The Science of Step 9 AA: How Making Amends Can Help

Second, the provider must be trained with the appropriate knowledge and skills to provide for the needs of the child related to the child’s self-identified sexual orientation, gender identity, and gender expression. Third, the provider must facilitate the child’s access to age- or developmentally appropriate resources, services, and activities that support their health and well-being. HHS has concluded that these conditions are generally necessary to effectuate the statutory promise of a safe and appropriate placement for children who are LGBTQI+ because of the extensive evidence of the specific needs LGBTQI+ children have which require more specialized support. This rule requires title IV-E/IV-B agencies to ensure that the totality of their child welfare system includes sufficient placements for LGBTQI+ children that meet each of these standards. Four states or government entities and the three letters representing 20 state attorneys general opposed the proposal. The state agencies and governments who opposed the rule stated a general belief that the NPRM creates a separate and distinct process for LGBTQI+ children that violates privacy and raised concerns related to the religious beliefs of providers.

Teen Guide To Health

ACF appreciates the opportunity to clarify that title IV-E/IV-B agencies are encouraged to continue their work to improve access to kinship care alongside implementing the requirements of this regulation. Indeed, ACF anticipates that in many instances, expanding access to kinship care and complying with the requirements of this rule will not be in tension. For example, some LGBTQI+ children may enter the foster care system unrelated to a familial conflict over their sexual orientation or gender identity. Other children who enter foster care because of a conflict with family over their LGBTQI+ status or identity may have a supportive relative who is willing to serve as a kin caregiver and a Designated Placement. To be clear as to the training requirement, this final rule only requires that providers, including kinship caregivers, be informed of the procedural requirements of this rule, including the non-retaliation provision.

Kinship Caregivers

This website does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this website is solely at your own risk. Making direct amends could be a simple “I’m sorry, and I’m working hard to change my life around and make sure it never happens again.” Sometimes it could be repaying money that you owe or promising to pay along with an apology and the assurance that you are working hard to change your ways.

Assessment of Federal Regulations and Policies on Families

It’s really hard to apologize to those you’ve hurt — it takes courage and humility and requires a deep, intense look at yourself. Thankfully, there are tips you can take to help make your living amends permanent and lasting. It’s also important to take great care when making amends to someone who is in active addiction because our primary responsibility is to safeguard our own health and recovery from substance abuse. If making an amends means exposing ourselves to triggering environments, we ought to reconsider and discuss healthy alternatives with a sponsor or addiction counselor.

First, in addition to the protections generally applicable, the provider must commit to establish an environment that supports the child’s LGBTQI+ status or identity. We have added the term “commit” to reflect that assent to this designation will be documented by title IV-E/IV-B agencies and in recognition that current placements, working toward designation as part of a placement stabilization plan, may express their commitment while working to establish the environment as described in the rule. The criteria for Designated Placements include provider training as discussed below. Finally, a Designated Placement must facilitate the child’s access to age- or developmentally appropriate resources, services, and activities that support their health and well-being. In response to these concerns, HHS has revised the terminology used in the final rule.

Impact of the Regulation on Foster Provider Availability and Participation

Additionally, consistent with the proposed regulation, this final rule requires that the title IV-E/IV-B agency ensure that no LGBTQI+ child experience retaliation in any placement, including those that are not Designated Placements. Revisions to the rule’s nonretaliation provisions are described below. Accordingly, if a placement provider were to engage in (or attempt to engage in) retaliation against an LGBTQI+ child, the title IV-E/IV-B agency must take steps to protect the child from such retaliation. Depending on the circumstances and child’s wishes, those steps could include moving the child to a new Designated Placement. The final rule expressly provides that insofar as the application of any requirement under the rule would violate applicable Federal protections for religious freedom, conscience, and free speech, such application shall not be required. The rule does not require any provider to become a Designated Placement, and specifies that nothing in the rule should be construed as requiring or authorizing a state to penalize a provider that does not seek or is determined not to qualify as a Designated Placement from participation in the state’s program under titles IV-E and IV-B.

• We will send an email outlying the expectations once you receive an award.
• Taking these actions helps us to separate ourselves from the disease of addiction.
• In this way, you can take the focus off of yourself and choose to live a life of greater meaning.
• We asked for weekly progress reports and are ready to intervene if we see a problem.
• Understanding why will require taking a closer look at what Step 9 is, its goals, and its possible outcomes.

• The board would consist of two members of the Senate, two members of the House of Representatives, two members from the Massachusetts Rehabilitation Commission, and eight members appointed by the Governor which would consist of caregivers, survivors, and brain injury providers.
• For every time you said you’d be there or that you’d help someone do something and didn’t show up, you’ve left an impression upon that person that they can’t rely on you to keep your word.
• A sober living community can allow you to return to a semi-normal life, but at the same time, the environment it provides gives you the accountability you need to remain sober.
• We believe that when you are paying for at least a portion of your stay at a facility, you’re more invested in the recovery process.

It’s much easier to just apologize and move on, but committing to living your life differently looks different. Making these types of life improvements typically requires that you work with a counselor or therapist who can provide an outsider’s perspective and objective view of your life. Making these types of life changes is difficult and requires lots of hard, emotionally-complex work, but it’s worth all the effort in the end. All types of amends are good, but living amends are some of the best kinds you can make!

Commenters who expressed opposition expressed a belief that the approach taken in the NPRM would harm, rather than help, children in foster care. There were also a substantial number of commenters who appeared to misunderstand or misinterpret the NPRM’s provisions, including a substantial number of comments discussing the appropriateness or lack thereof of gender-affirming care for children. These comments are outside the scope of the rule because this rule does not establish any particular standard of medical care or require living amends that anyone receive any particular medical services. Another commenter said that being designated to provide care for LGBTQI+ children should not be solely defined by the receipt of specific provider training and instead be determined by an ability and willingness of the caregiver to meet the child’s needs. Commenters also requested clarity on what constitutes “appropriate knowledge” and “skills,” recommending ACF work with faith-based groups on provider training development, while others suggested not to be overly specific.

• Of all the 12 steps, Step 9 is often referred to as particularly challenging.
• Making amends won’t necessarily play out like the ending of a Hallmark movie.
• A few commenters suggested clarification and support for challenges related to the Interstate Compact on the Placement of Children, such as the need for more placements across jurisdictional lines.
• We know addiction isn’t a 9-5 disease, please feel free to call or text anytime, 24/7.

Ensuring such placements may also reduce LGBTQI+ foster children’s high rates of negative health outcomes, homelessness, housing instability and food insecurity. This rule promotes a supportive environment for LGBTQI+ children in foster care. A few commenters made suggestions related to enhanced confidentiality provisions for data collection on a child’s sexual orientation, gender identity, or sex characteristics.