engaging families to identify their children’s underlying needs for scsws

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

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)

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…”

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)

Strength-Needs PracticeRequires Effective Working Relationships

Core Conditions:

• Respect• Empathy• Genuine• Competency

Rapport: First Step of Engagement

• Rapport is the Building Block to Engagement

• Engagement requires Rapport

• Rapport does not equate to Engagement

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

Adapted from Vincent, 2008

Rapport vs. Engagement

Rapport• Empathy• Kind/Respectful• Mutual understanding• Comfort• Trust

Engagement• Active listening• “Real” dialogue• Mutual feedback• Flexibility• Solution/Goal Focus

Rapport vs. Engagement

• Large Group Exercise

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

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?

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

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

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?

“Hunches” About Worker’s Needs

• Support• Time• Safety/Respect• Accountability• Core Values• Professional Development • Coaching and Mentoring• Other_______

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?

3 Engagement SkillsTo help children and families

identify and address their needs

• Exploring • Focusing • Guiding - Paul Vincent

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)

Adapted from Vincent, 2008

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

Vincent, 2008

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? Vincent, 2008

BREAK

Keys to Engagement

• Using Activity 3C, Observe Demonstration

• In small groups, utilize keys provided and engage clients regarding assigned tasks provided at each table

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?

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 developself-sufficiency skills, does resistance arisein a different way?

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

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

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?

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

WHEN I “REACT”… IT’S TIME TO REFLECT

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 non- productive 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?”

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

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

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?

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.’”

Remember, in Trauma-Informed Practice

Behaviors, Symptoms and Deficits reflect NEEDS!

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 __________

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

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

Engagement Requires: Looking at Our Potential Biases

• Clicker Activity regarding stigmas

• Please respond to the following statements

Los Angeles DCFS is the largest child welfare system in

the country

1 2 3 4 5

0% 0% 0%0%0%

1. Strongly Agree2. Agree3. Neutral4. Disagree5. Strongly Disagree

Individuals who have a mental illness have a disease

1 2 3 4 5

0% 0% 0%0%0%

1. Strongly Agree2. Agree3. Neutral4. Disagree5. Strongly Disagree

Individuals who are homeless have mental illness

1 2 3 4 5

0% 0% 0%0%0%

1. Strongly Agree2. Agree3. Neutral4. Disagree5. Strongly Disagree

Individuals who have mental illness can adequately care for

children

1 2 3 4 5

0% 0% 0%0%0%

1. Strongly Agree2. Agree3. Neutral4. Disagree5. Strongly Disagree

Individuals with substance abuse or addiction have

mental illness

1 2 3 4 5

0% 0% 0%0%0%

1. Strongly Agree2. Agree3. Neutral4. Disagree5. Strongly Disagree

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

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

Stages of Change:Primary Tasks

1. Precontemplation

Definition: Not yet considering change or is unwilling or unable to change

Primary Task: Raising awareness

2. Contemplation

Definition: Sees the possibility of change but is ambivalent and uncertain

Primary Task: Resolving ambivalence, Helping to choose change

3. Determination

Definition: Committed to changing but still considering what to do

Primary Task: Help identify appropriate change strategies

4. Action

Definition:Taking steps toward change but hasn’t stabilized in the change process

Primary Task:Help implement change strategies and learn to eliminate potential relapses

5. Maintenance

Definition:Has achieved the goals and isworking to maintain change

Primary Task:Develop new skills formaintaining recovery

6. Recurrence

Definition:Experienced a recurrence of the problems

Primary Task:Cope with consequences andDetermine what to do next

BREAK

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

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)

EMPATHYIt 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

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

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

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?)

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

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

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

Talking with Clients about the Value of Court Ordered

ServicesIn 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

Let’s Practice

SMALL GROUP EXERCISES

Effective Engagement Requires

Self Appraisal

Review Self Appraisal Check List

Effective Engagement Requires

Support!

Office Based Lead Coaches are being trained to Coach and Mentor SCSWs

Effective Engagement Requires

Self Care!

Review Self Care hand-out and make a plan to take good care of yourself

You Make A Difference !!

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!