Problem Solving Strategies for Coordinating Services

Problem Solving Strategies for Coordinating Services Juliann Woods, Ph.D. Florida State University June 18 PA Service Coordination Institute

TaCTICS http://tactics.fsu.edu

Our Goal To explore strategies that enhance our capacity to establish a problem solving approach within the early intervention service coordination and service delivery process

Consideration #1Recognize Adults as Diverse Learners You are in 1st grade… In your class, of 26 students 10 are from single parent households with low income 4 receive ST services 1 is repeating 1st grade 1 has mild cognitive delays, CP and receives resource support, PT 1 has ADHD and is on medication 1 has diagnosis of ASD (Asperger’s) and is not receiving any services 3 are being tested for the gifted program 8 are reading above grade level 6 are not reading at all 1 is in foster care 1 daddy just died 1 daddy is in jail 1 family is divorcing And what about your case load?

Comfortable Environment Respect for Values and Priorities Effective Communication History and Experiences Contributions and Participation Collaboration and Problem Solving Applicability to Life and Functionality Competing Commitments 8 Strategies to Support ALL Adult Learners

Identifying Adult Learning Styles • Why? • Enhances FSC ability to meet individual needs • Increases meaningful and confident family participation in EI process • Increases effectiveness and efficiency of services • How? • Formal measures • Continuum- intelligence tests to standardized questionnaires • Informal strategies • Continuum- professional assessment to self description

Active Experimenters Give it to me! Just do it; try, practice Parent completed measures e.g. LSI, interactive web sites Conceptualizers Tell me about it! Think, analyze, question Handouts, articles, case study, e-mail Observers Show me! Watch and reflect Videos of other parents or role play activities Experiencers Share with me! Feel, listen, project Questionnaires, structured interviews, parent-to-parent Adult Learning Styles

Learning About Adult’s Learning • Listen • Seek clarification: When you were identifying routines you mentioned you liked to read to Billy, would you like some information about EI to read? • Validate: You’ve mentioned different web sites, have you visited ours? You said you hated filling out forms, would like help with ours? • Ask • Just ask: Do you have any preferences for how information is shared with you? • Provide alternatives: Would you like to complete this later? With your partner? Would you like to read it? Would you like to do it together? • Support reflection: At other times when you have had new information that was important to you, what were the easiest ways to manage it?

Learning About Adult’s Learning • Observe • Analyze and hypothesize: Where do they sit? What do they do with papers? Do they ask questions? Are responses detailed or 1 word? • Scan environment: Are videos, computers, books, magazines, puzzles, newspapers in sight? • Follow-up: As relationship develops, which strategies seem to be most effective? • Join • Brainstorm: Use flip chart paper to record ideas, write lists and options. • Visualize: Ask for descriptions by the caregiver, draw out options or maps. • Problem solve: Set up situations, role play, case studies and record responses. Ask for feedback on satisfaction with the approach. • Strategize: Demonstrate the various strategies that could be used for gathering the information or embedding the intervention

Applying Adult Learning to FSC • Good News is… few folks are just 1 style • Combination strategies serve many • Questionnaires, checklists, pamphlets, videos, conversations, surveys • It’s the way YOU use the tools! • Adults can learn to use various strategies with support and need to for future programs • Participation is dynamic and progressive • IF… you set the stage for more

Consideration #2Recognize we’re in the problems too Have you ever heard (orasked) questions like these? • Who is supposed to do that? • Why can’t they communicate better? • How did that family fall between the cracks? • Why do we have to make more changes? • Why am I getting more assignments? • When can we just do our jobs?

Or these? • Why weren’t they home for the appointment? • How can they afford cable and cell phones but not food and diapers? • Why don’t they do their therapy activities? • How can they have routines when they don’t have any schedules?

IQs (akaIncorrect Questions) • Implies something or someone else is responsible for the problem or situation • Formed from a defensive or frustrated posture • Negative, blaming, judgmental, fearful • Indicates loss of control or choice • Results in procrastination • We – vs – them thinking and acting

Another Strategy…Question Behind the Question • What to really ask yourself: Practicing personal accountability in business and in life by John B. Miller www.QBQ.com • Affirms each of us has control… of ourselves • Focuses on action • Requires risk taking and courage • May result in mistakes but also learning and growth • Increases ownership, confidence, responsibility

QBQsQuestion behind the Question • What can I do to support you? • How can I make a difference with my team? • What can I change to improve my service to families? • How can I do my job better? • What can I do to improve the working situation for all? • What can I do to better understand your concerns? • How can I adapt to the changing world?

The Spirit of the QBQ • Begin with what or how • Not why, when, or who • Contain an “I” • Not they, them, we or you • Focus on action • Not procrastination, blaming or thinking

Consideration #3Recognize importance of problem solving • Randomized control group of families with a child diagnosed with cancer. Treatment group reported 48% higher intervention satisfaction scores and 78% higher quality of life ratings. • Families of children with significant behavioral challenges reported decreased stress and increased confidence in ability to parent child after intervention. • Teen age mothers identify the intervention as the most important component of the afternoon parenting and child education program. • What Is the Intervention? PROBLEM SOLVING SKILLS

4 Basic Steps for Problem Solving • Step 1. Defining the problem with data • Step 2. Generating ideas • Step 3. Evaluating ideas and choosing solutions • Step 4. Developing and implementing the plan

Problem Solving for Natural Environments and Service Coordination • Step 1. Defining the problem with data • What is the problem? • Who is affected? How? • What is the impact? • What could happen if it is ignored? • What could happen if it is addressed? • What are the facts? What is believed? • When, where, how and who should join in the problem solving process?

Defining the Problem – What and why? • Essential to determine what the problem is prior to determining how to solve it • Perceptions and assumptions must be identified • Data helps identify who should be involved and the structure of the problem • New definitions should be viewed as “working hypotheses” and open to further clarification • Too much information can limit creativity and enthusiasm for the process

Problem Solving for Natural Environments and Service Coordination • Step 2. Generating ideas • What has been tried? What worked? What didn’t? Any ideas why? • What recipes or guidelines have worked before? • What other ideas should be considered? • Suppose we couldn’t do it the way we always have, what should we do? • What have I always wanted to try? • What could technology offer? Additional resources of people, time, money?

Generating Ideas -Who and how? • Initially involve only those directly affected, interested, and able to contribute – more (people) isn’t necessarily better • Be informal but organized and systematic • Keep a record for easy review; set a time limit • Defer judgment – no criticizing, commenting, chuckling, teaming up. Be creative and crazy • Build on each other’s ideas – group intelligence is good – more (ideas) are better • Visualize the solution … what did it take?

Problem Solving for Natural Environments and Service Coordination • Step 3. Evaluating ideas, choosing solutions • What key factors must be considered? • What ideas “jump” to the top of the list? • How can ideas be combined to improve quality? • Are there any that can be eliminated as not feasible due to the key factors? • What has been ignored that should be reviewed? • Have any new ideas come up for consideration? • What looks like the best solution? • What might go wrong? What is the back-up plan?

Choosing Solutions • Watch the process • All voices, all ideas, all equal • Monitor emotion, tone, language • Stay on task and watch time • Use visuals to enhance memory • Highlight key factors for constant review • Underline, circle, check BUT gently… opinions change as the process continues • Clarify, review, sequence • Address best and worst case scenarios • Be willing to try new things (community options)

Problem Solving for Natural Environments and Service Coordination • Step 4. Developing and implementing the plan • What should be tried first? • What is an alternate plan? • Are resources (people and objects) available? • Who will do what? When? How? • What are the most important steps to prevent problems? • Who will monitor actions? • How will we know if it works?

Developing the PlanWhat, when, where, who • Address questions… now and later • Share the responsibilities (but not everyone has to be equal) • Get it in writing (but remember not all adult learners will respond… you can!) • Establish a plan for communication • Be realistic with timelines • Put “first things first”

Problem Solving for Natural Environments and Service Coordination • Choose the right approach • One size does not fit all • Use ready made solutions when appropriate • More isn’t better… enough is just right • Include informal supports and mentors • Promote independence • Timing is essential • Don’t wait too long… think prevention or early intervention… not crisis • Plan enough time for the process • Follow-up consistently and revise as needed

Problem Solving for Natural Environments and Service Coordination • Set the stage • Be prepared… setting, people, materials • Be sensitive to all the participants • Orient the group or individuals to your plan • Provide options and have back-ups if needed • Establish roles to increase participation, organization, efficiency, focus • Stay organized and keep participants engaged • Be prepared for disagreement; use consensus building strategies or voting

Strategies • Individual • Incidental: What do you think would happen if (C)? Let’s try this together (E). You told me you gave him your purse to out to the car… what could you try like that for getting from the car back in?(R) • Planned: Last week we talked about… Show me what worked… and we’ll try… I brought the materials for making… KISS; systematic observation data collection, list serv, chat rooms • Small group • Scheduled (IFSP review) • Ecomaps, Community Maps, Brainstorming, Force Field • Team • Creative Problem Solving; Group Process Approaches

Situations for Consideration • Initial Contacts • Assessment/Evaluation • IFSP Development • Intervention • Annual Re-evaluation • Transition

All about Aden • Aden was referred to EI at 18 mo. by his physician with concerns about hearing, communication, vision and general development delays. Several medical conditions have been considered but no diagnosis determined. Grandma is a retired teacher, has custody of Aden and an older sibling; mom has rejoined the family after drug rehab, is working toward restoration of rights and is seeking employment and a GED. G’ma wants Mom to succeed. No developmental testing has been completed for Aden. Medical records are available. • A newly employed FSC is assigned and asks colleagues in the office to problem solve what to consider on the initial contact. She feels under-prepared for the complexity of Aden’s needs and can’t understand why someone else won’t take the case. • What problem solving strategy (ies) would you use? What about the QBQ? Whose adult learning style should be considered?

Aden’s Assessment & Evaluation • The family has been involved with the medical model for Aden since shortly after his birth. Grandma is disappointed that no condition or cure have been identified. Mom is fearful, feels guilty, and is unsure of her parenting skills and the role she should play in Aden’s EI program. G’ma is practical and action oriented. She wants to get busy helping Aden anyway she can. • The FSC has pulled the team together to plan for the upcoming MDE. The team consists of an ST, ECSE, FSC and a consulting nurse from the Health Department. • What should the team consider? What strategies should the FSC plan to use to get the most done with the team? What knowledge is available about the adults’ learning style?

Aden’s IFSP • Aden spends most of his time with G’ma and big sister at G’ma’s house. Mom spends time looking for work, at NA, and taking classes. She watches the kids evenings so G’ma can participate in Church activities. Aden sees MDs almost every week. He travels with G’ma to and from Sissy’s school if mom isn’t home. He doesn’t have any organized social settings. His health is a constant concern. He likes to watch videos, play with his cars and trains, and walk around the house following the cat. G’ma feeds him to assure he gets adequate intake.He cooperates with hygiene activities but shows little independence. G’ma sees his health as a priority. She is relieved to know his vision and hearing are fine. Mom would like him to begin using words rather than the squeals and gestures he currently prefers. G’ma thinks that Sissy will be a great teacher and should be involved in his school work. • What problem solving strategies will facilitate the team’s and family’s development of a functional and meaningful IFSP? What community options should be discussed? What does the family need to know about NE? How can it be presented? What routines can be identified?

Getting into the Routine • The FSC checks in with the family and learns that G’ma and Mom are pleased with his progress. He is receiving ST twice a week at home; a home based teacher 2x week; a visiting nurse 1x month. The ST brings a bag of toys and works with Aden in his room. The EI works with Aden and makes suggestions to G’ma or Mom. None of the play or care giving routines identified on the IFSP are implemented. • The FSC recognizes that the spirit of NE is not being delivered. What’s a woman to do?????

Annual Re-evaluation • Aden is using a few words to name things especially in familiar books. He doesn’t engage in appropriate or functional toy play nor socialize with his sister. His health has improved significantly and the nurse has discontinued services. He still does not have a diagnosis. His motor skills are his strength. G’ma has begun to notice he does the same actions over and over and often begins to squeal when he is walking through the house. Mom is pleased at Aden’s improvements and at her ability to interact with him. He helps her get him dressed and in the bathroom. He is eating more and feeding himself. • The ST and EI are both concerned that Aden may have autism or PDD. They have not mentioned anything to G’ma or Mom. • What strategies might the team use during the IFSP annual meeting to discuss their concerns? How might they evaluate the effectiveness of their service delivery model?

Transition… Oh the places • Aden will be turning 3. Transition conversations have been occurring on a regular basis to prepare the family. G’ma has been firm in her commitment to seeking private services and maybe a private preschool as Aden’s health would tolerate. It is now 6 months prior to his actual birthday and Aden is undergoing educational assessments for ASD. • G’ma and Mom are realizing the importance of peer social interaction for Aden. They also know that he needs more intensive services and are ready to discuss other options. • What problem solving strategies would you suggest? What steps will be the most important?

Problem Solving Strategies for Coordinating Services