Treatment Tuesday - Life in a Group Home

This week's assessment is a little different. Camille wrote in to a writing loop I'm a part of, looking for experts in the fields of social service, child welfare, and foster care. While being a licensed therapist doesn't necessarily mean I'd have insight into the above, I wrote back to Camille to be one of her "experts," because having been a foster care social worker and currently working as a therapist in a group home for foster youth does!

Camille wants to know: Can you list a few common issues kids living in a foster care group home setting might have, as well as some typical behaviors? What does a typical day look like in a place like this? School, chores, meal times, free time, and activities? What medications to kids take for what kinds of issues? What issues do staff have, and what is the work environment like?

Before getting to common issues, I think it bears mentioning what type of child would most likely end up in a group home. It's pretty standard to assume that a group home is the absolute last option a social worker would want for a child on her case load. Far preferable would be a loving home somewhere, with parental figures who would accept the good with the bad.

Too often, though, the children who wind up in a group home are the children who have nowhere else to go. Like, zero options. Why? Because of their behavior, most likely. Many exhibit symptoms of Conduct Disorder or Oppositional Defiant Disorder. They likely have some history of theft, truancy, vandalism, bullying, running away, shoplifting, breaking and entering, physical altercations, juvenile hall time, probation involvement, alcohol/drug abuse or dependency...the list goes on.

These children are often not in the mainstream school system, either, but a continuation school or "alternative" school, as they are sometimes called. The atmosphere at these schools is very different. Rare is it to find a child who goes to school from 8-3. They might have as little as one hour of school a day to 3-5. Many try to get on independent study. As a result (or perhaps a consequence...not sure which) these kids are very unlikely to follow through with anything. But yet, don't judge them. No one has followed through for them, either, so they've had no role model.

At a typical small to mid-size group home, it'll have very much the feel of a home. I've taken a few pics from the internet to show the basic feel of one. I'm talking about a large house with several rooms that are most likely shared with same-sex roommates. There are chores expected to be done, but different group homes have different systems in place for this to be accomplished. I've seen point systems, where a child can earn overnights by fulfilling certain obligations, and I've seen more punitive systems where the child will be given a chore for an unexcused absence from weekly group or failing a room check. Meals are provided by staff either as a whole (usually before a therapeutic group night) or may be made by the children themselves, either with or without staff supervision. There usually is no "sit down" dinner at the group homes I know of.

Almost everyone of the children in a group home will be on some sort of psychotropic medication. Since they are in foster care, therapeutic and psychiatric services are "free" to the child (paid for by the American tax dollar), and social workers like to make these referrals. Here in California, a foster child has to be offered counseling because it's the law. The medication of choice seems to be Adderall here. It's from the amphetamine class of drugs and is highly abused (read: sold and acquired on the streets due to addictions). However, many children are on antidepressants or antianxiety medications. The links will give you some of the more common drugs in each category and what they are generally prescribed for. Psychiatrists are the ones who will generally be prescribing these meds to foster children, not family doctors. The child will also not have these medications in their room. Group home licensing requirements (at least in CA) stipulate that the medications are to be centrally locked, stored, and given to the child by staff.

As for staff issues, compliance from the children is a huge challenge. Group home teens like to square off...in fact, I think they more than like it. I think they thrive on it. They don't like people telling them what to do. They love their freedom and their friends. Friends and social networking are oftentimes all they have going for them from the outside eye.

Keeping staff on the same page is also difficult. Group homes are 24-hour facilities, which means staff have to work graveyards, swing shifts, and morning shifts. The group home I work for alternates these shifts for staff, meaning every staff has to work at least one graveyard a week. This can be difficult for staff to keep a normal sleeping routine. You will never, ever, get all staff to the same training. EVER. This makes staff professional development difficult and daunting.

Hope this helps, Camille. Thanks for writing in, and good luck with the story!

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