Transcript A Social Interaction Learning Model

MST’s analytical model
And a clinical case
Side 1
Side 2
MST Treatment Principles
1. Finding the Fit
The primary purpose of assessment is to understand the “fit” between the identified
problems and their broader systemic context.
2. Positive & Strength Focused
Therapeutic contacts should emphasize the positive and should use systemic strengths
as levers for change.
3. Increasing Responsibility
Interventions should be designed to promote responsibility and decrease irresponsible
behavior among family members.
4. Present-focused, Action-oriented & Well-defined
Interventions should be present-focused and action-oriented, targeting specific and welldefined problems.
5. Targeting Sequences
Interventions should target sequences of behavior within and between multiple systems
that maintain identified problems.
6. Developmentally Appropriate
Interventions should be developmentally appropriate and fit the developmental needs of
the youth.
7. Continuous Effort
Interventions should be designed to require daily or weekly effort by family members.
8. Evaluation and Accountability
Interventions efficacy is evaluated continuously from multiple perspectives, with
providers assuming accountability for overcoming barriers to successful outcomes.
9. Generalization
Interventions should be designed to promote treatment generalization and long-term
maintenance of therapeutic change by empowering care givers to address family
members’ needs across multiple systemic contexts.
Side 3
Team:
Case Summary for Supervision & Consultation
Family:
Age:
Therapist:
Date:
Startdate:
Reasons for Referral
Behavioe
Duration
Frequency
Extent
Initial Goals\Desired Outcome
Participant
Goal
Superior MST goals
Side 4
Affected
systems
Team:
Case Summary for Supervision & Consultation
Family:
Therapist:
Genogram:
Side 5
Dato:
Startdate:
Team:
Case Summary for Supervision & Consultation
Family:
Therapist:
Dato:
Startdate:
Systematic strengts
Systemic Weaknesses\Needs
Individual
Family
School
Peers
Community
Side 6
Team:
Weekly Case Summary for Supervision & Consultation
Family:
Age:
Therapist:
Date:
Startdate:
Number of calls:
Number of meetings:
I.
Overarching\Primary MST Goals
II.
Previous Intermediary Goals
Met
Partially
III. Barriers to Intermediary Goals
IV. Advances in Treatment
V. Assessment of “fit” between identified problems and their broader
systemic context.
VI. New Intermediary Goals for Next Week
Side 7
Not
Team:
Case Summary for Supervision & Consultation
Family:
Therapist:
“Fit” circle:
Side 8
Dato:
Startdate:
GENOGRAM OLA
67
72
80
D 1961
35
48
39
40
50
30 27 24
19
11
Side 9
15
B 75
D 77
Terapeut: 1001 Familie: 0002 Dato: 15/10 2003
Behavior
Duration
Frequency
Drugabuse
The past year
Ca. 2 -3 times a
week
Intensity
Hasj, alcohol og
pills
Truancy, no
classroom work
Truancy days or
Reacts negativly
classes every
when talked to.
week. Does not
Conflicts with
participate in the
class for the past 6 students and
teacher.
months
Physically
agressive
towards teacher
+other students.
School
problems
Started in 7th
grade
Increased the
past year
Verbally
and
physically
aggressive.
From 9 –10
years age.
Worsening the
past year.
Does not
follow the
family’s
rules
From 9 – 10
Daily
years age. Ran
away at night
Daily quarreling
and acting out
Shouting at and
threatening his
parents and at
school.
Breaks things
and sometimes
hits and kicks
parents
Does what he
wantsl, does not
follow curfew,
away nights
Involved
systems
Individually,
family,
school,friend
Individually,
family, school
School, home
Hjem, skole,
venner
Desired Outcomes of Family and key
participants
Participants
Goal
Mother
Wishes Ola was happier, that he stops
drugs, goes to school every day, stops
physical and verbal agressiveness,
does not stay away at night
Father
Same as mother
Ola
Wants his parents to leave him alone
School
Wants Ola moved to an institution with
classes there
Grandparents
He must have help to stop using drugs
and to stop the conflicts at home
Ola to stop using drugs and to
participate more at school. Lower
conflicts at home, help parents to set
limits for Ola.
Child Welfare
Side 11
A summary for supervision and
consultation
Terapeut: 1001
Familie: 0002
Systemic strengths
Individually:
Ola goes well together
with other people, can
be polite and sociable.
Cares for his little
brother. Plays guitar,
interested in computers
and og snowboard.
Side 12
Dato: 15/10 2003
Needs
Is easily lead to
negative activities. Use
of drugs, conflicts at
home. Out all night.
Can be threatening or
violent if he feels
pushed.
Interchangeable
friends. Always restless
and easily gets into
trouble. Suspecting
ADHD.
Systemic strengths
Family:
Mom has a permanent
job, involved in the
childres, caring. Dad is
good with practical
matters. Nice house,
OK economy.
Family has experience
with doing positive
things together (outdoor
activities, holidays,
eating nice meals
together). Parents have
some close friends and
good neighbours.
Side 13
Needs
Mom nags a lot and is
not heard. Dad is
irretabe and hottempered/explosive.
Disagree with the child
upbringing. Mom is
compliant, dad strict.
Mom feels alone in the
upbringing and fells she
has little support. Has
considred divorce. Dad
is on social security
because of back
problems from a
occupational injury.
Depressed because of
pain, no job. Problems
with alchohol and
mental sufferings in
dads familiy. Little family
live near.
Systemic strengths
School:
Ola has previously
shown good work in
arts and crafts and
computer science.
School is relatively
new. Many motivated
teachers and a
psincipal who seems
interested in Olas
problems. Curious
about MST.
Side 14
Needs
Has not worked in class
for the last six months.
Lots of absence. Acts
out according to
teachers and pupils.
School means he
should be placed in an
institution for youths
with behavior problmes.
Many in the same class
also has problems
(drugs and
disturbance). Mange i
samme klasse som har
problemer (uro og rus).
Conflict between school
and parents about
situation.
Systemic strengths
Friends:
Has one positive friend,
they play on the
computer and og
snowboarding.
Side 15
Needs
Stays in a negative
youth environment.
Drugs, petty crime and
skip school. Parents
have little control over
where tjey are and what
they do.
Spends the night at
friends the parents
don’t know.
Systemic strengths
Community:
Residental area close
to the city center with
all services.
Activity house open
once a week for a drug
and alchohol free disco
for youths.
Good bus service to
city centre.
Side 16
Needs
Few activities for youth.
Large mall with an
arcade near by. Typical
hang out place for
youth from the entire
district. Criminal, drug
abusing youth hang out
at the mall.
Drug sales, older youth
buy alchohol for the
younger.
New estate with a high
level of insecurity. Many
don’t know eachother.
Weekly Case Summary for
Supervision and Consultation
Therapist:
Familiy:
Date:
I. Overarching\Primary MST Goals
1.
Ola will be clean. This will be confirmed by
negative urine specimen and information
from parents, school and police.
2.
Ola will actively participate in a school
sitiation adapted for him. Confirmed by
information from school and parents.
3.
Ola will stop both verbal and physical
aggression. Confirmed by information from
school and parents.
4.
Ola will follow the family rules. Confirmed by
information from parents.
Side 17
PEER STATUS
Confirmed by: child
services
GETS WHAT HE
WANTS/GETS
POWER
Confirmed by:
parents
COMMUNICAT
ION STYLE IN
THE FAMILY
Confirmed by:
parents, Ola
COVERS UP
SADNESS
Confirmed
by: mom
VERBAL
AND
PHYSICAL
AGGRESSION
UNCLEAR
RULES AND
CONSEQUENSES
Confirmed by:
parents
LOW IMPULS
CONTOL
Confirmed by:
school, mom
INCONSITENT
PARENTING
Confirmed by:
parents, Ola
Side 18
SUBSTANCE
ABUSE
Confirmed by:
parents
PHYSICALLT
STOPPED BY
DAD IN
CONFLICT
SITUATIONS
Confirmed by:
Ola, parents
PEERS WHO
USE
Confirmed by:
youth support
team, parents
SUBSTANCE
ABUSE PROBLEMS
IN THE FAMILY
Confirmed by:
parents
EASY ACCESS
TO DRUGS
Confirmed by:
youth support
team, and Child
Services
CURBS UNREST
Confirmed by: Ola,
parents
SUBSTANCE
ABUSE
NO
CONSEQUENSES
Confirmed by:
parents
THRILL/RUSH
Confirmed by:
Ola
NO MONITORING
Confirmed by:
parents
Side 19
CONFLICTS
AT HOME
Confirmed
by: family
NO
PARTICIPATION IN
AFTER SCHOOL
ACTIVITIES
Confirmed by: Ola
NOR FRIENDS
IN SCHOOL
Confirmed by:
lead teacher
PROBLEM
CONCENTRATING,
SUBJECT.
Confirmed by:
school, rapport
from
EducationalPsychological
Service
FRIENDS NOT
ATTENDING
SCHOOL/NO JOB
Confirmed by:
school, Ola
CONFLICT
SCHOOL-HOME
Confirmed by:
parents, school
TRUANCY
BAD
RELATIONSHIP
WITH TEACHER
Confirmed by:
Ola
NO
CONSEQUENSES
AT HOME OR
SCHOOL
Confirmed by:
school, parents
NO PARENT FOLLOW UP
WITH SCHOOL
Confirmed by: parents
PARENTS HAVE NO
CONTROL OVER
ACTIONS
Confirmed by:
parents
Side 20
SUBSTANCE
ABUSE; GETS
HOME LATE;
TIERED
Confirmed by:
parents
Social Support
• Key particpants
• Identify need/tasks to ask for in support
• Make a plan for meeting participants
individually or in a group
• Make agenda for meeting
• Therapist is secretary at the meeting and
writes all agreements
• Examples of tasks:
• Come to the home in difficult situations
• Help in search for youth
• Babysit other children when parents need
• Be support for parents as needed
• Be support for youth with activities
II. Previous Intermediary
MET
PARTIALLY
NOT
Goals
1.
Make safety plan
X
2.
Mom contacts
neighbour and a
friend to ask if they
can be contacted in
an emergency
X
3.
Parents agree on
rules that will be
included in the
contract
III. Barriers to Intermediary Goals
Parents disagree on rules. They think it is hard to
find privileges. They’d rather punish than reward.
One serious conflict situation led to Ola hitting
dad. After this he ran away and did not come
home all night.
Side 22
X
IV
Advances in Treatment
Safetyplan is in place. Both neighbour and
moms friend are willing to be available in a
conflict situation. Both their names and
numers are on the safety
V
Assessment of “fit” between identified
problems and their broader systemic
context.
Side 23
Safety plan for Ola and his
family
LEVEL SITUATION
WILL DO
RESPONSIBILI
TY
1.
Someone
starts to yell at
eachother
Remove yourselves
form the situation, give
a stop message (agree
on a sign)
Don’t start a discussion
Everyone in the
family.
2.
Someone
threatens
another family
member
Notify the person on
whats to come in level 3
and 4 in a calm voice.
Don’t start a discussion
Person feeling
threatened.
3.
Distroyed
somethin in the
house, breaks
or destroys
something.
Call friends or other
family to ask for help.
Name/no:
…………………………
…………………………
Mom or dad.
4.
Physically
attacks
someone.
Calls the police and
MST therapist.
Mom or dad.
Side 24
Family Cohersion
• Identify strengths
• Help parents to rebuild warmth and support
• Establish clear expectations and rules
• Make family contract with predictable
rewards and consequences
• Plan for family activities
VI
New Intermediary Goals
for Next Week
1. Review of possible rules, privileges and
negative consequences with parents.
2. Map this weekends episode of violence.
Make a Fit circel on what happened and
make a plan to make sure this does not
happen again.
3. Make an action plan on how to handle a
situation where Ola is gone all night.
4. Dad contacts the school to set up a
meeting.
Side 26
School interventions
• Identify strengths and needs
• Plan meeting with school with the parents
• Parents contact school for meeting
• Plan for comunication flow between
parents and school
• Plan for implementation of rewards and
consequences are made
• Plan for school routines
• Particpants in meeting: (Principle) Class
teachers, social support teacher, parents
and therapist
Family contract
RULE
PRIVELIGE
NEGATIVE
CONSEQUENCE
Ola will come to
school at the right
time and stay all
day.
2 points (=20 kr)
per day to comply
with the rule.
If he comply to the
rule a whole week
he gets two hours
with the computer
group on the last
two hours on
Friday.
No points on days
he breaks the rule.
Ola will og straight
home afteer
school and do his
homework.
Gets to use the
computer/og online
two hours every
afternoon/night
Loses access on
days he breaks the
rule.
Ola will stop
2 points (=20 kr)
threatening, yell at per day to comply
and hassle other
with the rule
family members
Side 28
Failure to comply
with the rule loses
him access to TV
and phone the rest
of the day.
RULE
PRIVELIGE
NEGATIVE
CONSEQUENCE
Ola will be home
by 10pm on a
weekday and 1am
on Friday/Saturday.
He will inform his
parents on where
he is going, who he
is going with and
what he is doing
when he goes out.
2 points can be
exchanged to a
mobile cash card
when he has
enough points.
When he comply
with the rule for 1
week he gets to
chose his favorite
meal at a family
dinner.
Ola must be home
earlier the day
after, equivalent to
the time he was
late the previous
day.
If he does not come
home and his
parents have to go
and find him he has
to home by 6 pm
the following
weekend.
Ola will not use any
illegal drugs. He
will submit one
urine sample a
week. A refusal to
give a urine sample
is considered a
positive test.
With a negative
test he will receive
5 points (=50 kr)
that he can save
for snowboarding.
In addition the
travel expences to
get to the ski slope
will be covered.
With a positive test
Ola will loose his
privileges. He must
come home earlier
and prepare
unexpected urine
test.
Side 29
Peer interventions
• Identify peers
• Who, when and what they do
• Decide desired contact level
• Monitoring interventions
• Examples:
• Contact parents of negative peers
• Establish a collaborative approaches:
Try to make agreements on limits and
rules
• Plan for activities with prosocial peers
Plan for finding Ola
Behavior
What happens
Ola fails to
appear/does not
keep his curfew
1.
2.
3.
4.
5.
6.
Side 31
Responsibilty
Calls Olas cell
Mom and dad
phone
Calls his friends
Calls his friends’
parents
Drives around to
find him
Mom and dad
calls friend to
help with the
search
Call s MST,
consider if the
police should be
contacted
Physical and verbal aggression
• Make security plan
• Identify strengths and needs
• Rebuild family bonding
• Identify clear rules
• Identify triggers for aggresion
• Decide rewards for reducing verbal
aggression (which is always covered in the
family contract)
DAD YELLED
AT OLA
OLA DID
NOT
RECEIVE
MONEY
OLA
KNOWS IT
HELPS HE GETS
WHAT HE
WANTS
CONFLICT
BETWEEN OLA
AND PARENTS
ALREADY
PRESENT
OLA HIT
DAD
DAD
PHYSICALLY
HELD HIM
BACK
VAGUE
RULES
DID NOT
FOLLOW THE
SECURITY
PLAN
PARENTS GAVE
CONFLICTING
INSTRUCTIONS
Side 33
OLA WAS
INTOXICATED
Drug Abuse Interventions
• Identify level of addiction
• Identify peers who also use, what, when
and where
• Plans urine tests
• Make contract for stopping drug use