Transcript Utah State Department of Health Children with Special

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
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.
Outline of Presentation
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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.
-1INTRODUCTION TO THE
ABLE-differently PROGRAM
Current focus on three goals
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.
ABLE-differently - Program
Looking 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
Past Contributors to Able-differently
Program’s Concept
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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
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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.
-2THE ABLE-differenly
CHANGE PROCESS FOR
INDIVIDUALS AND
FAMILIES
Some Initial Social and
Personal Barriers to Child and
Family Health
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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
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.
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.
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.
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, strengthbuilding requires similar
support from many
sources.
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
-3ABLE-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
Health Providers Promotion/
Prevention Matrix
Levels of Care
Levels of Complexity PRIMARY
SECONDARY TERTIARY
HIGH COMPLEXITY
MULTIPLE
CONDITIONS
IDENTIFIED
MINIMAL IDENTIFIED
RISKS
NORMAL POPULATION
WITH UNIDENTIFIED RISKS
INCREASING
COSTS
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.
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
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.
-4THE ABLE PROGRAM
USES THE GOALS OF A
PUBLIC HEALTH MODEL
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.
Our experience has been both providing health for both
the Individual and the general population
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
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.
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.
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.
-5THERE EXISTS A NEED TO
UNDERSTAND COMPLEX
PROBLEMS AND COMPLEX
DIFFICULTIES WITHIN
COMPLEX SYSTEMS
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.
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 1318% of child population
have special needs and close
to 40% of special needs have
psychosocial needs on the
average.
-6THE ABLE-differently
PROGRAM
ADMINISTRATIVE AND
CLINICAL INTAKE
PROCESS
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.
ABLE-differently Program Two
Track Systems
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• 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
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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
Assessment Instruments Health
Care Providers may find useful in
their practices will be highlighted
in some of the following sections.
Psychological Assessment
Assessing Cognitive Abilities
Common Instruments Used or Requested
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INSTRUMENT
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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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AGES
Psychological Assessment
Assessing Learning/Attention
Abilities and Deficits
Common 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
Psychological Assessment
Assessing a Possible Autism
Spectrum Disorder
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Instrument
Asperger Syndrome Diagnostic Scale
Autism Diagnostic Observation Schedule (ADOS)
Child Autism Rating Scale (CARS)
Autism Screening Instrument
Clinical Interview
Ages
5- 18
2-Adult
3-18
Childhood
2-Adult
Psychological Assessment
Depression/Anxiety
Common Instruments Used or Requested
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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
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(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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AGES
Family Health Promotion Plan
Assessment of
Strengths, Weakness and Intervention Strategies
in the Areas Of:
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Child
Family
School
Community
Cultural & Economic Factors
Physical & Emotional Health
Child
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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
Family
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Housing/Food/Income
Insurance
Medical Home
Routines and Rituals
Celebrations/Recognitions
Recreation/Leisure
Extended Family Support
Spiritual Strengths
Mutual Respect
Sanctuary/Secure base
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
Community and Culture
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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
Family Health Promotion Plan
(Pulls from the listed resources)
F am ily H ealth P rom otion P la n
O u tside
S u b -spe cia lty
R e fe rra ls
O th er
C o m m u n ity
R e so u rces
P a re nt
A d voca cy a nd
S u pp o rt
G ro u ps
N e u ro lo gy
M e nta l He a lth
O rtho
R e so u rce
D ire cto ry/
W e b site
H a n do u ts
C a re
C o ord ina tion
S cho o l a nd
C o m m u n ity
C o nsu lta tion
L IN KS
C a re Te a m s
IE P M e etin gs
V o catio n al
R e ha b ilita tion
P a ren t Ce n ter
Te am
M a inte na n ce
S ch o ol
C o n fe re nce s/
H e a lth P lan
C o m p o ne nt
G e ne tics
P a rks a nd
R e crea tion
L e g al C en ter
P u b lic
R e la tio ns
D e n tal
H u m an S ervices
O th er
O th er
In su ra n ce
C o ord ina tion
w ith
M e d ical H o m e
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
-7FAMILY RESILIENCY
FROM RISK TO THRIVING
The Process of Moving from
Despair to Hope
Family Past and Present Realities
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Stressful Challenges
Problems
Vulnerabilities
Losses and Pain
Adversities
Traumas
Disappointments and
resentments
Just Making It
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Toxic Environments
Hollow Successes
Inflexible
Overly Defensive
Abuse Prone
Strained Relationships
Personality Disorders
High Dependence on
Society’s Safety Net
(Resource Supports)
Life Threatening
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Ineffective-Coping
Adaptive Dysfunction
Psychopathology
Antisocial
Destructive Narcissistic
Violence and
Lawlessness
ADAPTIVE COPING
Leads
to Increased Personal and Family
Assets and Increases Protective
Factors
Need for family LIFELINES
Beliefs 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 & Share & Respect
Forgiveness
Goal Differences
Positive Hopes
Social Supports
Have Empathy
Increased Skills
O.K. Economics
Honesty/Humor
Need for THRIVING abilities
in Children and Families
• People become
winners when they
start using sufficient
protective factors for
themselves and their
families.
Need for individual and family
FUTURE REALITIES AND
VISIONS
• Personal and Family
Well-being
• Wellness
• Improved Health
Status
• More Adaptablity
• Salutogenic (healthy)
Outcomes
-8INTERCONNECTIONS and
RECONNECTIONS
Useful Relationships for All Providers
and Families to Help Achieve Positive
Family Outcomes
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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