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Welcome to Trillium Family Services!

Trillium offers hope to families when they don’t know where else to turn. Whether it is a one-time mental health crisis or an ongoing condition, we equip children and their families with the right tools to treat conditions and create new environments that prevent reoccurrences and enable children to realize their full potential. Trillium, a nonprofit organization, was formed in 1998 when three historic agencies — the Children’s Farm Home in Corvallis and the Parry Center for Children and Waverly Children’s Home in Portland — merged to create an integrated treatment system with a statewide reach. Today, through programs at two campuses (Portland Metro Area and Mid-Willamette Valley) as well as in a wide range of community-based programs, Trillium serves thousands of children and families each year.

We look forward to working with you and your family, and are hopeful that you will find your time here to be beneficial and supportive. The treatment teams are family-oriented and strongly committed to your active participation in your child’s care and treatment. This guide is designed to introduce you to the program, our philosophy of care, and the treatment services offered. It will answer questions you may have about what we do in treatment, what you can expect from us, and what we will expect from you during your child’s time at Trillium. We consider families and young people to be our clients, and work hard to meet your family’s individual needs. This handbook was created with input from staff, clients, and family members, and is provided for your convenience. We hope that it assists you while you and your child receive treatment at Trillium.

Our Treatment Philosophy

The vision of Trillium Family Services is to provide a continuum of comprehensive mental health services, promoting growth and learning in a safe environment for young people and their families. Our staff is professional, competent, and well trained. We welcome productive change and are dedicated to promoting success through teamwork with families and the community. We provide integrated and culturally diverse youth, family, and community services, maintaining a constant focus on putting clients and their families at the center of their own treatment.

Trillium uses the guiding principal of Trauma-Informed Care in our programs. This means that we work to recognize the trauma that our clients have experienced in their lives, including abuse, neglect, poverty, homelessness, and sometimes even the experience of being in treatment. We work to avoid re-traumatizing our clients or families, and to create a supportive environment for both our clients and our staff.

Services Provided at Trillium Family Services

Trillium provides a wide variety of services to the children and families with whom we work. These services vary from prevention support and outpatient therapy in children’s schools to residential placement in 24-hour care. The guide below shows some of our services, grouped by amount and intensity of services provided.

Prevention Outpatient Intensive Community Day Residential Sub-acute Secure Support Therapy Treatment Services Treatment Services Care Inpatient

Prevention Support

Prevention Specialists (who are master’s level therapists by training) are based in schools and other community locations throughout Multnomah and Clackamas Counties to work with students, families, and the community to promote healthy development and formation of healthy lifestyles and behaviors. Prevention Specialists work to increase access to mental health services, identify behavioral health risks, increase protective factors and decrease risk factors, reduce stigma and improve mental health literacy, provide critical information on healthy child development and parenting supports, and promote cross cultural understanding of mental health. In some schools, Prevention Specialists also offer groups using the Chrysalis program to support and empower young women who have experienced trauma.

Outpatient Therapy

Trillium’s Outpatient therapists work within many schools in Multnomah and Clackamas Counties, and have offices within the school setting. We also offer Outpatient services based on the CFH Campus. Children are seen for individual therapy sessions in their school, and therapists often provide family therapy within the child’s home, to help make appointments convenient for families. Many times, skills training is also included as part of Trillium’s Outpatient services, which includes a staff assigned to each child who can provide support and training specific to their needs, such as social skills training, anger management, or community skills. If appropriate to the child’s needs, medication management can also be provided through a Trillium provider.

Therapeutic School

Trillium’s Four Corners program is a therapeutic school education placement, run in conjunction with the Reynolds School District. Children enrolled at Four Corners through their school districts receive additional support in the classroom, including small class size, individualized academics, and a structured schedule. In addition, Trillium provides behavioral support in each classroom, as well as the ability to take breaks and receive support from therapeutic staff in the milieu. In addition, a Trillium therapist works to bridge school and home needs, work with children’s therapy providers in the community, and provide referrals and support to each family.

Intensive Community Treatment Services (ICTS)

Intensive Community Treatment Services (also sometimes called Intensive Outpatient, or IOP) for children and their families include individual therapy, family therapy, medication management, and skills training. Services can be provided in the therapist’s office, the community, or in the family home, depending on the need and preferences of the team. These services are provided to families struggling to maintain their current difficulties, with the hope of keeping children in their homes. Staff are also available on a 24-hour basis to provide crisis support to the child and the family. These types of services are provided in several counties in the Portland metro area, as well as in areas surrounding our West Salem and Corvallis campuses.

Day Treatment

Day Treatment (sometimes called “partial day hospitalization”) is a mental-health program provided in a school-like setting, with a focus on mental health treatment including individual therapy, family therapy, medication management, and skills groups. Trained staff support children throughout the day in the therapeutic milieu, and remain with them in the classroom to provide support. Classes are lead by teachers from the school district local to the program, and children are encouraged to complete school work in addition to their therapy activities.

Residential Services

Residential services are offered to children and families whose difficulties are severe enough that the child needs support outside their home. In Residential care, children receive 24-hour support from therapeutic staff, as well as individual therapy, family therapy, medication management, and nursing care for physical and medical needs. Children attend on-campus schools staffed by teachers from the local school district, with therapeutic staff present throughout the school day. Children also participate in therapy groups during the day, and are encouraged to learn new skills to help them succeed in their home environment.

Sub-acute Care

Sub-acute treatment includes stabilization of mental health symptoms through intensive therapeutic support, frequent medication management services, individual and family therapy, as well as nursing care for physical and medical needs. Sub-acute treatment is designed to be intensive and brief (a few days to a maximum of several weeks), to move children quickly back to their homes. Treatment is provided within the on-campus school, so children participate in therapeutic activities throughout each day.

Secure Inpatient Treatment

Secure Inpatient care is designed for children who need longer-term support and intense therapy services. Trillium is the only provider of Secure Inpatient treatment for children and adolescents in Oregon, and this service is considered to be a state hospital level of care- all referrals must come through the state’s Department of Addictions and Mental Health. Children participate in individual and family therapy, therapeutic skills groups in the milieu, and school in a contained classroom. This program is highly supervised due to the intensity of the children’s needs.

Confidentiality

As a client at Trillium Family Services, your personal medical information will be held in the highest confidence. No information about you or your child can be given out without your consent, except in specific instances to protect safety. All Trillium employees are taught the importance of confidentiality, and are aware of the legal implications for any violation. There are times when situations dictate that we must violate confidentiality, such as to maintain safety. Your therapist will discuss these with you, and we encourage you to ask questions to ensure that you understand the rules and exceptions. At times, it is important to share information between treatment staff to support your child. Information about your child’s case is discussed only in a professional atmosphere among qualified mental health care staff, and for reasons necessary to treatment. To maintain confidentiality for your child and others, we do not allow cameras or video on Trillium campuses. This includes cell phones with camera or video capability, personal recorders, or other electronic devices with camera or recording ability.

Requests for Records

Due to federal privacy policies, only our Records Department may release copies of your child’s records. If you would like a copy of anything in the record, please call the reception desk and request to speak to our Records Department. We will respond to your request in a timely manner, and will work with you to meet your needs.

Clinical Care

Included in this handbook is a list of commonly provided treatment interventions at Trillium. However, please note that not all treatments here are available in all levels of care. Please refer to the handbook for your specific program for more information.

Treatment Plans

Each client at Trillium will have an Individual Plan of Care (IPC) which outlines their personal goals for treatment. Treatment plans are designed to meet the individual needs of each one of our clients. Goals are determined by the client’s treatment team as part of the admission process. This team includes the client themselves, you as their parent or guardian, the Child and Family Therapist, the Psychiatrist, and other community members that you may find to be supportive. Each child’s plan is reviewed periodically by the treatment team to determine progress towards goals and to discuss plans for the client after they leave care.

As the parent or guardian, it is essential that you participate in these IPC Review meetings. It can be difficult to coordinate everyone’s schedules, and we will do our best to ensure that they are held at a time that is most convenient to you. Wherever possible, the client is strongly encouraged to attend this meeting as well. Our goal is to place them in a position to help make treatment decisions and express their needs as part of the treatment team. You are also welcome to invite anyone that you feel would be helpful in planning your child’s treatment, including family members, advocates, or other supports. We will ask you to complete a written Release of Information for these people, as we will be discussing confidential client information during the meeting.

Individual Therapy

Generally, clients are assigned and scheduled to meet with their Child and Family Therapist at least once weekly for individual therapy. The schedule of sessions will be determined by the therapist and the team to meet the client’s needs; some younger children may require shorter sessions several times each week, where sessions one or two times per month may be appropriate for other clients. Young people may also check in with their therapist at other times when in need of additional support.

Family Therapy

Families are an important part of the treatment team and family therapy is a key part of a client’s treatment. Our goal is to learn more about your family and incorporate your family values into the treatment here, while supporting the client and family to develop more successful interactions. Our Child and Family Therapist will work with you to establish a schedule for therapy sessions which is both convenient for your family and adequate to meet therapy goals. We can also help you to find resources from other family members who have experience with this field and can provide support to you and your child.

Group Therapy

Many programs provide group therapy as part of the therapeutic services. In groups, children and adolescents are able to benefit from one another’s experiences and support each other in their treatment goals. The Outpatient programs frequently offer group therapy as part of treatment goals with groups ranging from self esteem groups, anger coping groups, and sexual abuse survivors groups. In our Prevention programs groups are also frequently provided. One of the consistently provided groups are Chrysalis groups, which are facilitated at multiple school sites. Chrysalis groups are supportive therapeutic groups for high school girls who are survivors of trauma. In our residential programs, group therapy is an integral part of the day with varying topics such as anger management, music and therapies, self-esteem, and community building.

Medication Therapy

Medication therapy and stabilization can be an important piece of all clients’ overall treatment. If medication is determined to be appropriate, Trillium can provide a medication provider (a Updated Jan. 2013, je www.trilliumfamily.org 8 Psychiatrist or Psychiatric Nurse Practitioner) with expertise in young people and mental health. In addition an initial evaluation, each young person meets with the medication provider on a regular basis. Sometimes it is determined that a trial of medication might be helpful for stabilizing a client or for helping them manage their behavior. If that is the case, medication will be prescribed and monitored for effectiveness. You will be involved in decisions regarding medications for your child, and you will have an opportunity to ask any questions you have to make sure you understand the medications and any potential side effects. In residential programs, medications are administered by nurses or staff members specially trained in proper medication administration. Each month medications and medication changes are included as part of the monthly treatment review.

Trillium encourages young people and families to be actively involved in the medication therapy process. Medications and the reason for their prescription are explained to clients and their families. Clients are encouraged to discuss how they feel about the medication and if it is or is not working for them. Families may also call and talk with the psychiatrist about their child’s medications. Information sheets that explain the benefits, side effects, and possible risks associated with the medication are also available. Prior to beginning any new medication, consent is required by the legal guardian. This is generally obtained through the family, legal guardian, or DHS caseworker (when DHS is the legal guardian).

Milieu Treatment

The term “milieu” describes the therapeutic environment that includes all the clients, staff, and activities in the program, for programs such as residential, day treatment, or therapeutic school. The milieu setting offers an opportunity for your child or teen to practice safe and appropriate interactions with peers and adults while becoming more responsible. Treatment staff are available to help clients with anything that may come up during the day.

Therapeutic Interventions

Trillium Family Services uses evidence-based interventions to help children and adolescents learn new skills, recognize maladaptive patterns in their lives, and maintain safe behavior. We work to find the interventions and styles which will match your family situation best, and will include you as a vital team member to determine the best interventions and goals for your situation. Some of our most commonly used treatment methods are Collaborative Problem Solving, Cognitive Behavioral Therapy, and Dialectical Behavior Therapy. There is a small amount of information below on each style of treatment, but please feel free to ask your child’s therapist if you have more specific questions.

Collaborative Problem Solving (“CPS”)

The Collaborative Problem Solving approach proposes that “children [and families] do well when they can.” At Trillium Family Services, we strongly believe in this philosophy, and feel that our role in your child’s treatment is to recognize their strengths, and to support and teach them in the areas in which they struggle. We work to evaluate each child’s lagging skill sets that prevent them from reaching their full potential, and we work to teach and develop those skills. Your child’s Child and Family Therapist can help to teach you these techniques as well, and will work to help you maintain your child’s progress so they can be more successful when they return home.

Cognitive Behavioral Therapy (“CBT”)

Cognitive Behavioral Therapy works to develop awareness of the links between our thoughts, feelings, and behaviors. Often when children engage in aggressive or self-harmful behaviors, they can be labeled as “bad,” when these behaviors are often just a natural reaction to their thoughts and feelings. In CBT, we work together with clients and their families to identify maladaptive thought patterns and emotions which lead to these behaviors, and then teach and guide clients to a more adaptive way of interacting. These techniques have been proven to be very effective with symptoms of anxiety, depression, and aggression, particularly in children and adolescents.

Dialectical Behavior Therapy (“DBT”)

Dialectical Behavior Therapy strives to have clients view their therapist as an ally, rather than an adversary. Accordingly, therapists aim to accept and validate the client’s feelings at any given time, while also informing the client that some feelings and behaviors are maladaptive, and showing them better alternatives. Therapy focuses on some elements of Cognitive Behavioral Therapy, in addition to teaching mindfulness, distress tolerance, and emotional regulation skills. At the Children’s Farm Home, one cottage is devoted to the DBT model, and we are recognized around Oregon as being a treatment leader. In other residential units, many therapists and staff have been trained to use this model, and will work with you and your child to develop new skills.

Behavior De-escalation

If clients become upset or frustrated, staff will do their best to help them calm down and provide support. In all cases, we consider the safety of your child, as well as the other clients in our care, and work to make sure that everyone feels safe in our treatment environments.

Of course, what works best for each client is different, and we work to learn the most effective interventions with each person. For some, talking through the problem may be the best way to calm, while others may prefer time alone to calm independently. We will work with you to learn about your child, and share with you anything that we find to be particularly helpful. Common interventions to help clients de-escalate when they become upset are one-to-one check-in with staff, time away from the group, verbal redirection, escort away from a situation, and validating their feelings. If a client becomes aggressive or assaultive when upset, we help them calm and then work to determine what triggered their upset, what they can do differently when they feel upset, and create a plan of how to maintain safe behavior when they become upset again.

Client Rights

All children and families served by Trillium Family Services are guaranteed certain fundamental rights, and we work to treat everyone with dignity and respect. Clients retain the same civil rights as they would have if they were not in treatment. Clients and families have the right to confidentiality, and to receive services without regard to ethnicity, gender identity, sexual orientation, religion, or other personal characteristics.

Other rights include:

Right to a receive services in the least restrictive treatment setting

Young people and families have a right to participate in the creation of treatment goals and to participate in discharge planning. We encourage you to be actively involved in decisions about the level of care appropriate to you and your family, and to participate in the periodic reviews of the treatment plan.

Right to refuse treatment

Clients and families have a right to refuse medication and any other treatment in which they prefer not to participate, to the extent that the law allows. At times, children or adolescents may have different ideas from their parents or guardians regarding their care. In these cases, your therapist will work with you and your team to help determine the best course of action.

Resolving Complaints

If you or your child has a concern about the care you receive at Trillium, you may inform any staff member. Feedback about the care provided at Trillium can be provided in writing on our feedback form, provided in this packet in our Policies section. If you would prefer, you can bring your feedback to a staff and they will complete the form for you.

  • This information is forwarded to the supervisor of the program, who will discuss your concern with you and with the treatment team to try to resolve the issue.
  • All feedback is sent to a committee to review, and you will be contacted to ensure that your concern was resolved to your satisfaction. If you are not satisfied, the committee will work to resolve the issue.
  • If this does not resolve the issue to your satisfaction, your concern can be appealed in writing to the Vice President in charge of the program, and he or she will work with the office of the Chief Executive Officer to come up with a solution.
  • If a client leaves Trillium’s treatment before a solution is reached, we will continue to work on a resolution to the issue until you or your child are satisfied.
  • At no time will any staff penalize you for filing a complaint or grievance. Trillium is interested in your feedback to improve our services.

Joint Commission

Family members of Trillium clients may report complaints about our care or safety directly to the Joint Commission.

e-mail: complaint@jointcommission.org
fax: 630.792.5636
mail: Office of Quality Monitoring
The Joint Commission
One Renaissance Boulevard
Oakbrook Terrace, Illinois 60181

Resources for Parents/Guardians

Trillium is pleased to help you find resources which will be helpful for you and your family. We’ve included a few here that we feel may be helpful, but there are many others. If you need information on a specific topic, please talk to your child’s therapist and they will do their best to find support for your unique needs.

Also, as someone involved with the children’s mental health system, we encourage you to participate in Trillium’s Family Advisory Council. There, you can meet other families and former clients, give your feedback on Trillium’s services, and participate in ongoing discussions to improve our care. For more information, please contact Jessie Eagan at 503.813.7730.

Resources

Oregon Family Support Network www.ofsn.org
Oregon alliance of family members, provide support, information, advocates, and other resources.

Building Bridges Initiative www.buildingbridges4youth.org
National group working to develop closer relationships between children’s mental health providers and the youth and families they serve.

National Alliance on Mental Illness www.nami.org
National group providing support, research, and advocacy for mental illness. Local chapters available, as well as resources and articles.

Collaborative Problem Solving support group www.legacyhealth.com
Legacy Emanuel provides this free class and support group for parents on ongoing Monday evenings to discuss family communication in difficult situations.

Involve Families www.involvefamilies.org
Family support, training, and advocacy by parents who have experience in the children’s mental health system

Children and Adults with Attention Deficit / Hyperactivity Disorder www.chadd.org
Information and support for children, adolescents, and adults living with ADHD. Monthly support groups held locally.

Autism Society of Oregon www.autismsocietyoregon.org
Statewide agency provides support groups, information, resources, and parent trainings.

Parents and Friends of Lesbians and Gays www.pflag.org
Advocacy, information, and support working for a society that embraces everyone through dignity and respect. Local chapters and support groups across Oregon.