Collaborative Helping: A Practice Framework for Family-Centered Services Bill Madsen Family-Centered Services Projec

1. Collaborative Helping:A Practice Framework for Family-Centered Services Bill MadsenFamily-Centered Services Projectwww.family-centeredservices.orgmadsen1@comcast.net

2. Plan for Day 1Collaborative Helping Context of Family-Centered Services Collaborative Helping as a principle-based practice framework Importance of attitude or relational stance Usefulness of a Story Metaphor Questions as interventions A practice framework for Collaborative Helping

3. Plan for Day 2Collaborative Helping in Challenging Situations Collaborative Helping in challenging situations Engaging �reluctant� families Having difficult conversations about concerns and worries Applying Collaborative Helping in your own work Wrap-up and integration

4. Family-Centered Services A broad approach to helping families with a wider range of services and flexible funding streams Culturally responsive, strengths-based, collaborative partnerships, empowerment-focused and family-driven Wraparound, systems of care, family group conferencing, and signs of safety as examples

5. Macro and Micro Shiftsin Family-Centered Services In Systems of Care, there are notable accomplishments at a macro-level. At a micro-level, there is less attention paid to the actual conversations between helpers and families. - Ellen Pulleyblank Coffey (2004) Workers were often operating without a clear framework to guide their work and important contributions from family therapy about engaging families, sustaining working relationships, hosting therapeutic conversations and building resilience were not being utilized.

6. Collaborative Helping An integrative principle-based practice framework for helping Emphasizes the relational stance we take with the people we serve Grounded in a story metaphor Organized around inquiry � our expertise is the ability to ask compelling questions

7. Collaborative Helping draws from: Appreciative Inquiry Motivational Interviewing Narrative, Solution-Focused, and Collaborative Therapy Approaches �Signs of Safety� work in CPS The reported experiences of families.

8. Decision-Making in Family-Centered Practice This work is messy. It often demands that we focus on the exception rather than the rule. At the same time, it is important that helping responses are grounded in a clearly articulated set of assumptions and principles. Efforts to bring order and certainty to work characterized by unpredictability run the risk of �missing the point.� We need to (re)discover our traditional strengths in working with ambiguity, uncertainty and complexity. (Parton and O�Byrne; 2000) Social work is in danger of losing its first voice of human connectedness and care due to the profession�s desire to validate our actions through �scientific claims.� We need reclaim the often obscured local knowledge at a front-line level (Weick, 2001).

9. Disciplined Improvisation Responding to the �messiness� of everyday practice often requires on-going learning with flexibility and improvisation. �Improvisation is too important to be left to chance� � Paul Simon Disciplined Improvisation � Developing flexible maps to operationalize family-centered values and principles the everyday �messiness� of practice

10. Some Advantages of Principle-Based Practice It offers a flexible map to help workers ground their work in core principles in the everyday �messiness� of practice. It promotes helper agency and ownership in their work. It contributes to practice depth and helps new developments to �stick.�

11. Relational Stance of an Appreciative Ally Standing in solidarity with the people we serve to help them develop preferred directions in life. Respect, Connection, Curiosity, and Hope.

12. Four Guiding Commitments Striving for cultural curiosity and honoring family and community wisdom. Believing in the possibility of change and building on family and community resourcefulness. Working in partnership with families and communities and fitting services to families rather than families to services. Engaging in empowering processes and making our work accountable to the people we serve.

13. Common Factors Literature

14. Conclusions of APA 29 Task Force on Empirically Supported Treatment Relationships: The therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of specific type of treatment. Efforts to promulgate practice guidelines or evidence-based lists of effective psychotherapy without including the therapy relationship are seriously incomplete and potentially misleading on both clinical and empirical grounds.

15. Literature from Child Protective Services Best outcomes for children and families occur when constructive working relationships exist between families and professionals and between professionals themselves.

16. Safety-organized, relationship-based child welfare practice Olmsted County � Minnesota - 1995 � 2007: Children coming into the system tripled. % of children taken into care halved % of families taken to court halved Recidivism rate - 2% (Federal standard is 6.7% which very few states meet)

17. Considering the Importance of Organizational Context 3 year study of 250 children served by 32 public children�s service offices in Tennessee. (Glisson & Hemmelgarn; 1998) Organizational climate (low conflict, cooperation, role clarity and personal relationships) was the primary predictor of positive service outcomes (children�s improved psychosocial functioning) and a significant predictor of service quality.

18. Organizational Climate, Turnover and New Program Sustainability Nationwide study of 100 mental health clinics in 26 states. - Glisson, et. al 2008 Organizations with strong organizational climates and cultures had half the employee turnover and sustained new programs for twice as long as organizations with weaker organizational climates and cultures.

19. Mary Byrne Study (2006) Compared CPS workers in Massachusetts using a strengths-based service planning approach with those using a traditional protective services approach (n=467) Found that workers using a strength-based approach had: Higher sense of self-efficacy in their work Lower sense of compassion fatigue Lower rates of burnout Higher rates of compassion satisfaction Higher rates of job satisfaction Suggests that Collaborative Approaches positively sustains CPS workers and offers the best continual learning and renewing environment for workers. 

20. Relational Stance as the Foundation for our work Clinical Practices (What we do with people) Conceptual Models (How we think about people) Relational Stance (The attitude with which we approach our people)

21. Evaluating the Effects of our Clinical Practices on Relational Stance Client Cultural Competence Inventory (Gail Switzer, et.al 1998) Family-Centered Behavior Scale (Chris Petr, Univ of Kansas) ORS and SRS Rating Scale (Miller, Duncan & Sparks, 2003) Wraparound Fidelity Index

22. ORS � Outcome Rating Scale People served evaluate how they are doing: Individually (personal well-being) Interpersonally (family, close relationships) Socially (work, school friendships) Overall (general sense of well-being)

23. SRS � Session Rating Scale People served evaluate how therapy is going in terms of factors empirically shown to be related to effective therapy: Degree to which they felt heard, understood and respected Degree to which therapy focused on what they deem important Degree to which they felt therapist�s approach is a good fit for them Degree to which the session felt right for them.

24. Wraparound Fidelity Index Four brief interviews (with caregivers, youth, wraparound facilitators, and team members) that measure the nature of wraparound process that a family receives. Keyed to 10 core principles of wraparound across 4 phases (engagement and team preparation, initial planning, implementation and transition). The process can also include team observation measures, document review measures, and an inventory of community supports for wraparound services.

25. Questions to guide efforts to insure that our work is effective and cost efficient How do we make sure that the voices of people served are included in outcome measurement efforts to ensure continued accountability to them? How do we develop nuanced measures that recognize that a particular helping practice cannot be separated from the worker practicing it and that helping relationships are jointly developed? How do we develop measures that recognize the uniqueness of human beings and encourage tailoring our efforts to particular individuals and families rather than specific conditions?

26. Questions to guide efforts to insure that our work is effective and cost efficient How do we take into account the importance of client factors and relationship factors as the two biggest contributors to psychotherapy outcome as we attempt to develop outcome measures and not focus only on isolated techniques (even though they may be easier to measure)? Finally, how do we think carefully about our intentions, purposes and values in this work to ensure that we are measuring what is valuable rather than simply valuing what is measurable?

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28. Metaphors that Guide our Work Romantic Metaphor � Peeling the onion Systems Metaphor � Fixing the broken machine Story Metaphor � Examining with people the stories that shape their lives From: Monk, Winslade, Crockett & Epston (1997). Narrative Therapy in Practice: The Archeaology of Hope.

29. Romantic Metaphor�Peeling the onion� People have an essential self, inner core, true nature. People seeking help are struggling with deep and painful conflicts or hurts that are covered up by defensive layers that serve a protective function. Our work is a process of working through defensive layers to get at inner core and express true feelings.

30. Systems Metaphor�Fixing the broken machine� Families are systems that have self-regulating rules and structures. Families seeking help are analogous to a broken machine. Our work is a process of identifying the problem, developing a treatment plan based on normative models of family functioning, and intervening to help family function better.

31. Post-Structuralist Metaphor�Families as storying cultures� We can think about people and families as cultures that organize their lives through stories. People come for help when organizing stories become stuck and obscure abilities, skills and wisdom that can help them in life. Our work can be a process of examining the stories that organize life, reflecting on the degree of fit and helping people �live into� stories that best serve them.

32. Clinical Implications of Post-Structuralist Metaphor Shift in therapeutic positioning from a hierarchical role of an outside expert attempting to repair family dysfunction to a lateral role of an appreciative ally working with families to help them develop desired lives with the support of their local communities.

33. Examining the Usefulness of a Story Metaphor

34. Stories, Experience, and Family-Helper Interactions Our stories about our lives shape our experience of our lives. Individual stories are embedded in and shaped by broader cultural narratives. Helpers� interactions with people served invite the enactment of particular life stories.

37. Introduction of Collaborative Inquiry

38. Collaborative Inquiry A process of joint exploration in which helpers pose questions designed to elicit people�s abilities, skills and knowledges in order to make them more available for constructive use. Not discovering pre-existing knowledge, but jointly developing it in therapeutic conversations.

39. Collaborative Inquiry Good questions generate experience. We ask questions that invite both the telling of a story and the experience of living that story. Not �old, bad� to �new, good� stories, but rather �thin� or under-developed stories to �thicker,� more richly described stories.

40. Collaborative Inquiry Our skill as helpers lies primarily in our ability to ask questions that elicit, elaborate and acknowledge people�s abilities, skills, and know-how that have been previously obscured. This process does not require helpers to ignore their values or abdicate their knowledge, but views professional knowledge as supplementary to the local knowledge of people served.

41. A Practice Framework for Collaborative Helping Building a foundation of family engagement. Helping family members envision preferred directions in life. Helping family members identify obstacles to as well as supports for preferred directions in life. Helping family members address obstacles and draw on supports. Helping family members develop a community to support the enactment of preferred lives.

42. A Framework for Collaborative Child Welfare Practice Building a foundation of family engagement. Developing a shared goal to insure safety, well-being, and permanency. Identifying signs of danger/risk and signs of safety to support the goal of safety, well-being, and permanency. Helping family members address signs of risk and draw on signs of safety, while maintaining a bottom line. Helping family members develop and draw on communities of support to maintain safety, well-being, and permanency.

43. VisionWhere would you like to be headed in your life? Obstacles What gets in the way? Supports What helps you?

44. Building a Foundation of Family Engagement Getting to know family members in ways that humanize them, build connection with them and encourage hope for shared work, while keeping important issues on the table.

45. Helping People Envision Preferred Directions in Life Envisioning a non-problematic future. Focusing on preferred coping in a difficult present.

46. Questions to Help People Envision Preferred Directions Beginning at the end Progress since first contact Miracle question Moving from absence to presence Appreciative inquiry questions Complaint to commitment questions

47. Vision Obstacles Individual level Interactional level Socio-cultural level Supports Individual Level Interactional level Socio-cultural level

48. Preferred Directions in Life Obstacles: Problems Experiences and feelings Old Habits and practices Constraining interpersonal interactions (vicious cycles) Beliefs, lifestyles, life stories Dilemmas and difficult situations Broader constraining cultural expectations Supports: Abilities, Skills and Knowledge Counter habits and practices Sustaining interpersonal interactions (virtuous cycles) Intentions, values, hopes, and commitments Supportive community members Broader sustaining cultural expectations

49. Viewing People as Being in a Relationship with Obstacles People are in an on-going and changeable relationship with the obstacles in their lives. The Person is not problematic. The Obstacle (problem) or the Person�s relationship with the Obstacle is problematic.

50. Obstacles and Supports as Externalized Elements

51. People are in a Relationship with Problems (Obstacles)

52. Some Advantages of Externalizing Creates a space between people and problems that enables people to draw on previously obscured abilities, skills and know-how to revise their relationship with the problem.

53. Some Advantages of Externalizing Allows a way to disentangle blame and responsibility. Problems are to blame for their effects. People are responsible for their responses to the invitations of problems.

54. Some Advantages of Externalizing Can help workers develop a more compassionate and connect view of people who engage in off-putting behaviors.

55. Some Advantages of Externalizing Offers a way to transcend dichotomy between problem and solution focus. Acknowledges problems and focuses attention on people�s resourcefulness in dealing with problems.

56. A Simple Outline for Externalizing Conversations

57. Purpose of Experience Questions To separate the problem from the person through externalizing language and develop a rich understanding of a person�s experience of their relationship with that problem.

58. Purpose of Effects Questions To develop a thorough understanding of the effects the problem has had on the person in varied aspects of their life as well as on important relationships in their life. While we may learn about complicated, multi-textured effects and possibly beneficial effects, the primary focus is on negative effects of the problem.

59. Purpose of Preferences Questions To invite a person to consider whether particular effects of a problem suit or do not suit the person�s preferred direction in life. To offer them an opportunity to take a position in relation to the problem, make their values and intentions known, and mobilize and align emotional energy behind that position.

60. Purpose of Preferred Responses Questions To elicit and elaborate a story of the person�s attempts to develop a different relationship with the problem (which may be to resist it, oppose it, overcome it, cope with it, contain or outgrow it, utilize it constructively, etc.). To invite the person to ascribe meaning to this story and examine future possibilities as the story unfolds.

61. A More Complex Map for Externalizing Conversations Story of Problem�s influence on Person Tracing the history of the problem Mapping the effects of the problem Exposing the tactics of the problem Identifying supports for the problem Story of Person�s influence on Problem Identifying exceptions to the Problem�s influence Developing counter-story of person�s influence Elaborating the meaning of counter-story story Building supports for the person

63. Re-Thinking �Strengths� We can elicit �strengths� in relation to an agreed upon goal (e.g. elements that support a parent�s �best judgment� with his/her children). We move from an internal view of strengths (as characteristics) to an intentional view of strengths (as skills of living, intentions, purposes, values, beliefs, hopes and dreams).

64. Questions about �Strengths� The ways in which a particular Strength is put into practice. The abilities, skills and knowledges that comprise this Strength. The history of the development of this Strength. The important others in a person�s life who have contributed to this Strength. The meaning this Strength holds for the person. The intentions, values and beliefs, hopes and dreams that stand behind this Strength.

65. Helping People Develop a Community of Support for New Lives It takes a village to raise a new story If identity is created in social action, it is important to find an appreciative audience for change. Recruiting communities of support can counteract the isolating effects of problems and help people stay in touch with preferred versions of who they are in life.

66. Developing Communities of Support Using re-membering conversations to evoke the presence of potential allies. Using reflecting teams or witnessing groups to engage actual audiences Using written documents to support witnessing Helping people identify, utilize and sustain actual allies in their daily lives.

67. Re-membering Conversations Re-membering conversations help people connect to and internally hold the voices of an appreciative audience. This audience could include important persons in the present or past, people who have passed away, pets, stuffed animals, admired celebrities, historical or literary figures, or spiritual presences.

68. Steps in Re-membering Conversations (1) Identify people or beings (alive or dead, real or imagined) in the person�s past or present who would could serve as allies; recognizing, appreciating and standing in support of the person�s preferred response to problems or pursuit of preferred directions in life. Get details of that relationship and its importance to both the person and ally.

69. Steps in Re-membering Conversations (2) Elicit specific times in which the ally witnessed examples of life outside the problematic story or within the alternative story. Elicit a detailed story of those events (e.g. who, what, where, when, and how) and their meaning through the ally�s perspective.

70. Steps in Re-membering Conversations (3) Weave together contributions the ally has made to the person�s life and possible contributions the person has made to the ally�s life. Explore the effects of these reciprocal contributions and their respective implications for the person�s identity.

71. Steps in Re-membering Conversations (4) Link the conversation to the present situation and to future possibilities. Inquire whether the person would be interested in bringing the ally�s presence more into their current life as a community of support for preferred directions in life.

72. Questions to Guide Reflections What were you particularly moved by in this conversation? (evoked images) How does that resonate with events in your own life? (embodied speaking) What from this conversation would you like to carry back into your work of life? (acknowledging impact)

73. Summary of Collaborative Helping Map

74. VisionWhere would you like to be headed in your life?Forward thinking, mutually shared, concrete visionBuilt on a foundation of motivation, resourcefulness and community Obstacles What gets in the way? Described in a way that externalizes problems Identifying obstacles at individual, interactional, and socio-cultural levels Supports What helps you? Described in a way that internalizes agency Identifying supports at individual, interactional, and socio-cultural levels

75. Day 2 Putting Collaborative Helping into Practice in Challenging Situations

76. Engaging Reluctant Families

77. Understanding Family Positions Services as a cross-cultural negotiation Beliefs about the Problem Beliefs about what should be done about the Problem - Treatment Beliefs about who should do what in relation to the Problem - Roles

79. �This is a Problem and I want to do something about it�This person is ready to do some work -We all prefer this!It is easierWe often secretly hope this is where people will be at and are disappointed when they are not

80. �No Control� Stance Situations where people express their helplessness about situation and can be seen as complaining, passive or �co-dependent.� Workers can fall into attempting to convince people served that they can or need to do something about the problem or trying to get people served to see how they are contributing to the problem. People served can experience these efforts as �minimizing� the magnitude of their difficulties and respond with arguments for why change is not possible.

83. Map for �No Control� Stance

84. �No Problem� Stance Situations often referred to as �denial.� Workers can fall into attempting to convince people served that the problem exists or try to force them to agree with how we see things. Workers and people served end up building their relationship around vastly different ideas about the problem and different agendas for dealing with it.

86. Map for �No Problem� Stance

87. Two Important Shifts in Challenging Constraining Patterns Shift from a focus on what caused the problem to what constrains alternatives. Shift from worker challenging constraint to worker offering irresistible invitations for person served to challenge constraint.

90. Difficult conversations about concerns and worries

91. Signs of Safety A Solution-focused approach to child protective services. Signs of Safety by Andrew Turnell & Steve Edwards � 1999 Working with Denied Child Abuse by Andrew Turnell & Susie Essex � 2006 www.signsofsafety.net

92. Three Questions

93. Three Questions

94. Danger Actual experiences of past harm to a child by a caregiver Actual experiences of current or ongoing harm The resulting likelihood of repeated future harm (RISK) Statistically, the best predictor of future harm is past/current harm The key is to consider the impact the danger has to children: There are difficult things that happen to and within families that don�t impact children. Shorthand: CAREGIVER, BEHAVIOR, IMPACT

95. Complicating Factors Warning signs, red flags, issues that make the provision of protection more difficult but in and of themselves are not direct dangers Mental illness, teenage parenting, poverty, low IQ, what else?

96. Safety Safety is regarded as actions of protection (specifically related to dangers & concerns) demonstrated over time All families have some signs of safety The best predictor of future protection is past protection Without searching for examples of protection it will be difficult to know the extent of the signs of danger or to determine how protection could be enhanced and measured in the present and future

97. Supporting Strengths Skills of living, coping skills, cultural or familial histories of recovery or support that are important but do not directly support the provision of protection Being organized, exercising, being good at sports/school, what else?

100. Safety Planning Detailed plans made in response to specifically identified and understood dangers Describes specific actions that family members can/must take to address the dangers Are developed and refined over time (they are a process not an event) Should involve everyone in the family and be communicated to as wide a range of formal and informal community members as possible

101. Making a direct connection

103. Three Questions with Children

105. To sexual abuse slide is 25 minutesTo sexual abuse slide is 25 minutes

107. Applying Collaborative Helping Map to your own work

108. Supervisory Interview As this interview progresses, please trace out: Vision (agreed upon focus of the work) Obstacles (elements that constrain helping progress) Supports (elements that support helping progress)

109. Vision Obstacles Supports

110. Collaborative Helping Map in SupervisionVisionIn 25 words or less, where would family say your work together is headed?In 25 words or less, what would you say your work with this family is headed?On a scale of 1-10, how would family members and you say the work is going?Are there other concerns or risk factors we should keep in mind? Obstacles What would different parties say gets in the way of the work going better? Identify obstacles at family, family-helper, and helper levels. Supports What would different parties say has contributed to the work going as well as it has? Identify supports at family, family-helper, and helper levels.

111. The ABCs of Collaborative Helping As you think back over the various ideas and thoughts that have emerged over our time together: What is one thing that you are already doing in your work? What is one thing that you would like to begin doing in your work? What is one thing that you might like to change doing in your work?