are familiar with the cans, the child and adolescent needs and strengths? Okay. And a lot of you will become increasingly familiar. So Dr. Lyons and I worked on the cans, oh, 13 years ago. And, you know, about 10 years later, the state realizes, oh, this could be a valuable tool for us. And he reminded me when I get a little frustrated in patients that systems change takes about 10 years. So one of the things I would encourage you is to have patience, persistence and passion. And to always remind yourself and remind those around you of why we do this work. So I guess I could end my talk with those kinds of things. But I think those are really important things for us to remind ourselves. So, okay, so now I'm actually going to talk about the presentation. Just kind of another disclaimer. There's a lot of information in there that I'm not going to talk about. Actually, our previous speaker addressed a lot of the ACEs, the adverse childhood events. So I'm not going to talk about that. You have that for reference. And you can, if you have specific questions, we can address them. I'm actually going to sit because I can facilitate this sitting down. Let's try this. Okay. So, you know, why do we do this work? Why do we try to keep children and families together? Because we know that that child-parent relationship is a core to the child's development. We know when we separate children and families, it causes stress. You know, Ann talked a little bit about toxic stress. And I think that's something we need to think about. Children and child welfare have experienced stress, right? We don't need to add to that stress, okay? It's sort of, stress is interesting. We have to kind of moderate it because if it becomes toxic, the effects become irreversible. And so as a system, you know, we don't want to add to the toxicity of that stress. We should be removing stress. So when we, unfortunately, when we move children multiple placements and there's no transitioning, because of a variety of factors, because our focus is to keep children safe. We also have to think about what that does to that child in terms of the stress. Anyway, the child-parent relationship is core to the child's development. You all know a little bit about attachment, and there's actually some attachment experts here. So I'm not an attachment expert, but I do know a little bit about children's development. And what children need is that available, responsive, and dependable parent. And unfortunately, when you have a parent that has substance abuse issues, when you have a parent that there's extreme poverty, when you have a parent in a domestic violence situation, when you have a parent with mental illness, you don't have those kinds of things. Not so much because they don't want to or their fault, but because of the situational factors. But that's what children need. And so when we go in and intervene, we try to build that. It's almost like we try to build those corrective attachment experiences, either with the biological parent or with an alternative caregiver that can provide that. And you know this with substance abuse, that's one of the big problems, is the inconsistency in parenting, that chaos. And we've all seen those really sad situations when the child is waiting for the parent to visit, and the parent doesn't show up. So just about attachment, and again I apologize if this is repetitive, but just so we have some basic knowledge, so this is how it's supposed to happen. You know, the baby cries, the caregiver's there to respond to the child's needs, then the child is soothed, they relax, there's some emotional regulation of that need. And you do that over and over and over. The child learns that there's somebody that they can depend on. There's a secure pattern of attachment. So how many of you have seen this stilled face experiment? Oh, I hope this plays. Let's see. How many of you have seen it? Ooh, a lot. Well, maybe I can't. Uh-oh. This might have been more technically advanced than... I might not be able to do this. Oh, well. See, I knew there would be a glitch. So, Adam, where are you? So in this experiment, so... Oh, you will. So how many of you have seen this? So why don't you tell who's willing to share what happens here? Let's see. Now, I think Adam's trying to play it. He's not? Okay. Well, if Adam comes around, we'll see the still face experiment. This is a fascinating demonstration of how children respond to a parent's availability. And when the parent becomes unavailable, the amount of distress that happens to that child. But then, if the parent comes back, it's like, wow, you're back. You know, I knew you were coming back. And it really is powerful. So I'm hoping that Adam will come around and... Let me see. Let me see if this button works. Nope. Uh-oh. That didn't work. Sorry. Anyway, we'll come back to that. Okay? Let me ask you a question. Yes, Judge. And our agreement here is we're really kind of going back and forth. We want to make it open. So if anybody has questions, let's just get it out. We'll talk as we're not going to stick strictly with the PowerPoint. Go ahead. Why don't you stand so everybody can hear? I don't think we have time. And I'm sorry, we are no longer in control of that PowerPoint. Somebody else is. Go ahead, Ms. Charles. Okay. Let me ask this question, Doctor. We have a family drug court in Bayer. We're hoped to have an early adventure program similar to your toddler court in Fort Bend that Judge Pope and you have been running for several years now. Ten years, Judge. Ten years. That's kind of how long our drug court has been. The question I have is sitting there and hearing these cases and from an attachment issue is we know that from what we call standard supervised, the lingo that CPS likes to use for access, visitation between parent and child. Even infant children, what I think the standard supervised, I've got CPS people in the room, two times a month, one hour at the department, big room, sometimes the workers there, sometimes it's a technician to supervise or somebody's in the room to make sure their safety. But apparently, and sometimes I get these stories through the parents that, Judge, you know, it's the most horrible place to have a visit. There's just no privacy, sometimes it's chaos, and if it's multiple children with parents, it doesn't seem to be meaningful. Help me understand from an attachment therapeutic point of view, how can we do this visitation access between parent and child, especially as we deal with a specialized court, which we'd hope we could provide better, more intensive, more therapeutic services for these parents and children. Judge, you went to the end of the presentation. I'm sorry. I'm the judge. No, no, that's... You're up. And then we will get to the still face. So Judge, I would say first step is install a one-way viewing mirror that costs about $170. Because one of the things is CPS needs to observe, CASA needs to observe, but when you're sitting there in the same room as a parent, that causes so much stress, so much anxiety. So you install a one-way viewing mirror. That means you have to have some space, right? And you maybe have a visitation bag that you give to the parents so that they can come prepared for visitation. Callee, and you can see if they bring the bag and they're prepared. Maybe if they don't bring the bag, that's a good sign. And maybe you have some developmentally appropriate toys that you could separate into bins that are cleaned after the visitation and that are age-appropriate. And you start with asking the parent how things are going. How has the week been? You know what? If you just... We had a parent that came in the other day that had been sexually assault-raped a couple of days before and she had actually filed charges. But we had a relationship with that parent so she felt comfortable talking to us about that. And if we hadn't taken that into consideration and we had noticed something different between her relationship or her interactions with her and her child, we made some inferences without knowing what was going on in her life. So I think the environment, Judge, we really... I know CPS doesn't have space and we don't have space but the environment, if we spent a little bit of time setting up the environment, we could do a much better job at facilitating those visitations. And I do have some other suggestions. But, oh, I don't know what happened here. So ready to go? Okay, Adam, I think we're ready. Babies this young are extremely responsive to the emotions and the reactivity and the social interaction that they get from the world around them. This is something that we started studying 34 years ago when people didn't think that infants could engage in social interaction. In this still phase experiment what the mother did was she sits down and she's playing with her baby who's about a year of age. I need my girl. And she gives a greeting to the baby. The baby gives a greeting back to her. This baby starts pointing at different places in the world and the mother's trying to engage her and play with her. They're working to coordinate their emotions and their intentions, what they want to do in the world. And that's really what the baby is used to. And then we ask the mother to not respond to the baby. The baby very quickly picks up on this and then she uses all of her abilities to try and get the mother back. She smiles at the mother. She points because she's used to the mother looking where she points. The baby puts both hands up in front of her and says, what's happening here? She makes that screechy sound at the mother like, come on, why aren't we doing this? Even in this two minutes when they don't get the normal reaction they react with negative emotions, they turn away, they feel the stress of it, they actually may lose control of their posture because of the stress that they're experiencing. Okay, I'm here. And what are you doing? Oh yes, oh what a big girl. It's a little like the good, the bad and the ugly. The good is that normal stuff that goes on that we all do with our kids. The bad is when something bad happens but the infant can overcome it. After all, when you stop the still face the mother and the baby start to play again. The ugly is when you don't give the child any chance to get back to the good. There's no reparation and they're stuck in that really ugly situation. It's always such a powerful video to watch. You asked that really hard question judge about the visitation. The one way viewing mirrors too, when I asked our facilities to install that they're like why do you want a one way viewing mirror? I mean actually I wanted video cameras but you know I couldn't. But it really has been just a great thing because so CPS can come in, observe, the attorney can come in. We let the parent know that folks can be coming in and observing them. After a while they really get used to it. We usually have sessions that are an hour and a half, two hours. We use interns to supervise some of the visitation. It provides them, you know, you have intern students that as long as we're supervising them it's a great opportunity for them. So I would really encourage you to look at your environment and how you can make the environment more conducive to those therapeutic visitations. And let me ask another hard question. How can you as a clinician, therapist, counselors in the room, I would assume that at-risk parent has no clue about that dynamic of what we just saw. So how do you help the parent understand that that child needs that attachment, that bonding, as what we just saw? You know, Judge, one of the... I'm going to ask questions. Yeah, one of the things that's really challenging is that these parents often already feel very inadequate, anxious, they're being judged, and they're being evaluated. They already struggle with a variety of issues, like their own parenting experiences, their own feelings. And you know that it's in one of the slides, I mean, there's usually mental illness, substance abuse, poverty, unemployment involved in child welfare. They have a variety of things that they're trying to manage. Some of them probably are fetal alcohol syndrome and so their ability to handle multiple tasks is limited. So one of the things that we do is talk about guidance. And I think it's actually the last slide. There's this little thing that I use, reflect. And it means you reflect a parent's experiences, their feelings by... I've got to remember what it is, by listening, engaging, coaching, and teaching. So you listen to them. You listen to what they're telling you. You ask them how the week was. You listen. And then you engage, you know, which is part of that listening. And then you coach and then you teach. We often do it the other way around. We're telling them what to do, judge. Kind of immediately, can't you figure out how to hold your child? You know, it's like, well, and think about how we do that. We do that. We had it cause it myself, my intern students, my staff. It's like they cannot sue that child. And we go in, we pick up the child and the child calms down. How does that parent feel? We've just reinforced their inadequacy. So we have to be so careful with that. Now, in one of the things is guiding, let them control of it. Kind of like, you can just say, you know, she seems to be having a really difficult day today. Do you want me to hold her for a while? You know, just instead of, let me show you how it's done. But that coaching and that guidance, I think is really, really critical. And then I have a colleague, Dr. Pranchesha, who's a developmental pediatrician. One time she was talking about teaching parents how to delight in their children. I'm like, what do you mean delight? And it's like, you know how, how many of you have kids? Gosh, you know how we feel so happy in that joy when they do something, whatever, that makes us happy? And our families often don't know how to delight in their children. And so it's kind of teaching them how to do that, pointing out the really good things that their child's doing. Can you believe that she can crawl this week? Look how well she's doing. Did you see her smile? And if you pick that up, that parent will start to pick up on those positive things. And it's that connection. I don't know if I answered your question, Judge. Does that also apply to caseworkers too? That probably applies to caseworkers also. We have to delight in our work. So, I mean, you all know this. I mean, we have so many children in foster care. And I think the previous presentation was just such a great reminder what we spend, what, $6? What was it, $6 for every dollar? $6 to support foster care for every dollar that we spend to develop an array of services to keep kids out of the foster care system. And you also know these and so many of our children. The main reason children come into foster care is what? Parental what? Substance abuse. Yep. And when you have substance abuse, you often have a variety of other factors like mental illness. You see a lot of domestic violence also. Okay, so you know all this. I mean, you know the system. 67% of the parents with children in the child welfare have substance abuse, but only about 31% are getting treatment. That's why the family drug courts are so important. And so let's see. You also know this. Children whose families do not receive appropriate treatment for alcohol and other drug abuse are more likely to end up in foster care, remain in foster care longer and more likely to reenter the foster care system. You also know that so many of our children and child in juvenile and in the criminal justice system have been in our foster care system. And I have to tell you I've had horror stories where I have 17 year olds in our jail and the case, the CPS closed, is case is closed while they are in jail. And often the people filing charges on those youth are treatment providers. And judge, I think that's a question. I mean, that is just something we need to look at because we have residential treatment centers. I'm not saying that their behavior should be tolerated, but not recognizing that a lot of these, most of these children, all of these children have suffered some form of abuse. So, you know, when they're restrained where they're taken down, we need to be very sensitive to how that's re-traumatizing our children and they don't need to be in our jail. Well, and that kind of goes to that school to prison pipeline movement that is trying to tell our education system that they can't keep dumping these children into our criminal justice system by writing tickets, suspending them, putting them out of the school system, and then expecting them to get their education, their needs met, or keeping them intact. And so I think that's kind of a corollary that it kind of goes into that trauma and form care that, you know, these families have been traumatized. So there has to be some degree of sensitivity, yet there needs to be that accountability piece. And I think that's where the court system comes in and trying to hold parents accountable. But I think, again, as judges, and I serve on a national board, National Council of Junior Family Court Judges, that is trying to help the judges recognize that we do have traumatized families coming in. So yelling and screaming at family or parents doesn't necessarily make things better or push these parents on to success. Sometimes it regresses and therapeutically. And we can certainly have that discussion as to what our judicial system does to families as a whole and how what traumatizations go through that. But we all know that, you know, those are the factors. So in all this echo what Dr. Miles saying is that we know here in Bear County, yes, it's drug and alcohol addiction. You know, we really have to deal with substance abuse. Then we have that mental health issue and the access to mental health services. And then that domestic and family violence and multiple lives here from the family violence prevention services, we've been able to develop a collaboration here locally where our domestic violence advocates and their programs, especially the batters intervention programs, have been utilized now by the child advocates, by CPS. And we really have created, I think, a cutting edge program here in Bear County where domestic violence and child advocates have really come together for the benefit and betterment of children and families. I think Martha has shared with me that sometimes doesn't always happen in our state and in the whole country because typically we get very siloed and we get very bureaucratic. And sometimes domestic violence advocates, and I've had to kind of get into that discussion of why can't these two sides work? And obviously sometimes domestic violence looks just that domestic violence and that silo. Whereas child protection is saying, well, yes, there's a domestic violence issue, but that doesn't excuse the mother or the caretaker from the protection of children. And I think locally what we've come up with, and Martha, you can speak for yourself on behalf of the family violence domestic violence advocate, is that basically we have just put the protection of children as a number one priority. And from there we will then try to find ways to find common bonds and commonality so that we can come up with common treatment and common goals for these parents that have domestic and family violence. One of the things that I've come to realize and through my communication and working with Martha is to understand there is a very big difference between effective therapeutic programs such as batters and invention programs and anger management. And typically what I get frustrated, and Dr. Madaprashe, you can help me understand, but I get these parents running in with these anger management certificates and saying, here's my certificate. Now I think I've pretty much dealt with the issues that you said I have. I have an anger problem, so give me my kids back. And usually when I say no, they throw the paper in my face or they start yelling at me and saying, you know, this is what's wrong with our system. You promise things, you know, get back and I go, I think that's why we have an anger management program. And so one of the things I've come to recognize, I'm not sure there may be some anger management people in the room so to speak, but one of the things is these programs truly do need to be therapeutic and they really do have to be extensive to change behavior. And so basically what I've come to the distinction is anger management is ineffective if it's basically a one-day educational program and my rough analogy and perhaps it's fair or unfair is no different than the prevention driving for traffic tickets. The prevention driving courses do not change driving behavior. It doesn't slow anybody down or make them say, it basically gets a ticket dismissed or it gets you a discount on your insurance. And that's why people engage with the prevention driving classes and it's a big business. But it doesn't change behavior, it doesn't make our streets any safer out there. And so I really push upon the people who are involved in these programs out there that we do need truly effective interventions, especially domestic and family violence issues because of complexity of that issue. You know, is there a batter? Is there a victim? Perhaps there are both. And sometimes it gets very confusing to us as a judge and sometimes to staff as to really what is the reality, what's the truth in those very complex relationships. You know, Judge, you bring up very important points. And because these are such complex issues, you know, as you see the systems evolve, what we've done is we add more. So we've become aware of mental illness or we've become aware of the anger issues or we've become aware of the domestic violence or we've become aware of the, I don't know, I think of something else, you know, the parenting. So we add to the checklist of what they need to do. And more is not necessarily better. And so, you know, I forgot who said this to me. You know, we have to be careful that we just haven't made our cookie cutter larger, you know. And it really is time, you know, and that's the therapeutic courts, the individualized courts. I know it's, we talk about this all the time, individualized integrated programming, but we really need to do that. You know, we need to look at what the needs are of that parent and that child, what their strengths are and really customize that. I know it's hard. I mean, child welfare, CPS is so challenging. You know, it's a lot easier for a variety of reasons to have kind of that checklist that do this, do that, but those things don't work. Because, you know, some parents, most parents probably do need anger management, but maybe that anger management needs to incorporate into their individual therapy, into their family therapy. You know, why can't we incorporate the parenting into the visitation? I mean, you know, and it's interesting, we've made progress. So, you know, we now all talk about visit coaching or therapeutic visitation, which so that the parent can learn the skills to interact appropriately and respond to their child's needs, right? And we can observe, but then we still make them go to parenting classes. Why? So, I think it's really important, and that's why these therapeutic courts, these specialty courts provides us with the opportunity because you bring together a judge that has that commitment, that has the judicial leadership, that has that knowledge with a specialized team to do something different so that we can improve outcomes so we can maybe generalize what we're doing to other places. Because our experience with the Bear County Family Drug Court is to strip that service plan that CPS prepares. And when they kind of start going over the litany of service, I say, what's that for? And they've learned, they better explain it to me as to why that service is needed or not needed. The other one is the use of psychosocials, psychologists, psychological reports. And you know, and it's like, why? I don't know, you know, I just wanted it. And so I said, well, is there a need? But on the other hand, we do have significant mental health issues that really need not only psychological, but psychiatric. Or we need, what's the neurological? Because sometimes there's brain damage or brain injury from past experiences that we don't understand and that's why there's this irrationality that these parents present and we don't understand. And so I push hard on staff of the Family Drug Court to dig down and if we can determine it's a mental illness, then fine, then we know what we're dealing with. Then we can kind of start understanding irrationality or if it's a significant brain injury that they suffered as a child or in a car wreck or whatever because they're a victim of crime or because they were a victim of crime that there's these significant mental health issues. So one of the things we've learned is we kind of have to drill down as opposed to just saying, well, we can't, this parent won't work with us so we're just going to have to terminate the parental rights. It's a big challenge for the staff. Judge, just to add a little bit to that in terms of, I mean, most of you are familiar with FASD, Fetal Alcohol Spectrum Disorders and given that the majority of our children and child welfare come into the system because of parental substance abuse, that's a population that's high risk for that and unfortunately that population falls through the cracks because it's really hard to diagnose and then what do you do? So it's kind of you get that borderline IQ, you get that impulsive behavior, you get the person that doesn't learn from their mistakes and it's like, golly, doesn't that sound like a lot of the families that we're working with? So again, you know, sometimes, I mean, sometimes people don't do stuff just because they don't want to do it. You know, they are oppositional, they are defiant, but sometimes they don't have the skills to do it and so we have to try to teach them how to do it a different way. I'm sorry, there was a question. Yeah, I mean, that's the big issue. When I say mental health, a lot of times it's not the fact we have parents with mental health issues, it's the fact that we don't have the funding to take care of the mental health issues and so it's not necessarily a parent who cannot get it together, so to speak, and it shows the oppositional defiance or the conduct disorders, this is the fact that we can't get affected treatment, perhaps sometimes with medication, perhaps with intensive therapy. I mean, for me, it's all with, as a judge in these specialized courts, especially our drug court, sometimes it's always, I just don't know if it's a chicken and egg situation, what's called first? Obviously, in our drug court, we sobriety is the first thing. Generally speaking, once we get sobriety, we're on our path. We're usually on our path to get these kids back because once we get, but occasionally, Dr. Mellon, and I'm sure in your infertility court, you get sobriety and then the mental health issues just come right to the very top and then we don't have the access to mental health services. Those are tough cases and they come in there and they're oppositional, they're defiant, now they're sober, but now they know how to talk back at me. Sometimes I just don't have to put up the hand and tell them... So obviously, the state of Texas has been very underfunded in terms of mental health services, so we know that. But here are some opportunities. For example, if you do work with the parent and the child, children and child welfare are covered under Medicaid, right? So if we do parent-child intervention to improve the child's functioning, why can't that be covered by the child's Medicaid? Just, you know, we have to think about those kinds of things because we really are working with the parent to improve the child's functioning. So, you know, there's a question there. So another, sort of another potential funding source that Harris County has actually been able to access, not Fort Bend, but helped Harris County with this, is VAWA. VAWA is Violence Against Women's Act Award, something like... Usually for Domestic Violence Act. So VAWA money can be used for some therapy services for your parents that have been victims of domestic violence. So the other one is VOCA money, Victims of Crimes Act. Interesting, that children that are abused are actually victims of crime. So I'm not saying there's a bunch of stuff out there. The other thing, too, is how many of you are familiar with federally qualified healthcare centers? Okay, so FQHCs, they're actually received some federal funding and they provide some level of behavioral health services. Not your very serious persistent, that you have to go to, you know, schizophrenia and all that, you have to go to your Community Mental Health Center, Center for Healthcare Services. FQHCs provide some counseling. They provide some low-cost medications. They provide some support for like depression, anxiety, and so on. So there's little, you know, we have to think of what other options there are for our families. I'm sorry. Any luck? We need to work on that. And that's where as providers, I'm sure we have a lot of providers in the room, you know, the company, the judge, you know, we want to provide services and I'm saying, great, but you're going to have to figure out the funding stream. You've got to figure out how to tie into the funding. And that's a whole bureaucracy. And as judge, I'd like to say, yeah, I can, I'll make it happen. But usually that means me having to deal with the federal government or the state government. And my power can't be limited at times. And so I do the best I can to help facilitate and create this collaboration. But that really gets into the bureaucracies. And you know, instead of discursing the darkness and saying, well, you know, we can't do anything. I say you be proactive and figure out and understand that. Yeah. I know there's providers that as I hear the Medicaid, I mean, that's a nightmare process. It's a terribly bureaucratic. It was very technical. There's a lot of glitches. And so I understand the frustration and saying, I don't want to deal with it. But ultimately these parents and families suffer for it if you can't get that access to funding. So stay in the fight. Yeah. And we have had, I've had several discussions with San Pataco, with the children's Medicaid for child welfare. And we've made some progress. And then, you know, we still haven't made the change, but we've had some discussion. Part of the challenge, too, is getting providers to, that are skilled and want to do this. I mean, and the only way you're going to get the providers is if you increase your reimbursement rate. So, you know, they could reimburse you. But if it's at the same rate, then you're not going to get enough provider. So I think it's sort of like you have to address this at multiple levels to increase it. But I think it's worth addressing again, because now, when we started doing this work 10 years ago, eight, nine years ago, it was like, huh? What is this parent-child stuff? Well, we now all recognize, oh yeah, that makes sense. Okay, so now I think we're really at the point where it's like, okay, let's really make a concentrated effort to say, let's really get some reimbursement strategy so we really can do this, because we know that it makes a difference. So I'd be happy to talk to you more about that. Okay, so let me see. So we know about the parent, you know, all those other slides were about the children, the risk factors for the children. You all know that. So you all know this. I mean, our kids are at risk. We have a serious problem, and we need to do something different. And we need to intervene early and appropriately. So, and it's interesting because there's so many, the system's so complex, so you have challenges at all these different levels. So the courts have challenges, children, the system, the service providers, you know, the reimbursement rates, and of course our families. So it can look really bleak. But there's always hope. There's always hope. You know, to be honest with you, I always get depressed when I listen to the ACE studies. I'm like, oh my gosh, every child that I know has four or more. You know? But then I remember about protective factors. Then I remember resiliency. Not every child who has a parent with a substance abuse ends up in jail. You know? Remember that whole side of that other research? You have one stable parent, grandparent, you have those protective factors. You know, this is just kind of an interesting side note, and I know I'm probably preaching to the choir, but strengths are so important. And it's like, why don't we start building and really focusing on building those strengths? Because there's some new research that actually says that if you don't build those strengths within a year, your treatment outcomes have sort of, you know, gone away. I can't think of a more sophisticated word, but you know what I mean. You go back to kind of your baseline. Those strengths are critical, that resiliency piece. Anyway, so courts, of course, are challenging and can be very adversarial. They are very adversarial, except for Judge Sakai's court and Judge Pope's court and so on. But it's really not a fun place to be. Let me make a comment on that, because what happens is sometimes, and I'm editorializing and so some people are like, I don't know, I believe that or not Judge. But sometimes the system wants to take families and children to the court system and say, you know what, that's where we can fix them, because there's a judge there. The problem is our justice system in principle, and this is where sometimes the lay people, even providers, especially providers, I get counselors and mental health therapists go, I don't want to go back there. It's insanity, it's craziness. But our system is built on an adversarial system. What that simply means is when you bring the lawyers in and you have the traditional lawsuit, it's there in theory to seek the truth. But the reality with an adversarial system with lawyers is that everybody's out to win. It's a zero sum game in the courtroom. And that's the reason why when the system says, we want to take our children and families and, you know, the court, it's not, it's zero sum. Somebody's going to win and somebody's going to lose unless y'all come and that's where the court system has pushed back to create mediations and what they call alternate dispute resolution where parties can hopefully come together. And here, and I'm sure before Ben and Harris they have a mediation process and most CPS courts now employ mediation because sometimes I know there's a frustration or perhaps, you know, CPS has a lot of frustration of, well, why do we have to cut a deal? It seems like we have to cut a deal here to move forward. And I think sometimes what needs to be recognized is the therapeutic issues of these children and families coming through our system because if you're saying, no, I don't want to work anything out, let's just let a jury or judge make a decision, then yes. Anybody who's been on the witness stand and been cross-examined by the parents' attorneys know that sometimes it's not about the truth. It's just being put words in your mouth and having you try to say certain things in a certain way attorneys want to do it. So I kind of give you that primer of our legal system so that when the system says, well, we just got, it is incumbent I think for the therapeutic part for these families is the system recognizes that sometimes you really do have to figure out a settlement. You do try to have to figure out your best and I know sometimes this gets misinterpreted or some people get offended, but sometimes you have to make the best deal and you have to move on because that's what's best for these kids. Because otherwise then when if it's a judge or jury then obviously you got an assistant DA that represents CPS, you got your attorneys, typically court-appointed attorneys and some can be therapeutic in nature and try to help their parents find their way through the CPS process and then you have attorneys that are very adversarial and say, you know what, these people deserve their day in court, they're presumed innocent and I'm not conceding anything to anybody on this particular case and that's why the legal system can be extremely frustrating and I just posit with the fact that sometimes it's not good for anybody, especially for those children. So I just leave you that to say it's a difficult process and there's a complexity to the legal system that it's not black and white and when it's a zero-sum mode I really sit back and I just shake my head going I just don't understand why the parties haven't resolved this but because of the... typically it usually gets personality driven by the lawyers and that's what we usually want to case what I call jumps the track. People have no... they're totally lost from the best interest. It's all about who's going to win and I don't know how many times you've seen that one, Dr. Yeah, definitely. It's sort of interesting because there's this movement around I'm sorry, there was a question? Yes, sir. Oh, thank you. And I think the way I used to do it and I think it's a good way is that we can pull the clients in and say we're a team and we need to work on this together and I need your help to make it work for everybody and that's the only way where everyone's going to win and administratively in the CPS they need to pull the case workers in and say we're a team instead of us against them mentality. The case workers with the clients instead of us against them you have to do it my way and I'm the parent and you do it what I say and that's not going to work. Our clients are oppositional. They're not... that's never going to work. Well, and that's the reason why you see the success of therapeutic court, especially our family drug court and Judge Pope's infant taller court. Basically, yes, it brings that type of concept. Sometimes lawyers have a hard time with that team concept so I respect that they're not team players so to speak and they take pride that they don't play with a team. They're there to defend their clients and so I just leave that with y'all because if y'all work with CPS or you are CPS or you come to the courts you're going to have to deal with that and I know that's very difficult. A lot of therapists get kind of ripped up so to speak in the courtroom with tough cross examination and I had a case the other day where I had six therapists, seven therapists come testify, both for and against the parent and in a sad reality all of them were contracted through the department. None of them had ever sat all together and talked to each other and so here I was to make a final decision on the termination of parental rights one therapist says one thing another therapist says another thing and it's like y'all are living in two different worlds on the same case and the thing was is that nobody would sit together so you can sit back and say well how come did anybody put that together and that's unfortunately because of the process and the silos or the rules or the contract so that's the reason why therapeutic courts I hope are the key to what I call restore to justice which is let's see if we can't put families and children back together again if we're good at breaking apart and sometimes we have to do that by removing children can we do at least take an equal effort to put it back can we put it back sometimes it's like Humpty Dumpty it's broken and it can't be put back but at least I would ask the system and statutorily I would remind that CPS and under the family code is required to make reasonable efforts to put these families back together so it's not just to feel good we're supposed to do that and one of the things that judges and courts can do is they can hold people accountable and you know when I first started talking about therapeutic courts it was kind of this irony I'm like this doesn't make sense all my life I've worked to keep people out of the courts you know so then but they end up in our courts that's how our systems have been set up both on the criminal justice system we have mental health courts now child welfare a lot of people end up in the courts system because of a variety of reasons so when you get to that court as Judge said how do you make it therapeutic and Judge Sakai already talked about those things but courts can be such an opportunity for information for training and for the holding people accountable so my first Judge Pope asked me to work with him for about six months and again it's been ten years but the first time I went to court there was somebody testifying it was a termination hearing and one of the therapists was asked to testify as to their recommendations regarding the parent-child relationship and so they testified to terminate you know that's what they were and I was shocked because I said oh I'm sorry how many and I was just really I said so how many times have you seen the parent and the child together and what did that look like they had never seen the parent and the child together and I'm thinking but that's actually that used to be pretty common practice and a lot of therapists would work with the family right the parent and they would go to court and testify about that parent's capacity to parent without ever seeing the parent so it's interesting because sometimes we have made improvements but we forget about those I think now judges would say well how many times have you observed that parent-child relationship or ask Casa have you seen the parent and the child together whereas before we would get into those situations but anyway I was just also going to mention Judge Pope does this he has a PowerPoint that he runs during court there's no voice right but it's on FASD so basically we have about 10 slides and it just during that whole CPS every Thursday morning there's FASD and it's like if you're sitting there you're going to see the slides and there's an opportunity for education I mean we're not promoting anything we're just educating so anyway this infant toddler court as we talked about it started out of a 0-3 grant we no longer have the grant Casa has been a big supporter I know that they're a big supporter in a lot of the therapeutic courts and CPS Casa actually now has an infant toddler specialist and they have specialized training for their volunteers and visitation so we work very closely with Casa so our Casa workers really support CPS in helping facilitate those visitations the other thing too is think about don't limit visitate when you think about visitation don't limit it to that CPS office visitation can be in a park visitation could be during the doctor's visit why don't you invite the parent to go to the doctor's visit with the child or this ECI visit and I know transportation is a big issue we know that we make slight improvements on that okay so this is early intervention court basically if we intervene early and appropriately we can heal some of the trauma experienced by these children early assessment and intervention matters I mean we've made progress then we regress a little bit because we have problems with providers I mean there was one point in time we were doing a substance abuse right at the emergency hearing we were really intervening very early because we knew that that was an issue now we're kind of back to we're not doing it as well you know you can't wait six months into the case to start services I mean it's just not going to work you know and then sometimes you wait on the psychological for the services it's like really why are you as the judge said why are you waiting on that psychological for the service if you have some other information I know child welfare is going to start using the cans and I'm which we talked about years ago I'm hopeful that that will facilitate that information and help with that service planning earlier on so then what we did in Harris County was actually take the family drug court and enhance it by including the children's services just want to so they actually just received a grant judge Harris County and so what you have there is this is their children's service module is it perfect no but this is the components and you don't use this with everybody you know but these are the specialized children's services that you would add to your family drug court so the clinical staffing around children's services trauma-focused services and planning placement stability you all know that parent-child visitation and bonding parent-child relationship assessment and really those are not rocket science they're not that difficult to do a developmental assessment you all do that already you have your educational assessment parent-child intervention therapy in the cans so the cans child welfare is actually going to start using those PCIT is an evidence-based intervention doesn't mean every child needs PCIT but it may be the ones that have more serious trauma and you know that you need more interventions but I'm hopeful because with this cans you can make we can make better decisions of what services are needed when because sometimes we throw everything on the table it's kind of like okay you got to get all this done that's impossible so it's like let's prioritize they need a place to live you know she needs to get out the mom or the dad needs to get out of that abusive relationship so it will help us maybe prioritize and again I remember when I went to go see Judge Sakai's court I was so impressed because there was like wraparound processes going on in the courts so so that's the children and then the same thing with the parent services module including a lot of domestic violence really evidence-based parenting services as the judge talked about you cannot go to those parenting programs and just get a certificate we really need to think about what it is that the parent needs to learn and how we're going to measure that and it sounds like it needs to go one step past that class the education there needs to be a coaching there needs to be hands on they need to be modeling mentoring I mean that's something that I've picked up you know sometimes these parents there's a limit capacity or they've just been on drugs so long they've become disconnected and so just getting the education that you would think anybody else our own kids could I think we do that with our own kids we continually have to model even though they sometimes don't seem to want to follow that and I think that's what we have to do with these parents I think that's sometimes what misses and sometimes I see in case we're going why can't you get in well you got to teach them so I think there's a teaching aspect that has to go further than just getting a certificate and that's kind of that visit coaching model and really the department I mean really when we started talking about this stuff ten years ago CPS wasn't very happy because we were saying more frequent visitation you know at minimum of twice a week visit coaching but CPS now has a whole toolkit on visitation I mean there's all these best practices and I think you're actually incorporating some of that visit coaching model it's really not that difficult it's kind of preparing the parent for the visit preparing the child for the visit asking them how it went and just saying okay what are we going to work on next time you know there's some basic components you can do it so what we talk so kind of what we're doing in these infant toddler courts is how do you stay connected to your child how do you learn about your child's needs how do you respond appropriately to those needs how do you recognize the impact of their behavior and emotional availability that's a hard one parents don't let me sorry kind of qualify that most parents that we work with really do not have insight into how their behavior and their emotional availability impacts their child and you have to think about where they're coming from or what they're under the influence of or struggling with so judge do you want me to cover I'll do like a five minute thing what are we at on time we have 20 minutes I thought we were only going an hour we have an hour and a half we can finish keep going doctor keep talking so you know we talk a lot about parent-child relationships and so you really you don't need your licensed psychologist to do this sometimes you do if you need a diagnosis and all that so let me just kind of briefly go over this so we have our little one way viewing mirror and if somebody comes in, if a parent comes in for either a parent-child observation or visitation this is the stuff we look at their affect their attitude what do they look like today angry, withdrawn depressed what do they look like their awareness of their child's developmental needs do they know that the baby is making progress I mean we've had a parent this was actually really sad she was actually there was a criminal case she had been a victim of abuse and she was actually found incompetent to stand trial on the criminal case and her parent rights were terminated but she would show up she would show up to visits, every visit you know but she just chronic schizophrenia very serious schizophrenia multiple state hospitalizations we could not restore her to competency she would just make bad decisions about what that child needed in terms of the food would give the child food that had been expired making them sick, the clothes she has a little boy that she named Abigail and so it was really hard but here's a parent because of her serious mental illness she was not aware of that child's developmental needs okay intrusiveness we see this a lot we have this parent that just kind of directs this child and here's a clue if the only thing their interaction with the child is around their phone and if they spend more time texting during that visitation than interacting with the child that's not a good sign so behavioral responsiveness so how do they respond to the child's developmental and behavioral needs when the child starts having a temper tantrum when they don't want to pick up the toys, how do they deal with that and then also emotional responsiveness that's a big area for our families they don't know how to deal with that and then discipline so here's a couple other things so is the parent prepared for the visit does the parent ask relevant question about the child's development does the parent recognize the child's needs and strengths do they know their favorite songs do they know their favorite foods do they bring their favorite foods do they bring their book can they sustain their engagement with their child that's such an important piece because if after 10 minutes they're on their phone that's not good okay does the parent delight in their child's accomplishments so I talked a little bit about the environment that we can help to facilitate this is we have to be prepared make sure we have toys and materials that are appropriate, okay books the one way viewing mirror videotaping if you can if not use your ipad your iphone of course you gotta get permission from cps but what a way to give parent feedback about what it looked like you no longer need that fancy videotaping and of course you gotta get the courts and cps's approval feedback is critical okay allow the transition time for the parents and children so when you wrap up the session okay give the parent in the child some time let the child know when the next visit is going to happen remind that parent that that is really important make the schedule consistent both for the child and the parent because some of these parents don't remember very well so don't change it all over the place if it can always be fridays at three o'clock try to make it fridays at three o'clock for the child's sake okay let the parent know that they're being observed in the expectations so here's just a little um if you want to see things if you want to have kind of see how parent reacts and expectations so the first part of your session is free play hi how are you okay time to power things going and then you leave you observe them during free play then you set up a structure task okay we're gonna do something different can you see if Johnny let's try to get Johnny to work on that puzzle or why don't you pick a toy that you might want Johnny to play with or something see how they do that see how the child responds to that structure task or we're gonna color today let's see how that works then you're gonna do cleanup that's always a good one okay time to go we gotta clean up the toys see how that parent presents that instruction and see how the child responds and when they don't respond see what the parent does and then this separation and reunion um I have hate when I do this but you do it for a little bit first of all say you know we're gonna kind of see I'd like for you to tell Johnny that you have to leave for a little bit but you're gonna come and just see how he responds now we have a one way viewing mirror so we make sure the child is safe but you can tell how the parent prepares the child for the separation when that child leaves that room and how that child reacts is worth a million dollars okay either they don't care they get upset they're looking for the parent and by the way that's the normal reaction if they don't care that's a sign but then you can only do this for 30 seconds I mean you know it's there's some standard like a couple minutes truly about 30 seconds a minute you can tell then how the parent comes back and that reunion is critical if all of a sudden it's like oh you're back you know they get back they start interacting unbelievable usually a sign that there's some secure attachment that again um there's some bonding um when the parent I mean I've had children that the parent leaves and they're just kind of like okay they left again um that really kind of please don't leave the children in the room without being observed so the one way viewing mirror or some way or somebody in there is critical you have to be very careful about that um we talked about that um this is my last slide we have another one a little video but so what can we do we can protect the child we can listen and hear to hear parents sometimes we listen but we don't hear um we can treat them with dignity value and respect we can create opportunities that allow them to be children this is sometimes both our children and also unfortunately sometimes our parents have never been children themselves but that's for the children we allow them to heal we provide trauma informed care we talk about the relationship we talk about the complexity of the needs this continuum of services now I'm a big data person so we gotta evaluate and we have to follow up we know that the after care and truly I added this I think last night we need to collaborate and we need to respect each other this is not easy work um judges I think I believe have one of the most difficult job um in this system um um and so I think there's child welfare workers um all of us and I think this need for us to really collaborate and truly respect what each one of us brings to the table is critical my last one is the video but I don't know if it's gonna work because any questions at this time no go ahead um to exercise an act on that expectation of the community providers and families to have nurturing courts that understand the needs of the family um it is something that we've grown accustomed here in very coming to have judges that are informed and by that I don't necessarily mean about the judiciary property and uh the law but also informed as to the dynamics uh that uh happen that are logical or functional dysfunctional in these families so that they in an informed way the judges in an informed way can um dispense uh the law in a fair way otherwise they're very unfair but still how do you take a good number of judges but for the most part is an infection and it's what needs to be one of the things I'll give you is an observation from our family drug court and I have staff in the room and so what they've learned is I hold them as accountable as I do the parents and I think that's an important message and that kind of goes to the treating people with dignity and respect when a case worker or staff or or mental health provider or somebody comes in there and they're unprepared or they don't know the answer and they should have known the answer they get held accountable by me and sometimes they would call out why don't you know and unfortunately you know I think sometimes there's a feeling or at least I get the impression that judge why are you holding me accountable I mean I'm staff and I'm overloaded I've got too many cases and I just didn't have enough time to get to it and I'll get you an answer but you didn't have to call me out but I think it's important in these therapeutic courts where you're trying to basically have this teen concept and getting away from the zero sum mentality and everybody's got to be treated equally there's no caste system and so one of the things is and I know each judge runs their therapeutic court differently that's the reason why I've chosen to basically and I think Dr. Millie you've seen me I get off the bench take the robe off and I sit at the table and I sit right across from the parent sometimes it's not the most comfortable place to be especially when parents sometimes maintain their high degree irrationality sometimes they come in still under the influence sometimes they still haven't gotten their therapeutic issues resolved and counseling their therapy but one thing that it seems to happen is that if you treat people with dignity and respect generally they will usually come to the right decision and I don't want to hold out that what we do in family drug court happy ever after but what we do get is we do get resolution and sometimes that resolution and we consider a success and we call it a success is that the parent comes to the realization that they cannot take care of their kids because of whatever reason and sometimes they will graciously or just voluntarily upset themselves saying but usually what we get in those situations at least is we usually get a sense of gratitude judge you tried your staff tried we appreciate it we just we have to move on we think our kids are in a good place typically when we put kids with family members relatives for the most part we understand the reality we may terminate the parental rights but it's in family so they'll get to see the kids and so the parents are able to move on and we think that's a success because what we hope for and we hope is that just with their time in court we've seen and I know we've got some anecdotal people who even drop out will get to sobriety people who drop out and don't follow through and graduate will get back into the work force and occasionally we've seen it we've seen them even get their children back even they don't necessarily walk the stage of our family drug court so we don't want to say we're the end all because obviously one of the tough issues for therapy if you say well judge why don't you just keep doing it you know I sat I've had those staff meetings where I go you know we can keep building drug courts and therapeutic court but they're very intensive and they're very small and they have to be if they're going to maintain their integrity consistency and adherence to best practices so what we're trying what one of the things for those in the room here that don't work with CPS in our court system that's what we're calling our bear counter redesign is we're trying to take some of the practice and principles we've learned from our family drug court basically the therapeutic model and trying to back it into our general system say can we look at this a little bit different so when our mother says you know what can we change the visitation then I know I got CPS in the room can we change the visitation process please can we quit just accepting the fact that visitation in one big room with no privacy and then case workers just standing there staring at the kids in the family and expecting positive reports come to the court can we really look at this differently mental health providers understand that yeah there's a tough job but sometimes we're asking you to be proactive and assertive in the system not so much to protect the parents or to defend them but just to get the information and I'd sit there going well I guess I just have to wait till the case worker calls me and tells me what to do and that one case where I had all these therapists that was really one of the responses well nobody told me I had to do that and I said wouldn't it have been helped you with working with this particular client parent sure I would have really loved to know what all the other mental health professionals have done and so it's just as you say we take steps forward and sometimes we take some steps back but what I'm hoping and especially with this type of presentation and the information you get here is that the net is that we're still moving forward we may take a step back at times or how we make the same mistake over and over but if we keep getting proactive and looking at how we can be more therapeutic, more restorative putting children and families together the better I think and healthier our community will be anything else no judging because my little video doesn't work again but you know so follow the yellow brick road and if you remember the Wizard of Oz you follow the yellow brick road to get back home and what do you need you need the lion you need the courage, the tin man the heart, the passion and the scarecrow oh wait the lion's the brain sorry so you need a lion which one's the brain I got this it's the scarecrow and the brains it's the tin man and the heart and it's the lion and the courage thank you judge and the Wizard of Oz is the judge and when you're walking down that hall to the hall of Wizard of Oz that's the courtroom the smoke is going the flames are going and if you really think about it our parents come in there with those big chips on their shoulder I promise you that's what they're doing they're shaking all the way in there and that's probably why we get the negative reactions we do from them in our court system and so we hope that y'all have learned something we're working hard on our court I can't say that everybody in our court system our judicial system but I think what you're seeing is especially I know my friend Judge Pope for a long time I think he's about ready to move on but hopefully there's another generation of judges to come and so as you work with the court system I'm going to press upon you to talk to the judge and work with the judge tell them what you do and how you do and what your thoughts are the judges sometimes will isolate themselves but I think you'll see generationally that the judges are more open I can promise you these young judges have Facebook and I don't have Facebook but they do and there's some issues with that but bottom line is they're pretty open now and you have access to them and so it's an opportunity to share your experiences and share your appearance with them and hopefully they can understand what y'all did we can make a better system so Dr. Meadow thank you for coming down here we've worked a lot together we're hopefully knock on wood we're going to have an early intervention program come up here pretty quickly and we're going to be barring all those things that y'all have learned through the years definitely please contact me and you know there's little things you can do you can all start carrying around a little visitation bag you know just thank you so much thank y'all