Nicole DelCastillo, MD was most recently a research fellow in the Department of Genetics, Rutgers University, Piscataway, NJ. She previously completed a Child and Adolescent Psychiatry Residency/Fellowship at the University of Iowa Hospitals and Clinics, Iowa City, IA in 2014. From 2011 to 2013, Dr. DelCastillo was an American Psychiatric Association/Substance Abuse and Mental Health Services Administration Minority Fellow. Her community service efforts in Springfield, IL have ranged from co-chair and mentor to the High School Pipeline Mentoring Program, to mentor at Enos Elementary School, to breakfast cook and server at the Washington Street Mission. All of her work thus far has been focused on working with disadvantaged youth with the goal of reducing disparities and eliminating the barriers of stigma, lack of education and access that prevent minority and underserved patients from receiving needed mental health services. Dr. DelCastillo received her medical degree from Southern Illinois University (SIU), School of Medicine (SOM), Springfield, IL in 2009. She completed her general psychiatry residency at the University of Iowa Hospitals and Clinics, Iowa City, IA in 2012.
Nicole DelCastillo, MD, MPH
Nicole DelCastillo, MD, MPH
Child Psychiatrist, Zionville, IN
Improving Trauma-Informed Practices to Safeguard Dependents after the Removal of a Caregiver
This project included working with the Cambridge Police Department (CPD) to develop a caregiver removal policy, procedure, and training. The goal of this project was to minimize the effects of trauma and state-created danger after the removal of a caregiver as well as to provide care dependents with the appropriate services if needed in order to promote emotional, psychological and physical well-being.
The removal of a caregiver places a care dependent at risk of residential instability, economic strain and financial hardship, mental health problems, antisocial and delinquent behavior and for children, poor academic performance. Many care dependents do not receive the services needed, such as mental health care, after the removal of a caregiver. The involvement of various systems of care, such as the mental health system, protective agencies, the educational system and the justice system, are all needed in order to maintain a care dependent’s physical and emotional wellbeing. Law enforcement agencies are in a unique position in defining how a care dependent experiences the removal of their caregiver as well as helping to alert and connect care dependents to the services that they need.
The CPD and Cambridge Health Alliance have a history of partnering with other agencies to improve the welfare of those in their community. For example, they both partnered with the Department of Human Services and Cambridge Public School to create the Safety Net Collaborative whose mission is to foster positive youth development, promote mental health, support safe schools and community environments, and limit youth involvement in the juvenile justice system.
The CPD recognizes the impact that removing a caregiver can have, resulting in the need for the department to better identify and respond to a care dependent(s) whose caregiver is removed in order to promote overall safety and well-being of their community.
A literature review was conducted on procedures and policies that address the removal of a caregiver in order to develop the Caregiver Removal policy and training manual. The International Association of Chiefs of Police and the Bureau of Justice Assistance U.S. Department of Justice’s documents on Safeguarding Children of Arrested Parents were used as a basis for the CPD policy. Furthermore, information was used from this document to incorporate into the training manual and PowerPoint presentation. Literature on normal development and the effects of trauma on normal development as well as available educational resources (e.g. videos) were obtained to incorporate into a CPD training manual and presentation. Case examples that illustrate the impact of caregiver removal at different developmental stages were obtained from model handbooks/training manuals that were available.
In addition to a literature review, this project involved working with the CPD’s Director of Outreach and Community Programs and Department’s Clinical Social Worker on editing the Caregiver Removal Policy and the CPD Removed Caregiver Worksheet. Meetings with key stakeholders within the department occurred to discuss the goals for and to make edits to the policy, training manual, CPD Removed Caregiver Worksheet, and Leave Behind Brochure.
In order to reduce trauma this project included a Removed Caregiver Policy as well as a Caregiver Removal Training Manual and PowerPoint Presentation. The training provided information on normal development, the impact of trauma on development, the procedure for caregiver removal, and age appropriate techniques in discussing the removal of a caregiver with a care dependent.
In order to provide care dependents with the appropriate services needed after the removal of a caregiver, the Removed Caregiver policy includes having officers complete a CPD Removed Caregiver Worksheet. This worksheet will provide a checklist for the officers to make sure that care dependent placement is arranged, and also follow up with mental health providers or schools can occur. Furthermore the policy includes having officers provide assigned caregivers of children a Leave Behind Brochure so that short term effects of trauma can be monitored. The brochure includes information about resources for services in the community.
As it relates to the Social Determinants of Health, the goal of this project is to minimize the effects of trauma from the removal of a caregiver by addressing a care dependent’s environment, health, education, and social and community context. This project hopes to do so by placing care dependents in safe home (Environment/Social); monitoring the short term symptoms of trauma and early treatment for those in need of mental health services (Health); and alerting schools and after-school programs of the removal of a child’s caregiver (Education/Social). Future plans include a pilot “Removal of a Caregiver” training to be held in June 2016. After the training, it will be imperative to measure the impact of the training, by obtaining feedback from participants through a survey. Also, it will be important to measure the impact of removing a caregiver by monitoring the placement of care dependents, mental health referrals, school performance, school/after-school disciplinary actions. Furthermore, data could be obtained about the long term outcomes (health, education, etc.) of the care dependents.
James Barrett, PhD
Co-founder of Cambridge Police Department’s Safety Net Program for At-Risk Youth
Staff Psychologist at Cambridge Health Alliance
Instructor of Psychology at Harvard Medical School