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Module 1 Introduction to Behavioral Health Professional Overview

This module sets the tone for the modules that follow by addressing why children and families pursue the services of a Behavioral Health Professional (BHP). This module includes information about the inherent value placed on children, families, and people with disabilities; the roles and responsibilities of the BHP; the legal and regulatory re uirements governing the delivery of these services; professional boundaries; and problem solving. This first module is the foundation of the BHP training curriculum and includes instruction about the types of personal traits, abilities, values and s!ills needed to offer uality services to children, youth and families. "uccessful completion of the module will demonstrate mastery of the competencies listed below.

Competencies
#. The participant will demonstrate an understanding of values related to wor!ing with children who are recipients of behavioral health services and their families. ($evel %) B. The participant will demonstrate an understanding of BHP roles, responsibilities and legal and regulatory re uirements including mandatory reporting of abuse and neglect. ($evel %) &. The participant will demonstrate an understanding of disabilities, including the effects of the disabilities on the child and the family, and community attitudes towards children with disabilities and their families. ($evel %) '. The participant will demonstrate an understanding of professional boundaries. ($evel () ). The participant will demonstrate the ability to solve problems related to the delivery of behavioral health services. ($evel () *. The participant will demonstrate an understanding of teamwor!. ($evel ()

Competency A The participant will demonstrate an understandin of values related to wor!in with children who are recipients of "ehavioral health services and their families# $%evel 1&
A B'I() HI*TO'+ There was a time not so long ago when children with emotional, behavioral and+or intellectual disabilities received treatment in institutional settings, i.e. hospitals and residential programs. ,ften times, the children were far from their home and community. 'uring the past few decades families and advocates have been influential in shifting how treatment services are provided. These changes have made it possible for many children to receive treatment in their homes and communities. The 'epartment of Health and Human "ervices ('HH") - &hildren.s Behavioral Health "ervices (&BH") is the "tate agency that oversees behavioral health services for children. 'HH" sets the rules, regulations and reimbursement rates for the delivery of all children.s behavioral health services. # Behavioral Health Professional (BHP) is ualified to wor! under several different /aine&are "ections including, but not limited to0 "ections (1 2&" (2ehabilitation and &ommunity "upport "ervices), "ection 3( &hildren.s 4aiver "ervices, "ection 56 H&T (Home and &ommunity Treatment), and "ection 56 'ay Treatment. These services are intended to improve the uality of life for children with disabilities by implementing the child.s plan and assisting the family in learning new methods to improve the uality of their child.s life. #t its core, this wor! is about establishing a wor!ing alliance and collaborative partnership with the child and family. This relationship is based on combining unconditional positive regard with the right s!ill, the right intervention and+or support and the right supervision to assist the child and family in reaching goals documented in the child.s plan. # successful wor!ing alliance between the BHP and the child and family will help create opportunities for transformation to happen in the child.s life. TH( ,O'The main focus of the BHP.s wor! is to implement the child.s plan that has been developed based on the child.s strengths and needs. This wor! can be done in a variety of settings. ,ne of the ways you will help is by developing a wor!ing alliance with the child and family. # part of your responsibility as a member of the child.s team will be to wor! with the team, child and family to create an environment in which change can occur. #n effective wor!ing alliance is made up of four (7) !ey components. These are0 8uiding Principles -The 'epartment of Health and Human "ervices ('HH"), &hildren.s Behavioral Health "ervices (&BH") 2esource 8uide /ission and the mission of your agency will guide your wor!.

2ules - 'HH" established licensing re uirements, regulations and legal mandates that you must follow in your wor! as a BHP. 2esponsibilities - 9our agency has policies and procedures that you will be e:pected to follow. 9ou will also have a ;ob description that outlines the function of your ;ob. The BHP - 9our life e:periences, beliefs and values combined with your talents, strengths, education and training are the tools you will use in your wor! as a BHP. 9ou will draw on all of these as you help the child learn and practice new s!ills.

./I0I1. P'I1CIP%(* # mission, vision and set of values are ideas that guide institutions, businesses, agencies and individuals as they carry out their wor!. 9our agency also has a mission statement. # clear understanding of these missions will help guide you in your day<to<day wor! with the child and family.

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MI**IO1 *TAT(M(1T Provide integrated health and human services to the people of /aine to assist individuals in meeting their needs, while respecting the rights and preferences of the individual and family, within available resources. The guiding principles are0 The statutory philosophy and intent of the 'epartment continues to be to0 Treat consumers with respect and dignity. 'eliver services that are individuali=ed, family<centered, easily accessible, preventive, independence<oriented, interdisciplinary, collaborative, evidence<based and consistent with best practices. >alue and support department staff as the critical connection to the consumer. )ngage staff, sta!eholders, providers and customers in a collaborative partnership that continuously see!s e:cellence in service design and delivery. Balance centrali=ed accountability with regional fle:ibility. #lign systems, actions, and values toward a common vision. 2A%/(* ?n support of our >ision, we in the 'epartment value0 CHOIC( People have opportunities to ma!e informed choices and get accessible, cost effective, individually tailored supports within their community.

ACC(** People have access to ;obs, education, healthcare, housing, social, spiritual and recreational opportunities. 0I.1IT+ People are treated with dignity and respect, and their rights are safeguarded by all who provide services to them. 3/A%IT+ People determine the uality of their supports based on the outcomes they e:perience. P'(2(1TIO1 4 (A'%+ I1T('2(1TIO1 ,ur emphasis on prevention and early intervention will help minimi=e the effects of illness and disability on people.s everyday lives.

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MI**IO1 *TAT(M(1T &hildren.s Behavioral Health "ervices provides leadership in the development of a comprehensive system of care that ensures that each child develops to their fullest capacity. The system of care strengthens the capacity of families, promotes natural helping networ!s and develops community resources to meet the behavioral, developmental, and treatment needs of children. +O/' MI**IO1 *TAT(M(1T # clear vision, mission, and set of values are an anchor for solving the day<to<day issues as well as the larger issues that can occur as individuals carry out their wor!. The mission statements of 'HH", &BH" and your agency will guide your wor! as a BHP. *or e:ample, the &BH" mission helps you focus on the child.s strengths and accomplishments and to have clear measuring progress. The &BH" 2esources 8uide /ission helps to focus you on ensuring the child develops to her+his fullest capacity and on the use of natural support networ!s. 9ou may also want to develop your own mission statement and define the set of values that you will bring to your wor!. "ituations will arise during your wor! with a child where you will be e:pected to ma!e a decision and ta!e a decisive action. # clear mission statement can provide you with guidance during your decision ma!ing process.

Competency B The participant will demonstrate an understandin of BHP roles6 responsi"ilities and le al and re ulatory re7uirements includin mandatory reportin of a"use and ne lect# $%evel 1&
'/%(* The rules that you are e:pected to follow as you perform the functions of a BHP have been established by 'HH", including licensing, regulations and legal mandates. $i!e the 8uiding Principles, a clear understanding of these rules will help you meet the day<to<day responsibilities of a BHP. %(.A% 'I.HT* 'HH" - &BH" has developed a set of rights to protect children who receive mental health treatment. These rights are in the Rights of Recipients of Mental Health Services Who are Children in Need of Treatment. Part # - 2ules of 8eneral #pplicability and Part & - 2ights in ,utpatient "ettings apply to you. 9ou are responsible for protecting the child.s rights. 9our agency is re uired to give you a copy of these rights and ensure that you read and understand them. Part B - discusses 2ights in ?npatient and 2esidential settings. Briefly, 2ights in Part # and & are0

'ules of .eneral Applica"ility


Basic 2ights @ "ame human, civil and legal rights accorded all minor citi=ens @ Human psychological and physical environment within the program @ Treated with courtesy and dignity @ 2espect for individuality @ 2ight to privacy @ *reedom of religion @ Protection from discrimination $east 2estrictive #ppropriate Treatment Aotification of 2ights #ssistance in the Protection of 2ights 2ight to 'ue Process with 2egard to 8rievances and &omplaints &onfidentiality and #ccess to 2ecords *air &ompensation for 4or! Protection 'uring ):perimentation and 2esearch ?ndividuali=ed "upport Plans

'i hts in Outpatient *ettin s


?ndividuali=ed Treatment Plans

?nformed &onsent to Treatment *reedom from "eclusion and 2estraint

These rights can be found in statutes for persons receiving intellectual disability services and apply to all children receiving behavioral health services. MA10ATO'+ '(PO'TI1. 'HH" has the authority to enforce Title (( - &hapter %BC%0 &hild and *amily "ervices and &hild Protection #ct. The section (located at the end of this module), "ubchapter ?? - 2eporting of #buse or Aeglect defines the legal responsibilities of individuals who, while acting in a professional capacity, suspect abuse or neglect of a child. This applies to the BHP. 9ou have the legal responsibility to report suspected abuse and neglect to 'HH". The BHP is a /andated 2eporter; this means0 D4hen, acting in a professional capacity, an adult, who is a E mental health professional E !nows or has reasonable cause to suspect that a child has been or is li!ely to be abused or neglected, that person shall immediately report, or cause a report to be made, to the departmentF. D4henever a person is re uired to report in a capacity as a member of the staff of a medical, public or private institution, agency or facility, that person shall immediately notify either the person in charge of the facility, or a designated agent, who shall then cause a report to be made. The staff may also ma!e a report directly to the 'epartmentF. D#ny person may ma!e a report if that person !nows or has reasonable cause to suspect that a child has been, or is li!ely to be, abused or neglected.F D4hen, while acting in a professional capacity, any person re uired to report under this section !nows or has reasonable cause to suspect that a child has been abused or neglected by a person not responsible for the child, the person shall immediately report or cause a report to be made to the appropriate district attorney.s officeF. ?mmunity from $iability # person E participating in good faith in reporting under this subchapter E is immune from any criminal or civil liability for the act of reporting E #buse or Aeglect #buse or neglect means a threat to a child.s health or welfare by physical, mental, or emotional in;ury or impairment, se:ual abuse or e:ploitation, deprivation of essential needs or a lac! of protection from these, by a person responsible for the child. 0OC/M(1TATIO1 'ocumentation is an important responsibility of the BHP. ?f you suspect abuse or neglect you must document all the things you observed that led you to suspect abuse or neglect. These should be facts0 what you saw and heard. 9ou should avoid stating your impressions or opinions. */P('2I*IO1

The reporting of abuse or neglect to 'HH" can be very stressful. ?f you suspect abuse or neglect you should first contact your supervisor to discuss your concerns. 9our supervisor will help you follow the agency.s policy and procedure and together you and your supervisor will decide on the best approach for handling the reporting of the abuse to the 'HH". ?f your supervisor disagrees with you and thin!s there is no reason to suspect abuse or neglect, but you suspect there is abuse or neglect occurring, you are still responsible for reporting it or causing a report to be made. ?f you find yourself in this situation, you should spea! to the ):ecutive 'irector of the agency before ma!ing a report to 'HH". ?t is best to get the support of your agency. 2emember, your role is not to investigate the situation. ?t is your responsibility to contact your supervisor, document the facts that caused you to suspect abuse or neglect, and report or cause a report to be made. Together with the support of the team, your supervisor can set in motion a process of getting help and being a support to the child.

I0(1TI)ICATIO1 8'easona"le Cause to Believe9 The BHP, school teachers and other school personnel are among the most effective advocates for children. These people may, in fact, be the only responsible adult in a particular child.s life. Because of the special relationship between the BHP, or teacher, and a child, it is essential that teachers be able to respond to the child who needs help. The reporting laws specify that school personnel who have Dreasonable cause to believeF that a child is being abused or neglected must report that suspicion to the 'epartment of Human "ervices - &hild Protective "ervices or cause a report to be made. ?dentifying the se:ually abused child is often difficult and undercut by uncertainty. The &ommittee for &hildren has provided training in prevention of child se:ual abuse to thousands of school personnel since %G1%. 'uring this time, many teachers have contributed to our understanding of the boundaries of Dreasonable cause to believeF. "ome of their recommendations follow0
2esolve doubt in favor of the child. 'iscuss your observations and concerns privately with another staff person who is familiar with the child. "ee! out and rely on your support system at school. Trust your instincts, your DgutF feelings. 2emember, you do not have to prove that se:ual abuse is occurring; reporting is a re uest for an investigation into a suspected case of abuse. &all &hild Protective "ervices or a se:ual assault center and re uest advice in determining Dreasonable causeF. Hnderstand the importance of early case finding. 2emember that an educator who reports is on firm legal ground. ?ncorporate a child se:ual abuse prevention curriculum into the health curriculum. $et the children in your class !now that they can tal! to you, a counselor, or a nurse about personal safety problems. ?f you sense a child is trying with difficulty to tal! with you, sit down with a simple pro;ect such as crayons or a pu==le - and let the child !now you will believe and help her+him with any problem. $isten to the child. Be direct; if you have a trusting relationship with the child, as! gently, but directly, if the child is having a problem with which s+he needs help. #void as!ing probing uestions. Believe the child who discloses; tell that child s+he has done the right thing by telling you; assure the child that s+he is not in trouble. 'on.t promise not to tell anyone else. Tell the child e:actly what to e:pect; if you don.t !now, say so, but let the child !now s+he can e:pect to be supported and helped by you. 2espect the child.s privacy by not discussing the situation out of school. ?f you are concerned about an administrator not ma!ing a report, call yourself; you could still be liable for failure to report.

** Adapted from material reprinted courtesy of the Charlotte White Center in Bangor, Maine (up to page 15)

Behavioral Indicators ?dentifying the se:ually abused child is often difficult. ?n general, few children spea! directly about se:ual abuse. Hnli!e physical abuse, se:ual abuse may not present readily visible indicators, especially in a school setting. The following list of behavioral indicators is offered with a gentle caution against over<=ealous case identification. 4hile no single indicator is an absolute indicator of se:ual abuse, several common behaviors have been noted in the literature and corroborated by teachers through the teacher<training program of the &ommittee for &hildren. The following behaviors do not necessarily indicate se:ual abuse, but can alert school personnel to a serious problem. Hnusual interest in and+or !nowledge of se:ual acts and language. Inowledge of se:ual acts, language inappropriate to the child.s age or developmental level. The child may focus on se:ual matters to the e:clusion of most other activities or interests. "eductive behavior with classmates, teachers, other adults. #cting out se:ual behavior; child may seem to e uate affection with se:. ):cessive masturbatory behavior. #ttempts to touch the genitals of other children, adults, animals. 4earing many layers of clothing, regardless of weather. ?nappropriate dress, such as tight and+or revealing clothing. &ontinual avoidance of bathrooms; some abuse within homes ta!es place in bathrooms, and a child can come to associate any bathroom with se:ual abuse. 2eluctance to go to a particular place or to be with a particular person. 2eluctance to go home and+or constant early arrival at school. ):cessive clinging, fear of being left alone. *re uent absence and+or constant late arrival to school, especially if the notes are always written by the same person. "udden school problems; a mar!ed decline in interest in school. #n abrupt change in behavior or personality. #n abrupt change in behavior in response to personal safety issues. #ggression, anger directed everywhere. #n:iety, irritability, constant inattentiveness. 2egression, fre uent withdrawal into fantasy. ,ver compliance, e:treme docility. &ompulsive behaviors, e.g., hoarding, constant washing. #ppearing to have overwhelming responsibilities. "uicidal threats or gestures; causing deliberate harm to her+himself. Hse of alcohol and+or other drugs. 'rastic change in appetite. "leep disturbances, e.g., bed wetting, nightmares, insomnia, falling asleep in class. 2unning away from home or attempting to run away. 'enial of a problem with a mar!ed lac! of e:pression. $ac! of affect, e:treme absence of e:pressiveness. 'epression, e:cessive crying. $ow self<esteem.

$ac! of friends, poor relationships with peers. 2eluctance to undress for P.)., continual avoidance of P.). class. ?ndirect hints, allusions to problems at home, fishing for attention. Physical Indicators #lthough school personnel are less li!ely to observe physical indications of se:ual abuse, there are symptoms to which school personnel should be aware0 >enereal disease in a child of any age. Pregnancy at %% or %(, especially with no history of peer sociali=ation. )vidence of physical trauma or bleeding to the oral, genital or anal areas. &omplaints of pain or itching in those areas. 'ifficulty wal!ing or sitting. Hnusual or offensive odors. Torn or stained clothing. ):treme passivity during a pelvic e:am.

)amily Indicators *amily indicators might underscore concern regarding abuse. Possible indicators include0 ):treme paternal dominance, restrictiveness, and+or over protectiveness. *amily isolated from the community and support systems. /ar!ed role reversal between mother and child. History of se:ual abuse for either parent. "ubstance abuse by either parent or by other children in the home. ,ther types of violence in the home. #bsent spouse (due to chronic illness, depression, divorce or separation). "evere overcrowding. &omplaints about a DseductiveF child. ):treme ob;ection to implementation of child se:ual abuse curriculum.

'is! Assessment Inventory How does each child present DselfF (behaviorally and emotionally)J #ge inappropriate behaviors )ngaged in criminal activity+delin uency 'evelopmental delays Poor academic performance Aon<verbal+reticent ?ntellectual disability 'efiant+rebellious ?mmaturity 4ithdrawn Aon<responsive+non<communicative+flat 'epression affect 2un away #ggressive+pugnacious+hostile ,verly compliant+submissive 'estructive Aeurotic "elf<destructive Precocious se:ual activity "hy 8uilt ridden Problem ma!ing+!eeping friends Poor self<concept and poor self<esteem *earful "elf<mutilating /ultiple, pervasive fears of normal "erious mood swings activities and things ,verly dependent #n:ious+tense Pseudo maturity Preoccupied with se: /istrusts+suspicious of parent+careta!er Hyperactive #voids interactions with parent+careta!er *lirtatious Aon<accepting of parent+careta!er Promiscuous *eels responsible for care of ?solated+alone parent+careta!er+siblings Thoughts+threat of suicide Ao display of affections towards "elf<blaming parent+careta!er+siblings Problem relating to adults ):cessive fantasy for age Problem relating to peers "hort attention span Problem ma!ing eye contact "leep disturbances + eating disorders 'isplays of bi=arre behaviors+emotions Ao sense of personal safety Hse+abuse of drugs+alcohol ):cessive worry+an:ious Psychosomatic illnesses+hypochondria Hyper<vigilant ):cessive attention see!ing *ire setting ):hibits habit disorders Poor impulse control 'isplayed+threatens cruelty toward others+animals Psychotic episodes, loss of reality, delusional, e:periencing hallucinations

0isclosure &hildren may disclose se:ual abuse in a variety of ways. They may come to you in private and tell you directly and specifically what is going on; unfortunately, this is one of the least common ways for children to disclose. /ore common ways include0 Indirect hints# e.g. D/y brother wouldn.t let me sleep last night.F D/r. Kones wears funny underwear.F D'addy.s trying to poison me.F D/y babysitter !eeps bothering me.F # child may tal! in these terms because s+he hasn.t learned more specific vocabulary, feels too ashamed or embarrassed to tal! more directly, has promised not to tell, or for a combination of these reasons. &ontact your supervisor and tell him+her e:actly what the child said. Bear in mind that in order to ma!e a report you do not need to !now e:actly what form the abuse has ta!en. 0is uised disclosure# D? !now someone who is being touched in a bad way.F D4hat would happen if a girl told her mother she was being molested but her mother didn.t believe herJF Here the child might be tal!ing about a friend or sibling, but he+she is ;ust as li!ely to be tal!ing about her+himself. &ontact your supervisor and tell him+her e:actly what the child said. 9our supervisor may suggest that you follow up with the child and as! him+her to be more specific. 0isclosure with strin s attached# D? have a problem but if ? tell you about it you have to promise not to tell anyone else.F /ost children are all too aware that some negative conse uences will result if they brea! the secret of abuse; often the offender uses the threat of these conse uences to force the child to remain silent. $et the child !now you want to help her+him, and that the law re uires you to ma!e a report if the child discloses abuse; ;ust as the molestation itself is against the law, so too is it for you not to report. #ssure the child you will respect his+her need for confidentiality by not discussing the abuse with anyone other than those directly involved with the legal process, who might include your supervisor and+or the &hild Protective "ervices ?nvestigator.
?t is not your responsibility to investigate what a child says. ?t is your responsibility to report suspected abuse or neglect. ?t is your responsibility to contact your supervisor, ob;ectively document what you suspect, report or cause a report of the abuse or neglect to be made, with the support of your supervisor, set in motion the process of getting help for the child, and finally, to be supportive of the child. Here are some suggestions for responding to disclosure0 *ind a private place to tal! with the child. 'o not panic or e:press shoc!. 'on.t promise not to tell. ):press your belief that the child is telling you the truth. $isten carefully to the child. #void as!ing probing uestions. Hse the child.s vocabulary. 2eassure the child that it is good to tell.

2eassure the child that it is not her+his fault, that s+he is not bad. 'etermine the child.s immediate need for safety. $et the child !now that you will do your best to protect and support him+her. $et the child !now what you will do. 2eport to your supervisor. 1ormal Childhood *e:ual 0evelopment

A# Infancy $"irth to ; years& %. &aregiver response to infant teaches trust, security, love; having basic needs met consistently creates hopeful attitude for the future (. &ommunication through touch, ease or tension in handling, eye contact, tone of voice, are earliest sensual messages 3. Aeed for oral satisfaction; suc!ing needs met by feeding, but pacifiers and other substitutes may be sought by infant 7. "e:ual response system begins wor!ing in the uterus and at birth, males with erection of penis, females with lubrication of vagina 6. "e: role conditioning begins (boy and girl babies treated differently) 5. *amily encourages male or female gender identity C. #wareness of anatomy differences 1. ):ploration of own body G. *amily builds or discourages self esteem B# Toddler $1 < to = years& %. &hild becomes aware of non<genital gender differences, personal gender identity becomes fi:ed (. Toilet learning brings beginning of separation and awareness of self 3. $anguage s!ills provide potential to begin to ac uire vocabulary for se:ual parts and processes 7. ?ncreasing independence in all areas, needs specific praise for accomplishments to enhance self esteem 6. 'eliberate genital touching, caregiver response can bring acceptance of body or shame 5. &oncerns about anatomy differences may be verbali=ed, uestions begin C# (arly Childhood $=>? years& %. #ctive curiosity about reproduction (where do ? come fromJ) and relation to family, community (. 8ender identity affirmed; play often ta!es on different gender roles 3. 'eliberate self<stimulation (not goal oriented as in adult behavior) 7. /ay participate in se:ual play with children of either gender 6. /ay have hostile feelings toward children of other se:, see!s closeness with same se: friends 5. &hild may develop need for privacy, modesty C. &ontinued need for positive, nurturing touch 0# %ate childhood $?>@ years& %. &uriosity about se:ual function and differences usually resolved or hidden; less open uestioning (. &hild absorbs messages about se:uality from wider world 3. 'eliberate gender segregation in play

7. #ctive interest in information and logical answers 6. "e:ual e:ploration by both same and other gender friends common (not necessarily a sign of orientation) 5. )steem enhanced by wor!, chores, success in industry C. ,nset of prepubescent surge in hormones, growth of internal and e:ternal se:ual organs (# (arly adolescence $@>1= years& %. Beginning of reproductive system functioning; males e;aculation by %7, females menstruation by si:teen (%5) (. ?ncreasing dependence on peer group 3. ?ncreasingly intense romantic attachments, e:perimental crushes 7. Physical changes often preoccupy child (am ? normalJ) 6. &hanging relationships with family, friends, primary concern 5. 'ifferences in male and female approaches to self<stimulation C. 4idest variety in growth and development 1. &hild may feel aw!ward, clumsy, mood changes common )# Adolescence $1A>;B& %. #bsorption in uestions regarding self and identity (. 9outh may e:periment with various roles 3. Body changes of puberty continue (male growth spurt by %6, females by %() 7. "trong needs for independence and guidance conflict 6. "e:ual feelings intensify, e:perimentation with behavior 5. #wareness of se:ual orientation clearer C. "elf<stimulation goal oriented 1. 2eproductive ability ma!es decision ma!ing re0 se:uality serious with life change repercussions G. &hanging from concrete to abstract thin!ing (youth may identify with social, religious, groups) %B. 'esire for clear gender differences change to awareness of different values %%. "e: role e:pectations may be uestioned in later adolescence %(. Higher capacity for social+moral ;udgments %3. Peer pressure and double standards for males and females influence decision on behavior %7. ?ncreased capacity for intimacy

'(*PO1*IBI%ITI(* The 'HH" ,ffice of /aine&are "ervices which administers /aine&are has established regulations for the delivery of &hildren.s Behavioral Health "ervices. 9our agency will give you a ;ob description that will include the regulations that apply to your wor! as a BHP. 9our agency will also have policies and procedures that will outline a range of responsibilities such as writing incident+accident reports, supervision, documenting the child.s progress, reporting abuse or neglect, as well as sic! and vacation time.

TH( 'O%( O) TH( B(HA2IO'A% H(A%TH P'O)(**IO1A%

The role of the BHP will vary depending upon the /aine&are "ection that is reimbursing the service, for e:ample0 The BHP, delivering services under "ection 56 H&T -Home and &ommunity Based Treatment is part of a clinical team that delivers mental health treatment in the home and community. The clinician and the BHP will wor! with the family and child to implement the child.s plan.

The clinician and the BHP assist the child and parent or caregiver to understand the child.s behavior and developmental level including0 &o<occurring mental health and substance abuse; Teaching the child and family or caregiver how to appropriately and therapeutically respond to the child.s identified treatment needs; "upporting and improving effective communication between the parent or caregiver and the child; *acilitating appropriate collaboration between the parent or caregiver and the child; and 'eveloping plans and strategies with the child and parent or caregiver to improve and manage the child.s and+or family.s future functioning in the home and community. "ervices include0 Therapy, counseling, or problem<solving activities in order to help the child develop and maintain s!ills and abilities necessary to manage his or her mental health treatment needs; $earning the social s!ills and behaviors necessary to live with and interact with the community members and independently; Building or maintaining satisfactory relationships with peers or adults; $earning the s!ills that will improve a child.s self<awareness, environmental awareness, social appropriateness and support social integration; and $earning awareness of and appropriate use of community services and resources.

The BHP delivering services under "ection (1 2&" - 2ehabilitative and &ommunity "upport "ervices is part of a service team that assists the child and family in reaching the child.s identified goals as described in the child.s plan. The services are designed to retain or improve functional abilities which have been negatively impacted by the effects of cognitive or functional impairment and are focused on behavior modification and management, social development, and ac uisition and retention of developmentally appropriate s!ills. "ervices include0 Problem solving activities in order to help the member develop s!ills and abilities necessary to manage his or her behavioral health treatment needs; To learn the social s!ills and behaviors necessary to live with and interact with other community members; and To build satisfactory relationships with peers and adults.

The services listed above are ;ust a couple of e:amples of /aine&are services that re uire non<licensed staff wor!ing directly with a child to be a &ertified Behavioral Health Professional. BHP.s should be informed by their agencies of the /aine&are section of policy under which they are delivering services. ?t is the responsibility of the BHP and their agency to understand and follow the re uirements set forth in the /aine&are Benefits /anual.

0OC/M(1TATIO1 #ccurate documentation of the child.s progress is the responsibility of a BHP. )ach child has a medical record that will, minimally, contain the following0 &linician )valuation - a clinician completes a clinical evaluation to determine a diagnosis. &omprehensive #ssessment - the clinician or supervisor is responsible for conducting the assessment and writing the child.s plan (along with the child, family and other team members). The &hild.s Plan - identifies the following0 Problem, 8oals, ,b;ective, /easures, and Person responsible. The name of the plan will vary according to the /aine&are service. ):amples are0 ?ndividual Treatment Plan (?TP), ?ndividual "ervice Plan (?"P), ?ndividual "upport Plan, 4aiver "ervice Plan, and others. Progress Aotes - the BHP must write a progress note for every direct contact with the child and family. Progress notes are !ept in chronological order. Luarterly 2eviews - the clinician or supervisor reviews and amends when appropriate the child.s plan every GB days, or earlier if needed. 'ischarge or &losing "ummary - the clinician or supervisor writes the discharge or closing summary. The elements of the child.s plan will be covered in /odule 5.

P'O.'(** 1OT(* 9ou are responsible for writing a progress note for every visit you have with a child, and for every collateral contact you have. 9our agency may as! you to write a summary note when you stop wor!ing with a child. )ach progress note should contain the following0 &hild.s name 'ate of service $ocation of service 'uration (hours of service) "hort<term goal and ob;ective that the child wor!ed on Progress made toward achieving the goal "ignature and credentials at the end of the note The note should be a description of what the child did to wor! on the goal and progress the child made toward achieving the goal. 9ou will write a description of how the child improved, regressed or stayed the same. ,ne way to thin! about writing a progress note is to answer the Mwho, what, where, when, why, and howM uestions. 9ou should write your ob;ective observations. This means that you state the facts about what the child did to wor! on the goal. The progress towards the goal states what the child did that showed improvement, regression or staying the same. *or e:ample, Jane or!ed on putting ords to her feelings" #he completed a role$play in hich she said, %When & fro n & feel 'lue" When & am 'lue, & am sad" ( )his as the first time Jane put ords to feelings in a role$ play" "tatements that a child ma!es are ob;ective and should be used in D uotesF. 9ou should try to avoid ma!ing sub;ective statements. # sub;ective statement is your impression or feeling or ideas about what happened. ?f you thin! it is important to ma!e a sub;ective statement, avoid stating it as a fact. 9ou should use words li!e DseemedF or DappearedF to introduce your sub;ective observation. #nd you should identify what made you form your impression. *or e:ample, John appeared to 'e upset hen his father left" *e sat on the couch and ould not tal!" The following are e:amples of "ub;ective and ,b;ective statements0 */BC(CTI2( OBC(CTI2( Koe had a tantrum. Koe hit, !ic!ed and yelled, D8et outNF &arol was angry. &arol said, D?.m upsetF and hit the table with her fist.

Ben was mean to his sister.

Ben told his sister, 2ita, D9ou smell funnyF. 2ita said, DBen is mean to meF.

Competency C The participant will demonstrate an understandin of disa"ilities6 includin the effects of the disa"ilities on the child and family6 and community attitudes towards children with disa"ilities and their families# $%evel 1&

*TI.MATIDATIO1 /erriam - 4ebster 'ictionary defines #tigma as Da mar! of shame or discredit or an identifying mar! or characteristic.F #tigmati+ation is defined as Dto characteri=e or brand as disgraceful or shameful.F ,ften when we meet a new person or find ourselves in a new situation, we will ma!e assumptions about the person or situation. 4hen we ma!e these assumptions, we are trying to get comfortable with the new situation or person. This is a normal strategy for ma!ing sense of a new situation or people who are different from us. Hsually, we chec! out assumptions to see if they are in fact correct. ?f and when we notice that our assumptions are incorrect, we change them so that we are responding appropriately to the situation or the person. 4e tend to create problems for ourselves when we respond to a situation based on our assumptions. 4e can treat people unfairly when we let our assumptions stand as facts. 4hen we ma!e an assumption about a person, label them, and then treat them according to the label we placed on them, we are stigmati=ing them. *or e:ample, when we say, DIatie is ,''F (,ppositional 'efiant 'isorder) we are implying that Iatie is only ,''; our perception of her is limited to seeing her as only being her diagnosis. 4e are only seeing one aspect of the person. 4hen we say, DIatie is a child with ,''F we are implying that the ,'' is only one part of who Iatie is; our perception is open to seeing other parts of who she is; perhaps she is good at baseball and li!es to sing. 4e can easily lose sight of the whole person when we refer to the person as the diagnosis. ?t is important to see the diagnosis as only one aspect of the person and to see all the uni ue strengths, interests, talents and traits of each person.

# family that has a child with a disability faces many challenges. /any of them have to do with the uni ue challenges that are specifically related to the disability. ,ther challenges have to do with how the disability is perceived by the child, family and community. The child and family may need support in coping with the stigma attached to mental illness or intellectual disability. ?t is e:tremely important to understand the subtle and not so subtle ways in which people with disabilities are stigmati=ed. #s a BHP, you will need to become sensitive to the many ways in which assumptions are made about children who have a disability and their families.

%etter from Parents 'ear BHP "tudent0 #s you ta!e your first step toward becoming certified by the "tate of /aine as a Behavioral Health Professional, there are a few things we mothers would li!e you to !now. To begin with, we don.t really want you in our home. ?t.s an invasion of our family.s privacy. 9ou will !now what.s in our laundry, the house!eeping we manage, our family.s brea!fast, lunch and dinner menus, the medications we.re on, our television preferences, and more about our marriages (or lac! of them) than anyone else on earth. ?f we had our way, you would not have this ;ob. But we need you. 4e don.t ant to need you, but we do. 'o you have any idea how hard it is for us as parentsOas mothers<<to admit that we need youJ That we lac! the s!ills and sometimes the stamina to care for our o n !ids, Ao, maybe you don.t. This impotence, this need, tears us up inside at least a little bit every single day. ,n a bad day it is positively soul destroying. 9ou need to !now that. 9ou need to see it. 9ou will probably never again get information this intimate, and this candid, to use as a tool in your new profession. ?f you do, report it to a "upervisor immediately0 under any other circumstances, this would be a Boundary >iolation beyond imagination. Here.s what we want you to !now0 'on.t pass ;udgment on us. *or one thing, no matter how great an actor you thin! you are at !eeping your opinions private, we can tell. Having special !ids e:poses one to facial e:pressions and turns of phrase we never heard before having special !ids. 4e have a basis of comparison that you do not0 ,ur world before disabilities and our world now. "econdly, we suspect you don.t have a clue. 4al! a mile in our shoes, (7+C, day in, day out, wee! after wee!, year after year. There are days we can.t Pfind our &enter.. 4e need your understanding. $et us wor! it through. ?f we loc! ourselves in a room to read a trashy novel or simply need to lie down for %6 minutes of uninterrupted rest, while you.re here, humor us don.t critici=e us, we need your unconditional positive regard. ,n the other hand, we.re not "aints and you don.t need to treat us as if we are. 4e need to wor! together as a team; share your ideas with us in a respectful manner so we can learn together. $et.s tal! about marriage. /arriage is a tric!y thing at best. #dd a !id or two with a disability, and the 6B+6B shot any marriage has to wor! becomes something li!e one chance in a hundred. ?f you.re wor!ing with a single parent, don.t ;udge. ?f you.re wor!ing with an intact family, don.t be naQve. ?t.s still probably the second<biggest struggle of our lives. 2emember everything that happens in a child.s home happens in a conte:t, the detail of which is not shared with you. Ieep your focus on helping my child reach his goals. 'on.t get your personal needs met in our homes. "ee! therapy. 4e don.t want to adopt

another child (you). 'o not disclose too much personal information. #) ?t.s a Boundary thing, something you will !now to steer well clear of if you.re trained properly, and B) 4e don.t want to !now because we already have enough to deal with in our own lives. $eave your preconceptions about disabilities at the door. Today is our reality. Tomorrow is our fervent dream. Try to find the optimistic view without being condescending or arrogant. 4hat we need from you is consistency. *ollow through, follow through, follow through. ,ur children aren.t stupid. ?f you.re ;ust putting in your time to collect a paychec!, our !ids will have you duct taped to a chair (physically or emotionally) in a heartbeat. Please, please show up when you are scheduled to wor!. 4e find that when BHP professionals call in sic!, a good percentage of the time the DillnessF is a direct result of the behavior the individual chose to engage in the night before. ,r maybe, it.s an absence that coincides with a perfect Beach 'ay. 4hen you call out li!e that, it is so hard to e:plain to our children that D4ell, yes, *rieda was supposed to be with you today, but something came up.F # child with a mental health, autism or intellectual disability diagnosis has a hard enough time understanding our world under the best of conditions. #dd the stress of unplanned change or dashed e:pectations, and it can be a nightmare. #long those same lines, please show up for wor! on time. 4e are always struc! by how, if the professional is scheduled to arrive at 3 pm, he or she routinely arrives at 30B6, 30B(, 30%6, and 30B1. . . *or some reason it.s never (07C, (06G, (073. . . #s we watch that minute hand creep past the appointed time, we plunge into the mental energy of &ontingency Planning0 "he-s not coming" Why didn-t she call, What do & tell my child, & as going to spend that time ith )immy, ho also needs me" What do & tell him, & on-t 'e a'le to ma!e that lasagna for dinner no " What do & ha.e in the free+er, /ats, there-s nothing in the free+er" & as going to ta!e )immy grocery shopping today, too" ,ur whole day falls apart in an instant. Besides which, how do you thin! your casual attitude about the importance of the wor! you do ith our children ma!es us feelJ 'on.t give up on our children. 4e tried that before (# little e:haustion humor). But seriously, you are the glue that !eeps us plugging away day, after day, after day. 9ou are capable of more than you !now. 4e !now that, because we never !new how much e could do until these precious, special children entered our lives. Believe in our children.

Teach our children to be independent. 9es, they are cute, and we !now how tempting it is to do everything for them. But as these !ids get older, they may not be cute anymore. The degree to which our children are dependent upon others as they grow up, and after they are adults, is the degree to which they are vulnerable to e:ploitation of all !inds. ?f it needs to be done, help the child do it. Teach our children to be as independent as they can be. The way our children learn is by repetition and doing. 2epetition and doing. 2epetition and doing. 4e may need to do the very same tas! (BB times before our children get it. ,r we may need to brea! down a tas! that already seems very basic into something even more basic. Aever, ever give up. *ind a way. 4e believe there is a way and we need to find it. 9ou are a role model for our children. How you say things, and how you do things mattersO not ;ust for the special needs child you wor! with, but for our other !ids as well. ?t.s your dress, your language, your mannersOthey all matter. #long those lines, please be professional. ?f this is some Dpic! upF ;ob for you, we can tell you right now you will not be successful. ,n the other hand, if you entered this field to ma!e a difference in a child.s lifeOin a family.s lifeOand if you view that responsibility from the perspective of a consummate professional, you are demonstrating respect for our family.s worth and dignity as human beings. Professionalism is a gift to us beyond measure. "ee! supervision and guidance from your agency when you have uestions we cannot answer, or if you need another perspective on an issue. This is not a sign of wea!ness; it is a sign of your good ;udgment, and that you care enough about our children to ma!e sure every minute of every hour you spend with these special !ids is as therapeutic as possible. Hnderstand that our vision for our children as adults is that they become completely independent. ?f that.s not possible, we pray our children can live as independently as possible, with supports. ,ur worst fear is !nowing that someday we will die, and we are afraid no one will care for our children with the same passion, the same commitment as our families do. These days of childhood learning are so precious to us, and so important to our children.s futures. Be our children.s cheerleader, cheer them on with D0ou can do itF. ,ur vision for our children is one in which he or she has friends. 4e want our children to drive a car someday, and to go to college. 4e want our children to have a home, a ;ob, maybe a family. People with disabilities can live incredibly rewarding lives. Aow is the time we lay the foundation for the future. 'on.t set e:pectations so low that our children fail to achieve.

'on.t coddle our children, or treat them too Dspecial.F 4hen these children are adults, $ife will not be as !ind.

Aow that we have that out of the way, don.t get us wrong. Those who have gone before you, professionals who have succeeded and earned our undying gratitude, are those who have compassion, dedication, professionalism and empathy for our family and for all people with disabilities. ?t is our prayer that this is the first step in your ;ourney toward being that !ind of professional.

"incerely, /others of children with disabilities Dawn, Emily, Jennifer,

Tonya

%etter from -ids

Dear BHP,

I want you to be fun. I work all day at school and then I have to come home and work all night. Thats really, really hard. rownu!s are telling me what to do all the time. I dont really know why I have a grownu! stuck to my side all the time. "ome days I #ust want to have fun and be a kid. $ou may need to teach me how to be a kid because sometimes I dont know how. Please try and make my work fun. I really do learn when you make the stuff I need to learn fun. %y body and my brain dont work like yours or like other kids. That makes it really hard. &ots of times it takes me longer to learn things. It hel!s me when you are !atient and encourage me and are !roud of what I do. It hel!s when you listen carefully and watch what Im doing. I cant always tell you whats going on with me, but I will show you. &isten to me even when I dont follow my rules. I really need you to follow through with my goals. I need structure so I know how the world works. Hel! me have a good life. Hel! me be like other kids. Hel! other kids like me. I know when there is a birthday !arty and Im not invited. It hurts me when I dont get invited. I know when !eo!le are talking about me and it bothers me. I dont want limitations' I want to be like other kids. (ven though I am struggling with my body and my brain, I am a !erson too. Please treat me like a !erson and hel! me be the best that I can be. Thank you) $ours truly, *+(D


DEAR NEW BHP,

%etter from BHPs

IT DOESNT SEEM LIKE THAT LON A O THAT WE WERE SITTIN WHERE !O" ARE NOW# SOME O$ "S HAD BEEN WORKIN WITH %HILDREN IN BEHA&IORAL PRO RAMS $OR A $EW WEEKS AND SOME O$ "S HAD NOT !ET ' OTTEN O"R $EET WET# B"T ALL O$ "S HAD MORE ("ESTIONS THAN ANSWERS# IN $A%T, THOSE O$ "S WHO HAD A LITTLE BIT O$ E)PERIEN%E WITH THESE KIDS HAD MORE ("ESTIONS THAN THE OTHERS# BE%A"SE WE HAD BEEN WORKIN WITH A KID $OR A WHILE WE BE AN TO "NDERSTAND J"ST HOW M"%H WE DIDNT KNOW# WE DID HA&E ONE THIN IN %OMMON# WE ALL WISHED THAT THERE WAS SOMEONE WHO HAD BEEN THRO" H WHAT WE WERE OIN THRO" H, TO HELP "S A&OID SOME PROBLEMS AND TO MAKE THE MOST O$ THE OPPORT"NITIES TO %OME# NOW THAT WE ARE NEARIN THE END O$ THE BHP %O"RSE, WE ARE MORE PREPARED $OR THE %HALLEN ES WE $A%E E&ER! DA! # WE WO"LD LIKE TO SHARE WITH !O" SOME O$ THE THIN S WE&E LEARNED AND WE HOPE THIS WILL HELP !O" AS !O" BE IN !O"R WORK AS A BHP#

*+# WHEN !O" START WORKIN WITH A %HILD $OR THE $IRST TIME !O" WILL PROBABL! BE NER&O"S# SO, AS !O" ENTER THE %HILDS HOME $OR THE $IRST TIME, IT MA! HELP !O" TO $EEL LESS NER&O"S I$ !O" LOOK AT THE SIT"ATION THRO" H THE E!ES O$ THE %HILD AND $AMIL! # THE! PROBABL! HA&E MAN! O$ THE SAME ("ESTIONS ABO"T !O" THAT !O" HA&E ABO"T THEM# AND THE PARENT,S- ARE TR"STIN THAT !O" WILL %ARE $OR AND HELP THEIR %HILD# SO, THE! ARE TR"STIN !O" WITH THEIR &ER! PRE%IO"S %HILD AND THE! ARE OPENIN THEIR HOME AND HEARTS TO !O"# %AN !O" IMA INE HOW &"LNERABLE THE! $EEL./ THE BEST WA! TO HANDLE THIS SIT"ATION IS TO BE !O"RSEL$ AND TO BRIN !O"R %"RIOSIT! WITH !O"# BE OPEN TO AND RESPE%T$"L O$ THE %HILD AND $AMIL!S THO" HTS AND IDEAS# LISTEN TO THEIR HOPES AND $EARS# MOST O$ THE TIME REALL! LISTENIN AND TR!IN TO "NDERSTAND THEIR SIT"ATION IS THE MOST HELP$"L THIN !O" %AN DO# R"SHIN TO HELP OR SOL&E THE PROBLEM %AN %REATE "NREALISTI% E)PE%TATIONS AND %O"LD END "P BEIN A PROBLEM $OR !O" LATER ON# LISTENIN IS PROBABL! THE MOST IMPORTANT SKILL THAT !O" NEED TO BE AN E$$E%TI&E BHP# *0# WE HA&E ALL HEARD O&ER AND O&ER A AIN THAT E&ER! %HILD IS DI$$ERENT# THIS IS TR"E, THE %HILD IS A "NI("E PERSON AND S1HE IS J"ST LIKE !O"# !O" APPRE%IATE BEIN TREATED WITH KINDNESS AND !O" PROBABL! RESPOND TO PEOPLE BEIN $RIENDL! WITH !O"# THE %HILD ALSO APPRE%IATES BEIN TREATED WITH KINDNESS AND E&EN I$ S1HE DOES NOT SHOW IT RI HT AWA!, O&ER TIME S1HE WILL RESPOND TO !O"R $RIENDLINESS# !O" MI HT $EEL THAT !O" ARE ALWA!S I&IN AND I&IN AND I&IN AND THE %HILD IS NOT MAKIN AN! PRO RESS# PLEASE BE PATIENT AND KEEP A POSITI&E ATTIT"DE# !O" ARE AN IMPORTANT WITNESS AND ROLE MODEL $OR THE %HILD# WHEN !O" ARE BEIN POSITI&E, BELIE&IN IN THE %HILD, TEA%HIN HIM1HER NEW SKILLS AND HAN IN IN THERE WHEN THE OIN ETS TO" H, !O" ARE PRO&IDIN THE

%HILD WITH TOOLS TO %REATE A RI%H AND MEANIN $"L LI$E $OR HIM1HERSEL$# !O" ARE PLANTIN SEEDS, !O" MA! NOT SEE THEM ROW, B"T THE! WILL AND ITS IMPORTANT $OR !O" TO BELIE&E IN THE %HILDS POTENTIAL# WHEN THE OIN ETS TO" H 2 "SE !O"R S"PER&ISOR# E&ER!ONE NEEDS S"PER&ISION3 IT IS THE S"PPORT THAT HELPS !O" DO !O"R JOB# *4# WE HA&E ALL $ALLEN INTO THE TRAP O$ LETTIN O"R %ON%ERN $OR THE %HILD WE WORK WITH E%LIPSE O"R OWN NEEDS# PLEASE REMEMBER THAT WE %ANT HELP AN!BOD! B! NE LE%TIN O"RSEL&ES# !O" NEED TO KEEP !O"R SKILLS SHARP AND !O" %ANT DO THAT I$ !O" ARE NOT TAKIN %ARE O$ !O"RSEL$# SO KEEP !O"R PERSONAL LI$E !O"R OWN# MAKE S"RE THAT WHEN !O" ARE O$$ WORK, !O" ARE O$$ WORK# DONT TAKE THE %HILDS PROBLEMS HOME WITH !O" AND DONT LET !O"RSEL$ ET P"LLED INTO THE $AMIL!S %ON%ERNS# LI&E A $"LL LI$E THAT IN%L"DES RE "LARL! RESER&IN TIME J"ST $OR !O"/ AND $INALL! AND PERHAPS MOST IMPORTANT, WHAT !O" ARE DOIN MA! BE SOME O$ THE HARDEST WORK !O" HA&E E&ER DONE# IT WILL BE PH!SI%ALL!, EMOTIONALL!, MENTALL! AND SPIRIT"ALL! DEMANDIN # B"T IT %AN BE THE MOST REWARDIN WORK !O"&E E&ER DONE# WEL%OME TO THE WORK O$ THE BHP, AND ENJO!/ BSI/HSS FROM A 2004 BSI/HS TRAINING CLASS

Competency 0 The participant will demonstrate an understandin of professional "oundaries# $%evel ;&

TH( BHP 9ou will bring your uni ue traits, talents, strengths, interests and life e:periences to your wor! as a BHP. 9ou will draw on these in your day<to<day wor! with the child. #s a professional you will also want to continuously increase your !nowledge and s!ills<base to ensure that you are providing the best service possible. P'O)(**IO1A%I*M Being a professional begins with you being aware of your thoughts, feelings, and actions. This is called self<awareness. "elf<awareness is a s!ill that involves developing and mastering the use of an observing eye and ear. ?t is the ability to interact with another person and notice how you perceive the situations, and what you are doing or saying. "elf<awareness also involves noticing your thoughts, feelings and actions when you are by yourself.

Being self<aware involves being interested in and curious about how you behave. ?t is being willing to uncover your unconscious motivations. ?t is in understanding where your beliefs and values come from. ?t is in !nowing that there are things you do not see about yourself. The Kohari 4indow way of visuali=ing self<awareness shows levels of self<awareness in four interacting uadrants. 9ou should strive to be impeccably self<aware. 9ou have impeccable self<awareness when you accurately understand your ,pen "elf. 9ou !now what is appropriate and inappropriate to share of your Hidden "elf. 9ou are curious to learn about what others see in your Blind "elf. 9ou understand that there are some parts of yourself that you and others

do not !now about in your Hn!nown "elf and you are willing to loo! at these un!nown parts when they arise. P'O)(**IO1A% BO/10A'I(* Professional boundaries are the foundation of professionalism. 4ell constructed and maintained boundaries will support a healthy wor!ing alliance with the child and family. 'HH" licensing regulations, legal mandates, /aine&are 2ules, and agency policy define the limits of your wor!ing alliance. These limits help form your professional boundaries. &lear boundaries will help you be an effective observer, an accurate reporter and to use sound ;udgment. "etting clear boundaries will also help you !eep your personal feelings separate from your professional responsibilities. "ituations will arise in which you have strong feelings. ?t will be important for you to stay in control of your feelings and maintain your professional boundaries. #nother way you will set your professional boundaries with the child and family is to establish trust. Being trustworthy will help you build a strong wor!ing alliance with the child and family. 9ou will begin establishing trust by being consistent, arriving on time, leaving on time, letting the family !now if you are going to be late, and being clear about your responsibilities. 9ou will also establish your professional boundaries by setting clear physical boundaries. This involves being aware of how you interact physically with the child, for e:ample, how close do you sit to the childJ ,ther aspects of physical boundaries are how you dress, enter the family.s home and show respect for the family.s property. ?n the normal process of developing and maintaining your professional boundaries you may e:perience a boundary violation; either you will unintentionally overstep a boundary or the child or family member will inadvertently cross a boundary. ?t will be important for you to correct the boundary violation as soon as possible. ?f you thin! you may have crossed a boundary, spea! with your supervisor, he+she will help you identify and correct boundary violation. P'O)(**IO1A% P('*O1A 'eveloping a professional persona is part of professionalism and it will help you maintain your professional boundaries. 9ou will need to pay careful attention to the image you pro;ect to the child and family. The image you pro;ect to the child and family is called the Professional Persona. ?t is the manner in which you present yourself to the child and family. 9ou will need to develop a professional persona. ,ne way you can do this is to be !nowledgeable, aware, confident and centered.

Being !nowledgeable means understanding and being able to e:plain the important aspects and functions related to your ;ob, i.e. o 9our ;ob description o The agency policies and procedures o 9our legal and regulatory responsibilities o 9our role as a member of the child.s team o 9our role in implementing the child.s plan o Inowing the community in which the child and family live and resources that are available to them. Being aware means observing the things around you. ?t involves assessing issues that could affect the child or the family. ?t also involves being sensitive to how you may be impacting the child and family. "ome of the things you will want to be aware of are0 o "afety concerns (yours, the child.s, the family.s) o Hnmet needs (food, clothing, medical, heat, etc.) o /a!ing ob;ective observations about the child.s progress o 9our consistency and dependability with the family (being on time, following through, !eeping promises) o Promoting a safe and secure environment o Building trust Being confident means being self<assured, positive and self<reliant. ?t involves showing the child and family that you will wor! with them to bring about positive change. &onfidence does not mean having all the answers, but it does involve being able to say you don.t !now and you will find out. Being confident can0 o ?nstill hope o Promote a safe and secure environment o Build trust Being centered means recogni=ing the physical sensation of having your feet firmly planted on the ground and a healthy emotional detachment. There are a number of ways in which you can be !noc!ed off your center in your wor! with children and families. They are0 o "omeone pushes your Phot button. o "omeone challenges a strongly held belief o 9our stress level gets too high, you have a strong emotion (fear, anger, sadness) or you have a cold o 9ou become emotionally involved o 9ou are distracted by an issue or event outside of wor! Because you are consciously using yourself in your wor! as a BHP it is very important that you ta!e good care of yourself. /aintaining good professional boundaries is an ongoing process and having strong boundaries is an essential part of ta!ing care of yourself. 8ood

supervision is important in the development and maintenance of a healthy professional persona. ?t is also essential to have a support system both at wor! and in your personal life.

Competency ( The participant will demonstrate the a"ility to solve pro"lems related to the delivery of "ehavioral health services# $%evel ;&
P'OB%(M *O%2I1. 9our wor! as a BHP will involve a great deal of problem solving. "ome of the problems will be simple, everyday types of problems. ,thers will be complicated and involve people inside and outside of the family. 9ou will need to become an effective problem solver. 4hen you are engaged in the problem solving process you are doing two (() important things. The first is solving a problem, the second is role<modeling problem solving for the child and family. >arious writers and trainers have developed procedures that assist individuals and groups in solving problems cooperatively. These procedures range from five to seven steps, but all follow the same pattern and include the same components. ?n general, the purpose of the various problem<solving strategies is to strengthen communication and enhance the ability of individuals wor!ing together. The following is a combination of several different problem solving approaches. /ichael /itchell, $&"4 developed this method.

9ou will need to !now how to effectively solve problems and also how to teach problem solving to the child and family. The effective use of the P,#2 problem solving strategy will enable you to gain a better understanding of the child and the interventions that are most effective. The POA' problem<solving method has four (7) steps.

"tep %0 Pro"lem - This is the critical first step that involves bringing the problem into the light of day. How the problem is defined will affect the rest of the process. This step recogni=es+identifies the immediate pro"lem and avoids being sidetrac!ed by the larger issues.

?t describes what is happening in the moment, what the child is actually doing and feeling or what is actually happening between two people and how they are feeling. The immediate problem is defined ob;ectively. The immediate problem is an ob;ective and accurate statement about the facts of the situation. *or e:ample0 Billy and "u=y are playing a game. "u=y wins the game, and Billy seems mad. Billy hits "u=y. The immediate problem is that Billy hit "u=y. # common mista!e that can occur when defining the problem is getting sidetrac!ed by the larger issues. There are often many layers that can affect the problem; attempting to address underlying issues while emotions are running high can cause the situation to escalate. #ccurately seeing and hearing what is happening in the moment is vital to effective problem solving. Ieeping the attention on the facts can help each person involved in the problem feel seen and heard. ?n our e:ample, the larger issue, which is not dealt with in the moment, may be that Billy is ;ealous of "u=y or that he feels inade uate because he lost the game or it is his inability to control his anger. These are guesses about what might be causing Billy to hit "u=y. The larger issue cannot be dealt with in the moment and trying to focus on it could cause the situation to escalate. Ieep the focus on the immediate problem. 4hat is happeningJ 4hat can help bring about a uic! and effective solutionJ ,ftentimes when a problem is occurring, the people involved in it have very strong feelings. "ometimes in your wor! as a BHP, you will have strong feelings about what is occurring. Paying attention to the facts helps you !eep control over your emotions. ?t also helps you to !eep your personal views and beliefs from clouding the issue. 'epersonali=ing the problem will help you ob;ectively describe the behaviors associated with the problem and can decrease the li!elihood of ma!ing ;udgments about the people involved. #ssigning blame, ma!ing ;udgments or focusing on the person and not the problem can cause the situation to escalate. There may be situations in which you will be able to tal! with everyone involved and together define the problem. ?n other situations, you will need to define the problem on your own. 4hether defining the problem with the people involved or on your own, the problem should be clearly stated so that everyone involved understands. ?t is often useful to recogni=e how each person might be feeling. *or e:ample, identifying that Billy feels mad and "u=y feels hurt. "omething that you might say in this situation is0 DBilly and "u=y, it loo!s li!e we have a problem. Billy it seems li!e you are mad and hit "u=y in the arm and "u=y, it seems li!e you feel hurt.F

"tep (0 Options - This is the creative aspect of problem solving. The aim is to develop a variety of solutions to the problem. ?n some situations, you will be able to engage everyone in coming up with solutions. 4hen this happens, you will engage everyone in a brainstorming process to generate ideas for solving the problem. 9ou will want to frame the brainstorming process by stating that the solutions need to be consistent with the child.s plan. This process should be done in a supportive and non<;udgmental way. The aim is to come up with as many options as possible for solving the problem.

?n other situations you will be formulating your own solutions. The solution is intended to respond to the immediate problem. #gain, the intent is to generate as many solutions as possible that will address the immediate problem and will be consistent with the child.s plan. Hsing our e:ample some of the options might be to0 'irect Billy to stop hitting "u=y. ?nvite Billy to play another game thus distracting him. )ngage Billy in a s!ill building activity such as a rela:ation e:ercise. ?dentify Billy and "u=y.s feelings. "upport a conversation between Billy and "u=y. #ssist Billy to manage his anger. #s! "u=y to go into another room. ,ften, similar problems will occur. ?t will be important to !eep in mind that options or solutions are Ptime dependent.. This means that the option or solution you used the last time to solve the problem may not necessarily solve the same problem when it occurs again. )ach time a problem occurs, no matter how familiar it is, you should be open to e:ploring new options. 9ou should approach each problem as though you were solving it for the first time.

"tep 30 Action - This is the implementation phase. There are two parts to the implementation phase. The first is Ptesting the options. by as!ing yourself some uestions that will help you decide on the best option. The second is putting the option into action. ?n situations when everyone has participated in defining the problem and created a list of options, they will pic! the one that seems best and implement it. 4hen you are acting alone, you will implement the option that seems most appropriate. ?t is important to !eep in mind that the option that is implemented must be consistent with the child.s plan. 4hen choosing an option you may want to as! yourself the following0 4hat are the ris!s and benefitsJ ?s there any reason why this option will not wor!J 4ill the option be hard to doJ 4ill it be hard to follow through with the optionJ ?s the option consistent with my agency.s policies and proceduresJ ?s the option consistent with the child.s planJ

?s the option fair to everyone involvedJ "ometimes, when you are Ptesting the options. a new option will arise or an original option will be improved upon. ?t is important to remain fle:ible. Pay careful attention to Ptesting the options. as it will help you pic! the one that seems to be the best.

?t is important to ma!e sure that everyone involved agrees on the option pic!ed. 4hen you are acting alone, you will pic! the options that seem the most appropriate. ,nce you select an option, it is time to put it into action. 9ou will ma!e a plan with everyone involved about how the plan will be carried out. 9ou will want to ma!e sure that everyone involved understands what was decided upon and what each person will do. )ach person.s responsibility and the time frame for completing it should be clearly stated and understood by everyone involved. 4hen you are going through the process on your own, you will want to be clear about all the steps that you will need to ta!e in order to carry out the option. "ometimes you may use more than one option to solve the problem. #s you decide on an option to use you should have an idea about how you will measure the effectiveness of your action. 9ou will want to have an idea about what a successful outcome will loo! li!e. 9ou will be in situations that re uire you to respond immediately. ,ften these situations will be comple: and multi<faceted and you will be moving uic!ly through the problem solving steps. 9our ability to attend to the immediate observable problem and not be side<trac!ed by the larger issues will impact the options you come up with to solve the problem, the action you ta!e and ultimately your effectiveness as a problem solver. ?n our e:ample, two options might be used. The first is that Billy is directed to stop hitting "u=y and the second is that Billy and "u=y are as!ed to come up with some ideas about how they might play together. ,2 The first action is to as! "u=y to go to another room and the second action is to coach Billy on managing his anger.

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"tep 70 'esults - This is the evaluation step. 2eflecting on the effectiveness of the action as well as the responses of everyone involved will help you to gain additional information about the child and family and effective methods for wor!ing together. ?t can be useful to discuss the results with the child and family and in supervision.

4hen you loo! bac! on a problem solving process you will want to loo! at how you functioned and the effectiveness of the process. "ome of the uestions you might as! yourself are0 4hat did ? learn about my reactionJ

'id ? stay calmJ ?f ? did not stay calm, what caused me to feel an:iousJ 'id ? focus on the immediate problem; the behavior as it occurredJ 'id ? focus on the issue that led up to the problemJ 'id ? focus on the affect of the behaviorJ How did my definition of the problem affect the outcomeJ

"ome of the uestions you might as! yourself about the process are0 4hat wor!edJ 4hat did not wor!J 4as there something that could have prevented the problem from occurringJ How did the people involved respondJ "ome of the uestions you might as! yourself about the child are0 ?s there a pattern in the child.s behaviorJ 4as there a change in the child.s ability to deal with the problemJ 4as the change an improvement or regressionJ 4hat need was the child trying to meetJ 'id the option address the child.s needJ

Thoughtful reflection on how you solved the problem will help you learn more about yourself, the child and effective ways to solve problems. ?t is good practice to review how you handle difficult situations in supervision. 9ou will want to use your supervisor to help you identify your strength and what you can do to improve your problem solving s!ills.

Competency ) The participant will demonstrate an understandin of teamwor!# $%evel ;&

T(AM 9ou are a member of the child.s team. The purpose of the team is to assist the child and family with identifying their goals and providing them with the support that is needed to meet them. The team should have the parents and child as the team leaders. The parents are the people who have spent the most time with the child and have the most intimate !nowledge about her+him. The parents are the people who have tried lots of different ways to meet the child.s challenges. The parents should be setting the goals for the child. The other members on the team need to learn from the parents. e:periences and build on them. The other team members are the BHP, the clinician+supervisor, as well as other people who are assisting the child and family. These could be natural supports li!e friends, relatives, a church group or other providers li!e a case manager, speech therapist or psychiatrist. )veryone on the team brings a uni ue perspective on what will help the child and family meet their goals. There are four (7) things that each team member can do to support a respectful and productive team. These are0 4or!ing interdependently - this means understanding how each person on the team will assist the child and family. *reely sharing ideas and talents - this means being willing to share your thoughts and observations and doing what is needed, within the scope of your ;ob. #ccepting disagreement as an opportunity to discover the best thing to do - this means seeing the differences in opinions and being open to changing an opinion if it is the best thing for the situation. $istening - this means see!ing to understand, instead of e:pecting to be understood. These four (7) characteristics of a good team member can be summed up in the Team 8olden 2ule - each team member treats every other team member as they would li!e to be treated. # good way to thin! about team is this acronym0

TEAM Golden Rule