risk of cognitive functioning difficulties

Identifying factors that can predict

cognitive difficulties during the breast cancer trajectory

well-documented in the research literature

cancer patients

Cognitive functioning difficulties in

systemic inflammatory processes

direct effect of

to explain the prevalence and onset of impaired cognitive functioning

mediated by cortisol dysregulation

cognitive functioning was mediated by steeper cortisol slope

association between childhood trauma exposure, cortisol, and cognition

mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope

Exposure to childhood trauma may impair cognitive functioning

HRV markers in patients undergo-ing HCT in the current study were disproportionally low

sepsis (Wang et al., 2004), and pancreatitis (

vidence has emerged to support the idea that the vagus nerve plays an important role in immune functioning via the inflammatory reflex (Tracey, 2002). Dysregulation in this reflex system, as may be indicated by low HF and rMSSD measures, is associated with increased inflammation, which, in turn, is implicated in the pathogenesis of cancer growth and initiation (De Couck et al., 2013). Stimulation of this inflamma-tory reflex via electrical inputs or selective drugs has been shown to result in reduced inflammation and enhanced likelihood of survival in models of hemor-rhagic shock

HF and rMSSD are the two recom-mended markers of parasympathetic nervous system activity and vagal tone, according to current standards of measurement

The two HRV measures found to significantly predict lon-gevity were increases in rMSSD and HF.

Heart Rate Variability Markers as Correlates of Survival in Recipients of Hematopoietic Cell TransplantationCaroline Scheiber, PhD, Laura Johnston, MD, Mary Melissa Packer, MA, Richard Gevirtz, PhD, Katharine S. Edwards, PhD, and Oxana Palesh, PhD, MPH

increases in HRV over time were correlated with survival in patients who underwent HCT. These findings are clin-ically significant because HRV is known to respond to behavioral and pharmacologic interventions

Crizanlizumab is a monoclonal antibody against P-selectin.[30] which has now been approved by Novartis on November 15, 2019 for the indication of vaso-occlusive crisis in sickle cell patients.

Specifically, IV-B Reunification Services can include: (i) Indi-vidual, group, and family counseling. (ii) Inpatient, residential, oroutpatient substance abuse treatment services. (iii) Mental healthservices. (iv) Assistance to address domestic violence. (v) Ser-vices designed to provide temporary child care and therapeuticservices for families, including crisis nurseries. (vi) Peer-to-peermentoring and support groups for parents and primary caregivers.(vii) Services and activities designed to facilitate access to andvisitation of children by parents and siblings. (viii) Transporta-tion to or from any of the services and activities described in thissubparagraph

mental health services; and

While frequently overlooked in practice, the right to maintain a relationship with oneʼs parents isfundamental to a childʼs best interest.

Dependency and neglect proceedings in child welfare are extremely serious, holding the gravityof parents possibly losing all custody and contact with their children.

Lawyers bill the ORPC for their work and also requestother resources from the ORPC, such as social workers, investigators, and experts

The Office ofRespondent Parentsʼ Counsel (ORPC) is an independent governmental agency within the Stateof Colorado Judicial Branch and has been vested with the oversight and administration ofRespondent Parentsʼ Counsel representation in Colorado since July 1, 2016

In dependency and neglect cases (also known as “child welfare” or “child protection” cases), theRespondent Parentsʼ Counsel (RPC) plays a critical role in protecting the constitutional and otherlegal rights of parents. Pursuant to statutory guidelines in C.R.S. § 13-92-101(1)(a), the RPChelps to achieve the best outcomes for children by providing effective legal representation forparents which includes protecting due process, presenting balanced information to the judgeand promoting the preservation of family relationships.

Colorado, the statewide officeoverseeing parents’ representation has incorporated social workers into their practice utilizingcontracted social workers who are supervised by a staff social work program coordinator.37

While attorneys for parents and children must becompetent litigators with knowledge of the law and rules of procedure and evidence, researchhas shown that children’s and parents’ attorneys work out of the court is as important asattorneys’ formal courtroom advocacy.22 Parents’ and children’s attorneys must spend significanttime with clients to build a trusting and supportive relationships, to understand the clients’ goals,and to counsel clients on all legal matters.23 This relationship building can require expertise inchild development, trauma, motivational interviewing, and cultural humility

CB strongly encourages all title IV-E agencies toapproach CFSR Round four with strong representation and active involvement in all aspects ofthe CFSR process, from members of their child and parent attorney bar in addition to agencylegal representation, judges, court administrators, and CIP.

No state achieved substantial conformity on Permanency Outcome 2: The Continuity ofFamily Relationships and Connections is Preserved for Children.

These critically important studies provide robust evidence consistent with existing research thathas found that enhanced parent representation leads to increased reunification and fasterpermanency for children.15CB strongly urges all title IV-E agencies to actively pursue utilization of title IV-E funding tocreate, expand and sustain models of multi-disciplinary representation for children in title IV-Efoster care, candidates for title IV-E foster care and their parents

Question 32. Does the policy at CWPM 8.1B #30 allow a title IV-E agency to claim title IV-E administrative costs of paralegals, investigators, peer partners or social workers that support an attorney providing independent legal representation to a child who is a candidate for title IV-E foster care or is in title IV-E foster care, and his/her parent, to prepare for and participate in all stages of foster care legal proceedings, and for office support staff and overhead expenses? Answer Yes, the policy permits a title IV-E agency to claim such title IV-E administrative costs to the extent that they are necessary to support an attorney in providing independent legal representation to prepare for and participate in all stages of foster care legal proceedings for candidates for title IV-E foster care, youth in foster care and his/her parents. The costs must be consistent with federal cost principles per 45 CFR Part 75 Subpart E. The title IV-E agency must allocate such costs so as to assure that the title IV-E program is charged its proportionate share of costs (See CWPM sections 8.1B and 8.1C).

Question 30. May a title IV-E agency claim title IV-E administrative costs for attorneys to provide legal representation for the title IV-E agency, a candidate for title IV-E foster care or a title IV-E eligible child in foster care and the child's parents to prepare for and participate in all stages of foster care related legal proceedings? Answer Yes. The statute at section 474(a)(3) of the Act and regulations at 45 CFR 1356.60(c) specify that Federal financial participation (FFP) is available at the rate of 50% for administrative expenditures necessary for the proper and efficient administration of the title IV-E plan. The title IV-E agency's representation in judicial determinations continues to be an allowable administrative cost. Previous policy prohibited the agency from claiming title IV-E administrative costs for legal services provided by an attorney representing a child or parent. This policy is revised to allow the title IV-E agency to claim title IV-E administrative costs of independent legal representation by an attorney for a child who is a candidate for title IV-E foster care or in foster care and his/her parent to prepare for and participate in all stages of foster care legal proceedings, such as court hearings related to a child's removal from the home. These administrative costs of legal representation must be paid through the title IV-E agency. This change in policy will ensure that, among other things: reasonable efforts are made to prevent removal and finalize the permanency plan; and parents and youth are engaged in and complying with case plans.

Antagonizing PTGDR-1 and -2 in human lupus could be quickly accessible and safe since Laropiprant was approved by the FDA to inhibit the flushing induced by niacin to treat dyslipidemias55, and Ramatroban, a dual Thromboxane A2 receptor/PTGDR-2 antagonist can be used in allergic rhinitis56

TNF is involved in autoimmune and immune-mediated disorders

anti-TNFα therap

regulated on a transcriptional and post-transcriptional level

a proper risk assessment is required. Mental health professionals have duty to protect obligations.

In all cases of a dangerous pathology, including possible psychological child abuse (DSM-5 V995.51Child Psychological Abuse

An additional clinical concern is that the allied parent is inducing this thought disorder in the child in order to (intentionally?) destroy the child’s attachment bond to the other parent

clinical pathology of concern in the family is for possible unresolved trauma with a parent that then distorts their thinking and perception of situations, and that the parent’s persecutory delusion is then imposed on the child

assessment for thought disorder pathology (delusions) is a Mental Status Exam of thought and perception conducted with the child and allied parent. Obtaining direct observation of the symptoms displayed in the parent-child relationship would confirm the diagnosis

Creating a shared persecutory delusion with a child that then destroys the child’s attachment bond to the other parent representsa DSM-5 diagnosis of V995.51 Child Psychological Abuse.

Adelusionis a fixed and false belief that is maintained despite contrary evidence. The type of delusion of concern is a potential persecutory delusion, i.e., a fixed and false belief in supposed “victimization.” The American Psychiatric Association provides the definition of a persecutory delusion:From the APA:“Persecutory Type: delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.” (American Psychiatric Association, 2000)

The professional concern with child psychological abuse isthe creation ofa thought disorder in the child, an induced persecutory delusion,

assessment for possible child psychological abuse requires ahigher level of professional knowledgein attachment pathology, complex trauma, personality pathology, and thought disorders.

requires a higher level of training than is available to the CPS professionals who are more focused on child physical, sexual, and neglect abuse.

Psychological child abuse (i.e., creating severe pathology in the child through aberrant and distorted parenting) is more difficult to assess

ensure a proper assessment andtheproper protection of the forensic evidence

Mental health professionals in the community are prohibited from conducting the risk assessment themselves for these forms of child abuse

A suspicion of child physical, sexual, or neglect abuse is a mandated report to Child Protective Services (CPS) to allow their trained assessment professionals to conduct a proper risk assessment for these types of child abuse

destroys the child from the inside out

are equivalent in the severity of the damage they cause to the child

Child Neglect (V995.52), Child Psychological Abuse (V995.51)

Child Physical Abuse (V995.54

There are four diagnoses of child abuse in the Child Maltreatment section of the DSM-5

abuse (child,

suicide

A risk assessment is conducted when any of three types of dangerouspathology are presented

Psy.D.Clinical Psychologist, CA PSY 18857

In all cases of court-involved custody conflict involving severe attachmentpathology, I recommend that the symptom documentation instruments of the DiagnosticChecklist for Pathogenic Parenting and Parenting Practices Rating Scale be routinelycollected.

Documentation of SymptomsDiagnosis is a pattern-match of symptoms to diagnostic criteria. To accuratelydiagnose (identify) the problem (pathology), begin by documenting the symptoms withclarity. For the purposes of clarity in diagnosis, I recommend that the clinical opinions ofthe involved mental health professional regarding the parenting practices of the targetedparent be documented using the Parenting Practices Rating Scale (Appendix 1), and thatthe child’s symptoms be clearly identified for diagnostic purposes using the DiagnosticChecklist for Pathogenic Parenting (Appendix2) for all cases of court-involved custodyconflict involving severe attachment pathology displayed by the child.

Professional Participation in Child Abuse & Spousal AbuseOne of the prominent professional dangers of misdiagnosing a shared persecutorydelusion is that if the mental health professional and/or the court misdiagnoses thepathology of a shared persecutory delusion and believes the shared delusion as if it wastrue, then the mental health professional and/or the court become part of the shareddelusion, they become part of the pathology. When that pathology is the psychologicalabuse of the child by an allied pathological parent, then the mental health professionaland/or the court become participants in the parent’s psychological abuse of the child byvalidating to the child that the child’s false (delusional) beliefs are true when they are, infact, symptoms of an induced persecutory delusion

It is theprofessional obligation of all involved mental health professionals to accurately diagnose(identify) the pathology (problem) so that an effective treatment plan can be developed tofix the problem (pathology).

Diagnosis Guides TreatmentIn all of healthcare, diagnosis guides treatment (the treatment for cancer is differentthan the treatment for diabetes). The term diagnosis means exactly the same thing asidentify, the term pathology means the same thing as problem, and treatment means thesame thing as fix it. We must first diagnose what the pathology is before we know how totreat it.

Targeted Parent Abusive: Is the targeted parent in the familyabusing the child in some way, thereby creating the child’sattachment pathology toward that parent?If yes, identify the DSM-5 Child Abuse diagnosis involved: yes  no• Child Physical Abuse (V995.54)  yes  no• Child Sexual Abuse (V995.53)  yes  no• Child Neglect (V995.52)  yes  no• Child Psychological Abuse (V995.51)  yes  no

Whenever a child displays severe attachment pathology surrounding child custodyconflict

ikely active for all involved mental health professionals, including the currently involvedtreatment providers

the duty to protect obligations are

Risk AssessmentAll mental health professionals have duty to protect obligations which becomeactive whenever there is concern for any of three dangerous pathologies, suicide, homicide,or abuse (child, spousal, or elder abuse), and they must conduct a proper risk assessmentor ensure that a proper risk assessment be conducted for the danger of concern. The typeof risk assessment depends on the type of danger involved, such as a suicide riskassessment when the client expresses suicidal thoughts (i.e., an assessment of prior history,current plan, recent loss, means, etc.)

In all cases of severe attachment pathology surrounding court-involved custodyconflict, a proper risk assessment for child abuse needs to be conducted to the appropriatedifferential diagnosis for each parent

When a child rejects a parent surrounding court-involved custody conflict, that is anattachment pathology,

To: Parents, attorneys, & mental health professionalsFrom: Craig Childress, Psy.D.Re: Diagnostic questions for court-involved custody conflict

From Bowlby

Attachment System & Attachment Pathology

Child Abuse Pathology

My vitae in supports the following six domains of specialized expertise inprofessional psychology:1. Thought disorders and delusional pathology2. Child abuse assessment, diagnosis, and treatment3. The attachment system and attachment pathology4. Factitious Disorder Imposed on Another (FDIA)5. Family systems therapy6. Court-involved custody conflict

M.A. degree in Clinical/Community Psychology

American Psychological Association

the Family,and theCore of Social Justice. Childress, C.A. & Pruter, D. Paper Presentation

The Return of Clinical Psychology to Court-Involved Custody Conflict.April 27 & 28, 2023.

3/74 –6/78 Crisis Counselor

Suicide Prevention

Managed all aspects of data collection and data processing

Received annual training to research and clinical reliability in the rating of psychotic symptoms

9/85 -9/98Research

9/98 -9/99Research

early childhood mental health

9/00 –4/02Postdoctoral Fellow Children’sHospital Los Angeles

4/02-9/02: Research Associate Children’s Hospital Los Angeles

4/02 –10/06: Pediatric Psychologist Children's Hospital Orange County

Diagnosis and Psychopathology; Child and Adolescent Psychotherapy; Child Development

1/09 –9/10:Faculty Argosy University

Child Development; Assessment and Treatment Planning; Advanced Diagnosis;Models of Psychotherapy; Counseling Psychometrics; Research Methods; Cultural Psychology

1/12–12/17: Faculty University of Phoenix;

. Juvenile Firesetting Intervention Program

5/03 –10/06: Clinical Director

comprehensive psychological assessment and treatment services

Directed

primary referralsource for the clinic was Child Protective Services

in foster care

Clinical director foran early childhood assessment and treatment center providing comprehensive developmental assessment and psychotherapy services to children

parent-child conflic

childhood trauma, family psychotherapy,

Specializing in attachment pathology

children, and families.

Consultation and expert testimony with court-involved family conflict.Psychotherapywith adults,

6/08–Current

10/06 -6/08: Clinical DirectorSTART Pediatric Neurodevelopmental Assessment and Treatment Center

Association of Family and Conciliation Courts(AFCC). An Attachment-Based Model of Parental Alienation: Diagnosis and Treatment.Childress & Pruter, Presentation at the AFCC National Convention, 6/1/17;Boston, MA

Pennsylvania: Legislature Briefing. Pennsylvania State Legislature; House Children and Youth Committee. Solutions to High-Conflict Divorce in the Family Court. November 15, 2017; Harrisburg, PA (https://www.youtube.com/watch?v=AIa1KbfsWIM

California Association forLicensed Professional Clinical Counselors(CALPCC). Parental Alienation Testing, Orders, and Treatmentin BPD/NPD Custody Proceedings. April 20, 2018;San Francisco, CA

Canada: Law Society of Saskatchewan. Solutions for the Family Court and Professional Psychology; Saskatoon 11/20/18; Regina 11/21/18

Psy.D. degree in Clinical Psychology, APA accredited

Psy.D.

CA License #: PSY 18857

Alison Butler, Esq.Carrie Ann Lucas Disability Advocacy DirectorOffice of Respondent Parents Counsel

Ashley Chase, Esq.Staff Attorney & Legislative LiaisonOffice of the Child’s Representative

Independent Assessment-QRTP Toolkit: https://drive.google.com/drive/folders/1nwJHWHlkPhmdw4Ehzuqo-qUw6lk3dj5R© 2021 ABA Center on Children and the Law37

Additional Placement Checks & BalancesProtocols to prevent inappropriate diagnoses•States must establish protocols ensuring children in foster care are not inappropriately diagnosed with omental health conditionsoother emotional or behavioral conditionsomedically fragile conditions, orodevelopmental disabilities.•Inappropriate diagnoses must not lead to inappropriate non-foster family home placements.

Colorado Care Continuum

Office of Respondent Parents’ Counsel

Family First Prevention Services Act: Judicial and Legal Practice ConsiderationsAfter a Petition is Filed: Child in Foster CareSeptember 15, 2021

Office of Respondent Parents’ Counsel

Family First Prevention Services Act: Judicial and Legal Practice ConsiderationsBefore a Petition is Filed: Prevention ServicesSeptember 1, 2021

Barbara FidlerPh.D., C.Psych., AccFM., FDRP P

Judge Mitchell Helton

Resist Refuse Dynamics:

COAFCC 2022 Spring Conference & Annual Members Meeting

Guided Reference in DependencyAn Advocacy Guide for Attorneys in Dependency Proceedings

First Edition: August 2012Pocket Part Supplement: August 2015Second Edition: August 2018Electronic Update and Pocket Part Supplement: September 2020Electronic Update: April 2022

olicymakers and practi-tioners may fail to recognize or evaluate thor-oughly the potential risks of problematic patterns

of att a c h m e nt.

theymay not appreciate, and may therefore fail to sup-port, the positive features of existing parent–childattachment relationships. As a result, servicesplans may not adequately support these relation-ships through frequent parent visits.

Policymakers and practitioners may makeinaccurate assessments and inappropriate decisionsif they rely on oversimplified assessments of thiscomplex phenomenon.

conducted

visits arelikely to reflect the stress of living apart and ofbeing in a strange environment.

Social workers, however, should be awarethat parental visits do not offer an ideal environ-ment for assessing parent–child relationships

In cases of problematic attachmentrelationships, visits typically should be coordi

nated with other intensive services

Theobservation of any problematicaspects of attach-ment relationships always warrants further inves-tigation, including medical and psychosocial as-sessments.

once there have been therapeutic gains,visits hold real promise for establishing or restor-ing an adequate attachment relationship betweenparent and child.

Plans for visits should be coordinated withprogress in therapy (Gowan & Nebrig, 1997)

if a disorganized and disoriented attach-ment relationship has been identified, parent–child interaction during visits in the absence ofintensive therapeutic intervention is unlikely to behelpful and could conceivably be harmful

it isvery important to observe the child not only withthe parents, but also with various other caregivers,such as grandparents, foster parents, and childcare providers (Cassidy, 1999; Howes, 1999)

assessment should includea broad range of contemporary and historical dataon the child, his or her primary caregivers, thefamily, and the social situation (Howe, Brandon,Hinings, & Schofield, 1999).

Problematic attachmentrelationships with primary caregivers are universalrisk factors, and their presence is cause for con-cern, regardless of the social and cultural environ-ment in which the attachment relationship devel-oped

Second, if Type D attachment relationships aredisplayed by neurologically normal children,practitioners should recommend a complete psy-chosocial assessmen

Research on problematic attachment relationshipshas several implications for foster care policy andpractice. First, if children display Type D attach-ment relationships, a medical evaluation is in or-der to assess neurological status

Thecharacteristics that these parents may share withmaltreating parents are behaviors that may alarma child

Disorganized and disoriented patterns of at-tachment behavior also are associated with a his-tory of parent psychopathology (Greenberg,Speltz, & DeKlyen, 1993), such as maternal de-pression (Ijzendoorn, Goldberg, & Kroonenberg,1992) and parents’ own traumatic and unresolvedloss of an attachment figure (Main, 1996)

19 per-cent of the children in the comparison group ex-hibited these behaviors

First, assessments of secure versus insecure attach-ment behaviors during visits are of limited value.In particular, practitioners should not assume thatinsecure attachment behaviors displayed in fostercare visits necessarily indicate pre-existing or per-vasive problems in parenting or the parent–childrelationship.

may reflect symptoms ofneurological impairments.

Children also may show severe appre-hension i

On reunion, their behavior may alternate be-tween seeking proximity and fleeing,

base or use any other coherent behavioral strategyto cope with stress. Rather, they show a range ofcomplex responses to the strange situation atypi-cal of children in secure or insecure attachmentrelationships (see Barnett & Vondra, 1999).

Children in Type D attachment rela-tionships do not use their caregivers as a secure

provides a foundation for recog-nizing any problematic aspects of parent–childattachment relationships

Understanding universal aspects of attachmentrelationships, as well as the ways in which suchrelationships develop within particular social andcultural groups

In themeantime, social workers must guard againstmaking judgments based on limited information

Unfortunately, many parental visits take place notjust under very difficult circumstances, but in un-familiar environments such as child welfare of-fices or fast food restaurants that are not condu-cive to socially and culturally distinct patterns ofparent–child play, talk, or caregiving

Furthermore, children in care have experi-enced disruptions in parental care. What may ap-pear to be insecure attachment behaviors shouldalways be evaluated in the context of separationand loss

uch behaviors are seen even in chil-dren from intact families living in far less stressfulsituations.

Finally, child welfare policy and practiceshould adequately prepare and support foster par-ents for providing corrective attachment experi-ences for some children

in cases where reunification is a perma-nency goal, the development of adequate attach-ment relationships between children and theirfoster and biological parents should be supported

se-workers should consider the multiple possiblecauses of such behaviors and not necessarily at-tribute them to problems in the attachment rela-tionship.

thechild who refuses to approach the parent mayeach be expressing the pain of separation.

which may be expressedthrough crying, angry outbursts, or withdrawal.

Third, child welfare policy and practice shouldsupport parents and children before, during, andafter visits

Visits maycause the parent and child to repeatedly re-experi-ence difficult emotions associated with reunionand separation.

Second, caseworkers should consider that thechild’s primary attachment relationships may bethe result of foster care placement itself, ratherthan the parent’s commitment to the child or ca-pacity to nurture.

Experience is necessary for the development ofattachment relationships, and without regularand frequent visiting, foster care can seriouslyand negatively affect parent–child attachmentrelationships

First,child welfare policy and practice should supportregular and frequent parental visitation wheneverreunification is a viable goal of service

severe neglect, as in the recent example of Roma-nian orphans, can substantially impair emotionaland cognitive development

findings that child abuse can result in lifelong vul-nerability to depression and personality disorders

The disruption of theseprocesses by inadequate or grossly distorted expe-rience can have lasting adverse consequences

For experience-expectantneural plasticity, experience that is impoverishedor distorted may have lasting effects on brain de-velopment

There are extended periods of neural plas-ticity in childhood during which experiences af-fect brain structure.

Indeed, biologicallybased attachment and many other processes re-quire enriched and structured experience for theirdevelopment

Recent neuroscience research also extendsBowlby

In addition, recent research has identified neu-ral processe

Recent neuroscience research supports Bowlby

Bowlby

They suggest theneed for intensive services beyond visiting

some parent–child attachment re-lationships have problematic aspects such as thefailure to develop an organized strategy for relat-ing in times of stress

Overthree decades of empirical research have con-firmed what diverse theoretical perspectives havepredicted—adequate attachment relationships arenecessary for children’s healthy development

Attachment re-fers to close, enduring affective bonds that de-velop throughout life (Ainsworth, 1973)

their quality may be compromised by the lim-ited ability of the parent or the child to cope withthe traumatic events that had occurred before orduring the placement

children and parents visitmay be less than ideal: a sterile office with no toysor other amenities, under the watchful eyes of fos-ter parents, caseworkers, or other “outsiders.”

eenage foster children regarding their “pre-dominant family identification,” that is, to whomthey spoke in times of trouble, who they loved themost, who loved them the most, and with whomthey wanted to live. As might be expected, whenparents did not visit their children, childrentended to identify with their foster parents. How-ever, only 41 percent of the children whose par-ents visited regularly identified predominantlywith their parents

interviewed

In some cases, visits may benecessary, but not sufficient, for supporting thedevelopment of adequate parent–child relation-ships

They also report a range of child behaviors,from visible anxiety (8 percent) to enjoyment (29percent) (Fanshel, 1982

It is not surprising, then,that some foster parents report a temporary wors-ening of children’s behavior following visits

report a range ofemotional and behavioral responses to visits. Forexample, some parents and adolescents reportthat visits evoke painful feelings about separation

Regularvisits are considered so critical to the effort to re-unite families that the Adoption Assistance andChild Welfare Act of 1980 (P.L. 96-272) requiresinclusion of regular visits in family preservationefforts.