How to design a trauma-informed quarantine or medical isolation program?

The Play

Create and implement a quarantine or medical isolation program* specifically designed for foster youth.

While “quarantine” and “isolation” are often used interchangeably, they actually refer to two separate processes. Both quarantine and isolation can help limit the spread of disease, but quarantine happens when someone who is well is separated, whereas isolation happens when someone who is already sick is separated.

Who Can Do This

Agencies responsible for identifying placements for foster youth.

Cost Factors

  • The cost of renting an apartment or small house unless otherwise donated.

  • Any adjustments that may be needed to facilitate foster licensing and procurement, especially resources that may be needed to fast-track said licencing of foster parents or procurement of housing and materials, etc.

  • Funding for foster parents and staff.

  • Living costs such as food, toiletries, transportation, and delivery services.

  • Personal protective equipment (PPE) and cleaning supplies.

  • Books, technology, toys, and other products for youth while in quarantine.

Timeframe

Varies. About a week of planning and leasing agreements, followed by time for quarantine (per CDC guidelines, the recommended isolation period is 10 days since symptoms first appeared, and the recommended quarantine period is 14 days), and lastly time for departure and transition (including cleaning of units) before another period of medical isolation.

Difficulty

Hard.

There are multiple factors that must be considered to meet the urgent demands of these circumstances in the initial design and set up of an alternative quarantine protocol, from procurement, to budgeting, and sourcing of necessary material.

The Problem It Solves

Foster youth that are COVID-19 positive or exposed to COVID-19 are currently being medically isolated in environments that are not trauma-informed, potentially triggering, and away from their support networks.

How To Do This

1. Forge partnerships to provide temporary housing for COVID-19 positive or exposed youth.

  • Identify vacancies in the area. Airbnb or other short term rentals, local landlords, or hotels are potential partners. It can be helpful to find a partner with multiple units available.

  • Reach out to potential partners to evaluate their interest in hosting temporary occupants who have potentially tested positive for COVID-19. It is important to emphasize safety precautions that will need to be put into place.

  • Collaborate with partners to identify changes that need to be made to accommodate foster care licensing and inspection requirements.

2. Select housing that can accommodate multiple social distancing occupants.

Follow the guidance of the Centers for Disease Control and Prevention (CDC) to maintain 6 feet of distance between occupants. Provide a separate bathroom and bedroom for youth to minimize potential cross-contamination within the housing unit.

3. Recruit foster parents to stay with youth during the medical isolation period.

Prospective foster families should be screened for motivation, commitment, and licensing. Unlicensed applicants should be fast-tracked through the licensing process given the urgency of the matter. A dedicated marketing campaign could potentially be deployed to attract prospective foster families.

4. Design a youth-centered process to test for and communicate COVID-19 status that is supportive and age-appropriate.

Designate a trusted adult for support. If no trusted adult can be identified, a therapist or mental health provider can be recommended instead as being informed that one is COVID-19 positive can be frightening. Youth should feel comfortable when being tested. The status should be communicated in an age-appropriate and trauma-informed manner.

5. Provide Personal Protective Equipment (PPE) education and equipment.

Equip homes with enough N95 or cloth masks and gloves for each occupant. Post graphics and signage in the home that demonstrates proper usage of these PPE and reminds occupants to wear PPE at all times.

Cleaning supplies should be available in every room to allow for quick and easy disinfection, such as wipes, paper towels, cleaning solution, sponges, etc. Educate youth, families, and workers about wiping down surfaces after use, even if PPE was worn when using the space. Post signage about cleaning different types of surfaces, especially high touch surfaces (e.g., tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, sinks, etc.).

6. Create a family-like setting to reduce system-induced trauma.

An institutional setting, such as a hospital, group home, doctor’s office, or similarly bland and sterile environment, can traumatize and/or re-traumatize foster youth. The use of colorful and comfortable furniture, planned group mealtimes, and bonding activities can enhance the experience of youth in medical isolation. Depending on their age, youth should be encouraged to make the space their own (within limits of the leasing agreement), so that they can feel more at ease.

7. Provide support for the physical, mental, and emotional wellbeing of youth.

Youth should have access to age-appropriate entertainment. A laptop can be provided by various organizations, including iFoster and One Simple Wish. Internet usage should be monitored as appropriate and in line with normal guidelines. Consider implementing a family media agreement (like this one by Common Sense Media) to discuss with youth agreements around screen time, permissible online activities, and digital monitoring.

Virtual family visitation should be implemented according to court-approved plans. Virtual communication with friends, classmates, and supportive adults should not be restricted. Access to tele-health and tele-mental health should be provided to encourage self-care. Games, toys, puzzles, books, movies, and other age-appropriate forms of entertainment should be provided.

8. Provide support and resources for foster families.

Resources such as behavioral aids and mental health staff that would be afforded to foster families in normal circumstances should still be provided.

9. Create an emergency plan in case of an absence without permission to leave (AWOL) or COVID-19 contamination.

The emergency plan should have clear guidelines and contingency steps for situations regarding runaway or missing youth, as well as clearly defined steps if a resource family member tests positive for COVID-19.

10. Create an exit plan.

Create an exit plan with the young person for their transition out of medical isolation that sets clear expectations for transportation and returning home. The exit plan should be trauma-informed, health compliant, and place youth at the center of the planning process.

Following the youth's transition back home, there will be a need to plan for the decontamination of the housing unit before another youth can be placed.

Who is already doing this?

The Los Angeles County Department of Children and Family Services, in partnership with Think of Us, has implemented an alternative quarantine program for Los Angeles foster youth.

Resources