1. FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATION REStArT MODEL

2. History of the Model Ongoing development of evidenced-based practice Trends in field moving toward evidence-based practice models Consulted with Bruce Wampold for comparative review of literature with our existing model 2 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

3. Key Factors to Successful Outcomes Coherent clinical model Family engagement Stabilization of discharge resource Availability of aftercare supports 3 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

4. Coherent Clinical Model REStArT Model: The Relational Re-Enactment Systems Approach to Treatment – Evolved from model we were already working within Implementation of Structure & Processes – Supported Top down – Horizontal Dialogue across all departments Formalized into REStArT principles & treatment guidelines 4 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

5. 5 The Conflict Cycle 2StressfulEvent Attachment Model View of Self & Others 3Youth’sFeelings 4Youth’sBehaviors 5 Adult Reaction a.Feelings b. Behavior c. Youth's Response c. Youth's Response Relational Trauma Re-Enactment Systems Meaning of behavior/ youth’s conflict Trauma History Trauma History (Wood & Long, 1991) Modified Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

6. REStArT Supervision & Dialogue Meetings Team Meetings w/ Clinical Focus CC/HC Groups Clinical Mtgs Cross-Trainings Group Supv for CC/HC Groups CR Dialogue Mtgs Dialogue Mtgs w/Dir & Clin Supv by VPs Supv w/Core Team by Dir & Clin Supv Supv w/UC & Therapist by Dir & Clin Supv 6 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

7. History of Family Engagement Previous Attitudes/Approaches Youth doesn’t have any family We are the experts—leads to blame game Treatment planning without youth & family input Discharge planning did not start until much later in treatment Focus on external demands for services by traditional view (i.e., all families need family therapy) “Menu” of choices RESULT: POWER STRUGGLES WITH FAMILIES 7 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

8. Change was Needed Families were having trouble accessing services Communications were happening across departments in silos Realization that change was needed 8 Access All Depts. Clinical Consultation Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

9. Clinical Consultation Clinical consultation framework – Team based Requires a shift from individualized contact toward team based approach Allendale team---(Unit Coordinator, Case Specialist, Teacher & individual therapist) with family (and often other collaterals) – Consultations via phone at regularly scheduled times 9 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

10. Clinical Consultation Is… Family focused – Frequency of contacts & time arranged around family’s availability It is family treatment NEW RESULT: Increased family involvement – Data showed dramatic increase in family involvement from FY07 31% to FY10 81% 10 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

11. Clinical Consultation is NOT… To get the parents “on board” with us To “fix” the family to fit an ideal To “get” them into family therapy To move our hidden agenda forward To solely respond to a crisis situation 11 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

12. Stabilization of Discharge Resource Discharge must be center stage issue – Work with youth & family throughout treatment to identify & implement community supports Add community support staff into clinical consultation framework during treatment Planning for discharge must be family and youth driven – Clinical Consultation is the way to help family & youth as they work together to develop a plan – Provider must regularly review how they are working to support the family & youth 12 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

13. Availability of Aftercare Supports Support the Placement – Continued support of the adults/placement post- discharge – Continued clinical consultation framework post-discharge Support the Youth – “Letting go” of the youth – Build upon the youth’s ability to form new relationships 13 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

14. The “Team” Systems Oriented – Identify all the systems involved with the youth and have them come together – Acknowledge current supports & explore past relationships – Finding families Ask the youth 411 or web based searches Appreciate diversity of team members 14 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

15. Seeing the Whole Youth System-wide investment serves function of creating “wholeness” Compartmentalization & Polarization 15 Hero Villain Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

16. Alliance Alliance in treatment refers to “agreement” – Shared understanding of goals & tasks – “Family wants” versus “provider wants” What part can we give them? – As provider we take first step Results in ownership by family and youth – Consultation and dialogue among all team members supports all members as equal partners in the process 16 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

17. Factors that Affect Alliance Unspoken and/or unresolved splits & divisions in the system Compliance without support Members of the system may be dealing with ambivalence 17 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

18. Ambivalence: What is it? “Ambi” means “both” so if you are ambivalent, you have both positive and negative feelings toward something or having feelings for both sides of the issue. It naturally occurs when facing any change It is to be expected as a part of the treatment process 18 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

19. All members may experience ambivalence Youth Family Provider 19 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

20. Youth’s Ambivalence Examples: Youth says he wants to leave but shows only one side of his ambivalence through acting out Youth changes his/her plan frequently What keeps it going? We may rationalize, interpret it as “sabotage”, or minimize We INTERFERE by getting in the middle 20 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

21. Family’s Ambivalence Examples: Family says they will do “x” but then does not follow through Family says one thing but then they do something else Family is not developing a discharge plan Family is not calling in for clinical consultation &/or planning meetings What keeps it going? We try to either push them or empathize with them We INTERFERE by getting in the middle of youth and family working through the issue Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

22. Provider Ambivalence “Getting in the Middle” – Taking over – Holding the anxiety – Taking a conflicting position – Championing one side of the ambivalence – Caring more about the plan & outcome than youth & family do – Deliberate attempts to resolve the ambivalence by pushing for change Not expecting health 22 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

23. Expecting Health from the Youth One person’s picture of “health” may look different than that of another Youth are able to tolerate natural setbacks as a result of failures and disappointments Youth have the resiliency to tolerate disruptions in relationships and work to repair them Treatment allows youth to work through difficult feelings & situations, rather than always removing the stressor 23 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

24. Expecting Health from all Members of the Team Expect that all members want the best for the youth Do not attribute mal intent to the behaviors of others Expect that all members will do “their job” in a “healthy” way Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

25. Working with Control Sensitive (CS) Youth CS youth interpret everything we do as an attempt to try to control them The antidote is to give them more control through providing choices with (logical & natural) consequences Telling the CS youth they have to do “x” before they can get what they want inadvertantly sets up a power struggle When they begin acting out (i.e., hospitalization, AWOL, arrests) we need to assess the meaning behind the behavior – May be related to ambivalence – May be a lack of alliance or ownership 25 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

26. Significant Trends Overall findings FY07 through FY10 data suggest the following: – We see more kids going home and going home in quicker time frames, which suggests an increased alliance with families – Further, the decrease in negative events, especially AWOLS, suggests we have an increased alliance with kids 26 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

27. DCFS Trends When comparing data for DCFS funded youth versus all other (DHS, ISBE, county courts, private), FY07 through FY10 data: – DCFS funded youth have an average 8 month longer length of stay than non-DCFS funded youth (14 months versus 22 months) Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

28. Chi Square Statistics There is a trend toward greater positive discharges (69.9% in FY07 compared to 81.7% in FY10, with no down turns in between). However, the change wasn’t statistically significant. The proportion of discharges to home compared to other positive discharges did change significantly, in the hoped-for direction (p= 0.02). Discharges to home were 29.3% of all positive discharges in FY07 and were 44.9% in FY10. This significant change was true comparing the proportion of discharges to home to all other discharges, positive or negative (p= 0.01). Discharges to home were 20.5% of the overall discharges in FY07 and 36.7% of discharges by FY10. The proportion of AWOL discharges compared to all other discharges changed significantly (p= 0.05) with the proportion of AWOLs shrinking over the four years (16.9% in FY’07 compared to 8.3% in Fy’10). The proportion of DCFS clients being discharged to home, compared to all other DCFS discharge types changed at a rate that approached statistical significance (p=0.07) 28 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

29. Summary Ongoing Challenges – Commitment at all levels – Family “driven" milieu Case Examples Questions & Answers 29 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

30. Presenter Information Contact Information: Judy Griffeth, LCSW jgriffeth@allendale4kids.org; (847) 245-6330jgriffeth@allendale4kids.org Saray Hansen, MA shansen@allendale4kids.org; (847) 831-4216shansen@allendale4kids.org Ronald Howard, LCSW rhoward@allendale4kids.org; (847) 245-6329rhoward@allendale4kids.org Howard Owens, LCPC howens@allendale4kids.org; (847) 245-6170howens@allendale4kids.org Dr. Pat Taglione, PsyD ptaglione@allendale4kids.org; (847) 245-6302ptaglione@allendale4kids.org 30 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010