Sunday, August 07, 2011

Connection Post Discharge

I received a call last week from a woman who is a relatively new CEO of one of the agencies we have trained. She had discovered that her agency had a policy that clients once discharged are not allowed to have contact with the agency for two years. She asked if this seemed consistent with trauma informed care.

My answer is no. Why did we all have these policies once? The time frame may have differed… six months, a year… but contact and return visits were forbidden for some period of time. It was explained to me that contact was not allowed in order to help the clients form new relationships. If they had contact with their former treaters this would block the new relationships in their next setting.

We don’t apply these odd ideas to ourselves or our own children. If you start a new job are you forbidden to talk to anyone at your previous job? When your daughter goes to college do you forbid her to talk to any of her childhood friends, or to her family, in order to encourage the formation of relationships at college?

No, because in fact contact with existing relationships actually supports the formation of new ones. We are trying to teach these kids that relationships are worthwhile. How can they be if they must be arbitrarily severed? The old relationships help us feel safe and cherished, and give us the courage to connect with new people. They are there to offer sympathy and advice when things don’t go smoothly, and to encourage trying again.

I believe that kids should be allowed as much contact as they need when they are discharged, and their new placement should support and facilitate such contact. This applies no matter whether it was a positive or a negative discharge. The teams at the two places should work out a plan that they both support. It is especially important when discharging from a higher to a lower level of care. From their many years in the system our kids know how to get themselves back to a higher level of care, and they are very skillful at it. If the only way they can maintain their connections is through dangerous behaviors, they will do so. Instead, let’s set up many opportunities for the child to share with former treaters his success, his life events, and his new relationships.

Occasionally, but not often, an individual child who has been discharged will return to cause havoc. She will tell the current residents bad things about the staff, or offer to help them run away. Then individual plans can be made for that child, such as speaking only with staff. As usual, the team should consider what needs the discharged youth is trying to meet, and whether they can help her meet them in a more positive way.

One other caveat is that individual staff should not have contact with a client outside of the structure of the agency. They should not become mentors, friends or confidants with a child they treated, as this opens all sorts of opportunities for real or alleged boundary violations and moral dilemmas. And they should not friend former clients on Facebook or use any of the many ways technology enables us to keep in touch.

Clients should be redirected to the agency. They can call the unit or programs, come to visit, write letters. As they discover that people still exist and still care, they will have more courage to form new relationships wherever they travel.

How does your agency handle post-discharge contact? PLEASE click on “comment” and tell us all what you do and why, and share any experiences you have in this area. Thank you.

No comments: