‘Name of Child: Jack Herrera DOB: 7/5/2013, Service Providers: Katie Page Proposed Supports for the Family Related to the Ini IFSP Support # 4 © Resource Name: Parent-Child Interaction Therapy through Boston Child Study Center ‘© Description of the Resource: This program offers therapy in behavioral training between parents and children, The intention is to improve the quality of the parent-child relationship and change their interaction patterns so they ean improve their behavior overall ‘* ‘Type of Support: Formal and Informational ‘+ Type of Organization: Private Organization ‘+ Contact Informatio © Website: http://bostonchildstudycenter.com/service/treatment/ © Email address: Info@BostonChildStudyCenter.com © Phone Number: (857) 400-9211 © Street Address: 800 Boylston St. Suite 1600 Boston, MA 02199 © Contact PersonTitle: Carolyn Snell/ Pediatric & Clinical Psychologist © Policy Information: There is a cost for therapy through this program. Some insurance will cover the cost but the family will need to check with their individual insurance to see if it would be covered. The cost depends on the specific needs that Jack has but sessions run $125 on average and families usually complete the program within 12-20 sessions. This type of therapy is appropriate for children between the ages of 2 to 7 and they are eligible as long as they are struggling with behavior issues that are interfering with their daily routine. * Pamphlets/Handouts: Program Handout attached ‘* Applications/Forms: ‘The application can be accessed and printed from the Child Study Center's ‘website. In order to access this support the family will need to fill out the application and meet with the Representative Psychologist to set up times for therapy and work out appointment details. The support takes place in the Study Center. The application is attached. Family Concern/Priority/Outcome That This Support Will Address: This resource will tie to and support the family in their priority of having parents that can work together along with him to build a better relationship with extended family members, Because of their cultural background they want to be able to interact with their families on a regular basis and have everyone get along without any aggression. This resource will give them a way to practice interacting with each other better as an immediate family, so they can take those skills to their extended family as well, (Current Situation Related to The Concern/Priority: The family currently feels uncomfortable around their extended family because they are afraid of what Jack might do, and on top of that they are really not welcome in those settings so they no longer attend, Aura and Orlando also have differing styles and abilities when it comes to dealing with Jack so they are at a stand still when it comes to working together to help him.Name of Child: Jack Herrera DOB: 7/5/2013, Service Providers: Katie Page Suggested ction: We as intervemtionists suggest that the family complete the program in the recommended manner it is designed with attendance once a week or at least every other week for 12-20 sessions until the program is complete. We are hopeful that through the completion of this program they will be better capable of working together as an immediate family when it comes to behaviors and can in turn relate that to their every day lives and interactions with extended family. Rationale: This support was chosen above all other options because it is a great way for the family to learn how to better interact with each other and control their behaviors on all ends. The support is not going to completely fix Jack’s behavior struggles, but it should help him learn how to better convey what he is feeling with his parents by integrating things he learns in other therapies and completing sessions where they specifically practice those skills, We chose to focus on this particular area of concer or priority because the family really wants to be able to interact with the people they care about most. They are unable to do this with Jack's current. behaviors so they want help. This interaction therapy will help both the parents and Jack to grow and develop skills that will be useful to do so through the information they are given and the ideas for new skills to practice. It is because of this that the support is considered to be Informational and not Emotional or Material.We are excited to announce our new 1ocation in te rrugental Lower! BC Boston Child Cee ara} SAU h@roblcely ties in anxiety and depression, behavior disorders, tic disorders, and autism spectrum disorders. For more information about our services please contact us at: P: (857) 400-9211 Email: Info@BostonChildStudyCenter.comwww.BostonChildStudyCenter.com Application for Services Today's Date Patient Name: Age Date of Binh Gender Patient Phone:(__)___ _ Patent Email: Home Street Adress: ci Zip School Name & Grade . Parent/Guardian Information (If Applicable): Parent 1 Name Profession: _ Phone:(__) Type: Craw Email Address May we contact you over email? Y/N Home Adres (if ferent from patient), iy: Zip Parent 2.Name:_ Profession: Phone:(__) = Type CHW sil Address: May we contact you over email? Y/N Home Adres i ferent from patient) Citys Zip Parents’ marital status: If separated, are legal proceedings in process or anticipated: Y/N ‘€parents are not married please describe the current legal and physical custody agreement: How were you referred to the Boston Child Study Center? ibe the nature of the probl which vou are pursing servi ‘Symptoms (e.g. anxiety, depression, suicidal ideation) Onset: ‘Triggers: