Welcome and Introductions

Engaging Families to Identify Their Children’s Underlying Needs for SCSWs

Welcome and Introductions

“Supervisors are the Heart of Everything”
“Social Work supervision is a basic and integral part of the profession’s approach to education and practice. It is based on the principle that those with more knowledge, skills and experience, guide the development and practices of others.” -NASW “During the past several years, as states focused on child welfare system improvement, major attention has been paid to the critical role of supervision. The result has been a vast breadth of research focusing on supervision of social workers practicing in child welfare environments.” (3) DCFS believes that the systematic utilization of a Coaching and Mentoring Program, led by Supervisors who are familiar with the individual cases while themselves also participating in ongoing coaching, will significantly enhance a worker’s practice skills and ability to work with children and families. SCSWs “translate the organization’s vision, mission and values to front line social work staff.” (5) By implementing the Coaching Program, DCFS Leadership recognizes that Supervisors are the most equipped to oversee and develop the casework practice of each Children’s Social Worker. (3)National Association of Social Workers (NASW), Shulman 2008; (5)SCSW Standards

Research Supports Engagement
Research Demonstrates: a direct correlation between family engagement and child safety and re-occurrence of maltreatment Engagement is key to conducting comprehensive assessments, enhancing decision making and making individualized plans that fit families “Approach matters” when helping children and families “The Social Worker matters” and is related to client success (Lambert and Barley, 2002) 1st time in SW History that we have data/research about outcomes. Research Based approach Lorrie Lutz: Minn Alternative Response study (7 year longitudinal study) More children die from abuse in 1st year of life? Half of child abuse victims are under 7 85% of fatalities are under 6 Children exposed to Domestic Violence are 15 times more likely to be abused than the national average Battered women are 2 times more likely to abuse their children than comparison groups High correlation between Domestic Violence and Child Abuse U.S. ranks 3rd among 27 industrialized countries in child maltreatment deaths (Gentry, 2004; UNICEF, 2003, Children’s Bureau, 2003, Osofsky, 2003, Edleson, 1999, Margolin & Gordis, 2000, McCloskey, 1995) 4

Approach Matters “Small things such as the way that workers introduce themselves, the way that workers describe the allegation and the tone of voice impact the willingness of the family to allow us in the front door, and into their lives.” Lorrie Lutz, “Operationalizing the DCFS Practice Model…” “SMALL THINGS” ACTUALLY ARE “BIG THINGS” THAT IMPACT THE RELATIONSHIP BETWEEN THE WORKER AND THE FAMILY 5

Strength-Needs Practice
Requires appreciating the needs of the parent’s child and finding common ground about their worries Requires engaging the parent through the NEEDS of the child Requires focusing on needs throughout the life of the case (assessment and planning are ongoing) Shifting from focus on BEHAVIORS and DEFICITS to NEEDS requires Skill Building and Continual Practice and Coaching. We will be talking more about how to Engage others around a Child’s Needs 6

Strength-Needs Practice Requires Effective Working Relationships
Core Conditions: Respect Empathy Genuine Competency PLAY MUSIC HERE!!!! Ask the group about how they would define each of these core conditions Respect: Empathy: to be later discussed in depth Genuine: Honest, full disclosure, Appreciative Inquiry; Culturally curious Competency: Continually committed to professional development PARALLEL PROCESS: DO THESE TERMS PARALLEL CONDITIONS WE ALSO NEED TO BE EFFECTIVE SUPERVISORS? 7

Rapport: First Step of Engagement
Rapport is the Building Block to Engagement Engagement requires Rapport Rapport does not equate to Engagement Let’s take a closer look at the tools needed for Engagement. Sometimes we confuse ENGAGEMENT WITH RAPPORT. RAPPORT IS ABSOLUTELY NEEDED TO ENGAGE BUT WE NEED ENGAGEMENT SKILLS TO HELP MOVE CLIENTS THRU THE STAGES OF CHANGE 8

Engagement: Moves Beyond Rapport
Effective working relationships with shared tasks and goals Mutual accountability Active listening that supports family empowerment Honest, open dialogue about concerns and success Flexibility in response Ability to solicit feedback from children & families Revisit what was written on the poster board earlier. Connect these points to the examples provided by the trainees ENGAGEMENT REQURIES BE ABLE TO HAVE HONEST, RESPECTFUL CONVERSATIONS ABOUT WHAT’S GOING WELL, WHAT CONCERNS THERE ARE AND PROGRESS REGARDING THE CASE/ COURT ORDERS. ENGAGEMENT ALSO REQUIRES DIALOGUING WITH FAMILIES ABOUT WHAT IS WORKING WELL AND WHAT COULD BE BETTER. HOW ARE THEY EXPERIENCING THE CSW AS A “HELPER” FLEXIBILITY IN RESPONSE MEANS 2 THINGS: OUR ABILITY TO UTILIZE DIFFERENT TOOLS/APPROACHES WITH DIFFERENT CLIENTS 2) FLEXIBILITY WITH VISIT TIMES, FLEXIBILITY REGARDING COURT ORDERS AS MUCH AS POSSIBLE (THERAPIST, AGENCY, TYPE OF PROGRAM, UTILIZING COUNSELING TO ADDRESS D.V ISSUES OR PARENTING ISSUES, UTILIZING INFORMAL SUPPORTS (CHURCH) When we move from Rapport to Engagement, there is a greater likelihood of change Adapted from Vincent, 2008 9

Rapport vs. Engagement Rapport Engagement Empathy Kind/Respectful
Mutual understanding Comfort Trust Engagement Active listening “Real” dialogue Mutual feedback Flexibility Solution/Goal Focus Rapport = Positive working relationship but may not produce results. On a few occasions, some families can succeed with only rapport Engagement is needed with those clients who may struggle more or exhibit more resistance (which is addressed later) 10

Large Group Exercise Rapport vs. Engagement
ACTIVITY (See instructions for activity Rapport vs. Engagement) After the activity, ask the audience for examples of rapport building and engagement techniques they have used successfully in their practice. Reinforce examples that reflect “good practice.” 11 11

Engagement and the Use of Authority
Seek to avoid, to the extent possible, actions that minimize/undermine parents’ power It is important to remember that invoking authority is easier and requires less skill than engaging families People are more disclosing, open, and cooperative if they don’t feel threatened and judged Lorrie Lutz TALKING POINTS: Have group read aloud each quote and invite discussion What parts do you agree with? Disagree with?

Moving From Rapport to Engagement
Small Group Discussion: Share examples of when your observed too much or too little use of authority? How would you assess yourself? (Do I find myself being too uncomfortable with using authority or being directive?) What are some engagement strategies that I use even when I need to use protective authority? PROPOSED SMALL GROUP ACTIVITY: 1) DISCUSS WAYS YOU HAVE OBSERVED IN YOURSELF OR OTHERS USE TOO LITTLE OR TOO MUCH AUTHORITY? 2) DISCUSS HOW YOU FEEL ABOUT THE USE OF YOUR AUTHORITY WHEN WORKING WITH CHILDREN AND FAMILIES 3) What skill would I like to enhance in order to become an effective “accountable ally” How would you assess yourself? Too uncomfortable with using authority or Too authoritative and directive? SEEING OURSELVES AS AN ACCOUNTABLE ALLY PROMOTES AN EFFECTIVE BALANCE OF AUTHORITY AND HELPLER 13

Shifting the Focus of Engagement - Talking About Needs Instead of Behaviors
Behaviors are important but may unintentionally distract us from a client’s real need Needs are not services but are what “drives the behavior” Addressing needs is key to sustaining meaningful change Connecting needs to behaviors can strengthen a family’s willingness to work together with DCFS and partners (How can you do this?) Needs reflect the unique experience of the child within the context of their culture GiVE DCFS EXAMPLES FOR EACH BULLET Bxs that often distract us from need, include runaway, defiance, anger, opposition regarding emancipation, When talking to youth about those behaviors it is highly helpful to reframe the “acting out behavior” into a need. It makes it easier to create dialogue with youth and families who are struggling to make constructive choices. Examples: if a mom is using substances, what need might this drug use be serving? (denial, difficulty thinking about her won childhood trauma), if a teenager is acting out by lying, again, what need might this be serving? (deflecting from failing in school, distraction from family trauma, agitated depression) Too often at DCFS (EX: TDMS) when we talk about “NEEDS” we say, “They need counseling, or they need parenting”; This does not reflect the NEED, it reflects a service to address the need. One goal of identifying the need is so that we can all be on the same page when it comes to what we are hoping to achieve. This will also help us to talk about the behaviors that also need to be demonstrated that reflect that the NEED has been addressed. When we address the NEED for children to feel safe or have a place to healthily grow and develop, then we can help the parent be more invested in making changes that are reflected in their behaviors 14

Systemic Challenges to Engagement (“no wonder the work can sometimes feel overwhelming”)
Child/Youth/Family’s Needs Resistance Workers’ Needs Case Load/Work Load Competing Priorities Limited Resources Court Service Providers Training THIS IS AN EXCELLENT TIME TO ALLOW WORKERS TO DISCUSS HOW “TRAINING” CAN ALSO FEEL LIKE A CHALLENGE DESPITE THE GOOD INTENTIONS OF TRAINING, PARTICIPATING IN TRAINING CAN SOMETIMES BE PERCEIVED AS A CHALLENGE TO GETTING THE JOB DONE. THIS IS A GREAT SEGWAY TO TALK ABOUT HOW THEIR FEELINGS MAY PARALLEL THE CLIENTS EXPERIENCE AS WELL. HOW CSWS GO INTO PEOPLE’S LIVES WITH GOOD INTENTIONS AND MAY HAVE GOOD/IMPORTANT INFORMATION TO ENHANCE THEIR LIVES BUT THAT IT STILL CAN FEEL INTRUSIVE, DISCONNECTED, OR OVERWHELMING . 15 15

Challenges to Engagement Reflect Workers’ Needs
Let’s Discuss: What are some of the needs you see related to workers better engaging children & families? What are some of the strengths you see related to how workers engage children & families? WRITE DOWN THEIR ANSWERS: WORKERS HAVE NEEDS AS WELL and it is important to acknowledge those needs. Using this time to discuss the workers’ needs helps the workers experience the value of talking about their challenges in the context of needs. (We are demonstrating and modeling how behaviors reflect needs along with helping them understand the value of parallel process) 16

“Hunches” About Worker’s Needs
Support Time Safety/Respect Accountability Core Values Professional Development Coaching and Mentoring Other_______ MATCH ANSWERES WITH TRAININGS ANSWERES: What do Line Workers need? When needs are not met at work (nonsupportive supervisor, etc..) what can we do? What choices do you have (what can you control and what can you not control?) Segway the conversation to: How do any of these parallel the client’s experience? “Accountability” is a point of conversation. We may not want it or like it but do we need it? Important to differentiate between our “WANTS and our NEEDS. 17 17

Parallel Process How our own experience helps us to effectively engage with others
Small Group Activity: Write down differences and/or similarities we (and our workers) have with our clients’ feelings, experiences, and/or needs? Discuss: How does this awareness of differences/similarities contribute to effectively working with clients? Discuss: How does the way we manage our own experiences or feelings impact the quality of the work we do with our families? ACTIVITY: After small groups have each group report out How awareness for “Parallel Process” can contribute to being more effective when engaging with others? 18 18

3 Engagement Skills To help children and families identify and address their needs
Exploring Focusing Guiding - Paul Vincent These are 3 strategies for Engagement: Exploring (50%) Focusing (30%) Guiding (20%) Note: If appropriate, demonstrate offering transportation and/or child care supports for a parent as well as a willingness to adjust scheduling and meeting location, as strategies to increase, support, and encourage family engagement and participation. 19 19

1) Exploring Skills Active listening and hearing what people want to say before addressing “the problem” Attentive and Interested (Physically and Psychologically) Recognizing Strengths and Needs Encouraging Expressions of Feelings (Ventilation, Validation, Conciliatory Gestures) Normalization and Objectivity Reflection (Convey Understanding) ENCOURAGE CONVERSATION: HEARING THE FAMILY FROM THEIR PERSPECTIVE; SETTING THE CONDITIONS FOR DISCLOSURE ACT INTERESTED; BE ATTENTIVE DEMONSTRATES CARING FOR THE PERSON and THEIR SITUAITON; HONORS THE FAMILY and IT”S UNIQUENESS ENCOURAGE VENTILATION; AVOID REACTING; BE INTERESTED IN WHAT CONTRIBUTES TO HOW THEY VIEW IT THAT WAY USE CONCILLATORY GESTURES TO DIFFUSE: “You may be right” NORMALIZATION: other families have challenges {PP} REFLECTION and use of silence can be very powerful when used skillfully Adapted from Vincent, 2008 20

2) Focusing Skills Centering discussion on the needs that are most important
Questions (Open, Closed, Indirect) Summarization (concise review) Clarification (together, define words used) Concreteness (no DCFS/social work jargon) Reframing (look for positives) Solution-Focused CONCRETENESS: Families who have been involved in the child welfare system often tell us that they were unclear what was required of them (especially if their children were in out of home care). According to a study at KIDSRUS Visitation Center in New Haven Connecticut, 85% of the families served over an 18 month period of time did not know specifically what they had to do to get their children back.[1] This lack of clarity often occurs because the child welfare worker is more focused on the tasks that must be completed i.e. attend parenting classes, attend substance abuse treatment, attend domestic violence counseling than the specific behavior that has to change. [1] Gobbard, Lynn. KidsRUs Visitation Center. (2007) SOLUTION FOCUSED= Discovery of The use of strength focused/solution focused questions provides optimal chance for families to tell their story and talk about how their family functions in their day to day environment. This approach intends to remind families of the times in the past when they have succeeded, when things have gone well for them, and/or when their decisions have resulted in positive outcomes. It is an effective model when families are feeling despondent or hopeless as it communicates optimism and the possibility of things being different. Vincent, 2008 21

3) Guiding Skills Collaboratively identifying solutions and creating a plan to carry out ideas
Formulating options with family input Partialization Information/Suggestions Strengths/Needs based Feedback Positive Feedback: What is working well? Constructive feedback: What can be working better? Options and choices provide opportunities for the family to feel empowered We can ask the family if we can make a suggestion or give some advice. This approach honors them. Telling clients what they need to do is rarely effective towards lasting change. The art of ENGAGEMENT is leading the discussion and questioning to getting the client to identify their need or consider that there may be a need. Telling clients what they need usually reflects the need for skill development. Let’s discuss. Vincent, 2008 22

Keys to Engagement Using Activity 3C, Observe Demonstration
In small groups, utilize keys provided and engage clients regarding assigned tasks provided at each table ACTIVITY Utilizing vignettes and keys: Help Christine identify her needs; Help mother identify her needs TRAINER”S NOTES NEEDED FOR ROLE PLAY! Note: If appropriate, demonstrate offering transportation and/or child care supports for a parent as well as a willingness to adjust scheduling and meeting location, as strategies to increase, support, and encourage family engagement and participation. 24 24

Let’s Discuss How did the utilization of keys
Invite discussion and disclosure Identify and mobilize strengths Discuss hunches around needs Focus on solutions Offer hope …strengthen the working relationship? LARGE GROUP DISCUSSION: KEY GOAL: STRENGTHEN THE WORKING RELATIONSHIP NOTE: The trainer should ask the participants what they say to clients at the end of the interview. We are looking for the participants to say: A summary of content Perhaps a comment on a strength (complement) Opportunity for choices and Encouraging hope Next the trainer should do one (or more) of those four things; then ask their (participant) reaction and comment on the parallel process. 25

Understanding and Normalizing “Resistance”
(When helpful intent sometimes collides with a lack of trust) Let’s Discuss: Resistant Behaviors/Situations you observe If you have worked with youth who need to develop self-sufficiency skills, does resistance arise in a different way? DISCUSS WHAT BEHAVIORS OR SITUATIONS THAT YOU ENCOUNTER WHERE YOU FACE “RESISTANCE” 26

Common Signs of Resistance
Avoidance Passivity Anger/Hostility Physical Flooding with details False compliance Flight to health Pressing for solutions Silences Excuses Denial Rationalization Threats Aggressive posturing Blaming Clients exhibit these signs…SOMETIMES WE ARE QUICK TO FOCUS ON THESE BEHAVIORS AND GET STUCK HERE Do we sometimes exhibit these signs? 27 27 27

Good Practice Recognizes
“RESISTANCE IS A PREDICTABLE AND NATURAL EMOTIONAL REACTION TO FEELING FORCED TO CHANGE OR WHEN FACING DIFFICULT ISSUES.” “RESISTANCE OCCURS AS A RESPONSE TO FEELING VULNERABLE, OUT-OF-CONTROL AND THREATENED BY CHANGE.” Adapted from Vincent 2008 EXPECT RESISTANCE: IT IS NATURAL, IT IS PART OF THE PROCESS OF CHANGE 28 28

Good Practice Recognizes
Resistance Reflects Needs Let’s Discuss: What “Needs” may be underlying the resistance? What Practice Skills are required to address those needs? RESISTANCE IS often A WINDOW INTO THE CLIENT’S WORLD AND their family of origin issues. WORKERS ALSO CAN EXHIBIT RESISTANCE TO TRAINING, LEARNING, SUPERVISION….FOR VERY SIMILAR REASONS 29 29

Strategies That Help Clients Move From “Resistant to Ready”
Resistance is important information; not to be judged Prepare for resistance; it’s part of the change process Actively listen, validate feeling and reflect what is happening Remain respectful Focus on the needs of the child as a place to join together Focus on solutions or desired results Reflect when we do react, and remain available to help We need to have the skills and knowledge to recognize that “resistance” is part of the change process and that it requires COMPETENT SKILLS to mediate and promote positive change. DON’T GET STUCK IN THE RESISTANCE. 30

WHEN I “REACT”… IT’S TIME TO REFLECT
DEFINE “REACT” = behaving in nonproductive ways 31 31

Self Reflection Promotes Engagement!
In Small Groups: Write down some “reactions” that I observe in myself or others that may be nonproductive? What might be going on with me or a worker when I “react” in nonproductive ways? How do “reactions” sometimes get in the way of forming effective working relationships with children and families? What is one strategy that I will try and apply to my work to help move clients from “resistant to ready?” “REACTIONS” may be acting in NON PRODUCTIVE WAYS (not just getting angry) such as avoiding certain clients, not returning calls, etc. Allow for discussion/ventilation 32 32

What is Mental Health? For Adults: “The capacity to love well and
work well” Sigmund Freud For Children: “The capacity to grow and to love well” Alicia Lieberman, PhD Provide base line for defining “MENTAL HEALTH” ASK GROUP FOR THEIR DEFINITIONS OF MENTAL HEALTH! (eg. “peace, balance, absence of pathology, unstable, not being crazy, managing symptoms, joy, etc” MENTAL HEALTH IS BROADLY DEFINED AS THIS LOVE AND WORK WELL = “WELL ENOUGH” (Minimal Sufficient Standards of Functioning); There are also CULTURAL implications as well. 33

Mental Health Needs of Children
TRAUMA-BASED NEEDS 30 to 85% of youngsters in foster care have significant emotional disturbances Adolescents living with foster parents or in group homes have about four times the rate of serious psychiatric disorders as those living with their own families TRAUMA = ABUSE/ NEGLECT AND DCFS INVOLVEMENT (DETENTION, LOSS, FEAR OF REMOVAL) Do these numbers ring true? ENGAGE GROUP IN DISCUSSION OF WHAT THEY SEE IN CHILDREN WHO EXPERIENCE TRAUMA “BE ON THE LOOK OUT FOR THOSE CHILDREN WHO PRESENT AS RESILIENT OR HIGH FUNCTIONERS” Behavior: Avoidance, “numbness”, impulsivity, substance abuse, “acting out” (defiance/disrespectful attitudes) self injury/mutilation, etc. Cognition: Poor focus/insight; Distorted sense of self (blaming self) or view of others (“no one can be trusted”); Irrational beliefs Physical: Headaches, stomach aches, grinding of teeth, twitches, general struggle with health Emotional: Fear, anger, depression/sadness; APATHY (dispondent), affective dysregulation, hyper-vigilance, paranoid (irrational), reactive, etc 35 35

Let’s Discuss: Mental Health Symptoms of Children and Youth
List symptoms you’ve observed How do these children typically get labeled? What might be some of their underlying needs? ACTIVITY: HAVE WORKERS SHOUT OUT AND WRITE ON POSTER BOARD PRIOR TO REVEALING POTENTIAL ANSWERS Health problems Difficulty in school Difficulty making and/or keeping friends Difficulty with rules/structure/authority Multiple placements/runaways Self-harm/suicide Substance abuse and use Negative choices Criminal activity Unmotivated to emancipate or to develop self-sufficiency skills Other _________

Besse Van Der Kolk, MD: “Developmental Trauma Disorder”
“Unless caregivers [and professionals] understand the nature of trauma reenactments, they are likely to label the child as ‘oppositional,’ ‘rebellious,’ ‘unmotivated,’ or ‘anti-social.’” WHICH CHILDREN MIGHT THIS REFER TO HERE? (PP YOUTH) THOUGHTS? EXAMPLES? Understanding the Nature of TRAUMA impacts the healing process and the understanding that challenging behaviors will emerge and professional skills and core competencies are required to work with the complex needs of children. When we understand the NEEDS that drive the behavior, we can help caregivers (parents and foster parents) on learning how to reframe those challenging behaviors into TRAUMA based NEEDS that require our attention and patience for the child to successfully require from the trauma he or she experienced 37

Remember, in Trauma-Informed Practice
Behaviors, Symptoms and Deficits reflect NEEDS! The challenge of the work is to help ourselves and others to see past the behavior and to see the NEEDS of children Historically we tend to focus on the BEHAVIORS/SYMPTOMS and not really get to the UNDERLYING NEEDS. It takes a TEAM to identify and address those needs. It is also important to recognize that many caregivers (PARENTS) have unresolved child trauma needs that keep them from being the parent they aspire to be 38

POSSIBLE BARRIERS TO ADDRESSING MENTAL HEALTH NEEDS
Delayed engagement/assessment Overwhelmed by multiple, urgent needs Delayed linkage to services, limited resources Denial or ambivalence regarding treatment Bias or stigmas held by helpers & families Other __________ Discuss ROLE OF Katie A and MHST/CSAT COMPLEX NEEDS usually require COMPLEX interventions 39

Mental Health Stigmas Stigmas = negative biases, which focus on behaviors and distract us from the unmet needs Stigmas may contribute to negative feelings that may deter us from seeking help Stigmas may contribute to negative feelings that may deter us from providing help Examples of STIGMAS about Mental Health. FOCUS ON HOW MAYBE ARE OWN STIGMAS GET IN THE WAY OF PROVIDING HELP TO OTHERS

Overcoming Stigmas About Mental Health Services
Be sensitive to the idea that children, families and community partners (foster parents) may have biases about mental health diagnoses and services Be willing to look at our own bias Through motivational interviewing and stages of change 41

Engagement Requires: Looking at Our Potential Biases
Clicker Activity regarding stigmas Please respond to the following statements Conduct the clicker exercise by beginning with the following practice question and continue through each item (there are nine additional slides/questions). You will review each trainer note for each slide as well as integration of discussion from the audience. After you have gone through all clicker slides and reviewed each response, you will then hand out Colleen Friend’s Fact Sheet (this will be a separate handout not in the participants packet) that will provide the audience with the factual information for each item. 42 42

Los Angeles DCFS is the largest child welfare system in the country
Strongly Agree Agree Neutral Disagree Strongly Disagree According to a handout from the California Judicial Council’s Access and Fairness Conference, “Los Angeles County is one of the largest counties in the U.S. and represents over 35% of California’s child welfare population” (Access and Fairness Conference, 2007). 43

Individuals who have a mental illness have a disease
Strongly Agree Agree Neutral Disagree Strongly Disagree According to an article published by the Centers for Disease Control and Prevention (CDC) in their monthly journal Preventing Chronic Disease, “Definitions of mental illnesses have changed over the last half-century. Mental illness refers to conditions that affect cognition, emotion, and behavior (eg, schizophrenia, depression, autism). Formal clinical definitions now include more information (ie, we have moved from a partial to a more holistic perspective and transitioned from a focus on disease to a focus on health)” (Evolving Definition of Mental Illness and Wellness, 7(1), 2010). Possible CSW/Family Perspectives: CSW: This is saying that we have moved from a medical and deficit model to a holistic perspective and a focus on health. Do I believe in the medical/ deficit model or am I more aligned with a model that emphasizes what an individual/ family can do? Family: I am not sure about the medical model if it is saying I am sick. Are sick and crazy the same things? I am not crazy, and I do recognize that I have to attend to certain things in order to stay healthy. 44

Individuals who are homeless have mental illness
Strongly Agree Agree Neutral Disagree Strongly Disagree According to a study published in the American Journal of Psychiatry, “The prevalence of homelessness in persons with serious mental illness is 15 percent” (Prevalence and Risk Factors for Homelessness and Utilization of Mental Health Services, 162, 2005). Possible CSW/Family Perspectives: CSW: While only 15% of individuals with serious MI are homeless, I believe there are high rates of MI ( diagnosed and undiagnosed ) among the homeless population. Family: Just because I am homeless, it does not mean I am crazy. And, if I am told I have MI, it does not mean I am headed for homelessness.

Individuals who have mental illness can adequately care for children
Strongly Agree Agree Neutral Disagree Strongly Disagree Possible CSW/Family Perspectives: CSW: We can’t automatically assess parents with MI as inadequate. The evidence shows they are motivated and often competent. The needs of the child are the key to engaging these parents. Family: I can still be a good parent even though I have a MI diagnosis; succeeding at parenting is very important to me. 46

Individuals with substance abuse or addiction have mental illness
Strongly Agree Agree Neutral Disagree Strongly Disagree According to the National Alliance on Mental Illness, “Of all people diagnosed as mentally ill, 29 percent abuse either alcohol or drugs” (Dual Diagnosis and Integrated Treatment of Mental Illness and Substance Abuse Disorder, 2003). Possible CSW/Family Perspectives: CSW: Not everyone with an addiction is self medicating for MI. Some may be…. While the DSM classifies substance abuse as a disorder, people abuse drugs for a variety of reasons. . Family: Just because I sometimes drink or use drugs (minimization) that does not make me crazy or sick. Most of the people I know do use (minimization) alcohol or drugs. 47

Encouraging Participation in Mental Health Services
Explain the purpose/goals of mental health treatment Address any issues or fears of stigmatization Provide space for healthy ventilation and validate feelings Together, discuss informal and formal supports that fits the the family’s needs Have a discussion about the “pros and cons” of treatment Provide options and agree to a plan with the family Regularly assess how their plan is working and adapt as needed DISCUSS FORMAL VS. INFORMAL SUPPORTS (PRO’S AND CON’S) CSW helps provide the link to Community Partners; Those Community Partners (formal and informal) help us learn about the culture and needs of the family; This helps up with making a plan to address those needs, which are meaningful and “best fit” the needs of the family. Large group discussion of the pros and cons of formal and informal supports 48

Addressing Needs Through Community Partnerships – Teaming Training to Follow
Requires engaging community partners Best outcomes arise when there are strong working relationships between a family and it’s helper Requires helping children and families engage with their community Best outcomes are sustained when families feel connected to and supported by their communities “real partnerships” refers to genuinely engaging and wanting to see a family make positive changes; not just comply with Court orders and “get out of the system” “BUILD BRIDGES”, engaging community partnerships can also be exhausting and challenging, so acknowledge this to workers, more money coming in for Wraparound, underscore tiring but worth it, even when there are barriers, WE STILL HAVE TO ENGAGE 49

Stages of Change: Primary Tasks
Precontemplation Definition: Not yet considering change or is unwilling or unable to change Primary Task: Raising awareness 6. Recurrence 2. Contemplation Definition: Experienced a recurrence of the problems Definition: Sees the possibility of change but is ambivalent and uncertain Primary Task: Cope with consequences and Determine what to do next Primary Task: Resolving ambivalence, Helping to choose change 5. Maintenance 3. Determination Definition: Has achieved the goals and is working to maintain change Definition: Committed to changing but still considering what to do Provide Hand Out to hang on cubicle Give credit to Prochaska and DiClemente CHALLENGES TO ENGAGEMENT: FOCUS ON Pre-Contemplation STAGE OR DENIAL STAGE, where we often get stuck: DISCUSS CHALLENGE TO NOT TRY AND MOVE PEOPLE TOO QUICKLY BUT RECOGNIZE THE STAGES OF CHANGE SO YOU MOVE PEOPLE FROM DENIAL (PRE-CONTEMPLATION to CONTEMPLATION) No serious intention of change Unaware or underestimate the problem People who seek treatment in this phase usually do so under pressure THE KEY IS NOT TO TRY AND GET PEOPLE TO MOVE FROM PRE-CONTEMPLATION TO ACTION; THERE ARE USUALLY SOME OTHER STEPS THAT REQUIRE PATIENCE AND PROCESS; WHEN WORKING WITH CLIENTS IN DENIAL, IT IS IMPORTANT TO LOOK AT STRATEGIES OF ENGAGEMENT THAT OBJECTIVELY ADDRESS THEIR PERSPECTIVE, THEIR GOALS, THEIR AMBIVALENCE ABOUT CHANGE AND MOVE THEM TOWARDS THE POSSIBILITY OF CONSIDERING CHANGE (BABY STEPS) 4. Action Primary Task: Develop new skills for maintaining recovery Definition: Taking steps toward change but hasn’t stabilized in the change process Primary Task: Help identify appropriate change strategies Primary Task: Help implement change strategies and learn to eliminate potential relapses 50

Key Points to Remember Recognize Stage and focus on the “Primary Task”
Remember not to move too quickly (one stage at a time) People may repeat stages of change or move back and forth along the stages of change (i.e. relapse) Most people cannot move through stages alone (your encouragement matters) Build on strengths and recognize success This speaks to the fluidity of assessment, reassessment, case planning, goal setting with the client. Rapport and engagement drive one’s ability to move through these elements/journey through the CPS process with a client/family. REMEMBER CHILDREN AND YOUTH ALSO MOVE THROUGH THE STAGES OF CHANGE 52 52

Motivational Interviewing: Creating Conditions for Change
Five Basic Principles Express Empathy Avoid Argument Support Strengths Roll with Resistance Discuss Discrepancy (Changing Behavior: Using Motivational Interviewing Techniques; Bundy2004) MOTIVATING OTHERS TOWARDS POSITIVE CHANGES REQUIRES SKILLS THAT REQUIRE ONGOING DEVELOPMENT; WHEN WE EQUIP OURSELVES WITH SKILLS AND TOOLS WE HAVE A BETTER CHANCE OF ENGAGING OTHERS AND FEELING BETTER ABOUT THE WORK WE DO ARTICLE IS PROVIDED IN PACKET AND ENCOURAGE TO READ AFTER TRAINING 53

EMPATHY It is not so much identifying with a person’s experience or expressing sympathy or just being kind to people…. It is: Conveying a real, informed, understanding of a person’s predicament and what maintains the ambivalence Requires active listening and reflection Provide concise statements that encapsulate what person is trying to communicate DISCUSS: WHAT DO YOU THINK IS EMPATHY? This is a skill that is developed over time. Empathy is not just being respectful. It is being able to articulate what the client is sometimes trying to say but cannot yet say it. Empathy, which requires really HEARING what the other is saying, is a powerful way to connect to others 54

In Small Groups: Read the following scenarios (see hand-out) and make empathetic statements Remember to attempt to genuinely express the person’s predicament and the challenges to change

Avoid Argument Arguments are Counterproductive
Be proactive and prepare self before the conversation (remain calm at all times) Encourage clients to state what they want to change Listen and offer available choices IMPORTANT DISCUSSION POINT: WHEN DO WE SOMETIMES GET SUCKED INTO ARUING WITH CLIENTS? Calm = Remember my role: recognizing that I am here to listen and help guide and provide structure Focused: Prepare for what I would like to accomplish and talk about prior to a visit or phone call Focused on child needs Avoid getting sucked into dynamics. When you feel argumentative: ask: What do you want me to know? How can i 56

Support Self Efficacy Genuinely promote the belief that people can change! When the individual makes any type of statement about their belief that they can change…or that they intend to do something, validate the statement. Support and highlight success ASK: WHAT ARE SOME WAYS WE CAN ASK PEOPLE TO TALK ABOUT THEIR STRENGTHS? (eg. #2. “even though you say you tried and failed before, the important fact is that you have tried…Let’s focus on that you keep trying even when it’s hard to change” and/or “it sounds like you know you need to change, and that your willing to accept help) Ask for more examples related to cases Some strength based responses are “You are here now. It takes courage to talk about making changes. What are some other things that you have overcome that make you strong and capable of facing challenges?” 57

Roll with Resistance Use thoughtful questioning, clarification and/or reflection to gently challenge thoughts that become barriers to change Help the person see incongruency between their beliefs and their actions Discuss the concept of ambivalence (change is hard) Offer new perspectives without imposing them Remain solution-focused (How will this be beneficial?) What from previous day’s discussion on Resistance resonated with you that you can actually use to work with a client and “roll with it” rather than react to it? Objectively and respectfully pointing out incongruencies and help clients take responsibility for what they would like to happen Empathize with how hard change can be even when it is good change 58

Resistance I May Encounter
“Why should I go to counseling?” “Talking doesn’t help…” “I don’t need to talk to anyone…” In Small Groups: Discuss what I could say to a “roll with this resistance” (what are the benefits to counseling?)

Discuss Discrepancy Identify together, realistic goals which address needs Discuss discrepancies between stated goals and current behavior Regularly discuss progress towards those goals Respectfully point out consequences for behavior/choices and how those choices impact others (i.e., children) Encourage change but don’t insist; Inspire hope -adapted from Bundy, 2004 THIS IS A SKILL TO BE LEARNED; THIS IS WHERE YOU ARE AN ACCOUNTABLE ALLY AND GENTLY AND RESPECTFULLY POINT OUT WHAT THE CLIENT”S GOAL IS AND WHAT THEIR BEHAVIOR ACTUALLY IS. THIS CAN BE A POWERFUL WAY TO MOTIVATE AND INSPIRE CLIENTS TOWARD PARTICIPATING IN COURT ORDERED PROGRAMS THAT THEY MAY NOT LIKE BUT THAT THEY NEED TO BE SUCCESSFUL Make sure goals are realistic Use regular meetings/visits/calls to review progrss and discuss barriers #3: (“I’m concerned that if you don’t do what the Court has ordered, than your children will not be able to return to you and that you will be delayed in reuniting as a family) #4(Doing what the Court has ordered is hard when you don’t believe you need this help. You have a hard choice to make.) 5) All you can do is offer support and assistance; Remain available and patient with the process AND know that you cannot make it happen 60

How does MI fit with my work?
Developing tools to help motivate others to make needed changes Each contact with the child and family is an opportunity to engage and inspire hope Motivating others to get connected to their community supports to support long lasting change It is important to connect MI to the ongoing case work of a CSW. The Trainer reminds Workers that they have the opportunity to MOTIVATE and INSPIRE children and families towards making POSITIVE, LONG LASTING CHANGES (which is no easy feat) Particularly emphasize the importance of following these principles in the beginning stages of building working relationships with children and families. Also emphasize the importance of VISITATION as it relates to the use of MI as a tool to strengthen engagement and to address concerns when there are bumps in the road

Effective Case Management: “Reasonable Efforts” Involves Engagement
Call potential resources prior to providing referrals and find out about the resource to facilitate success Ask if assistance is needed with contacting community supports (if so, model how it is done) Regularly discuss how each resource is working (What are you learning? Any challenges?) Regularly discuss the value and benefits of participating in services (What changes are you making? How is this meeting your needs?) Document these conversations in your contacts and Court reports ASK: HOW DO WE CURRENTLY PROVIDE REFERRALS TO FAMILIES? LET’S DISCUSS (SOMETIMES WE PROVIDE A LIST OF REFERRALS AND ASSUME THE CLIENT CAN INDEPENDENTLY ENGAGE) “Real” implies how it will actually help the family (not just comply with Court orders) CSWs have a great opportunity to help families understand the importance of the Court order and how this “negative situation” can be turned into a positive one 62

Talking with Clients about the Value of Court Ordered Services
In Small Groups: Identify a youth or parent who has been ordered to counseling, parenting, drug treatment, etc. Discuss what you could say to ENGAGE and MOTIVATE: participation in counseling participation in parenting program participation in a substance abuse treatment a youth to remain in a “good” placement a youth to take psychotropic medication a youth to consider transitional housing ACTIVITY: UTILIZE VIGNETTE AND PRACTICE HOW TO TALK TO CHILDREN AND FAMILIES ABOUT COURT ORDERED SERVICES This helps change client’s attitudes from compliance mode to learning and engaging mode. Focus on ACTUAL CHANGE rather than false or simple compliance 63

Let’s Practice SMALL GROUP EXERCISES
ACTIVITY: UTILIZING VIGNETTES (Reverse Role Play)

Effective Engagement Requires
Self Appraisal Review Self Appraisal Check List Write Down 3 things I can do to take good care of myself to avoid COMPASSION FATIGUE or BURN-OUT 65

Support! Office Based Lead Coaches are being trained to Coach and Mentor SCSWs Write Down 3 things I can do to take good care of myself to avoid COMPASSION FATIGUE or BURN-OUT 66

Self Care! Review Self Care hand-out and make a plan to take good care of yourself Write Down 3 things I can do to take good care of myself to avoid COMPASSION FATIGUE or BURN-OUT 67

You Make A Difference !! For all your dedication and hard
Your continued commitment to providing quality Social Work supervision positively impacts the lives of children and families. For all your dedication and hard work with children and families!

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