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changing ABLE to:

changing ABLE to:. Able-differently, a Utah non-profit community service PO Box 9757 Salt Lake City, Utah, 84109 801-520-7376 Fax 801-466-7569.

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changing ABLE to:

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  1. changing ABLE to: Able-differently, a Utah non-profit community service PO Box 9757 Salt Lake City, Utah, 84109 801-520-7376 Fax 801-466-7569

  2. ABLE-differently would like to welcome you to this power-point presentation of ideas and services used to serve school age and younger children having secondary social and emotional concerns associated with their special health care needs. We will address several areas important to community health care providers, parents and educators, that they have found useful in their involvement with this population.

  3. Outline of Presentation • 1. Refocus ABLE-differently program ideas. • 2. Change process. • 3. Levels of care and tools for change. • 4. Public Health Model goals. • 5. Understanding complex problems and systems. • 6. The ABLE-differently community process. • 7. Family resiliency. • 8. Interconnections and reconnections. • 9. Relationships to the families and schools. • 10. Health Provider involvement in school/family systems.

  4. -1-INTRODUCTION TO THE ABLE-differently PROGRAM Current focus on three goals

  5. Children are referred to the ABLE-differently Program for having emotional or behavioral excesses or deficits contributing to personal difficulties, or failure within social or educational systems.

  6. ABLE-differently - ProgramLooking children in terms of their functional emotional intelligence: • A – Adapting: personal coping abilities and resiliencies • B – Biopsychocultural behaviors from context of experiences • L – Lifelines: available support systems • E – Experience: social, physical, emotional and psychological

  7. Heidi Ahlers RN Ellen Ahlers RN Lou Allen MD MPH Gail Brown PhD George Delavan MD Susan Dickinson MS Lila Hutchinson Bettyeann Mayer RN Julia Mathews PhD Sterling Redd LCSW Hermann Peine PhD Judy Peters Chris Sandoval Jim Taliaferro LCSW Walt Torres MSW Barbara Ward RN Great thanks to Utah Dept. of Health/ Children with Special Health Care Needs and the many more than listed here and foremost the families who were entrusted to our care and taught us many of these ideas. Past Contributors to Able-differently Program’s Concept

  8. -2-THE ABLE-differenly CHANGE PROCESS FOR INDIVIDUALS AND FAMILIES

  9. Some Initial Social and Personal Barriers to Child and Family Health • Poverty • Lack of or use of Educational Opportunities • Poor Physical Health • Mental Illness • Disabling Conditions • Abuse, Neglect, or Abandonment • Poor Access to Resources • Cultural-institutional Factors and Considerations

  10. People Can Change Personal Stories from Frustration and Hopelessness to Resilience and Strength through use of Team Wraparound Approaches with the family that helps re-story, sometimes hidden, unique exceptions to the problem laden narratives.

  11. Working positively with the people who currently help or support the family or specific family members (family helpers). Learning to recruit community team players. Learning to maintain community helpers. Learning leadership skills. Developing new solutions. Developing communication, problem solving, and goal-setting skills. Must perceive positively their partnership status To be heard, respected, felt and understood so to act on their own preferences and decisions. Families Must be at the Center of a self help Change Process

  12. Family helpers assist families to: • Increase hope. • Be encouraged towards action. • Grow in life skills. • Build supportive relationships. • Be motivated. • Respect their own culture. • Feel cared for and actively care for themselves.

  13. Families Have Opportunities to Learn Community Team Building • Traditional Interventions focused primarily on problems, not strengths. • However, problems often require multiple interventions using resources from many directions. • Therefore, strength-building requires similar support from many sources.

  14. Families Learn to Build Teams Within the Community and share partnerships • Department of Health • Family Medical Care (Medical Home) • Schools • Extended Family • Worship Groups • Social Services • Mental Health Services • Law Enforcement • Friends & Neighbors

  15. -3-ABLE-differently RECOGNIZES AND PROMOTES THE NEED FOR LEVELS OF CARE AND THE CLINICAL TOOLS REQUIRED FROM LOCAL SYSTEMS IN THE COMMUNITY RECOGNIZING ESPECIALLY, FAMILY, SCHOOLS, AND MEDICAL HOMES THAT ARE INTEGRATED AND CONTINUOUS

  16. Health Providers Promotion/Prevention Matrix Levels of Care Levels of ComplexityPRIMARY SECONDARY TERTIARY HIGH COMPLEXITY MULTIPLE CONDITIONS IDENTIFIED INCREASING COSTS MINIMAL IDENTIFIED RISKS NORMAL POPULATION WITH UNIDENTIFIED RISKS

  17. There exists a Clinical Toolbox for Intervention and Integration of the Child and the Family with the Community • Finding the right key to a child or family’s difficulties and unlocking their strengths.

  18. Some Tools in the Box • Traditional and Strength Based Assessment • Education & Working Together • Referrals & Resource Guide • Family & Child Consultation • Promote Mentoring • Support Help that Works • Practices that Look at Solutions • Communication Enhancement • Changing Personal Negative Stories to Positive Stories • Job Sampling • Building Positive Rituals & Routines • Building Positive Self-identity • Focus on everyday function and natural resources

  19. Children and families with the highest risks tend to be the most expensive for society as a whole. ABLE’s rich program resources are not to be absorbed in serving just a select few clients, but also used for the empowerment of a broader community serving the same population. Public Health methods and practices can serve these functions and rightfully should.

  20. -4-THE ABLE PROGRAM USES THE GOALS OF A PUBLIC HEALTH MODEL

  21. By Building Bridges with the Community • The clinical work becomes the workshop for training and teaching the community. • Population based practices are envisioned supporting wellbeing, wellness with imbuing positive mental health within local systems of care for special needs.

  22. Our experience has been both providing health for both the Individual and the general population

  23. By People Understanding and Acting On the Interaction of Complex Issues and Multiple Influences in Their Lives, they can Influence and Determine Their Own Destiny and Health Outcomes

  24. By Providing Cost-effective Models for Community Health • Make available online web based resources. • Assure collaboration among local line services in the community. • Integrate physical and behavioral health in family, schools and health care • Use everyday and natural resources to highlight children’s experiences and their needed stories of those opportunities.

  25. By Demonstrating that Promotion, Protection, and Prevention of many social emotional difficulties associated with special health needs are all important functions of a Public Health System and are presumed to be prerequisites in local communities of care as being in the back yard of the medical home. • There are few magical fixes.

  26. By Supporting the World Health Organization’s Definition of Health as a State of Complete Physical, Mental and Social Well Being-Not Just the Absence of Disease.

  27. -5-THERE EXISTS A NEED TO UNDERSTAND COMPLEX PROBLEMS AND COMPLEX DIFFICULTIES WITHIN COMPLEX SYSTEMS

  28. PROBLEM VS. PROBLEMSWouldn’t it be nice if all children and families came in with just one isolated identified problem? But life is more complex, and multiple difficulties abound and must be understood in more coherent ways.

  29. Patient Characteristics on Intake • Percent of Patients by problem coming into the Salt Lake City ABLE Clinic, and the Provo, Price, Moab, and Blanding Itinerant Clinics in the recent past. • MCH studies reports 13-18% of child population have special needs and close to 40% of special needs have psychosocial needs on the average.

  30. -6- THE ABLE-differently PROGRAM ADMINISTRATIVE AND CLINICAL INTAKE PROCESS

  31. The ABLE-differently Program Services Must Match Needs • Before intake the severity of needs are assessed and immediate referrals are made. • Children and families will be best served by multiple intervention tracks with consideration of non medical and related services as critical as a medical referral. • Families will be involved in making this determination as well as managing their team.

  32. COMMUNITY CONSULTATION TRACK 1. Many Strengths 2. Low Risk 3. Fewer Problems 4. Identified Supports 5. Short Term 6. Problem Focused 7. Physician driven ongoing care. COMPREHENSIVE MULTI-ENCOUNTER TRACK 1. Fewer Identified Strengths 2. Moderate/High Risk 3. Many Problems with lower resources 4. Supports Needing to be Built 5. Long Term 6. Broad Solution Focused 7. Collaborative Team Efforts 8. On Going Follow-up Care Complexity involving social emotional and behavioral concerns May best require collaborative, teaming ABLE-differently Program Two Track Systems

  33. Assessment Instruments Health Care Providers may find useful in their practices will be highlighted in some of the following sections.

  34. Psychological AssessmentAssessing Cognitive AbilitiesCommon Instruments Used or Requested • INSTRUMENT AGES • Bayley Scales of InfantDevelopment 0-4 • WPPSI 4.5-7 • WISC – IV 6-16 • Unit 5-17 • Slosson – R 4-Adult • WCST-64 6.5 - 89

  35. Psychological AssessmentAssessing Learning/Attention Abilities and DeficitsCommon Instruments Used P/T= (Parent/Teacher) • INSTRUMENT AGES • Vanderbilt Assessment Scale 6-12 (P/T) Brown Attention Deficit Disorder Scales (BADDS) 4-Adult • Conners’ Continuous Performance Test 6-Adult • Behavior Rating Inventory of Executive Functioning 5-18 • Behavioral Observations 0-Adult • Child Behavior Checklists 3-18

  36. Psychological AssessmentAssessing a Possible Autism Spectrum Disorder • Instrument Ages • Asperger Syndrome Diagnostic Scale 5- 18 • Autism Diagnostic Observation Schedule (ADOS) 2-Adult • Child Autism Rating Scale (CARS) 3-18 • Autism Screening Instrument Childhood • Clinical Interview2-Adult

  37. Psychological Assessment Depression/AnxietyCommon Instruments Used or Requested • INSTRUMENT AGES • Revised Children’s Manifest Anxiety Scale (RCMAS) 6-above • Reynolds Child/Adolescent Depression Scale (RCDS) Grades 3-6/7-12 • Multidimensional Anxiety Scale 6-18 Suicide Ideation Questionnaire Grades 7-12 Clinical Interview 2-Adult

  38. Psychological Assessment Social/BehavioralCommonly Used or Requested Instruments • INSTRUMENT AGES • (P/T) Conners’ 6-18 • (P/T/Adolescent) Child Behavior Checklist 3-18 • (PT) VINELAND Adaptive • Behavior Scales 0-Adult • Aberrant Behavior Checklist 0-Adult • Positive and Negative • Reinforcer Survey (ABLE website) 2-18 • Behavioral Observations 0-Adult • Youth Outcome Questionnaire 6-18 ABLE Strength 4-Adult Clinical Interview 2-Adult

  39. Family Health Promotion PlanAssessment of Strengths, Weakness and Intervention Strategiesin the Areas Of: • Child • Family • School • Community • Cultural & Economic Factors • Physical & Emotional Health

  40. Child • Self regulation/safety • Belonging/attachment • Exploration/Play • Physical and Developmental Health • Body Systems and Sensory Motor Functioning • Adaptive Self-help • Emotional and Social Health • Sense of Self and Identity • Industry/Achievement

  41. Family • Housing/Food/Income • Insurance • Medical Home • Routines and Rituals • Celebrations/Recognitions • Recreation/Leisure • Extended Family Support • Spiritual Strengths • Mutual Respect • Sanctuary/Secure base

  42. School • Achievement/Grades • Parent Partnership • Friendships and Peer Relations • Citizenship and Conduct • Teacher/Student Fit • Cultural Acceptance • Recognitions • School Health Care Plan • After school programs

  43. Communityand Culture • Language • Beliefs and Customs • Cultural Heritage and Identity • Safety Issues • Community Working Together • Religious Supports • Resource Availability • Political/Economic Realities • Providing Public Health and other community needs as safe places to play and re-create • Collaborative local systems of care responding and pulling together on behalf of individual families with their child in school/preschool/headstart or early intervention

  44. Family Health Promotion Plan(Pulls from the listed resources)

  45. Follow-up and Outcome Assessment • Are we better off from what we are doing? • Scaling • YOQ • Other Psych. Measures • School Performance • School and Clinic Attendance • Team Management Form • Parent Outcome Rating Scale

  46. -7-FAMILY RESILIENCY FROM RISK TO THRIVING The Process of Moving from Despair to Hope

  47. Family Past and Present Realities • Stressful Challenges • Problems • Vulnerabilities • Losses and Pain • Adversities • Traumas • Disappointments and resentments

  48. Just Making It • Toxic Environments • Hollow Successes • Inflexible • Overly Defensive • Abuse Prone • Strained Relationships • Personality Disorders • High Dependence on Society’s Safety Net (Resource Supports)

  49. Life Threatening • Ineffective-Coping • Adaptive Dysfunction • Psychopathology • Antisocial • Destructive Narcissistic • Violence and Lawlessness

  50. ADAPTIVE COPINGLeadsto Increased Personal and Family Assets and Increases Protective Factors

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