child psychology

therapeutic gains

Should I suggest a new protocol? Or go with the flow?

@TheHorse (220085)

Walnut Creek, California

April 8, 2016 10:59am CST

In one of my jobs, I work with kids who have been referred by their schools for behavior problems. I take them hiking, play sports with them, teach them music, sneak in some "book learnin',"and of course teach them gardening. The kid I went out with yesterday has been with me for a year. Our protocol is to see kids for a year and then "terminate." This kid has made incredible gains in several areas. Yesterday, as we were working in the garden, he expressed his sadness that we'd be ending soon. I told him I was sad too, and he asked if I could check in on him in a few weeks or months, "just to play catch or somethin'" I told him I would, but the fact is that our protocol does not include "follow up." If I check up a client, I'd be doing it on my own time. Part of the problem is financial. We (the Company I work for) bills MediCal for our services. But once we've closed someone's file, we can no longer bill for services for that client. But from a clinical perspective, I think checking up on former clients might not be such a bad idea. They could know they are cared for, and seeing a former "mentor" might "reactivate" the part of them that made gains in our presence. What do you think? Should I mention this to my superiors? Or just go with the flow? The photo is from last May or so, right before the ground squirrels ate our garden.

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26 responses

Lenore Plassman

@sallypup (61566)

• Centralia, Washington

8 Apr 16

That's a hard one. Are you a paid friend or do you really care? Can you afford to go the extra mile? My hubby is a social worker and is not supposed to be friends with his clients. And yet we live in a little town and are not church folks so how do you get friends? He has done some under the table stuff and continues, with discretion. I don't think he is supposed to have granola bars in the office, either. And yet how can he talk sanely with somebody who has had no food for a couple of days?

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Lenore Plassman

@sallypup (61566)

• Centralia, Washington

8 Apr 16

@TheHorse One of hubby's bus drivers is having a boundary issue right now. One of the other riders has physical and mental issues so even though the lady is in her 30s she lives with her parents. The lady has gotten to be good buddies with the driver. Now the lady keeps nudging the driver about moving in with her cause she is sick of living with her parents. The driver finally requested that the dispatch folks not schedule her as a driver for the lady.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

Everyone I've worked with, both in Oakland and here in Concord, has done that as well. The fact is: we do care. And a little under the table follow-up (often just meaning a "how you doing?" phone call) is not uncommon. As you say, always with discretion and good professional boundaries.

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@vandana7 (100533)

• India

8 Apr 16

Of course, it also helps the child to get any further help if needed in time.

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@vandana7 (100533)

• India

8 Apr 16

@TheHorse .. Actually that is not fair. Follow up can help to prevent crimes in future and should be good for your employers as well as they can claim lower percentage of failures after required amount of guidance. In fact, they can ask for higher charges, duly billing for monthly follow ups for a while.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

@vandana7 That's actually a really good point. If research shows that follow-up helps, then perhaps the company could ask for more grand money or more compensation from MediCal. But, truth be known, I've seen the books, because I've seen how much we're paid for each client I work with. It is NOT a small amount.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

Of course, the bean counters wouldn't want us to spend too much time with follow-up, since we can't bill for it.

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@Asylum (47893)

• Manchester, England

8 Apr 16

I would expect an abrupt cessation of contact to be potentially detrimental in such circumstances. It seems absurd that the authorities would go to such lengths to help a troubled child, then risk destroying any progress by allowing the child to feel they have been abandoned.

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@Asylum (47893)

• Manchester, England

8 Apr 16

@TheHorse After all that dedication the child could be devastated by believing that the one person they have learned to rely on has just turned their back. A gradual reduction of contact would seem more appropriate. I am not really qualified to say that for certain, but it is what common sense dictates to me.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

That's kind of the way I feel abut it.

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@scheng1 (24649)

• Singapore

9 Apr 16

How about asking the kid to get his school to refer him again? He will be termed as a new case, and he will get another year of personal attention.

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@scheng1 (24649)

• Singapore

9 Apr 16

@TheHorse That is your company protocol, but not the school protocol. Even though he may get another person to take care of him for a year, he is still better than without a minder. Once the school puts in the request, your company will have to tend to it, or some other companies have to tend to it.

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@TheHorse (220085)

• Walnut Creek, California

9 Apr 16

@scheng1 I have known of kids who had a mentor for a year, and then another mentor a year or so later. We'll see what happens.

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@TheHorse (220085)

• Walnut Creek, California

9 Apr 16

That's what his mother wants. But our company protocol is to see a kid for a year (and change) and then move on for a bit.

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@rebelann (112961)

• El Paso, Texas

9 Apr 16

That must be so very hard for you to do. Why won't medical follow up on these kids, don't they care?

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@rebelann (112961)

• El Paso, Texas

9 Apr 16

Poor kids but I do understand @TheHorse I admire those of you who can do that kind of job.

@TheHorse (220085)

• Walnut Creek, California

9 Apr 16

I think everyone cares, but there has to be a protocol for billing. Like teachers, I think a lot of therapists work "overtime."

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@Tampa_girl7 (50596)

• United States

9 Apr 16

Checking up on them sounds like a good idea.

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@TheHorse (220085)

• Walnut Creek, California

9 Apr 16

Our next clinical meeting is a week from Tuesday. I'll ask about it then.

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@kamel622 (310)

• United States

8 Apr 16

I would suggest it. It couldn't hurt. I'm sure these kids need the continuity of knowing the adults in their lives care.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

That's what I'm thinking. Even the occasional phone call would show support.

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@Hatley (163776)

• Garden Grove, California

18 Apr 16

I think the call I back has some merit I wo ld talk to my s u periors and maybe y u coulget

1 person likes this

i think call backs could be helpful so do talk to

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@Hatley (163776)

• Garden Grove, California

18 Apr 16

@TheHorse hi hope that they approve and you get paid more

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@TheHorse (220085)

• Walnut Creek, California

18 Apr 16

I'll bring it up at tomorrow's clinical meeting.

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@TheHorse (220085)

• Walnut Creek, California

18 Apr 16

@Hatley Getting paid more would be great, but nobody expects to be paid a lot in social services. I'm really wondering if it might be beneficial for the clients.

@Vjvals (906)

• Roseville, California

8 Apr 16

I would if we I liked him and he liked me as opposed to having only a professional relationship. Otherwise not. It's sad when bills get in the way mentally.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

Psychology is weird in that way. It's a professional relationship, and yet it's a very personal relationship.

@amadeo (111938)

• United States

8 Apr 16

Yes,I do.At least mention it or do something about it.would not hurt

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

My thoughts exactly. No harm in mentioning it.

crazyhorseladycx

@crazyhorseladycx (39509)

• United States

8 Apr 16

sadly most've those companies put more emphasis'n the financial end versus the actual well-bein' 'f the clients. i'd bring't up to 'em myself. either way they swing, i'd still be checkin' from time to time with those young'uns.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

I find my colleagues to be genuinely concerned with the clients' well-being. But I suppose there are some that have to be concerned wit the bottom line.

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@PainsOnSlate (21852)

• Canada

9 Apr 16

Either or. if you think you will be told by the business NO, then I would just not mention it and see the kid when you have time. I think your job is wonderful ...for the kids and you.

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@TheHorse (220085)

• Walnut Creek, California

18 Apr 16

I do enjoy it. I think I enjoyed my work in Oakland, where I got to see the same kids every day, even more.

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@paigea (36316)

• Canada

24 Jun 16

It is always worth mentioning. There could be reasons for that protocal, such as the client needs to move on to other relationships. If there is a way to show progress is still happening then continuing with a client could be a great idea. And on another note, I wish my former students had a service such as yours.

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@TheHorse (220085)

• Walnut Creek, California

24 Jun 16

I think "mentoring" does yield benefits, but of course I worry that things to "back to where they were" when we're done with the kids.

@paigea (36316)

• Canada

24 Jun 16

@TheHorse That is the trouble. That transition.

• Lillington, North Carolina

8 Apr 16

I think a good solution to this is to maintain contact via mail like a pen pal take pictures etc talk on the phone and maybe see them once every six months or once a year on your own time.

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@TheHorse (220085)

• Walnut Creek, California

8 Apr 16

I agree. I may bring it up at work, just to see/hear what others say.

@mommaj (23112)

• United States

9 Apr 16

May I ask why the company only helps them for a year? Are they automatically cured of whatever they were sent to you for? I don't think it is right to put a time frame on it. It should take as long as it takes and if it is something they need help with for the rest of their life then, the professional should see them that long.

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@marguicha (223720)

• Chile

8 Apr 16

From your post I can read between lines that you really care. And also that the chidren also need it. A follow up might make a big difference. I hope that you can get paid fot your efforts. You should mention it.

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• Richmond, Virginia

9 Apr 16

in this technological age follow up can be a phone call or email or text you don't have to physically see anyone. even if you wanted to see them in person they could come see you and hang out you don't have to take them anywhere meet at Mcdonalds

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@TheHorse (220085)

• Walnut Creek, California

18 Apr 16

Yep, those are some real options. But I best most of the kids would want to do stuff we were familiar with, like hiking.

@Jessicalynnt (50523)

• Centralia, Missouri

9 Apr 16

I'd mention it, there aught to be a way to work in some follow up contact even if small.

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@JudyEv (341752)

• Rockingham, Australia

9 Apr 16

I think you should suggest it. I'm not sure how your health system works but a follow-up service of some kind could save the authorities money in the long run by helping keep boys on the straight and narrow.

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@ridingbet (66854)

• Philippines

9 Apr 16

you treat the children as your own. I think you are doing a great job

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@TheHorse (220085)

• Walnut Creek, California

18 Apr 16

Thanks! Yes, I'd say I learned as much from how my father treated me (well, but with good boundaries and high expectations) as from my psychology classes.

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