Transcript Slide 1

Caregiver Consultant Refresher
Training
2013
Minnesota Board on Aging and
Minnesota Area Agencies on Aging
This curriculum is owned by the State of Minnesota and cannot be
reproduced or used without written permission.
Components of the Basic Caregiver Consultant Curriculum
I.COACHING CONTEXT
•Goals and Objectives
•Differences Between Coaching and Other
Disciplines
•Common Assumptions
•Desired Outcomes
•Seven “Guiding Principles”
II. CAREGIVER /FAMILY CONTEXT
Caregiver Context:
•Caregiver Definition
•Common Challenges
•Caregiving Circumstances
•Caregiver Theories
•Caregiving “Landmarks”
Family Context:
•Family Definition
•Different Types/Styles of Caregiving
•Family Systems Theory
•Caregiver Conflicts
•Barriers to Effective Family Care
•Effective Family Caregiving
•Cultural Considerations
III. APPLICATIONS OF COACHING/CONSULTING SKILLS
AND TOOLS
Coaching Process Skills:
•Progression Involved
•Five Major Skills Needed for Successful Coaching
Coaching Skills w/Caregiver:
• Education and Skill Development about Illness
and Care
• Accessing Services and Resources
• Awareness of Strengths and Abilities
• Self-Awareness and Stress Management
• Communication and Assertiveness Skills
• Expanding Support Network/Partnering with
Physician
Learning Objectives
• Describe common caregiver challenges
• Review key theories
• Learn information about different cultures and
communication tips
• Learn key elements of a caregiver assessment
and how to approach difficult topics
• Provide overview about dementia capability
training
Introductions
• Name
• Organization/job title
• Geographic area served
• Types of persons served (gender, age, race)
• How does caregiver coaching fit within their
role in their current position?
Context of Caregiving
• Family plays a vital role
• Every 1% decline in family caregiving, costs an
estimated $30 million in formal care
• Success of most care plans rests on familycentered approach to care
• Can result in higher levels of stress, depression,
reduced immunity, poorer physical care
• Family caregivers with higher levels of stressmore likely to place
Studies Show that the Presence of a
Family Caregiver:
• Improves medical compliance
• Reduces length of stay in hospital and hospital
readmissions
• Prevents unnecessary ER and other doctor visits
• Prevents (or delays) premature nursing home
placement
• Improves quality of life
Source: TCARE® (Tailored Caregiver Assessment and Referral)
Presentation, November 2012
Our Role
 Help navigate through
the course of caregiving
and various diseases.
 Assessment, planning,
and problem solving.
 Emotional support
History of Minnesota
Caregiver Coaching/Consulting Service
•
In 2000, Congress authorized first federal funding earmarked for services to
support family caregivers. Title III-E of the Older Americans Act
•
State and AAAs recognized the need for a service to empower caregivers in
their role and assist caregivers in achieving a more balanced lifestyle while
caring for another person. The label given this service varied – with caregiver
coaching used in some parts of the state and caregiver consulting used in
others. For the purpose of this training, we’ll refer to it as the “caregiver
consultant performs caregiver coaching.”
•
A group of state, AAAs and providers defined service key components,
developed service standards and a standardized training curriculum to
instruct professionals.
•
Today Minnesota has 50 – 60 trained caregiver consultants statewide
Assumptions for Caregiver Services
• Aging is a family affair
• People are naturally resourceful
• Caregivers are resilient and have many strengths
• Benefits for both caregivers and care receiver
• Caregiver is the “expert” and the agenda comes
from caregiver; caregiver consultant encourages
caregiver responsibility
Service Definition
caregiver coaching
• Personalized service that equips family caregivers with knowledge,
skills and tools to achieve a balanced lifestyle while caring for another
person
• They assist caregivers in identifying needs and values…facilitate goalsetting and development of person-centered plan….provide ongoing
coaching and support to assist caregivers in reaching established goals
• People who provide this service in MN are usually referred to as
caregiver consultants.
Overall Goal of Caregiver Coaching
Goal is to equip
the caregiver
with knowledge,
skills and tools
to become a
stronger
caregiver
capable of selfdirected care.
Three Main Functions of
Caregiver Coaching
1. Help caregiver define reasonable, realistic,
and attainable goals
2. Provide structure
3. Support, validate, and help caregiver “stay
on track”
Components of the Basic Caregiver Consultant Curriculum
I.COACHING CONTEXT
•Goals and Objectives
•Differences Between Coaching and Other
Disciplines
•Common Assumptions
•Desired Outcomes
•Seven “Guiding Principles”
II. CAREGIVER /FAMILY CONTEXT
Caregiver Context:
•Caregiver Definition
•Common Challenges
•Caregiving Circumstances
•Caregiver Theories
•Caregiving “Landmarks”
Family Context:
• Family Definition
• Different Types/Styles of Caregiving
• Family Systems Theory
• Caregiver Conflicts
• Barriers to Effective Family Care
• Effective Family Caregiving
• Cultural Considerations
III. APPLICATIONS OF COACHING SKILLS AND TOOLS
Coaching Process Skills:
•Progression Involved
•Five Major Skills Needed for Successful Coaching
Coaching Skills w/Caregiver:
• Education and Skill Development about Illness
and Care
• Accessing Services and Resources
• Awareness of Strengths and Abilities
• Self-Awareness and Stress Management
• Communication and Assertiveness Skills
• Expanding Support Network/Partnering with
Physician
II. Caregiver Context
Purpose
To gain an understanding of the variety of
situations faced by caregivers, and some of
the areas where coaching can help them
Learning Objectives
• Review common caregiving challenges
• Review useful theories for understanding
caregivers and discuss how these theories
have been applied in your work
External Caregiver Circumstances
Long distance
caregivers
• Within state
• Out of state
Rural vs urban
caregivers
• Isolated
• Travel difficulties
• Fewer services
Cultural differences
Family dynamics
• Racial
• Same-sex relationships
• Multi-cultural
• Conflicted families
• Disconnected families
•Argumentative families
Common Caregiver Challenges
• Knowing enough
• Lack of insight
• Need for additional
skills and more
resources
• Ability to match
services and resources
with needs and goals
• Communication
struggles
• Self-talk/selfawareness
• Asking/accepting help
• Work/life balance
Group Discussion
What types of caregiver issues “challenge” you?
How do you manage these challenges in your
work?
Internal Caregiver Circumstances
Onset of
illness
Type of
illness
Course of
Illness
Effects of
Illness
Impact of Care Receiver Stage of Illness
Diagnosis/
Early stage
• Sudden
Chronic Care/
End-of-life/
Middle Stage
End Stage
• Increase of
fatigue/stress
• Ambiguous
• Slow onset
• Trial and error
• Planning critical
• Fast or sudden
• Long drawn-out
process
• Difficult
decisions
Exercise
In small groups, share your experiences with
caregivers in each of stage (using the previous
slide).
What did you see as the biggest obstacles?
How did the caregiver succeed in negotiating
these challenges?
Theories to Consider in Working
with Caregivers
• Caregiver Identity Change Theory (TCARE®)
• Stress-Process Model
• Strengths-Based Approach
The Caregiving Journey
Is a Systematic Change Process
• Change in activities
• Change in relationship with care receiver
• Change in identity of caregiver
•
Cite: http://www4.uwm.edu/tcare/about.cfm
Five Phases of Caregiving
Example of a spouse caregiver
Caregivers Experience Distress
• When behavior
doesn’t match
personal rules
• “It’s not what you
are doing - It’s how
you feel about it
Discussion
Describe your experience using TCARE® (what
lessons have you/client learned, successes,
obstacles)
Pearlin’s Stress Process Model
Caregiving Context
Sociodemographics
History of Care
Primary Stressors
Secondary Stressors:
Role Strain
Objective Stressors:
Cognitive Status, ADLs
Behavioral Changes
Family Conflict
Job-care Conflict
Economic Problems
Subjective Stressors:
Overload
Loss of Relationship
Stress Appraisals
Cite: Pearlin et al., 1990
Aneshensel et al., 1995
Secondary Stressors:
Intrapsychic Strains
Mastery
Self-esteem
Loss of Self
Competence
Gain
Outcomes
Well-being
Health
Yielding of Role
Resources:
Coping
Social support
National Center on Caregiving at
Family Caregiver Alliance
Strength’s Based Approach
• Caregiver is the “expert of their situation”
• Mobilizes caregiver’s talents, knowledge,
capacities, and resources
• Perceives individuals as possessing the
capability to problem-solve, cope, and thrive
Discussion
How have you used either of these theories in
your work?
Components of the Basic Caregiver Consultant Curriculum
I.COACHING CONTEXT
•Goals and Objectives
•Differences Between Coaching and Other
Disciplines
•Common Assumptions
•Desired Outcomes
•Seven “Guiding Principles”
II. CAREGIVER/FAMILY CONTEXT
Caregiver Context:
•Caregiver Definition
•Common Challenges
•Caregiving Circumstances
•Caregiver Theories
•Caregiving “Landmarks”
Family Context:
• Family Definition
• Different Types/Styles of Caregiving
• Family Systems Theory
• Caregiver Conflicts
• Barriers to Effective Family Care
• Effective Family Caregiving
• Cultural Considerations
III. APPLICATIONS OF COACHING SKILLS AND TOOLS
Coaching Process Skills:
•Progression Involved
•Five Major Skills Needed for Successful Coaching
Coaching Skills w/Caregiver:
• Education and Skill Development about Illness
and Care
• Accessing Services and Resources
• Awareness of Strengths and Abilities
• Self-Awareness and Stress Management
• Communication and Assertiveness Skills
• Expanding Support Network/Partnering with
Physician
“FAMILY” CONTEXT
Purpose
To understand how the intersection of needing care
due to illness, disease, etc. impacts the caregiver,
elder and the extended family. To see how family
complexities can be viewed as both an asset and
a challenge, and to talk about building upon
family strengths to produce support and positive
change.
Learning Objectives
• Revisit the definition of “family”
• Review different styles of caregiving families
• Become more familiar with family systems
theory
• Discuss possible conflicts and barriers to
effective family care
Family Definition
• A group of people who are connected
• Each family’s pattern of interacting personalities
is unique to them
Different Styles of Caregiving Families
• Solitary caregiving
• “Observed caregiving”
• Tag team approach
• Uneasy caregiving alliance
• Collaborative caregiving
• Cite: Savvy Caregiver Training Manual, Ken Hepburn, Marsha Lewis, Jane Tornatore, Carey Wexler Sherman
Discussion
Which of the caregiving styles have you seen in
your work?
What has been the most challenging?
Unraveling the Family Component
• Family can greatly impact primary caregiver
• Family Systems Theory
• Caregiver Coaching (Advanced Skills Training)
provides further education on facilitating
formal family meetings
• Important to be aware of these variables
Family Systems Theory
“The whole is greater than the sum of its parts”
•
•
•
•
Systems are composed of subsystems
Each member of the system has a “role”
Look at the system’s structure (rules) and tasks
Maintaining same patterns create equilibrium
Family Systems Theory
Basic Concepts
gender
history
roles
boundaries
patterns
http://family.jrank.org/pages/597/Family-Systems-Theory-Basic-Concepts-Propositions.html
BALANCE IN FAMILY SYSTEMS
Exercise
Describe your approach in working
with a family that may not be in
equilibrium?
Conflicts Among Caregivers
May occur when families differ about:
• What “caring” means and what the limits of caring “should
be”
• Actions or attitudes towards the family member needing
care
• Seriousness of the illness, disease or impairment
• Whether a primary caregiver is appreciated
Conflict also occurs when:
• One caregiver is more competent and/or has more time
• A family member isn’t able to look at the reality of the
situation or use their abilities to help
Barriers to Effective Care
Denial
Lack of role flexibility
Lack of experience or necessary knowledge and skills
Lack of a plan or goal
Poor Communication in Issues within the Group
Cultural Influences
Did you know?
• Minnesota has the largest Somali population in the US
• Minnesota’s Hmong population is second only to California, and St. Paul is
home to the largest urban population of Hmong in the world
• The numbers of African American, Asian, and Hispanic/Latino
Minnesotans are expected to more than double over the next 30 years
while the number of white Minnesotans is projected to fall
• The continued aging of the baby boom population will produce a
significant increase in the number of people ages 55-69. By 2035, 22
percent of the population will be age 65 or older
• Death rates for Black Americans are more than one and a half times higher
than whites in most age groups
Cite: http://www.culturecareconnection.org/matters/index.html
Understanding Other Cultures
“Cultural competence is having the capacity to function
effectively within the context of the cultural beliefs,
behaviors, and needs of consumers and their
communities (Office of Minority Health).”
Cite: http://www.culturecareconnection.org/
Tools for Cultural Competence
• Family/Caregiver
• MN Dept of Health
http://www.health.state.mn.us/divs/idepc/refugee/topics/cultcom
p.html
• Stratis Health-website
http://www.culturecareconnection.org/resources/tools/index.html
• Council of National Psychological Associations for
the Advancement of Ethnic Minority Interests
http://www.apa.org/pi/oema/resources/brochures/treatment
-minority.pdf
Somali
Social Structure:
• Father is wage-earner and primary decision-maker
• Family lives in multi-generational household
• Men/women do not touch members of the opposite sex outside family
• Islam as religion-women cover bodies, including hair
Medical Care:
• Health prevention through prayer and living through Islam
Death and Dying:
• It is uncaring to tell others (or be told) that the person is dying
Hmong
Social Structure:
• 18 clans determined by ancestral lineage. Do not call each other by first
name
• Have large extended families and the clan leaders are usually the key
decision-makers
Medical Care:
• Tend to have an increase in many chronic health issues
• Generally do not practice preventative health
• View illness from holistic approach-combination of spirit and body
• May/may not accept western medicine as treatment or combine eastern
practice with healing
Death and Dying:
• Life is a continuous journey. Death is phase to pass from this existence to
next
Black American
Social Structure:
• Often matriarchal
• Families include “non family members”
• More unmarried women than men
• Older generation tends to be conservative in favor of traditional gender roles
• Family has taken care of elders rather than placement
Medical Care:
• Older adults may be suspicious of health professionals
• Believe their health is personal and God’s will
Death and Dying:
• Family should be informed of impending death
• Cremation generally avoided and organ donation may be viewed as
desecration of body
Hispanic/Latino
Social Structure:
• Traditional families include extended family
• Children are highly valued and elders are respected/cared for
Medical Care:
• High chronic health concerns
• May use both western medicine and consult folk healers/spiritualists
Death and Dying:
• Religious beliefs influence perception
• Influence of Roman Catholic church
• Elderly may wish to die at home-the spirit may become lost in hospital
American Indian
Social Structure:
• Family includes: immediate, extended family, as well as community and
tribal members.
• Women are traditional caregivers
• Children are expected to respect and care for elders
Medical Care:
• Limited access or no access to health care services
• Health is related to spirituality. Sickness may be viewed as a result of
disharmony between sources of life
• Patient may seek treatment from local clinic and from medicine man
Death and Dying:
• Immediate and extended family should be informed
• Family Centered approach is advised
• Entire family may be involved in decision-making
• Need for signed forms may be an obstacle
Exercise
Using this very limited information, discuss how
your role may be perceived by the assigned
culture. How would you proceed with
beginning your work as a caregiver
consultant?
Communication Reminders
• Treat primary caregiver, care recipient and other family members with
courtesy and respect
• Recruit younger family members to be an interpreter when trying to
communicate with the primary caregiver, the older care recipient or
other family members
• Learn about cultural differences from the family
• Honor lifestyle practices and traditions
• Be aware of primary caregiver’s and other family members’ possible
feelings of social isolation
Components of the Basic Caregiver Consultant Curriculum
I.COACHING CONTEXT
•Goals and Objectives
•Differences Between Coaching and Other
Disciplines
•Common Assumptions
•Desired Outcomes
•Seven “Guiding Principles”
II. CAREGIVER /FAMILY CONTEXT:
Caregiver Context
•Caregiver Definition
•Common Challenges
•Caregiving Circumstances
•Caregiver Theories
•Caregiving “Landmarks”
Family Context:
• Family Definition
• Different Types/Styles of Caregiving
• Family Systems Theory
• Caregiver Conflicts
• Barriers to Effective Family Care
• Effective Family Caregiving
• Cultural Considerations
III. APPLICATIONS OF COACHING SKILLS AND TOOLS
Coaching Process Skills:
•Progression Involved
•Five Major Skills Needed for Successful Coaching
Coaching Skills w/Caregiver:
• Education and Skill Development about Illness
and Care
• Accessing Services and Resources
• Awareness of Strengths and Abilities
• Self-Awareness and Stress Management
• Communication and Assertiveness Skills
• Expanding Support Network/Partnering with
Physician
III. APPLICATION OF SKILLS AND TOOLS
Purpose
To enhance the process a consultant uses to
develop supportive and empowering
relationships. Also learn how to complete an
assessment-based process for goal setting
purposes as well as action planning with
individual caregivers.
Coaching Process Skills
Learning Objectives:
• To review the progression involved in caregiver
coaching
• Apply five primary skills
• Learn how to complete useful caregiver assessment
• Conduct eight-step process for action planning and
goal setting
• Understand basics of consultant’s follow-up/along
role
Caregiver Coaching Progression
Referral
Intake
Consultant Skills – 5 Primary Skills
•
•
•
•
•
Active Listening
Curiosity and Inquiry
Assessing/Reassessing - Interviewing
Goal Setting & Action Planning
On-going Follow-up
Evaluating and Ending
• Encourage Caregiver Independence
• Survey for Effectiveness
Referral Process
Referrals
• Caregiver
• Agency
• Clinic
• Faith Communities
• Family & Friends
• Social Services
• Senior LinkAge Line®
Intake Process
• Starting point for building good relationships
• Clarity of purpose is important!
o This is a process not event
o Caregiver Coaching is not for everyone
Exercise
Discuss the following:
• How do you describe your role as a Caregiver
Consultant? What are some analogies?
• In the intake process, what are your triggers
that coaching wasn’t the best service? Or does
this reaction make a difference to you?
Five Primary Skills of Caregiver
Coaching
Skill
#1
Skill
#2
Skill
#3
Skill #
4
Skill #
5
• Active listening
• Curiosity/inquiry
• Assessing/reassessing - interviewing
• Goal-setting
• Action planning
• Follow-up
• On-going facilitation
Skill
#1
Active Listening
Considered the most important coaching skill
“Listening is the oldest and perhaps most powerful
tool of healing. It is often through the quality of
our listening and not the wisdom of our words
that we are able to effect the most profound
change in people around us. When we listen, we
offer with our attention an opportunity for
wholeness.”
(Rachel Naomi Remer)
Skill
#1
Active Listening
• Being attentive
• Articulating
• Acknowledging/Affirming
• Clarifying
• Big-Picture View
• Using Metaphors
Skill
#2
Curiosity/Inquiry
Powerful Questions:
The most effective questions are:
• Open-ended
• Short and simple
• Creates awareness and responsibility
• Invites introspection and reflection and looks
into the future
Skill
#2
CURIOSITY/INQUIRY
Examples of Powerful Questions:
• What have you tried already?
• What can we learn from this?
• What are you going to focus on now?
• What are you settling for?
• What do you wish you had more of, less of, or was
different?
• How can I help you succeed?
Discussion
How have you used powerful questions in your
work? What have you learned from using
these questions?
Skill
#3
Assessing/Reassessing Interviewing
Interview and gather information
specific to the caregiver
Describe caregiving situation and
identify issues within cultural context
Identify problems - needs resources - strengths
Skill
#3
• Consultant
builds
rapport
• Consultant
learns
about
Trust with
caregiver
Caregiver’s
capacity,
needs
• Consultant
Understanding
Caregiver’s
Culture
Baseline
and setting
of goals
• Consultant
defines
Why do an Assessment?
Skill
#3
Is Coaching a Good Fit?
• “Who me, a caregiver?”
• “I can do it myself”
• High emotion & high stress (difficulty focusing)
• Difficulty with self-care
• Fear of being judged
• Shame, and/or not wanting to talk about situation
Skill
#3
Areas of Concern
SAFETY (Emotional, Psychological, Physical)
•Isolation/withdrawn
•Unexplained injuries
•Repeated accidents/injuries, vague complaints
•Pain – abdominal, pelvic, headaches, etc.
FINANCIAL CONCERNS (Know who is an Influence)
• Signs of intimidation
•Anxiety about personal finances
•Lack of knowledge regarding finances
•Sudden changes in spending habits
DEPRESSION or MENTAL HEALTH ISSUES
•Crying or lack of interest in things previously enjoyed
•Unexplained weight loss or gain
•Poorly groomed
•Disturbance in sleep patterns
REMEMBER – YOU ARE A MANDATED REPORTER
Skill
#3
Process for Assessing
• Purpose of coaching
• Time commitment
• Ethical
responsibilities of
coach
Set Up
Organization
• Comfort level of
setting
• Options to
accommodate style of
caregiver
• Use Seven Domains
as guide
• Types of preferred
assessment
• Set attainable goals
Implementation
Overview of the Seven Domains
1. Context/Circumstance/Environment
2. Caregiver’s perception of the care receiver’s health and functional
abilities for care of themselves and their home
3. Caregiver’s values and perceptions
4. Well-being of the caregiver
5. Consequences of caregiving
6. Skills/abilities/knowledge to provide care receiver with needed care
and support as they age
7. Potential resources that caregiver could use
Caregiver Assessment
Assessment options:
Caregiver Minimum Assessment Questionnaire
TCARE® and Family Memory Care (NYUCI)
•
•
•
•
Helps identify depression
Types and levels of stress
Caregiver goals and strategies
Services
Learn about both TCARE and Family Memory Care
assessments in the resource guide provided at the end of
the sessions.
Components of the Caregiver
Minimum Assessment
•
•
•
•
•
•
•
Demographics
Care receiver information
Rapid Screen-family caregiver
Additional caregiver questions
Caregiver screen-Montgomery Burden Scale
Depression screen-CESD
Care planning
Skills used to Build Rapport
•
•
•
•
•
Reflective listening
Empathy
Validation
Normalizing
Reassurance
More Skills
•
•
•
•
•
•
Probe
Reflect
Clarify
Paraphrase
Summarize
Empathetic listening
Is it a Road Block or Emotional
Reaction?
Emotional Reactions
• Assessments may trigger emotional reactions
• “Setting the stage” throughout the process
• Normalize/validate thoughts and feelings to
build the alliance
• Burden and depression components may be
especially difficult
“Setting the Stage”
• Introduce yourself and housekeeping details
• Share that this is a conversation
• Talk about what they can expect (how long it
will take, types of questions- multiple choice,
open-ended questions, emotional reactions)
• Call out the “obvious” (caregiver generational
differences, cultural differences)
• Share what will happen after the assessment
Burden and Depression
What is your definition of burden?
What is your definition of depression?
Types of Burden
• Objective (“I have little time for friends and
relatives,” “My social life has suffered)
• Stress (“My caregiver responsibilities have
created a feeling of hopeless,” “I feel anxious”)
• Relationship (“My caregiver responsibilities have
caused conflicts with my relative,” “My caregiver
responsibilities have increased attempts by
relative to manipulate me.”
Discussion
How do you introduce the Montgomery Burden
Scale to a caregiver during the assessment
process?
Depression
• Caregivers are at an increased risk of mood
disorders, such as depression and anxiety
• Counseling/support can be effective
• Referral for therapist & medication treatment
may be required
Discussion
How do you introduce the Depression Screen
during the assessment to a caregiver?
Interpretation
Now that you have the data from
the caregiver assessment, what is
the next step?
Assessment Analysis
• Review sections for Rapid Screen risks
• Caregiver demographics (Employed? Veteran?
Health? Services? Concerns?)
• Burden scores
• CESD-depression screen
• Self-care
The Big Reveal-Symptoms of
Depression
• CES-D Scores:
Low: 10-18
Medium: 19-25
High: 26-40
Process to Reveal:
Provide evidence, normalize, strategize and refer
Concerns with Burden
• Relationship Burden Scores:
Low: 5-7
Medium: 8-12
High: 13-25
• Objective Burden Scores:
Low: 6-17
Medium: 18-23
High: 24-30
• Stress Burden Scores:
Low: 5-11
Medium: 12-16
High: 17-25
Care Pathways for Burden
• Relationship: Focus on education about the
disease process, especially true for dementia
• Objective: Focus on caregiver not having
much time to themselves or others
• Stress: Focus on emotional symptoms of
caregiving and how it impacts both caregiver
and care receiver.
Other Recommendations for
Addressing High Burden Scores
• There are many services used to address
burden (education, adult day, transportation,
in-home support, counseling, respite, etc)
• Avoid “shot gun approach”
• Using an evidence-based model (TCARE) is the
preferred method
• To learn more about becoming TCARE
certified, please contact your local AAA
Exercise
How do you initiate conversation with a
caregiver about high symptoms of depression?
Research Findings
• Support programs are most effective for
reducing burden when appropriately “timed
and dosed”
• Multiple-component, comprehensive support
services have had the most impact
Skill
#4
Action Planning & Goal Setting
1) Gather information
2) Identify problem areas and potential goals
3) Brainstorm
4) Evaluate options
Struggles with Goal-Setting
Sometimes, caregivers struggle to set goals
and follow through
When this happens, we want to:
• Express empathy
• Help caregiver appreciate changes
• Roll with resistance
• Embrace caregiver autonomy
Brainstorming/Evaluate Options
• Think outside of the box
• Encourage an experimental attitude (What if
you tried…?) or (What would happen if…?)
• Constantly evaluate options
Skill
#4
Action Planning & Goal Setting
5) Create and write a plan
6) Assess plan – is it S.M.A.R.T.?
Specific? Measureable? Attainable? Realistic? Timed?
7) Take action
8) Evaluate
Take Action & Evaluate the Plan
• Action plans can be formal & informal
• After plans are created, we help the caregiver
evaluate the plan
• Celebrate both successes and identify what
worked and what didn’t work
Remember whose journey it is
Skill
#5
Ongoing Follow-Up
Follow-Up Session Format
• Check-in
• Progress update
Skill
#5
Ongoing Follow-Up
• Today’s agenda
• Clarify next steps
Skill
#5
Ongoing Follow-Up
Coaching Skills Needed:
• Reframing
• Making requests/gently challenging
caregiver
Skill
#5
Ongoing Follow-Up
Reassessments & Closure
THE USE OF THESE SKILLS
TAKES PRACTICE!
Discussion
What strategies do you use in follow
up/evaluation/closure do you use that we
haven’t talked about?
Case Review
Describe a situation where you felt challenged
that you would like to discuss
Share lessons learned or reach out to group for
guidance
Case consultation is critical in this work
Components of the Basic Caregiver Coaching Curriculum
I.COACHING CONTEXT
•Goals and Objectives
•Differences Between Coaching and Other
Disciplines
•Common Assumptions
•Desired Outcomes
•Seven “Guiding Principles”
II. CAREGIVER /FAMILY CONTEXT:
Caregiver Context
•Caregiver Definition
•Common Challenges
•Caregiving Circumstances
•Caregiver Theories
•Caregiving “Landmarks”
Family Context:
•Family Definition
•Different Types/Styles of Caregiving
•Family Systems Theory
•Caregiver Conflicts
•Barriers to Effective Family Care
•Effective Family Caregiving
•Cultural Considerations
III. APPLICATIONS OF COACHING SKILLS AND TOOLS
Coaching Process Skills:
•Progression Involved
•Five Major Skills Needed for Successful Coaching
Coaching Skills w/Caregiver:
• Education and Skill Development about Illness
and Care
• Accessing Services and Resources
• Awareness of Strengths and Abilities
• Self-Awareness and Stress Management
• Communication and Assertiveness Skills
• Expanding Support Network/Partnering with
Physician
Ongoing Training for
Caregiver Consultants
Additional Modules (Dementia Capability Training)
State Training Options
Associations
On-Line Trainings
Alzheimer’s Association
Dementia Resources
24/7 Information Helpline 800-272-3900
Website: www.alz.org/mnnd
Caregiver Center:
http://www.alz.org/care/overview.asp
Safety Center:
http://www.alz.org/care/alzheimers-dementiasafety.asp
Local Resources:
http://www.alz.org/mnnd/in_my_community_1849
7.asp
Thanks for Your Participation!
• For questions about the presentation, case
summaries and related information contact:
 Heidi Haley-Franklin, Associate Program Director,
Clinical Services, Alzheimer’s Association:
[email protected]
 Elaine Spain, Program Developer, Minnesota
River AAA, Inc.: [email protected]
• Questions about state caregiver program
initiatives and educational opportunities:
 Sue Wenberg, Family Caregiver Program Consultant,
Minnesota DHS/MBA: [email protected]