Posted by Lee Fuoco

Everyone at JF&CS In-Home Services who has had contact with *Victor agrees he’s an old soul, and not in a fun way. “He’s seen things,” an In-Home Behavioral Therapist told me recently. And he has, including abandonment as a toddler by his substance-addicted mother to his substance-addicted grandmother, removal from that grandmother after being taken to the ER with a backside full of open sores the size of moon craters because she left him in soiled diapers for days on end, placement in the child welfare system, and placement in multiple foster homes. While in foster care, his Department of Children and Families (DCF) social worker took him to visit his mother, who told him that she was terminating her parental rights because she could not give him the home he needed. She also shared that he deserved to live with a family who could give him the necessities and security she could not provide. All this before he was six years old.

Nothing about Victor’s story is unique to me or the clinicians I supervise, who are providing services under the Massachusetts Children’s Behavioral Health Initiative. We are mandated by MassHealth to provide rigorous, intensive clinical and behavioral therapy to children and families whose needs are not met by a traditional outpatient model. Several times a week, we are in families’ homes triaging crises, processing trauma, and assessing, reassessing, and re-reassessing risk. We are mandated to keep close contact with kids, bringing services to them rather than removing them (often repeatedly) for stabilization and treatment in a hospital setting. This means we spend mornings at individualized education plan (IEP) meetings or school observations and the afternoons and evenings driving from home to home to provide in-home services. Any time we have in the car between meetings is spent on the phone with a child’s prescriber, teacher, or DCF worker spearheading efforts to establish a cohesive treatment team addressing thoughtful goals. This work is not for the faint of heart, the easily deterred, or the disorganized. So much is required every day of the clinicians I supervise, and they are bearing witness to so much sadness, loss, and defeat, that my own head is often left spinning.

So while Victor’s story seems almost pedestrian to someone who has been doing this work for as long as I have, there is something about this child that feels different. That old-soul-ness – a stoicism and downright refusal to engage in joyfulness or optimism that is surely his spirit’s stonewall against a world that has proven itself, thus far, to be nothing but emotionally harrowing. He seemed virtually unreachable at first – difficult, guarded, obstinate, and more motivated by creating stress for those caring for him than taking the emotional risk of being loveable. The literature and research are clear: trauma, especially trauma at an early age, changes a body’s physiology and cellular structure. It breaks brains as well as spirits, leaving gaping wide holes in some places and in others, layer upon layer of defenses that a hundred sticks of dynamite couldn’t break open. A seemingly simple request to clear breakfast dishes or brush teeth are fighting words for kids who spend all day in hypervigilance mode. But, utilizing the team approach that has come to be the clinical hallmark of JF&CS In-Home Services, we are making progress.

JF&CS In-Home Therapists work with Victor on accepting limits and direction, and expressing frustration appropriately. Staff also utilize trauma-focused cognitive behavioral therapy, a progressive, component-based, trauma-informed treatment model. Victor has been able to identify feelings and physical symptoms related to early life trauma and now practices relaxation skills to reduce anxiety. He is in the process of developing a feelings survival kit and writing his trauma narrative. A JF&CS Therapeutic Mentor is working with him in the community to enhance his self-esteem and positive, effective communication of wants and needs. When Victor’s Therapeutic Mentor told me that, following an incident of Victor stealing money from his teacher’s desk, JF&CS staff supported him to confess the theft to the teacher and apologize to her, my heart was in my throat for the boy who used to behave badly to get confirmation that he exists.

DCF is in the final stages of firming up Victor’s adoption. Soon, he will start home visits with what we all hope will become his new family. I feel proud of JF&CS In-Home Services and these clinicians who have made him a little more prepared for this next chapter, who have filled up the holes, broken through the defenses, and added a few years to his old soul.

*Name changed to protect privacy

Lee Fuoco, MSW, LICSW is the Clinical Director of JF&CS In-Home Services, which provides home-based clinical services to kids and families under the Children’s Behavioral Health Initiative (CBHI). Lee graduated from Salem State University’s MSW program in 2010 with a Child and Family concentration. She is a family therapist who has worked exclusively with systemically-involved, high-risk kids and families utilizing systems-focused and social justice perspectives. She also has a specialty in clinical work with LGBTQI clients. Lee also teaches as adjunct faculty at Salem State University’s MSW program and sits on the planning committee of the Youth at Risk Conference.

Originally published on the JF&CS blog.