The Power of Collaborative Intervention: Julia

Julia, 12, was hospitalized at the time of referral to the Juvenile Court Clinic due to suicidal ideation and threatening a family member. The hospital had advised her parents to file a Child Requiring Assistance (CRA) Stubborn Childpetition and the Judge asked for a Juvenile Court Clinic Clinician to provide a Consultation. The referral stated Julia needed Community-Based Acute Treatment (CBAT) level of care which was being denied due to lack of insurance. 

Early History

Julia was very vulnerable. Exposed to substances at birth, she was in a Neonatal Intensive Care Unit for two months. Upon release she was briefly returned to her mother’s care but removed again due to neglect and placed in foster care. 

Months later, after the court terminated her mother’s parental rights due to extensive neglect, Julia was able to be adopted. Through the Department of Children and Families (DCF), she was adopted by her current family— mother, father, their biological child and two adoptive children. Currently, Julia’s home life is full and challenging. Her father works long hours; her mother runs the household. The family struggles economically, but they have private medical insurance plus an adoption subsidy for Julia that includes MassHealth.

A Collaborative Approach: Getting the Agencies Together

The family gave the Juvenile Court Clinician permission to contact all agencies. The Clinician began thoroughly reviewing Julia’s history with programs, hospitals and schools. She learned that Julia had been struggling for years. She was psychiatrically hospitalized 12 times in the past three years and psychiatrically screened for risk to self or others an additional eight times. The family sought help from a therapist and adoption support services, but these were not enough. Hospitalizations stabilized Julia but didn’t initiate longer term services other than telling the family to seek help through DCF, Department of Mental Health (DMH), and the Juvenile Court. Though the school responded appropriately with special education services, both DCF and DMH denied the family services.

The clinician initiated multiple meetings, bringing the family and agencies together. Through this collaborative approach, the group identified a short-term program where Julia’s needs could be addressed, and the family could visit and engage in treatment. As Julia began to improve, the agencies involved continued to meet to solve problems as they emerged, and to find a longer-term solution.

Healing and Stability for Julia to Succeed

Finally, DCF approved Julia for residential care including a strong educational component, individual and family treatment plus occupational services—all covered by insurance. It took time, but the collaborative, inclusive approach facilitated by the Juvenile Court Clinician enabled Julia and her family to begin healing and achieve stability. 

To protect confidentiality, MAJCC does not use real names or identifying features in case examples.

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1 Child Requiring Assistance (CRA) Stubborn Child petition is a status offense (non-delinquent matter) which brings a child between the ages of 6 and 18 before the Juvenile Court alleging the child repeatedly fails to obey the lawful and reasonable commands of the parent or guardian, and whose behavior results in the parent or guardian not being able to adequately care for and protect the child.

2 To work in the Juvenile Court Clinics, clinicians must become Certified Juvenile Court Clinicians through a DMH-directed specialized training with on-site supervised clinical work conducted at the Juvenile Court Clinics.

3 Community Based Acute Treatment (CBAT) is intensive, structured inpatient treatment for children who need a higher level of care.