Intake/Admission:
Parents who intend to be involved in the complete program of The Institute must attend an Orientation Meeting, complete an assessment packet complete with the RADQ (Randolph Attachment Disorder Questionnaire), Parent Trauma History, Assessment of Parenting Style, Randolph Movement Assessment, and extensive history of the child and family. Parents must be willing to commit to an initial training (together) offered to cover the basics of attachment and trauma, one additional training (review) during the active treatment period, at least monthly parent support meetings, possible developmental attachment interventions between parent and child and ongoing clinical sessions with the therapist, parent(s) and child. Parents also go through couples therapy when it is indicated.  The expectation is that parents may join the network of respite parents that provide appropriate time out for each other, or invite their support network to one of the respite trainings I provide so that there is continuity in the care giving for the child.

Families and individuals seen through The Institute are impacted by medical trauma, intergenerational trauma, early caregiver disruption, maltreatment, and multiple placements. Generally, this population also struggles with attachment problems.  The majority of clients are families with children who are experiencing both attachment difficulties and post-trauma related stress.  About half of the families are in the process of adopting, or have adopted children from the child welfare system.  The other half are biological parents, foster parents, or kinship caregivers. The client population typically reflects the demographics of the area, which include Caucasian, African-American, and Hispanic clients. Children adopted from countries outside the US are commonly seen. Ages range from 18 months through adulthood, with most of the children ages 5 years through adolescence. The families have been struggling with attachment issues for at least two years on average with problems to a severity level of complex. Most children have received diagnoses of ADHD and ODD (Oppositional Defiant Disorder). Many also have a diagnosis of PTSD, and RAD (Reactive Attachment Disorder).  A more rare, albeit not uncommon diagnosis is BiPolar Disorder; Childhood Onset. Many of the children seen are already receiving medication for one or more of the mentioned disorders, and are in some special service category of the education system.

Client families are also accepted for parent consultation services. They may not be interested in the wholistic approach offered by the Institute. It is my hope, however, that they might become interested in the whole range of services offered. I believe this speeds the process and makes our work together even more “family friendly.”   Parent(s) with a sincere desire to work together with their child in therapy will not be refused.

Assessment:
Parents will complete an initial written application with identifying information and documentation of presenting problems, school history, child’s medical history, medications, any testing information already obtained, developmental history known to them, parent goals for the child and family in therapy. They are also expected to attend an orientation (offered at least quarterly, or more frequently as needed) and an initial introductory Parent Training where they will meet me, be introduced to the philosophical approach I use, and be presented with information to fully inform them about problems with attachment and what might be expected in the Institute’s program. Once they are fully informed, they are presumed to be better able to determine whether they will be willing to commit to the full program.  At that time a treatment contract, fee agreement or arrangements for payment and release of information forms will be obtained.

Often, an in home assessment of both the child and family is completed in order to evaluate the strengths, the nature of the problems, collect parent history and gain the chronology of trauma history on the parents and child. Assessment instruments including the RADQ, the CROPS, PROPS, LITE-P and LITE-S and Parent Satisfaction Survey will be administered before the development of a comprehensive treatment plan.

Treatment Planning:
Parents are an integral part of the treatment team and their input and identified needs for the family are crucial to planning.  Parents are expected to attend parent-training sessions and read various materials pertinent to their situation.  Because the Family Attachment Parenting style is a significant part of the treatment, parents are also expected to be willing to implement a new approach with their child/ren.

Treatment Techniques Used:

• Family Attachment Parenting classes
• Behavior management
• Parent participation in all sessions
• Coordination with schools where necessary
• Developmental Therapy for caregiver and child
• Movement Therapy
• Claiming narratives
• Development of a coherent narrative for the child
• EMDR
• Couples counseling
• Participation in the Attachment Respite Network
• Parent “Date Nights”

Safety/risk management plan: Parents are included in all child sessions. The ATTACh safety guidelines define our approach and children are continually monitored for safety, physical and psychological well-being. We do not ever intentionally cause pain or allow physical or emotional suffering to be a part of any treatment.  Parents are instructed in alternative methods to influence compliance at home and these are discussed at the beginning of each session.  Shaming, degrading and restraint are strictly prohibited both in the treatment room and at home. The importance of this approach is an integral part of Family Attachment Parenting classes and the approach in general.

Evaluation/outcomes/follow-up: Children are administered the Randolph Movement Assessment, the RADQ and other trauma evaluation instruments at the beginning of treatment and again at various points in therapy.  These results guide the treatment, along with ongoing behavioral observations, mental status evaluations, parent reports, teacher reports, and psychiatric medication evaluations as indicated.  Families are invited to continue to participate in the parenting classes as often as they wish, and 3 month, 6 month, 9 month and 1 year follow-up appointments. Additional sessions are available as needed after treatment is concluded.