Defining a Caregiver
A caregiver is a family member or paid helper who provides physical, emotional, and/or developmental support for an individual who is unable to fully care for themselves. When an individual is in care or receiving services, it is often important to look at multiple aspects of their life – strengths, risk behaviors, functioning, and school/work. Nearly always with children, and sometimes with adults, it can be just as vital to consider the resources and needs of those entrusted to care for the individual. If you interact with the various TCOM tools, you know there is a separate domain called “Caregiver Resources and Needs”; this domain serves to understand the capacity of the caregiver(s) to support the needs of the individual. Items in this domain include knowledge of services, resources (social and financial) along with the current mental/physical health needs of the caregiver. It is when we have a full picture of the people in the individual’s life, that we understand the best ways to support their ongoing physical, emotional, developmental needs and more.
Of course, our work can be quite complex. Caregiver circumstances can also be complex. When there are multiple adults involved in the individual’s life, how do you determine who should be considered as the individual’s main support? The guiding principle of TCOM is that you want information that informs good decisions, so that principle can influence who is rated as the caregiver.
For example, when rating the caregiver section in the CANS for a child involved in the child welfare system, the caregiver is the person(s) who will fulfill the individual’s permanency goal. For example:
- If the individual is in foster care, and the permanency goal is for the child to be reunified with their biological parents, then you rate biological parents even though the individual is not currently living with the biological parents. If there is no permanency goal, then you would rate the person(s) that the individual is currently living with.
- If an individual is in foster care and the biological parents are not actively participating in the individual’s life, and there is no permanency goal, then you would rate the foster parent(s). For individuals placed in residential treatment centers and group homes who have no permanency goal, there is no caregiver and this domain is not rated.
This logic might also follow for an adult transitioning from a hospital or residential program to live with a relative. That relative would be a relevant caregiver to understand. The same logic applies to youth and adults in corrections environments if they have a caregiver waiting for them in the community. However, in behavioral health and crisis/stabilization programs, the logic might shift somewhat to reflect what is useful information for the treatment or crisis plan. In these circumstances, it is far more likely that the relevant caregiver is the person with whom the individual is currently living. For example, a successful foster care stabilization intervention would require an understanding of the needs and resources of the foster parent, regardless of the circumstances with the permanency plan caregiver. The same logic applies to many behavioral health interventions.
The other major question involving caregivers arises from the fact that oftentimes there is more than one person involved in the caregiver role. The most common strategy in these circumstances is to combine the ratings to describe the ‘caregiving environment’ and rate the needs/resources based on their impact on the process of caregiving generally. If one caregiver has a need that a different caregiver can compensate for, then there is likely less need of assistance (e.g. more of a ‘1’ level on the action priorities). The exception to this general rule are child welfare circumstances where it is necessary to do concurrent planning. In those circumstances sometimes it is useful to understand the needs and resources of each of the caregivers individually.
It is important not to make assumptions when rating the Caregiver Resources and Needs domain. In other words, since this is a needs-based domain, we assume that caregivers are effective unless we have evidence to the contrary. When becoming certified in the TCOM tools, we offer vignettes as a reliable method of obtaining certification. When rating a vignette, it is important not to make assumptions about the caregiver based on previous experience in the field. Rather, base your ratings only on what is written in the vignette, and remember that the items in this domain are rated as they relate to caregiving. This means that the item is only rated if it affects the caregiver’s ability to provide care.
This is a useful example of how the vignettes encourages us to practice the communimetric principles. Read the item description at the top of each item in the Caregiver Resources and Needs domain, then go through the vignette and see if you have actual evidence of that caregiver need. Remember to focus on the action levels here. If, for example, the caregiver has mental health issues but is parenting well, the action level on “Mental Health” would be a “0.”