§4 ch5: Placement/Replacement of the Child
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5.2 Placement in a Residential Treatment Facility
This placement resource should be considered for children who need structured and therapeutic intervention provided in a residential treatment setting.
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5.2.1 Indicators of Treatment Needs in Children Age 0-6
Residential treatment services for a child(ren) under the age of seven (7) years are not usually recommended or utilized. However, certain behavior conditions can exist which would indicate need for a structured treatment setting for such a child. In most instances, it is preferable that foster family care be selected. Referrals using these indicators can be made for behavioral (where available) or medical foster care. These indicators must be used as guidelines in assessing whether a referral for such services is to be made to the RCST:
- Physical Handicaps/Medical Problems- Acute or chronic physical/medical problems which require nursing or specialized caregiving skills on a frequent and regular basis in order to maintain, control, or remediate problem(s) such as:
- Infants:
- Failure to thrive: difficulties in feeding, slow weight gain, discrepancy in height/weight, malnourishment.
- Feeding difficulties: may be seen as resistance to food, does not eat effectively or remains fussy after adequate amount of feeding - no pleasurable relief.
- Fetal alcohol syndrome: withdrawal symptoms, physiological and neurological disturbances.
- Premature birth: may result in serious respiratory problems, seizures, etc.
- Other conditions for any 0-6 year old child:
- Physical trauma: fractures, subdural hematomas;
- Cerebral palsy necessitating use of "range of motion" exercises, physical therapy, etc.;
- Seizure disorders; and
- Casts, wheelchairs.
- Infants:
- Developmental Level - Delayed development in one or more areas of basic skills essential to readiness for the tasks required in normal daily living such as:
- Motor skills (gross and fine) - Specific skills vary according to age but observation can detect a disturbance in progressive mastery of tasks requiring muscle tone and control (sitting, crawling, standing, jumping, etc.) and coordination.
- Cognitive skills - Specific skills vary according to age but observation and testing can detect a disturbance in object relatedness, perception and response to environmental stimuli (internal and external, task readiness).
- Self-help skills - Specific skills vary according to age but are characterized by difficulties in caring for self (dressing, eating) and interacting with others (play, separation).
- Speech/Language - Delays in the development of speech or language, or a problem (physical/emotional) which impairs the ability to use or respond to verbal communication such as:
- Expressive:
- No babbling by six (6) or seven (7) months of age;
- No attempts at simple words by 12 months;
- No attempts at simple sentences by 24 months; and
- Speech difficult to understand after three (3) years of age.
- Receptive:
- Not localizing to sound of voice by six (6) months;
- Not responding to simple requests (say "bye-bye") by 12 months;
- Not recognizing common objects by name (i.e., "show me the ball") by 24 months; and
- Not understanding long and complex sentences or unable to carry out two (2) to three (3) commands by three (3) years.
- Any significant disparity between expressive and receptive language skills.
- Expressive:
- Emotional Adjustment - Difficulties:
- 0 to 1 year:
- Poor sucking - no medical reason;
- Poor and infrequent eye contact, not molding to body of parent or substitutes after six (6) months;
- Not exploring environment;
- Does not look to one person to be special/primary to them (i.e., bonding); and
- No sign of separation trauma/stranger anxiety.
- 1 to 3 years: Not seeking some autonomy/independence from adults
- 2 to 3 years:
- Having long temper tantrums;
- Showing aggression towards peers and adults;
- Not following simple clear instructions (i.e., being defiant, ignoring); and
- Regular night terrors, nightmares.
- 3 to 6 years:
- Inability to occupy self for short period of time;
- Not curious or experimental;
- No role model assumed;
- Not engaging in social play;
- Not toilet trained;
- No imaginary play;
- Manipulative behaviors - lying, hoarding, overeating;
- Excessive fears, phobias;
- Possessions more important than people;
- Clinging/dependency;
- Role-reversals with adults;
- Consistent questioning "Do you like me?" "Are you my friend?";
- Repeated rigid body movements;
- Not talking;
- No risk taking; and
- Rocking.
- 0 to 1 year:
- Sexual Adjustment - Inappropriate sexual behavior which may result from sexual abuse or be symptomatic of emotional/psychological problems such as:
- Frequent masturbation;
- Fear of going to sleep;
- Frequent exposure of genitals;
- Seeking genital contact with others;
- Cross-sex dressing; and
- Provocative sexual behavior.
- Relationship within Family Setting: Cannot accept close familial relationships or cannot function in a family setting.
- Aggression as a Problem: Random purposeless aggression, poor impulse control, attention-getting aggression, purposeful (aimed at serious hurting) such as aggression, biting or scratching, aggression against peers, adults - aggression against self.
- Background Factors: A social history reflecting prolonged sexual abuse or malnourishment/failure to thrive, though these may not be the presenting problem; and experience with several placements, separation, or loss of caregivers, or experience with a non-bonding relationship.
- Physical Handicaps/Medical Problems- Acute or chronic physical/medical problems which require nursing or specialized caregiving skills on a frequent and regular basis in order to maintain, control, or remediate problem(s) such as:
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5.2.2 Residential Treatment Referral
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