1. Building Bridges: Engaging Families in Child Mental Health Services Tierra Sydnor-Diggs, LGSW

2. Objectives 1. Identify common barriers to engagement from both the perspective of the service provider and the family 2. Identify goals of engagement at each stage of the treatment process from the start of services up until the moment of discharge. 3. Understand critical elements necessary for engaging families. 4. Participants will learn to go beyond barriers and myths often associated with disengaged families.

3. Roll Call !!!!!

4. Understanding Engagement Family engagement is a family centered and strengths-based approach to partnering with families in making decisions, setting goals, and achieving desired outcomes. It supports the disclosure of culture, family dynamics, and personal experiences in order to meet the individual needs of every child and family. Engagement is the foundation and essential process in the clinician-client relationship from the moment a family is considered for treatment until they are discharged.

5. Understanding Engagement Continued Although attendance is important and a necessary component of engagement, research shows that there are key behavioral components as well. According to a review by Staudt (2007), the following behavioral components are essential to gage a families level of engagement. -Attendance -Participating in sessions (e.g., talking about relevant topics, practicing new skills. -Completion of homework assignments -demonstration of progress towards goals -discussing feelings and engaging in efforts outside of sessions (Cunningham & Henggeler,1999; Hansen & Warner, 1994; Prinz & Miller, 1999; Staudt, 2007)

6. Benefits of Family Involvement in Child Mental Health Minimizes stigma and feelings of distrust by improving communication (Linhorst & Eckert, 2003) Improves activation in seeking care (Alegria et al., 2008) Improves self-efficacy- i.e., active participation in decision-making (Heflinger & Bickman, 1997; Bickman et al.; 1998) Improves knowledge and beliefs about children’s mental health and this is associated with use of higher quality of services for children (Fristad et al., 2003; 2008)

7. More on the Benefits of Family Engagement Enhances the helping relationship Promotes family “buy in” Problematic behaviors exhibited by the child decrease Enhances the fit between family needs and services (Child Welfare Information Gateway)

8. Let’s Chat In a small group discuss obstacles and/or barriers that you have encountered as you tried to involve children and their families in mental health services. Look at the perspective of the family and as the professional.

9. Barriers to Engagement Barriers can reside with the family, the provider and/or the system in which the provider works. Common concrete obstacles may include time, other priorities, transportation, child care, agency waiting list Common perceptual obstacles may include attitudes about mental health, stigma, prior experiences, race, ethnic/cultural issues, recognition of poverty, safety and the parents’ personal needs and stressors.

10. Research Findings on Barriers to Engagement Addressing perceptual barriers may be more important than focusing only on concrete obstacles. Perceptual barriers (e.g.; parent stressors) and prior negative experiences have been shown to have the greatest influence on initial and ongoing engagement.

11. Family Engagement Video

12. Key Elements Needed for Fostering Healthy, Supportive and Trusting Relationships in the Family Engagement Process Clear, honest, and respectful communication Commitment to family centered practices Sufficient frequency and length of contact A strengths based approach Shared decision-making and participatory planning Broad based involvement Understanding the role of confidentiality Appropriate individualized treatment plans Address concrete needs Praise and recognition of parents/families

13. Key Elements From a Systems Perspective to Foster Effective Family Engagement Agency leadership that demonstrate a commitment to family centered practices. Organizational culture that models desired behaviors, actions, and communication. Program improvement plans that detail strategies for family and youth involvement. Policy and standards that clearly define expectations and identify requirements for family engagement. Professional training and coaching on skills such as family engagement techniques, effective communication skills and cultural diversity.

14. LET’S CHAT Think about some of your favorite stores that you patronize on a regular basis. What are factors that keep you going back to shop at the store? What are factors that will cause you not to return to a particular store? How do you think some of the same factors effect families decisions as to whether or not they will continue to participate in mental health services?

15. Tools For Building the Bridge Between Families and Mental Health Services Just like building an actual bridge, engaging families in mental health services is a process which often requires patience, time and the right tools.

16. Goals of Early Engagement Help the family process and clarify the need for mental health care Increase caregiver investment Assist caregivers with discussing attitudes about previous experiences with mental health care services and institutions Problem-solve around obstacles (concrete and perceptual) to care

17. Goals of Retaining Families Setting and maintaining a strengths based tone to treatment through empowerment and keeping them involved in the treatment process. Friendly reminders of appointments. Continue discussions identifying barriers to ongoing involvement in treatment. Identify barriers that impact the change process. Encourage parents to attempt new strategies and problem-solving skills in their daily lives.

18. Interventions That Promote Engagement Early Engagement Strategies: -Use of telephone prompts/scripts during initial contact with the clinic. -Use of reminder phone calls and/or letters about appointment dates and times. -Having paraprofessionals and clinical staff available to address parents concerns.

19. Interventions That Promote Engagement Technology Based Interventions -Telephone reminders about appointments, especially directly from the therapist or helping professional. -Text message reminders about appointments -Web-based appointment system that allows clinicians and staff to make, change and confirm appointments

20. Interventions That Promote Engagement Use of paraprofessional staff -Utilizing trained parents or family advocates who have special needs children themselves. -Family advocates are trained and coached to help support families in need of mental health services utilizing the skills they have already developed in obtaining services for their own children.

21. Interventions That Promote Engagement Strengths based: Motivational Interviewing -MI is a counseling approach developed by clinical psychologist Professor William R. Miller, Ph.D. and Professor Stephen Rollnick, Ph.D. -MI is goal oriented and client centered. -MI techniques can be used in the work done with families for eliciting behavior change by helping them to explore and resolve ambivalence.

22. A Day in the Life of a Family At Your Site……. Think about a first contact with a parent and their child at your site. Based on our discussion today, describe what would make the experience perfect for that parent and child. What might you do different from what you may have previously done during your interaction with families in the past?

23. Steps Moving Forward Improving how we engage our families in mental health services should be a continuous process involving careful planning, monitoring, evaluation and use of the findings to refine your agencies family engagement plan.

24. Q & A Questions/Remarks

25. References Gopalan,G., Goldstein, L., Hoagwood K., Rodriguez J., Murray L., Legerski J. (2010). Engaging Families into Child Mental Health Treatment: Updates and Special Considerations. Canadian Academy of Child and Adolescent Psychiatry, 19(3): 182-196 Mckay MM, Bannon WMJ. Engaging Families in Child Mental Health Services. Child and Adolescent Psychiatric Clinics of North America. 2004; 13(4): 905-921 [PubMed] Mckay MM, Hilbert R, Hoagwood K, Rodriguez J, Murray L, Legerski J. Integrating Evidence-Based Engagement Interventions Into “Real World” Child Mental Health Settings. Brief Treatment and Crisis Intervention Vol. 4, No. 2, 2004 www.childwelfare.gov/pubs/f_fam_engagement/ Video: Centre of Excellence: What is Family Engagement (www.youtube.com)

26. Resources 1.Family Navigators: www.mdcoalition.orgwww.mdcoalition.org 2.Federation of Families for Children’s Mental Health: www.ffcmh.orgwww.ffcmh.org 3.Motivational Interviewing Training in Maryland: https://theinstitute.umaryland.edu/topics/ebpp /interview.cfm https://theinstitute.umaryland.edu/topics/ebpp /interview.cfm 4.Motivational Interviewing: http://www.motivationalinterver.org

27. Contact Info Tierra Sydnor-Diggs, LGSW Tsydnor@psych.umaryland.edu