Facilitating Family and Child Teams It s a Wrap

1. 2009 Children Come First Conference Kalahari Resort & Conference Center, Wisconsin Dells November 17, 2009 Facilitating Family and Child Teams�It�s a Wrap!

2. What we�ll cover today Wraparound Principles Building and Facilitating Effective Teams Strengths-Based Approach Questions

3. Wraparound Definition A way of providing mental health services to children and their families involving a collaborative team-based approach.

4. Wraparound Principles Voice � The child and family are active partners in making treatment decisions. Team � The approach must involve a team consisting of members of those social systems (family, school, community, neighbors, church) who are most important to the child. Community Based � Mental health treatment success is best achieved in the community in which the child lives. Culturally Competent � The process must be built on each family�s unique values, preferences, and strengths. Individualized � Every child has different needs and abilities and treatment plans need to reflect this. Strengths-Based � Mental health treatment success can be best achieved if we focus not only on the problems of a child and family but also what is going well and is healthy about the family.

5. Wraparound Principles Cont. Natural Supports � The use of informal community supports such as neighbors, church or friends is important to the success of children. Continuity of care � Unconditional commitment to continue to help the families through whatever services are necessary to meet treatment goals. Collaboration � The child is best treated if all the important systems in her life are working together towards similar goals. Flexible Resources � It is important to be able to flex resources towards what the team believes is most important to the mental health needs of the child. Outcome-based services � Goals and services must be measured and treatment adjusted to improve outcomes.

6. Traditional Services vs. Wraparound Dan Naylor, White Pine Consulting Service

7. Enrollment & Eligibility Criteria for Children Come First Program DSM-IV-TR � Axis I diagnosis. Functional impairment at self care, community, social relationships, family, school/work. Involvement in at least 2 systems: mental health, special education, child protection, juvenile delinquency, social services. Imminent risk of institutional placement (hospital, residential, or corrections). Other interventions have not been successful over time; there are persistent barriers to service access; and/or there is a need for service coordination. Parents/Legal Guardian willing to be involved.

8. Establishing a Team The Child and Family Team are comprised of Parents, Child (if appropriate), and the 4-8 people who know the Family best. Ideally, membership is at least 50% non-professionals who have access to informal resources and support. The Family gets to decide who is on the team based upon who knows them best and who cares about them.

9. Develop Your Child & Family Team

10. Questions to Ask to Help Family Members Identify Team Members Who do you call in a crisis? Who is your most reliable support person? Do you have any family members that are a positive support to you or your child? Do you have any neighbors or friends who are a positive support? Who does your child trust? Who has been a positive support for your child? Are there any service providers that you have worked with in the past that that you feel has been helpful? What associations, organizations, or groups have been especially helpful to you in the past?

11. Expectations of Team Members Attend team meetings regularly. If you can�t attend, notify the Care Coordinator ahead of time and share your information on progress or concerns. Actively participate in meetings � listen to others, participate in decisions, involvement in the development of the Plan of Care (POC), and state your opinion. Respect the Family�s values and culture. Focus on strengths and progress. Share responsibility for implementing the plan. All team members come to the table with resources (knowledge, skills, funding, connections, energy). If the Team comes up with strategies to meet a Child/Family need, the Team has to make it happen. Volunteer to complete tasks and follow through.

12. Expectations of Team Members Decisions are made by consensus. Be willing to compromise and support the Team�s decisions even if it is not your personal first choice. If you have a conflict with another Team Member, talk with them directly about it and come to a resolution. Own your opinions or concerns. If you can tell a Team Member about a concern, you should be able to tell the Parent or Team Member directly involved about that concern. Be flexible. Team meetings may need to be held at times and locations that are outside of your normal routine in order to meet the needs of the family. Communicate. Communicate. Communicate.

13. Role of the Care Coordinator Coordinator is guide and expert on the Team Process. Help Family build Child & Family Team. �Hub� of the Team. Assure Team Develops POC. Guarantee POC is monitored, including reassessment and updates. Ensure the Team uses the POC to move through the Team Process. Facilitate team meetings, or assign designee.

14. The Care Coordinator Is Not� One and only decision-maker. Person who does all of the work. The only person everyone calls. Person who everyone expects will have all of the answers. Person who knows everything. Messenger for all team members. To dictate what should be done. To be a policy and procedural manual for other agencies.

15. Skills for Effective Team Facilitation Listen accurately. Communicate clearly. Develop trust of team members. Understand multiple perspectives. Intervene on unproductive behavior. Accept feedback without reacting defensively. Provide support and encouragement. Maintain and demonstrate patience.

16. Facilitator Role Families can request a team meeting whenever they feel it is necessary. Team meetings are held monthly, but may occur more frequently. Team meetings will not be held without the parent having the ability to give input into the meeting. If parent is not able to attend Care Coordinator should get their input prior to the meeting. Team meetings will be scheduled at a time and place that is comfortable and convenient for the family. Develop and follow an agenda. Families may be consulted about what they want on the agenda ahead of time. Ensure that the child and family have a voice.

17. Facilitator Role Cont. Keep everyone on track. The purpose of the meeting is to discuss progress on goals and strategize ideas on how to build on the family strengths. Assure equal participation by all team members, including speaking during meetings and taking on tasks. Assure team members discuss and develop plan to address important issues. Foster brainstorming which leads to multiple, creative ideas. Ensure meetings are productive. At the end of the meeting, summarize duties assigned to team members as well as any decisions that were made. The next meeting should be scheduled at the end of each meeting in order to facilitate scheduling. The team may even consider scheduling several months in a row. Send out team meeting minutes if requested by Team Members to help assure that everyone left the meeting with the same understanding.

18. Initial Team Meeting Agenda Introductions. What is your role? What strength do you bring to the team? Identifying child/family strengths. What does Jane/the family do well? What do you like about Jane/the family? What is unique about Jane/the family? Identify child/family needs and goal areas. Prioritize. What needs to be different or better? What is your primary concern for Jane/the family?

19. Initial Team Meeting Develop strategies/Plan of Care. What is already in place to address some of the needs? Where are the gaps? Review Crisis Plan. Summarize what decisions were made, who is assigned to tasks, when tasks will be completed. Schedule next team meeting.

20. Ongoing Team Meeting Agenda Introductions. Review agenda � additions, questions. Start with identifying what has been going well and/or strengths of the child and family. Cover agenda items. The focus of agenda items will be on discussing progress on goals, evaluating effectiveness of interventions and services, and discussing what else might be helpful. Review/update POC and/or Crisis Plan if needed. Summarize what decisions were made, who is assigned to tasks, when tasks will be completed. Schedule the next meeting.

21. Facilitation Challenges Open-ended teams. Side conversations. Inappropriate use of time. Members not being team players. Meeting starts or ends late. Poor follow-through. Members focus on negativity rather than productivity. Members not �thinking outside the box.�

22. When to Use Different Decision-Making Methods

23. Family Centered Approach Voice: Children and families are listened to and heard in all phases of the planning process Access: Children and families have valid options. No services are withheld for categorical reason. Ownership: Children and families agree with and commit to any plan concerning them

24. Building Trust with Families Listen with true concern without judging Don�t rush decision making Two way conversation Be honest Do not pretend to understand if you truly do not understand Treat parents as equals; they are the ones that know their child the best

25. Building Trust with Families Be aware of the family�s world: Be willing to meet and work with the family where they are Do not give an answer just to give an answer: If you do not know the answer, say so Have clear expectations

26. Raising the Family Voice The most important supports that increase caregivers� capacity to participate in their children�s education and treatment are: staff treated me with dignity and respect staff made me feel my participation was important staff provided a contact person Friesen, Kruzich, Ogilvie, Pullman, Gordon, & Jivanjee, 2001

27. Raising the Family Voice Team meetings are not held without parent input and/or presence Seek input from parents and youth first Parents and youth choose who is on the team Direct questions to the parent and youth Ask �what does the parent or youth want� Making sure parents know what to expect Informing parents about their rights and helping them exercise them

28. Strength-Based Planning Clearly identify the family and team�s unique situation/needs Use the resources and knowledge within the team to meet needs Take into consideration the child, family, and team members� interests, relationships, hobbies, activities, culture, and personal traits. Strengths can be found in these areas. Bullet #1, should this be a heading? Ex. Strength bases planning means:Bullet #1, should this be a heading? Ex. Strength bases planning means:

29. Strength-Based Planning Children and families have an active voice in decisions that are made as well as access to services and supports that meet their needs. Include a balance of traditional services and non-traditional community and family supports. Every child and family has strengths; a good skill for a care coordinator to have is to know how to ask the right questions to draw out the strengths. No two plans should look the same.

30. Why Be Strength-Based? A therapeutic relationship is likely to have a stronger foundation when a family experiences the provider as recognizing and valuing positive aspects of the family members� personalities, life histories, accomplishments, and skills. If the point of the service encounter is to help the family develop improved coping skills for dealing with the challenges in their life, it will be easier to start that process using the family�s existing competencies and characteristic as a foundation. -John Franz, from the National Wraparound Initiative Website

31. Why Be Strength-Based? A process that identifies and highlights the strengths of the family members will make it easier to identify potential points of attachment that can grow into informal sources of friendship and support. If our goal is to help families with the complex needs of transition from service dependence to normalized social interdependence, an approach that only focuses on eliminating negative characteristics is less likely to be successful than one that balances the reduction in vulnerabilities with a measureable and sustained increase in capabilities. -John Franz, from the National Wraparound Initiative Website

32. Common Factors for Positive Behavioral Change Asay & Lambert, 1999

33. Building on Strengths Strengths assessment at intake Incorporate strengths into treatment plan Start child-family team meetings with a discussion of strengths and progress

34. Building on Strengths Focus interventions on what works for youth and family Recommendations of others (court, evaluations) Child and family input about what they believe would be most successful History of services already used and what�s been effective Least restrictive and least intrusive for the child and family. Child and family strengths Family culture

35. Building on Strengths Age of the youth (age appropriate resources) Youth�s learning style Diagnosis Continuity of care after CCF enrollment Explore natural support options first as they tend to be less intrusive and are generally longer term than paid service

36. Shifts in Beliefs and Attitudes Participants Hopelessness Helpfulness Self-Blame Understanding Staff Seeking Deficits Seeing Strengths Expecting Little Expecting Much Knowing Better Different Knowledge Staff Choosing Child & Family Choosing Power Over Power With

37. Shifts in Beliefs and Attitudes Programs, Agencies, and Communities Conflict & Competition Collaboration Crisis Intervention Crisis Prevention Adapted from Christian Dean, Cornell, 1993

38. Reflecting the Individual and Family Culture in the Work of the Team Culture is defined as �the unique values, ideas, customs, skills, arts, of a family or a people that are transferred, communicated and passed along.� Culture refers to the unique way that an individual, family or people operate and function, including habits, characteristics, preferences, roles, values, beliefs, traditions, etc.

39. Reflecting the Individual and Family Culture in the Work of the Team Culture is more than race, language, or food preferences. Plans are less likely to be successful without the reflection of culture in the work of the team.

40. Strengths and Needs Assessment: 13 Life Domains Living Situation Basic Needs and Financial Status Child and Family Situation Mental Health Social Interaction Access to Community Resources Cultural Involvement Spiritual Status Educational/Vocational Status Legal Involvement Medical Status AODA Status Crisis Response

41. Initial Strength-Based Assessment for the Child Baseline Summary Home Information Peer Information Sexual History Religious History Significant Past Events Recreation Medical information Major Illness AODA Developmental History Psychiatric Hospitalization History Medications Legal (CPS and/or Delinquency) Education/Vocation

42. Initial Strength-Based Assessment for the Family Family structure External/Natural Supports Origin/Culture of the Family Stressors that affect the family Major Medical Illnesses Mental Health History AODA Legal

43. Moving from the Assessment to the Plan of Care (Treatment Plan) Review the strengths and needs that have been identified by the child, family, and team. Determine the top 3 areas of need for the child, family, and team. Prioritize

44. Developing the Plan of Care Individualized plans Plans should be strength-based, needs driven, individualized, culturally competent, and community-based. The care coordinator schedules meetings with the family and team to develop the plan. The team reviews process principles and identifies the strengths of the individual and the family members. The team reviews each domain, identifying strengths, needs, and the child�s current level of functioning. The team prioritizes the needs. Clean up the extra bulletClean up the extra bullet

45. Developing the Plan of Care The team develops the plan of care to include: The child and family�s present level of functioning The goals, objectives, and activities Who will be involved How services will be paid for How outcomes will be evaluated How to evaluate the effectiveness of the plan Enhance natural supports Use of non-traditional interventions Brainstorming multiple ideas to meet the identified need Clean up the extra bullets -Clean up the extra bullets -

46. Crisis Response Plan Development �A crisis occurs when adults don�t know what to do.� �Carl Shick

47. Crisis Response Plan Development Expect that a child with multiple needs living in the community will experience crisis at some time. Brainstorm Consider the most challenging act(s) that could happen Strategies that have worked for the child and family in the past Strengths of the child, family, and team Include a brief summary of important information Clean up extra bulletsClean up extra bullets

48. Crisis Response Plan Development Consider each possible intervention for the situation Pre-plan interventions with people and/or agencies who may be involved in a safety issue for the child. Pre-plan through police and hospital interventions Develop a plan around who will be notified and in what timeframe that notification needs to occur Make sure that the team evaluates the effectiveness of the crisis response plan and make changes when needed

49. When is the team done? Outcomes indicators show that the goals for the child and family are being met or the child and family are working towards meeting the goals. The child and family have involved natural supports and are using them ongoing. The child and family have found access, voice, and ownership.