Transcript It Works In Practice, But Does It Work In Theory?

School-Based Mental Health
Programming: Concentric
Collaborative Conversations
Collaborative and Dialogic Practices in Therapy and
Social Change
April 24, 2010, Cancun, Mexico
Jeff Chang, PhD, R.Psych.
Athabasca University
and
The Family Psychology Centre
School-Based Mental Health Programming:
Concentric Collaborative Conversations
Acknowledgements:
Alberta Health Services (program funder)
Independent Schools Advisory Committee,
Calgary, AB (organizational sponsor)
Almadina Charter Language Academy and
Calgary Islamic School
Athabasca University:
Academic/Professional Development Fund
Research Incentive Grant
School-Based Mental Health Programming:
Concentric Collaborative Conversations
In this workshop I will describe the
development and operation of a schoolbased mental health service, operating in two
schools of choice serving Muslim students.
Program consultation, program development,
staff supervision, consultation to school staff,
and service delivery to children and families,
were executed using collaborative practices
based on solution-focused therapy, narrative
therapy, and appreciative inquiry, with
attention to the discourses in which education
and school based mental health services are
embedded, and attending to the interface
between Muslim and mainstream culture.
School-Based Mental Health Programming:
Concentric Collaborative Conversations
 What attracted you to this workshop?
 Fast forward: The Project as it currently operates
 Situating the work:
Calgary and Alberta
Me
The discursive nexus
 Project Description: Development and Operation
 Local wisdom
Fast Forward: The Project as it currently
operates
The “Wellness Empowerment Program” –
name eventually selected by the schools
Funded by Alberta Health Services
One of 30+ school-based “mental health
capacity building projects” in Alberta.
All others were creations of specific
individual school boards; the nature of our
organizations led to some very different
organizational practices
Two schools:
Fast Forward: The Project as it currently
operates
 A publicly funded, ESL charter school
 Elementary and Middle School Campus with
about 650 students
Fast Forward: The Project as it currently
operates
 Calgary Islamic School: Private religious school
 K-12 on one campus (650 kids)
Fast Forward: The Project as it currently
operates
 Eventual service configuration:
4 FTE bachelors level School Support
Counsellors
.6 FTE mental health OT
1 Masters level Project Coordinator
 Services
Universal
Group oriented
Contextual/consultative
Family
Individual
Situating the work: Calgary, Alberta,
Canada
 1 million people, 70,000 Muslims
Successive waves of immigration started in late 1960s/
1970s
 Oil capital of Canada: “Boom and bust” mentality
 Somewhat resistant to recession:
Conservative banking regulation
Balanced budgets
We’ve got oil!
 Politically conservative
Low tax, low regulation, socially conservative
Surprisingly unpopulist and intolerant
Situating the work: Calgary, Alberta,
Canada
Situating the work: Me
 Influenced by postmodern ideas (mainly
solution-focused and narrative therapies), and
appreciative inquiry
 Counselling psychologist
 Youth and family mental health programs and
private practice, now in a faculty position
 Commitment to developing others through:
Clinical supervision
Teaching and curriculum development
Creating collaborative workplaces by obtaining
large service delivery contracts
 Qualitative research (new paper in JST on
hermeneutic inquiry for postmodern therapists)
Situating the work: The Discursive Nexus
Intersecting discourses:
“Diversity and inclusion” and “crosscultural counselling”
“Mental health”
“Community mental health”
“Capacity building and resilience”
“Partnerships”
“Islam and the world”
“Diversity and inclusion” and “crosscultural counselling”
“Diversity and inclusion”
 Government-speak and policy-speak for wellmeaning efforts to study and address inequity
 Acknowledgement of real power inequities,
and differential access to resources and
opportunity, based on differences in class,
gender, race, linguistic fluency, sexual
orientation, and physical ability
 Little appreciation of privilege on the part of
policy-makers and funders
 Pragmatism/cynicism about this amongst
funding recipients
“Diversity and inclusion” and “crosscultural counselling”
“Cross-cultural counselling”
Initial attempts to articulate cross-cultural
counselling approaches were
conceptualized from the perspective of
dominant culture counsellors relating to
“the culturally different” and being
“culturally sensitive”
At the conference of a national
counselling association last year, several
participants commented that the field still
largely approaches this from the
standpoint of the dominant culture
“Diversity and inclusion” and “crosscultural counselling”
“Cross-cultural counselling”
“Office practice” is seen as the model, and
we extrapolate to figure out what to do in
community based settings
Although we are of the dominant culture,
we are guests in the schools where we
work.
The metaphors from which we operate
(anthropologist, missionary, traveler,
tourist) are not quite fitting
“Mental health”
 Originally an individualistic, modernist
discourse that underemphasized or ignored
context, community, and collectivism
“Community Mental Health”
 Oriented to keeping people struggling with
chronic mental health problems out of
institutions.
“Mental Health Capacity Building”:
From the description of this project
 “The thirty-one sites address the capacity
building and risk reduction service components
in selected at-risk communities (italics mine).
“Mental health”
“Resiliency” (and its cousins “StrengthBased,” “Positive Psychology,” and
“Character Education”):
 A step in the right direction to focus on what’s
going right.
 Reifies “resiliency factors,” “strengths,”
“positive character traits,” etc.
 As a function of logical type, we must
therefore reify pathologies
 If “character strengths” reside within persons,
as opposed to being a function of relational
patterns and linguistic constructions, so must
pathologies and deficits
Islam and the World
Take five minutes and chat with your
neighbor about reaction to the phrase
“Islam and the world.”
Islam is not monolithic:
In our schools, 30+ countries of origin of
students
Arabic, sub-Saharan African, south Asian,
Asian, Caucasian
Arabic, Urdu, Somali, Persian/Farsi are
predominant languages
Islam and the World
 Islam is much
misunderstood, exoticized in
a negative way, and
pathologized
 This cartoon appeared in the
Montreal Gazette after an
article reported that a
women was asked to leave a
publicly funded French
language class because she
would not remove her niqab.
Islam and the World
 A cultural/discursive context exists for the
maintenance of stereotypes and the perpetuation
of polarization that overwhelms conversations with
the potential to construct new understandings
Islam and the World
Accordingly, thin descriptors like:
 “terrorist”
 “radical”
 “enemy”
 “subjugating of women”
 “separatistic”
 “I know one. He’s normal…”
… crowd out alternative understandings, like:
Islam and the World
spiritual
respectful of women
feminist
family oriented
inclusive
advocating for social justice
embracing Canada as fully participating
citizens
Project Description
Possible pilot project funding afforded us
the opportunity to develop a program for a
high needs school population
Because we (service providers and
Independent Schools Association) already
had a relationship with both schools, we
initiated a conversation with them about
seeking this funding
Parameters of Funding
Salamon, Grevelius, & Andersson, 1993:
The AGS Commission Model:
Presented commission > hypothetical
commission
Primary commission vs. secondary commission
Appreciative Inquiry
Using Appreciative Inquiry, the following
assumptions guided our development process
 In every human situation, something works
 What we focus on becomes our reality
 Reality is created in the moment and there are
multiple realities
 The language we use shapes our reality
 The act of asking questions influences the
outcome in some way
Appreciative Inquiry
People have more confidence going into
the future (unknown) when they carry
forward parts of the present (known)
If we carry parts of the past into the future,
they should be what are best about the
past
It is important to value differences
Appreciative Inquiry
The “4-D Cycle”
 Dream: “What might be?”
Envisioning Results
 Design: “What should be - the ideal?”
Co-constructing
 Deliver: “How to empower, learn, and
adjust/improvise?”
Sustaining
 Discover: “What gives life?”
Appreciating
Dream: “What might be?” Design:
“What should be - the ideal?”
Eight consultation meetings with
parents, schools’ boards, mental
health professionals familiar with the
community:
Parents:
 Someone to help our kids transition
to new schools
 Help to figure out how to get kids to
be successful in Canada – and to be
faithful Muslims
Dream: “What might be?”
 Success in the Canadian school
system
 Dealing with worries and troubles
 How to work together to keep our
kids safe.
 How to get kids to listen
 Someone to help us with family
stress
 Someone to talk to about family
problems who is not part of the
community
 How to get help for kids
 A more caring school community
Dream: “What might be?”
Professionals
 Prevent young men being
radicalized
 Support for our grads in high
school – they get labeled as
“gangs,” “A-Rabs,” “towel heads,”
“jihadis.”
 Early school readiness. Our kids
are behind the 8-ball in
Kindergarten. How can we
improve this?
 Test anxiety – provincial
achievement tests and other tests.
They need to learn how to handle
this
Dream: “What might be?”
 Connections with community
resources
 Organizational skills – some kids
need help badly.
 A safer school -- not every kid feels
safe. Help for bullies and the
victims. A school where everyone
feels safe
 Our religion is very important – how
can we work together with you to
support families? Sometimes I don’t
know what to do
 They know the services are there in
high school, but are afraid to go. If
someone would support them to use
what’s there, that would be great.
Dream: “What might be?”
 Isolated women and men who abuse
their wives – how can we help them?
 If you are part of the school, and the
parents see you all the time, they’ll
trust you
 Parents have to know that they just
can’t pull their kids out for months at
a time.
Dream: “What might be?”
Themes/categories:
 Community connections
 School readiness and academic
support
 A safe and caring school
 Generational connections
(includes faith)
 Dealing with transitions
Design: “What should be - the ideal?”
Not clinical therapy or assessment
Next to no “therapy” has been done
Embedded in the school, positioning
ourselves as:
Collaborative
Respectful guests
Those who ‘serve’ rather than those who
‘help’
Deliver: “How to empower, learn, and
adjust/improvise?”
Sustaining
Solution-focused supervision
AI informed staff meetings and meetings with
the schools
AI-informed problem-solving processes – not
everything has been hunky-dory
Staff problems
Leadership vacuum and changes
Conflicts about access to information
Lines of accountability and communication
Discover: “What gives life?”
Appreciating
Quarterly meetings with schools
Triennial meeting with funder
Classroom Presentations
o Alongside individual and small group work,
we’ve also offered many classroom
presentations for ECS-Grade 10
o Over 35 different topics in areas of peer
relationships, safety, academic skills,
personal development, problem-solving
and many more!
“I never knew what cyber bullying was until
your presentation. It has been going on
for 1 year now and I need help.”
- Grade 6 student
Weekly Lunchtime Skill-Building Groups
Small-Group Skill Building
About 130 students per year have participated in
weekly lunch-time skill building groups
“ This group really helped me a lot
and gave me lots of ideas and
tips…”
- Student
“I liked how group is not taught in a text book-ish
way - it's done in a fun way.”
-Student
ECS- Leadership Program at Almadina
o Grades 6, 7 and 9 students volunteer for 6 week
blocks to provide leadership activities for ECS
students during recess.
o October 2008: 4 leaders
o September 2009 to January 2010: 64 leaders
o Teachers report that playground problems have
decreased
o Positive relationships between ECS and Junior
High students
o Leaders demonstrate increased maturity and
responsibility outside of volunteering time
Environmental/Leadership Program
Nineteen Grade 9 and 10 students:
o Green initiatives
o Service at school events
o First aid and CPR training
o Outdoor pursuits
o Peer conflict resolution
o Encouraged by Imam
School Bus Program
• Initial driver comments: “This program will never
work, nothing will change.”
“I have some of the best kids
• Now….
on the bus!”
“Getting better!”
“Lots of changes…
• Significant improvement in driver retention
Student Transition Activities
o Requested by schools at start of project
o Supporting student transitions...
 Into ECS
 ECS to Grade 1
 Grade 5 to Grade 6
 Grade 9 to High School
Grade 6 orientation…
“I wish we had this when I was going into
Grade 6. We were just thrown into junior
high and figured it out ourselves!”
–Student
“This is so cool! I’m so glad I know how to
open my lock and read my timetable
before I get to the junior high. It’s not that
scary anymore.”
-Student
Parent Support
“Thank you for helping me with [pediatrician]
appointments. It’s good to know that this
type of support is in the school.”
-Parent
We hired a van-taxi and sent a staff member
to take a mother and four children to the
public health nurse’s office for treatment of
head lice.
She spoke: Treatment of Selective Mutism:
 8 year old Grade 3 student, who was not speaking
in class
 Had not spoken in school since K
 The school was concerned, but was not sure what
to do.
 We facilitated a referral to a service at Alberta
Children’s Hospital. This meant:
Accompanying the child and mother for sessions with
the clinical psychologist
Implementing a behavioral shaping program in school
SSC interacted with the child 83 times over the school
year
She spoke: Treatment of Selective Mutism:
E-Mail from School Support Counsellor to clinical
psychologist:
Hi Annette,
I am pleased to announce.....THERE HAS BEEN
PROGRESS. I am so happy for YZ over the past two
sessions.
My first session she shut down and wouldn't speak and
covered her face with a binder. Ever since then, she has
responded very well.
She spoke: Treatment of Selective Mutism:
Last session she was noticeably louder when speaking
in class (so that I didn't need to strain to hear her) and
she seems to be more engaged and interested in the
points for some reason. We are doing it so that YZ and
[mother] need to work together to get points and the
points will work towards some sort of party of their
choice at the end of the school year.
During today's session, I was able to get her to speak to
the teacher and do a "mini" presentation on a recycled
picture her and [mother] made together (with her
classmates present in the room). The teacher was also
able to ask her a question or two in which she verbally
responded…. This upcoming Monday, I am going to try a
session without her mother in the classroom. Hopefully it
goes really well!
The Re-Connect Booth
 One Grade 5 class: many demands on home
room teacher or the School Support Counsellor
to have their disagreements, miscommunication
and misunderstanding “solved”
 To teach the students how to use the booth,
which was set up in a corner of the classroom,
the School Support Counsellor delivered a
presentation to the class on basic
communications skills: The acronym is C.A.R.E.
The Problem-Solving Booth
C=Conflict is happening, address it!
A= Active Listening . Students meet together at the
booth and practice active listening skills
R = Reflect and Make a Plan. Brainstorm 3 possible
solutions to the problem, and agree on which solution
they would like to try first).
E = Evaluate. 2-3 days later
 Children have been actively using the booth as a
location to deal with day to day social difficulties
 Formerly skeptical VP now wants them in all
Grade 5 classes
Local Wisdom
 In the real world, delivering services is messy
 Collaboration breeds collaboration and creativity
 A focus on what works trumps models and
approaches to therapy
 Relationships and connections with others are
enhancing – whether we conceptualize this from
“attachment theory,” “family systems theory,” or
“solution focused therapy” matters little
 Service delivery and knowledge creation can coexist: inductive, participatory action research
 Transcultural competence is mutual and
recursive
Local Wisdom
 Required attributes for staff are: flexibility, “cando” spirit, and boundaries
 We did not design a program based on a theory.
We serve based on the strengths and talents of
our staff.
adventure therapy, play-based approaches, instructional
approaches to family support
 Relational positioning is more important than
model, technique or method
 Macro-application of working alliance
 All (children of all ages, parents, teachers) are
capable of helping if resources are called forth