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FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATION REStArT MODEL

FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATION REStArT MODEL. October 29, 2010. History of the Model. Ongoing development of evidenced-based practice Trends in field moving toward evidence-based practice models

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FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATION REStArT MODEL

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  1. FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATIONREStArT MODEL October 29, 2010

  2. History of the Model • Ongoing development of evidenced-based practice • Trends in field moving toward evidence-based practice models • Consulted with Bruce Wampold for comparative review of literature with our existing model Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 2

  3. Key Factors to Successful Outcomes • Coherent clinical model • Family engagement • Stabilization of discharge resource • Availability of aftercare supports Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 3

  4. Coherent Clinical Model • REStArT Model: The Relational Re-Enactment Systems Approach to Treatment • Evolved from model we were already working within • Implementation of Structure & Processes • Supported Top down • Horizontal Dialogue across all departments • Formalized into REStArT principles & treatment guidelines Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 4

  5. The Conflict Cycle Relational Trauma Re-Enactment Systems Attachment Model View of Self & Others Trauma History Meaning of behavior/ youth’s conflict 2 Stressful Event • 5 • Adult Reaction • Feelings • b. Behavior • c. Youth's Response 3 Youth’s Feelings 4 Youth’s Behaviors (Wood & Long, 1991) Modified Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 5

  6. REStArT Supervision & Dialogue Meetings Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 6

  7. History of Family Engagement • Previous Attitudes/Approaches • Youth doesn’t have any family • We are the experts—leads to blame game • Treatment planning without youth & family input • Discharge planning did not start until much later in treatment • Focus on external demands for services by traditional view (i.e., all families need family therapy) • “Menu” of choices RESULT: POWER STRUGGLES WITH FAMILIES Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 7

  8. Change was Needed • Families were having trouble accessing services • Communications were happening across departments in silos • Realization that change was needed Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 8

  9. Clinical Consultation • Clinical consultation framework • Team based • Requires a shift from individualized contact toward team based approach • Allendale team---(Unit Coordinator, Case Specialist, Teacher & individual therapist) with family (and often other collaterals) • Consultations via phone at regularly scheduled times Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 9

  10. Clinical Consultation Is… • Family focused • Frequency of contacts & time arranged around family’s availability • It is family treatment NEW RESULT: Increased family involvement • Data showed dramatic increase in family involvement from FY07 31% to FY10 81% Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 10

  11. Clinical Consultation is NOT… • To get the parents “on board” with us • To “fix” the family to fit an ideal • To “get” them into family therapy • To move our hidden agenda forward • To solely respond to a crisis situation Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 11

  12. Stabilization of Discharge Resource • Discharge must be center stage issue • Work with youth & family throughout treatment to identify & implement community supports • Add community support staff into clinical consultation framework during treatment • Planning for discharge must be family and youth driven • Clinical Consultation is the way to help family & youth as they work together to develop a plan • Provider must regularly review how they are working to support the family & youth Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 12

  13. Availability of Aftercare Supports • Support the Placement • Continued support of the adults/placement post-discharge • Continued clinical consultation framework post-discharge • Support the Youth • “Letting go” of the youth • Build upon the youth’s ability to form new relationships Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 13

  14. The “Team” • Systems Oriented • Identify all the systems involved with the youth and have them come together • Acknowledge current supports & explore past relationships • Finding families • Ask the youth • 411 or web based searches • Appreciate diversity of team members Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 14

  15. Seeing the Whole Youth • System-wide investment serves function of creating “wholeness” • Compartmentalization & Polarization Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 15

  16. Alliance • Alliance in treatment refers to “agreement” • Shared understanding of goals & tasks • “Family wants” versus “provider wants” • What part can we give them? • As provider we take first step • Results in ownership by family and youth • Consultation and dialogue among all team members supports all members as equal partners in the process Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 16

  17. Factors that Affect Alliance • Unspoken and/or unresolved splits & divisions in the system • Compliance without support • Members of the system may be dealing with ambivalence Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 17

  18. Ambivalence: What is it? • “Ambi” means “both” so if you are ambivalent, you have both positive and negative feelings toward something or having feelings for both sides of the issue. • It naturally occurs when facing any change • It is to be expected as a part of the treatment process Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 18

  19. All members may experience ambivalence Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 19

  20. Youth’s Ambivalence Examples: • Youth says he wants to leave but shows only one side of his ambivalence through acting out • Youth changes his/her plan frequently What keeps it going? • We may rationalize, interpret it as “sabotage”, or minimize • We INTERFERE by getting in the middle Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 20

  21. Family’s Ambivalence Examples: • Family says they will do “x” but then does not follow through • Family says one thing but then they do something else • Family is not developing a discharge plan • Family is not calling in for clinical consultation &/or planning meetings What keeps it going? • We try to either push them or empathize with them • We INTERFERE by getting in the middle of youth and family working through the issue Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

  22. Provider Ambivalence • “Getting in the Middle” • Taking over – Holding the anxiety • Taking a conflicting position • Championing one side of the ambivalence • Caring more about the plan & outcome than youth & family do • Deliberate attempts to resolve the ambivalence by pushing for change • Not expecting health Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 22

  23. Expecting Health from the Youth • One person’s picture of “health” may look different than that of another • Youth are able to tolerate natural setbacks as a result of failures and disappointments • Youth have the resiliency to tolerate disruptions in relationships and work to repair them • Treatment allows youth to work through difficult feelings & situations, rather than always removing the stressor Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 23

  24. Expecting Health from all Members of the Team • Expect that all members want the best for the youth • Do not attribute mal intent to the behaviors of others • Expect that all members will do “their job” in a “healthy” way Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

  25. Working with Control Sensitive (CS) Youth • CS youth interpret everything we do as an attempt to try to control them • The antidote is to give them more control through providing choices with (logical & natural) consequences • Telling the CS youth they have to do “x” before they can get what they want inadvertantly sets up a power struggle • When they begin acting out (i.e., hospitalization, AWOL, arrests) we need to assess the meaning behind the behavior • May be related to ambivalence • May be a lack of alliance or ownership Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 25

  26. Significant Trends • Overall findings FY07 through FY10 data suggest the following: • We see more kids going home and going home in quicker time frames, which suggests an increased alliance with families • Further, the decrease in negative events, especially AWOLS, suggests we have an increased alliance with kids Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 26

  27. DCFS Trends • When comparing data for DCFS funded youth versus all other (DHS, ISBE, county courts, private), FY07 through FY10 data: • DCFS funded youth have an average 8 month longer length of stay than non-DCFS funded youth (14 months versus 22 months) Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

  28. Chi Square Statistics • There is a trend toward greater positive discharges (69.9% in FY07 compared to 81.7% in FY10, with no down turns in between). However, the change wasn’t statistically significant. • The proportion of discharges to home compared to other positive discharges did change significantly, in the hoped-for direction (p= 0.02). Discharges to home were 29.3% of all positive discharges in FY07 and were 44.9% in FY10. This significant change was true comparing the proportion of discharges to home to all other discharges, positive or negative (p= 0.01). Discharges to home were 20.5% of the overall discharges in FY07 and 36.7% of discharges by FY10. • The proportion of AWOL discharges compared to all other discharges changed significantly (p= 0.05) with the proportion of AWOLs shrinking over the four years (16.9% in FY’07 compared to 8.3% in Fy’10). • The proportion of DCFS clients being discharged to home, compared to all other DCFS discharge types changed at a rate that approached statistical significance (p=0.07) Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 28

  29. Summary • Ongoing Challenges • Commitment at all levels • Family “driven" milieu • Case Examples • Questions & Answers Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 29

  30. Presenter Information Contact Information: Judy Griffeth, LCSW jgriffeth@allendale4kids.org; (847) 245-6330 Saray Hansen, MA shansen@allendale4kids.org; (847) 831-4216 Ronald Howard, LCSW rhoward@allendale4kids.org; (847) 245-6329 Howard Owens, LCPC howens@allendale4kids.org; (847) 245-6170 Dr. Pat Taglione, PsyD ptaglione@allendale4kids.org; (847) 245-6302 Allendale Association - DCFS Summit - Governors State Univ 10/29/2010 30

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