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TheBuildingBridgesInitiative(BBI):AdvancingPartnerships.ImprovingLives.
Family-driven and Youth-guided Care
South Carolina State Agencies & Providers: A Partnership Towards Positive Outcomes for South Carolina Youth & Families
April 20, 2018
Presentedby:Dr.JaniceLeBel,PhD,ABPP
WhatisFamilyDriven?FamilyDrivenmeansfamilieshaveaprimarydecisionmakingroleinthecareoftheirownchildrenaswellasthepoliciesandproceduresgoverningcareforallchildrenintheircommunity,state,tribe,territoryandnation.
Thisincludes:• Choosingculturallyandlinguisticallycompetentsupports,services,andproviders;• Settinggoals;• Designing,implementingandevaluatingprograms;• Monitoringoutcomes;and• Partneringinfundingdecisions.
Source:FederationofFamiliesforChildren’sMentalHealth
WhyIsItImportant?• Strongestpredictorofpost-transitionsuccess,aftereducation,issupportfromfamily• Fiftypercent(50%)ofyouthwhohaveagedoutwilllivewithsomememberoftheirfamilywithinacoupleofyears (aboutequallydividedbetweenparentsandotherrelatives)
Source:Courtney,M.,2007;Courtney,M.,etal,2004
• “Workwithfamilyissuesandonfacilitatingcommunityinvolvementwhileadolescentsareinresidentialtreatmentmayhaveassistedtheseadolescentstomaintaingainsforasmuchasayearafterdischarge..”
Source:Leichtman,M.,etal,2001
“Theeffectivenessofservices,nomatterwhattheyare,mayhingelessontheparticulartypeofservicethanonhow,when,andwhyfamiliesorcaregiversareengagedinthedeliveryofcare.Whiletraditionalformsofcareapproachedmentalhealthtreatmentinahierarchicaltopdownapproach(withtheclinicianmaintainingsomedistancefromtherecipientsoftreatment),thisapproachisnotreflectedinnewerformsofservicedelivery.Itisbecomingincreasinglyclearthatfamilyengagementisakeycomponentnotonlyofparticipationincare,butalsointheeffectiveimplementationofit.“
Source:Burns,B.etal,1999,p.238
WhyisitImportant?
PutanURGENTANDSTRONGFocusonPermanencyPractices– ‘doingwhateverittakes’toensureeverychild
hasapermanenthomeANDthatyourstaffareworkingwiththefamilymemberstoensuresuccessfuldischarge
FROMPRE-ADMISSION
DownloadfollowingdocumentfromtheBBIwebsite:ABuildingBridgesInitiativeGuide:FindingandEngagingFamiliesforYouthReceivingResidentialInterventions:KeyIssues,Tips,andStrategiesforResidentialLeaders
ESPECIALLY:AppendixA:FamilyFindingandEngagementModels
www.buildingbridges4youth.org
1st:THEMOSTIMPORTANTSTEP:
TheImportanceofPermanency• Familyconnectionsareassociatedwithimprovedoutcomes• Lackofpermanencymakespasttraumaticeventsmoredifficulttomanage• Connectionswithfamilyincreasespositiveidentitydevelopment• Treatmentalonedoesnotmeettheneedsofyouthwithoutfamilyconnections
“RightsizingCongregateCare:APowerfulFirstStepinTransformingCWSystems”,AnnieE.CaseyFoundation,2009
HireFamilyPartners/Advocates2nd MOSTIMPORTANTSTEP:
• Hiremultiplefamilypartners/advocates
• Haveseniorfamilypartneraspartofexecutiveteam&providesupervisiontoallfamilypartners
• Havefamilypartners(ANDFAMILYMEMBERS)aspartofEVERYorganizationalworkgroup/committee/taskforce
• Havefamilypartnersshareofficeswithotherstaff–spreadthroughouttheorganization
HireFamilyPartners/Advocates
• Theyserveasco-trainersinstafforientationandongoingtrainingprograms
• Theyserveaspartofhiringgroupstohirestaff
• Theyserveaspartofevaluationteamstoevaluateeachindividualstaff
• “Nothingaboutuswithoutus!”
• DevelopAStrategicPlantoSuccessfullyEngageFamiliesandOperationalizeFamily-drivenCare
Go to the BBI website download, review and planto use the BBI Self-Assessment Tool as part of your strategic plan
www.buildingbridges4youth.org
3rd MOST IMPORTANT STEP:
AsPartofaStrategicPlanHaveallleadershipteammembersreadandreadandread:
• BBIFamilyTipSheets (longandshortversions)&BBIEngageUs:AGuideWrittenbyFamiliesforResidentialProviders
• MassachusettsDepartmentofMentalHealthCreatingPositiveCulturesofCareGuideChapters:
▫ SuccessfullyWorkingwithFamilyPartners
▫ EmbracingFamily-drivenCare
• Avarietyofothermaterialstosupportincreasedunderstandingandimprovedknowledge-base(seereferencesatendofthischapterandinthePositiveCulturesofCareGuideChaptersreferencedabove)
Board/ExecutivesFocusingonSpecificAreas
IfTheseAreasareNotAlreadyinPlace,ConsiderIncludinginaStrategicPlan
Board/ExecutiveFocusAreas▫ LeadershipPassionatefocusontransformationtowardsFDC(alaBillAnthony:walkthewalkvs.justtalkthetalk)
▫ Agencyclearvalues(e.g.,strength-based,trauma-informed,individualized&flexible;family-driven;youth-guided;culturalandlinguisticcompetence;communityintegrated)
▫ 100%staffcompetentinskills which=values(primarily:respect/compassion/empathy/listening/choice/kindness/patience)
▫ Multipleprogrampracticesclearlyspelledoutforeachvalue
▫ SophisticatedSupervision Systems– especiallyClinical
SmallStepExampleRaquelHatter,CEOoflargeresidentialprogram,wentbacktoheragencyafterthefirstBBISummitandimplementedmultipleimprovements,including:
• Primaryfocusonwelcomingfamiliesasfullpartners• Hiredseniorexecutivefocusedonfamily• RewrotejobdescriptionstoincludeFDC•Madesupervisorsaccountable(someeventuallyaskedtoleave)
Board/ExecutiveFocusAreasFullyimplementing:▫ FamilySearch&EngageorFamilyFindingorOtherPermanencyPractices▫ Wraparound/Child&FamilyTeams▫ BestPracticeClinicalEngagementSkills(i.e.variationsofFunctionalFamilyTherapy/Multi-systemicTherapy)▫ Clearexpectationsforalldisciplinesofstafftoworkinterchangeablyinresidential,home&community
Board/ExecutiveFocusAreasUsingDatatoInformPractice:▫ Restraint/Seclusion▫ AchievingPermanencyforEveryChildinaSHORTTimeframe▫ PuttingintoPlaceforEveryChildaBroadCommunitySupportNetwork▫ PrecipitousDischarges▫ Hospitalizations▫ Re-admissionsintoOut-of-homeCare/HospitalsforallYouthatLeast1to2YearsPostDischarge
THE NEW BAR IS HOW CHILDREN AND FAMILIES ARE DOING 6 MONTHS TO 3 YEARS POST DISCHARGE
WHATS HAPPENING IN THE COMMUNITY IS WHAT COUNTS
Board/ExecutiveFocusAreasQualityImprovement:▫ %ofYouthSpendingTimeEveryDaywithFamilyMembersand/orinCommunityEngaginginPro-socialActivitiesw/Pro-socialPeers
▫ %ofFamilyMembersMetwithEveryWeek
▫ %ofFamiliesConnectedtoandPartofFamilySupportGroupsinCommunity
Board/ExecutiveFocusAreas▫ EnsureFiscalStrategiesthatSupportWorkingwithFamiliesintheirHomesandCommunitiesduringandpostresidentialstays(i.e.6monthsto2yearspost)
▫ OfferLongTermSupport:Respite/In-homeservice
▫ SetExpectationsinStaffJobDescriptions/ContractsforMinimum%ofTimeStaffSpendinCommunitiesw/Families
▫ RenamePositions(i.e.‘ClinicalStaff’ Become‘ReunificationSpecialists’)toEmphasizeFocusonPermanency/Reunification
Board/ExecutiveFocusAreasEnsureExecutiveTeamMembers:▫ HaveOpenDoorPolicyforFamilyMembers
▫ AtLeastOneTeamMemberMeets/GreetsEvery NewFamily
▫ AtLeastOneTeamMemberInterviewsEveryFamilyIndividuallyatDischargeandAgain– 6MonthsPostDischarge
▫ AndAllAgencyStaffRepresenttheCultures/Ethnicities/Races&SpeaktheLanguagesoftheYouthandFamiliesServed
ExamplesofPracticesYouWouldSee:
▫ EveryStaffis‘DirectorofFirstImpressions’(TitleUsedInNewZealandorganization)
▫ FamiliesCanCometoProgram24/7▫WarmandComfortablePhysicalEnvironments▫ FamiliesCangotoEveryPartoftheProgram–SpendingTimeinTheirChild’sRoomandClassroomandActivities
ExamplesofPracticesYouWouldSee:
• LoseTheWords‘Home-Visits’
• FamilyFocusGroupsDecideEducationOfferingsforFamilies
• FamiliesCalledEverydaytoShareChildStrengths– NotJustAboutIssues&EncouragedtoCallMultipleTimesDaily
• YouthCallDifferentFamilyMembersMultipleTimesDaily
ExamplesofPracticesYouWouldSee:
• EnsureFamiliesHaveDedicatedTimetoTalkwithFrontLineStaff
• MakeitaPracticetoConsultwithFamiliestoSeekCounselandEngageTheminDecision-making
• CreateOpportunities(i.e.WeekendCamping)forFamiliestobeProudoftheirChildren/toCreatePositiveMemories
• SupportSiblings
ExamplesofPracticesYouWouldSee:
• NOMOREGROUPREC– AllRecreationFocusedonYouthIndividualInterests/Talentsandany‘Group’ActivityInvolvesSiblings/Families/ExtendedFamilies- i.e.Cousins
• GatherTickets/Freebies forFamiliestoUsewithChildren(maybewithastaffforsupport)
• DevelopCloseCollaborationswithClinicalExpertiseinCommunity(e.g.,Trauma;SubstanceAbuse;DomesticViolence)&Supports(e.g.,Housing;CommunityActivities;PeerMentors;Respite)
HavePolicies/Practices/StaffTrainingtoENCOURAGE:
• YouthCallingasManyFamilyMembersasPossibleANDFriendsWheneverWant/NeedTo
• HaveManyPhones/NoRestrictionsonWhenCanUse(ExceptMaybeSchool/AfterCertainTimeofNight)
• AllowCellPhones(w/Security– i.e.PhotosTaking/VideoTurnedOff)
• Skype/GoogleChatDAILY
HavePolicies/Practices/StaffTrainingtoENCOURAGE:
• Do‘WhateverItTakes’ toGetYouthHome2xWeekMinimum(andWhenCrisisComesUp;ALSO- DONOTALLOWYOUTHTOMISSANYIMPORTANTFAMILYEVENTS)– Upto3PlusHoursDrive1-way/WorkedonRevisingBudgetItemsi.e.Gas$
• Develop/LicenseCommunityProgramsinCommunitiesYouthComeFromAND/ORDevelopStrongPartnerships(e.g.,JointValues;JointTraining;FormalSign-offs)
• HaveStaffPhoneandEmailRegularly– ESPECIALLYTOSHARESTRENGTHS;CommunicateOften;
HavePolicies/Practices/StaffTrainingtoENCOURAGE:
• Trainclinicalstafftodofamilysystemsworkonthephone(justforsomemeetings– MOSTSHOULDHAPPENINHOMES)
• Haveaclinicalstaffandafamilyadvocateworkinthecommunitymostyouth/familiesreside(alaSCO/NYC)
• Getagranttobuyi- Pads/laptopsandrent(i.e.$1)forfamilies(or- ifchargemore- return$’swhenreturned)
• Createbackandforthartproject/binderforfamiliesandyouthtoworkon2to3xweeklyordailyandeithertakeeachweekendhomeand/orscan/emailbackandforth(alaSCO/NYC)
WhatToBeCautiousOf:• EventsonResidentialCampuses(why?)
• LackofSophisticated/CommittedClinicalSupervisors
• GroupResidentialRecreation(why?/whotoinvite?(BuildMemorieswithFamilies)
• ResidentialHolidayTraditions(“IsitAbouttheProgramorAbouttheYouth/Family?”)
Whatcanyoudotoimprovefamily-drivencareinyourprogram?
Thinkof:•1improvementyoucanmakeinthenexttwoweeks?•1improvementyoucanmakeinthenextsixmonths?
InterfaceBetweenYouth-guided&Trauma-informedCare
• Focusonpromotinghealingenvironments
• Understandimpactoftraumaonbrainandbody
• Strongfocusonyouthvoiceandchoice
• Focusonprogrampracticesthatarestrength-based,collaborativeandempoweringforyouth
• Focusonstrategiesthatsupportself-soothing/self-regulation(e.g.,individualsafety/soothingplans;sensorymodulationstrategies;holisticapproaches- i.e.meditation/yoga/taichi/rhythmic&repetitiveactivities)
• Focusonnormalizingactivities,hope/permanency
EmbraceYouth-guidedCareYouthGuidedmeansthatyoungpeoplehavetherighttobeempowered,educated,andgivenadecision-makingrole inthecareoftheirownlives.
Thisincludesgivingyoungpeopleasustainablevoice andthefocusshouldbetowardscreatingasafeenvironmentenablingayoungpersontogain self-sustainability inaccordancewiththeircultureandbeliefs.
Throughtheeyesofayouthguidedapproachweareawarethatthereisacontinuumofpowerandchoicethatyoungpeopleshouldhavebasedontheirunderstandingandmaturityinthisstrengthbasedchangeprocess.
Youthguidedalsomeansthatthisprocessshouldbefunandworthwhile.
YouthMOVENational,Inc.(2008)
ProgramPhilosophiesAssociatedwithPositiveTransitions
• Treatingyoungpeopleasemergingadults.
• Partneringwithyouthindevelopingandimplementingtheirindividualizedsuccessplan.
• Individualizingplanningfocusedoneachyoungperson’suniqueneeds,strengths,andpreferences.
• Believeinrecovery– thatyoungpeoplewillgoontoleadproductivelives.
• Highexpectations– beliefthatyoungpeoplecanbesuccessfulincareers,college,vocationaltraining,andjobsoftheirchoice.
(Jivanjee,P.et.al.,2008)
YouthEngagement/Voice/Choice• Youthengagementisassociatedwithpositiverelationshipsandincreasedmotivation.Youthwhoactivelyengageintreatmenttendtodevelopstrongrelationshipswithserviceproviders,expressawillingnesstochange,andparticipateandcollaboratewithothersinthecontextoftreatment-Smith,Duffee,Steinke,Huange,&Larkin(2008).
• Residentialsettingsthatlimitopportunitiesforchoiceandexplorationdonotpromotethisnormativedevelopmentalprocess,leavingyouthillpreparedtore-enterthecommunity.Therefore,itisessentialtoprovideconcreteopportunitiesforyouthtoexpresstheirchoicesandopinionsregardinghelpfulservices.- Mohr&Pumariega(2004);Warner,&Yoder;Joyce&Shuttleworth
THINKABOUTTHESTRENGTHSOFYOURPROGRAM
Intheareaofyouth-guidedcare,whatareoneortwopractice
strengthsthatyourprogramcurrentlyengagesinconsistently?
StrategiesforYouthEngagement
• Hirestaffwithexpertiseinthisprocess.
• Usepeerswhoarealreadylivinginthecommunitytoteach/modelskills
• Haveyouthlearnanduseskillsintheirdailyactivitiesinresidentialcare.
• Normativeexperiencesshouldnotbetreatedasprivilegesorwithheldtomanagebehavior.
• Residentialprovidersinremoteareasshouldplanprogramsandhousingtomoveolderyouthintothecommunitywithsupport.
Courtney(2007);Davis&Koyanagi (2005)
StrategiesforYouthEngagement• Communityschoolsshouldbeusedasmuchaspossible.
• Maintain&buildnetworkofsupport.Youthconnectionwithsupportsystemcorrelatestohowyoutharedoing10to15yearsaftercare.
• Familyengagementmayplayastrongerroleintheoutcomesthantheactualinterventionprogram
• Servicesaccommodatethecriticalroleofpeersandfriends
Courtney(2007);Davis&Koyanagi (2005)
NFINorth– NewHampshire– ProgressMadein4Months
NFINorth- DavenportSchooltakesgreatprideintheBuildingBridgesInitiativeanddecidedfromthestartofthisprojectthattheonlywaytoevokeonthisjourneywastoduesothroughalensthatallowedforopenandhonestexaminationofpracticesaswellasopenandhonestcommunicationamongstFamily,Youth,andStaff.
SmallStepExample
ComparisonPriortoNHBBIKick-off
1. HomeVisits2. Limitedphonecalls3. ApplyforCommunityService4. LevelSystems5. NoPC(PersonalContact)6. Goinghomeeveryotherweekend7. ClinicianLedTx Meetings8. FocusonTransitionlast90days9. Scheduledbedtimes10.Pre-arrangedcommunityservice11.NoParentSupportGroups
4MonthsLater
1. “GoingHome”2. Unlimitedaccesstophones3. Unrestrictedaccesstocommunity4. Nolevelsystem5. HighFivesandFistsBumps6. Homeeveryopportunitypossible7. YouthLedTxMeetings8. FocusonTransitionfromday1!9. Youthdecidedbedtimes10.Youthdesignedcommunityservice11.ParentGroupsofferedonceamonth
BigStepExamples
MassachusettsDMHStatewidePrograms•FocusingonR/SPreventionleadstoyouthengagement,empowerment,rolesandservicetransformation
StartedbyFocusingonWhatwewereDoingTo Youth…• Restraintusewithkidsincreasingeachyear• Populationdiscrepancies(4-17x)• Systemicdiscrepancies
66.5
6.9
0
50
100Rate per 1000
Patient-days
Hospitals A and B
Acute Care Hospital Comparison - 2000
High Utilization
Low Utilization
Restraint Episodes per 100 Admissions (Licensed Facilities)
Pre-Initiative
0
25
50
75
100
125
1998 1999 2000Years
Ep
iso
de
s p
er
10
0
Ad
mis
sio
ns
Child (L) Adult (L) Adolescent (L) Mix CA (L)
DMHC/AStatewidePrograms• Anetworkofprivatized,locked,intensiveMHservicesformosttreatmentcomplex&traumatizedyouth(6-18yo)inMA• Previousadmission/treatmentlitmustestdrivenbypathology/deficit/previousS/Ruse• Focusshiftedtostrengths,skills,future-orientedtreatmentdrivenbyyouth/familygoals
WhatElseChanged?AttheStatewideProgramServiceLevel
1999 2017
üMechanicalrestraint 100%
üSeclusion 100%
üMedicationrestraint 100%
üPoint&levelsystems 100%
üServicedogs/petRx 0
üAvg.lengthofstay 406
üTotalS/Repisodes 6,742
üTotalcapacity 206
üMechanicalrestraint 0üSeclusion 0üMedicationrestraint 2programsüPoint&levelsystems 0üServicedogs/petRx 100%üAvg.lengthofstay 138(66%)üTotalS/Repisodes 337üTotalcapacity 117(54%)
closed6programs
WhatElseChanged?AttheStateLevel
1999 2017
üNoS/RphilosophyüPolicy15yearsoldüRegulations>10yearsoldüLtd.TraumaAssessmentsüNoCrisisPlanningüNoSensory/comfortroomsüNoeducationonconsumerexperienceorinclusion
üNoS/Rpreventiontrainingorframework
üHaveS/RphilosophystatementüNewpolicycallsforS/ReliminationüNewregs.onS/RPreventionüTraumaAssessmentforallüCrisisPlanningforallüSensory/comfortroomsinallsvcs.üConsumershired&teachstaffüEveryhospital&securetreatmentfacilityinMAtrainedinSixCoreStrategies©
MovingForwardasaSystem
• InteragencyS/RPreventionefforttointegrateC/Ainpatient,community-based,residential,&andpublic/privateschools
▫7StateAgenciesinvolved&7CommissionerssignaChartertomovethestateforwardtogether!
WhatElseChanged?AttheC/ACommunitySystemLevel
1999 2017
üNoR/Sreduction/preventionexpectationorframework
üNocommonR/Sdefinitions
üNoyouth-guided,familydrivenframework
üNoyouth/familyrequirementre:providerinvolvement
üNoyouth/familyonstaff
üNoFamilyPartners
üAllprovidersmustadopt6CS &havestrategicplans ifused
üCommondefinitionsinprogressüResidentialreprocurementrequiresBuildingBridges framework
üPoints&levelsystemssunset**üProvidersmusthavefamilyontheirBoards&y/finclusion inservicedesign,delivery&QM
üAllDMHIRTPstohavey/frolesüFamilyPartnerpilotunderway
CriticalFactorsinChangeProcess:YouthasPeerLeaders
Youth and families are equally represented with elected officials and the average age on the ‘topping off’ platform significantly lowered ...
ByPayingAttentiontoWhatweWereDoing
“To”Youth- WE changed–
andBegantoFocusonWhatweWereDoing
“With”Youth
TheShifttoRealInclusion&MeaningfulEngagement
• Shiftedourthinkingandapproachfrom:▫ “Didweasktheyouth?”to“Startbyaskingtheyouth.”▫ “Canweorganizeayouthpanel?”to“Let’sdeveloptheagendawithyouth,co-welcome,andco-present”
• Solicitedperspective,creativity&wisdom:▫ handbooks▫ newroles▫ jobdescriptions▫ staffhiring&stafftraining▫ operations,policies&procedures
New&EmergingRoles
• PeerHumanRightsAdvocate• ResidentSupportTeam• PeerOutreach• ServiceReviewTeam• ServiceDesign• RFRReview&ContractAwardProcesses• PeerMentorsinnewcommunityservices• PartofRegionalQualityServiceTeams
AnotherBigStepExample:YDI,Arizona
YDIimplementedtheEBP,theSixCoreStrategies©:1. Leadershiptowardorganizationalchange2. Theuseofdatatoinformpractice3. Workforcedevelopment4. Fullinclusionofindividualsandfamilies5. Theuseofseclusionandrestraintreductiontools,
whichincludetheenvironmentofcareanduseofsensorymodulation
6. Rigorousdebriefingaftereventsinwhichseclusionandrestraintmighthavebeenused
ProcessofChangingtheCultureOldThinking NewThinking
• Restraintsarenecessarytokeepthekidssafe
• Satisfiedwithrestraintreduction• WillnotSkill• Blamingtheoutliersor“FrequentFlyers”
• ConfrontandTeach• Blamingoneortwonewadmissions
• Whenrestraintsdecreased,assaultsonstaffincreased
• Restraintsre-traumatizeandCAUSEHARM
• IntentiontoELIMINATErestraints• SkillnotWill• “Kidsdowelliftheycan.”typingextra
• Calm,Comfort,Connect• Allstaffcreateatherapeuticalliancewiththeyouth
• Regulationiscontagious
• SeclusionandrestraintareNOT treatmentinterventions• Seclusionandrestraintaredemonstrationsofpowerandcontrol▫ Verytraumatizingtoyouthincareandtothosewhoworkwiththem
• Oftentheseinterventionsareimplementedinarbitrary,abusiveandviolentways
ParadigmShift:EliminateRestraints
FullInclusionofYouthandFamilies
YDIStudentAdvisoryBoarduWhoarewe?
"Wearenotthestudentcouncil!Wedon'tdobakesalesorpromotewackydressdays.Wedothingsthatmakebeinghereeasiersowecanleavefaster.Inordertoworkwithusyoudon'thavetobeperfectbutweneedyoutoworkhardandbehonest.Everyonetrustsusandgivesusalotofresponsibility.Whatyoudoinherewillinfluencethelivesofkidsyouwillnevermeetandthat'sprettycool."
- StudentAdvisoryBoardmemberJustinwheninterviewinganapplicantforStudentAdvisoryBoard
FullInclusionofYouthandFamiliesYDIStudentAdvisoryBoard
• GivetourstokidsnewtoYDI▫ GiveBBIYouthTipSheet&reinforcethatYDIisa“handsoff”programandthattheirtreatmentisbasedupontheirchoices.
• Reviewandwritepolicyandprocedures• Receivetraining/supporttohelpresolveyouth-to-youthgrievances• Identifyandsolveproblemsspecifictomilieu• ReporttotheirunitswhatisgoingonwithYDIasawholecommunity.• Tourvisitingagencystaff.• Intervieweveryemployee• PartofOrientationTrainingandongoingstafftrainingprograms• Partofstaffevaluation
FullInclusionofYouthandFamilies
StudentAdvisoryBoard
“Justbecauseyouworkhere,don'tthinkwewilltrustyou.Ihavehadadultscomeintomylife,promisetheywillbethereformeandleavetimeandagain.Kidsherewillcussatyouandcallyounamesbecausewedon'ttrustyou.Youhavetoprovetouswithyouractionswhatyouareabout.”
-StudentAdvisoryMemberwhentalkingtonewstaffintraining
FullInclusionofYouthandFamiliesStudentAdvisoryBoard
• OutcomesasaresultofYDIStudentAdvisoryBoard:▫ 94%successfuldischargerateforStudentAdvisorymembers;YDIsuccessfuldischargerateiscurrently77%
▫ Whatyouths’exitsurveystellus� Senseofempowerment,purpose,andvalueasamemberofacommunity
StepstoCreateInformal Roles
• Asktheyouth• Askthestaff• Conductyourowngapanalysis:whereisthereaproblem,achallenge,aquestion,achangethatisneeded?• Involvetheyouthinthesolution-buildingprocess• Examples:▫ Humanrights/complaintsoverload▫ ‘newkidsyndrome’▫ residentsupportteam
ExamplesofYouthGuidedCare
• Youthprovidedtraining/supporttoleadowntreatmentteammeetings• Hiringofyouthadvocates(meaningfulrolesthroughouttheorganization)• Youth/youthadvocatesareonEVERYprogramcommittee/workgroup• Providingyouthmentors(homecommunity)• Youthadvisorygroup– meaningful• Providingleadershiptrainingforallyouth• Skilltrainingimbeddedeverywhere
ExamplesofYouthGuidedCare• Staffinteractionsarerespectful,inquisitiveandempowering– notdirective/authoritarian(i.e.more“Howdoyoufeelaboutthat?” VSpraise)
• Individualizedapproaches– notlevelorpointsystems(Mohr&Pumariega,2004)
• Interests/Activitiesoccurinthecommunity– notinprogram
• FormeryouthonBoardsofDirectors
YouthGuidedCare:BasicstoAdvancedBasic:
• Morephonesavailable/expandphonetimes
• Moreflexibilityw/bedtimes
• Doawayw/points;designarevised/‘looser’ levelsystem
• Programexpandsamountoftimeyouthgointocommunityfornormalizingactivities(w/otherresidentialyouth)
MovingbeyondBasics:
• Cellphones(w/filters)/norealphonerestrictions
• Youthchoosewake-up,bed&showertimes
• Nolevels- allprivilegesandamendsareindividualized
• Timeincommunityaloneorw/pro-socialpeersengagedinactivitiesthathighlightindividualtalents/strengths
ExamplesofYouthGuidedCareProgramReviewsAllPracticesandRulesAgainstTIC&YGC.
Examplesinclude:▫ Afterschoolquiettimeorstudytimesoyouthquietduringchangeofshift▫ Anypracticesthatdelayorlimittimespentathome▫ Strongfocusonbehavioralapproaches(evenPBIS)whichfocusesonearningactivities(e.g.,dinnersout;stayuplate;studentoftheweek;specialtimewithastaff- toplevelmoreindividualized)
▫ ALLPROGRAMPRACTICES/RULES
YouthRecommendations• “Everystaffwantstotalktomeaboutmyproblems.Itgetssoold.Whydon’twejusttalkaboutwhatinterestsme?”
• “Wecanhelpeachotheraswell,ifnotbetter,thanstaffcanhelpus.Theyshouldpromotewaysofdoingthis.”
• “Justlisten,trulylisten– staffneedtonotbesoobviousthattheyarewaitingtosaysomething.”
• “Makemesmileandlaugh;bethereforme– notjusttheretoremindmeofrules.”
• “Nobodyasksmeaboutmydreams.Theyaskmeaboutmybehaviors.”
StepstoFormal RoleDevelopment
1. Valuesleadtocommitment2. Commitmentleadstodecision3. Decisionleadstoprioritization4. Prioritizationstartstheformalprocess5. Processbeginswith$identification/allocation6. Discussionwithkeyconstituents7. Craftingtherole(s)8. MeetingwithHRD9. Vettingtheroles10. Layingthegroundworkwithcare
TheChallenges&Pitfalls• Aligning$$andvalues• Preparingyouthfornewroleswith‘professionals’• Preparingyouthforentryintoaprofessionalrole• Supervisingyouthclosely• Teachingtoskill&competencydevelopment• Flexibleimplementationtobefullysuccess-oriented• Continuallymonitoringrole/implementation• Startingsmall&expandingwithsuccess• Measuringtooutcomes• Preparing&supervisingnon-youthstaff
Hiring&StaffingPragmatics
• BasicSupport:▫ flexiblehours(noearlyAMorlatePMhours)▫ flexiblesupervision▫ regular,weeklyaccesstoleadershipstaff;▫ regular,weeklysupervision– individual&group▫ hiremorethanone- peergroupisessential▫ payfortransportation/parkingorprovidetransportation▫ payfortraveltoconferences,meetings,trainings▫ payforconferencesfees
Hiring&StaffingPragmatics
• AdvancedSupport:▫ Personalgrowth&development:
• Teachwellnessskills:goodselfcare,hygiene,grooming
• Assistwithhowtodressforaprofessionalrole,clothingchoices
• Businesscards• Teachingprofessionalskills• Teachingsocialskills• Teachinghowtodescribeanddocument• Encourageandelevatewellnessactivities• Recognizingpersonallimitsandrecoveryneeds
Hiring&StaffingPragmatics
• AdvancedSupport:▫ Howtosupportfellowpeers&creategroupsupervision▫ Howtorespondto/workwitholderprofessionalcolleagues▫ Howtoactivelyparticipate,co-lead,leadmeetings▫ Howtoplanalifeandidentityasa‘full’person▫ Howtoprepareforleaving‘youth’statusbehind� “You’reelderly!You’rewearingatie!”
SomeTypicalStaffFears
• “You’reactuallygoingtohirethem?Andyouthinkthisisagoodthing?”• “Youaregoingtogivethemakey?”“Whatiftheylosetheirkey?”• “Howmuchareyoupayingthem?”“Aretheygoingtogetpaidasmuchasus?”• “Theyaregoingintothetreatmentteammeetings?”• “Whataboutconfidentiality?”
Source:CarolineMcGrath,UMassAdol.Services,08/12
PostImplementationAppreciation
• AprogramwithoutaPeerMentorasked:▫ “CanweborrowLori?”▫ “Couldsheworkwithoneofmykids?”▫ “Whenarewegoingtogetapeermentor?”▫ “Cantheygoonpre-admissionmeetingswithus?”
• ThepsychiatristsstartedaskingthePeerMentors:▫ howtobettertalkwithteensaboutmedication▫ howtobetterunderstand▫ howtohelpkidsdecreaseself-injuriousbehavior.▫ “Cantheycometonewstafforientationandtalkaboutwhatit’sliketobeinaprogram?▫ “Canthey...,Willthey...,Couldwe…?”
Source:CarolineMcGrath,UMassAdol.Services,08/12
YouthRecommendations• “Everystaffwantstotalktomeaboutmyproblems.Itgetssoold.Whydon’twejusttalkaboutwhatinterestsme?”
• “Wecanhelpeachotheraswell,ifnotbetter,thanstaffcanhelpus.Theyshouldpromotewaysofdoingthis.”
• “Justlisten,trulylisten– staffneedtonotbesoobviousthattheyarewaitingtosaysomething.”
• “Makemesmileandlaugh;bethereforme– notjusttheretoremindmeofrules.”
• “Nobodyasksmeaboutmydreams.Theyaskmeaboutmybehaviors.”
AuthenticYouthEngagementHappenswhen…
• Thevoiceandactionsofyoutharevalued.
• Youthareutilizedasaresourceinthedevelopmentofthemselvesandtheircommunity.
• Authenticyouthvoiceispresent,empoweredandinterwoventhroughoutyoursystemandyourorganization.
• Youtharevaluedfortheirexperienceandexpertise(notastheproblem).
• Youthconsumersareadvocatesandeducators.
• Youthmembersareonboardsandcommittees.
• Youtharedecisionmakers.
• Thereisequalpartnershipandsharedrespect.
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www.buildingbridges4youth.org