Delivering Resolution-Focused Interventions

Transcription

1 Mobile Crisis Intervention Advanced Regional Training: Delivering Resolution-Focused Interventions Facilitated by: Kappy Madenwald, MSW November, 2010

2 Session Overview Group Coaching/Consultation Highly Flexible, Participant-Driven Format Fine-Tune Skills Peer Review of Challenging Interventions Application of skills 2

3 Session Overview What outcomes do we wish for children and parents/caregivers? Defining resolution The art of resolution-focused work Kicking habits of practice Framing an intervention Strategic use of bi-disciplinary team Spanning the 72-hour time frame 3

4 Strengths-Based and Change- Focused Intervention Tools Motivational Interviewing Stages of Change Dialectical Behavioral Therapy (DBT) Solution-Focused Interventions Recovery Model of Care Family-driven Treatment including Wraparound Care Planning Peer Delivered Services 4

5 Strengths-Based and Change- Focused Intervention Tools Trauma-Informed Care Integrated Dual Diagnosis Treatment 5

6 Strengths-Based and Change- Focused Intervention Tools Competency development related to culture/religion/ethnicity Competency development related to economic class Culture of Poverty (Phil DeVol and Ruby Payne are great resources) Competency development in working with DCF-involved families Competency development in working with criminal justice-involved persons 6

7 Strengths-Based and Change- Focused Intervention Tools Learning the mechanics is very important. The more tools you have to choose from the better. The tools offer: Change-promoting language Strategies to avoid power struggles Frameworks for understanding phases or stages Techniques that empower the persons in treatment to find the best solutions Broadened understanding of the impact of culture on a person s perspective and journey 7

8 Strengths-Based and Change- Focused Intervention Tools However, applying the mechanics alone, is insufficient. Mastering the art or spirit of the work is most important A part of this involves challenging our own belief system until it is crystal clear to us that: Recovery is possible Persons in crisis are their own best expert They are responsible for their own change Real, lasting change cannot be externally imposed We can co-create a climate for change 8

9 Strengths-Based and Change- Focused Intervention Tools A person who is disconnected from this most important resource him or herself is certainly more vulnerable When we see people as talented and expert, it comes through in our body language and our words. It creates a climate that gives a person the best opportunity to reconnect to his/her own skill set and to create new ones 9

10 The Question: But I still don t really believe that the person in crisis is the expert. The response: Is there really another choice? If the person experiencing it doesn t figure out the problem who will? If the person with the problem behavior/circumstances cannot change the behavior, who can change it? If the person who is stressed cannot tap into coping mechanisms who else can do it for them? 10

11 Apply the Chronically Normal Person rule Who has to figure out any problem that I am facing? Who changes my behavior? Who taps into coping mechanisms for me? Who can best assess goodness of fit of a risk management safety plan? Chronically Normal Person is a phrase coined by, Fred Frese, a PhD psychologist who has schizophrenia. 11

12 Don t believe everything you think Source: Bumper Sticker 12

13 Have you ever had a boss, teacher, or other authority figure that thought poorly of you? You felt you were pre-judged? Your behaviors were misinterpreted? Marginal performance was expected? Your problem solving was second-guessed? You felt stymied or restricted in being creative? Errors were magnified, but successes minimized? 13

14 What do you remember as your reaction to that kind of treatment? Behaviors Feelings What was the impact on your actual performance? Was it clear to you that there was a disconnect between your abilities and how you were being judged? 14

15 How did you know that this person in authority thought poorly of you? 15

16 Many of us in the Behavioral Health field have developed habits of thinking about the kids and parents we work with that have not served them well. Some of the habits of thinking are about pre-judgment What are some common pitfalls in our field in terms of how we view the kids and parents we serve? 16

17 It is human nature to think or tell a story about a person or situation based on limited information. The story is influenced by our beliefs, training, experience and our own personal journey It is easy to then begin believing that the story we made up is factual and we start acting accordingly 17

18 A staff person in a residential care facility that serves unruly and delinquent youth learns that three more teenagers are on their way to the facility. What is the staff person expecting to experience? How does the staff person prepare? How might the expectancy of the staff person change the outcome of the admission process? 18

19 Habits of thought that tell an unhealthy or pathological story about a child or parent or school teacher or DCF worker work against crisis resolution The art and spirit of resolution-focused work includes figuring out how to tell a better story, every time. Act as if it is the better story is true and watch as the person becomes more likeable and compelling in your eyes. 19

20 When you change the way you look at a person, the person you look at changes. 20

21 In order to effectively frame a resolution-focused intervention it is very useful to try to identify ahead of time your hopes for the child and parent(s) you are about to see. This exercise helps to set the energy of the intervention An approach to doing this is to think about the current circumstances and the nature of the crisis and to imagine the experience from the shoes of each person/system involved 21

22 When you are imagining from someone s shoes: See them as their best self See them as strong, resourceful and healthy Like them This does not mean ignoring signs of illness or dangerous behavior. This is about tapping into the wellness within we believe in its existence even if in this moment the person cannot tap it. 22

23 The more we can understand and respect the story and the journey of each person/system, the more effectively we can join with them, where they are, at this moment. Joining is not the same as agreeing with them. It is about creating an environment where change (and resolution) is possible. 23

24 The school initiated the call to MCI. The adjustment counselor describes the situation as follows: 8 yr old Louie has been continuously disruptive in school. He is restless in his chair, he interrupts other children who are trying to focus on their work and he has repeatedly left the room without permission. Today he threatened another child with a ruler holding it like a rifle and threatening to kill him. Louie s mother has been very difficult and defiant. She won t answer the phone when the school calls and has missed several meetings. She has gotten verbally abusive with school staff at previous meetings and (the adjustment counselor) thinks that Louie is subjected to similar verbal abuse at home and suspects that it is why he acts out so much in school. His dad left when Louie was 3 yrs old which probably contributes to the trouble at home. The school has asked repeatedly that she take Louie for an evaluation for medication and warned her that he is at risk of suspension. The school has filed a 51A previously and plans to file another one. The adjustment counselor states Louie needs a different school placement or partial hospitalization and medication for ADHD. The school left a message for Louie s mother informing her that Louie would be getting a crisis evaluation today. 24

25 What does this crisis look like from Louie s perspective? What outcomes do we wish for Louie? Why do we like him? What is the risk of NOT liking Louie? 25

26 What does this crisis look like from Louie s mother s perspective? What outcomes do we wish for Louie s mother? Why do we like her? What is the risk of NOT liking Louie s mother? 26

27 What does this crisis look like from Louie s teacher s perspective? What outcomes do we wish for Louie s teacher? Why do we like her? What is the risk of NOT liking Louie s teacher? 27

28 If you find yourself in the very common situation of feeling negatively about the child/parent/system representative you are interacting with Stand in their shoes. Tell a more compelling story that helps you to like them Respect where they are. You do not have to agree but you do have to figure out a way to accept where they are to join with them in order to promote change This can feel counterintuitive particularly when it hits a hot button for you personally 28

29 Esperanza s mother calls the MCI team and describes the following: 11 year old Esperanza assaulted her 6 year old sister this afternoon and needs to be removed from the home immediately and put in a hospital or residential treatment. Esperanza was adopted 7 years ago and we told her if she hurt her sister again that would be it. Esperanza is currently calm and is playing video games. We have called DCF to let them know that we are terminating the adoption. We just don t think we can keep doing this. We were told that Esperanza was a normal healthy child, but we were lied to. She has been dangerous to our younger daughter for years. She was jealous when we had a biological child and we have always had to keep a close watch on her. Lucy is our miracle baby. We were told we could not conceive. It isn t fair that Lucy is the victim. She loves her older sister, but Esperanza is cold and mean in return. 29

30 What does this crisis look like from Esperanza s perspective? What outcomes do we wish for Esperanza? Why do we like her? What is the risk of NOT liking her? 30

31 What does this crisis look like from Esperanza s parents perspective? What outcomes do we wish for Louie s parents? Why do we like them? What is the risk of NOT liking Esperanza s parents? 31