Informing and Engaging the Family to Participate in a Structured, Curriculum-

Based Family Treatment Model Kara M. Dean-Assael, LMSW

Lydia Franco, LMSW, Ph.D. Candidate

to Improve Child Behavioral Difficulties

2013 Learning Community Training Webinar #1

◦ Who are We? LET’S TALK: What is a Learning Community?

◦ What is the 4 Rs and 2 Ss? LET’S TALK: The 4 Rs and 2 Ss and Working with Caregivers. LET’S SHARE: Video: Message to Clinicians

◦ Identifying, Informing, and Engaging Families LET’S TALK: Step One: Identifying Families for a Successful Program LET’S TALK: Step Two: Informing and Highlighting Family Strengths LET’S PRACTICE: Video: Initial Contact Demonstration and Discussion LET’S SHARE: Informational Brochure LET’S TALK: Step Three: Engaging the Family and Addressing Challenges LET’S PRACTICE: Video: Initial Engagement Demonstration and Discussion LET’S SHARE: Discussion of Barriers to Engagement

◦ Roadwork and Next Steps

◦ Q&A

WHO ARE WE?

Trainers and Participants

◦ Group of organizations committed to improving services related to

a specific area of quality, guided by a Resource Team

◦ Members communicate regularly with each other to share their

experiences and to learn from each other

◦ Builds on the collective knowledge and real world experiences of

participants

◦ Efficient and effective method to support widespread practice

improvement

◦ Ensures that the common and unique concerns, challenges and

needs are addressed

Kara Dean-Assael, LMSW Clinical Consultant and Trainer. Clinic Technical Assistance Center, NYS

Lydia Franco, LMSW Clinical Consultant and Trainer. Clinic Technical Assistance Center, NYS

Lydia Franco, LMSW. Clinical Consultant and Trainer. Clinic Technical Assistance Center, NYS

Lydia M. Franco, LMSW, is a PhD Candidate at Rutgers University School of Social Work and a past recipient of the SAMHSA funded Council on Social Work Education's Mental Health and Substance Abuse Minority Doctoral Fellowship Program. Her current area of concentration in doctoral studies is Latino child and family mental health issues, with a focus on assessing parenting cognitions and how this can improve the provision of culturally sensitive services to Latino families. Ms. Franco received her MSW at Columbia University’s School of Social Work in 2004. She is currently a trainer and clinical consultant at The Clinic Technical Assistance Center (CTAC), funded by New York State Office of Mental Health, where she focuses on disseminating a number of practice and business initiatives to mental health clinics across the state and nationally. Further, she serves as a Senior Research Coordinator for an NIH-funded study assessing the effectiveness of a multiple family group approach for children with behavioral difficulties. Lastly, she has clinical experience in a variety of settings working with children and families in the areas of mental health and health care. She recently held a position of Social Worker in Mount Sinai’s Child Outpatient Psychiatry Department. Ms. Franco is also a Part-Time Lecturer at Rutgers University School of Social Work and a Field Instructor for social work students at McSilver Institute.

Kara M. Dean-Assael, LMSW. Clinical Consultant and Trainer. Clinic Technical Assistance Center, NYS

Kara Marie Dean-Assael, LMSW has been working with children and families for the past 15 years. As a graduate of Columbia University School of Social Work in 2001, she focused on Program and Planning. She is passionate about helping to create programs and practices to increase engagement and family functioning. She was the co-director of the MFG Project, an NIMH funded project that is now known as the 4 Rs and 2 Ss for Strengthening Families Program. She has facilitated and supervised many groups and has worked for the past 4 years on training clinicians and supervisors on how to utilize the model in their clinic settings. She currently works for the Clinic Technical Assistance Center as a trainer and consultant. She co-leads the clinical lunch and learn series with Lydia Franco, as well as other initiatives that are offered through CTAC. She continues to participate in the learning process by participating in conferences and trainings and is also a field instructor at the McSilver Institute for Poverty and Policy Research. Ms. Dean-Assael has co-founded a soon-to-be 501c3 called Fareground Community Café, which is a collaborative project with the community of Beacon, NY. Here, children and families from the entire community can gather to enjoy a healthy meal by providing a donation or volunteering in exchange for their meal. (www.fareground.org)

Agency Clinic City

FEGS Jerome Clinic Bronx

FEGS South Bronx Counseling Center Bronx

FEGS Rego Park Clinic Queens

FEGS Copaigue Clinic Long Island

FEGS Hempstead Clinic Long Island

FEGS Central Islip Counseling Center Long Island

FEGS School Based Clinic Bronx

Kings County Hospital Center Adult OPD Brooklyn

Kings County Hospital Center Child and Adolescent OPD Brooklyn

South Nassau Community Hospital Mental Health Counseling Center Long Island

Nassau University Medical Center NuHealth Therapy Center for Children, Adolescents, and Families Long Island

Bellevue Hospital Center Child and Adolescent Psychiatry Clinic Manhattan

Safe Space Jamaica Family Life Clinic Queens

Harlem Hospital Center Division of Child and Adolescent Psychiatry Manhattan

Northeast Parent & Child Society Child Guidance Center Schenectady, NY

Astor Services for Children & Families Astor Counseling Services, Kingston Clinic Poughkeepsie, NY

Allegany Rehabilitation Associates The Counseling Center Wellsville, NY

WHAT IS IT?

The 4 Rs and 2 Ss for Strengthening Families for

Individual Families

How often are you able to work with caregivers?

◦ All of the time

◦ Some of the time

◦ None of the time

The most common reasons school age children are referred for mental health services are conduct and behavioral difficulties

The evidence indicates that the involvement of primary caregivers is an integral ingredient for successful outcomes

All too often, school age children with conduct difficulties are provided individual therapy with no or little involvement of caregivers

Caregivers of children with conduct problems often experience high levels of distress and low levels of social support

◦ These factors compromise the ability of caregivers to implement strategies to improve conduct problems

Rules

Relationships

Responsibilities

Respectful Communication

Stress

Social Support

Rules organize the family

◦ Organizes a child’s life in other areas like school, neighborhood, etc.

◦ Parents set up systems for knowing when rules are

being followed and when they are not

Rules are only as good as what comes after them!

Consistency is key!

Both kids and parents have responsibilities within their families.

◦ Each member has a say

◦ Each member contributes to the family

◦ Each member helps to fix those things that are not going well

Relationships are the cement of the family.

◦ Relationships represent how members cares about each other

◦ Children behave better with more positive relationships

Good communication is the foundation for spending positive time together.

◦ Helps parents monitor their children ◦ Kids feel better supported ◦ Talking to each other with respect

How often do you work with children and families who have really high levels of social support and low levels of stress?

◦ All the time

◦ Some of the time

◦ None of the time

Stress can get in the way of seeing strengths in each other and ourselves.

◦ A child’s behavior can look exaggerated when seen by a parent who is under a lot of stress

◦ Parental stress can negatively impact the child

Both parents and children need positive, responsible sources of support.

◦ Sources of support can be found in many different areas

◦ Importance of advocating for oneself

Identifying, Informing, and Engaging Families

22

◦ Clinicians use the treatment model with at least 1 family per clinician

◦ Family sessions with client begins by beginning of March

◦ Informational Brochure

Steps for Identifying and

Engaging Families:

1) Identifying Families for a Successful Program

2) Informing and Highlighting Family Strengths

3) Engaging the Family and Addressing Challenges

24

Children, ages 7-11

Children with externalizing behavioral difficulties

At lease 1 primary caregiver capable of participating in the treatment with the identified child

25

Go through own caseload

Go through new intakes or families soon to be evaluated

Present at a staff meeting to get referrals from colleagues

Use the brochure to present the program

26

27

This is an example of one way of informing the client about the program.

What did you observe during this video?

What other approaches would you suggest to consider?

Informational Brochure:

◦ Use as a guide to discuss with the family the principal components of the model

◦ Use of the last page of the brochure to begin a discussion of the strengths and challenges the families are experiencing with each R or S

One helpful step in your first meetings with a family is to help them identify strengths.

By beginning the discussion before group starts this helps to encourage positive-parent child interaction.

The family’s ability to identify (or not identify) strengths in their family is a helpful assessment tool for you to determine how the family is functioning.

30

You can use the following questions in your initial meeting with a family or just before they begin services:

◦ 1) What’s working well in your family?

◦ 2) Think about something positive you (the caregiver) can say about your child?

◦ 3) Think about something positive you (the child) can say about your parent?

It is helpful to have a list of strengths ready to help families who are struggling identifying them. Every attempt should be made to leave on a positive note with at least one strength identified, even if a minor one.

This is an example of one way of informing the client about the program.

What did you observe during this video?

What other approaches would you suggest to consider?

The very reasons why children with conduct disorder can be so hard to see in clinical appointments are the same reasons why parents are often frazzled and exhausted by the time their children enter mental health treatment.

Parents of children with conduct problems are really disempowered because their best parenting has not worked, so enhancing parent self-efficacy is important.

Using effective communication skills and problem-solving techniques are important to help parents learn reinforcement, alternatives to physical punishment, and to focus on treatment gains rather than exclusively on antisocial behaviors.

(Miller & Prinz, 1990)

34

What are some reasons that families do not show up for their appointment?

35

Barriers can reside with the family, the provider, and/or the system in which the provider works

Triple threat: poverty, single parent status, stress

Concrete obstacles: time, competing priorities, transportation, child care

Perceptual obstacles: attitudes about mental health, stigma, negative experiences, parents’ own stress and needs

McKay, Pennington, Lynn, & McCadam, 2001; Bannon & McKay, 2005; Kazdin & Wassell, 2000; Owens et al., 2002; Deane, Wilson, & Ciarrochi, 2000;

Harrison, McKay, Bannon, 2004; McKay, McCadam, Gonzales, 1996

Copyright © TIES 36

Not all barriers are “equal.”

Perceptual barriers (e.g., stigma) and prior negative experiences have been shown to have the greatest influence on initial and ongoing engagement.

Addressing perceptual barriers may be more important than focusing only on concrete obstacles.

Validate parents and take time to understand their perspective

• Parents with high-need children who do not receive validation for their experience or feel blamed are at a higher risk for dropout.

• Parents who do not trust the provider or feel the information shared will not be held in confidence are also at a greater risk for dropout.

• Youth may also have concerns about privacy and confidentiality.

• Cultural and racial differences between the provider and family can lead to misunderstanding.

Kerkorian, McKay, & Bannon, 2006; Illinois Children’s Mental Health Partnership, 2005; U.S. DHHS,1999; U.S. PHS, 2000; Cunningham & Henggeler, 1999; Liddle, 1995; Szapocznik et al., 1988; Lazear & Worthington, 2004;

Tarico, Low, Trupin, & Forsyth-Stephens, 1989; Kuhl, Jarkon-Horlick, & Morrissey, 1997; Starr et al., 2002; Snowden & Cheung, 1990; Sue, Fujino, Hu, Takeuchi, & Zane, 1991; Takeuchi, Mokuau, & Chun, 1992; Wallen, 1992

Empower parents to explore new strategies and develop problem-solving skills by:

• Helping parents identify barriers to implementing change within the home and other settings

• Working with families to problem-solve around these barriers

• Providing positive feedback to parents

• Family engagement is the process by which families and service providers work together to achieve family goals.

• Providers cannot assume there will be another appointment and must maximize their time with families.

40

Begin identifying families from your caseload

Let your colleagues know that you are looking for families

Distribute brochures

Think about potential barriers to attending the sessions for families and how to address them

Begin familiarizing yourself with the manual and the quick reference guide.

41

Materials will be provided on our website http://www.ctacny.com/4-rs-and-2-ss-individual-family-learning-collaborative.html

Manual Quick Reference Guide Informational Brochure Schedule of Learning Community Activities Webinar Recordings Demonstration Videos And more!!!!

42

February 14, 2013; 12-1pm

Clinician Training Webinar #2:

Core competencies to Implement the 4 Rs and 2 Ss in individual family sessions.

February 21, 2013; 12-1pm

Clinician Training Webinar #3:

Session and Manual Content Review and Preparation for Sessions 1-4.

Q&A:

What are some of your concerns?

Any questions or concerns?

Kara Dean-Assael

kara.dean-assael@mssm.edu

Lydia Franco

lydia.franco@mountsinai.org

45