1 May 12, 2016 CMHACY Conference Kappy Madenwald, MSW Columbus, OhioMadenwald Consulting. LLC Notes from a Recovering Expert: The Bumpy Road on the Way to Delivering Family-Centered Care May 12, 2016 CMHACY Conference Kappy Madenwald, MSW Columbus, Ohio
2 Notes from a recovering expert…Across medical specialties, children and their families must navigate health care systems in search of treatment providers whose services and approaches best fit their family. This can be particularly challenging in the behavioral health field where: Specific providers are not always chosen by families, but rather assigned Admission is sometimes to the only available bed rather than the best bed for a child’s unique needs Care is, in some programs, done to a child and his/her family rather than done with. We sometimes hold the power to compel or coerce These realities have a significant impact on a family’s CARE EXPERIENCE But for a provider, they can be difficult to see and understand Here is one Social Worker’s story…
3 “True-North” concept of family-centered careMadenwald Consulting. LLC “True-North” concept of family-centered care
4 “True-North” concept of family-centered careMadenwald Consulting. LLC “True-North” concept of family-centered care The person and his/her experience is the orientation point for service delivery It requires: Seeing person as whole, credible, capable, and intuitive Seeing strengths and not pathology Honoring the journey Holding a belief in their recovery Joining person where they are Beliefs Culture Preferences
5 Aligning with “true north”Madenwald Consulting. LLC Aligning with “true north” Here is your opportunity to: Understand (rather than challenge) the individual’s perspective Imagine world view from the individual’s “shoes” Here is the “join” opportunity Where there is resistance or ambivalence… Affirm the “not ready for/not right fit” of it Get curious about it Promote exploration of reasons behind “positions” or “beliefs” (sometimes it can be addressed) Make a deliberate decision to engage a person who is: Credible Capable Intuitive Able to collaborate
6 Aligning with “true north”Madenwald Consulting. LLC Aligning with “true north” It is easier said than done because it is such a shift in perspective Rather than coming at a problem from my (service provider) lens, perspective and priority, I must re-orient so that I understand his/her (service user’s) lens, perspective and priority and start there. Think of what that means in terms of what I, the service provider, have to give up!
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11 Holding a “true north” orientation can be hard!Madenwald Consulting. LLC Holding a “true north” orientation can be hard!
12 Aligning with true northMadenwald Consulting. LLC Aligning with true north It requires continuous self-examination: What do I believe about this individual? What am I thinking about him/her? What stories am I telling? How am I acting/reacting? What emotions am I experiencing as I work with them? Whose priorities, preferences and ideas are guiding this encounter, mine or his/hers? And…what are these thoughts and experiences telling me about me?
13 Aligning with true northMadenwald Consulting. LLC Aligning with true north “Experts” have it a WHOLE LOT easier because when I am the “expert”, and something goes wrong or fails to improve it is not about me. It is about…?
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16 Madenwald Consulting. LLC“Those who think they know it all have no way of finding out they don't…” -Leo Buscaglia
17 Kappy Madenwald: Recovering expertMadenwald Consulting. LLC Kappy Madenwald: Recovering expert Recovering: Knower Problem assesser Interpreter Diagnoser Decider Rescuer Solution-maker My early workplaces were STEEPED in “expert think” and I jumped in with both feet. Key aha for me: Luncheon address by Fred Frese, PhD I still battle with it from time to time—I am more honest with myself about it I more readily able to recognize, translate and shift my perspective
18 Madenwald Consulting. LLC…Recovering expert Family-centeredness is a second language to me—I am an immigrant to the culture and delivery of it My increasing fluency in family-centeredness did not come overnight And it came at a personal cost that I had to reconcile Role/Identity Beliefs about self How satisfaction is derived Perception of power SOBERING CLARITY that I have the propensity to harm Now on the other side of the big learning, I have no doubt about the benefit—but I don’t forget that it was quite a journey
19 Aligning with true northMadenwald Consulting. LLC Aligning with true north Experts get stuck on two tracks… I know it all I am supposed to know it all
20 Aligning with true northMadenwald Consulting. LLC Aligning with true north Expertise is important Expert stance is risky We don’t, won’t and can’t know it all What we know is ever-evolving Approaches believed to be best, are not necessarily “best for me”
21 “It's what you learn after you know it all that counts.”Madenwald Consulting. LLC “It's what you learn after you know it all that counts.” -John Wooden
22 Aligning with true northMadenwald Consulting. LLC Aligning with true north It is important to remember that there is no perfection in family-centered care. We all slip into “expert” role The challenge is developing strategies to recognize it early, to adjust, and to minimize any harm that comes from it. We have to figure ways to do this… Personally As a team As an agency As a system
23 Aligning with true northMadenwald Consulting. LLC Aligning with true north Four primary approaches I use when working with teams Listening to and learning from individuals with lived experience Immersive Exercises: “Standing in the shoes…” Taking a personal look at our services Remembering/exploring “when it was me” THIS is lived experience
24 Achieving Precision: Resolution-Focused Care
25 Resolution-focused careFamily-centeredness is about alignment Resolution-focus is about creating the climate for healing/recovery/change Resolution Empowerment/activation Clarity Diminished risk/REAL harm reduction Diminished angst Increased hope Return to higher level functioning
26 Resolution-focused careQUESTION: Is admission to a psychiatric hospital an example of crisis resolution? No, resolution and disposition are unrelated. A referral for formal treatment services MAY offer relief and the treatment that follows may offer additional relief, but it is incorrect to assume that a disposition=resolution.
27 Resolution-focused careCare quality and care experience are more about precision than about length, quantity or intensity Precision work involves: Person/family-centered orientation (true north) Clear intention for the intervention (resolution) Selection and use of productive (step forward) approaches
28 The key is precision…
29 Resolution-focused care and the mangled foot
30 The mangled foot Assessment vs. Treatment Disposition vs. Resolution WHAT IS THE DIFFERENCE? If you are the person with the mangled foot, what are you in this for?
31 The mangled foot… My hard work doesn’t automatically translate to your relief I have to pay a lot of attention to my INTENTION (fix, DO TO, hold accountable, limit set, observe, assess) These intentions (subconscious or overt) are tied to the stories I tell and they are tied to my belief about my role in your life
32 “The simplicity on the far side of complexity…”Source: Oliver Wendall Holmes, Jr.
33 It turns out, people know the difference…