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

• Consulted with Bruce Wampold for comparative review of literature with our existing model

2Allendale Association - DCFS Summit -

Governors State Univ 10/29/2010

Key Factors to Successful Outcomes

• Coherent clinical model

• Family engagement

• Stabilization of discharge resource

• Availability of aftercare supports



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



5

The Conflict Cycle

2Stressful

Event

Attachment ModelView of Self & Others

3Youth’s Feelings

4Youth’s

Behaviors

5Adult Reaction

a. Feelingsb. Behavior

c. Youth's Response

Relational Trauma Re-Enactment Systems

Meaning of behavior/ youth’s conflict

Trauma History

(Wood & Long, 1991) Modified

Allendale Association - DCFS Summit - Governors State Univ 10/29/2010

REStArT Supervision & Dialogue Meetings

Team Meetings w/ Clinical Focus

CC/HC Groups

Clinical MtgsCross-Trainings

Group Supv for CC/HC Groups

CR Dialogue Mtgs

Dialogue Mtgs w/Dir & Clin Supv by VPs

Supv w/Core Team by Dir & Clin Supv

Supv w/UC & Therapist by Dir & Clin Supv



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 FAMILIES7


Change was Needed

• Families were having trouble accessing services• Communications were happening across

departments in silos • Realization that change was needed

8

Access

All Depts.

Clinical Consultati

on


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



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%



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



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



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



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



Seeing the Whole Youth

• System-wide investment serves function of creating “wholeness”

• Compartmentalization & Polarization

15

Hero

Villain


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



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



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



All members may experience ambivalence



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



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 meetingsWhat 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 -


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



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



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


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



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



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)


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)



Summary

• Ongoing Challenges– Commitment at all levels– Family “driven" milieu

• Case Examples

• Questions & Answers



Presenter Information

Contact Information:

Judy Griffeth, LCSW [email protected]; (847) 245-6330

Saray Hansen, MA [email protected]; (847) 831-4216

Ronald Howard, LCSW [email protected]; (847) 245-6329

Howard Owens, LCPC [email protected]; (847) 245-6170

Dr. Pat Taglione, PsyD [email protected]; (847) 245-6302



mailto:[email protected]





FAMILY ENGAGEMENT through The ALLENDALE ASSOCIATION REStArT MODEL.

Documents

existing model

family treatment new

counterresponse model

clinical needs

conflict situations

based practicetrends

challenging behavior

treatment programs