Day3JohnMurphyJacquelineSparks

www.heartandsoulofchange.com June 19, 2010 Shouldn't I Be Telling You What I Think?! How To Use Consumer Feedback to Improve Services for Young People and Caregivers in Schools, Homes, and Communities John Murphy JMurphy@uca.edu Jacqueline Sparks jsparks@uri.edu Aha Moments Along the Road… Surprise and Shaping —Why didn’t it work? —Why did it work? Monique and Justin —If you had only asked —“You’re upset, Justin” 1

www.heartandsoulofchange.com June 19, 2010 Michael – age 12 Children have an uncanny sense of what they need to help them get through tough situations—we just need to ask, listen, and respond. Valuing the Voices of Children and Caregivers Whether in schools, service agencies, or other community systems of care, professionals work tirelessly, sometimes against great obstacles, to help troubled children and adolescents and their families 2

www.heartandsoulofchange.com June 19, 2010 The reality is . . . Professional training, policies, paperwork, and procedures can work against including all voices in the helping process . . . and on a level playing field. Professional meetings can be intimidating for many parents and caregivers, and certainly for young persons. 3

www.heartandsoulofchange.com June 19, 2010 There are few ways to systematically include everyone’s voice in a way that anchors helping processes in the goals and preferences of key players—young persons and their immediate caregiving networks. often resulting in . . . • children’s and adolescents’ voices not being invited to the table and considered of value • parents’ and caregivers’ voices being muted • a potential circle of mistrust and alienation that can exacerbate problems and stymie the creation of a solution-building team that includes everyone 4

www.heartandsoulofchange.com June 19, 2010 To the Rescue Client-Directed, Outcome-Informed Practice What Does It Mean To Be Outcome-Informed? • Consumer-oriented vs. product-oriented • Practice based evidence vs. evidence-based practice • Obtaining and discussing client feedback • Using client feedback to enhance what is working and change what is not • Collaborating with clients on all major decisions and aspects of therapy Trusting that the “Client Knows Best” 5

www.heartandsoulofchange.com June 19, 2010 Being Outcome-Informed. . . Begins with an Attitude of R-E-S-P-E-C-T “That Just Makes Good Sense” —Nicole, Age 14 Client = Consumer We = Service Provider WHO is the best judge of effectiveness? Frees us from “Silver Bullet Syndrome” Not Rocket Science…“Just makes good sense!” 6

www.heartandsoulofchange.com June 19, 2010 …especially with Young People Alliance…Even more important with young people? Mandated Clients…Kids/teens often referred by others Developmental…Quest for independence Sociology of Childhood…Disadvantaged group? Solution Proximity…Kids/teens are close to problem and the solution and Families • Parents can be blamed when kids are having problems • Parents are often not on an even par in many professional settings • Parents have their own history of experiences with helping professionals • Parents know their kids • Parents are close to the problem and to potential solutions 7

www.heartandsoulofchange.com June 19, 2010 Proximity of Influence Child Problem & Solution Caregivers Helping Professionals When this happens... We lose out on key resources needed to accomplish change and a positive outcome. Child and family interpersonal functioning, family environment, and motivation all play an important role. •Strengths and resources; 13% •Social/environmental support; 87% •Chance events in the child and family’s life. 8

www.heartandsoulofchange.com June 19, 2010 We lose out on extending the benefit of use of systematic feedback to children and. . . and families. • In a review of five trials 22% of TAU at-risk cases reached clinically significant change compared with 45% for at-risk feedback cases (supplemented with clinical support tools) (Lambert, 2010). • Feedback couples (205) had over 4x the rate of clinically significant change compared with TAU couples. Divorce and separation rates for couples that used feedback were 46.2 percent less than that of TAU couples (Anker, Duncan, & Sparks, 2009). . . . including feedback related to the therapeutic alliance. • No alliance feedback: – 3x more likely not to return for a second session – Significantly poorer outcomes than feedback clients • Use of alliance and progress feedback: – Double effect-size – Improved retention rates. 9

www.heartandsoulofchange.com June 19, 2010 Feedback & Family Studies • Obtaining frequent measurements for multiple persons in a given family unit is complex; studies are in infancy. • MFT and counseling trainees (N = 28) assigned to the continuous feedback condition and who shared feedback with their supervisors were approximately 2x as effective as those in the no-feedback condition. Nuts & Bolts 10

www.heartandsoulofchange.com June 19, 2010 Validation of brief child measures and validation of the adult measures for adolescents means that all ages and families can benefit from routine feedback in a variety of service settings. Child-friendly measures . . . • help express the child’s understanding • help express child’s viewpoint about how to make the situation better • engage the child 11

www.heartandsoulofchange.com June 19, 2010 • Given at the beginning of each point of service • Validated for ages 6-12 • Parent or caretaker provides rating also • Each line is 10 cm. • Add each line for total score Child Outcome Rating Scale (CORS) Child’s Name ________________Age (Yrs):____Sex: M / F_________ Session # ____ Date: ________________________Who is filling out this form? Please check one: Child_______ Caretaker_______ If caretaker, what is your relationship to this child? _________________ How are you doing? How are things going in your life? Please make a mark on the scale to let us know. The closer to the smiley face, the better things are. The closer to the frowny face, things are not so good. If you are a caretaker filling out this form, please fill out according to how you think the child is doing. 12

www.heartandsoulofchange.com June 19, 2010 Me (How am I doing?) I-----------------------------------------------------------------I Family: (How are things in my family?) I-----------------------------------------------------------------I School: (How am I doing at school?) I-----------------------------------------------------------------I Everything: (How is everything going?) I-----------------------------------------------------------------I © 2003, Barry L. Duncan, Scott D. Miller, & Jacqueline A. Sparks Adolescents • Use adult ORS • Validated for ages 13-17 • 10 cm. each line • Add lines for total © 13

www.heartandsoulofchange.com June 19, 2010 The ORS also allows parents or caretakers to provide feedback on how they see the young person doing. • Give at the end of each point of service • Before the child and parent or caretaker leaves, discuss their scores, especially if they fall below 36 14

www.heartandsoulofchange.com June 19, 2010 • Under 6 • Involves all members of the family, even the youngest • Have crayons and places to color ready 15

www.heartandsoulofchange.com June 19, 2010 3 Skills: The Three I’s • Introducing the measures • Integrating client feedback into practice • Informing and tailoring services based on client feedback 16

www.heartandsoulofchange.com June 19, 2010 Introducing • Describe as routine • Explain that it is a way to help ensure the best outcome • Give guidance as needed • Emphasize importance! • Emphasize that you really want to know what they think! Examples Getting routine feedback Feedback and from families can be a little like a 3-ring circus. Families • Invite all members of the family to participate. • Create the space and tools needed for children to take part. • Invite all members of the family to interpret. • Summarize progress and focus as entry point into the meeting. 17

www.heartandsoulofchange.com June 19, 2010 Integrating • Starting the meeting and connecting to the client’s experience • Focusing and structuring the meeting Examples Integrating The clinical cutoff is the first chance to make meaning of the measure with the client’s life experience. 40 30 s c o re ORS 20 10 0 1 2 3 4 5 6 7 8 9 10 Session number Projected change 75th percentile ORS Scores Estimated Clinical Cutoff 25th percentile 18

www.heartandsoulofchange.com June 19, 2010 Ages 6-12 6- Ages 13-17 13- Clinical Cutoff: Children (6-12) = 32 (6- Adolescents (13-17) = 28 (13- Difference in Child and Adult Scores & Change • The trajectory of 40 change is less 35 steep than O u tc o m e S c o r e 30 25 typically seen in 20 15 adults. 10 • High child score 5 0 require attention 1st 2nd 3rd 4th to small bits of Session Number information. Actual Score Cutoff 25th % 75th % 19

www.heartandsoulofchange.com June 19, 2010 Connecting to the Youth’s Experience • Connect the youth’s described experience of their lives to the marks on the scales. • At that moment, both the counselor and young person know what the marks mean and how success will be measured. • Make sure you get a good rating. If you are unsure, ask the young person to clarify. Age 9 How could we use 9 this information to begin or focus the 8 session? 4 7 Total = 28 20

www.heartandsoulofchange.com June 19, 2010 Age 11 9 How could we use 7 this information to 9 begin or focus the session? 8 Total = 33 Informing: Identifying & Responding to Change • Measures are our third ear for listening for change • Things are better: Amplify and re-story • Things are the same: How can we get things moving forward? • Things are worse: What needs to happen for us to get things moving in the right direction? Examples 21

www.heartandsoulofchange.com June 19, 2010 Informing: The CSRS • Thank the child for completing the measure and maintain an openness to feedback. • Most useful if negative! Total = 24 Informing: Identifying At- At- Risk Situations Children and their parents may feel like “mandated” clients. Engaging them and developing a good working relationship requires monitoring how things are going before it is too late. 22

www.heartandsoulofchange.com June 19, 2010 Expanding the Horizons of CDOI Work: Schools, Homes, & Other Communities In Schools • Involving students (IEP meetings, report-writing) • Outcome-informed group work • Parent-school meetings 23

www.heartandsoulofchange.com June 19, 2010 “It is somewhat ironic that for most school systems,...the largest population of consumers (i.e., the students attending the school)—although having a strong vested interest in the school’s successful operation, may have the least influence over the school’s operation.” Parsons, R. D., & Kahn, W. J. (2005). The school counselor as consultant. Belmont, CA: Brooks/Cole. Shouldn't I Be Telling You What I Think? In Homes Top 5 Reasons Why “They” Say It Won’t Work • Families’ home lives are often chaotic • There are too many distractions • Families are often in crisis • Families and kids may not trust us and be suspicious of the measures • I have too much paperwork already 24

www.heartandsoulofchange.com June 19, 2010 Top-5 Reasons Why It Will Work • Routine use of measures in the homes provides a • Families’ home lives are predictable structure for work often chaotic • Use of the measures with all • There are too many persons involved marshals distractions everyone’s engagement • Families are often in • Use of the measures is re- crisis assuring in a crisis and helps • Families and kids may families plot their recovery not trust us and be • Asking for and valuing client suspicious of the feedback can be unexpected measures and welcome, given negative • I have too much prior experiences paperwork already • When larger systems of care see the benefits, paperwork can be reduced. And the #1 reason. . . When the teen is engaged and trusts you, you just might get invited to tour her room! 25

www.heartandsoulofchange.com June 19, 2010 In Other Communities… Use Your Imagination • Community Centers • Churches • Residential Centers • Groups • Police/Community Initiatives • Hospitals Your Challenges, Your Ideas? Creating communities where children, adolescents, and those who care for them lead the way and have a voice in helping services. 26

www.heartandsoulofchange.com June 19, 2010 Points to Consider… • Gather information regarding progress (ORS, CORS) no more than 1x per week • Have 1 person gather progress information and then share with the helping network • Gather information regarding the alliance after each point of service • Computer and web-based outcome management systems can centralize data, automatically compute trajectories of change, and provide a range of effectiveness data for program funding and improvement Creating a Culture of Feedback 27

www.heartandsoulofchange.com June 19, 2010 Parting Thoughtfrom the 17th Century “People are generally better persuaded by the reasons which they have themselves discovered than by those which have come into the minds of others.” —Blaise Pascal (1623-1662) To Learn More About It… 28

www.heartandsoulofchange.com June 19, 2010 Shouldn't I Be Telling You What I Think?! Thank You ! John Murphy JMurphy@uca.edu Jacqueline Sparks jsparks@uri.edu 29

Day3JohnMurphyJacquelineSparks

by Barry Duncan on Jun 05, 2010

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