"The mission of the Mental Health Division is to promote recovery and safety."
A Parent's Guide to Individualized and Tailored Care
More Resources: Paper Boat Website | Community Partners Inc. | University of Vermont | Research and Training Center on Family Support and Children's Mental Health | Georgetown University Center for Child and Human Development
An Overview of Individualized and Tailored Care
In other states, Individualized and Tailored Care (ITC) is known as Wraparound or Child and Family Team. ITC is NOT a program, a type of service, or family therapy. It is a process based on the idea that services should be tailored to meet the needs of children and their families. There is an underlying value and commitment to create services and supports "one kid at a time" to promote community-based options to support children and youths with complex needs and their families.
Often one or more agencies are involved with the family and work collaboratively with them and others who are close to the family. They function as a team to support the family, and each other, to work towards common goals. Usually an ITC Facilitator works with the family and team to discover the family's strengths, set goals, determine major needs, and develop strengths-based options to meet those needs.
In this process your child, family members, and other people YOU select are part of the team. This is your family's team. Together, you develop an ITC plan to support you and your family. This plan is built around the strengths of your child and family. This is called strengths-based planning. This plan becomes your family's plan of care.
The following are the steps in developing a plan of care for your family. Each step will be explained in further detail on the following pages.
- Getting to know your family and their strengths
- Decide who should be members of your team
- Start the meeting with strengths
- Set team goals
- Determine needs
- Prioritize needs
- Brainstorm options to meet needs
- Decide which options the team will pursue
- Team members make commitments to do different tasks
- Develop a safety plan
- Evaluate progress and modify plan as necessary
Remember, just as no two families are exactly the same, no two ITC plans look exactly alike. This is called INDIVIDUALIZED planning.
BEFORE THE TEAM MEETING
1. Getting to know you and your family
An ITC Facilitator will meet with you to get know you and your family
and to establish a relationship with you as a person. The ITC Facilitator
will want
to get a good understanding of your family's history from your perspective
and what has been helpful THE TEAM MEETING
have for your child, your family's strengths and needs, and your situation.
You will notice that your ITC Facilitator will ask you questions about
things such as your likes, dislikes, hobbies and interests, what you
are good at doing, etc. The same kinds of questions will be asked about
each family member. The facilitator looks for strengths in order to
1) learn about your family and child 2) get a balanced picture of your
family (perhaps people have only heard the negatives and problems) and
3) discover what resources your family already has. Resources may include
other family members and their skills and talents, neighbors, community
resources, and whatever has helped in the past. This is done to discover
your family member's strengths. Since ITC is a STRENGTHS-BASED
process, service plans are built around things your family likes, is
good at, has interest in, and what has worked in the past.
2. Deciding who is on your team
The people you choose to be on your team may include close friends, neighbors, church members, your child's coach, perhaps people from work and perhaps, if appropriate, your child's friends. These should be people who know your child and your family and perhaps have helped you out in the past. Include agency staff who are already involved with your child and family as well as a parent support (such as a parent who has previously had an ITC team) and your child's case manager. Youths should have some say on who is on the team.
It takes time to feel supported by your team and it helps if you start with team members who you feel comfortable meeting with. Remember, other people can be added later.
THE TEAM MEETING
1. Start the meeting with strengths
Your strengths are what pulls you through periods of crisis, not your weaknesses and problems. We need to build on the assets of your family and enlist the help and support of your family's friends, relatives, and neighbors. This supports your family's existing community who will be there over time.
At the first meeting the facilitator will explain that the process utilizes strengths-based discussions and creative problem-solving. They will lead a discussion on how the team will make decisions. The meeting should be framed as a strength-oriented discussion on how to support your child and family. Meetings should be blame free and family friendly.
The facilitator will post the child's and your family's strengths she discovered during previous meetings with you. The facilitator will ask other team members to add to the strengths list so they can buy into the process. THE STRENGTHS OF YOUR FAMILY AND CHILD AND YOUR TEAM ARE THE MOST USEFUL PARTS FOR MAKING THE PLAN WORK.
2. Set team goals
This is the most frequently overlooked activity in the process but it is very important for these reasons: 1) the quality of the plan depends on doing this activity 2) this determines what the plan will look like and 3) it gives the team a sense of movement and purpose. These outcomes are like a map that tells your team where you want to go.
Most facilitators use one of two methods.
Futuring: The facilitator will ask team members to pretend that they are a year down the road and your child's life is better. The facilitator will then ask the team to identify the characteristics that describe that better life.
Normalization: The facilitator will ask the team to describe the life of a typical person who is doing okay and is of the same age, location, culture, and gender of your child.
When the goal or outcome statements have been identified, and agreed upon by team members, they should be written. The team will use these to determine progress and if necessary, to change the plan.
3. Determine needs
Once the team has decided on the outcomes it is time for the child and family to identify needs. Be careful not to list services. For example, a tutor, mentor and therapy are services, not needs. These are only one of many ways that a need might be met. Some examples of needs are someone to talk to when upset, help with homework, help with making friends, a way to help John to be able to ride the bus without getting kicked off.
Be sure that your team looks at all the life areas of your child's and family's life when listing needs. In ITC these are called LIFE DOMAINS. The life domains include: Home/Family, School/Job, Financial, Medical, Legal, Emotional/Behavioral, Social/Fun, and Spiritual/Cultural. Be sure to include needs of all your family members across all these areas. This is called a FAMILY CENTERED approach.
4. Prioritize needs
Once you have listed the needs, the team prioritizes them to determine the importance of each need by voting. The team should think about how these needs relate to achieving the outcomes you decided on earlier. There are many ways a team can vote.
The team should begin working on the three to five top needs. Any more than that is impractical and could be discouraging for team members.
Be sure that you are honest and choose the needs that are important to your child and family so you can reach the outcomes you have chosen. Remember, THIS IS YOUR PLAN. You and your family have to live the plan. Everyone else provides the support and resources to help you and your family carry out the plan.
5. Brainstorming options
Next, the team will take a close look at the needs that were chosen. For each of these needs, the team should list ALL POSSIBLE OPTIONS that might help meet that need. This is done quickly without any judging, criticizing, or discussion. Suggest ideas no matter how strange, silly, or impractical they may seem. The facilitator should write down every suggestion so the entire team can see the list. This is called BRAINSTORMING. The team can get as creative and inventive as possible! No options are too far out.
For example, if the need was "Help with handling anger," some options might be:
- Take an anger management class
- Tape-record thoughts to discuss later with an adult
- Design a volcano
- Learn bio-feedback
- Master karate
- Take up jogging
- Become a peer conflict-resolution person
- Start an "anger journal"
- Work out at the health club
6. Decide options team will pursue
The team will look at the list of brainstormed options and decide which strategies (options) to use to meet the needs. From the list of all possible options, choose only those that you can match with strengths (look at the list of strengths that were listed earlier). Do not choose an option just because someone likes it, or because that service or program has an opening. When an option matches the strengths of family members it is much more likely that it will work to meet that need. For example, if Tommy is outspoken, honest, stands up for other kids, and thinks it would be neat to become a lawyer when he grows up, the options to help with handling anger in the example in Step 5 might be:
- Become a peer conflict-resolution person, or
- Tape record thoughts for later discussion.
Putting him in a room by himself for time-outs would probably not work since we know how verbal he is.
7. Team members make commitments to different tasks
When the team has developed a plan, the question of who will do what comes up. Remember the team is there to support you. You should not be doing all the tasks on the plan and conversely, you should not expect the other team members to do all of the tasks for you. Remember a team works together and you are part of the team. The facilitator should encourage team members to do whatever they think they can, or should accomplish. When people have committed to tasks it is important that target dates be established so the tasks are completed.
8. Making a Safety Plan
Keeping you, your family, and your child safe are VERY important parts of ITC planning. You have probably lived through frightening situations with your child and may be worried about what may happen because of certain behaviors. You and your team will talk about things that could possibly get out of hand in the future, and what this would look like for you in your home or for your child in school. Be sure to imagine the very worst of your fears. This way your team can prepare for whatever may happen.
The SAFETY PLAN will tell what steps you and your family will take to prevent a crisis as well as steps to take if something does happen. The plan will tell who else will help to keep you all safe. This plan should work any time of the day or night, and any day of the week. It will be simple and easy to follow. It will include "who, what, when, and where." Who will help? Who will call who? What should you do? When will the call be made? Who will go where?
Your job is to make sure that you have all the supports and resources you need to carry out the plan. If there is even one part of the plan that you think will not work for your family, be sure to let the team know. You need a safety plan that will work for you and your family or it will not keep you safe.
9. Evaluate progress and modify your plan as necessary
Within the support plan, each goal must have outcomes stated in measurable terms and the progress on each monitored on a regular basis. For example, one of Johnny's goals might be "Help with handling anger" because Johnny was having anger outbursts several times a day. The team might pick a strategy based on Johnny's strengths such as learning karate. If Johnny was having anger outbursts three times a day, the outcome might be to reduce the number or intensity of the outbursts. This gives the team a way to measure and evaluate progress and to determine if the plan needs to be modified.
Helpful Hints:
Be honest and let your team know what you really think and what your family really needs. Let them know what's working and what isn't and why. Work together as a team to try something new if something is not working. Celebrate every step towards success, no matter how small.
Hang in there! Keep working together to make life better for your family. You can do it!
What grade would you give YOUR ITC? ____ Community-based? - Services are based in the
home community of the child and family ____ Individualized? - The plan considers all aspects
of your lives and is flexible to meet ____ Strengths-based? - Services and supports are
based on identified strengths of your ____ Family access? - Are you included in all meetings
about your child and family? ____ Family voice? - Are our family's choices, preferences,
cultural values and ____ Family ownership? - Do you and your child feel like the ITC plan is YOUR plan? ____ Blend of formal and informal resources? ____ Respectful of your unique family culture? ____ Hopeful "never give up, we can make it!" attitude? ____ Outcomes? - Is there a way to measure progress to tell if things are getting better? |
Statewide Action for Family Empowerment
of Washington
We gratefully acknowledge the Association for Children's Mental
Health
Lansing, MI
