the building bridges initiative (bbi) · 2018-04-17 · program, went back to her agency after the...

TheBuildingBridgesInitiative(BBI):AdvancingPartnerships.ImprovingLives.

Family-driven and Youth-guided Care

South Carolina State Agencies & Providers: A Partnership Towards Positive Outcomes for South Carolina Youth & Families

April 20, 2018

Presentedby:Dr.JaniceLeBel,PhD,ABPP

FamilyDrivenCare:What’sItAllAbout?

WhatisFamilyDriven?FamilyDrivenmeansfamilieshaveaprimarydecisionmakingroleinthecareoftheirownchildrenaswellasthepoliciesandproceduresgoverningcareforallchildrenintheircommunity,state,tribe,territoryandnation.

Thisincludes:• Choosingculturallyandlinguisticallycompetentsupports,services,andproviders;• Settinggoals;• Designing,implementingandevaluatingprograms;• Monitoringoutcomes;and• Partneringinfundingdecisions.

Source:FederationofFamiliesforChildren’sMentalHealth

WhyIsItImportant?• Strongestpredictorofpost-transitionsuccess,aftereducation,issupportfromfamily• Fiftypercent(50%)ofyouthwhohaveagedoutwilllivewithsomememberoftheirfamilywithinacoupleofyears (aboutequallydividedbetweenparentsandotherrelatives)

Source:Courtney,M.,2007;Courtney,M.,etal,2004

• “Workwithfamilyissuesandonfacilitatingcommunityinvolvementwhileadolescentsareinresidentialtreatmentmayhaveassistedtheseadolescentstomaintaingainsforasmuchasayearafterdischarge..”

Source:Leichtman,M.,etal,2001

“Theeffectivenessofservices,nomatterwhattheyare,mayhingelessontheparticulartypeofservicethanonhow,when,andwhyfamiliesorcaregiversareengagedinthedeliveryofcare.Whiletraditionalformsofcareapproachedmentalhealthtreatmentinahierarchicaltopdownapproach(withtheclinicianmaintainingsomedistancefromtherecipientsoftreatment),thisapproachisnotreflectedinnewerformsofservicedelivery.Itisbecomingincreasinglyclearthatfamilyengagementisakeycomponentnotonlyofparticipationincare,butalsointheeffectiveimplementationofit.“

Source:Burns,B.etal,1999,p.238

WhyisitImportant?

Family-drivenCare:WhatareyourProgram’s

Strengths?

Writedown1or2strengths

What Can Programs Do?

PutanURGENTANDSTRONGFocusonPermanencyPractices– ‘doingwhateverittakes’toensureeverychild

hasapermanenthomeANDthatyourstaffareworkingwiththefamilymemberstoensuresuccessfuldischarge

FROMPRE-ADMISSION

DownloadfollowingdocumentfromtheBBIwebsite:ABuildingBridgesInitiativeGuide:FindingandEngagingFamiliesforYouthReceivingResidentialInterventions:KeyIssues,Tips,andStrategiesforResidentialLeaders

ESPECIALLY:AppendixA:FamilyFindingandEngagementModels

www.buildingbridges4youth.org

1st:THEMOSTIMPORTANTSTEP:

TheImportanceofPermanency• Familyconnectionsareassociatedwithimprovedoutcomes• Lackofpermanencymakespasttraumaticeventsmoredifficulttomanage• Connectionswithfamilyincreasespositiveidentitydevelopment• Treatmentalonedoesnotmeettheneedsofyouthwithoutfamilyconnections

“RightsizingCongregateCare:APowerfulFirstStepinTransformingCWSystems”,AnnieE.CaseyFoundation,2009

HireFamilyPartners/Advocates2nd MOSTIMPORTANTSTEP:

• Hiremultiplefamilypartners/advocates

• Haveseniorfamilypartneraspartofexecutiveteam&providesupervisiontoallfamilypartners

• Havefamilypartners(ANDFAMILYMEMBERS)aspartofEVERYorganizationalworkgroup/committee/taskforce

• Havefamilypartnersshareofficeswithotherstaff–spreadthroughouttheorganization

HireFamilyPartners/Advocates

• Theyserveasco-trainersinstafforientationandongoingtrainingprograms

• Theyserveaspartofhiringgroupstohirestaff

• Theyserveaspartofevaluationteamstoevaluateeachindividualstaff

• “Nothingaboutuswithoutus!”

• DevelopAStrategicPlantoSuccessfullyEngageFamiliesandOperationalizeFamily-drivenCare

Go to the BBI website download, review and planto use the BBI Self-Assessment Tool as part of your strategic plan


3rd MOST IMPORTANT STEP:

AsPartofaStrategicPlanHaveallleadershipteammembersreadandreadandread:

• BBIFamilyTipSheets (longandshortversions)&BBIEngageUs:AGuideWrittenbyFamiliesforResidentialProviders

• MassachusettsDepartmentofMentalHealthCreatingPositiveCulturesofCareGuideChapters:

▫ SuccessfullyWorkingwithFamilyPartners

▫ EmbracingFamily-drivenCare

• Avarietyofothermaterialstosupportincreasedunderstandingandimprovedknowledge-base(seereferencesatendofthischapterandinthePositiveCulturesofCareGuideChaptersreferencedabove)

Board/ExecutivesFocusingonSpecificAreas

IfTheseAreasareNotAlreadyinPlace,ConsiderIncludinginaStrategicPlan

Board/ExecutiveFocusAreas▫ LeadershipPassionatefocusontransformationtowardsFDC(alaBillAnthony:walkthewalkvs.justtalkthetalk)

▫ Agencyclearvalues(e.g.,strength-based,trauma-informed,individualized&flexible;family-driven;youth-guided;culturalandlinguisticcompetence;communityintegrated)

▫ 100%staffcompetentinskills which=values(primarily:respect/compassion/empathy/listening/choice/kindness/patience)

▫ Multipleprogrampracticesclearlyspelledoutforeachvalue

▫ SophisticatedSupervision Systems– especiallyClinical

SmallStepExampleRaquelHatter,CEOoflargeresidentialprogram,wentbacktoheragencyafterthefirstBBISummitandimplementedmultipleimprovements,including:

• Primaryfocusonwelcomingfamiliesasfullpartners• Hiredseniorexecutivefocusedonfamily• RewrotejobdescriptionstoincludeFDC•Madesupervisorsaccountable(someeventuallyaskedtoleave)

Board/ExecutiveFocusAreasFullyimplementing:▫ FamilySearch&EngageorFamilyFindingorOtherPermanencyPractices▫ Wraparound/Child&FamilyTeams▫ BestPracticeClinicalEngagementSkills(i.e.variationsofFunctionalFamilyTherapy/Multi-systemicTherapy)▫ Clearexpectationsforalldisciplinesofstafftoworkinterchangeablyinresidential,home&community

Board/ExecutiveFocusAreasUsingDatatoInformPractice:▫ Restraint/Seclusion▫ AchievingPermanencyforEveryChildinaSHORTTimeframe▫ PuttingintoPlaceforEveryChildaBroadCommunitySupportNetwork▫ PrecipitousDischarges▫ Hospitalizations▫ Re-admissionsintoOut-of-homeCare/HospitalsforallYouthatLeast1to2YearsPostDischarge

THE NEW BAR IS HOW CHILDREN AND FAMILIES ARE DOING 6 MONTHS TO 3 YEARS POST DISCHARGE

WHATS HAPPENING IN THE COMMUNITY IS WHAT COUNTS

Board/ExecutiveFocusAreasQualityImprovement:▫ %ofYouthSpendingTimeEveryDaywithFamilyMembersand/orinCommunityEngaginginPro-socialActivitiesw/Pro-socialPeers

▫ %ofFamilyMembersMetwithEveryWeek

▫ %ofFamiliesConnectedtoandPartofFamilySupportGroupsinCommunity

Board/ExecutiveFocusAreas▫ EnsureFiscalStrategiesthatSupportWorkingwithFamiliesintheirHomesandCommunitiesduringandpostresidentialstays(i.e.6monthsto2yearspost)

▫ OfferLongTermSupport:Respite/In-homeservice

▫ SetExpectationsinStaffJobDescriptions/ContractsforMinimum%ofTimeStaffSpendinCommunitiesw/Families

▫ RenamePositions(i.e.‘ClinicalStaff’ Become‘ReunificationSpecialists’)toEmphasizeFocusonPermanency/Reunification

Board/ExecutiveFocusAreasEnsureExecutiveTeamMembers:▫ HaveOpenDoorPolicyforFamilyMembers

▫ AtLeastOneTeamMemberMeets/GreetsEvery NewFamily

▫ AtLeastOneTeamMemberInterviewsEveryFamilyIndividuallyatDischargeandAgain– 6MonthsPostDischarge

▫ AndAllAgencyStaffRepresenttheCultures/Ethnicities/Races&SpeaktheLanguagesoftheYouthandFamiliesServed

StaffofAllDisciplinesImplementingaVarietyofFamily-DrivenPractices

ExamplesofPracticesYouWouldSee:

▫ EveryStaffis‘DirectorofFirstImpressions’(TitleUsedInNewZealandorganization)

▫ FamiliesCanCometoProgram24/7▫WarmandComfortablePhysicalEnvironments▫ FamiliesCangotoEveryPartoftheProgram–SpendingTimeinTheirChild’sRoomandClassroomandActivities


• LoseTheWords‘Home-Visits’

• FamilyFocusGroupsDecideEducationOfferingsforFamilies

• FamiliesCalledEverydaytoShareChildStrengths– NotJustAboutIssues&EncouragedtoCallMultipleTimesDaily

• YouthCallDifferentFamilyMembersMultipleTimesDaily


• EnsureFamiliesHaveDedicatedTimetoTalkwithFrontLineStaff

• MakeitaPracticetoConsultwithFamiliestoSeekCounselandEngageTheminDecision-making

• CreateOpportunities(i.e.WeekendCamping)forFamiliestobeProudoftheirChildren/toCreatePositiveMemories

• SupportSiblings


• NOMOREGROUPREC– AllRecreationFocusedonYouthIndividualInterests/Talentsandany‘Group’ActivityInvolvesSiblings/Families/ExtendedFamilies- i.e.Cousins

• GatherTickets/Freebies forFamiliestoUsewithChildren(maybewithastaffforsupport)

• DevelopCloseCollaborationswithClinicalExpertiseinCommunity(e.g.,Trauma;SubstanceAbuse;DomesticViolence)&Supports(e.g.,Housing;CommunityActivities;PeerMentors;Respite)

StrategiesForEngagingwithFamiliesFromLongDistances

HavePolicies/Practices/StaffTrainingtoENCOURAGE:

• YouthCallingasManyFamilyMembersasPossibleANDFriendsWheneverWant/NeedTo

• HaveManyPhones/NoRestrictionsonWhenCanUse(ExceptMaybeSchool/AfterCertainTimeofNight)

• AllowCellPhones(w/Security– i.e.PhotosTaking/VideoTurnedOff)

• Skype/GoogleChatDAILY


• Do‘WhateverItTakes’ toGetYouthHome2xWeekMinimum(andWhenCrisisComesUp;ALSO- DONOTALLOWYOUTHTOMISSANYIMPORTANTFAMILYEVENTS)– Upto3PlusHoursDrive1-way/WorkedonRevisingBudgetItemsi.e.Gas$

• Develop/LicenseCommunityProgramsinCommunitiesYouthComeFromAND/ORDevelopStrongPartnerships(e.g.,JointValues;JointTraining;FormalSign-offs)

• HaveStaffPhoneandEmailRegularly– ESPECIALLYTOSHARESTRENGTHS;CommunicateOften;


• Trainclinicalstafftodofamilysystemsworkonthephone(justforsomemeetings– MOSTSHOULDHAPPENINHOMES)

• Haveaclinicalstaffandafamilyadvocateworkinthecommunitymostyouth/familiesreside(alaSCO/NYC)

• Getagranttobuyi- Pads/laptopsandrent(i.e.$1)forfamilies(or- ifchargemore- return$’swhenreturned)

• Createbackandforthartproject/binderforfamiliesandyouthtoworkon2to3xweeklyordailyandeithertakeeachweekendhomeand/orscan/emailbackandforth(alaSCO/NYC)

WhatToBeCautiousOf:• EventsonResidentialCampuses(why?)

• LackofSophisticated/CommittedClinicalSupervisors

• GroupResidentialRecreation(why?/whotoinvite?(BuildMemorieswithFamilies)

• ResidentialHolidayTraditions(“IsitAbouttheProgramorAbouttheYouth/Family?”)

Whatcanyoudotoimprovefamily-drivencareinyourprogram?

Thinkof:•1improvementyoucanmakeinthenexttwoweeks?•1improvementyoucanmakeinthenextsixmonths?

YouthGuidedCare:What’sItAllAbout?

InterfaceBetweenYouth-guided&Trauma-informedCare

• Focusonpromotinghealingenvironments

• Understandimpactoftraumaonbrainandbody

• Strongfocusonyouthvoiceandchoice

• Focusonprogrampracticesthatarestrength-based,collaborativeandempoweringforyouth

• Focusonstrategiesthatsupportself-soothing/self-regulation(e.g.,individualsafety/soothingplans;sensorymodulationstrategies;holisticapproaches- i.e.meditation/yoga/taichi/rhythmic&repetitiveactivities)

• Focusonnormalizingactivities,hope/permanency

EmbraceYouth-guidedCareYouthGuidedmeansthatyoungpeoplehavetherighttobeempowered,educated,andgivenadecision-makingrole inthecareoftheirownlives.

Thisincludesgivingyoungpeopleasustainablevoice andthefocusshouldbetowardscreatingasafeenvironmentenablingayoungpersontogain self-sustainability inaccordancewiththeircultureandbeliefs.

Throughtheeyesofayouthguidedapproachweareawarethatthereisacontinuumofpowerandchoicethatyoungpeopleshouldhavebasedontheirunderstandingandmaturityinthisstrengthbasedchangeprocess.

Youthguidedalsomeansthatthisprocessshouldbefunandworthwhile.

YouthMOVENational,Inc.(2008)

ProgramPhilosophiesAssociatedwithPositiveTransitions

• Treatingyoungpeopleasemergingadults.

• Partneringwithyouthindevelopingandimplementingtheirindividualizedsuccessplan.

• Individualizingplanningfocusedoneachyoungperson’suniqueneeds,strengths,andpreferences.

• Believeinrecovery– thatyoungpeoplewillgoontoleadproductivelives.

• Highexpectations– beliefthatyoungpeoplecanbesuccessfulincareers,college,vocationaltraining,andjobsoftheirchoice.

(Jivanjee,P.et.al.,2008)

YouthEngagement/Voice/Choice• Youthengagementisassociatedwithpositiverelationshipsandincreasedmotivation.Youthwhoactivelyengageintreatmenttendtodevelopstrongrelationshipswithserviceproviders,expressawillingnesstochange,andparticipateandcollaboratewithothersinthecontextoftreatment-Smith,Duffee,Steinke,Huange,&Larkin(2008).

• Residentialsettingsthatlimitopportunitiesforchoiceandexplorationdonotpromotethisnormativedevelopmentalprocess,leavingyouthillpreparedtore-enterthecommunity.Therefore,itisessentialtoprovideconcreteopportunitiesforyouthtoexpresstheirchoicesandopinionsregardinghelpfulservices.- Mohr&Pumariega(2004);Warner,&Yoder;Joyce&Shuttleworth

THINKABOUTTHESTRENGTHSOFYOURPROGRAM

Intheareaofyouth-guidedcare,whatareoneortwopractice

strengthsthatyourprogramcurrentlyengagesinconsistently?

StrategiesforYouthEngagement

• Hirestaffwithexpertiseinthisprocess.

• Usepeerswhoarealreadylivinginthecommunitytoteach/modelskills

• Haveyouthlearnanduseskillsintheirdailyactivitiesinresidentialcare.

• Normativeexperiencesshouldnotbetreatedasprivilegesorwithheldtomanagebehavior.

• Residentialprovidersinremoteareasshouldplanprogramsandhousingtomoveolderyouthintothecommunitywithsupport.

Courtney(2007);Davis&Koyanagi (2005)

StrategiesforYouthEngagement• Communityschoolsshouldbeusedasmuchaspossible.

• Maintain&buildnetworkofsupport.Youthconnectionwithsupportsystemcorrelatestohowyoutharedoing10to15yearsaftercare.

• Familyengagementmayplayastrongerroleintheoutcomesthantheactualinterventionprogram

• Servicesaccommodatethecriticalroleofpeersandfriends

Courtney(2007);Davis&Koyanagi (2005)

NFINorth– NewHampshire– ProgressMadein4Months

NFINorth- DavenportSchooltakesgreatprideintheBuildingBridgesInitiativeanddecidedfromthestartofthisprojectthattheonlywaytoevokeonthisjourneywastoduesothroughalensthatallowedforopenandhonestexaminationofpracticesaswellasopenandhonestcommunicationamongstFamily,Youth,andStaff.

SmallStepExample

ComparisonPriortoNHBBIKick-off

1. HomeVisits2. Limitedphonecalls3. ApplyforCommunityService4. LevelSystems5. NoPC(PersonalContact)6. Goinghomeeveryotherweekend7. ClinicianLedTx Meetings8. FocusonTransitionlast90days9. Scheduledbedtimes10.Pre-arrangedcommunityservice11.NoParentSupportGroups

4MonthsLater

1. “GoingHome”2. Unlimitedaccesstophones3. Unrestrictedaccesstocommunity4. Nolevelsystem5. HighFivesandFistsBumps6. Homeeveryopportunitypossible7. YouthLedTxMeetings8. FocusonTransitionfromday1!9. Youthdecidedbedtimes10.Youthdesignedcommunityservice11.ParentGroupsofferedonceamonth

NHContactInformation

NFINorthArrayofServicesJenniferAltieri603-586-4328jenniferAltieri@Nafi.com

BigStepExamples

MassachusettsDMHStatewidePrograms•FocusingonR/SPreventionleadstoyouthengagement,empowerment,rolesandservicetransformation

StartedbyFocusingonWhatwewereDoingTo Youth…• Restraintusewithkidsincreasingeachyear• Populationdiscrepancies(4-17x)• Systemicdiscrepancies

66.5

6.9

0

50

100Rate per 1000

Patient-days

Hospitals A and B

Acute Care Hospital Comparison - 2000

High Utilization

Low Utilization

Restraint Episodes per 100 Admissions (Licensed Facilities)

Pre-Initiative

0

25

50

75

100

125

1998 1999 2000Years

Ep

iso

de

s p

er

10

0

Ad

mis

sio

ns

Child (L) Adult (L) Adolescent (L) Mix CA (L)

DMHC/AStatewidePrograms• Anetworkofprivatized,locked,intensiveMHservicesformosttreatmentcomplex&traumatizedyouth(6-18yo)inMA• Previousadmission/treatmentlitmustestdrivenbypathology/deficit/previousS/Ruse• Focusshiftedtostrengths,skills,future-orientedtreatmentdrivenbyyouth/familygoals

RestraintEpisodes1999-2017

RestraintDuration1999-2017

WhatElseChanged?AttheStatewideProgramServiceLevel

1999 2017

üMechanicalrestraint 100%

üSeclusion 100%

üMedicationrestraint 100%

üPoint&levelsystems 100%

üServicedogs/petRx 0

üAvg.lengthofstay 406

üTotalS/Repisodes 6,742

üTotalcapacity 206

üMechanicalrestraint 0üSeclusion 0üMedicationrestraint 2programsüPoint&levelsystems 0üServicedogs/petRx 100%üAvg.lengthofstay 138(66%)üTotalS/Repisodes 337üTotalcapacity 117(54%)

closed6programs

WhatElseChanged?AttheStateLevel

1999 2017

üNoS/RphilosophyüPolicy15yearsoldüRegulations>10yearsoldüLtd.TraumaAssessmentsüNoCrisisPlanningüNoSensory/comfortroomsüNoeducationonconsumerexperienceorinclusion

üNoS/Rpreventiontrainingorframework

üHaveS/RphilosophystatementüNewpolicycallsforS/ReliminationüNewregs.onS/RPreventionüTraumaAssessmentforallüCrisisPlanningforallüSensory/comfortroomsinallsvcs.üConsumershired&teachstaffüEveryhospital&securetreatmentfacilityinMAtrainedinSixCoreStrategies©

MovingForwardasaSystem

• InteragencyS/RPreventionefforttointegrateC/Ainpatient,community-based,residential,&andpublic/privateschools

▫7StateAgenciesinvolved&7CommissionerssignaChartertomovethestateforwardtogether!

WhatElseChanged?AttheC/ACommunitySystemLevel

1999 2017

üNoR/Sreduction/preventionexpectationorframework

üNocommonR/Sdefinitions

üNoyouth-guided,familydrivenframework

üNoyouth/familyrequirementre:providerinvolvement

üNoyouth/familyonstaff

üNoFamilyPartners

üAllprovidersmustadopt6CS &havestrategicplans ifused

üCommondefinitionsinprogressüResidentialreprocurementrequiresBuildingBridges framework

üPoints&levelsystemssunset**üProvidersmusthavefamilyontheirBoards&y/finclusion inservicedesign,delivery&QM

üAllDMHIRTPstohavey/frolesüFamilyPartnerpilotunderway

CriticalFactorsinChangeProcess:YouthasPeerLeaders

Youth and families are equally represented with elected officials and the average age on the ‘topping off’ platform significantly lowered ...

Youth&YoungAdultsCreatetheirownPositionStatement

YouthDeclareThemselves!

ByPayingAttentiontoWhatweWereDoing

“To”Youth- WE changed–

andBegantoFocusonWhatweWereDoing

“With”Youth

TheShifttoRealInclusion&MeaningfulEngagement

• Shiftedourthinkingandapproachfrom:▫ “Didweasktheyouth?”to“Startbyaskingtheyouth.”▫ “Canweorganizeayouthpanel?”to“Let’sdeveloptheagendawithyouth,co-welcome,andco-present”

• Solicitedperspective,creativity&wisdom:▫ handbooks▫ newroles▫ jobdescriptions▫ staffhiring&stafftraining▫ operations,policies&procedures

New&EmergingRoles

• PeerHumanRightsAdvocate• ResidentSupportTeam• PeerOutreach• ServiceReviewTeam• ServiceDesign• RFRReview&ContractAwardProcesses• PeerMentorsinnewcommunityservices• PartofRegionalQualityServiceTeams

MeetSomeoftheMAGroundbreakingTeam&WorkforceGen-Next!

AnotherBigStepExample:YDI,Arizona

YDIimplementedtheEBP,theSixCoreStrategies©:1. Leadershiptowardorganizationalchange2. Theuseofdatatoinformpractice3. Workforcedevelopment4. Fullinclusionofindividualsandfamilies5. Theuseofseclusionandrestraintreductiontools,

whichincludetheenvironmentofcareanduseofsensorymodulation

6. Rigorousdebriefingaftereventsinwhichseclusionandrestraintmighthavebeenused

ProcessofChangingtheCultureOldThinking NewThinking

• Restraintsarenecessarytokeepthekidssafe

• Satisfiedwithrestraintreduction• WillnotSkill• Blamingtheoutliersor“FrequentFlyers”

• ConfrontandTeach• Blamingoneortwonewadmissions

• Whenrestraintsdecreased,assaultsonstaffincreased

• Restraintsre-traumatizeandCAUSEHARM

• IntentiontoELIMINATErestraints• SkillnotWill• “Kidsdowelliftheycan.”typingextra

• Calm,Comfort,Connect• Allstaffcreateatherapeuticalliancewiththeyouth

• Regulationiscontagious

• SeclusionandrestraintareNOT treatmentinterventions• Seclusionandrestraintaredemonstrationsofpowerandcontrol▫ Verytraumatizingtoyouthincareandtothosewhoworkwiththem

• Oftentheseinterventionsareimplementedinarbitrary,abusiveandviolentways

ParadigmShift:EliminateRestraints

FullInclusionofYouthandFamilies

YDIStudentAdvisoryBoarduWhoarewe?

"Wearenotthestudentcouncil!Wedon'tdobakesalesorpromotewackydressdays.Wedothingsthatmakebeinghereeasiersowecanleavefaster.Inordertoworkwithusyoudon'thavetobeperfectbutweneedyoutoworkhardandbehonest.Everyonetrustsusandgivesusalotofresponsibility.Whatyoudoinherewillinfluencethelivesofkidsyouwillnevermeetandthat'sprettycool."

- StudentAdvisoryBoardmemberJustinwheninterviewinganapplicantforStudentAdvisoryBoard

FullInclusionofYouthandFamiliesYDIStudentAdvisoryBoard

• GivetourstokidsnewtoYDI▫ GiveBBIYouthTipSheet&reinforcethatYDIisa“handsoff”programandthattheirtreatmentisbasedupontheirchoices.

• Reviewandwritepolicyandprocedures• Receivetraining/supporttohelpresolveyouth-to-youthgrievances• Identifyandsolveproblemsspecifictomilieu• ReporttotheirunitswhatisgoingonwithYDIasawholecommunity.• Tourvisitingagencystaff.• Intervieweveryemployee• PartofOrientationTrainingandongoingstafftrainingprograms• Partofstaffevaluation

FullInclusionofYouthandFamilies

StudentAdvisoryBoard

“Justbecauseyouworkhere,don'tthinkwewilltrustyou.Ihavehadadultscomeintomylife,promisetheywillbethereformeandleavetimeandagain.Kidsherewillcussatyouandcallyounamesbecausewedon'ttrustyou.Youhavetoprovetouswithyouractionswhatyouareabout.”

-StudentAdvisoryMemberwhentalkingtonewstaffintraining

FullInclusionofYouthandFamiliesStudentAdvisoryBoard

• OutcomesasaresultofYDIStudentAdvisoryBoard:▫ 94%successfuldischargerateforStudentAdvisorymembers;YDIsuccessfuldischargerateiscurrently77%

▫ Whatyouths’exitsurveystellus� Senseofempowerment,purpose,andvalueasamemberofacommunity

StepstoCreateInformal Roles

• Asktheyouth• Askthestaff• Conductyourowngapanalysis:whereisthereaproblem,achallenge,aquestion,achangethatisneeded?• Involvetheyouthinthesolution-buildingprocess• Examples:▫ Humanrights/complaintsoverload▫ ‘newkidsyndrome’▫ residentsupportteam

ExamplesofYouthGuidedCare

• Youthprovidedtraining/supporttoleadowntreatmentteammeetings• Hiringofyouthadvocates(meaningfulrolesthroughouttheorganization)• Youth/youthadvocatesareonEVERYprogramcommittee/workgroup• Providingyouthmentors(homecommunity)• Youthadvisorygroup– meaningful• Providingleadershiptrainingforallyouth• Skilltrainingimbeddedeverywhere

ExamplesofYouthGuidedCare• Staffinteractionsarerespectful,inquisitiveandempowering– notdirective/authoritarian(i.e.more“Howdoyoufeelaboutthat?” VSpraise)

• Individualizedapproaches– notlevelorpointsystems(Mohr&Pumariega,2004)

• Interests/Activitiesoccurinthecommunity– notinprogram

• FormeryouthonBoardsofDirectors

YouthGuidedCare:BasicstoAdvancedBasic:

• Morephonesavailable/expandphonetimes

• Moreflexibilityw/bedtimes

• Doawayw/points;designarevised/‘looser’ levelsystem

• Programexpandsamountoftimeyouthgointocommunityfornormalizingactivities(w/otherresidentialyouth)

MovingbeyondBasics:

• Cellphones(w/filters)/norealphonerestrictions

• Youthchoosewake-up,bed&showertimes

• Nolevels- allprivilegesandamendsareindividualized

• Timeincommunityaloneorw/pro-socialpeersengagedinactivitiesthathighlightindividualtalents/strengths

ExamplesofYouthGuidedCareProgramReviewsAllPracticesandRulesAgainstTIC&YGC.

Examplesinclude:▫ Afterschoolquiettimeorstudytimesoyouthquietduringchangeofshift▫ Anypracticesthatdelayorlimittimespentathome▫ Strongfocusonbehavioralapproaches(evenPBIS)whichfocusesonearningactivities(e.g.,dinnersout;stayuplate;studentoftheweek;specialtimewithastaff- toplevelmoreindividualized)

▫ ALLPROGRAMPRACTICES/RULES

YouthRecommendations• “Everystaffwantstotalktomeaboutmyproblems.Itgetssoold.Whydon’twejusttalkaboutwhatinterestsme?”

• “Wecanhelpeachotheraswell,ifnotbetter,thanstaffcanhelpus.Theyshouldpromotewaysofdoingthis.”

• “Justlisten,trulylisten– staffneedtonotbesoobviousthattheyarewaitingtosaysomething.”

• “Makemesmileandlaugh;bethereforme– notjusttheretoremindmeofrules.”

• “Nobodyasksmeaboutmydreams.Theyaskmeaboutmybehaviors.”

StepstoFormal RoleDevelopment

1. Valuesleadtocommitment2. Commitmentleadstodecision3. Decisionleadstoprioritization4. Prioritizationstartstheformalprocess5. Processbeginswith$identification/allocation6. Discussionwithkeyconstituents7. Craftingtherole(s)8. MeetingwithHRD9. Vettingtheroles10. Layingthegroundworkwithcare

TheChallenges&Pitfalls• Aligning$$andvalues• Preparingyouthfornewroleswith‘professionals’• Preparingyouthforentryintoaprofessionalrole• Supervisingyouthclosely• Teachingtoskill&competencydevelopment• Flexibleimplementationtobefullysuccess-oriented• Continuallymonitoringrole/implementation• Startingsmall&expandingwithsuccess• Measuringtooutcomes• Preparing&supervisingnon-youthstaff

Hiring&StaffingPragmatics

• BasicSupport:▫ flexiblehours(noearlyAMorlatePMhours)▫ flexiblesupervision▫ regular,weeklyaccesstoleadershipstaff;▫ regular,weeklysupervision– individual&group▫ hiremorethanone- peergroupisessential▫ payfortransportation/parkingorprovidetransportation▫ payfortraveltoconferences,meetings,trainings▫ payforconferencesfees


• AdvancedSupport:▫ Personalgrowth&development:

• Teachwellnessskills:goodselfcare,hygiene,grooming

• Assistwithhowtodressforaprofessionalrole,clothingchoices

• Businesscards• Teachingprofessionalskills• Teachingsocialskills• Teachinghowtodescribeanddocument• Encourageandelevatewellnessactivities• Recognizingpersonallimitsandrecoveryneeds


• AdvancedSupport:▫ Howtosupportfellowpeers&creategroupsupervision▫ Howtorespondto/workwitholderprofessionalcolleagues▫ Howtoactivelyparticipate,co-lead,leadmeetings▫ Howtoplanalifeandidentityasa‘full’person▫ Howtoprepareforleaving‘youth’statusbehind� “You’reelderly!You’rewearingatie!”

SomeTypicalStaffFears

• “You’reactuallygoingtohirethem?Andyouthinkthisisagoodthing?”• “Youaregoingtogivethemakey?”“Whatiftheylosetheirkey?”• “Howmuchareyoupayingthem?”“Aretheygoingtogetpaidasmuchasus?”• “Theyaregoingintothetreatmentteammeetings?”• “Whataboutconfidentiality?”

Source:CarolineMcGrath,UMassAdol.Services,08/12

PostImplementationAppreciation

• AprogramwithoutaPeerMentorasked:▫ “CanweborrowLori?”▫ “Couldsheworkwithoneofmykids?”▫ “Whenarewegoingtogetapeermentor?”▫ “Cantheygoonpre-admissionmeetingswithus?”

• ThepsychiatristsstartedaskingthePeerMentors:▫ howtobettertalkwithteensaboutmedication▫ howtobetterunderstand▫ howtohelpkidsdecreaseself-injuriousbehavior.▫ “Cantheycometonewstafforientationandtalkaboutwhatit’sliketobeinaprogram?▫ “Canthey...,Willthey...,Couldwe…?”

Source:CarolineMcGrath,UMassAdol.Services,08/12

YouthRecommendations• “Everystaffwantstotalktomeaboutmyproblems.Itgetssoold.Whydon’twejusttalkaboutwhatinterestsme?”

• “Wecanhelpeachotheraswell,ifnotbetter,thanstaffcanhelpus.Theyshouldpromotewaysofdoingthis.”

• “Justlisten,trulylisten– staffneedtonotbesoobviousthattheyarewaitingtosaysomething.”

• “Makemesmileandlaugh;bethereforme– notjusttheretoremindmeofrules.”

• “Nobodyasksmeaboutmydreams.Theyaskmeaboutmybehaviors.”

AuthenticYouthEngagementHappenswhen…

• Thevoiceandactionsofyoutharevalued.

• Youthareutilizedasaresourceinthedevelopmentofthemselvesandtheircommunity.

• Authenticyouthvoiceispresent,empoweredandinterwoventhroughoutyoursystemandyourorganization.

• Youtharevaluedfortheirexperienceandexpertise(notastheproblem).

• Youthconsumersareadvocatesandeducators.

• Youthmembersareonboardsandcommittees.

• Youtharedecisionmakers.

• Thereisequalpartnershipandsharedrespect.

So…WhatCanYouDoToImproveFamily-driven,Youth-guided/Trauma-informedPractices?

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the building bridges initiative (bbi) · 2018-04-17 · program, went back to her agency after the...

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