Workshop 5: Relationship-based Practices

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1 College of Education and Human Services Center for Autism and Early Childhood Mental Health Voice: Fax: Workshop 5: Relationship-based Practices Overview of Topic This session will help participants recognize the importance of supporting and fostering the primary relationships in a child s life. We will consider the importance of relationships and emotional connections as fundamental to work with infants, young children, and families. Participants will come to understand the importance of understanding their relationship with the child and with the child s family and how to strengthen these connections on behalf of parent/child relationships. The implications of relationship-based work including the concepts of parallel process and use of self will be discussed. We will consider ways to build strong relationships in our work while also maintaining professional and emotional boundaries. The session will also include an introduction to the NJ Pyramid Model Partnership which provides a framework for supporting the social and emotional wellbeing of infants, young children, and families. The mission of this initiative is to create an integrated approach which supports all who work with infants, young children, and their families. Recommended Duration: 3 hours New Jersey Birth to Three Early Learning Standards Domain I: Social & Emotional Development Components: Relationships with Peers and Adults Michigan Association for Infant Mental Health Competency Guidelines Theoretical Foundations Knowledge Areas: Infant/very young child & family centered practice Relationship-focused practice Family relationships & dynamics Cultural competence Learning Objectives 1. Participants will learn to examine ways in which they form relationships with young children and families. 2. Participants will learn about the distinction between how we are and what we do in our work with families, and learn ways to use your self in relationship-based work. 3. Participants will learn about the importance of establishing helping relationships in which they can maintain professional and emotional boundaries. 4. Participants will learn to identify Red Flags when boundaries are not maintained, and learn strategies when helping relationships become difficult

2 College of Education and Human Services Center for Autism and Early Childhood Mental Health Voice: Fax: LITTLE JOE ACTIVITY Reflect quietly and think about your fist impressions of this picture of a man and an infant. Break out in your small group and: 1. Describe your impressions of this man and infant with your group 2. What do you want to know more about? What are you WONDERING? 3. How are you going to begin your working relationship with this man and infant? 4. Think about our 2 Key Questions for Reflection- What about the baby? What is being stirred up in me? 5. What does this person need to know about you and the agency/program you represent? Adapted from: Touchpoints Faculty Level Training Curriculum

3 College of Education and Human Services Center for Autism and Early Childhood Mental Health Voice: Fax: l WHAT WOULD YOU DO? Situations for Reflection Situation 1 You are on a home visit. A mother is changing an infant s diaper and seems not to respond to the crying infant then speaks harshly to the child saying, What are you crying for? I m not killing you. Situation 2 You meet a dad for the first time and he is very agitated and upset. He tells you that he has heard bad things about your program and wants you to know that he has heard from other parents that he won t get what his son needs, other programs give more services and you people don t know what you re doing. Situation 3 You see a parent in the supermarket and the parent asks you for a ride home. It is raining very hard and almost dark out. The mother has her infant and 3 year old with her. You will drive right by where the family lives on your way home. You agree and the parent then invites you in for coffee and cake to thank you for the ride. Situation 4 You are working with a family who is rebuilding their home following damage from Superstorm Sandy. They are upset with the many delays and long waiting lists for help. They have a 6 month old infant and an 18 month old toddler. The mother and father are both stressed and anxious about the costs of rebuilding their home. The toddler has been having tantrums and sleeping problems.

4 Situation 5 A family you work with has a 3 year old boy who reminds you of your son at that age. You enjoy working with him and his mother tells you he often talks about you. She describes him as being difficult and spoiled. You notice she does not give him attention unless it is to criticize or discipline him. Situation 6 You are working with a mother who has children around the same ages as your own children. You know the family is struggling financially since the father lost his job following Superstorm Sandy. You have bags of children s clothing that is in good condition and you have been meaning to donate. Do you offer the clothing to this family? Situation 7 A family you are working with has a 2 year old who was in the room when his grandfather had a massive stroke. His grandmother was his primary caregiver while his parents worked. The grandmother now spends her days at a rehab center with the grandfather. A neighbor is babysitting on a temporary basis. The 2 year old cries easily and has started to hit the family s dog. How does this situation make you feel? What do you think the parent is feeling? What about the baby? What can you do in this situation? Can anyone else help? Consider the options and consequences

5 College of Education and Human Services Center for Autism and Early Childhood Mental Health Voice: Fax: Questions to Help Us Wonder About Our Feelings, Reactions, Responses in Relationship-based Work From: Parlakian, R. (2001). The power of questions: Building quality relationships with families. Washington, DC: ZERO TO THREE. How do I feel about this person? What about this person rubs me the wrong way? Who does this person remind me of? Why do I identify with them so strongly? How are we alike/different? What is it like to be this person? What is his/her experience? What can I do to stop myself from immediately reacting? What does the request mean? (Does it mean the family considers me a friend?)

6 College of Education and Human Services Center for Autism and Early Childhood Mental Health Voice: Fax: How does this request make me feel? Am I flattered, uncomfortable, pleased? If I fulfill this request, am I likely to feel differently about the family (less objective)? What would be the impact of the request if I fulfill it? Given what I know about this family, what need is the request fulfilling? Is it appropriate for me to be the one to fulfill this need? Is there a way I can help the family fulfill this need themselves?

7 New Jersey Pyramid Model Partnership New Jersey s Vision: All infants and young children ages 0-8 in New Jersey will have the opportunity to develop social emotional competence. New Jersey s Mission: The Pyramid Model Partnership of New Jersey will create an integrated approach using the Pyramid Model that will support all who work with infants and young children age 0-8 and their families to develop social emotional competence. Goals: 1. To develop and maintain an interagency, collaborative state leadership team to develop policies, procedures, and other mechanisms to plan, implement, evaluate, and sustain a standardized professional development system that supports the use of The Pyramid Model and practices; 2. To provide the early childhood community with the support needed to implement The Pyramid Model with fidelity; 3. To ensure families are knowledgeable about and have access to programs that implement The Pyramid Model; and 4. To ensure that the public and private funding sources recognize The Pyramid Model as an evidence-based approach that promotes the healthy social and emotional development of infants and young children. In 2012, the Infant and Early Childhood Mental Health subcommittee of the New Jersey Council for Young Children developed a goal to fund, promote and implement The Pyramid Model statewide for ages 0-8 years old. This led to the creation of the New Jersey Pyramid Model Partnership Team. The Pyramid Model for Supporting Social-Emotional Competence in Infants and Young Children is a conceptual model of evidence-based practices for promoting young children s social-emotional competence and preventing and addressing challenging behavior. Overview: The project was started in 2009 with a shared vision of increasing the social emotional competency of infants and young children across New Jersey through the implementation of The Pyramid Model. This evidence-based model represents a sound framework for early care and educator systems that was developed by two national training centers: The Technical Assistance Center on Social Emotional Interventions for Young Children (TACSEI) funded by the Office of Special Education Programs at USDOE and; The Center on the Social and Emotional Foundations for Early Learning (CSEFEL) funded by the Office of Head Start and the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services The New Jersey Pyramid Model Partnership team is putting in place the mechanisms required to adopt, implement, and sustain the Pyramid Model in the state of New Jersey. The New Jersey Pyramid Model Partnership will work closely with the New Jersey Association for Infant Mental Health and other entities concerned about the optimal development of infants and children, birth to age 8, their families, and other caregivers. Projected Results: Increase self-regulation, social skills and positive behaviors in infants and young children. Enhance awareness of the significance of infant and early childhood mental health. Strengthen family participation in the development of socialemotional competence in infants and young children. Increase the number of high quality programs available to families of infants and young children.

8 1 Relationship Based Practices Part of a series funded by: The New Jersey Department of Children and Families Developed by: Gerard Costa, Ph.D.,IMH-E IV, Clinical Mentor Director Lorri Sullivan, M.Ed., IMH-E IV, Research/Faculty Curriculum Coordinator Kaitlin Mulcahy, LPC, IMH-E IV, Clinical Mentor, Associate Director No part of this material may be copied without the express permission of: The Center for Autism and Early Childhood Mental Health Keeping Babies & Young Children in Mind Workshop 1: In the Beginning What Happens Early Matters Workshop 2: Infant & Early Childhood Development Workshop 3: The Language of Behavior Workshop 4: Encountering Early Stress and the Power of Meaningful Connections Workshop 5: Relationship-based Practices Workshop 6: Me, My Family, My Community Workshop 7: Reflective Practices: Caring for Ourselves 1

9 A Developmental Perspective Maintains that all development unfolds over time and is profoundly organized by the nature of attachment relationships. Human development is patterned (stages of development have certain skills and characteristics that cluster together) and is sequential (follows an order of unfolding). Development during earlier periods influences the course and outcome of later periods. 4 A Relational Perspective Development occurs within the context of relationships. These relationships influence who we become, and are becoming, on many levels, including: biological, emotional, and psychological. 5 The Main Point 6 All development in all areas unfolds within the Context of Relationships! 2

10 Group Activity 7 Discuss the meaning of the word: NURTURING Think about a nurturing relationship in your own life - one that makes you feel special. 8 Think about a time you spent together. NOTE THAT Nobody said, Someone who told me what to do or someone who gave me advice 9 3

11 Nurturing, usually.. does not involve skills development does not focus on problem-solving does not focus on weaknesses involves preparedness and support 10 provides a holding environment for growth addresses the first three points -Based on Bernstein, Parallel Processes in Relationships 11 Child/family Worker Affective Experiences can occur from the child and family to the worker, or vice-versa. In Relationship-based work we must engage in Active Listening 12 Using not just our ears, but our intellect, feelings, verbal and physical responses to give us information about the interaction Convey a sense of genuine connectedness - consider the concept of attunement STOP LOOK LISTEN RESPOND 4

12 Relationship-building 13 Three Stages of Relationships in Gentle Teaching PRESENCE PARTICIPATION SHARING OF VALUES Projective Identification The notion that another person can induce in us, something about what it feels like to be him/her. 14 Resonance Relationship-based Practices Based on the notions that: Life begins within the context of a relationship Families are supported by the nature of our helping relationships 15 The nature of our work must activate feelings within us that influence how we are and what we do - AND these must be attended to. 5

13 Implications of Relationship-Based Work We must attend to the needs of the helper. 16 All relationships are largely experienced, expressed and enacted on non-verbal (even pre-verbal) levels. The use of Self -WE ARE THE AGENTS OF CHANGE. G.Costa, Ph.D. Three Major Influences on Adults who work with infants and young children The nature of their our childhood. 17 Their ability to recall good and bad events and feel the feelings again. Their ability to separate adult needs, problems, feelings and thoughts from those of the infants and children. Thinking About Families 18 6

14 Little Joe Activity 19 Adapted from: Brazelton Touchpoints Faculty Level Training 20 Partnership 1. The state of being a partner. 2. A relationship between individuals or groups that is characterized by mutual cooperation and responsibility, for the achievement of a specified goal. 21 From: The American Heritage Dictionary of the English Language, 4 th Edition. Houghton Mifflin Company,

15 Mental Health Work and Our Subjective Experiences Our subjective experiences and feelings about the infants, children and families we work with, has a profound, but often unexamined impact on our work. 22 Vote With Your Feet Activity 23 TOUCHPOINTS PARENT ASSUMPTIONS 24 1) The Parent Is The Expert On His/Her Child 2) All Parents Want To Do Well By Their Child 3) All Parents Have Strengths 8

16 TOUCHPOINTS PARENT ASSUMPTIONS 25 4) All Parents Have Something Critical To Share At Each Developmental Stage 5) All Parents Have Ambivalent Feelings 6) Parenting Is A Process Built On Trial and Error What Families Bring A personal perspective & important information. They usually know what works best or doesn t work for their child. 26 Communication that is jargon free and helpful in communicating across disciplines. Knowledge & understanding of the strengths and needs of family members-critical to the success or failure of any service plans. From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together, What Families Bring An emotional investment over time-the family is the constant. Service providers may come and go. Ability to monitor progress or regressions. If they are satisfied consumers, families are the best advocates an agency or professional can have. 27 From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together,

17 Thinking About Professionals 28 What Professionals Bring A body of knowledge that draws upon well established theories and approaches. Legitimacy and sanction of their work via: education, certification, licensing or credentialing. 29 From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together, What Professionals Bring 30 A code of ethics allowing them to set standards of behavior. These codes offer protections to families i.e.: confidentiality, child abuse/neglect Professionals can make the transformation to defining family members as included in their culture of helpers. From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together,

18 Guiding Principles 1) Value and understand the relationship between you and the parent 2) Use the behavior of the child as your language 3) Recognize what you bring to the interaction 4) Be willing to discuss matters that go beyond your traditional role 31 Guiding Principles Value passion wherever you find it Focus on the parent-child relationship Look for opportunities to support parental mastery Value disorganization and vulnerability as an opportunity 32 Practitioner Assumptions 33 Each practitioner is the expert within the context of his/her practice setting Practitioners want to be competent Practitioners need support and respect of the kind we are asking them to give to parents Practitioners need to reflect on their contribution to parent-provider interactions 11

19 Touchpoints-Relational Framework 34 A touchpoint is an opportunity for the professional to join with a parent to form a supportive alliance. Central to effective anticipatory guidance is collaboration between the parent and the provider. Interactions focus on parental strengths. TOUCHPOINTS: PARALLELS BETWEEN PARENTS AND PROFESSIONALS KNOWLEDGE PARENT their child s development and individuality PROFESSIONAL process of typical and atypical child development ABILITY CONTEXT parenting skills nurturing ability observational skills reflective ability nurturing history social support/stress in parenting role interpersonal communication skills observational skills reflective ability own nurturing history supportive/stressful work environment 35 Bodies & Feelings Activity 36 12

20 Parallel Processes in Relationships 37 Affective experiences & transference can occur from the family to the work OR from the worker to the child/family Parallel Processes in Relationships 38 REMEMBER Affective experiences & feelings can pass from the child/family to the provider OR From the provider to the child/family Remember.. 39 How you are is as important as what you do Jeree Pawl, Ph.D. 13

21 Look Building Relationships with Parents 40 Listen Learn Ways to Build Strong Relationships 41 Use what you know Point out the positive Acknowledge parents feelings Refocus issues on the child Take time to listen From: Lerner, C., Dumbro, A., Powers, S. (2001). Learning and Growing Together Kit. Washington, DC: ZERO TO THREE Understand the parent s view of their child Ask for HELP Questions to Ask-Wonder About Your Reactions and Feelings 42 How do I feel about this person? What about this person rubs me the wrong way? Who does this person remind me of? Why do I identify with them so strongly? How are we alike/different? What is it like to be this person? What is his/her experience? What can I do to stop myself from immediately reacting? From: Parlakian, R. (2001) The power of questions: Building quality relationships with families. Washington, DC: Zero To Three. 14

22 Questions to Think About What does the request mean? (Does it mean the family considers me a friend?) How does this request make me feel? Am I flattered, uncomfortable, pleased? 43 If I fulfill this request, am I likely to feel differently about the family (less objective)? What would be the impact of the request if I fulfill it? Given what I know about this family, what need is the request fulfilling? Is it appropriate for me to be the one to fulfill this need? Is there a way I can help the family fulfill this need themselves? From: Parlakian, R. (2001). The Power of questions: Building quality relationships with families. Washington, DC: Zero to Three. Boundaries in Our Work 44 Notion of Boundaries Our Goal: To establish helping relationships where we can achieve optimal distance - being empathic and sensitive, without being too close or too distant in our relationship with families

23 Notion of Boundaries Important Considerations 46 Privacy & Confidentiality Self Disclosure Respectful/ Non-intrusive/ non-judgmental posture Setting limits Intrusive/Invasive procedures Parental Involvement & Shared roles Expectations of colleagues & team members Challenges posed by high need, over-controlling, demanding families in difficult situations 47 Don t own all the problems of the system Maintain awareness that transferences occur. Sometimes we are treated as if we were the problem, the hurtful other, when families have needs which are not being met. Group Activity 48 W H A T W O U L D Y O U D O? 16

24 What Would You Do? 49 How does this situation make you feel? What do you think the parent is feeling? What about the baby? What can you do in this situation? Can anyone else help? Consider the options and consequences Situation 1 You are on a home visit. A mother is changing an infant s diaper and seems not to respond to the crying infant then speaks harshly to the child saying, What are you crying for? I m not killing you. 50 Situation 2 51 You meet a dad for the first time and he is very agitated and upset. He tells you that he has heard bad things about your program and wants you to know that he has heard from other parents that he won t get what his son needs, other programs give more services and you people don t know what you re doing. 17

25 Situation 3 52 You see a parent in the supermarket and the parent asks you for a ride home. It is raining very hard and almost dark out. The mother has her infant and 3 year old with her. You will drive right by where the family lives on your way home. You agree and the parent then invites you in for coffee and cake to thank you. Situation 4 53 You are working with a family who is rebuilding their home following damage from Superstorm Sandy. They are upset with the many delays and long waiting lists for help. They have a 6 month old infant and an 18 month old toddler. The mother and father are both stressed and anxious about the costs of rebuilding their home. The toddler has been having tantrums and sleep problems. Situation 5 54 A family you work with has a 3 year old boy who reminds you of your son at that age. You enjoy working with him and his mother tells you he often talks about you. She describes him as being difficult and spoiled. You notice she does not give him attention unless it is to criticize or discipline him. 18

26 Situation 6 55 You are working with a mother who has children around the same ages as your own children. You notice the children s clothing is worn and does not fit well. You know the family has limited resources. You have bags of children s clothing that is in good condition and you have been meaning to donate. Do you offer the clothing to this family? Situation 7 56 A family you are working with has a 2 year old who was in the room when his grandfather had a massive stroke. His grandmother was his primary caregiver while his parents worked. The grandmother now spends her days at a rehab center with the grandfather. A neighbor is babysitting on a temporary basis. The 2 year old cries easily and has started to hit the family dog. Red Flags 57 Indicators that the helpful nature of your relationship with a child/family, may be compromised. 19

27 RED FLAGS 58 Frequently sharing personal information and opinions Providing home phone number for contact Giving up personal time to be with families or to attend to their needs Your family expresses anger, resentment or concern about the time spent with cases or the effects on your life. The 2:00am agenda Wanting to bring gifts, food, lend money or give rides. RED FLAGS 59 Unable to get notes or Unable to change pace of paperwork done. intervention when Rescheduling client needed or to be flexible appointments to or more available at accommodate elongated times of true crisis or time with other clients concern Feeling personally Showing up late for distressed, frazzled, appointments or noshows forgetful and in crisis Avoiding phone calls, dread around phone Blaming family for lack or progress Teaching and Advising primary mode of communicating Unwilling to accept refreshments or to meet other members of family Feeling detached, bored, or burdened much of the time

28 When Helping Relationships Become Difficult 61 When Helping Relationships become Difficult Acknowledge the difficulty. Comment on the obvious. This slows you down and helps establish reflection vs. reaction. Pay attention to yourself. Get in Cahoots with Yourself. If you are aware of very strong feelings, ask for a momentary pause, or create a distraction for yourself. Adopt a non-confrontational posture Meet the child/family where they are. Avoid casting relationships into win or lose Actively listen. Focus on the emotion and belief behind the words and state those. Let the other take the lead for the moment. Listen, don t interrupt. We all need to be heard. Establish guidelines for discourse. State clearly and calmly that you do not want to be spoken to in harsh or threatening ways, but allow and accept every emotion expressed. Recognize that under stress fault lines appear and we rely on our character more than our knowledge or skill. 21

29 Show care & concern even in the face of mistreatment. (don t dish back) 64 Keep our word. Follow up if we say we will Acknowledge our mistakes & apologize Engage in respectful pursuit What Can We Do to Support Staff? 65 What Can We Do To Support Staff? 66 We should employ a variety of formal and informal individual and group methods to monitor our responses to clients and to ourselves. Among these methods are: 22

30 67 Clinical supervision reflective, routine, consistent Team meetings with focus on case presentations and discussion 68 Planned conferences and workshops Education/Training Collegial support formal and informal gatherings (e.g. brown-bag lunch, networking with other agencies, phone support, etc.) Mental health consultation services 69 Psychotherapy 23

31 Take Home Messages Relationships are the key to development and often involve parallel process 70 Helping relationships involve optimal distance and attention to red flags Relationships withy families may contain challenges that require thoughtful, principled responses This work engages our minds and our hearts New Jersey s Pyramid Model Partnership 71 A Framework for Supporting the Social Emotional Well- Being of Infants, Young Children, and Families NJ Pyramid Model Partnership Vision: All infants and young children ages 0-8 in New Jersey will have the opportunity to develop social emotional competence 72 24

32 NJ Pyramid Model Partnership 73 Mission: Utilizing The Pyramid Model, the NJ Pyramid Model Partnership will create an integrated approach to support all who work with infants and young children ages 0-8 and their families to develop social emotional competence 74 Anticipated Results 75 Increase self-regulation, social skills and positive behaviors in infants and young children Enhance awareness of the significance of infant and early childhood mental health Strengthen family participation in the development of social-emotional competence in infants and young children Increase the number of high quality programs available to families of infants and young children 25

33 Center for Autism and Early Childhood Mental Health 76 Montclair State University College of Education and Human Services 1 Normal Avenue Montclair State University Montclair, New Jersey Fax: Website: 26

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