Delivering Behavioral Services into the Home and Community

Amber Rogers, program director of CHD’s In-Home Therapy and Therapeutic Mentoring services, started working at our agency a decade ago as a therapeutic training & support specialist. She chuckles at the notion that she “rose through the ranks,” especially because this idiom is so clichéd when it comes to talking about someone’s career path.

But she really has worked her way to the top of her program, and she acknowledged that the experience of becoming a clinician, then clinical supervisor, assistant program director, and program director last November has served her well.

“It has been rewarding, and surreal, in a way, because this isn’t something I planned,” she said. “It just kind of happened naturally, and I think my professional growth of working through those roles helps me support my staff in providing true outreach.”

CHD’s In-Home Therapy and Therapeutic Mentoring services are part of the Massachusetts Children’s Behavioral Health Initiative (CBHI), which connects families with teams of support staff to coordinate services. While still a family specialist in New York state 18 years ago, Rogers saw the appeal of this community-based system of care in Massachusetts immediately: bringing trauma-informed, family-centered CBHI services into the home has made the process of treating children and youth under 21 with serious emotional and behavioral health needs much more efficient.

“In Massachusetts they said, ‘Let’s incorporate these services that go above and beyond what already exists,’” said Rogers. While an outpatient clinician is typically limited to an approximately hour-long session a week, in-home therapists meet with families from four to eight hours a week.

“We work with the whole family, instead of treating the child or the youth in a bubble, and we’re gathering as many resources as possible and working together as a team collaboratively to achieve goals in an individualized plan.”

If the child is already seeing an outpatient therapist the family is happy with, in-home therapy can still give the family more support, if they wish. In-home therapists come to not only people’s homes, but also schools, libraries, or other neighborhood locations. It’s a “family systems” approach—meeting a family where they are. Appointments with children in the home or school is ideal, according to Rogers, because they are more comfortable in familiar surroundings. “We’re also able to gather a lot more pertinent information about their functioning, because we’re seeing them in all kinds of life domains,” she said. “In an outpatient clinic, the child or youth might think, ‘Hey, I’m going to be on my best behavior here.’” However, in the home, the therapist is right in the “nitty gritty,” can observe the family dynamics, and intervene to address behaviors as they occur.

In-home therapists also work with other important people in the child or youth’s life, such as teachers, doctors, caseworkers, and coaches, and extended family members. According to Rogers, the key to success is communication. “The school counselor, for instance, might not be privy to information about what’s going on in the home,” said Rogers. “With the care team communicating and on the same page, the result will be beneficial for everybody. We try to think outside the formal helping system. We create goals for the family or caregiver, and the treatment plans address the whole family unit, not just the child.” Sometimes it’s as simple as “introducing the art of quality time—having dinner as a family for the next three nights might be a therapeutic homework assignment for the family,” she said.

Of course, in 2020, COVID forced our agency’s CBHI services to quickly adapt to the way they provide support to children, youth, and their families. The transition seemed to happen overnight, but fortunately Rogers and her team was able to nimbly pivot into telehealth. “When your team is a 100 percent outreach program, we had to be quick on our feet and deliver these services with the same level of quality and intensity,” she said. It’s also no secret that the pandemic exacerbated staffing shortages in human services that affected—and continue to affect—children’s behavioral therapy programs at CHD and other similar programs nationwide. This loss of staff happened at a time when mental health services were even more desperately needed. But as the pandemic became somewhat more manageable, and in-person services resumed, a silver lining appeared in the form of extremely dedicated in-home therapy interns. “The interns are motivated and excited,” said Rogers. “They bring in new energy, and they stay because they really believe in the work.”

  • Know of anyone needing children’s behavioral therapy, including In-Home Therapy and Therapeutic Mentoring? Have them call 1-844-CHD-HELP.
  • Those interested in making a difference in the lives of children, youth, and families can apply for a clinician position in our In-Home Therapy program by clicking here. Be part of an effective team! We offer a competitive salary, a community approach to care, opportunities for collaboration and networking, and flexible hours.