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Effective and Efficient Counseling and Guidance and its Documentation

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1 Effective and Efficient Counseling and Guidance and its Documentation
IT CAN BE DONE! Effective and Efficient Counseling and Guidance and its Documentation Vera & Greg Hook: Maya Angelou said, “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” If this is accurate, and I think it is, even though consumers may forget what we say to them, they won’t forget how we made them feel by saying what we said and just as importantly how we said it – with our voice tone and inflection, body language, facial expressions, etc. By making our consumers feel good – about themselves, about what they’ve accomplished, etc. – we have the power to change their lives for the better, which is what we do, isn’t it? There’s also a practical component of this – if consumers feel good when they are with us, they are more likely to stay connected to us, follow our guidance/our lead, etc. So, we’ll be talking a lot today about what words mean and the impact they can have on people’s lives, particularly our consumers’ – good or bad. We all know words have power and we will use certain words to guide today’s training. According to Merriam-Webster, Effective means producing a result that is wanted : having an intended effect. Efficient means capable of producing desired results without wasting materials, time, or energy. In light of the recent Sunset Staff Report and Recommendations, these two words have the potential to wield more power than ever before. Vera Gist, MRC, LBSW DARS/DBS Field Director, Southeast Greg Mason, MA, LPC-S DARS/DBS Field Director, Waco

2 INTRODUCTIONS Presenters Audience Content Greg
Presenter bios, perhaps a favorite counseling-related story Ask audience members to identify themselves by hand according to: MRC, Masters in Counseling or other, CRC, LPC or other, years experience – public and private practice? We will be sharing with you old and new ideas and look forward to not only your participation, but your ideas on how to improve this training, if necessary. We will also be presenting at the TRAN Conference and hopefully at the next VRS/Coordinators Meeting. To encourage your participation and ideas we will be asking open-ended questions and practicing other effective counseling skills.

A professional intervention and service to consumers for the purpose of reducing the disability-related impediments or other barriers to employment through consistent and comprehensive application of proven principles and methods, including but not limited to informed consumer choice Greg What do you think of this definition?

A Skilled Clinician An Expert in Assessment and Planning An Expert in Disabilities An Expert in WOW Effective in Helping Consumers Overcome Greg According to one journal definition a VRC: Is a skilled clinician in terms of developing relationships with consumers Has expertise in the “World of Work” Has expertise with disabilities Is able to effectively help consumers address and overcome environmental or community obstacles as well as individual issues Has expertise in assisting people with disabilities in developing and implementing a plan to overcome barriers and obstacles created as a result of the disability in order to achieve life goals In our society, in terms of success, employment is THE life goal. In many ways Vocational Rehabilitation is the foundation of all other rehabilitation efforts. It consists of much more than “placement.” It is helping a person adjust totally to the WOW. Further, research tells us that Vocational Counseling and Guidance is the foundation for Vocational Rehabilitation. It is the primary service and the foundation on which all other services are based. Recent examples Journal articles, students studies presented at TRA. Also, this presentation itself grew out of an FD/VRS Meeting wherein C&G was identified as one of the top five areas needing improvement in order to increase overall effectiveness and productivity. So we’ve talked about who performs Vocational C&G, and who benefits from it. We’ve also talked a little about why Vocational C&G is so important. Now let’s move on to the what, when, where and how of C&G.

Establish and Maintain Trust Create a Strong Forward-Moving Relationship Challenge Consumer to be a Practicing Partner Empower the Consumer Identify ALL Disabilities and Barriers to Success Help Consumer Develop Essential Skills Ensure Accountability & Consumer Choice Increase Likelihood of Success Vera If performed effectively and efficiently, VOCATIONAL C&G will accomplish the following: Establish true trust and rapport between counselor and consumer Enable counselor and consumer to uncover and identify all disabilities, barriers and potential barriers to success Empower the consumer to access and analyze for themselves applicable labor market trends and other important career-related information Create a strong forward-moving relationship between counselor and consumer Facilitate the consumer developing important critical thinking and problem solving skills Challenge the consumer to be a practicing partner in the process, from beginning to end, and enable the counselor to hold consumer accountable Increase the likelihood of consumer employment and counselor success. Question: Does this about cover it or do any of you have anything else to add? Which ones do you think are more important than others?

6 WHEN SHOULD C&G HAPPEN? Every contact with your consumer is an opportunity to provide effective and efficient C&G . . . Greg What does opportunity mean and how does it apply to our work? According to Merriam Webster, it means “an amount of time or a situation in which something can be done; a favorable juncture of circumstances; a good chance for advancement or progress. What are some typical opportunities do we have to interact with our consumers? .

7 . . . REGARDLESS OF Time Space or Location Case Status or Phase
Medium of Communication Consumer’s Current Orientation or Functioning Greg Provide and discuss examples of each.

8 HOW DO WE PROVIDE C&G? Whatever the nature of the contact, take time to check: The IPE Previous case notes Yourself Vera Question: What are the benefits of reviewing IPE and/or previous case notes? What do we mean by “checking yourself?”

9 HOW DO WE PROVIDE C&G? Actively Listen To: Identify the Issue(s)
Determine the appropriate Intervention(s) Partner with Consumer to be Intentional moving forward Greg This is beginning of the new idea we referred to earlier. Over the years, we’ve struggled with how to make the connection between the actual C&G and its documentation, and we’ve heard from others, such as you, who have the same problem. Just recently I heard from one of my newer Adult VRC’s about how difficult it’s been for her to identify the significant issues her consumers have discussed with previous counselors. Her statement was “Everyone documents C&G differently and there is just no structure, no consistency.” We suspect Sunset Staff experienced the same. I know most of you, if not all of you, have heard of or even used the SOAP or DAP methods of case noting, and you may have heard of or used others. My problem with that and others is that there doesn’t seem to be a direct link between the actual C&G and documentation, at least in regards to the kind of C&G we provide as VRC’s. Keep these three simple I words in mind. We’ll discuss them in more detail throughout the rest of our time together.

10 HOW DO WE PROVIDE C&G? With professionalism, and acting with courage and consideration, control the interaction/process to ensure effectiveness and efficiency. Vera What is acting with courage and consideration? How does that help you control the process while achieving the other goals of C&G? What are the other goals of C&G? What is the direct link between control and efficiency; and consideration and effectiveness?

ISSUE: An important subject or topic INTERVENTION: To become involved in something in order to exert influence INTENTION: The thing that you plan to do or achieve; what one intends to do; a determination to act in a certain way; (For example, “I resolve to do “) Greg Again, according to MW: ISSUE: Something that people are talking about, thinking about, etc.: an important subject or topic INTERVENTION: To become involved in something (such as a conflict) in order to have an influence on what happens INTENTION: The thing that you plan to do or achieve; what one intends to do or bring about; an aim or purpose; a determination to act in a certain way; resolve (For example, “I resolve to do “) Isn’t this what we do – day in and day out? What are some issues that we bring to consumers or that they bring to us? How do we intervene? As we discussed earlier, words have power. What do you think about the words Intent or Intention versus some other word such as Plan or ? You probably know where we’re going with this regarding the next big topic – documentation. We hope you see the connection between what we as VRCs actually do and how we can simply use these same terms to structure our documentation. But before we get there, let’s explore completely the How of C&G.

Active listening is a skill that involves listening to, and focusing on, what the other person is saying and how they are saying it with the whole of you to fully understand them, including the emotional content and significance of the words, and reflecting back the meaning so that they know they have been understood. Greg Active listening is a skill taught primarily to counsellors and other health care professionals. It involves listening to, and focusing on, what the other person is saying with the whole of you. It involves understanding what has been said, including the emotional content and significance of the words, and reflecting back the meaning so that the person doing the talking knows they have been understood. When you actively listen to someone you encourage them to explore their feelings further, without the fear that they may be judged or ridiculed. You don’t interrupt them, or give them your viewpoint on what they are saying – you listen. What I just read is a journal article definition that I modified on the slide for our purposes. Sometime we do have to interrupt in order to control the process, but we always do it with kindness, consideration and respect. Why do you think active listening is important to our work? What does is accomplish? How does it relate to what we talked about earlier – “What can C&G Accomplish?”

The SOLER Method: S = Sitting Squarely O = Open Posture L = Leaning Towards E = Eye Contact R = Relaxed Greg We talk a lot about actively listening, but not so much about how to really do it. Gerard Egan defined the acronym SOLER as part of his “Skilled Helper” staged approach to counselling. It is a non-verbal listening process used in communication, and a key skill taught to counsellors as part of their training. It’s a tried and true method that I learned in my Masters program Let’s go through each of these in more detail: S: Sitting squarely says “I’m here with you, I’m available to you.” Turning your body away from another person while you talk to him or her can lessen your degree of contact with that person. If, for any reason, facing the person squarely is too threatening for them, then an angled position may be more helpful. O: Adopt an open posture. Crossed arms and/or crossed legs can be a sign of lessened involvement with or availability to others. An open posture says you are open to the client and what he or she has to say. It is non-defensive in nature. L: It is possible to lean towards the client. It says, “I’m with you, I’m interested in you and what you have to say.” Leaning back can suggest the opposite. Remember not to lean too far forward, or this may be seen as placing a demand on the client. He or she may find it intimidating. E: Maintain good eye contact. It’s another way of saying, “I’m interested, I’m with you.” Remember this is not the same as staring. You will need to look away every so often, in order not to stare, but monitor the amount you look away. It could say something about your own level of comfort/discomfort. R: Be relaxed or natural. If you are fidgeting nervously it will distract the client. Being relaxed also tells the client that you are comfortable with using your body as a vehicle of personal contact and expression. It helps put the client at ease.

Handout Exercise/Self-Assessment Vera We sent each of you the ????? and hope you completed it and brought it with you. The purpose of our doing this is two-fold: To give you the opportunity to take an inventory of yourself in regards to certain counseling skills, and to underscore to some and reveal to others the theory we think we should be using for our work. There are a lot of theories and we are free to choose and apply different ones, and/or their techniques, depending on our or our consumers’ needs at any one time. Those could be CBT, Cognitive, Behavioral, REBT, Gestalt, Reality, Existential, Psychodynamic, etc. Which one do you think this inventory emphasizes? Why do you think we are endorsing Client-Centered over all others? Discuss Does anyone want to share what they learned as a result of completing the inventory?

15 WHAT IS DOCUMENTATION? Documentation demonstrates how the VR process is ensuring informed consumer choice, and reducing the disability-related impediments and other barriers to employment, leading to a successful employment outcome. It has multiple implications, including legal and ethical. Vera What do you think of this definition? We’ve covered actual Counseling and Guidance. Now let’s take a look at how to document that C&G. We are recommending you use the same terms as we just used to describe the C&G process – Issue, Intervention, and Intention. Again compare to other systems – SOAP, for example. But before we talk about HOW to document C&G, let’s discuss fully what documentation is, its purpose or why it’s important, and what it helps us to accomplish or how it benefits us and our agency.

“Tells the Story” of the VR Process Demonstrates that informed consumer choice has taken place at every phase Substantiates the positive impact that has taken place on the consumer’s life Facilitates follow-up and follow-through Communicates services and participation Increases likelihood of success Greg Effective documentation makes it possible for the counselor to comprehensively “Tell the Story” of the consumer moving through the VR Process and how VR services are having a substantial impact on the consumer achieving a successful employment outcome. Facilitate the counselor’s ability to follow-up and follow-through with planned services Communicate clearly to any case reader the full extent of services provided the consumer by the counselor and consumer participation in their individual vocational rehabilitation program Easily allow the counselor to get full credit for the provision of C&G Increase the likelihood of agency success Why are all these things important? Who else might be reading your C&G case notes other than you and your RA? How does good documentation lead to success?

17 HOW DO WE DOCUMENT? Select Topic Add to Topic Case Note Issue(s)
ReHabWorks Select Topic Add to Topic Case Note Issue(s) Intervention(s) Intention(s) Vera Demonstrates how to document a C&G case note in RHW by selecting a topic, adding a topic, and creating a content structure using the three I’s.

18 HANDOUTS Issues Interventions Intentions Vera and Greg
Distribute handouts and quickly discuss how they can be useful tools.

19 ROLE PLAY C&G Greg and Vera
Conduct role plays emphasizing everything presented to this point – The Three I’s, SOLER Method of Active Listening, etc.

Vera and Greg Go to RHW case note that Vera created and document final role play scenario with assistance from audience.

Assessment Planning Case Management Vera Can skip this slide if running out of time. Basic idea is C&G is important part of all three of these.

22 WHAT DOES POLICY SAY? Vocational Rehabilitation Manual
Counseling and Guidance, Chapter 10 Definition of C&G, 10.1 Examples of C&G, 10.2 Case Management, Chapter 40 Case Notes, 40.1 Purpose, What to Include, What Not to Include, Vera Purpose of this slide is to let them know where to find policy. Skip if running out of time; discuss as needed to fill time. Actually show audience how to find policy and go to it.

Question: What do you think of the Three I’s system; do you think it can help you provide effective and efficient C&G and document that in your case notes? What do you think of the way we delivered our ideas and materials – what counseling skills and interventions did we demonstrate throughout? Do any of you have any ideas of your own that would improve this and make it even more helpful for you as counselors in particular, and our agency in general?

24 "A life is not important except in the impact it has on other lives.“
Jackie Robinson Greg & Vera: This speaks for itself and does a good job underscoring our major theme – that we as counselors have arguably the most opportunities of any other professionals to make a positive impact on people’s lives. We hope the system we presented today will empower and enable you to more effectively and efficiently do that.

25 “Nothing will work unless you do.”
Maya Angelou Vera and Greg: We began today with a quote from Dr. Angelou and it’s appropriate that we finish with one. It’s as simple as this. Thanks for your participation and everything that you do day in and day out to change people’s lives for the better.

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