1 / 31

Family-driven Residential Practices that Support Positive Outcomes – from Basic to Advanced

Family-driven Residential Practices that Support Positive Outcomes – from Basic to Advanced. Beth Caldwell/Director, Building Bridges Initiative /MA Georgetown Pre-Institute Training Program Effective Residential Service Interventions July 2012 Orlando, Florida. Family Driven:.

Download Presentation

Family-driven Residential Practices that Support Positive Outcomes – from Basic to Advanced

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Family-driven Residential Practices that Support Positive Outcomes – from Basic to Advanced Beth Caldwell/Director, Building Bridges Initiative /MA Georgetown Pre-Institute Training Program Effective Residential Service Interventions July 2012 Orlando, Florida

  2. Family Driven: What’s it all about?

  3. Family-driven Leads to Permanency • Permanency is a stable, healthy, culturally appropriate, and lasting living situation with at least one committed adult. It also involves reliable, continuous, and healthy connections with siblings, birth parents, extended family, and a network of other significant adults identified by the youth and the family (Casey Family Programs, 2011).

  4. Definition of Family Driven? Family Driven means families have a primary decision making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation. This includes: • Choosing culturally and linguistically competent supports, services, and providers; • Setting goals; • Designing, implementing and evaluating programs; • Monitoring outcomes; and • Partnering in funding decisions. Source: Federation of Families for Children’s Mental Health

  5. Why is Family-driven important? • Strongest predictor of post-transition success, after education, is support from family • Fifty percent (50%) of youth who have aged out will live with some member of their family within a couple of years (about equally divided between parents and other relatives) Source: Courtney, M., 2007; Courtney, M., et al, 2004 • “Work with family issues and on facilitating community involvement while adolescents are in residential treatment may have assisted these adolescents to maintain gains for as much as a year after discharge..” Source: Leichtman, M., et al, 2001

  6. Why is Family-driven important? “The effectiveness of services, no matter what they are, may hinge less on the particular type of service than on how, when, and why families or caregivers are engaged in the delivery of care. While traditional forms of care approached mental health treatment in a hierarchical top down approach (with the clinician maintaining some distance from the recipients of treatment), this approach is not reflected in newer forms of service delivery. It is becoming increasingly clear that family engagement is a key component not only of participation in care, but also in the effective implementation of it.“ Source: Burns, B. et al, 1999, p. 238

  7. What does Research tell us? 7 Residential-specific research shows improved outcomes with shorter lengths of stay, increased family involvement, and stability and support in the post-residential environment(Walters & Petr, 2008).

  8. What is the Reality? Very few residential programs: • have implemented evidence-based/best or promising family engagement/motivation practices • have provided clinical staff with evidence-based or best/promising practice training programs on family engagement and family systems • have developed a promising/best practice framework for supervising and evaluating individual family engagement/satisfaction/ effectiveness throughout the course of treatment • require staff to spend time weekly in the homes of families using recognized best/promising practices

  9. How do we achieve permanency/how do we ensure that children are raised in communities with families if we have not yet put together and implemented a practice model that has evidence for supporting families in living successfully together in the community?

  10. We achieve permanency by: • Implementing evidence-based/best or promising family engagement practices • Providing clinical staff with evidence-based or best/promising practice training programs on family engagement and systems • Developing a promising/best practice framework for supervising and evaluating individual family engagement/satisfaction/effectiveness throughout the course of treatment • Requiring trained/quality staff to spend time weekly in the homes of families using recognized best/promising practices

  11. What to do? • We can develop our own framework based on the work of others who have led the way; AND/OR • We can use components of tried and true models – e.g., Functional Family Therapy; Multisystemic Therapy.

  12. Some Promising FDC Leaders: Those here at the Pre-Institutes or already mentioned: • Damar/IN - Jim Dalton • MA BBI – Janice LeBel • Hathaway/Sycamores – JoeAnne Hust & William Martone williammartone@hathaway-sycamores.org • CA Reform - www.rbsreform.org • Children’s Village/NY – Jkohomban@childrensvillage.org There are many others too – HELP US FIND THEM AND SYNTHESIZE THEIR PRACTICES TO INSPIRE AND SUPPORT OTHERS Let Beth know: bethcaldwell@roadrunner.com

  13. Magellan/PA Intensive Residential Project Jessica Wormer, Lead Primary Therapist, Warwick House, shares during the NYS OMH NYC transformation training: • “You can’t write this stuff… • Specific strategies • Engaging families (i.e. relationship; hope; ‘do whatever it takes’) • In home work (and community work – i.e. prisons/SA/MH) • Work with family challenges • How “not-interested,” “dysfunctional,” and “resistant” have been jettisoned to a galaxy far far away… ”

  14. Contact Information Magellan & Warwick House • John Lees, Care Management Supervisor, Magellan (jglees@magellanhealth.com; 610.814.8041 Ext: 68041) • Jeff Friedman, Director, Warwick House (jfriedman@warwickfamilyservices.com; 215.491.7404 Ext:20)

  15. Multisystemic Therapy (MST) Overview

  16. Core Clinical Skills for Engagement (Henggeler et al., 2009) Empathy • Striving to maintain an empathetic stance throughout treatment in order to develop interventions congruent with the family’s current state of being • Therapists monitoring their own state of empathy & accessing support as needed is important • When needed, suspend clinical assessment & intervention for “Non-Clinical Time” aka “Cup of Coffee” Intervention in order to gain better understanding of the client’s experience & ecology

  17. Core Clinical Skills for Engagement (Henggeler et al., 2009) Demonstrating interpersonal warmth through empathy, posture, facial expressions etc.. Flexibility – adjusting to changes quickly, managing situations with “can do” attitude & good humor General Strategies from Motivational Enhancement (covered below): Reflective Listening Reframing

  18. MST Non-Clinical Approaches to Engagement Reviewing Family Photos to show interest and learn more about the family as a whole, not just in terms of their problems Bringing Food as a “foot in the door” strategy & accepting food as a sign of respect/honor Helping with Practical Needs – going above & beyond with information and goods Five Minute Sessions – as an alternative to cancelling, acknowledge the barrier while still trying to complete one task

  19. Questioning versus Affirming and Reflecting Research shows interventions and engagement is effective when the interviewer provides twice as many affirmations and reflections than questions Doing so shows a real attempt to understand the person’s struggle around changing their behavior Too much questioning can start to feel like an interrogation, implying the interviewer wants them to change more than they want it

  20. Affirmations Compliments. Statement of appreciation. Highlights client strengths. Are a form of Reflective Listening. Is client-focused.

  21. Contact Information Paul Schiller, LMSW Division Director Multisystemic Therapy The Children's Village 400 East Fordham Road 6th floor Bronx, NY 10458 Cell 917 359-8627 Office 212 932-9009 x 7118 PSchiller@childrensvillage.org

  22. Functional Family Therapy: Family Engagement & Motivation Strategies Andrea Morgia Functional Family Therapy-Director East Cayuga Centers Formerly Cayuga Home For Children

  23. FUNCTIONAL FAMILY THERAPYCLINICAL MODEL Early Middle Late Engagement Behavior Change Generalization Assessment Goal-Skills Goal-Skills Goal-Skills Intervention Motivation Behavior Change Generalization

  24. WHAT IS HELPFUL….. • Resistance is NOT because of: • the family/youth’s not wanting/needing help • the family/youth’s lack of “motivation” • We expect them to be discouraged, lack motivation, angry, unhappy with the systems Services in home offer an advantage/disadvantage : -Be flexible -Be upfront with your programs expectations -Be relentless -Understand that families are saturated with services be open to the idea that services can be sequential in nature. -Immediately look for ways to reduce negativity and blame

  25. ENGAGEMENT & MOTIVATION What we do in E/M to help achieve these things with our families: Work relentlessly to understand and involve family members Work to reduce negativity and blaming between family members Develop a family focus for the problems presented by the family. Talk about the family in an alliance based-non blaming way. Be credibility: It comes from what you are able to do in early sessions .

  26. WHY REFRAMES & THEMES WORK: “RESPECT BASED” REFRAMING • Reframe (“and….)…what you “add to” the session • Alternative meaning for what was acknowledged • what might be “behind” or “the reason” • Focus… • Person focused (their part) • Family focused (all of the parts) (“…yes that is what is important here…) • Non-blaming…just an alternative description • Non-interpretative • Doesn’t explain away…or excuse….DESCRIBES • “theme hint”…just a guess • Based on what you have heard, what you know about them, what is common to adolescents • Over time…. Built a “theme” about the family that is more inclusive than this one event/situation

  27. REFRAMES, THEMES, & ORGANIZING THEMES • Reframing…a response to a CLIENT statement • Acknowledge (acceptance/support of the intent, the position, the values) of the client….. • not agreement…not empathy…. • Personal not general • Reattribution of that statement (change in meaning) • Building Themes…..reframing a CLIENT statement to: • Your hypotheses of a theme (theme “hint”) • An existing theme in the conversation • Organizing Theme…..a theme that describes: • Each persons motivate in non negative ways • Links everyone in the family together….to a common problem, challenge, of situation

  28. Contact Information Andrea Morgia M.S. Functional Family Therapy-Coordinator East Cayuga Centers Formerly Cayuga Home For Children Cell-315.591.7004 Fax-315.349.3057 andrea.morgia@cayugacenters.org

  29. And one more thing… • In addition to implementing a range of Family-driven care Practices • In addition to implementing a promising/best practice family engagement/ motivation framework • BEWARE OF CERTAIN LONG-TERM RESIDENTIAL PRACTICES

  30. What to be cautious of: • Events on campus (why?) • Lack of sophisticated/committed Clinical Supervisors • Group recreation (why?/who to invite? - build memories with families) • Holiday traditions (“Is it about the program or about the youth/family?”) • Empowering & Supporting Family Advocates, but having High Expectations

  31. BBI Contact Information 31 Beth Caldwell bethcaldwell@roadrunner.com 413-644-9319 www.buildingbridges4youth.org

More Related