Strategies for Developing Family-Directed Outcomes Minnesota Association for Children’s Mental Health

Strategies for Developing Family-Directed Outcomes

Minnesota Association for

Children’s Mental Health

Minnesota Association for Children’s Mental Health ©2006www.macmh.org

Developing Family-Directed Outcomes

HousekeepingIntroductionWelcomeOutcomes


Thank You MDE!

Funding for the development and publication of this workbook and training was provided by the Minnesota Department of Education using federal resources received through the Individuals with Disabilities Education Act (IDEA).


Thank you for attending!As workers in the field of early childhood intervention, we routinely record what we do. Now, we are going to measure what changes occur because of our work with a family.

Welcome!

3


Why are we here?

IDEIA—the Individuals with Disabilities Education Improvement Act focuses on outcomes (or benefits) reported by families after they have received Part C services.

Families will be asked to describe the benefits their family experienced as a result of the services they have received.

3


Why Focus on Family-Directed Family Outcomes?

6


Research Supports Family-Directed Family Outcomes

Early interventions focused on the parent and child produce longer-lasting gains.

Family is often the long-term teacher.

Parents are excellent educators.

7


Federal Reporting Accountability increasingly means looking at results – not just process.• Early Childhood Outcomes Center (ECO) www.the-eco-center.org

• Improvements in the family’s ability to help their child grow and learn.

7


Report to Office of Special Education Programs (OSEP)

Families participating in Part C who report that early intervention services helped them

to effectively communicate their children's needs,

to know their rights, andto help their children develop and learn.

7


State Reporting

Any child/family who has received services in Minnesota for 6 months or more AND who is exiting services under Part C because

their child is turning 3, the family is moving out of the state, the family has opted to discontinue services, or

a re-evaluation has determined the child is no longer a child with a disability.

8


State Reporting Enter the child’s MARSS number on the survey and print a copy of the survey (in the appropriate language).

Deliver the survey and envelope addressed to the Minnesota Department of Education during a home visit.

Assure families that their answers are private and will not be shared directly with program staff.

8


Getting Started

9


Activity: Introduction and Intention

The work you do

A benefit you hope to experience as a result of today’s workshop

10


Understand the importance of keeping services and outcomes family-directed.

Be able to help families turn their concerns into specific statements of need.

Know how to help families recognize and build on their strengths.

Know how to help families enhance their ability to mobilize resources.

Know how to use ecomaps to promote untapped resources to insure the availability and adequacy of resources for meeting families’ identified needs.

Outcomes

10


Family-Directed Family Outcomes

11


Family-Directed Family Outcomes

11


Enable

Enabling: creating opportunities for family members to become more competent, independent, and self-sustaining when it comes to mobilizing their social networks to get their needs met and attain desired goals.

11


Empower

Empowering: carrying out interventions so family members are able to control how their child’s (and their family’s needs) are met.

11


Strengthening Families Help families clarify and strengthen their decision-making skills rather than usurp their power.

Help families identify their social support networks rather than supplant those networks with professional services.

Enhance families’ competencies that allow them to capably meet the needs of their family.

11


Activity: Benefits of Family-Directed Family Outcomes What are the benefits to you and the programs you support?

What are benefits for families? How will an individual child benefit?

11-12


Empower Families! Families are already competent or have the capacity to become competent.

Failure to display competence at a given moment is not due to deficits in the person, but a failure of the system to create opportunities for competencies to be displayed.

Parents attribute behavior change to his or her own actions and feels the sense of control necessary to manage family affairs. 13


Shift in Focus? Have a proactive stance toward families--rather than treating problems or preventing negative outcomes, emphasize growth-producing behavior.

Not our needs. Identify and build on the family’s capabilities in order to strengthen the family.

Shift focus away from professionally identified needs and instead emphasize the family’s goals.

13


Strategies

15


Principle 1:Identifying the Needs of the Family

Outcomes are based on the needs, interests, and strengths of caregivers.

The greatest impact on child, parent, and family functioning occurs when interventions are based on what a family considers important and therefore deserving of time and energy.

16


Translate Concerns into Needs

Concerns are the recognition that what is and what ought to be are very different.

A need is the recognition that something can reduce the distance between what is and what ought to be.

• Dunst, Trivette, and Deal (2003)16


Family Interviewing 101

Purpose of the interview

Purpose of the tool

Build rapport Invite everyone to share

Clarify concerns and needs

Deepen the conversation, reflective listening

Restate needs and prioritize

16


Activity Jonah and Sarah have a son, Matthew who is 6

weeks old. Matthew was identified as hearing impaired during his postnatal screening.

Jonah and Sarah have few connections in the community because they have just moved to the area from several states away and Sarah has been feeling the “baby blues ”.

Jonah and Sarah have had few discussions about what to do next with Matthew, however, Sarah did follow-through and call the Early Intervention Program after Matt’s 1-month pediatric visit.

Sarah’s first comment during screening was “We just are not ready to decide what to do; it is too big for now.” In the same conversation, Jonah stated flatly, “I won’t have my child running around flapping his hands in people’s faces like a fool.”



Jonah, Sarah, & Matthew’s Needs

TimeResources and education for Sarah’s baby blues

Encouragement about communication with Matthew right now


Right and Wrong… What is best for the family

What works for the family

See multiple options

Get creative In their own time, in their own way

19


Principle 2:Identifying Family Strengths

20


Finding Strengths

How does this family deal with life’s challenges?

What is the family already doing well?

Routines Based Assessments

20


Can We Define a “Healthy” Family? In order to recognize family strengths, we need to generally define healthy family characteristics.

Let’s list 12.

21


Healthy Families Commitment to well-being and growth of individual members and

family system. Appreciate family members’ strengths-- the big and small things. Spend time together. Have a sense of purpose. Agree on the value and importance of assigning time and energy to

meet needs. Communicate in ways that encourage positive interactions. Have clear rules, values, and/or beliefs that guide expectations

of acceptable and desired behavior. Solve problems together. Have varied coping strategies to deal with everyday and unusual

life events. Have a positive outlook and can view challenges as a chance to

learn and grow. Flex and adapt to changing roles as they pursue resources. Use a balance of internal and external family resources for

coping and adapting to life events and planning for the future.22



Jonah, Sarah, and Matthew

Strengths:•Committed to the family•Have varied coping skills•Have clear rules, values, beliefs that guide expectations of acceptable and desired behavior

•Hunch: Flex an adapt to changing roles as they pursue resources


Family Outcome

Jonah and Sarah will learn more about communication options that fit with their family values and beliefs in order to make informed decisions about their child’s communication strategies (as evidenced by selection of intervention method/ communication strategy).


Principle 3: Identifying Sources of Support and Resources

27


Support

27


Identifying Resources

An ecomap is a picture of a family and their environment.

27


Generating an Ecomap Make a list of people, organizations, & agencies the family has contact with on a regular basis.

Think about the stories the family members have shared and- ask about people or resources you have heard them talk about.

Ask who they first spoke with when they had a concern about their child.

Ask about medical professionals and specialists the family is already working with.

27


Identifying Resources The ecomap should create a picture of the family and their community.

Simply creating the list can be useful in locating resources to support the family.

27


The Ecomap Picture

It can be benificial and a richer experience to use the list to create an an ecomap picture

Identify whether the relationship is:•Strong: denoted with a solid line•Weak: denoted with a dashed line•Tense: denoted with x’s for the line xxxx

28


Defining the Relationships

28



Willingness to Ask for Help Response Cost – the cost of seeking and accepting help compared to benefit

Dependability – the extent to which the family can depend on the resource and that resource’s willingness to provide assistance

Indebtedness – the extent to which there is a personal or psychological obligation

Reciprocity – the extent to which the exchange of help is welcome but not expected

Satisfaction – the extent to which one is satisfied with the help 31


Matching Resouces with Priorities

Reivew what the family determined to be the most pressing need

Help the family to use their ecomap to identify resources that best address the need

The needed resource may not be on the ecomap, so it may be necessary to suggest additional resources to the family

31


Develop a Plan (Write the Outcome)

Contingent on the family playing an active role

Define the steps Create the opportunity for the family to actualize the plan and meet their identified needsWe do not wish to usurp their

decision-making power, nor replace their personal social

support networks with professional services. 32


Develop a Plan (Write the Outcome)

No outcome should ever be written without the agreement of the family.

Keep the dialogue open. Honor and respect the family’s values, beliefs, and priorities.

32


Writing Outcomes Describe what is to occur (the process) then explain what is to be expected (the outcome).

Combine the two statements with an “in order to” phrase to show the relationship between the process and the outcome.

Learn more about communication options that fit with their family values and beliefs in order to make informed decisions about their child’s communication strategies (as evidenced by selection of intervention methods).

32


Family-Directed Outcomes Include 1. Direction of change (as identified by the family)•What do we want to accomplish?

2. Behavior to be performed (by the child and family members)•Who? (child or caregiver)•What? (will do what?)

In order to 3. Expected annual ending level of performance (for the family and/or child)•How will the family know if it worked??


The Final, Final Step

“I followed the steps, but the family member didn’t follow

through.”

Assume that something got in the way

Review the the 5 “willingness to ask for help” features

Step back make sure the plan was family-directed

32


Willingness to Ask for Help Response Cost – the cost of seeking and accepting help compared to benefit

Dependability – the extent to which the family can depend on the resource and that resource’s willingness to provide assistance

Indebtedness – the extent to which there is a personal or psychological obligation

Reciprocity – the extent to which the exchange of help is welcome but not expected

Satisfaction – the extent to which one is satisfied with the help 31


Principle 4: The Early Childhood Professional’s Role

Activley listen Activley observe and support

Wisely advise and consult

Encourage and support Trust Build confidence and competence

We are not advocating that early childhood professionals be passive.

33


Eye on the Prize

Families will developan understanding of how to effectively communicate their child's needs,

An understanding of their rights and responsibilities, and

ways to help their child develop and learn.


Important Roles We Play Teacher: Instruct parents on interventions that can be incorporated into their daily routine. Identify and utilize family, parent, and child strengths to meet the needs of the family.

Consultant: Provide information in response to requests made by the family.

Resource: Share information about sources of support and resources–specifically, support available in their community and through the organization you represent.

Enabler: Create opportunities for families to become skilled at accessing services.

33


Important Roles We Play Mobilizer: Bring together key players who can assist the family. Point out potential untapped resources and provide alternative perspectives to getting a need met. Help the family remove barriers!

Mediator: Sometimes it is necessary to help a family communicate with or build relationships with other service providers, particularly a family has had a difficult or negative previous experience.

Advocate: Provide families with the necessary knowledge, skills, and connections to help their child grow and learn!

33


Activity: The Roles We Play

Which come easiest to you?

Which are difficult?

Write a goal to expand your knowledge/comfort level playing that role.

34


Working Together

37


Why Do My Feet Hurt? Most professionals make a conscious decision to work with young children and their families. Most families, however, would prefer to have a life that did not require such support.

Many parents feel that this relationship is not only uninvited, but awkwardly intimate.

Professionals are committed to the growth of the child. Too often, parents feel left out or set aside when they want to be and should be the primary partner. Most children will benefit from the involvement of an early childhood provider, but the child cannot survive without the parents’ involvement. 38


Why Do My Feet Hurt? Lack of clarity. Traditionally, the professional is the expert; now, the parent might find their provider calling her the expert when she feels at a total loss. Ideally, each is contributing ideas, resources, and knowledge in different areas – a partnership with two contributors.

The 5th dimension is the differing sets of priorities caused by different views of life.

38


Asking Families to Stretch

I realize this idea is something new for you:

What have I missed? How will this change or disrupt your life?

Will this complicate your daily living? What do I need to understand from your point of view?

39


Growth-Producing Behavior

Make sure our families hear us say we want to work with them to develop additional competencies.

We are empowering and enabling them to advocate, care for, support, and teach their child who has special needs.

39


Grieving and Growth

ENUF (Dr. Ken Moses)

Empathy Non-Judgment Unconditionality

Feeling Focus

40


Considering Culture

When two persons come together, inevitably difference exists between them.

Each person has a unique set of values, expectations, and histories that create the basis from which they act.

42


“Culture Speed Bumps”

1. Develop an understanding of the cultural meanings behind the perceived “bump.”

2. Time and “skilled dialogue” will help to discover what impact the “bump” will have on the relationship.

3. Openness, creativity, and flexibility to develop a “third space” to stand in to restart the dialogue.

• Barrera and Corso

42


Creating 3rd Space

Respect: stay with the tension of differing perspectives.

Reciprocity: develop opportunities for equalizing power (horizontal plane).

Responsiveness: create a response that integrations and provides access to the strengths and diverse perspectives.


Cultural Speed Bumps

When our cultural assumptions, beliefs, and values are violated, we react with strong emotions.

Shock and a sense of bewilderment often overwhelm us, limiting our responses and generating immense barriers to effective communication.


Culture as Shared Knowledge

Cultural knowledge is based upon our interactions with others and is continually modified in the context of these interactions.

We acquire cultural knowledge through our life experiences and social interactions.


Two Complementary and Ongoing Processes

Self-awareness of one's own cultural assumptions, values, and beliefs;

Willingness to explore the cultural knowledge of others in the full context of their personal and shared histories, assumptions, goals, beliefs, and practices.


Finding Solutions What have I missed? How will this change or disrupt your life?

Will this complicate your daily living?

What do I need to understand from your point of view?


Boundaries

What is the impact on the family if I fulfill this request?

Will my relationship with the family begin to resemble a friendship if I fulfill this request?

Would fulfilling this request reduce my ability to be objective about this family?

(from ZERO TO THREE Center for Program Excellence.)

44


Defining Relationships

Friendship is a reciprocal, long-term relationship with emotional give-and-take and a sharing of resources.

A professional relationship is one of limited duration designed so that the provider supports the family’s achievement of specific goals.

44


Activity

How do you re-charge?

45


Activity: Boundaries

What helps you maintain professional boundaries?

45


Facilitated Communication Interpreting is a complex act. Must convey thoughts, attitudes, and feelings.

A sentence’s practical, social meaning and any subtle variations must also be transferred for a successful transaction.

It may be nearly impossible for an interpreter to “assign” a word to some words or concepts.

46


Apparent Disagreements Extended time to begin speaking Nonverbal cues indicate anger or frustration

Ask if there is a problem you can clarify

Try to ensure that an interpreter’s own values, beliefs, and feelings do not creep into explanations

Encourage the interpreter to offer information only

46


Reflective Practice Working with infants, toddlers, and their parents is rewarding and challenging, evoking powerful feelings in the professionals who deliver these relationship-based services. By “stepping back” to explore our observations, feelings, and actions, we can begin to understand our emotional responses. This practice of reflection helps us to remain emotionally available and connected to families—within appropriate professional boundaries—so we can develop interventions that support the evolving relationship between the parents and the child. (CEED, 2006) 48


Wrap Up

49


Rating Levels for Family Outcomes

1. We are just beginning to understand where our child is developmentally. There is a lot we need to learn about our child’s special needs or disability, and we need to find out where we can go to get this information.

51



3. Our family has a basic understanding about where our child is developmentally, but we still have a lot to learn. We know some things about our child’s special needs or disability, but there is a lot of information out there that we still need to find. We have some ideas about where to go to get this information, but could use some help.

51


Rating Levels for Family Outcomes5.Our family has a pretty good understanding about our child’s development, but we occasionally find that we still have questions. We know a fair amount about our child’s special needs or disability, but there are still some questions that we are trying to find the answers to, and we are not always sure exactly where to go to find those answers. We’re pretty confident in our ability to help professionals know whether things they are doing are making a difference with our child. We might be willing to share all of this information with other families, but we’re not sure that we are quite ready to do this.

51



7. We fully understand our child’s development and how it compares with typical development. We have a clear idea about our child’s health, behavior, and learning needs. We know a lot about our child’s special needs or disability, and how to find more information when we need it. When new treatments are tried with our child, we can help professionals know whether they are really working or not. We know all of this information well enough that we would feel very comfortable helping other families learn it.

51


Thank You MDE!

Funding for the development and publication of this workbook and training was provided by the Minnesota Department of Education using federal resources received through the Individuals with Disabilities Education Act (IDEA).

Documents

Strategies for Developing Family-Directed Outcomes Minnesota Association for Children’s Mental Health