The FIRST Program

Bluewater Family Support Services Inc. (hereinafter known as Bluewater), opened to provide care in 1982. Bluewater is a network of foster family-based intensive support homes located in both the rural and urban areas of southwestern Ontario. Licensed by the Ministry of Community and Social Services, Bluewater serves a co-ed population of children and youth ranging in age from newborn to eighteen years.

Intensive Support Philosophy

Through trained Intensive Support Families, Bluewater provides family-based, individualized, responsive, safe, and trauma-sensitive (FIRST) care for troubled children.

At Bluewater, there is an uncommon commitment from staff and Intensive Support Parents to caring for troubled children and youth in family homes: while family may have torn them apart, we believe only family can put them back together.

Bluewater children often display evidence of a serious emotional disturbance (SED) and/or remarkably concerning behaviours. They often have problems functioning and struggle to face the significant family issues that have resulted in their placement outside the home (often in multiple foster homes and residential treatment prior to the referral to Bluewater). They are frequently young people with impaired attachments to others, affect regulation and modulation challenges, and beleaguered, easily exhausted, social competencies.

Bluewater Family Support Services is an intensive support program offering a unique philosophy and methodology to private foster care with troubled children. At Bluewater, foster families are families, too. In some ways, Intensive Support foster families are unique: not every family could invite a troubled child to be part of their home and family life. However, in many other ways they are no different from other families. The life of an Intensive Support Parent often looks like everyone else's (with some "exciting" exceptions). We know one thing that makes Intensive Support Parents unique: they all share a deeply held conviction to give something back.

Foster families are families. How a family is structured and organized is important. Attending to the structure of families enables Bluewater to be respectful of the unique strengths of each family. Bluewater's trauma-sensitive program attempts to maximize those family strengths to promote positive change for children.

Just as importantly, Bluewater family support workers know how families live, especially Bluewater families. Bluewater's FIRST program is supervision intensive. Bluewater staff are engaged with the families they supervise. To Bluewater families, we hope the message is, "we will help you stay in charge of your family when the turmoil of a troubled child in your home erupts."

At Bluewater, special needs children occupy a position within the Bluewater Intensive Support Family that may be unique to their experience the position of a child within the family. An important, although often overlooked, dimension of healthy psychosocial emotional maturity is knowing where you "fit"; experiencing that "fit" within a family is an important element in uncovering that knowledge. To paraphrase others, we believe children are normal in normal situations and "crazy" in crazy situations! It is our responsibility to try to create as normal a family environment as possible.

Bluewater provides intensive support to children in a family setting. These children need families with parents who understand the underlying causes of troublesome behaviour and have skills to help children manage their behaviour. They need parents who understand this is an opportunity to help children acquire and develop the skills they need to manage their lives more effectively. They need parents who are skilled at joining with children who are working to overcome their struggles and who can craft the healing power of the family in a planned way every day. They need parents trained, supervised, and supported by the family support staff of Bluewater.

Natural Family

Bluewater encourages the involvement of the child's natural family in the intensive support process for the child. The nature and degree of family involvement varies depending on the wishes of the child and his/her family, the recommendations of the Placing Agency, the Courts, and the observations and experience of the Intensive Support Parents and Bluewater family support workers. The Foster Plan of Care addresses the ways through which all parties support that relationship.

Religion

Bluewater ensures the child who actively participated in a particular religious observance can continue to do so. In addition, many Bluewater families expect children-in-care to attend church with them as a routine part of their family life.

The foster care model at Bluewater is based on our current knowledge of developmental trauma and its impact on children and their behaviour. In 2008, Margaret Blaustein and Kristine Kinniburgh introduced ARC: Attachment, Regulation and Competencies. Providing a neuro-developmental framework of intervention with children of trauma, ARC provides the conceptual framework for the Bluewater model of intensive foster care.

Very simply, Blaustein and Kinniburgh (2008) suggest regulation precedes attachment, and attachment precedes the development of social competency. In other words, one must be regulated to become attached and it is within the security of attachment that social competencies can be developed and mastered. In brief, this is the process Bluewater attempts to capture.

11 Principles of Care

1. Eye contact, voice tone, touch (including nurturing-holding), movement, and gestures are actively employed to communicate safety, acceptance, curiosity, playfulness, and empathy. These interactions are reciprocal, not coerced or threatening.
2. Opportunities for enjoyment and laughter, play and fun, are provided unconditionally throughout every day with the child.
3. Decisions are made for the purpose of providing success, not failure.
4. Successes become the basis for the development of age-appropriate skills.
5. The child's symptoms or problems are accepted and contained. The child is shown how these simply reflect his history and how they need not be experienced as shameful.
6. The child's resistance to parenting and treatment interventions is also accepted and contained and is not made to be shameful by the adults.
7. Skills are developed in a patient manner, accepting and celebrating "baby-steps" as well as developmental plateaus.
8. The emotional self-regulation abilities of the adult must serve as a model for the child.
9. The child needs to be able to make sense of his/her history and current functioning. The understood reasons are not excuses, but rather they are realities necessary to understand the developing self and current struggles.
10. The adults must constantly strive to have empathy for the child and to never forget that, given the child's history, the child is doing the best the child can.
11. The child's avoidance and controlling behaviours are survival skills developed under conditions of overwhelming trauma. They will decrease as a sense of safety increases, and while they may need to be addressed, this is not done with anger, withdrawal of love, or shame.

Modalities

Bluewater has a long history within the foster family-based treatment community. While Bluewater believes in the primacy and power of the family to promote and generate health, Bluewater teaches and utilizes a number of therapeutic tools to empower Intensive Support Parents in their work with children:

• "Parenting Skills Training: the ABC Model" developed by People Places, Inc. is a well-researched, effective training model for behaviour management;
• The "narrative approach" offers Intensive Support Parents a conversational and naturalistic model for therapeutic dialogue with children;
• "Understanding Traumatized and Maltreated Children" features the work of Bruce D. Perry, M.D., Ph.D. presenting comprehensive information on the primary problems facing maltreated children and dynamic approaches for effective care-giving for professionals and lay people alike;
• Child care;
• Psychological assessment;
• Psychiatric evaluation;
• Art and play therapy; and
• Cognitive behaviour therapy.

Goals

Bluewater believes in "normalization": attempting to integrate the child as much as possible into the family and community. Consequently, expectations of the child are consistent with the Intensive Support Family's norms while remaining appropriate to the child's abilities. In addition, Bluewater encourages a strong life skills focus within each home.

Bluewater believes improved regulation is a desirable outcome. Post and Forbes (2006) write, "Regulation is the ability to experience and maintain stress within one's window of tolerance." Trauma significantly distorts the ability to experience and maintain stress. As an outcome, Bluewater strives to ensure the window of tolerance for each child-in-care has greater range.

Bluewater does not operate a specialized school program; children attend local, community school programs. (On rare occasions, Bluewater purchases specialized school services from other facilities.) Programs are usually available within the community school system to facilitate an appropriate placement.

It is our hope that "children will not be discharged from Bluewater due to poor functioning or troublesome behaviour." Bluewater hopes every child's discharge is to a less restrictive setting: regular foster care, transitional living program/apartment, extended family care, biological family, or adoption.

Bluewater accepts for placement a broad spectrum of children, including those with aggressive, acting-out behaviours, impaired relational skills, attachment difficulties, maladaptive coping patterns, significant development/maturational delays and deep-seated emotional/psychological problems. Within the FIRST program, Bluewater accepts children for placement who have experienced significant traumagenic events and children who are developmental trauma survivors.

A small percentage of the population is mentally or physically challenged.

Gender on Referral

Bluewater serves a co-ed population with an approximate breakdown of 58-42% male-female. The majority of children in placement with Bluewater are wards of a Children's Aid Society.

Referral Trends (Historical)

Referral and Admission

Bluewater requires written background information on the child from the Placing Agency to make informed decisions regarding the child's appropriateness for the program and for appropriate placement decisions.

Agencies are encouraged to call Bluewater prior to initiating a written referral, to allow for a preliminary screening. After an initial determination of placement possibilities, Placing Agencies send a referral package. Upon receipt of this, a further evaluation is undertaken regarding placement possibilities, and a preliminary visit may be set up with the child and his/her worker to obtain a further reading on the child's needs. The format and duration of the pre-placement visit(s) may vary depending on circumstances, time available, agency preferences, and needs of the child. When this is completed, Bluewater and the Placing Agency will set a placement date.

Documentation

Within thirty days of placement, there is a Foster Plan of Care for each child. The plan looks at both long term and short term goals and includes specific strategies. The Intensive Support Family continuously monitors the child's progress. Written summaries and renewed plans are prepared regularly. Bluewater sends copies of all reports to the Placing Agency.

A team that includes, at minimum, the child, the guardian, Intensive Support Parents and Bluewater staff, develops the individual Foster Plan of Care. Additionally, other professionals and informal supports to the child may participate in planning, implementation, and reviewing the plan.

Bluewater's Foster Plan of Care is strength-based, and includes cultural preferences and other interests expressed by the child. Plans of care include needed supports and services that are outside of the Intensive Support Family setting (e.g. individual therapy, respite, and educational support) and change to reflect the changing needs of the child.

Intensive Support Parents, for each child in their care, document a variety of issues as they affect the child, from administrative concerns such as payment of allowances, medical / dental visits, to intensive support issues, unusual events and Serious Occurrences.

Professional Development

Bluewater typically has between thirty and forty Intensive Support Families. Using interviews, personal, family- and self-evaluation forms, and collateral contact (references) in the determination of suitability, Bluewater staff screen applicants for Intensive Support Parents very carefully. Frequently, once approved as Intensive Support Parents, new families provide respite services during which time Bluewater assesses their motivation and native skills responding to emotionally troubled children.

Once approved as Intensive Support Parents, Bluewater provides an eight-hour orientation / training program to acquaint them with Bluewater's program and philosophy.

Data & Research

Since its inception, Bluewater has made an effort to collect data such as reason for referral, presenting problems, demographic details, and length of stay on residents in the program.

Not only does this data enable Bluewater to evaluate program effectiveness and quality of care issues, it also lets Bluewater examine the pattern of needs of foster children and Intensive Support Parents. These results will enable Bluewater to refine and modify our intensive support model and adapt to the changing needs of children and families.

We owe it to the children and agencies we serve, current and future, to manage the business of Bluewater efficiently and efficaciously. Clearly, fiscal stewardship and accountability will enable our program to flourish and grow into the future.