 Well, good afternoon everybody and Welcome to the Congress for Children and Voices for Children has done such a great job hosting us again for another great information And I'm also grateful to be here. My name is James Castro. I'm the CEO for St. PJ's Children's Home here in San Antonio and we're an organization that's been around about 130 years Caring for kids started out as an orphanage and now we provide shelter residential foster care adoption Counseling all of those kind of supports for kids and their families and so I am very Grateful to be here with you this afternoon This is going to be an informal opportunity to talk about what does it take to heal children and All of us probably have some ideas what that means and what that looks like and we want to be able to get that from you We have a panel up here. That's going to talk about some of their programs and what they do to heal kids And so we are going to let them kind of get the ideas flowing for us We will then obviously record that but what one of the things that I would like to get particularly from all of us today is How do we take? Some of these good ideas or some of these great programs that some of you may be a part of and take it to scale as A non-for-profit one of the things that I encounter occasionally and some of you do too is a funder will say You know it just doesn't seem to be getting any better You know I keep funding you guys every year and the numbers aren't going down or Children continue to age out of the system and end up in the criminal justice system Or they end up being homeless or drug and alcohol addictions or the worst one of all The cycle of abuse right they go on and commit similar types of offenses to their own kids their own family dynamics And it's hard to have an answer for that. Isn't it? I mean you immediately we go to start talking about what we do well This is what we do and we are making a difference yet when you look at the big numbers statistically It's hard to prove collectively. We're making a difference And so that's what I hope we can kind of get moving towards in this time that we have this afternoon How can we take what we're doing to scale? How do we get the people who who can move the rock? move the rock and so This is the first of this kind of discussion in this forum, but it won't be the last right before I got up here We did have one of our Family court judges judge Garcia as you know He's on the front lines every single day here in these cases and working with child protective services and Admin of attorneys and CASA and providers like all of us and and the counselors in the community and His job is to obviously keep children safe But one of his big concerns like Madeleine McClure brought up earlier is we don't have enough prevention in our community Is there any people who do any kind of prevention services here in this room? Okay? So all right when we get to that I want to hear a little bit more, but And also as we get into some of the solutions, I'll share what the judge had to say about that So let us begin. I'm going to pass the mic To my panelists here to my left and I'm going to allow them to introduce themselves And then when we get to Tony on the end, we'll let her start Since she has her power point up there first to describe her program Hi I'm Anne crowd ace and I'm a doula and a doula trainer. Does anyone here know what a doula is? Yeah, that's so great So for those of you that don't know what a doula is it's a Greek word and it means servant and generally nowadays We as servants Support moms during pregnancy birth and postpartum and one of the things that we employ to help moms is touch I'm going to talk a little bit more about that later No, my name is Jessica I'm the outreach director for Methodist Children's home here in San Antonio Methodist Children's home offers foster care services to children both through The CPS system and on a voluntary basis So not all of our kids that that come into foster care are Through the system sometimes our families recognize that they just need some help right now Which might mean out of home placement So we provide foster care to those children and services to those families as well We have several abuse and neglect prevention programs Both intensive case management in home and also for grandparents who are Taking care full-time of their grandchildren in their home and we also offer a nurturing parenting programs Hi, my name is Tony Heineman and I'm here from San Francisco I met Kathy about two or three years ago at a conference in Memphis and She invited me to come speak today, so I'm thrilled to be here and to talk about scaling Okay, now, how do I get where's Dan Would you'd like to stand up But I want to get the whole Full does anybody know how to make that the whole Down on the bottom slide chef. Yeah, go to the top. Is it all Sorry, so while this we're figuring this out I'm gonna pass around some sheets of paper if you After hearing this would like to be on our mailing list. We'd love to put you on the mailing list So I'll just start some back and You can pass them from table to table So there we go. Okay. Thanks, so I I'll just start talking a little bit And we'll see if we can get it working Okay great How to make it go forward? Okay, so the agenda is a little different because I wasn't quite sure how this was gonna work today, but a Home within is a national nonprofit started in San Francisco. I'm the founder We are now in 22 states and 44 communities and I know that Kathy's real reason for bringing me here is The hope that we can have at least one chapter of a home within in San Antonio Maybe two or three we Promote the emotional well-being of current and former foster kids. We do this through two programs We have our clinical chapters Which is a private practice model? I'm started out in private practice. That's the world I know we ask clinicians in private practice in every community where that we serve to take one current or former foster child Into weekly pro bono psychotherapy for as long as it takes and as those of you who work in the foster care system Know that an open-ended relationship is often very difficult for kids to come by Particularly in terms of therapy where they often see as Williams said this morning interns and sometimes they get lucky as He did That's that's our direct service program we offer all of our clinicians ongoing training and support We have continuing education credits approved by the American Psychological Association and one of the things that happens is that Our clinicians all have ongoing pro bono consultation with senior members of the community and these consultation groups become very important Sorry professional networks The other program I want to talk to you about is We're launching this week. It's a web-based program for non clinicians working in the foster care system and and this includes online trainings curriculum decks and Expertise in relationship-based practices. I have with me. Maybe somebody can help me pass these out, too I Think there's probably one or two one for each table for people to look at so these what we've done is taken what we've learned over 30 years of working with foster kids and Created this is the the work the web-based program and Distilled and synthesized what we've learned and put it into accessible materials for non clinicians working in the foster care system the web the website offers information about typical development at these four ages it Offers information about the impact of trauma on development at each of these ages and then we offer Online training about tips things that you can do to address trauma and they're very very specific We also offer these cards that you can see that we're passing around now Each of the car each of the decks with with the exception of sensibilities is 16 cards on the back of each card is That's in Spanish. They're all Two of them are now translated into Spanish. The rest will be translated into Spanish Trying to find the back of a card So on the back of each card That's not the card There we go on the on the front of each card You can see there's a photograph on the back of each card is a quote a suggestion for reflecting on the quote and An activity that brings it the conversation to a close so the cards are designed to help people have some of those difficult Conversations and how to get the conversation started So and they're all very open-ended so they don't have to be They're not don't have to be provocative So everybody's looking for something one thing that makes it all complete You'll find it in strange places places. You never knew it could be I think that's the kind of thing that a young person can talk about it many many different levels and then to the issue of what's the difference between belonging and Fitting in again, that's the kind of question that could be a very simple short conversation or it can really provoke Provoke a very deep conversation and that's what we're trying to do everything about fostering Relationships and a home within is about relationships and because the evidence all suggests that what cures is Relationships and we know that kids who have been hurt in relationships Then stay away from the very thing that could be helpful to them Which is developing a relationship with a caring adult and that's what we're trying to help people do So I don't want to take up too much time So the fostering relationships materials are available to anybody in San Antonio Anybody any place who has access to the internet those materials are there the information is there There's a lot of information about development typical impact of trauma And then there are these tools that can be used in a variety of settings And we would like very much to come to San Antonio with one of our clinical chapters or two San Antonio is a big place. You've got a lot of foster kids and That means identifying at least one and maybe more Therapists in private practice who would be interested in becoming one of our volunteer clinical directors And that would mean coming to San Francisco at the first weekend in February for training and meeting all of the clinical directors from across the country and Helping us help you get something started. So I'll leave it at that All right, thank you Tony Okay, next Jessica, I don't have a PowerPoint. So apparently I'm a really big slacker So I apologize But how many of you guys heard about trespass relational intervention or TBR I? Okay, cool trespass relational intervention or TBR I was developed by the TCU or Texas Christian University for out-of-towners The Institute of Child Development with Dr. Karen Purvis and Dr. David Cross. They've been working on this for over 10 years it's it's an amazing application of Working with children from difficult places or that they say working from kids from hard places We've had a relationship with them at Methodist Children's home for probably the past three or four years They've been very very gracious in coming out to our campus in Waco To facilitate nurture groups with our with our teens on campus and to train our direct staff and professionals on Trust-based relational intervention and how we can incorporate it into the care for our kids so Basically what it is and this is just in a nutshell I am not as eloquent as dr. Purvis is if y'all have ever have had the chance to hear her speak She's amazing and if you haven't You should She she does a really good job at relaying that the information and what they do but And there's kind of a theme with this with this conference And I've heard it a thousand times already this morning and it's like one of meeting kids where they are meeting our clients where they are that means Setting the bar really low when we first encounter kids, especially those of you that work in foster care You get those emails and it's like You know Baby boy needs placement today Caucasian Like that's great like and you have no other information So we have to meet these kids where they at set the set the bar low and work from there So at some point when children are acting out or if they're having issues They're coming from difficult places the theory behind TBR. I is that at some time or another they kind of got off track Because if you think about it and think about babies think about toddlers, you know, 18 months and younger How many times do we say yes to them a? Lot a lot if you're hungry, I'm gonna feed you you need to be changed I will change you if I was a kid and I went up to you like this What are you gonna do? You're gonna pick me up and if you don't pick me up. What am I gonna do? And I'm gonna cry So that's saying yes as many times as we can to build that trust because at some point they didn't get that So and also working on kind of putting them back in balance near with their neurochemical Issues that some of these kids especially kids that are born and those of you. They're in healthcare like the preemies What are their first experience of touch? Heel pricks IVs Things like that. Do they get said be held like I say normal babies are held Not for a really long time So their sense of touch the way that they perceive touch is so much different than how What I guess normal like I said babies would perceive touch So just incorporating sensory issues and or sensory Items into the care for kids weighted blankets if you have kids that haven't slept through the night and you give them a weighted blanket Chances are they're they're gonna sleep like a rock and It's gonna be for the first time in a long time because if I was to hold a weighted blanket I would think it weighs a ton But when they hold it, it's like getting a hug It's it's so different So just incorporating those things like I said if you haven't heard about TBR I didn't come prepared with a big presentation about it But I'll just give you a couple of the highlights that we've done both with kids on campus and in our foster care program Like I said, we have weekly nurture groups with with the kids on campus in their home units We've implemented really simple life Rules and skills so that's really easy to remember and they can pick it up really quickly Making food and water more accessible to kids How many of y'all need like a coffee in the morning like don't talk to me unless you have your coffee I'm cranky pants if I don't have coffee in the morning So making those food and water available to kids to where they can get it if they need it If they're hungry, you can get a snack You don't have to wait till lunchtime because it when you don't get that snack They're gonna get cranky pants and they're gonna become a little bit difficult to work with and most of the time They're not gonna know that they're hungry because their body is not telling them that they just know that there's something wrong And they need to fix it and they don't want to ask you because they don't trust you yet. So I'm gonna smack her or something so Making those things accessible and both in the home units and in the school. We do have a charter school on our campus We incorporated into our new hire orientation with direct staff with professional staff We've taken kids to the TBRI camp in Brownwood Most of our professional staff and Outreach staff have attended the one week training in Fort Worth and If you have the money to go, it's really worth it It's a lot of money if you don't you know, it's a lot of money Um Yeah, and we also have a sensory room in our school Where if kids need that time out like William was talking about earlier, we have that room available that has different Fidgets or different things that are textured where they can go and fulfill those sensory needs of what they need weighted blankets sitting in a beanbag chair You know something to kind of get them back on track. Yes Sure. Yes, it is at the recommendation of a therapist Um, is there any other questions about I mean, I guess well we're talking about it Awesome, okay Okay, and then in our foster care outreach programs we Majority of us have gone to the one week TBRI training We have six certified TBRI instructors throughout the state of Texas myself being one of them We incorporated into our pre-service training for foster families and they get the training annually every year Um, they the TCU Institute of Child Development has published a booklet that we give all of our foster families We incorporate TBRI techniques and special needs into our service plans for kids And using that language with them TBRI is reviewed in the home every home visit with foster families And we do have that special funds set aside for sensory items if children need it I Have a PowerPoint too Hopefully you can see it It's the bottom one. I don't know who's doing it. It's the man behind the curtain. It's the bottom one That's it, but it's showing up as a PDF think he loaded it Oh It's in the middle Do you see the one that says healing trauma touch that's the one That's the one. Nope the one below it Okay, so I'm gonna talk about using healing touch to help with trauma Okay, I got my little power point tool here. Let's hope I don't mess it up So we're gonna talk about it as it relates to maternity care because that's my realm I don't really know about the older child as much as I do the the tiny little babies So the first thing to talk about is I'm just supposed to push forward, right The first thing to talk about is how do mothers and babies get traumatized in the first place when you're talking about birth How many of us kind of have a perception of birth being a scary crisis emergency sort of situation Yeah, that it's Hollywood helps us to have that perception So what happens is a lot of times women will go into it Kind of expecting it to be a train wreck and that's okay That's their perception if they walk out of it being a train wreck Oftentimes that means that they won't have been traumatized. Does that make sense? So your expectation oftentimes will create How you perceive the experience that you had So if moms walk into it having maybe a healthier perspective of birth in that it's a natural physiological process and It becomes a train wreck Sometimes then they do become traumatized and the trauma of mom then disconnects her from her baby Which can cause trauma for baby so what I wanted to talk to you guys about is how to bring them back together again because Whether you realize it or not this happens a lot in the maternity care that we provide in the US The first thing is is that women often in birth feel because they're so vulnerable they feel powerless. Oh, there it is. Yay okay, so they feel powerless and Because of their powerlessness and because this event is happening to them oftentimes They feel violated when maybe they have an idea of how it should go and it doesn't go that way and they're they're Forgive me for using this terminology, but sometimes they're bullied or pressured into making a decision that they didn't really want to make And that leaves them wounded So then let's see if this works for me. Yay Okay, so how do we make a change? We need to understand the causes of maternity related trauma. That's So very complicated that I'm not going to get into that today But the next thing we need to do is identify those moms and babies who have been traumatized And then prevent trauma and respond to it quickly when it has happened. Sometimes it's in it's unavoidable I mean we can work to prevent it, but at times You know the birth might go awry and or the immediate postpartum and Trauma happens when you know it's going when you know a mom is going to have a cesarean or when you when you know Things are going to get a little hairy in the birth room You can try to do things that counteract the separation or the disconnect that happens But when trauma goes untreated we have these broken attachments. So Mom is a little more apathetic toward her baby. She's not really attached because she's really wounded and she's struggling with things herself baby's not attaching to her because They're not getting that feedback from mom. It causes stunted growth emotional social as well as physical And then you have things like colic and digestion issues postnatal mood disorders like anxiety post-war depression and psychosis Which then leads to neglect and abuse So some of the things we can do to prevent that is Immediate skin-to-skin when babies are first born we know that connecting them with their mom through touch skin-to-skin Can cause? Physiological stability in the baby and that means their heart rate stabilizes their blood pressure stabilizes it's amazing how mom's body is actually cool or warm according to what temperature the baby needs to be at mom's body knows and A warmer can't always catch up to a baby as quickly as the mom's body can The maternal attachment behavior behaviors are seen earlier and more frequently It also protects from separation effects. So even if baby, let's say baby has to go to the NICU or Has to have a surgery later It protects From the trauma or from the separation that happens later that initial skin-to-skin does It also encourages brain development and increases breastfeeding success, which we all know that breastfeeding is very important for the health and the intellectual development of our babies so What are some things we can do we can change hospital protocols stop unnecessary interventions There are hospitals here that are now employing non Separation it's called transitioning at the bedside North Central Baptist actually has that going right now where a baby doesn't get sent to the nursery for a non Medical reason if baby needs to go to the nursery there's a reason for it Otherwise, baby stays with mom and they encourage that skin-to-skin Also educating we've heard this a bunch of times today about educating parents both prenatally and as soon as babies born The organization that I run it's called tranquil seasons and we're a doula agency and we provide a lot of classes prenatally and postnatally and Protect mother's space provide doulas Keep mom and baby together Allow that skin-to-skin, but also not just at delivery, but for the first six months We've seen that that creates a healthier mom baby relationship and And as we know that touch we have kind of a sixth sense, you know if you're sad and someone gives you a hug That lifts you up right our bodies are electric. What do we do when someone's heart stops? We give an electric shock Our bodies are elected we feed off of each other so touch not just with moms and babies, but Adult-to-adult child-to-child That's how sometimes you see that twins have better outcomes when they're left together than when they're separated Because they feed off of each other electrically So once damage has been done and trauma has happened What can we do? the the touch that we Want that skin-to-skin it increases oxytocin, which is the love hormone vasopressin in the father, which helps dad settle down and Typically you'll see that dads will then become more protective and more nurturing When dads get skin-to-skin Prolactin it helps with breastfeeding it also encourages the nurturing response in mom Opioids so when you get the skin-to-skin with your baby you actually are creating something like an addiction because your brain starts putting out Opioids it makes you happy it makes baby happy and then you want more of that So that's a good thing pheromones help baby to identify mom and vice versa Bacteria actually bacteria on our skin and bacteria on baby's skin helps with the baby scent You all know what the newborn baby smell is right that mmm. It smells like a newborn baby and Then also something else that people don't often realize is that your the baby spit on mom's areola When the baby goes to breastfeed Tells the bodies tells the mom's body how to formulate that milk So this form of skin-to-skin is really important because it helps the baby to get just exactly the amount of protein hydration Everything including immunoglobulins within seven seconds that milk is being formulated exactly to what baby needs Physiologically speaking as well as them getting that emotional need met of being touched and Then the other thing is is that babies can smell anxiety. Have you ever heard of people saying you can they can smell your fear? It's true. So when when we're working with babies The more confident that we are the more that babies settle down So when moms can have their babies skin-on-skin with them and be doing things like massage It calms baby down and the more calm that mom is the more calm that the baby is the more trusting they can be when babies have experienced trauma, they're very high in anxiety and they're very Reactive kind of like what William said this morning very alert and to everything century, you know Loud noises different smells it can stimulate them But in a negative way and get them agitated and fearful when you have a very calm Persona yourself and you encourage mom to kind of fake it till she makes it it calms the baby down and In that we're reprogramming their stress response So massage for bonding a couple little tips here It's intuitive. Everybody does it you hold a baby. You're gonna rub their back you know, but The lay person you don't have to have special training. Okay, just think about How you would want to be approached if you were being massaged Especially if you were a traumatized child or an infant you would want to be respected, right? So having someone talk to you and kind of explain what they're doing So when you approach a baby and you're going to be doing massage on the baby You want to talk to the baby and you're gonna explain. All right, we're gonna do your feet now This is your right foot. This is your left foot and then you move on you want to use firm gentle pressure light stroking sometimes can be more agitating and when you lift your hand and Put your hand back on that can actually be a negative stimulus So you want to keep the pressure there and you want to use gentle but firm pressure Using over-the-clothes versus bare skin clothes gives a little bit more drag ability Skin bare skin is fine with mom and baby, but as practitioners We might not be able to demonstrate that right for moms So we would do it over their skin over their clothes also oils are helpful There's different essential oils out there that can be calming like obviously lavender essential oil and things like that, but Using an oil on a baby's skin can also help as far as the drag so you can explain that to mom and the lavender can be helpful to mom too Using it as a daily routine when babies have kind of a routine built in with their parents They have they build an expectation and it provides a sense of security Right, so then they feel safer with that person because they know what to expect As caregivers we should be teaching baby touch before and after birth We should be Hopefully the nurses in the hospital that moms encounter should be encouraging the touch right away immediately upon delivery and then for the next 24 to 48 hours that they're there and Then modeling by postpartum doulas if you are able to Have a postpartum doula come into your home Then she can Explain, you know the benefits of massage and teach the mom hands-on with her baby and help her to learn what her baby prefers and likes So if the if you have a healed mom and baby you have a calm relax secure happy interactive baby who cries less And you have a mom who feels confident. She's interactive. She's calm She's nurturing and she's attentive to the baby's cues which again is building security the more attentive and the more Educated mom can be as far as her particular baby and what those cues are that her baby's giving her the quickly she is the more quickly she can respond and the baby will then cry less and You begin this healing environment where the baby can get over what traumatized them Thank you so much For allowing me to speak today All right, terrific And we're gonna We will take we will ask each of them some questions But I I wanted to bring something to our attention to when it comes to children in in our child welfare system Children who've been exposed to abuse and neglect I didn't share at the beginning that but my training to as I'm a licensed marriage and family therapist And I'm a licensed counselor and prior to my current job. I worked at the Center for Healthcare Services And I know we have some Center for Healthcare Services staff here today. I saw a couple tables But the rest of you may not know but at least when I was there at the center probably about a third of the children that we served We're from the Child Protective Services system. There were referrals from Foster families who were caring for the kids or kinship families most often or the for those children that stayed in their home They were still with the biological family another third was from the juvenile probation system and Some of you also know the juvenile probation system depending upon which county you're from 25 to 40 percent of the kids in the juvenile probation system were first in the CPS system, right? And then the other third that the center sees is from the school districts When the school districts have those children whose issues are most severe Suicidal homicidal behaviors that are too, you know, too much difficult the center would get those referrals Well, we also know in Child Protective Services world. We've seen the statistics That really only about a third of the cases ever get reported, right? Okay, so that means an awful lot of kids out there are receiving some if they got reported or identified abuse and neglect issues I Think a lot of those children are some of the ones that are coming from our school districts So there's awful lot of healing that needs to occur So let me bring this to all of us clinicians The therapeutic environment all of us are providing as a whole as as a new paradigm to consider and that is When child protective services in the court identify that a child is an imminent harm We remove the child right once that's proved we remove the child we get them to a safe place And then the law says certain things have to occur if the child Physically imminent harm obviously they go to a hospital or they go to a place like child safe. They have physically Stabilized as well as some type of forensic interview or crisis Counselor may be interacted with the child depending upon the age. That's all good. Okay Now the child goes to the placement wherever that placement is a shelter or foster home residential Now the law says they also have to get to a doctor within 72 hours of that placement. Correct. All right What is the law say or what did the standard say when it comes to addressing the mental health trauma issues of the child? Anybody know Gotta see a psycho. I heard somebody say psychologists, right? well, the standard say that you have 30 days to get scheduled an appointment with a psychologist within 90 days and That's only if the child hasn't been seen by a psychologist in the past 12 months Right So that's and I'm just speaking globally. This isn't pointing fingers anywhere I'm just saying system-wise It doesn't appear we respond with the same Urgency to address the mental health trauma as we do the physical well-being of the child now That doesn't mean that we all know the children get mental health care, but how is that determined? Well, that's determined possibly by the CPS worker Involved with the case. You need to go see a counselor or it could be the judge or it could be the cost a worker or the Adlinum or it could be when that child gets to the provider. They say yeah, you need to see a counselor or oh, wow You should probably really see a psychiatrist Okay, and so my point is it's a real shotgun subjective decision when children get their mental health trauma issues addressed and So my position and I'm thinking is well if all of us in the field Kind of have this we'll get to it when we get to it kind of response Then it's no surprise that the public is going to have the same response And it's no surprise at times. We may we may not get to Healing children as quickly as we could So part of the solution I believe is that we all Push the urgency to address the mental health trauma of the children right up front So when CPS and the judge is making the decision to remove that child We should also say okay. When are we getting them to the mental health professional? Within the next 72 hours or less if possible When are we going to have the plan to begin the healing? That should happen right away because that's what we do in physical health care You go to the emergency room all the specialists come to you they identify the problem They give you a plan you leave with a plan, and you're already on the road to healing. I Believe we need the same kind of response In our child welfare system to healing the children of the trauma And so as we hear some of these things that are going on here How great would it be when if the judge says this child needs to be removed and It's a baby as we know the percent of five and younger is the majority of the kids that enter the system And that child's taken to a foster home that foster parent knows within the first 24 hours. They're beginning some of this Wouldn't that be great? Okay, or let's say that child is 13 years old and they've just come into the system and we know that they've probably been through years of some kind Of abuse and neglect years We need to begin healing that child immediately and so what does that look like? Where do they go? so Think of that as we come up with some strategies some solutions to Implement some of the healing things that we're going to learn today Because I believe if we all started operating that way the system would respond that way and we too would get better outcomes For what we're doing for our kids Alright, so let me open it up to questions For or our panelists can get more specific on some of their programs Tony first So to that point a few years ago. We did a study For the city of San Francisco to see when kids were being referred for mental health services and what we discovered at that time The average age of which the child children were entering the foster care system was at the age of five and their first Referral on average for mental health care was at the age of 11 and that was after the third placement So when you stop to think you know any five-year-old is happy to go play with a nice lady in her toys But the 11-year-old who's being told you need to go talk to someone That puts makes our job a lot harder when they come into our offices So I think to your point. That's it wasn't until there was some Behavioral problem that they got sent not because of the emotional pain and unfortunately. I think that continues All right. Okay, so let me open it up to either questions or Some of you in the room from particular programs or agencies obviously here in San Antonio or elsewhere What is it that you are doing that you have found to? begin that healing process for children and I'm going to ask you to be a little bit more specific Than just say we make sure they get to counseling once a week Okay, need to let's let's let's get down into the weeds about what you believe is helping to heal children Is this working? Yeah, perfect. All right Anyone out there? Okay over here the question for Anne is do they accept Medicaid? We don't currently accept any insurance what we do is not covered by health insurance straight out as a Straight out claim, but we do help our clients to get reimbursement For Medicaid patients though. We do have ways to get them either discounted or free services We always offer Medicaid student or Medicaid Recipients free admission in all our classes as well. I couldn't hear Yes, yes, and if we can't help them we know people who can So I'd agree that they will accept the referrals even if the clients don't have Medicaid They will either help them get qualified or find another source of service correct. All right Okay Yes She she is again bringing the highlighting the zero to three ages and how important it is that we address and provide the mental health Supports even at that age and and if I could Let me give a shout out to Somebody that here in Texas is pretty popular. Some of you have heard of him. Dr. Bruce Perry With the Child Trauma Academy The reason why I bring that up is because you know what what we all know today In the healing field we all know today at what? age What stage of development The brain should be maturing. We know which parts of the brain are maturing at what age at what stage for a typical child What we also know today for the most part is which part of the brain is Responsible for what type of functioning Okay now those two things together is pretty important because You put that to the age and the and and this and the duration of abuse and neglect that a child may have Experienced and you can start to bring science into understanding how that child may have been impacted or impaired or delayed in their brain development Because of the abuse and neglect and why is that important because then you can start getting specific in Targeting through interventions and activities and stimulation Those parts of the brain to introduce healing and so that's a lot of the work coming out of Dr. Bruce Perry And that's work coming out of others too that here in town. We have an organization. It's a for-profit organization Anybody ever heard of the Brain Balance Center? Okay, they kind of work from the same premise, but they also bring nutrition Into the healing of the child because we also know that the brain is in the body is very impacted by the nutrients and the Elements and all that other stuff that we get all right Any other questions or thoughts? Techniques interventions for healing children But they don't go to us in these situations are very very critical. And so we know that a lot of those children They don't necessarily have to be hospitalized. And so our crisis rested is going to allow us to keep those children in house for two years at times and work with them with proper interventions to be able to help them recognize those signs that are The president That is the crisis and they won't be happy to allow us to you know Intervene And then from a program We also provide a skill building and over you know Child education agency all of our foster parents get trauma-informed Specialized curricula and we also have three foster parents that are going to allow us Those are parents that are interested in providing services for children Not necessarily in a basis of 255 days but being able to work with them For example for a weekend to help with the rest of the needs of the families Because what we know is that the families many times don't have no hope for And then you find that even the children only need that child care that they experience And so they have a real half-time finding resources in the community to get to the rest of it And so that's one of the things that we're really working very very actively at the senate to be able to be remediating our community And so many of you are interested in becoming a foster parent Those are going to be licensed people You know going to be licensed They're going to have the option of just providing services for children You know for these families And then you know we're standing back That's really going to be open in some time in October You know we're going to be able to offer that service to the community And so That's terrific So to summarize because I'm familiar with the Center for Healthcare Services And Selina is doing in this area They're going to start a 16 bed crisis respite kind of unit And so like she said If a bio family or foster family has a child They may not need psychiatric hospitalization But they need some kind of intervention Maybe separation parent and child They're going to have the ability to care for that child In a clinically therapeutic environment And so that is open wind We're going to hire all the staff We're just waiting to be licensed I don't know if I can I don't know if I can I don't know if we're talking to a remedy For the operational We're not going to have our facility We have all the staff And yes you're absolutely right We're going to offer those children to be able To also have access to psychiatric services If they need them But they don't And you know it's going to be a combination You know so they get accessible And you get you know like your support services And so we're really looking forward to that Terrific Okay so there's an example of a new program Something coming on board to help families What else? Yes sir The early childhood well-being program And we target children 0 to 5 That are already exhibiting some behavioral Or developmental issues We worked with the child care centers Having for hope Some of the school districts And Head Start and Early Head Start Both in San Antonio and in the rural areas One of the concerns that keeps coming up Is that for Most mental health programs Look at serving children Who have been diagnosed Part of our goal is to prevent that diagnosis And to prevent sometimes the premature Diagnosing and medicating of young children We have children again that's 2 and 3 That are already being given Psychotropic medication So a big part of our effort Is to try to prevent that So there's a lot of intervention That can be done at that age Without having to turn to the diagnosis Because sometimes it is the trauma That's affecting, that's driving those behaviors And so the medication and some of the interventions Aren't addressing or dealing with that trauma So a lot of what our presenters are talking about Is so crucial especially with that age group And with the parents With the moms and the families But again just trying to promote Catching as early as possible Addressing the trauma And the context of the trauma So we're also working with the teachers And we promote a lot of our interventions With the teachers, with the caregivers And in child care Most child care providers require 24 hours of training And nothing else So they're not prepared to really deal With some of the traumatic symptoms Or outcomes of these children's lives And so we're also doing some training For them as well Terrific Yes Family service association Let me put this out there too As we talk about healing children And I'll take liberally with saying this Like I said I'm a licensed therapist Licensed counselor myself One of the things that I also believe Our industry has done a little bit And again this is just my opinion Is that the profession again Of child welfare Has maybe empowered the clinicians The mental health professionals To be the mighty Oz We're gonna heal the child Okay Yet in the healthcare profession as a whole Yes we go to the doctor And the doctor begins the healing And we understand that And we appreciate that Yet when the patient, us Is home That's where the real healing occurs It's in the day to day normal living Settings And so I would like to hear If anybody and I'm sure There's some of you are that out there What are you doing to train caregivers On being a crucial factor element Partner with the professional In healing children Give me an example of that Anybody, yes ma'am We have children who are ages 0 to 8 And we had an extensive summer program Last year and had no help at all It was chaotic It was horrible for the children For their families, for the caregivers Then we heard of a group that we could contact And ask them if they would come And partner with us And they did The world was totally different They gave training to the caregivers They intervened for our families They intervened for our children We had about as perfect as a summer As we could have We have lost some of the children They are, you know, they're in school now But the group is still working with them And they are to be commended And if you do not contact them And you're in San Antonio You are missing the best bet And they are family services And they really need to stand up And be recognized Because they truly made a difference In the life of our family children Is that the early head start? Are you referring to that? Is that what she's referring to? The early head start? This gentleman Yeah Wonderful, thank you All right, who else? What other kind of... Yes, ma'am We also partner with Fighting Hope They provide free counseling For our girls So we have an obstacle program A summer program And a spring break program This is where administrators And principals can direct girls to our program Who traditionally Will follow to the, you know At-risk definition So our girls, we help them With science, technology, engineering, arts, and math Which are traditionally led by extraordinary men But we are both useful to make leadership With extraordinary women in these views And they also have a So it is a community We recognize though That if you don't interact with Having a home Then all of our good work Will kind of escape the world So we partner with parents And we do offer parents A parenting program Again, we partner with the counselors Who actually participate in our parenting program And they offer on-site counseling For as long as it's needed With their family In addition to that We partner with basic needs resources Because oftentimes The trauma of the violence Is all subject to these Areas that generally suffer Economic divestment And so Instability is there And we might have these great messages But we don't want to adhere To the lives of any girl Or we don't know where that Community comes from So it is about relationships Building And we also work with Our girls who Age out of the program With the high school leaders And the 90% of our girls Have to cast Not fish-emoted Into their next grade again They truly are a reason Of our relationship So we're excited about Being a partner with the counselors And engage with families To offer them the best they really want So they're not as young But they're still Very, very much Rich Sure, very important One of the Things that I've noticed too For being at the same pj's In the six years That I've been involved In child welfare Eight years prior to that Mental health and prior to that You know, private counseling Is we all know That there's also the Challenge of when children Age out of the system, right When they age out of child welfare And this may sound a little harsh But I think Why these children That age out, young adults In 18, 19, 20, 21 They could have extended Independent living But collectively I think we all do a great job Helping children cope But our challenge to ourselves is I'm not so sure we're healing them As evidenced by, again When they age out How much they struggle So how do we also And I'm not saying We come up with a solution today But I ask you to keep Asking yourselves the question Within your own organization How do we extend Our services How do we extend our programs Because I'll start with ourselves At St. P. J's We're a children's home That's what we do We care for kids And then once they grow up Okay, bye-bye, right We haven't historically been There for them But that's part of the healing To still have somebody There for you indefinitely Forever Like a healthy family would That's part of the healing So I ask us as a community What are we doing to be there For these children indefinitely How do we make sure We have the communication Amongst ourselves Or we have, you know Some kind of process, ability To serve those folks Because again, going back to the data It's kids who've been abused and neglected They make up the highest percentage Of those folks that are in jail The highest percentage of homeless And teen pregnancy and school dropouts Yada, yada, yada, right? So that's, I think, another solution We have to come up with as a community How do us child-serving agencies Maybe re-look at our mission To still be there for the kids That we served when they were children And still serve them later on In their adult lives So could I just use that as Why we really want to come to San Antonio Because what we talk about is One child, one therapist for as long as it takes And we have kids who have been Maybe they're not in weekly psychotherapy anymore But they've been in touch with their therapist For over 15 years So there is that assumption You know, the idea of therapy To my mind is a means to an end It's to have a healthy relationship That creates other healthy relationships But the therapist is there inside the child As well as that there's somebody You can call and say, hey, guess what Just happened, this really great thing Or remember when I used to do such and such Not doing it anymore or whatever So I think we really would like to be here And be able to provide that long-term contact For kids in foster care Terrific, alright Other examples of programs that you do That you believe is being impactful In helping heal children Any of our therapists in the room Maybe you have a particular intervention That you utilize and you see it gets great results That you could share with the rest of us Alright, well then let me move us on To the next step And that is as I started with I said how do we take what we Are trying to do here in the congress For children and how do we take Healing strategies to scale How do we collectively Working with our court systems Child protective services Make sure that we're able to Every child that's placed in every Foster home, every family That the child isn't removed Family based services Get to the place that they're Giving access to strategies To heal kids. Any thoughts? George The kids who needed therapy For probably insurance reasons Were sort of shifted to more of a counseling model Because probably quicker and cheaper And I've just sort of seen that shift Continue away from Therapy flash healing to Counseling flash coping And it seems we're biasing Everything towards quick and cheap And we haven't yet acknowledged That there really is a qualitative Difference Right, right In other words it seems like We're checking off the boxes That we're getting the prescribed Requirements out of the way That again maybe the courts Or other powers it be Say we have to do, but we're not Providing the necessary kind of Ongoing follow through consistency I think well I have an insurance Where it used to be sort of open ended Pretty soon they were covering five visits Sure And then it sort of went from there Everybody was covering five visits And then pretty soon you're getting 20 minutes Right, right I think one of the things that Particularly true and I think it speaks What we're talking about is that When you, this is very true In the child welfare system is The people are there to serve a function Not to build a relationship And if you're there to serve a function You can be replaced as long as You get somebody who can do a good job You can just get somebody different to do a good job And I think the same thing is true Is happening in mental health care You're there to remove symptoms Of relationships that will heal And so the focus is entirely different It's really on the behavior rather than The internal processes that give rise To the behavior Of course, yeah It kind of leaves the person out of it It's about the actions rather than the person So wouldn't it be nice too Is unfortunately sometimes our children Are moved in their placements For different reasons and every time they're moved They may or may not get to continue on With therapy or counseling They may or may not get to stay With the same therapist that they may Have started with, okay So to me that would be a strategy That we all encourage or a practice We all encourage and that is Again that the, that the clinician Gets to stay, to be that child's Clinician no matter where they may Further get placed And again making the comparison to health care That is the practice You move throughout the city more often than not You're not changing your doctor You're not changing the pediatrician Yet we've accepted that In the mental health world that that's okay To just keep changing, you know Wherever you're at or just let it go You don't need it anymore Well I think we might be just kind of Again shooting ourselves in the foot Since we've kind of accepted that And maybe we need to be a little bit more To be assertive and insisting That the child get to keep their clinician Wherever they may have started with that Any other thoughts? Yes? I would love to be a counselor For some of the foster care For extended life, life now in the big door To actually move through Just being that honest, I would love it And also with the way it's worded And done with the relationship And I'm very vegetarian in my approach And so as I did it all To have made myself include this other situation Where at my heart I knew this was what I wanted to do So I need to talk about the school system Work together with the school systems I just met with the school district representative Not too long ago suggesting That school districts have a place That leads to our crisis A classroom where they can be Not as punishment and not in the way A place where they can be safe While they're going through this crisis But dead in the family Domestic violence and things like that And then also the little bit of systems That we can pull together And the sense that practices That the medical law may be in their aid Some of the practices be people People in the system And then they do it at the moment And so we can stand together In some way to bring about I think that we can be closer To that community in place I agree On the first one The good news is Judge Specia is willing to look at And he has put this upon licensing His licensing division As well as some of his other directors And that is to look at all of the paperwork And all of the layers of stuff That has to be done And start asking where could they simplify So I'll bring that example back As part of those conversations So we'll put that out there right away And hopefully we can get some movement on that So that's good Regarding the school environments Anybody have you experienced that Where a school or a school system Has some kind of safe place to go For a child? The happiness that I've seen in my life And I normally did it in my school And what I could see Is something called Why This was a community thought And it became more complicated But it occurred to me that this child Made its place A safe place Where her needs could mean that Like evidently Promotionally in all ways And so then like that's when I Also opened a school or a representative School And what ended up happening It comes down to violence So how do we do violence What are your thoughts I don't know I pay taxes Let's see if somebody else did that Do you think that that's me Very good Yeah I would agree That's something we've talked about And we do a little bit Over there at St. P. J.'s Children's Home Is allow that safe place Kind of we all need our distance at times Yeah I was just going to talk about I know I mentioned a little bit earlier That at our charter school We have the sensory room Now if kids need that time That you know Now we work with teenagers on our campus Of course it's a little bit dramatic It's like Miss I'm about to flip this desk Then it's like Okay do we need to have a time in Because we don't call it a time out Time out is like you know We're sending away The time in is We're going to go to this room You do whatever it is that you need to do Whether it's You know do a puzzle Or hold a blanket Or something to help you Go from here To right about here And then I'm here when you need me So it's investing that time Our teachers are investing that time Well our aides are investing that time At our school to Walk these kids down to that sensory room And you do what you need to do And when you're done We're cool And then it's done We don't bring it up again Once it's done It's done and we move on And they get praised for You know hey thanks for asking That you needed to go out Instead of flipping my desk You know they get that That praise that they've asked They recognize what they needed at that time And then we went and did it And now we're good So it works And the number of like Containments The number of write ups Has dramatically increased We've incorporated that room Very good Alright Anyone else? Any suggestions? Any strategies? Any practices? Yes ma'am In providing care for the boss I started giving out You know a new vehicle But then I shared it with a family Session that I was going to give a boss With here and the children Because it's really important that You bond and be able to be That healing relationship With the child at the time of their New year I think it can get into the Decrease of multiple Places that are not as good Or if you have a new vehicle Or if you have a new child I was wondering Especially when you were talking about Foster children And their past and life Sure I'm sure we all agree The more we can support The caregiver of these children Their bio family Foster family Kinship family Whoever that may be The more we can support them In building that relationship Working as caregivers As parents We've all got our own Charities and triggers And those sorts of things So as most of we can get Those out of the way So we can have that relationship With the child Absolutely that's going to bring Very impactful for healing Of the children We had not to get too Too and you all have these Examples but again Like I said at the beginning How do we take this to scale How do we get everybody To have these kind of commitments No surprise these children They run away a lot too don't they Right we've experienced that Okay And yet When children run away often It's the system It's very difficult Whoever was that provider They may say oh Well I can't care for that child Anymore they're just you know They're more than we can handle And then that There's that next placement That next placement But if we could get to that Place collectively That even those children That run away And they ran away from That organization Or that foster family Kinship family said Okay we're going to give Them another we're going to Give this another chance Give us another chance And give us another chance Even if we made a dent there In the runaways That would begin healing for kids That one example If we could reduce How often a child has to move Because they ran away So there's one take away We could work on I think I saw a hand up back here We're almost out of time But let me ask Put this question to you then Besides San Antonio Not having a home within What else are we missing What do you think we need What would contribute Towards the healing In our community For our child welfare system For the kids that we serve Anybody have any of you Ever thought You know what Why don't we do this Or how can we Don't have this kind of Program here Helping dads Understand that And kids do you know If I see a lot of dads And that There's nothing wrong With that Or I'm just Spelling out of the room And that's not That helpful to anyone Okay So just having a more nurturing program That are focusing on Educating dads and power Over their kids And how do we Have that emotional Connection Did you say Southwest Keys Nurturing father program Responsible fatherhood Okay Very good About how many Do you guys Get to You serve a year In that program I just started Okay Very familiar Okay Is that a referral By CPS To your program To that Okay Terrific Very good I believe The children's shelter Has something similar Right Some kind of fathering program Alright Anybody else What else does San Antonio need Right Right Absolutely So yes Getting into the school systems And I know there are some groups That are working on that Trying to That things happen So that's a good thing Eventually Any other thoughts Yes I think there are a lot of children In the same way Like the video that we saw About communities Where the kids can actually Go outside and play And we've seen a lot of problems Because of the lack of Bidending That the children Have been dreaming of So much I mean 90% of the kids The officials have seen Right now The officials are buying the deal I think that Has community Promoting those activities You know In which They can go out And party And chat And organize In a way that children Can be You know The children Because Not necessarily Every sometimes They need to work To get You know Play with kids In the school But outside of that They don't Have a good That's a great point You know Again our children Coming from abuse And neglect Backgrounds Often they did not Get the chance to play Play is very therapeutic Play is very healing Right And it doesn't have to happen In a formal structure Such as play therapy Right So the Encouraging Foster families Kinship families Coaching them Teaching them How to play With the kids Absolutely That would be something We all can encourage And remember all the time Very good Alright Anyone else Yes So I think that everyone Should have a doula Obviously But You know When I work with families It doesn't matter what Socioeconomic background They're coming from We work with them We get to know them Throughout their pregnancy And then when the baby Is born We're not just seeing a baby Be born We're seeing a mother Be born And hopefully If we've done our job Correctly She's equipped She's patient Because she understands The baby's language And she understands What her own needs are And that right there Even Oftentimes We work with moms Who are at risk for depression Because maybe they've experienced Depression before Or postnatal depression With other children And just by Getting them some sleep Getting them some practical Help in the home And that social support And having someone That they've gotten You know Got in the relationship Going with That they can trust That is You know The source of information And of wisdom They then have someone to turn to That they can really rely on For good information And when they're frustrated They can go to that person So it's That relationship And when you have a doula Because we're your servant We're there to Boost you up Not to have any kind of Judgments But to take you where you are In the situation that you're in And to help you Become the best mom And the best dad That you can be Yes, we do. Yes, in fact We've done births Mila who's Wave at everyone Mila She and I did a birth Not too long ago Where we had dad on Skype During the delivery So I mean We do We do provide Free and or low cost Care for military families It would be Lovely If Insurances would just pay For doula services outright We do cut The cesarean rate in half We cut Abuse rates You know In half or down to nothing If you look at some You know Some agencies And It would It would really behoove The government to pay For doula services But unfortunately They don't yet Although we're working on it So Thank you for asking that Question The military is very dear To our hearts All right Well if I may I'll just kind of Leave you all with That Was there another question Oh yes sir One of the things That The team Are having a lot Of connection And Our social services We don't have a lot of Melons It's mainly As females And One of the things That I'm Participating in right now Is the Volunteering program And the school system We sell Lots of Ones Basically A lot of it Is going into the programs Going into the school System gym To help them act There's nothing to do With some of our programs But If you Are Various other males There's A number of others To join Some of these Programs Like Our Our kids Who are Traumatized And In the School system as well You can see Some positive Role models As far as our Mentals Are concerned I saw that I went into the school And It's a That's a great idea I like the name By itself That's pretty cool Very good The Watchdog We'll kind of Promote that Where you can get your Chance too But like Okay So I just kind of Like to leave you all With One of the things That I'm Participating in The school system Is That I'm Participating in The school system And I'm Participating in The school system I just kind of Like to leave you all With One of the things That I Appreciate about All of us That are In this field And Obviously the staff Where I work At St. PJ's Children's Home Is you know If you have The desire To do The right thing If your Intention Is pure Right You think And you believe You're giving The right Solution At the moment That you wanted Okay Again we're not Mind readers Yet Keep that with you It's important Not to get Down on yourself Second Guess yourself Yeah Learn Learn from it If you didn't get The result That you had hoped for But continue to believe That you're Doing the right Thing I believe That people Who believe They're doing The right thing Then we're Able to overcome All of those That we didn't go The way that we had hoped for When their child Did run away If you desire To do the right thing Then more often Than not You're going to get Good outcomes So I just Want to leave you With that Remember that And thank you All for what you do God bless