Family Solutions Center Jamestown Public Schools Helping Families help themselves to a brighter future. Presenters:Mike McElrath Judy Gustafson Thom Wright

Family Solutions Center A grant funded service delivering short-term coaching to families in the Jamestown District Uses a team approach to help families realize change using their strengths and abilities. Fills a gap between school interventions and outpatient treatment A fundamental approach is easily transferred to other school based interactions.

Jamestown Public Schools Small Urban District serving 5,200 students in ten buildings. 65% Reduced/Free Lunch at Elementary 19% Minority Population 20 School Counselors 8 at the one high school at each of the three middle schools at each of the six elementary schools Prek-4

Class of 2005 Self Report N=318 78% Planned on attending college 4% Planned on joining the military 11% Planned on joining the workforce 8% Did not graduate

Class of Cohort View 403 students upon entering 9th grade in students finished in four years Actual non-completers 22% or 85 students from class of 2005

FSC and SFBT FSC - Family Solutions Center SFBT - Solution Focused Brief Therapy

Why FSC? Gap in Services Levels of Severity New and Alternative Approach School Day Limitations Typical outpatient “medical” approach not always the right fit for families.

FSC Timeline Initial Interest in SFBT Site Visits (2003 and 2004) Full Day Workshop SFBT Fall 2004 Extended Observations

FSC Timeline Grant Dollars Released - Summer 2005 ($27,000) September 2005 – Form Advisory Group Secure Training Dates for Fall 2005 Continues with Advisory Group - Physical Components and Process Considerations Center Opens - Late November 2005

Expenditures Professional Salaries Support Salaries Purchased Services Supplies

Supervisor’s Reflections Supporting Counselor Interest Value of the Model Attention to Detail Data for Future Support

Solution Focused Brief Therapy Applications for School Settings

Brief Therapy Background Steven deShazer and Insoo Kim Berg developed SFBT at the Brief Family Therapy Center (BFTC) in Milwaukee, WI. deShazer was interested in simplicity, respect for the client, and solution building. It drew from work that regarded problems as blocked resources and capacities. Originally it was not intended to be brief, but was found to be time-limited when used.

Shifts in Thinking of SFBT Approach FROM: Medical model----  (diagnosis/treatment) Limitations  Problems  Past  TO:  Client as expert on own problems Strengths Solutions Future

40% 30% 15% Client Factors Relationship Hope & Expectancy Technique Contribution to Client Change Common Factors Research Miller, Duncan & Hubble (1997)

Factors that Enhance Client Change Client Factors (40%) personal strengths, talents, resources, beliefs, social supports Relationship Factors (30%) empathy, warmth, acceptance, respect, joining with client Hope and Expectancy Factors (15%) hope, motivation, and expectations that change is possible Model or Technique Factors (15%) theoretical orientation and intervention techniques employed Lambert (1992)

Assumptions Regarding Problems Having a problem does not mean having pathology that needs a cure. Problems are not necessarily caused by negative past experiences, underlying disturbances, or other problems. Solving a problem does not always require knowing what it is or why it occurs. Talking about problems and thinking of them as ever present maintains them and causes the individual to view him/herself as disabled.

Assumptions Regarding Solutions When a client envisions how they want life to be different, solutions can be found. Solutions involve recognizing what works and doing more of it. They involve seeing and doing less of what doesn’t work and doing something different. There are always exceptions when the problem is less troublesome or does not occur – the solution is already happening. Rapid personal change is possible. Small changes create the impetus for further change and can lead to a whole new pattern (notice what is better).

Most Important Elements of SFBT Steve deShazer (1994) Respecting clients “If the choice is between the therapist or the client being stupid, it should be the therapist.” They are not damaged or inferior. They want change. They want to be regarded as competent. They want personal control Taking clients seriously “If the therapist’s goals and the client’s goals are different, the therapist is wrong.” They are doing their best. They are experts on their problem. They should be listened to and allowed to define their own goals and solutions. Their judgments about what works for them should be paid attention to.

Areas of Conversation in SFBT Verbalizing clear and specific descriptions of GOALS the client would like to experience as a result of the conversation. Exploration of SOLUTIONS and how those outcomes can be achieved utilizing the client’s strengths and resources.

Four Types of SFBT Questions Outcome questions What will be different when the problem is solved? Exception questions Describe some times when the problem was better. Scaling questions Rate where you are on a scale from one to ten. Endurance questions How have you managed to cope with the problem?

Outcome or Goaling Questions Help client shape their goals into “small, specific, behavioral, positive, situational, interactional, interpersonal, and realistic terms” (Miller in Hoyt, 1994) What will need to happen for you to say it was a good idea to come, or to talk to me? How will you know when the problem is better or solved? What will be the first or smallest sign? What parts of that are already happening? If I had a video camera, what would I see and hear that would tell me it was solved? When you are no longer…, what will you be doing instead? Goals are always stated as the presence, not the absence of something. “Crystal Ball Technique” (deShazer) “Miracle Question” (Insoo Kim Berg)

Exception Questions How has the problem improved since the time it was the worst? (66% report positive pretreatment change – Hoyt, 1994) What are some times when the problem was less troublesome for you or you were managing it better? What was different about those times, or how were you different then? What have you tried that’s been successful? What would it take to recreate or maintain these improvements?

Scaling Questions How would you rate where you are now, with 1 being the worst ever and 10 meaning that it’s completely resolved? (baseline at beginning of conversations) What tells you that you are at that number? What will be different (in your life, family…) when you have moved up on the scale one number? What will it take to move from where you are to there? On a 1 to 10 scale, rate how hopeful or confident are you that you can…? On a 1 to 10 scale, rate how willing you are to do whatever it takes to make this outcome happen? How would you rate where you are right now? (subsequent sessions)

Endurance Questions (when things don’t seem to be getting better) How do you manage to cope with…? How do you overcome the urge to…? How did you know that…would help you? Where did you learn to do that? How have you prevented this from becoming worse? Seeing how bad things have been, how come they aren’t worse?

Sample Homework Tasks “First Session Formula Task” (deShazer) Pay attention to what is happening that you would like to have continue to happen and report it next time. Just notice how…is different when you…. Just notice how you are different when…. Try an experiment and see what happens when you… or try something different. Try to predict how many times…will occur the next day. Write your goals down on paper and figure out which one you want to work on first.

Considerations for the Application of SFBT Techniques Use social amenities Introduce what will happen Listen, acknowledge, validate, and attend Form a non-judgmental, inviting alliance with client Make the client the expert Move client from problem talk to goaling/solution talk Presuppose change by saying “when” instead of “if” and “will” instead of “would” Ask what is better at the beginning of subsequent sessions Find out what the client did to create the change Reinforce and amplify the client’s solutions Help client feel “on track” Ask them how they will continue the changes Let the client determine when they’re ready to end therapy

Successful Applications of SFBT Schools Students with diagnoses Academic or social problems Parenting groups Student groups Consultations Behavior issues Family therapy Couples and marriage therapy Adolescents in correctional facilities Eating disorders Domestic abuse Alcohol abuse Addictions Smoking cessation Grieving Professional Supervision

Ask Yourself the “Miracle Question” Say you go home and go to sleep tonight and while you are sleeping a miracle occurs. When you wake up tomorrow, your problem has completely disappeared. What will be the first thing you notice that is different? Who will be the first to notice and what will they see that is different? What little piece of your miracle is already happening?

Specifics to our Family Solutions Center Physical setting Procedures What the client experiences Outcome and Session Scales Data

The physical components of the FSC Centrally located in District Comfortable and private area for session room and observation team AV equipment obtained “in house” Privacy considerations

Procedures/Paperwork Borrowed heavily from other centers Created forms, brochures and logs “in-house” Set up policies and procedures as far as: How to access appointments, cancellations Consent for involvement, taping, and sharing information with school or referral source Client handouts to help explain the process Marketing materials (brochure) Session logs Rating scales (using SRS© and ORS©)

Marketing/Referrals FSC staff main source of referrals District’s principals,counselors, nurses and truant office Mailings to local helping agencies, pediatricians offices, community groups Client word of mouth

Booking appointments One staff member handles the scheduling and “phone orientation” staff scheduling In house to alert staff of schedule for the week Staff,family pairing accommodated No shows reminder calls, remain invitational + grateful towards families Staggered appointment times- allows time for meet and greet, paperwork and privacy Staff supervision Already exists in the programs layout, very positive staff reactions

What clients can expect during initial meeting Greeted at door,escorted to meeting room Helps put families at ease,sets relaxed tone Review specifics of model Discuss team format, video camera, informed consent, confidentiality, paperwork & scales Process explained 40 min. talk, 5-7 min break, 10 minute follow up (compliments and feedback) Session begins with some variation of… What brings you in today? How do you want things to change? End session with compliments, feedback, homework Follow up letter

Follow up sessions Greeted at the door escorted to “waiting room” complete outcome scale Move to meeting room Begin session with What’s better? What changes have you noticed? How did you make that happen? If negative, How did you manage to deal with that?

Presenting Issues and Concerns Adolescent “attitude” School problems behavior, attendance, grades Parent/child conflicts Parenting style struggles Blended family concerns Common Diagnosis's ADHD, Bipolar, Major Depression, PTSD, Anxiety, Separation Anxiety,ODD, PDD

Outcome & Session scales Completed at the beginning (outcome) and end (session) of each appointment Four items to rate, a subjective scale that extracts the client’s view of themselves. Allows for “course correction” or possibly determining if the “relationship is meeting the needs of the client”

Outcome Scale Session Scale Individually Personal well-being Interpersonally Family, close relationships Socially Work,school,friendships Overall General sense of well-being Relationship Goals and topics Approach or method Overall

Outcome Scales

Staff/Hours/Clients 8 members on the “coaching” staff Sessions are held 4-8pm Tuesdays and Thursdays In 6 months of operating 22 families involved 3 had only first session 9 had less than 4 sessions 10 had 4 or more sessions 5 from elementary 11 from middle school 6 from high school

Future Considerations Hours of operation Client and staff availability Staff training Increasing size of team Become a “training center for grad students” Procedural updates

Factors that enhance “counseling” outcomes Client factors- 40%, personal strengths, talents, resources, beliefs, social supports Relationship factors- 30%, empathy, acceptance, warmth, joining with client Expectancy factors- 15%, hope, motivation and expectations for change Model/technique factors- 15%, theoretical orientation and intervention techniques employed by the therapist Lambert, 1992

What it all boils down to Directing the conversation to how they want to have things be, rather than how they are. Talking about how to expand those moments when the problem is not occurring. Maintaining a positive “reframing” attitude Moving the conversation from complaining to planning.

Sources of Information Duncan,Miller Insoo Kim Berg

Key characteristics of the approach Clients have resources and strengths to resolve their complaints Change is constant The “counseling” is to help identify and amplify the change Don’t need to know much about the complaint, in order to resolve it. Not necessary to know cause, function or history of the complaint to resolve it. A small change is all that is necessary A change in one part of the system can affect change in another. Reality is subjective, be with the client.

Solution Focused “Brief therapy” Short term therapy Based on strengths and client’s goals No long assessments No diagnosing, pathologizing or blaming of clients and families Focuses on what is working and expanding that to produce more successes. Begin at clients definition of reality (problem) and go from there

Common conversation starters What brings you in today? How can we be helpful? How do you want things to change? What’s going on that you want to be different? How is this a problem for you? What else would be different, about you about them? When things are different, what will you be doing then? What else will be better? (Presumption of success)

Searching for exceptions Look for when the problem is not happening or not as bad, have them scale to define levels When was the last time the problem wasn’t taking up your time. What have you tried? What worked? Even a little bit. How did you get yourself to do that?

Goaling questions To help client identify their goals What will they begin to notice as different as things begin to get better, does any of it happen now, and if so, how does that happen. What can they do to make it happen more. The goal is always stated as the presence of something, rather than the absence of something. “I’ll enjoy reading to my kids, I’ll be able to talk calmly with my husband, rather than I won’t be depressed.”

Scaling Questions On 1-10 where are you in regards to Confidence in change, motivated What tells you that you are a 4 What will you need to see more of to be at a 4.5 or 5 When you are one point higher, what will be different in your life, with family, with friends.

Later sessions Start off with presumption of success, What’s better, how did you make that happen, what else is better, what have you noticed, now that you are doing…, what else do you notice, reinforce effort, do more of what is working, If nothing is better, how are you managing, keeping it from getting worse?, how did you get yourself to … despite…

Why the FSC? Identified a need in the community Family struggles not quite severe enough for referral to mental health agency Issues that may not have been rectified by conventional counseling approaches The limitations of school day family interventions Typical outpatient “medical” approach not always the right fit for families.

FSC Development Timeline 2003Initial interest by staff from a grad class in SFBT. 2004Planned site visits during in-service for multiple staff members 3-04Full Day Workshop SFBT 2005 Additional site visits by interested staff 2005 Grant dollars released making the FSC a possibility 9-05 Formed advisory group Department-wide elective training for 2 and 1/2 days 11-05Developed FSC staff team from those who trained and expressed an interest 11-05Opened Center

Considerations Physical Needs Location Furnishings Equipment Paperwork Process Considerations Participation Communication Payment Structure Marketing Referrals