Communities of Care Training and Learning Collaborative Scavenger Hunt Exercise Families raising youth with SED often find themselves having to work with many different providers: Challenges Families Face when working with multiple providers > Feeling “caught in the middle” when different providers are giving different recommendations, suggestions and/or state agency mandates > Feeling anxious or concerned (or in extreme situations, hopeless) when different providers are in conflict with one another > Feeling “not listened to” when providers attempt to meet with each other to improve their collaboration, but do not include the family > Feeling exposed or even intimidated when attending meetings with providers > Feeling discouraged and frustrated with “one size fits all” models Core Value Based Competencies > Child Centered and Family Driven > Collaborative and Integrated > Culturally Responsive > Strength Based > Continuous Quality Improvement Child Centered and Family Driven We have found this to be the best method of Engagement Different Approaches > The Expert Approach: the responsibility for analyzing the problem, figuring out the causes, and coming up with solutions all rests with the professional (expert). Tends to rely exclusively on professional knowledge. > The Collaborative Approach: responsibility is shared between the family and the professional(s). Both bring complementary knowledges (professional and experiential) and strive to combine them to generate positive change. A Day In the Life … “I just can’t take it anymore…” > This can be a humorous, non-threatening way to help participants understand the apparently “disproportionate negative responses” that workers sometimes feel from parents > The take home message here is that struggles and set backs can be cumulative. This exercise can illustrate why at times family members can seem very upset over the smallest issues—it is because it isn’t just about this issue (i.e. that one rock)– but the cumulative effects of struggles and set backs over a long period of time. In order to Collaborate, we need to appreciate two important types of “Knowledge” Professional Knowledge: > Comes from formal education and training > Comes from experience gained through your professional role > Comes from scientific or “objective” sources– research, books, articles Experiential Knowledge: > Comes from lived experience — not a professional role > What is it like to live in this specific family, with this specific child, with these specific values and culture, in this specific neighborhood Getting the Family Experience into the Classroom > Training and Learning Collaborative Model > Parent / Caregiver Panels > Youth Panels > Guest Lecturers > Family Quotes and stories > Exercises (“A Day in the Life”) IN THEIR OWN WORDS … “It’s just like someone has died because this is not our little girl any more. I dread people asking how our kids are doing. What can I say? When I look at the family album, I see the family we could have been and were supposed to be. The future looks bleak and full of worry. We really don’t look forward to much any more; this takes up so much of our time and energy.” -from Grillo, L., Meaney, D., & Rich, C. (1999). Empathizing with the Parenting Experience enhances Engagement Entering into working relationships > Recognize and accept as legitimate different levels of motivation for change: “get you off my back” --> “get me services”--> “help me change” > “Apathy,” “hostility”, or “resistance” are characteristics of our working relationship with the family, not characteristics of family members > Recognize that cooperation is developmental and grows slowly over time > If you sense lack of “motivation,” attempt to understand it…(previous bad experiences? unfounded fears? afraid of feeling blamed?) > Listen to the reasons behind the anger with genuine curiosity—ask about it—get the “story behind the feelings” > Resist temptation to defend the system if the family expresses anger, hostility towards them—validate that you hear them … that is not the same as agreeing with them > Ask what has helped them get through the anger in the past…what has helped them cope with these feelings all this time? Engagement is Influenced by ALL Interactions > All interactions produce experience > The result of any interaction can be either a positive or negative experience > Multiple negative experiences, however small, unintended or seemingly insignificant, tend to increase resistance, hopelessness, and defensiveness over time > Multiple positive experiences, however small, unintended or seemingly insignificant, tend to increase hope and collaboration and reduce defensiveness over time There is no such thing as an “Innocent” interaction The Benefits of Transparency Core Value Based Competencies > Child Centered and Family Driven > Collaborative and Integrated > Culturally Responsive > Strength Based > Continuous Quality Improvement The 3 Principles of Team Building > Family Members are the most important Team members > Families should exercise control over Team membership > Team membership should include not only providers but natural supports as well Circle Exercise How do you define family? Core Value Based Competencies > Child Centered and Family Driven > Collaborative and Integrated > Culturally Responsive > Strength Based > Continuous Quality Improvement Culturally Responsive Cultural Awareness Exercise Culture Stereotype Exercises > Present scenarios and encourage honest disclosure about assumptions and attitudes > Promotes increased self-awareness about our assumptions and how they are manifested in our work Core Value Based Competencies > Child Centered and Family Driven > Collaborative and Integrated > Culturally Responsive > Strength Based > Continuous Quality Improvement Myths Regarding Strength Based Work The Process of Talking about Strengths and Culture… The Content of Strengths and Culture Conversations…. What are Strengths (….. and how do I find them) Example “Conversation Starters” Moving from the General to the Specific Talking about Problems (the “flip side” of strength-based) Narrative and Solution Focus Approaches Problem Focus vs. Vision Focus > Usually our attention is drawn to “problems” as the things that are “wrong” or the things that we want to see “stopped.” (Problem Focus) > In order to create positive change, it is best to attempt to translate what we want to see stopped into “what do we want to achieve” (Vision Focus) Exceptions exist alongside “problems” Exceptions provide the “clues” to possible solutions: Exceptions in Time: > Have there been times when the problem has taken less of a toll on you, your family? Is this the worst it has ever been? If yes, what was it like before? If no, how is it better now? Exceptions in Situation: > In what situations does this problem have less influence? How are you different in those situations? > What makes for a good day? (specifically) Exceptions in Point of View: > Who thinks the best of you, your family, etc.? > What does it say about you that you are here and trying to get help — even when nothing yet has worked? Language is Important Internalizing > He is impulsive > She is Bi-polar > They are abusive Problems as Needs Think of Problems as Constraints Constraints can exist at multiple levels: > Biological (i.e. attentional problems) > Psychological (i.e. emotional effects of trauma) > Family (i.e. destructive patterns of communication) > Social Network (i.e. isolation from extended family, stigma in the local neighborhood) > Social Cultural Context (i.e. racism) Group Discussion References and Further Reading Anderson, C.M., Robins, C.S., Greeno, C.G.,Cahalane, H., Copeland, V.C.,& Andrews, R.M. (2006). Why lower income mothers do not engage with the formal mental health care system: Perceived barriers to care. Qualitative Health Research, 16(7), 926-943. Berg, I. K. & Kelly, S. (2000). Building Solutions in Child Protective Services. New York: W.W. Norton & Company Burchard, J.D., Bruns, E.J., & Burchard, S.N. (2002). The Wraparound Approach. In B.J. Burns & K. Hoagwood (Eds.), Community Treatment for Youth: Evidence Based Interventions for Severe Emotional and Behavioral Disorders. New York: Oxford University Press. Donner, R., Jennings, M.A., Westerfelt, A. (1993). A Strength-Based Approach to Serving Families. University of Kansas School of Social Work. Epstein, R.A. (2004). Inpatient and Residential Treatment Effects for Children and Adolescents: A review and critique. Child and Adolescent Psychiatric Clinics of North America, 13, 411-428. Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press. Johnson, H.C., Cournoyer, D.E., Fisher, G.A., McQuillan, B.E., Moriarty, S., Richert, A.L., Stanek, E.J., Stockford, & C.L., Yirigian, B.R. (2000). Children’s Emotional and Behavioral Disorders: Attributions of Parental Responsibility by Professionals. American Journal of Orthopsychiatry, 70(3), 327-339. Madsen, W.C. (2007). Collaborative Therapy with Multi-Stressed Families. Second Edition. New York: Guilford Press. Pinkard, T.J. & Bickman, L. (2006). The Evidence for Home and Community-Based Mental Health Services: Half Full or Half Empty or Create other Glasses? In Research in Community and Mental Health, Volume 14: Research on Community-Based Mental Health Services for Children and Adolescents (Fisher, W.H., Ed.) California: Elsevier Press. President's New Freedom Commission on Mental Health (2003), Achieving the Promise: Transforming Mental Health Care in America. Final Report. SMA 03-3832