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FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATION REStArT MODEL. October 29, 2010. History of the Model. Ongoing development of evidenced-based practice Trends in field moving toward evidence-based practice models

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history of the model
History of the Model
  • Ongoing development of evidenced-based practice
  • Trends in field moving toward evidence-based practice models
  • Consulted with Bruce Wampold for comparative review of literature with our existing model

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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key factors to successful outcomes
Key Factors to Successful Outcomes
  • Coherent clinical model
  • Family engagement
  • Stabilization of discharge resource
  • Availability of aftercare supports

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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coherent clinical model
Coherent Clinical Model
  • REStArT Model: The Relational Re-Enactment Systems Approach to Treatment
    • Evolved from model we were already working within
  • Implementation of Structure & Processes
    • Supported Top down
    • Horizontal Dialogue across all departments
  • Formalized into REStArT principles & treatment guidelines

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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slide5

The Conflict Cycle

Relational Trauma Re-Enactment Systems

Attachment Model

View of Self & Others

Trauma History

Meaning of behavior/ youth’s conflict

2

Stressful

Event

  • 5
  • Adult Reaction
  • Feelings
  • b. Behavior
  • c. Youth's Response

3

Youth’s

Feelings

4

Youth’s

Behaviors

(Wood & Long, 1991)

Modified

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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restart supervision dialogue meetings
REStArT Supervision & Dialogue Meetings

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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history of family engagement
History of Family Engagement
  • Previous Attitudes/Approaches
    • Youth doesn’t have any family
    • We are the experts—leads to blame game
    • Treatment planning without youth & family input
    • Discharge planning did not start until much later in treatment
    • Focus on external demands for services by traditional view (i.e., all families need family therapy)
    • “Menu” of choices

RESULT: POWER STRUGGLES WITH FAMILIES

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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change was needed
Change was Needed
  • Families were having trouble accessing services
  • Communications were happening across departments in silos
  • Realization that change was needed

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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clinical consultation
Clinical Consultation
  • Clinical consultation framework
    • Team based
      • Requires a shift from individualized contact toward team based approach
      • Allendale team---(Unit Coordinator, Case Specialist, Teacher & individual therapist) with family (and often other collaterals)
    • Consultations via phone at regularly scheduled times

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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clinical consultation is
Clinical Consultation Is…
  • Family focused
    • Frequency of contacts & time arranged around family’s availability
  • It is family treatment

NEW RESULT: Increased family involvement

    • Data showed dramatic increase in family involvement from FY07 31% to FY10 81%

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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clinical consultation is not
Clinical Consultation is NOT…
  • To get the parents “on board” with us
  • To “fix” the family to fit an ideal
  • To “get” them into family therapy
  • To move our hidden agenda forward
  • To solely respond to a crisis situation

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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stabilization of discharge resource
Stabilization of Discharge Resource
  • Discharge must be center stage issue
    • Work with youth & family throughout treatment to identify & implement community supports
      • Add community support staff into clinical consultation framework during treatment
  • Planning for discharge must be family and youth driven
    • Clinical Consultation is the way to help family & youth as they work together to develop a plan
    • Provider must regularly review how they are working to support the family & youth

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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availability of aftercare supports
Availability of Aftercare Supports
  • Support the Placement
    • Continued support of the adults/placement post-discharge
    • Continued clinical consultation framework post-discharge
  • Support the Youth
    • “Letting go” of the youth
    • Build upon the youth’s ability to form new relationships

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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the team
The “Team”
  • Systems Oriented
    • Identify all the systems involved with the youth and have them come together
    • Acknowledge current supports & explore past relationships
    • Finding families
      • Ask the youth
      • 411 or web based searches
  • Appreciate diversity of team members

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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seeing the whole youth
Seeing the Whole Youth
  • System-wide investment serves function of creating “wholeness”
  • Compartmentalization & Polarization

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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alliance
Alliance
  • Alliance in treatment refers to “agreement”
    • Shared understanding of goals & tasks
    • “Family wants” versus “provider wants”
  • What part can we give them?
    • As provider we take first step
  • Results in ownership by family and youth
    • Consultation and dialogue among all team members supports all members as equal partners in the process

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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factors that affect alliance
Factors that Affect Alliance
  • Unspoken and/or unresolved splits & divisions in the system
  • Compliance without support
  • Members of the system may be dealing with ambivalence

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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ambivalence what is it
Ambivalence: What is it?
  • “Ambi” means “both” so if you are ambivalent, you have both positive and negative feelings toward something or having feelings for both sides of the issue.
  • It naturally occurs when facing any change
  • It is to be expected as a part of the treatment process

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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all members may experience ambivalence
All members may experience ambivalence

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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youth s ambivalence
Youth’s Ambivalence

Examples:

  • Youth says he wants to leave but shows only one side of his ambivalence through acting out
  • Youth changes his/her plan frequently

What keeps it going?

  • We may rationalize, interpret it as “sabotage”, or minimize
  • We INTERFERE by getting in the middle

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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family s ambivalence
Family’s Ambivalence

Examples:

  • Family says they will do “x” but then does not follow through
  • Family says one thing but then they do something else
  • Family is not developing a discharge plan
  • Family is not calling in for clinical consultation &/or planning meetings

What keeps it going?

  • We try to either push them or empathize with them
  • We INTERFERE by getting in the middle of youth and family working through the issue

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

provider ambivalence
Provider Ambivalence
  • “Getting in the Middle”
    • Taking over – Holding the anxiety
    • Taking a conflicting position
    • Championing one side of the ambivalence
    • Caring more about the plan & outcome than youth & family do
    • Deliberate attempts to resolve the ambivalence by pushing for change
  • Not expecting health

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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expecting health from the youth
Expecting Health from the Youth
  • One person’s picture of “health” may look different than that of another
  • Youth are able to tolerate natural setbacks as a result of failures and disappointments
  • Youth have the resiliency to tolerate disruptions in relationships and work to repair them
  • Treatment allows youth to work through difficult feelings & situations, rather than always removing the stressor

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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expecting health from all members of the team
Expecting Health from all Members of the Team
  • Expect that all members want the best for the youth
  • Do not attribute mal intent to the behaviors of others
  • Expect that all members will do “their job” in a “healthy” way

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

working with control sensitive cs youth
Working with Control Sensitive (CS) Youth
  • CS youth interpret everything we do as an attempt to try to control them
  • The antidote is to give them more control through providing choices with (logical & natural) consequences
  • Telling the CS youth they have to do “x” before they can get what they want inadvertantly sets up a power struggle
  • When they begin acting out (i.e., hospitalization, AWOL, arrests) we need to assess the meaning behind the behavior
    • May be related to ambivalence
    • May be a lack of alliance or ownership

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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significant trends
Significant Trends
  • Overall findings FY07 through FY10 data suggest the following:
    • We see more kids going home and going home in quicker time frames, which suggests an increased alliance with families
    • Further, the decrease in negative events, especially AWOLS, suggests we have an increased alliance with kids

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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dcfs trends
DCFS Trends
  • When comparing data for DCFS funded youth versus all other (DHS, ISBE, county courts, private), FY07 through FY10 data:
    • DCFS funded youth have an average 8 month longer length of stay than non-DCFS funded youth (14 months versus 22 months)

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

chi square statistics
Chi Square Statistics
  • There is a trend toward greater positive discharges (69.9% in FY07 compared to 81.7% in FY10, with no down turns in between). However, the change wasn’t statistically significant.
  • The proportion of discharges to home compared to other positive discharges did change significantly, in the hoped-for direction (p= 0.02). Discharges to home were 29.3% of all positive discharges in FY07 and were 44.9% in FY10. This significant change was true comparing the proportion of discharges to home to all other discharges, positive or negative (p= 0.01). Discharges to home were 20.5% of the overall discharges in FY07 and 36.7% of discharges by FY10.
  • The proportion of AWOL discharges compared to all other discharges changed significantly (p= 0.05) with the proportion of AWOLs shrinking over the four years (16.9% in FY’07 compared to 8.3% in Fy’10).
  • The proportion of DCFS clients being discharged to home, compared to all other DCFS discharge types changed at a rate that approached statistical significance (p=0.07)

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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summary
Summary
  • Ongoing Challenges
    • Commitment at all levels
    • Family “driven" milieu
  • Case Examples
  • Questions & Answers

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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presenter information
Presenter Information

Contact Information:

Judy Griffeth, LCSW jgriffeth@allendale4kids.org; (847) 245-6330

Saray Hansen, MA shansen@allendale4kids.org; (847) 831-4216

Ronald Howard, LCSW rhoward@allendale4kids.org; (847) 245-6329

Howard Owens, LCPC howens@allendale4kids.org; (847) 245-6170

Dr. Pat Taglione, PsyD ptaglione@allendale4kids.org; (847) 245-6302

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

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