News from the CIUSSS

When a crisis hits home

Helping families of youths in distress

Maxim’s family was running desperately low on options in helping the troubled 13-year old. Their home life had deteriorated to the point that they communicated only by screaming—or not at all. At school, the situation was no less bleak: Maxim was hyperactive, abusing various substances, and had expressed suicidal thoughts. He was sent home nearly every day with a note about his ‘inappropriate behaviour’, until the day he wasn’t sent home. Instead, he found himself at a hospital.

“We ended up at the Saint-Justine Emergency Department at the insistence of the school’s psychosocial worker,” says Maxim’s mother, Arlette. “It had been going so badly at school, at home. For ages we’d been shuffled from one service to another, but Maxim was not getting the help he needed. He had been on medication for his Attention Deficit Hyperactivity Disorder (ADHD), but then his doctor was no longer available, so he stopped taking it. We had met so many healthcare professionals, and each time I had to retell the story. I simply couldn’t take it any more.”

Once the team of physicians and social workers at the hospital ER dealt with the immediate threat, they directed Arlette to the CAFE program. “It was the first time we’d heard of the service, and despite our skepticism after years of feeling neglected by our medical system, we entered the program. And what a blessing that we did— it saved our family.”

CAFE (Crise-Ado-Famille-Enfance) is led by a dedicated team of experts in crisis, who help children aged 5 to 17 and their families once they are on the brink of a family breakdown. “We see families who have lost control of their child, they have no respect for the rules, no positive exchanges,” says Sophie Menard, Team Lead of the CAFE program. “Families that find themselves in a deadlocked relationship are often feeling helpless. That psychological distress can trigger a sense of emergency. If an intervention does not take place quickly, there is a risk of ruptured ties, of a runaway, of crime, or a possible suicide attempt.”

The urgency of such crisis situations places the social workers and psycho-educator who form the CAFE team ‘on call’ 365 days of the year to intervene within two hours of receiving a phone call. They respond during school hours and evenings, from 2:00 to 9:00 p.m., directly at the scene of the event. “The service is accessible,” notes Ms. Menard. “Our team operates in the natural environment of the youth, be it at school, at home, or at their community hangouts. That way, we are well placed to prevent further deterioration and reduce the sense of emergency. We want to avoid a situation where exasperated parents throw up their hands and say ‘I’ve had enough’.”

Maxim’s parents had just about reached that threshold with the distressed teen. “We were at the end of our tether,” recalls Arlette. “Our home environment had become so negative. We were each fixed in our positions and couldn’t speak to one another anymore. That was compounded by the notes coming home every day from the school telling us only what Maxim was doing wrong. That negativity contaminated our home to the point where we said, ‘we can’t do this any longer, we need to breathe, Maxim needs to leave our home’.”

The aim of CAFE is to find alternative solutions to a placement or a report to the Director of Youth Protection (DYP), ideally ones that keep the youth within their family environment. “When the situation becomes too heavy, it escalates and reaches its head,” says Ms. Menard. “That can become a trigger for change.”

For Maxim and his family, that change came in the form of Nicolas Masse, a social worker for the CAFE program. Arlette says that she is astonished, looking back, that the many counsellors her son had met in years’ past had been women. “Maxim needed a masculine figure. He was wary after so many failed interventions, so initially he was a bit defensive, but he quickly developed a strong and trusting relationship with Nicolas. Nicolas didn’t make us any promises, but from the very beginning he set about restoring Maxim’s self-image, encouraging him, validating him.”

Within one month, the two-to-three weekly home visits by Nicolas (during which he met both with Maxim and his family) had calmed the crisis, reports Arlette. The tension had dissipated enough that they were now able to speak with one another. “It was remarkable, once we embarked on the

program, we were experiencing only progress,” she says. In subsequent weeks, through Nicolas’s continuous support and flexible approach, says Maxim’s mother, the social worker guided the family in establishing boundaries.

The CAFE counsellors work individually with families for up to three months, as needed, to tackle the underlying causes of the crisis. They create a structure within the home as a safety net to avoid a recurrence. “Our role is to provide tools that can help re-orient a family mired in dysfunction,” says Mr. Masse. “They learn how to resolve problems, negotiate rules, ease conflicts, and cope with changes and transitions. When a family has faith that we can work together to improve situation, it brings back the light of hope.”

“With our support, a shift takes place in the home atmosphere, in the quality of family interactions, so that parents and their children feel they can communicate more freely and effectively,” explains Mr. Masse. In parallel, says Arlette, Mr. Masse took steps to remedy the school front. “There was a constant barrage from them that was harsh and relentless, so Nicolas intervened there too. He worked with the school on centralizing their critical comments so that we weren’t overwhelmed by the negativity. He also asked them to convey what Maxim did well, for the encouragement.”

To get Maxim on course with a medical treatment for his ADHD, Mr. Masse was involved in arranging a consultation for the teen with a physician who specialized in the condition. He also proposed a lifeguarding course for the youth, which Maxim dove into with great energy.

“Nicolas was full of good ideas and initiatives. All of these strategies, along with the medication, have completely transformed our son,” attests Arlette. “Maxim feels valued, which has done wonders for his confidence and self-esteem. In the past, he felt he was always failing, but now he feels he is good, which has been very motivating. Friends at school have approached him to tell him that he has changed so much. He stays calm and attentive in class and he is doing his homework, which has helped his grades. Maxim is approaching everything with a positive attitude. These changes at home, at school, in his leisure time, they are all feeding in to a positive upward spiral in Maxim’s life.”

The CAFE counsellors are based at CLSC Côte-des-Neiges and CLSC Benny Farm, but they are available to eligible families in crisis throughout CIUSSS West-Central Montreal, upon referral. Parents may contact Info-Social at 8-1-1 at any time. A follow up with the CAFE team will take place without delay if the family in crisis meets the program’s criteria. Otherwise, the parents will be directed to an alternate program appropriate to their situation.

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