changing ABLE to:
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Transcript of changing ABLE to:
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changing ABLE to:
Able-differently, a Utah non-profit community service
PO Box 9757
Salt Lake City, Utah, 84109
801-520-7376
Fax 801-466-7569
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ABLE-differently would like to welcome you to this power-point presentation of ideas and
services used to serve school age and younger children having secondary social and emotional concerns associated with their special health care needs. We will address several areas important to community health care providers, parents and educators, that they have found useful in their
involvement with this population.
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Outline of Presentation• 1. Refocus ABLE-differently program ideas.• 2. Change process.• 3. Levels of care and tools for change. • 4. Public Health Model goals.• 5. Understanding complex problems and systems.• 6. The ABLE-differently community process.• 7. Family resiliency.• 8. Interconnections and reconnections.• 9. Relationships to the families and schools.• 10. Health Provider involvement in school/family
systems.
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-1-
INTRODUCTION TO THE ABLE-differently PROGRAM
Current focus on three goals
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Children are referred to the ABLE-differently Program for having emotional or behavioral
excesses or deficits contributing to personal difficulties, or failure
within social or educational systems.
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ABLE-differently - ProgramLooking children in terms of their functional
emotional intelligence:
• A – Adapting: personal coping abilities and resiliencies
• B – Biopsychocultural behaviors from
context of experiences
• L – Lifelines: available support systems
• E – Experience: social, physical, emotional and psychological
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Past Contributors to Able-differently Program’s Concept
• Heidi Ahlers RN
• Ellen Ahlers RN
• Lou Allen MD MPH
• Gail Brown PhD
• George Delavan MD
• Susan Dickinson MS
• Lila Hutchinson
• Bettyeann Mayer RN
• Julia Mathews PhD
• Sterling Redd LCSW
• Hermann Peine PhD
• Judy Peters
• Chris Sandoval
• Jim Taliaferro LCSW
• Walt Torres MSW
• Barbara Ward RN
Great thanks to Utah Dept. of Health/ Children with Special Health Care Needs and the many more than listed here and foremost the families who were entrusted to our care and taught us many of these ideas.
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-2-
THE ABLE-differenly CHANGE PROCESS FOR
INDIVIDUALS AND FAMILIES
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Some Initial Social and Personal Barriers to Child and
Family Health• Poverty• Lack of or use of Educational Opportunities• Poor Physical Health• Mental Illness• Disabling Conditions• Abuse, Neglect, or Abandonment • Poor Access to Resources• Cultural-institutional Factors and Considerations
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People Can Change Personal Stories from Frustration and Hopelessness to
Resilience and Strength through use of Team Wraparound Approaches with
the family that helps re-story, sometimes hidden, unique exceptions
to the problem laden narratives.
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Families Must be at the Center of a self help Change Process
Working positively with the people who currently help or support the family or specific family members (family helpers).
Learning to recruit community team players. Learning to maintain community helpers. Learning leadership skills. Developing new solutions. Developing communication, problem solving,
and goal-setting skills. Must perceive positively their partnership
status To be heard, respected, felt and understood so
to act on their own preferences and decisions.
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Family helpers assist families to:
• Increase hope.• Be encouraged towards
action.• Grow in life skills.• Build supportive
relationships.• Be motivated.• Respect their own culture.• Feel cared for and
actively care for themselves.
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Families Have Opportunities to Learn Community Team Building
• Traditional Interventions focused primarily on problems, not strengths.
• However, problems often require multiple interventions using resources from many directions.
• Therefore, strength-building requires similar support from many sources.
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Families Learn to Build Teams Within the Community and
share partnerships• Department of Health • Family Medical Care
(Medical Home)• Schools• Extended Family• Worship Groups• Social Services• Mental Health Services • Law Enforcement• Friends & Neighbors
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-3-ABLE-differently RECOGNIZES AND
PROMOTES THE NEED FOR LEVELS OF CARE AND THE
CLINICAL TOOLS REQUIRED FROM LOCAL SYSTEMS IN THE
COMMUNITY RECOGNIZING ESPECIALLY, FAMILY, SCHOOLS, AND MEDICAL HOMES THAT ARE INTEGRATED AND CONTINUOUS
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Health Providers Promotion/Prevention Matrix
Levels of CareLevels of Complexity PRIMARY SECONDARY TERTIARY
HIGH COMPLEXITY
MULTIPLE CONDITIONS
IDENTIFIED INCREASING COSTSMINIMAL IDENTIFIEDRISKS
NORMAL POPULATIONWITH UNIDENTIFIED RISKS
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There exists a Clinical Toolbox for Intervention and Integration of the
Child and the Family with the Community
• Finding the right key to a child or family’s difficulties and unlocking their strengths.
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Some Tools in the Box• Traditional and Strength Based
Assessment • Education & Working Together• Referrals & Resource Guide • Family & Child Consultation• Promote Mentoring• Support Help that Works• Practices that Look at Solutions• Communication Enhancement• Changing Personal Negative Stories to
Positive Stories• Job Sampling• Building Positive Rituals & Routines• Building Positive Self-identity• Focus on everyday function and
natural resources
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Children and families with the highest risks tend to be the most expensive for
society as a whole.
ABLE’s rich program resources are not to be absorbed in serving just a select few clients, but
also used for the empowerment of a broader community serving the same population. Public Health methods and practices can serve these
functions and rightfully should.
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THE ABLE PROGRAM USES THE GOALS OF A
PUBLIC HEALTH MODEL
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By Building Bridges with the Community
• The clinical work becomes the workshop for training and teaching the community.
• Population based practices are envisioned supporting wellbeing, wellness with imbuing positive mental health within local systems of care for special needs.
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Our experience has been both providing health for both the Individual and the general population
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By People Understanding and Acting On the Interaction of Complex Issues and Multiple Influences in Their Lives, they can Influence and Determine Their Own Destiny and Health Outcomes
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By Providing Cost-effective Models for Community Health
• Make available online web based resources.
• Assure collaboration among local line services in the community.
• Integrate physical and behavioral health in family, schools and health care
• Use everyday and natural resources to highlight children’s experiences and their needed stories of those opportunities.
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By Demonstrating that Promotion, Protection, and Prevention of many social emotional difficulties associated with special health needs are all important functions of a Public Health
System and are presumed to be prerequisites in local communities of care as being in the back yard of the medical
home.
• There are few magical fixes.
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By Supporting the World Health Organization’s Definition of Health
as a State of Complete Physical, Mental and Social Well Being-Not
Just the Absence of Disease.
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THERE EXISTS A NEED TO UNDERSTAND COMPLEX
PROBLEMS AND COMPLEX DIFFICULTIES WITHIN
COMPLEX SYSTEMS
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PROBLEM VS. PROBLEMS
Wouldn’t it be nice if all children and families came in with just one isolated
identified problem? But life is more complex, and multiple difficulties abound and must be understood in
more coherent ways.
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Patient Characteristics on Intake
• Percent of Patients by problem coming into the Salt Lake City ABLE Clinic, and the Provo, Price, Moab, and Blanding Itinerant Clinics in the recent past.
• MCH studies reports 13-18% of child population have special needs and close to 40% of special needs have psychosocial needs on the average.
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THE ABLE-differently PROGRAM
ADMINISTRATIVE AND CLINICAL INTAKE
PROCESS
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The ABLE-differently Program Services Must Match Needs
• Before intake the severity of needs are assessed and immediate referrals are made.
• Children and families will be best served by multiple intervention tracks with consideration of non medical and related services as critical as a medical referral.
• Families will be involved in making this determination as well as managing their team.
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ABLE-differently Program Two Track Systems
• COMMUNITY CONSULTATION TRACK
• 1. Many Strengths• 2. Low Risk• 3. Fewer Problems• 4. Identified Supports• 5. Short Term• 6. Problem Focused• 7. Physician driven
ongoing care.
• COMPREHENSIVE MULTI-ENCOUNTER
TRACK• 1. Fewer Identified Strengths
• 2. Moderate/High Risk
• 3. Many Problems with lower resources
• 4. Supports Needing to be Built
• 5. Long Term
• 6. Broad Solution Focused
• 7. Collaborative Team Efforts
• 8. On Going Follow-up Care
• Complexity involving social emotional and behavioral concerns
• May best require collaborative, teaming
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Assessment Instruments Health Care Providers may find useful in their practices will be highlighted
in some of the following sections.
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Psychological Assessment
Assessing Cognitive AbilitiesCommon Instruments Used or Requested
• INSTRUMENT AGES
• Bayley Scales of Infant Development 0-4
• WPPSI 4.5-7
• WISC – IV 6-16
• Unit 5-17
• Slosson – R 4-Adult
• WCST-64 6.5 - 89
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Psychological Assessment Assessing Learning/Attention
Abilities and DeficitsCommon Instruments Used P/T= (Parent/Teacher)
• INSTRUMENT AGES
• Vanderbilt Assessment Scale 6-12 (P/T) Brown Attention Deficit Disorder Scales (BADDS) 4-Adult
• Conners’ Continuous Performance Test 6-Adult
• Behavior Rating Inventory of Executive Functioning 5-18
• Behavioral Observations 0-Adult
• Child Behavior Checklists 3-18
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Psychological Assessment Assessing a Possible Autism
Spectrum Disorder• Instrument Ages
• Asperger Syndrome Diagnostic Scale 5- 18
• Autism Diagnostic Observation Schedule (ADOS) 2-Adult
• Child Autism Rating Scale (CARS) 3-18
• Autism Screening Instrument Childhood
• Clinical Interview 2-Adult
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Psychological Assessment Depression/Anxiety
Common Instruments Used or Requested• INSTRUMENT AGES
• Revised Children’s Manifest Anxiety Scale (RCMAS) 6-above
• Reynolds Child/Adolescent Depression Scale (RCDS) Grades 3-6/7-12
• Multidimensional Anxiety Scale 6-18 Suicide Ideation Questionnaire Grades 7-12
Clinical Interview 2-Adult
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Psychological Assessment Social/Behavioral
Commonly Used or Requested Instruments • INSTRUMENT AGES
• (P/T) Conners’ 6-18• (P/T/Adolescent) Child Behavior Checklist
3-18• (PT) VINELAND Adaptive • Behavior Scales 0-Adult• Aberrant Behavior Checklist 0-Adult• Positive and Negative • Reinforcer Survey (ABLE website)
2-18• Behavioral Observations 0-Adult• Youth Outcome Questionnaire 6-18 ABLE Strength 4-Adult
Clinical Interview 2-Adult
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Family Health Promotion Plan Assessment of
Strengths, Weakness and Intervention Strategiesin the Areas Of:
• Child
• Family
• School
• Community
• Cultural & Economic Factors
• Physical & Emotional Health
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Child• Self regulation/safety
• Belonging/attachment
• Exploration/Play
• Physical and Developmental Health
• Body Systems and Sensory Motor Functioning
• Adaptive Self-help
• Emotional and Social Health
• Sense of Self and Identity
• Industry/Achievement
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Family
• Housing/Food/Income
• Insurance
• Medical Home
• Routines and Rituals
• Celebrations/Recognitions
• Recreation/Leisure
• Extended Family Support
• Spiritual Strengths
• Mutual Respect
• Sanctuary/Secure base
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School• Achievement/Grades
• Parent Partnership
• Friendships and Peer Relations
• Citizenship and Conduct
• Teacher/Student Fit
• Cultural Acceptance
• Recognitions
• School Health Care Plan
• After school programs
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Community and Culture• Language• Beliefs and Customs• Cultural Heritage and Identity• Safety Issues• Community Working Together• Religious Supports• Resource Availability• Political/Economic Realities• Providing Public Health and other
community needs as safe places to play and re-create
• Collaborative local systems of care responding and pulling together on behalf of individual families with their child in school/preschool/headstart or early intervention
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Family Health Promotion Plan(Pulls from the listed resources)
O th er
D e n ta l
G e ne tics
O rtho
N e u ro lo gy
O u ts ideS u b -spe c ia lty
R e fe rra ls
In su ra n ce
H u m an S erv ices
P a rks a ndR e c rea tion
V o ca tio n a lR e ha b ilita tion
M e nta l H e a lth
O th erC o m m u n ityR e so u rces
O th er
L e g a l C en ter
P a ren t Ce n te r
L IN K S
P a re ntA d voca cy a nd
S u pp o rtG ro u ps
R e so u rceD ire c to ry/W e b s ite
H a n do u ts
P u b licR e la tio ns
T e amM a in te na n ce
C a re Te a m s
C a reC o ord ina tion
S ch o o lC o n fe re nce s/H e a lth P lanC o m p o ne nt
IE P M e etin gs
S cho o l a ndC o m m u n ity
C o nsu lta tion
C o ord ina tionw ith
M e d ica l H o m e
Family Health Promotion P lan
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Follow-up and Outcome Assessment
• Are we better off from what we are doing?
• Scaling• YOQ• Other Psych. Measures• School Performance• School and Clinic
Attendance• Team Management
Form• Parent Outcome Rating
Scale
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-7-FAMILY RESILIENCY
FROM RISK TO THRIVING
The Process of Moving from Despair to Hope
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Family Past and Present Realities
• Stressful Challenges• Problems• Vulnerabilities• Losses and Pain• Adversities• Traumas• Disappointments and
resentments
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Just Making It
• Toxic Environments• Hollow Successes• Inflexible• Overly Defensive• Abuse Prone• Strained Relationships• Personality Disorders• High Dependence on
Society’s Safety Net (Resource Supports)
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Life Threatening
• Ineffective-Coping
• Adaptive Dysfunction
• Psychopathology
• Antisocial
• Destructive Narcissistic
• Violence and Lawlessness
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ADAPTIVE COPINGLeads
to Increased Personal and Family Assets and Increases Protective
Factors
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Need for family LIFELINESBeliefs and Values Systems
Organizational Patterns
Communication -
Problem Solving
New Meanings Flexibility/Open Open Dialogue
Reframing Balanced Roles Open Feelings
Make things Normal Respect Differences
Listen to Others Opinions
Give Proper Perspective
Connectedness & Forgiveness
Share & Respect Goal Differences
Positive Hopes Social Supports Have Empathy
Increased Skills O.K. Economics Honesty/Humor
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Need for THRIVING abilities in Children and Families
• People become winners when they start using sufficient protective factors for themselves and their families.
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Need for individual and family FUTURE REALITIES AND
VISIONS
• Personal and Family Well-being
• Wellness• Improved Health
Status• More Adaptablity• Salutogenic (healthy)
Outcomes
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-8-
INTERCONNECTIONS and RECONNECTIONS
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Useful Relationships for All Providers and Families to Help Achieve Positive
Family Outcomes• 1. Relationships with Schools
• 2. Relationships with Medical Providers
• 3. Relationships with our Social networks
• 4. Relationships to Community Support Systems beyond our extended family and friends
• 5. Relationships to Educational Resources
• 6. Relations with leisure and recreation