Sample of Separate Circle of Care Treatment Plan For A Student Who Requires Coordinated Multisystem Services
1. Identifying Information
Name: Tim
Birth Date: 87/10/21
Age: 10yr 5mos
Date of Plan: 98/3/17
Parent/Guardian: North by Northwest Child and Family - Temporary
Guardian
Joe and Susan Smith; Foster Parents as of October 1, 1997
School: Central
Grade:
4 (Grade 1 repeated)
2. Description of Concerning Emotional/Behavioural Problems
(Specify the student's behavioural/emotional problems, how they endanger self/others, the problem's persistence over time, and their pervasiveness in the student's environment at home, at school, and in the community.)
Tim's behaviour can be quite extreme when someone gets in his way or when he is upset. His actions at these times are not particularly rational and some of his behaviours endanger others or himself. A few samples of these types of behaviours are given in the following table. Overall, there have been 24 documented examples of such behaviours since September of this year. Most involve an attack (one quick hit or push) and then escape (running out of the room or building). However, a couple of incidents have resulted in intense fights when people did not back down. If restrained at these times, it can take many hours for Tim to deescalate.
| School | Home |
|---|---|
| Held a young girl by the throat when she got in his way | Fought with his brother during an arranged visit and threatened to knife him |
| Pushed a paraprofessional when she stood in front of him while he was trying to leave the classroom during recess (he was to stay in at recess), he used sufficient force to cause her to lose her balance | Ran out of the house and stayed away most of the night – never indicated where he was |
| Hit a paraprofessional seated in front of him in the back with his fist, this was without apparent reason and he used sufficient force to cause the para to leave the room in pain | Was found on the roof of the house one night when he had been grounded, was trying to get out – the house is two stories |
| Threw a book at the teacher when he was having trouble with assignment | Has damaged his room and some of his own things when upset |
| Ran out in front of a car during recess (was chasing a ball) | Youth Emergency Crisis Stabilization Team has been called into the home twice in the last two months |
| Hit another child on the calf with a stick causing bruises when angry with him for scoring a winning goal on his team | Tim has had difficulties in school since kindergarten, and some difficulties were reported in daycare. Child and Family Services has been involved since he was two and has been his legal guardian at various times since then. |
Coping Strategies and Patterns
When Tim is intent on doing something and someone tries to get him to stop, Tim usually ignores the person and continues what he is doing. It appears to matter little if the person is a peer or an adult, although Tim does appear to respond more positively to young children when they try interrupting him. If the person becomes more demanding, Tim (on a good day) will stop what he is doing but will stop loudly. For example, if he is to stop working on his mathematics and begin language arts, he may slam his book closed and loudly state "I’m closing it". At home, if asked to turn the TV off to come for supper, he will make loud statements about "this stupid house" or "who wants to eat the stupid meal anyway". On a bad day at school, Tim may simply refuse to recognize the adult or get up and leave the room, usually quite loudly with some comment such as "I don’t have to work in this stupid place". Twice when teachers have tried to stop Tim from leaving the room by standing in front of him, the result was physical. At home he may begin calling everyone names and, if they don’t retreat, leave the home saying "I don’t have to live in this stupid place " and may damage something on the way out.
Tim will work quietly and intently on a task when he knows exactly what to do and has a high chance of success. He does not appear to be bothered by the fact that the task is repetitive. In fact he appears to take comfort in familiar tasks. This is particularly noticeable when Tim is agitated. On good days he may offer to help his foster mother with a chore. He may lose interest after a while but, if the task is short, he will complete it and seems quite pleased with himself. This is one of the few times he will accept praise if gently given. He likes hanging around playgrounds where there are younger children and will sometimes help a child who needs a swing or spin. However, he did get into trouble a few times when he intervened in a situation where a larger child was bullying a smaller one.
3. Development and Function of Student's Emotional/Behavioural Problems
(This section details the developmental context in which the child learned the current emotional/behavioural coping style. The team summarizes those relevant events, including experiences with caregivers, family dynamics, trauma, and any significant occurrences that may account for the student's present coping style and the factors that maintain and drive present behaviours.)
Tim has been moved around a great deal. His birth family moved many times for various reasons and he has had four foster placements since entering school. There are still some unresolved issues and his father has threatened to take him from school when difficulties arise at school even though his father is not to have unsupervised contact with Tim. Tim has seen and possibly experienced extreme violence from a trusted adult and will, when he feels cornered or unfairly treated, strike out although his first response is to withdraw or run.
Tim's birth parents have failed to follow through on various commitments, creating extreme emotional reactions. This is particularly noticeable when they fail to show up for a planned visit. Tim takes a great deal of time getting ready to meet with his parents. When it is evident that they are not coming, Tim initially is very quiet and uncommunicative. Later, he gets into an argument over simple issues and will sometimes destroy things, particularly things he values. Tim is also very stressed leading up to court cases and will become confrontational and defiant over simple requests when a court case is nearing.
During early life, Tim sometimes went without food or adult supervision. He needed to learn to fend for himself and his brother. He can be very self-reliant and may not always trust adults to come through for him or meet his basic needs, including nurturance. This creates conflict when adults want him to "wait" for meals or trips to the mall or theatre. Tim becomes quite anxious and agitated while waiting for positive events and may do something that causes the event to be cancelled.
Through much of his early life, Tim survived through his own wit, skill, and determination. He is highly self-reliant and has limited experience in meeting the needs or requests of others. He has learned to take care of his own needs and his brother's needs. He does not connect with adults easily. He is also very vulnerable to failure. This may tie in with a sense of shame, a feeling that there is something basically wrong with him. After all, he is the one who cannot live at home. When most vulnerable, he becomes agitated when faced with a difficult task and may give up easily. If any corrections are attempted, he may react in an extreme manner. Many people have given up on him in the past and it is not a surprise if someone gives up on him now.
4. Diagnostic Information
(Summarizes formal diagnostic information completed to date by school clinicians, social services and health personnel, identifying critical factors to be considered in developing the multisystem (Circle of Care) plan and Individual Education Plan.)
Dr. Jeff, a psychiatrist, has made a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), predominately hyperactive type with some symptoms consistent with Oppositional Defiant Disorder. There has also been some discussion as to whether Tim's behaviour is truly related to ADHD or to an underlying depression or anxiety. The school psychologist has reported elevated scales on the BASC in both anxiety and depression. A diagnosis of depression would fit with some of Tim’s statements. However, the depression could be more situational than clinical. He certainly seems more "down" and defeated when his parents don’t show for visitations or when court cases regarding custody are near.
A trial of Ritalin has been given. On good days the Ritalin seems to help Tim control his impulsive behaviours. On bad days, it has little impact. Although the medication will be continued and monitored by home and school, it is clear that additional interventions will be required.
Weschler Intelligence Scale for Children indicates that Tim’s underlying thinking skills and conceptual understanding are appropriate for his age group. His nonverbal skills are in the high average range and his verbal skills are in the high end of the low average range. The results compare Tim with students at the same age level. He would be at the low end of the normal range if he were compared with other students in the classroom. Nevertheless, Tim may need help with some verbal concepts. He may become confused if instructions are only given verbally, but he will benefit from a teaching style that demonstrates and models expectations when a task is given.
5. Summary of School Performance
(Pertinent information that gives direction for educational programming.)
See school's Individual Education Plan
6. Multisystem Education and Treatment Plans
(The purpose of this section is to identify Shared Service Goals that will coordinate the implementation of the Multisystem Service Plan to address the student's critical social learning and personal needs and the system's safety needs.)
Critical programming needs underlying these goals are listed on the attached sheet.
6a. Safety Goals (goals that address system’s needs):
- provide alternative placements for times when Tim is at risk of injuring others or himself
- create crisis response supports for the Smiths when Tim puts himself in jeopardy
- reduce damage to the Smith’s valuables
6b. Shared-Service Goals (goals that address personal/emotional and learning needs):
- create a predictable and consistent environment with few changes, to help Tim develop a sense of trust (learning need) and safety (personal/emotional need)
- create opportunities for Tim to have low-stress times (personal/emotional need) and more control (personal/emotional need) when he is most vulnerable to emotional stress
- create an environment where some basic needs such as food (personal/emotional need) can be met and where Tim can learn to wait for some needs to be met (learning need)
- create opportunities where completion of work is rewarded (learning need) and where Tim can begin to see himself as a competent learner in new situations (personal/emotional and learning need)
- create opportunities where Tim can learn new social skills (learning need) and possibly develop friendships (learning need)
6c. Educational Goals: (see school's Individual Education Plan)
7. Multisystem Education and Treatment Plans
(Specifies the service plans developed by the multisystem team to address the educational and shared service goals. The plans include specific strategies that will be implemented in each of the child's living/learning environments and identifies the services provided to support the child and caregivers by each member of the team.)
7a. Safety Plan (Designed to address Safety Goals)
7b. Circle of Care Plan (Designed to co-ordinate the activities of all service systems in all the student's living/learning environments)
7c. Educational Plan (see school's Individual Education Plan)
8. Case Management Process
(This section explains how the plans identified above will be managed and co-ordinated.)
Ruth, the caseworker with Child and Family Services, will manage the community part of the program and insure that resources are available to Tim and the Smiths. She will convene meetings with parents and outside professionals as needed. She will also arrange for additional home supports if they become necessary.
Mary-Sue, the resource teacher, will manage the school part of the plan to insure that resources are in place and that strategies are successfully implemented. She will chair school-based meetings to address educational concerns and provide training and direct support where necessary.
The full team will meet monthly until it is felt that the program is progressing successfully. Communication around the program will go directly to the appropriate case manager, who will resolve problems at their own level or call a meeting of the full team if necessary.
9. Implementation Costs
(Detail the school division/district costs of implementing the school component of the multisystem education/treatment plan.)
