changing ABLE to: Able-differently, a Utah non-profit community service PO Box 9757 Salt Lake City, Utah, 84109 801-520-7376 Fax 801-466-7569
ABLE-differently would like to welcome you to this power-point presentation of ideas and services used to serve school age and younger children having secondary social and emotional concerns associated with their special health care needs. We will address several areas important to community health care providers, parents and educators, that they have found useful in their involvement with this population.
Outline of Presentation 1. Refocus ABLE-differently program ideas. 2. Change process. 3. Levels of care and tools for change. 4. Public Health Model goals. 5. Understanding complex problems and systems. 6. The ABLE-differently community process. 7. Family resiliency. 8. Interconnections and reconnections. 9. Relationships to the families and schools. 10. Health Provider involvement in school/family systems.
-1- INTRODUCTION TO THE ABLE-differently PROGRAM Current focus on three goals
Children are referred to the ABLE-differently Program for having emotional or behavioral excesses or deficits contributing to personal difficulties, or failure within social or educational systems.
ABLE-differently - Program Looking children in terms of their functional emotional intelligence: A – Adapting: personal coping abilities and resiliencies B – Biopsychocultural behaviors from context of experiences L – Lifelines: available support systems E – Experience: social, physical, emotional and psychological
Past Contributors to Able-differently Program’s Concept Heidi Ahlers RN Ellen Ahlers RN Lou Allen MD MPH Gail Brown PhD George Delavan MD Susan Dickinson MS Lila Hutchinson Bettyeann Mayer RN Julia Mathews PhD Sterling Redd LCSW Hermann Peine PhD Judy Peters Chris Sandoval Jim Taliaferro LCSW Walt Torres MSW Barbara Ward RN Great thanks to Utah Dept. of Health/ Children with Special Health Care Needs and the many more than listed here and foremost the families who were entrusted to our care and taught us many of these ideas.
-2- THE ABLE-differenly CHANGE PROCESS FOR INDIVIDUALS AND FAMILIES
Some Initial Social and Personal Barriers to Child and Family Health Poverty Lack of or use of Educational Opportunities Poor Physical Health Mental Illness Disabling Conditions Abuse, Neglect, or Abandonment Poor Access to Resources Cultural-institutional Factors and Considerations
People Can Change Personal Stories from Frustration and Hopelessness to Resilience and Strength through use of Team Wraparound Approaches with the family that helps re-story, sometimes hidden, unique exceptions to the problem laden narratives.
Families Must be at the Center of a self help Change Process Working positively with the people who currently help or support the family or specific family members (family helpers). Learning to recruit community team players. Learning to maintain community helpers. Learning leadership skills. Developing new solutions. Developing communication, problem solving, and goal-setting skills. Must perceive positively their partnership status To be heard, respected, felt and understood so to act on their own preferences and decisions.
Family helpers assist families to: Increase hope. Be encouraged towards action. Grow in life skills. Build supportive relationships. Be motivated. Respect their own culture. Feel cared for and actively care for themselves.
Families Have Opportunities to Learn Community Team Building Traditional Interventions focused primarily on problems, not strengths. However, problems often require multiple interventions using resources from many directions. Therefore, strength- building requires similar support from many sources.
Families Learn to Build Teams Within the Community and share partnerships Department of Health Family Medical Care (Medical Home) Schools Extended Family Worship Groups Social Services Mental Health Services Law Enforcement Friends & Neighbors
-3- ABLE-differently RECOGNIZES AND PROMOTES THE NEED FOR LEVELS OF CARE AND THE CLINICAL TOOLS REQUIRED FROM LOCAL SYSTEMS IN THE COMMUNITY RECOGNIZING ESPECIALLY, FAMILY, SCHOOLS, AND MEDICAL HOMES THAT ARE INTEGRATED AND CONTINUOUS
Health Providers Promotion/ Prevention Matrix Levels of Care Levels of Complexity PRIMARY SECONDARY TERTIARY HIGH COMPLEXITY MULTIPLE CONDITIONS IDENTIFIED INCREASING COSTS MINIMAL IDENTIFIED RISKS NORMAL POPULATION WITH UNIDENTIFIED RISKS
There exists a Clinical Toolbox for Intervention and Integration of the Child and the Family with the Community Finding the right key to a child or family’s difficulties and unlocking their strengths.
Some Tools in the Box Traditional and Strength Based Assessment Education & Working Together Referrals & Resource Guide Family & Child Consultation Promote Mentoring Support Help that Works Practices that Look at Solutions Communication Enhancement Changing Personal Negative Stories to Positive Stories Job Sampling Building Positive Rituals & Routines Building Positive Self-identity Focus on everyday function and natural resources
Children and families with the highest risks tend to be the most expensive for society as a whole. ABLE’s rich program resources are not to be absorbed in serving just a select few clients, but also used for the empowerment of a broader community serving the same population. Public Health methods and practices can serve these functions and rightfully should.
-4- THE ABLE PROGRAM USES THE GOALS OF A PUBLIC HEALTH MODEL
By Building Bridges with the Community The clinical work becomes the workshop for training and teaching the community. Population based practices are envisioned supporting wellbeing, wellness with imbuing positive mental health within local systems of care for special needs.
Our experience has been both providing health for both the Individual and the general population
By People Understanding and Acting On the Interaction of Complex Issues and Multiple Influences in Their Lives, they can Influence and Determine Their Own Destiny and Health Outcomes
By Providing Cost-effective Models for Community Health Make available online web based resources. Assure collaboration among local line services in the community. Integrate physical and behavioral health in family, schools and health care Use everyday and natural resources to highlight children’s experiences and their needed stories of those opportunities.
By Demonstrating that Promotion, Protection, and Prevention of many social emotional difficulties associated with special health needs are all important functions of a Public Health System and are presumed to be prerequisites in local communities of care as being in the back yard of the medical home. There are few magical fixes.
By Supporting the World Health Organization’s Definition of Health as a State of Complete Physical, Mental and Social Well Being-Not Just the Absence of Disease.
-5- THERE EXISTS A NEED TO UNDERSTAND COMPLEX PROBLEMS AND COMPLEX DIFFICULTIES WITHIN COMPLEX SYSTEMS
PROBLEM VS. PROBLEMS Wouldn’t it be nice if all children and families came in with just one isolated identified problem? But life is more complex, and multiple difficulties abound and must be understood in more coherent ways.
Patient Characteristics on Intake Percent of Patients by problem coming into the Salt Lake City ABLE Clinic, and the Provo, Price, Moab, and Blanding Itinerant Clinics in the recent past. MCH studies reports 13- 18% of child population have special needs and close to 40% of special needs have psychosocial needs on the average.
-6- THE ABLE-differently PROGRAM ADMINISTRATIVE AND CLINICAL INTAKE PROCESS
The ABLE-differently Program Services Must Match Needs Before intake the severity of needs are assessed and immediate referrals are made. Children and families will be best served by multiple intervention tracks with consideration of non medical and related services as critical as a medical referral. Families will be involved in making this determination as well as managing their team.
ABLE-differently Program Two Track Systems COMMUNITY CONSULTATION TRACK 1. Many Strengths 2. Low Risk 3. Fewer Problems 4. Identified Supports 5. Short Term 6. Problem Focused 7. Physician driven ongoing care. COMPREHENSIVE MULTI-ENCOUNTER TRACK 1. Fewer Identified Strengths 2. Moderate/High Risk 3. Many Problems with lower resources 4. Supports Needing to be Built 5. Long Term 6. Broad Solution Focused 7. Collaborative Team Efforts 8. On Going Follow-up Care Complexity involving social emotional and behavioral concerns May best require collaborative, teaming
Assessment Instruments Health Care Providers may find useful in their practices will be highlighted in some of the following sections.
Psychological Assessment Assessing Cognitive Abilities Common Instruments Used or Requested INSTRUMENT AGES Bayley Scales of Infant Development 0-4 WPPSI 4.5-7 WISC – IV 6-16 Unit 5-17 Slosson – R 4-Adult WCST-64 6.5 - 89
Psychological Assessment Assessing Learning/Attention Abilities and Deficits Common Instruments Used P/T= (Parent/Teacher) INSTRUMENT AGES Vanderbilt Assessment Scale 6-12 (P/T) Brown Attention Deficit Disorder Scales (BADDS) 4-Adult Conners’ Continuous Performance Test 6-Adult Behavior Rating Inventory of Executive Functioning 5-18 Behavioral Observations 0-Adult Child Behavior Checklists 3-18
Family Health Promotion Plan Assessment of Strengths, Weakness and Intervention Strategies in the Areas Of: Child Family School Community Cultural & Economic Factors Physical & Emotional Health
Child Self regulation/safety Belonging/attachment Exploration/Play Physical and Developmental Health Body Systems and Sensory Motor Functioning Adaptive Self-help Emotional and Social Health Sense of Self and Identity Industry/Achievement
Family Housing/Food/Income Insurance Medical Home Routines and Rituals Celebrations/Recognitions Recreation/Leisure Extended Family Support Spiritual Strengths Mutual Respect Sanctuary/Secure base
School Achievement/Grades Parent Partnership Friendships and Peer Relations Citizenship and Conduct Teacher/Student Fit Cultural Acceptance Recognitions School Health Care Plan After school programs
Community and Culture Language Beliefs and Customs Cultural Heritage and Identity Safety Issues Community Working Together Religious Supports Resource Availability Political/Economic Realities Providing Public Health and other community needs as safe places to play and re-create Collaborative local systems of care responding and pulling together on behalf of individual families with their child in school/preschool/headstart or early intervention
Family Health Promotion Plan (Pulls from the listed resources)
Follow-up and Outcome Assessment Are we better off from what we are doing? Scaling YOQ Other Psych. Measures School Performance School and Clinic Attendance Team Management Form Parent Outcome Rating Scale
-7- FAMILY RESILIENCY FROM RISK TO THRIVING The Process of Moving from Despair to Hope
Family Past and Present Realities Stressful Challenges Problems Vulnerabilities Losses and Pain Adversities Traumas Disappointments and resentments
Just Making It Toxic Environments Hollow Successes Inflexible Overly Defensive Abuse Prone Strained Relationships Personality Disorders High Dependence on Society’s Safety Net (Resource Supports)
Life Threatening Ineffective-Coping Adaptive Dysfunction Psychopathology Antisocial Destructive Narcissistic Violence and Lawlessness
ADAPTIVE COPING Leads to Increased Personal and Family Assets and Increases Protective Factors
Need for family LIFELINES Beliefs and Values Systems Organizational Patterns Communication - Problem Solving New MeaningsFlexibility/OpenOpen Dialogue ReframingBalanced RolesOpen Feelings Make things NormalRespect Differences Listen to Others Opinions Give Proper Perspective Connectedness & Forgiveness Share & Respect Goal Differences Positive HopesSocial SupportsHave Empathy Increased SkillsO.K. EconomicsHonesty/Humor
Need for THRIVING abilities in Children and Families People become winners when they start using sufficient protective factors for themselves and their families.
Need for individual and family FUTURE REALITIES AND VISIONS Personal and Family Well-being Wellness Improved Health Status More Adaptablity Salutogenic (healthy) Outcomes
Useful Relationships for All Providers and Families to Help Achieve Positive Family Outcomes 1. Relationships with Schools 2. Relationships with Medical Providers 3. Relationships with our Social networks 4. Relationships to Community Support Systems beyond our extended family and friends 5. Relationships to Educational Resources 6. Relations with leisure and recreation