Dylan*: Overcoming Countless Obstacles
Dylan’s* mother Sarah*, turned to the juvenile justice system as a last resort when her son’s behaviors became dangerous, and she feared she could no longer keep him safe. When Dylan arrived in court, the Judge ordered an Emergency Mental Health Evaluation in order to determine his immediate needs. An ACS clinician promptly met with Dylan and his mother to evaluate the situation and to determine the best plan for his safety.
The ACS clinician realized the severity of Dylan’s mental health needs and explained the range of clinical options to Sarah. The clinician recommended that Dylan be placed in a Partial Hospitalization program (PHP). This intensive treatment setting would provide a safe environment in which Dylan’s symptoms could stabilize while still allowing him to spend nights at home. While explaining this recommendation to Dylan and his mom, the clinician became aware of several obstacles to accessing this level of care for Dylan.
Dylan’s Mass Health coverage had lapsed, rendering him ineligible for the PHP. Sarah spoke limited English and did not own a car. Arranging transportation to the hospital would be costly and scheduling appointments with her son’s treatment team meant arranging for an interpreter. The clinician tackled each of these hurdles. Together, they called Mass Health and the Department of Children and Families to reinstate Dylan’s health insurance. The clinician provided Sarah with an MBTA pass and explained how to get to the hospital via public transportation. She also called the hospital to schedule the intake interview and arranged for an interpreter to be present for Sarah when they arrived.
Sarah and Dylan, like many of the children and families we serve, face multiple challenges when accessing care and resources. The Educational and Advocacy services at ACS enable our clinicians to devote additional time to families to ensure they have the information they need to access appropriate services for their child. A few weeks after their initial meeting, the ACS clinician followed-up with Sarah and Dylan and learned that Dylan had been admitted to the PHP and was making meaningful strides in treatment.
Chloe*: Finding Her Voice
Chloe was 15 years old when she was referred to ACS through the Juvenile Diversion program. She had been charged with Assault and Battery after an argument with a peer escalated to a physical fight. Engaging in mental health treatment at ACS would mean the charge would be cleared from her permanent record.
Chloe began individual therapy sessions with an ACS clinician right away. It soon became clear that Chloe’s behavior was likely linked to some challenges she was facing at home. Chloe lived with her mother, Jessica*, and her older siblings. Her father was incarcerated due to gang violence, which Chloe and her siblings witnessed growing up.
As treatment progressed, Chloe began to understand that her exposure to violence as a child played a significant role in her chronic feelings and impulses of aggression. Traumatic events from her childhood were also important factors in understanding her strained relationship with her mother. Chloe’s clinician suggested that in order to work through some of these issues, it could be helpful to include Jessica in some of the treatment session. Chloe was adamantly against this. Her clinician patiently helped Chloe to understand that improving communication with her mom could ease tensions.
In time, Chloe came to trust her clinician and she allowed her mom to join her in session. This shift gave Chloe a voice. She was empowered to verbalize her need for her mom’s support and to express how much she needed Jessica to really listen to her feelings. The clinician also provided support and guidance to Jessica to help her better understand and respond to her daughter’s emotional needs.
A few months after ending treatment, Chloe’s clinician followed up with the family. Chloe had engaged in no further altercations with her peers and shared that her relationship with her mother was slowly improving. It will continue to take time, but Chloe is clearly on a positive path forward.
Jacob*: Not Always As It Appears
In many ways, Jacob is your typical 11-year-old-boy. He is artistic, tech savvy, and enjoys school. His teachers describe him as engaging and cooperative, but that’s only when he can stay awake in class. Despite his interest in school, he would often fall asleep in class and was increasingly absent altogether.
Due to his chronic absences, Jacob’s school filed a Child Requiring Assistance (CRA) application with the Juvenile Court. The presiding Judge referred Jacob to ACS for a comprehensive diagnostic evaluation. A clinician then met with Jacob, interviewed his family members and teachers, and carefully reviewed his medical and school records.
It soon became clear that Jacob was dealing with some challenges at home. Jacob lived with his grandparents because his parents both struggled with addiction. There was also a family history of mental illness and domestic violence. Jacob’s presenting symptoms, the painful events leading up to his separation from his parents, and his family history of mental illness led the clinician to suspect that Jacob was suffering from depression. Knowing that depression tends to impact energy levels, internal motivation, and having a sense of purpose in life, this insight was critical factor in understanding Jacob’s school attendance problems.
Jacob’s clinician recommended that he be referred for further medical follow-up to receive a proper diagnosis and treatment. She also recommended enhanced support services to assist the whole family. She asked the Judge to provide Jacob’s teachers and service providers with a copy of her report so they could be made aware of the family’s needs. With a better understanding of his needs and with the proper treatment, there is reason to hope that Jacob will be feeling better soon.
Jessie*: Understanding Herself
Jessie juggles the multiple roles that define her: teenager, adopted from a foreign country, child of divorce, and transgender.
Her life began in a Romanian hospital. Jessie was later placed in an orphanage. By the time she was adopted by an American couple, she had suffered serious emotional and physical neglect, the effects of which have stayed with her. Jessie is very small for her age. It is also difficult for her to develop meaningful attachments to others.
After joining her new family, the impact of Jessie’s early life experiences began to show. She began to act out at home and in school. These behaviors put a strain on her relationship with her mother, Amy. While a certain degree of turbulence often accompanies adolescence, Jessie was struggling to make sense of her past while also trying to come to terms with her gender identity. She had no idea how to explain this struggle to Amy or how to cope with everything on her own. She started to spend her time with older kids and began to smoke marijuana heavily.
Because Amy worried she could no longer keep Jessie safe, she filed a Child Requiring Assistance (CRA) application. Jessie and Amy met with an ACS clinician who conducted in-depth interviews, both individually and together. The clinician came to better understand Jessie’s present needs. Rather than diagnosing her with a list of conditions and disorders, the clinician considered Jessie in the context of her life experience and what required immediate attention. As it turned out, Jessie was pretty “tired of” talking about being adopted and how her parents’ divorce had affected her. What she really wanted support and guidance around was how to be true to her identity as a girl.
Along with the regular strains on parent-child relationships during adolescence, Amy was facing the reality that she was losing her son and gaining a daughter. The clinician helped her process these feelings. She also educated her about some of the risks associated with being transgender, including bullying, higher rates of suicide, and mental health issues. The ACS clinician linked Jessie and Amy to separate support groups geared toward both of their needs.
Jessie is still involved with the court, but as subsequent court dates approach, she and Amy have reason to be hopeful. While Jessie still seeks out older peers and continues to use marijuana, her relationship with Amy is slowly improving. The support groups recommended by the ACS clinician have helped. Today, Jessie is happy and energetic. She feels accepted and supported by other kids in the transgender youth support group and her new therapist is a great fit for her. Her ACS clinician continues to check in and offer continued support to Jessie and Amy. Jessie is getting the support she needs to begin to build her self-confidence, make healthy choices, and work toward a positive future.
Ryan*: Driving Through Chaos
Ryan was raised amidst the chaos and violence that seemed to follow his mother, Cheryl. The men in their lives had been abusive and Cheryl was hospitalized more than once with severe injuries. They’d had to move around a lot so it had been difficult to put down roots.
Cheryl eventually found a stable job, a safe place to live, and it seemed like things were looking up. But Ryan had trouble adjusting to this new life. He began to exhibit emotional and behavioral outbursts. By the time Ryan entered high school, these outburst had become quite serious. Ryan disobeyed rules and routinely skipped school. Cheryl began to fear that she could no longer keep her son safe. She filed a Child Requiring Assistance (CRA) application with the court. That’s when Ryan was referred to ACS for a mental health evaluation.
An ACS clinician met at length with Ryan and interviewed his family members. She reviewed his school and medical records and consulted with his teachers. It became clear that Ryan’s behaviors were delayed symptoms of the chronic trauma he and Cheryl had experienced.
Ryan began the new school year at an alternative high school designed to support his needs and strengths. In time, his behavior stabilized, and he began to thrive. He even joined the high school basketball team. The structure and support of this setting, paired with the self-esteem he gained from playing his favorite sport, proved to be a winning combination. Because Ryan had made such strides, the school system began to plan for his return to the mainstream high school. Ryan’s clinician strongly advised against this plan, explaining that Ryan was at significant risk for losing the ground he had gained and reverting to old behaviors.
Upon completing her evaluation, the judge approved the clinician’s recommendation that the report be distributed to everyone who was invested in Ryan’s continued progress. His clinician is working with the Department of Children and Families to advocate for an expansion in the services Ryan and Cheryl receive. The family’s attorney informed the clinician that reading her evaluation helped him develop greater empathy for Cheryl. Ryan now has a larger team supporting him and rooting for his continued success.
Jayla*: Finding Home
Jayla spent a lot of time on her own as a young child. Her father was incarcerated, and her mother, Maria, had to work nights. Frequently, Jayla would phone her aunt, who would talk her through making a simple dinner for herself. Maria also had men in her life who abused substances and at times, these men also abused Jayla and Maria.
Jayla was eventually placed in foster care. She found her foster parents to be good people, but “it’s like living in a foreign country.” She knew they meant well, but everything was just so different. First of all, the food was healthy – not the take-out that she was used to. And her foster parents expected her to eat meals with them, come home every night, and stop swearing. While their home was “nice” and the school was “good,” Jayla, a biracial child, felt out of place in the largely white, upper middle class school and community. She often skipped school to return to her old neighborhood in search of her friends. Eventually, Jayla’s school filed a Child Requiring Assistance (CRA) truancy application, which led to her evaluation at ACS.
At age 15, Jayla was quiet and thoughtful as she met with her ACS clinician. After meeting and interviewing Jayla and those close to her, Jayla’s clinician recommended that she be temporarily placed in a group home with the ultimate goal of reuniting her with her mother. Her clinician also recommended trauma-informed therapy for Jayla, and a parent partner, who could provide support and coaching to Maria as they worked toward reunification.
Upon completing her evaluation, Jayla’s clinician followed up with the family and learned that Jayla was already back at home with Maria. Jayla was attending school regularly and doing better overall. Maria continues to work with her parent partner and Jayla has continued with therapy. Their relationship is improving, and Jayla is moving in a positive direction, which is reason to celebrate.
Analisa*: Transforming Conflict into Understanding
Analisa is a 14-year-old young woman who became involved with the District Attorney’s Diversion program. Her charge was domestic assault and battery, the result of a physical altercation between Analisa and her mother, Elena. Analisa was functioning well in all other areas of her life, but she and Elena had a difficult relationship. Elena had sought family therapy, but treatment was not yet scheduled due to long waitlists. An ACS clinician intervened at a critical time, providing family therapy at no cost.
Because even trivial conversations would quickly escalate, the clinician immediately focused on helping Elena and Analisa improve the safety of their communication. As their relationship improved, they both learned new skills and began to practice compromise. The clinician helped Elena to better understand normal adolescent behaviors and to see how her feelings of guilt about being a single mother were affecting her parenting. She helped Analisa learn to understand and gain control over her anger. Both mother and daughter worked hard in treatment and made meaningful strides.
Analisa successfully completed the Diversion program. She was truly diverted from the court: She has no delinquent charges and no permanent court record. Analisa remains at home with her mother, where they continue to build on their progress.
* To protect confidentiality, ACS does not use the names, photos, or identifying features of our clients.