Coaching Out of the Box With Families: The Sunny Hill Pilot Project

1. Coaching Out of the Box With Families: The Sunny Hill Pilot Project We Want To Live It! Feb 28, 2013

2. Project Team & Partnerships • AldaAntunes Silvestre, RN BSN MSN • Sandy Tatla, MSc. Candidate, MOT, • Shelley Woodman, RN, BScN • Dori Van Stolk, RN, BScN, MA, CEC • Tal Jarus, Phd, OTR • Susan Greig, Partners in Care Family Liaison • Meghan Husson, MOT Candidate • Stacey Burnes, MOT Candidate

3. Outline • Literature Background • The Sunny Hill Experience • Coaching out of the Box • Pilot Project • Preliminary Findings • Lessons Learned • Closing

4. Literature Review: The Gap • Family involvement is frequently identified as a key element of successful rehab Yet, we don’t know how clinicians can best involve them1 • Family centered care & effective communication were among the top quality of care indicators for rehabilitation of children with traumatic brain injury2 • A strong need exists for improved communication skills3

5. Literature continued… • Health care professionals need to work together and also with the patients & their families5 • Disrespect or insensitivityreported more commonly than technical errors in diagnosis and treatment4

6. Approaches to Improve Communication • Various methods used to improve communication skills, including: • training workshops run by experts • lectures and education sessions • interviews and questionnaires • role playing and feedback in small groups • shared decision-making training

7. Our Challenge – “Connecting With” Families The Chinese Characters for Listening: 1. Ear Gather 2. Eye Perceive 3. Heart Sense 4. King Respect

8. Who you need to be • Curious • Supportive • Accepting • Focused • Committed How: 5 steps • Identify • Discover • Strategize • Clear the way • Recap What Skills To Use • Listening- 3 Levels • Encouraging • Questioning • Requesting • Action Planning Level 1 Listening…………………………………………”Scratching The Surface” Level 2 Listening…………………………………………What is said – Content Level 3 Listening…………………………………………What We Feel + Think Coaching Fundamentals

9. Project Aim • To demonstrate the feasibility of coach training • Improve family & service provider: • Satisfaction • Communication • Engagement • Collaboration ….To ultimately facilitate a successful rehabilitation experience

10. Multi-disciplinary Acute Rehabilitation Team in pediatric rehabilitation centre 45 health care professionals Family representatives Participants

11. Intervention • Workshop 1: • Core Coaching Competencies & the Case for Coaching • Workshop 2: • Who you need to be • Naming Triggers • Taming Triggers • Learning Language • Yours, Mine & Ours: Shared Goals • Learning in relationship Practice, practice… and more practice!

12. Mixed Methods Evaluation

13. Preliminary Results • Feasibility • Participation • 93% participation in coaching workshops • Triads still in process @ 5 months • Learning Burst workshops in process • 1st burst: 75% attendance • 2nd burst: 43% attendance (nursing was missing due to staffing issues) • Budget • Ongoing facilitation needs • Anecdotal results • Satisfaction • Communication • Engagement • Collaboration

14. Lessons Learned Family representation was critical to the program’s success All stakeholders need to buy-in Recognizing the different work flows of a multidisciplinary team Learning as a team was key to providing a shared language & common approach to care Practicing the skills & follow-up is critical Facilitating the sustainability of coaching within our team Next Steps….. “Something is happening”…… synergy is occurring as team members learn & journey together

15. Closing • Have an understanding of: • Literature & Practice Gaps in Communication • Coaching Pilot Project • Preliminary Findings from the project “The Road goes ever on and on Down from the door where it began. Now far ahead the Road has gone, And I must follow, if I can, Pursuing it with eager feet..” J.R. Tolkien Thank you!

16. References • Levack, W.M.M., Siegert, R.J., Dean, S.G., & McPherson, K.M. (2009). Goal planning for adults with acquired brain injury: How clinicians talk about involving family.Brain Injury 23(3), 192-202. DOI: 10.1080/02699050802695582 • Rivara, F.P, Ennis, S.K., Mangione-Smith, R., MacKenzie, E.J. & Jaffe, K.M. (2012).Quality of care indicators for the rehabilitation of children with traumatic brain injury. Arch Phys Med Rehabil, 93, 381-395. DOI:10.1016/j.apmr.2011.08.015 • Lefebvre, H., Pelchat, D., Swaine, B., Ge’linas, I., & Levert, M.J. (2005). The experiences of individuals with traumatic brain injury families, physicians and health professionals regarding care provided throughout the continuum.Brain Injury 19(8), 585-597. DOI: 10.1080/02699050400025026 • Jangland, E., Gunningberg, L., & Carlsson, M. (2009). Patients' and relatives' complaints about encounters and communication in health care: evidence for quality improvement. Patient Educ Couns, 75(2), 199-204. doi: 10.1016/j.pec.2008.10.007 • Legare, F., Politi, M. C., Drolet, R., Desroches, S., Stacey, D., Bekker, H., & Team, Sdm-Cpd. (2012). Training health professionals in shared decision-making: an international environmental scan. Patient Educ Couns, 88(2), 159-169. doi: 10.1016/j.pec.2012.01.002

17. Extra Slides

18. Next Steps • Continuing coaching & learning bursts in the Fall as part of core competency development for our all staff in our setting • Articulate & integrate these core competencies into our orientation pathway for new staff • Explore strategies to continue to nurture & facilitate the integration of coaching into practice • Move from individual awareness to more dialogue & work on the team

19. Challenges/ Limitations • Time • Reflection – both in the moment & after • Ongoing practice, mentorship, own coaching • Integration + testing of new learning & skills in the moment; trial + error • Recognition what skills/tools to use in the moment or context (eg. verbal aggression) • Knowledge & wisdom

20. Rehab: Philosophy of Care • Maximizing people’s potential • Def: “Habilitation includes all the activities & interactions that enable an individual with a disability to develop new abilities to achieve his/her maximum potential, whereas rehabilitation is the re-learning of previous skills, which often requires an adjustment to altered functional abilities and altered lifestyle. (Pg 4, Edwards, Hertzberg, Hays, + Youngblood, 1999, pediatric Rehab Nursing). • Patient engagement is fundamental – the vehicle – to maximize rehab benefits (Lequerica & Kortte, 2010).

21. Mixed Methods Evaluation • Quantitative Pre & Post Evaluation: • Feasibility • Measures of Processes of Care-Service Providers (MPOC-SP) • Study-Specific Coaching Skills Questionnaire • Tracking of Communication Related Safety Events • Measures of Processes of Care-Families (MPOC) • Qualitative Evaluation: • Field notes throughout intervention • 1:1 qualitative interview with families present pre & post (n=1) • Focus groups: Service providers • Focus groups: Families

22. Feasibility