Ready, Set, Goal: Goal-Setting from Start to Finish New York City Family Resource Centers May 13, 2016 Agenda Session I: Uncovering Family Needs Review of March Learning Collaborative Approach Assessment Understanding Prioritization Session II: Translating Needs Into Parent/Youth's Vision, and More! Parent/Youth's Vision Strengths and Concerns/Needs SMART Goals Action Plans Outcomes Review of March’s Learning Collaborative Effective outreach is a strategic process! A plan that is the same for every family is not an effective plan; a pitch that is the same for every audience is not an effective pitch. Select the right organization, identify the right person, and include the right content. Pitches should be brief, specific, and genuine. Focus on values, needs, and goals. Descriptions of programs and services can be found in your folder. Purpose of the Workshop To provide you with the support and tools necessary to assist a family in translating their needs into a concrete vision. To learn how to use the overarching parent/youth's vision to plan SMART goals, SMART action steps, and create desired outcomes for families. Question How do we make goal-setting meaningful for you and the families you serve? Key Elements of Person-Centered Recovery Planning Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Approach Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Principles of the Approach Mutual Respect Shared Listening Wise Decision-making Courageous Conversation 3 Methods of Communicating The Power of Language Language shapes how we see the world. The words we choose and the meanings we attach to them influence our feelings, attitudes, and beliefs. We choose the words we use to describe ourselves, others, and the world around us. These choices have a powerful effect on how we view mental health and people with mental health conditions. People-first language means we literally put ourselves and others first in a sentence. Instead of calling someone “mentally ill,” the more appropriate, respectful phrase is “a person living with a mental illness.” Active Listening In the workplace, listening is used at least 3 times as much as speaking, and four to five times as much as reading and writing. What is the Difference between HEARING and LISTENING? Hearing: the physical ability Listening: a skill. Listening allows one to make sense of and understand what another person is saying. Listening is active. It means being alert to and understanding the meaning behind the speaker’s words. Barriers to Listening Noise Language differences or accents Worry, fear, or anger (our emotional response) Lack of attention span Talking over the person Planning your response Bias or judgment How to put the ACTIVE in Active Listening 1. 2. 3. 4. 5. Pay attention Show that you are listening Provide feedback Defer judgment Respond appropriately Paying Attention Give the speaker your undivided attention, and acknowledge the message. Recognize that nonverbal communication also “speaks” loudly. Look at the speaker directly. Put aside distracting thoughts. Don’t mentally prepare a response. Avoid being distracted by your involvement. “Listen” to the speaker’s body language. What does their body language say to you? Using Body Language Humans have more than 700,000 forms of body language. Show that You are Listening Use your own body language and gestures to show your attention. Nod occasionally Smile and use other facial expressions Note your posture and make sure it is open and inviting Encourage the speaker to continue with short verbal comments like ‘yes’, and ‘uh huh’. Reflective Listening Our personal filters, assumptions, judgments, and beliefs can distort what we hear. As a listener, your role is to understand what is being said. This may require you to reflect back and ask questions. Reflect what has been said by summarizing what the person is saying in your language, “What I’m hearing is…” and “Sounds like you are saying…” Ask questions to clarify certain points. “What do you mean when you say…?” or “Is this what you mean…?” Summarize the speaker’s comment every so often through out the conversation. Focusing Questions Use focused questions to get a more definitive answer than you would with an open-ended question. Example: Advocate: “Where do you spend most of your day?” Youth/Parent: “I don’t know – it’s hard to say.” Focused question: “Okay, let’s take yesterday. Was that a regular day for you? What did you do in the morning?” Focusing Questions #2 Advocate: What would you like to achieve through our work together? Youth/Caregiver: I don’t really know. I want to do better? I’m just not really sure what you are asking. Advocate: Being better, if you were “better” tomorrow, what would that look like? How would you know that you are better? Closed vs. Open-Ended Questions Close-ended questions invite a yes or no answer. They begin with Do, Does, Did, Is/Are, Was, Has, Have, Could, Would, and Will. Open-ended questions cannot be answered by yes or no. They begin with: Who, What, When, Where, Why, and How. Practice: Do you work? Do you have any side effects from the medication you are taking? Tip! If you find yourself responding emotionally to what someone has said or is saying, say so. Ask for more information: “I may not be understanding you correctly, and I find myself taking what you said personally. What I thought you just said is…; is that what you meant?” Defer Judgment Interrupting can be a waste of time. It frustrates the speaker and limits full understanding of the message. Allow the speaker to finish Don’t interrupt with counter arguments Sometimes it is appropriate to interrupt in order to refocus the conversation or to clarify what the speaker is saying. Tip! Interrupt to focus: Use the person’s name to get their attention, and when he/she pauses, redirect the conversation the issue at hand. I really need to ask… Let me interrupt you for a just a second... I think we need to focus on… Can we get back to… It would really help me to know more about… Any clarifying question: “What do you mean when you say…?” or “Is this what you mean…?” Respond Appropriately Active listening is a model for respect and understanding. You are gaining information and perspective. You add nothing by attacking the speaker or otherwise putting them down. Be open and honest in your response But give these opinions in a respectful way. Treat the other person as you would want to be treated Assessment Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Telling a Story Through your Documentation Each record should tell a story about the care that’s being provided. Like any other story, the record has a particular setting and a cast of characters that the “reader” should understand in order to make sense of the record. Even when information is “stored” in various parts of the record, the record needs to be consistent. The record is a legal document and should be a complete unit of information. The Assessment Process: What Works? What is the purpose of the assessment? What do we gain? What is included in your assessment? How do you approach family members during assessment? Purpose of the Assessment Get information that guides service planning. Deepen your understanding of the whole person. Identify areas for growth and opportunities for change. Identify strengths, talents, and gifts. Identify valuable resources and those that haven’t worked. Create enthusiasm, confidence, and motivation for goal achievement. Reason for Seeking Services What brings you here today? What would you like to change in your life? What would you like to see happen as a result of participating in these services? What else? Using the FES as a tool to Assess The FES is designed to give you some jumping off points to identify areas that your parent self-identifies as an area of concern/need. Allows you to have a conversation about their strengths and resources. Addresses many facets of parenting skills and styles. Understanding Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach The Importance of Understanding Data collected in an assessment is by itself not sufficient for planning – only identifies the “what.” Data must be woven together, explored, and interpreted in order to gain an understanding of the person as a whole – identified the “why.” True understanding is informed by: The individual’s understanding Your professional opinion An Example… The FES may indicate that the parent (Mrs. Bernard) does not have a good understanding of her child’s problems. The summary notes: “Mrs. Bernard does not understand her son’s diagnosis or how the IEP fits in.” This does NOT reflect true understanding; it merely re-states the data/facts. The task is to try to understand WHY Mrs. Bernard does not understand her son’s problems. This may take the plan in very different directions. Let’s BRAINSTORM… Determining Direction Mrs. Bernard is concerned that getting an IEP will label her son as “different” from his peers, worsening bullying issues. Education on the IEP process, skills training in parent advocacy, youth advocacy services to promote son’s social skills development. Mrs. Bernard doubts her son’s diagnosis because while he acts up at school, he is cooperative and social at church and in the home. Collaboration with faith-based or cultural organizations, education on mental illness, family-based Action Plans. Mrs. Bernard does not know how to talk to her son about his mental health, fearing that he will feel blamed and stop communicating with her. Peer support, communication skills training. Take it to the Bridge Understanding means using the information gained during the assessment process to come to a consensus about the current situation. Only by doing this can we determine what should happen next. “This is how I am seeing you and your situation at this moment. Did I get it right?” Stages of Change Stage 1: Not Ready (Pre-Contemplation) The family member/youth doesn’t see a real need to change even if others do. Stage 2: Getting Ready (Contemplation) The family member/youth is beginning to think about and discuss making a change BUT is not completely convinced that change is needed. Stage 3: Ready to Take Action (Preparation) The family member/youth understands that his or her issue is doing more harm than good and determines steps to address issue. Stage 4: Taking Action (Action) The family member/youth actively works to address issue. Stage 5: Ready to Maintain Gains (Maintenance) The family member/youth is ready to take steps to keep from slipping backwards. Understanding a Family’s Readiness to Change Assessing a family’s readiness Establish a rapport with the family Understand if their resistance is internal and/or external Meeting the family where they are Understand why a family is not ready to change Ask yourself: How it has served them to stay in this situation? “People do not change because of logic. People only change when they have an emotionally compelling reason.” – Author Unknown Understanding Parent/Youth's Vision: A Motivational Interviewing Approach Change occurs naturally and Motivational Interviewing (MI) mirrors natural change. When behavior change occurs it is usually within the first few weeks. Advocates have a significant influence on goal dropout, sticking with the plan, and goal achievement. Using empathy regularly with your families improves the family’s ability to change; the absence hinders change. Understanding Parent/Youth's Vision: An M.I. Approach con’t…. People who believe that they are likely to achieve their vision do so. When advocates believe in families, families can begin to believe in themselves! What people say about change is important. Statements that reflect motivation for and commitment to change do predict achievement of their vision, goals and action plans. Whereas, arguments against change (resistance) produce less change. You have the ability to CHANGE the conversation – to replace argument with motivation. Ambivalence: The Dilemma of Change Example: “I want to move closer to my mother and sister so that my children can be close to their family, but I’m afraid that transferring schools would be tough on the kids.” For every goal, there are benefits to changing and benefits to NOT changing. Use the Decisional Balance Sheet! Rolling with Resistance Worst case scenario is when WE advocate for change while our parent/youth argues against it. So, if you don’t argue for change, what do you do? We do not oppose resistance, we roll or flow with it. Remember that ambiguity/resistance is a natural part of goal setting and achievement. Avoid arguing for change. New perspectives are introduced but not forced. Let the family member/youth be the primary resource in finding answers and solutions. At the end of the day, they know their life, themselves, and their situation better than anyone else. If we offer solutions, we become the problem solver and the one responsible for the improvements. Resistance is a signal that you need to respond differently. Example of Rolling with Resistance Example: Advocate: You haven’t been coming to the parenting class. I’m really concerned about you. Parent: I know. The first two classes really helped me. I know what I’m doing now. Advocate: It may be that you find the classes take away time from your life and kids. That the time spent on them right now is more important than completing the course and dealing with the consequences with ACS. Parent: Well, I don’t know if it’s that important. I don’t want to lose custody of my children or deal with any more issues with ACS. Tips for Staying Empathetic Understanding change is hard Show warmth and caring Try not to argue or be “pushy” Show family members that you understand their perspective Be optimistic, supportive, and hopeful Adapted from Jonathan Fader, 2014 Prioritization Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Balancing Priorities in the Plan People have multiple needs and goals – need to PRIORITIZE. Addressing too many things at one time can: Need to balance what is important TO the person with what the provider thinks is important FOR the person. Make the plan feel fragmented Dilute efforts Plan must make room for both perspectives. Considering time-sensitivity or urgency of different factors can assist in prioritizing efforts. Finding the Right Balance Neglect: Let participant do what he/she wants Control: Get participant to do what I think is needed Parent/Youth's Vision Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Vision, SMART Goals & Action Plans Vision Goal 1 Action Step 1 Action Step 2 Goal 2 Action Step 1 Goal 3 Action Step 1 Action Step 2 Essential Features of Parent/Youth's Vision They are broadly stated and reflect the big picture. In the language of your parent/youth Always expressed in person’s words using “I” statements. Is written in the notes. Moves toward the positive – “glass half full” Achieve rather than reduce – “glass half empty” “I want to have a better relationship with my kids.” “I don’t want to argue with my kids.” Parent/Youth's vision is linked to “discharge” criteria Identify the desired destination and what the destination looks like. Where the Vision Goes in eCOMPAS Vision Development – It’s a Process! Not everyone can easily articulate their vision – the process takes time! It will unfold through reflective listening that highlights what’s important to the person. People are often ambivalent about their vision. Effective Parent/Youth's Vision Meaningful to the individual Easily understood by any reader Broad enough that all of the work you do together will fit into this idea but not so broad that it will take years to achieve (similar idea as prioritization). Example of Too Broad: “I want my daughter to become an astronaut.” Example: “I want to be able to support my daughter to graduate with her High School Diploma” (still working towards to idea of becoming an astronaut but the first major vision in achieving that overly broad vision). Example of not broad enough: “I want to support my daughter to go to school every day next week”. Strengths and Concerns/Needs Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Strengths and Concerns/Needs in eCOMPAS Strengths and Supports: What Works? How do you ask about strengths? How do you identify strengths a family member may not know they have? Active Use of Strengths Strengths are not meant to “sit on a shelf” How are strengths used in recovery planning? For example: A youth who loves music might benefit from listening to music with headphones as a way to relieve anxiety on the subway. A parent with strong family supports might have family members assist her with grocery shopping and learning to cook healthy meals. Strengths and Supports “Tell me about the important people in your life.” “What are you good at?” “What activities give you a sense of accomplishment?” What else could you ask? Identifying Concerns/Needs: What Works? How do you ask about concerns and needs? Identifying Concerns/Needs “What has created challenges in achieving your vision?” “What have you tried in the past to address these concerns?” Both what DID and DID NOT work Ask yourself: What’s keeping them stuck? Concerns/Needs Challenges/roadblocks experienced as a result of family circumstances. What is getting in the way of the person achieving their goal? Why can’t they do it tomorrow? Why can’t they do it themselves? Why haven’t they already done it? How are roadblocks getting in the way of identifying and achieving your parent/youth's vision? Putting it Together Capitalizing on strengths and accounting for concerns/needs illuminates how you will achieve an identified goal, which leads to… SMART Goals Out comes Action Plans SMART Goals Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach SMART Goals in eCOMPAS SMART Goals S = Simple, straightforward, specific M = Measurable A = Attainable, action-oriented R = Relevant (to goal and stage of change) T = Time-bound Effective SMART Goals Meaningful to the individual Easily understood by any reader Effective in tracking progress Encourage the person to try new skills Contains ONE behavior that works toward achieving the vision. Formula for SMART Goals Within [amount of time (time-bound)], [insert name] will have improved [insert documented concern/need (relevant)], as evidenced by [insert a meaningful change in functioning or behavior that is related to the vision (measurable and action oriented)]. Measurability The intended change should be obvious and readily observed by the individual and the family, as well as the staff. It is acceptable to measure change by observation, self-report, and/or completion of an assignment. Journals, behavior charts, etc. SMART Goals Should NOT be Limited to Service Participation Ann will attend the parenting class 1x weekly for 12 weeks. This is about service participation. People can participate in services for years and not achieve the intended benefits. SMART Goals are what the person hopes to change with the assistance of services. Ask yourself the question: As a result of attending the parenting class, how do you expect the parent’s behavior/quality of life/status to change in a measurable way? Ann will apply communication techniques to reduce instances of arguing with her son to no more than one time per week for four consecutive weeks, as measured by self-report. Sample SMART Goals Over the next 3 months, Kris will reduce his social anxiety by attending at least one social event per week for 30 minutes with a family member, as measured by self-report. Over the next 30 days, Kris will experience a decrease in anxiety when talking to people at social events, as evidenced by his tracking of anxiety levels in his mood log. Within the next 3 months, Kris will try 3 different types of social events that fit his needs and report progress toward independently meeting new people through his advocate’s monthly report. Common Mistakes When Writing SMART Goals Describing what the advocate is expected to do instead of what the individual is expected to do. Including more than one expected behavior in a single SMART Goal. Using terms for performance that are subjected to many interpretations, are not action-oriented, and are difficult to measure. Writing SMART Goals that do not relate to the vision. Cluttering a SMART Goal by including unnecessary information. Being too general and not clearly specifying the expected outcome. Using general verbs or action words such as “understand” – instead, use concrete verbs such as “demonstrate,” “discuss,” “participate,” etc. Detail: SMART Goals Make Goals SMART… Specific SMART Goals are more easily accomplished when they are clearly stated. Answering the 5 W’s – who, what, when, where, and why – is helpful in setting specific goals. Measurable Establishing concrete criteria for measuring progress can help motivate continued effort to achieving the goal. How will we know when the goal is accomplished? Attainable The goal should be reasonable and achievable. Trying to do too much in too little time is not the best way to succeed. Realistic A goal is probably realistic if the person believes that it an be accomplished. To be realistic, a goal must represent something a person is willing and able to do. Timely Goals are more grounded when there is a time frame attached to them. Identifying short-term steps within a longer term goal can help to create hope and momentum. Practice, Practice, Practice Turn these 3 Goals into a SMART Goal: Gloria will get an IEP for her daughter. Erica will argue less with classmates at school. Jesse will take a parenting class so that he is closer to his family. Within [amount of time], [insert name] will have improved [insert documented concern/need], as evidenced by [insert a meaningful change in functioning or behavior that is related to the vision]. Action Plans Out comes Action Plans Objectives Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Action Plans in eCOMPAS Action Plans aka Services Action Plans serve as a contract for who is responsible for what actions, including the person receiving services and natural supports, that is, supports that they already have in place. Action Plans include services which: Are tailored to the stage of change/recovery Are connected to a specific objective Action Plans from natural supports are not services. Describe medical necessity by clearly identifying how recommended services can help the individual overcome specific concerns A Note from Our Sponsors… Medical Necessity “…shall mean payment of part or all of the cost of medically necessary services, as authorized by Medicaid, which are necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with such person’s capacity for normal activity, or threaten some significant disability and which are furnished to an eligible person in accordance with this title and the regulations of the department.” What???? In plain English, it means that your services have to be described in a way that prove they should help your parent/youth achieve their goal while also connecting with the overall vision. Action Plans aka Services Action Plans serve as a contract for who is responsible for what actions, including the person receiving services and natural supports, that is, supports that they already have in place. Action Plans include services which: Are tailored to the stage of change/recovery Describe medical necessity by clearly identifying how recommended services can help the individual overcome specific concerns Are connected to a specific objective Action Plans from natural supports are not services. Client’s Vision: “I want to create a better lifestyle for my son and me.” Goal 1: Goal 2: Within one month, Celia will improve her chances of getting a full-time job by applying to at least 5 jobs per week, as evidenced by copies of completed and submitted applications to her family advocate. Within 3 months, Celia will improve her relationship with her son by identifying at least 3 methods for setting healthy boundaries with her son, as evidenced by report of Family Advocate. Action Plan: Family Advocate will hold 15-minute check-in calls once a week (in addition to regular meetings) for the next month in order to discuss job search, application completion, and provide support. Action Plan: Celia will attend Emotional Fitness Parenting Class once weekly for the next 12 weeks in order to learn new skills in discipline and boundary-setting. Activity! Goal vs. Action Plan Service Action Plans – 5 Ws Must specify: WHO will provide the service, i.e. name and job title WHAT: The NAME of the service, e.g., basic living skills training, AND the modality in which the service will be provided, e.g., individual sessions or in group WHEN: The SCHEDULE of the service, i.e. the time and day(s) WHERE the service is being provided WHY: The intent and purpose of the service/intervention Tip Read plan from the bottom to the top Is it clear why THIS service is being provided in response to THIS SMART Goal that connects to achieving the Parent/Youth’s Vision? Examples Examples of Service Action Plans: Taking Parenting Class Attending Youth Group Participating in individual advocacy sessions Examples of Self-Directed and Natural Support Action Plans: Asking trusted family member for assistance with child care Gathering all documents and records needed to apply for benefits Common Documentation Errors SMART Goals Don’t support the vision Not measurable or behavioral Action Plans become SMART Goals Not time-framed or generically time framed Action Plans Purpose not included Frequency, intensity, and duration not included Don’t reflect multidisciplinary activity Don’t include natural supports Don’t link to the goal Quick Review Parent/Youth's Vision: What the person would ultimately like to achieve The desired outcome SMART Goals: What the person will do, change, or accomplish to achieve Vision Measurable changes the person will make and skills to be gained Action Plans: Services and supports that help person achieve Parent/Youth's Vision and SMART Goals Not limited to providers; may include actions by person, family members, and support network Remember, services are not SMART Goals! Outcomes Out comes Action Plans Objectives Strengths and Concerns/Needs Parent/Youth's Vision Prioritization Understanding Assessment Approach Outcomes Identified and agreed-upon end point for services Individual’s needs and likely destination at discharge plays a critical role in determining the anticipated length of stay For example, someone who has just moved into a new apartment might have a shorter length of stay than someone who has not yet identified their options and preferences for housing Anticipated discharge or transition shapes the individual’s plan Shift from “complete the program” to “achieve Parent/Youth's Vision” Documenting Progress Over Time Provides an opportunity for the family member/youth and advocate to evaluate how things are going on a regular basis and document the continued medical necessity of the services being provided. Progress notes can be considered a mini plan review Contact notes are not progress notes Service Plan reviews Following up on Progress Questions to ask the family when revisiting Parent/Youth's Vision (Open-ended questions are helpful) Why did we set this goal? What is keeping you from completing this goal? What steps will it take to complete this goal? Who can help you? How can your FRC staff help you? Next Learning Collaborative We will be reviewing what we learned in this LC. Identify areas that were particularly challenging and trouble-shoot as a group. Plus: learn how to write effective progress notes (documenting progress or lack of progress over time). Practice, Practice, Practice! Documentation and role play practices Thank you!
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