changing ABLE to:

Able-differently, a Utah non-profit community service

PO Box 9757

Salt Lake City, Utah, 84109

801-520-7376

Fax 801-466-7569

ABLE-differently would like to welcome you to this power-point presentation of ideas and

services used to serve school age and younger children having secondary social and emotional concerns associated with their special health care needs. We will address several areas important to community health care providers, parents and educators, that they have found useful in their

involvement with this population.

Outline of Presentation• 1. Refocus ABLE-differently program ideas.• 2. Change process.• 3. Levels of care and tools for change. • 4. Public Health Model goals.• 5. Understanding complex problems and systems.• 6. The ABLE-differently community process.• 7. Family resiliency.• 8. Interconnections and reconnections.• 9. Relationships to the families and schools.• 10. Health Provider involvement in school/family

systems.

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INTRODUCTION TO THE ABLE-differently PROGRAM

Current focus on three goals

Children are referred to the ABLE-differently Program for having emotional or behavioral

excesses or deficits contributing to personal difficulties, or failure

within social or educational systems.

ABLE-differently - ProgramLooking children in terms of their functional

emotional intelligence:

• A – Adapting: personal coping abilities and resiliencies

• B – Biopsychocultural behaviors from

context of experiences

• L – Lifelines: available support systems

• E – Experience: social, physical, emotional and psychological

Past Contributors to Able-differently Program’s Concept

• Heidi Ahlers RN

• Ellen Ahlers RN

• Lou Allen MD MPH

• Gail Brown PhD

• George Delavan MD

• Susan Dickinson MS

• Lila Hutchinson

• Bettyeann Mayer RN

• Julia Mathews PhD

• Sterling Redd LCSW

• Hermann Peine PhD

• Judy Peters

• Chris Sandoval

• Jim Taliaferro LCSW

• Walt Torres MSW

• Barbara Ward RN

Great thanks to Utah Dept. of Health/ Children with Special Health Care Needs and the many more than listed here and foremost the families who were entrusted to our care and taught us many of these ideas.

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THE ABLE-differenly CHANGE PROCESS FOR

INDIVIDUALS AND FAMILIES

Some Initial Social and Personal Barriers to Child and

Family Health• Poverty• Lack of or use of Educational Opportunities• Poor Physical Health• Mental Illness• Disabling Conditions• Abuse, Neglect, or Abandonment • Poor Access to Resources• Cultural-institutional Factors and Considerations

People Can Change Personal Stories from Frustration and Hopelessness to

Resilience and Strength through use of Team Wraparound Approaches with

the family that helps re-story, sometimes hidden, unique exceptions

to the problem laden narratives.

Families Must be at the Center of a self help Change Process

Working positively with the people who currently help or support the family or specific family members (family helpers).

Learning to recruit community team players. Learning to maintain community helpers. Learning leadership skills. Developing new solutions. Developing communication, problem solving,

and goal-setting skills. Must perceive positively their partnership

status To be heard, respected, felt and understood so

to act on their own preferences and decisions.

Family helpers assist families to:

• Increase hope.• Be encouraged towards

action.• Grow in life skills.• Build supportive

relationships.• Be motivated.• Respect their own culture.• Feel cared for and

actively care for themselves.

Families Have Opportunities to Learn Community Team Building

• Traditional Interventions focused primarily on problems, not strengths.

• However, problems often require multiple interventions using resources from many directions.

• Therefore, strength-building requires similar support from many sources.

Families Learn to Build Teams Within the Community and

share partnerships• Department of Health • Family Medical Care

(Medical Home)• Schools• Extended Family• Worship Groups• Social Services• Mental Health Services • Law Enforcement• Friends & Neighbors

-3-ABLE-differently RECOGNIZES AND

PROMOTES THE NEED FOR LEVELS OF CARE AND THE

CLINICAL TOOLS REQUIRED FROM LOCAL SYSTEMS IN THE

COMMUNITY RECOGNIZING ESPECIALLY, FAMILY, SCHOOLS, AND MEDICAL HOMES THAT ARE INTEGRATED AND CONTINUOUS

Health Providers Promotion/Prevention Matrix

Levels of CareLevels of Complexity PRIMARY SECONDARY TERTIARY

HIGH COMPLEXITY

MULTIPLE CONDITIONS

IDENTIFIED INCREASING COSTSMINIMAL IDENTIFIEDRISKS

NORMAL POPULATIONWITH UNIDENTIFIED RISKS

There exists a Clinical Toolbox for Intervention and Integration of the

Child and the Family with the Community

• Finding the right key to a child or family’s difficulties and unlocking their strengths.

Some Tools in the Box• Traditional and Strength Based

Assessment • Education & Working Together• Referrals & Resource Guide • Family & Child Consultation• Promote Mentoring• Support Help that Works• Practices that Look at Solutions• Communication Enhancement• Changing Personal Negative Stories to

Positive Stories• Job Sampling• Building Positive Rituals & Routines• Building Positive Self-identity• Focus on everyday function and

natural resources

Children and families with the highest risks tend to be the most expensive for

society as a whole.

ABLE’s rich program resources are not to be absorbed in serving just a select few clients, but

also used for the empowerment of a broader community serving the same population. Public Health methods and practices can serve these

functions and rightfully should.

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THE ABLE PROGRAM USES THE GOALS OF A

PUBLIC HEALTH MODEL

By Building Bridges with the Community

• The clinical work becomes the workshop for training and teaching the community.

• Population based practices are envisioned supporting wellbeing, wellness with imbuing positive mental health within local systems of care for special needs.

Our experience has been both providing health for both the Individual and the general population

By People Understanding and Acting On the Interaction of Complex Issues and Multiple Influences in Their Lives, they can Influence and Determine Their Own Destiny and Health Outcomes

By Providing Cost-effective Models for Community Health

• Make available online web based resources.

• Assure collaboration among local line services in the community.

• Integrate physical and behavioral health in family, schools and health care

• Use everyday and natural resources to highlight children’s experiences and their needed stories of those opportunities.

By Demonstrating that Promotion, Protection, and Prevention of many social emotional difficulties associated with special health needs are all important functions of a Public Health

System and are presumed to be prerequisites in local communities of care as being in the back yard of the medical

home.

• There are few magical fixes.

By Supporting the World Health Organization’s Definition of Health

as a State of Complete Physical, Mental and Social Well Being-Not

Just the Absence of Disease.

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THERE EXISTS A NEED TO UNDERSTAND COMPLEX

PROBLEMS AND COMPLEX DIFFICULTIES WITHIN

COMPLEX SYSTEMS

PROBLEM VS. PROBLEMS

Wouldn’t it be nice if all children and families came in with just one isolated

identified problem? But life is more complex, and multiple difficulties abound and must be understood in

more coherent ways.

Patient Characteristics on Intake

• Percent of Patients by problem coming into the Salt Lake City ABLE Clinic, and the Provo, Price, Moab, and Blanding Itinerant Clinics in the recent past.

• MCH studies reports 13-18% of child population have special needs and close to 40% of special needs have psychosocial needs on the average.

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THE ABLE-differently PROGRAM

ADMINISTRATIVE AND CLINICAL INTAKE

PROCESS

The ABLE-differently Program Services Must Match Needs

• Before intake the severity of needs are assessed and immediate referrals are made.

• Children and families will be best served by multiple intervention tracks with consideration of non medical and related services as critical as a medical referral.

• Families will be involved in making this determination as well as managing their team.

ABLE-differently Program Two Track Systems

• COMMUNITY CONSULTATION TRACK

• 1. Many Strengths• 2. Low Risk• 3. Fewer Problems• 4. Identified Supports• 5. Short Term• 6. Problem Focused• 7. Physician driven

ongoing care.

• COMPREHENSIVE MULTI-ENCOUNTER

TRACK• 1. Fewer Identified Strengths

• 2. Moderate/High Risk

• 3. Many Problems with lower resources

• 4. Supports Needing to be Built

• 5. Long Term

• 6. Broad Solution Focused

• 7. Collaborative Team Efforts

• 8. On Going Follow-up Care

• Complexity involving social emotional and behavioral concerns

• May best require collaborative, teaming

Assessment Instruments Health Care Providers may find useful in their practices will be highlighted

in some of the following sections.

Psychological Assessment

Assessing Cognitive AbilitiesCommon Instruments Used or Requested

• INSTRUMENT AGES

• Bayley Scales of Infant Development 0-4

• WPPSI 4.5-7

• WISC – IV 6-16

• Unit 5-17

• Slosson – R 4-Adult

• WCST-64 6.5 - 89

Psychological Assessment Assessing Learning/Attention

Abilities and DeficitsCommon Instruments Used P/T= (Parent/Teacher)

• INSTRUMENT AGES

• Vanderbilt Assessment Scale 6-12 (P/T) Brown Attention Deficit Disorder Scales (BADDS) 4-Adult

• Conners’ Continuous Performance Test 6-Adult

• Behavior Rating Inventory of Executive Functioning 5-18

• Behavioral Observations 0-Adult

• Child Behavior Checklists 3-18

Psychological Assessment Assessing a Possible Autism

Spectrum Disorder• Instrument Ages

• Asperger Syndrome Diagnostic Scale 5- 18

• Autism Diagnostic Observation Schedule (ADOS) 2-Adult

• Child Autism Rating Scale (CARS) 3-18

• Autism Screening Instrument Childhood

• Clinical Interview 2-Adult

Psychological Assessment Depression/Anxiety

Common Instruments Used or Requested• INSTRUMENT AGES

• Revised Children’s Manifest Anxiety Scale (RCMAS) 6-above

• Reynolds Child/Adolescent Depression Scale (RCDS) Grades 3-6/7-12

• Multidimensional Anxiety Scale 6-18 Suicide Ideation Questionnaire Grades 7-12

Clinical Interview 2-Adult

Psychological Assessment Social/Behavioral

Commonly Used or Requested Instruments • INSTRUMENT AGES

• (P/T) Conners’ 6-18• (P/T/Adolescent) Child Behavior Checklist

3-18• (PT) VINELAND Adaptive • Behavior Scales 0-Adult• Aberrant Behavior Checklist 0-Adult• Positive and Negative • Reinforcer Survey (ABLE website)

2-18• Behavioral Observations 0-Adult• Youth Outcome Questionnaire 6-18 ABLE Strength 4-Adult

Clinical Interview 2-Adult

Family Health Promotion Plan Assessment of

Strengths, Weakness and Intervention Strategiesin the Areas Of:

• Child

• Family

• School

• Community

• Cultural & Economic Factors

• Physical & Emotional Health

Child• Self regulation/safety

• Belonging/attachment

• Exploration/Play

• Physical and Developmental Health

• Body Systems and Sensory Motor Functioning

• Adaptive Self-help

• Emotional and Social Health

• Sense of Self and Identity

• Industry/Achievement

Family

• Housing/Food/Income

• Insurance

• Medical Home

• Routines and Rituals

• Celebrations/Recognitions

• Recreation/Leisure

• Extended Family Support

• Spiritual Strengths

• Mutual Respect

• Sanctuary/Secure base

School• Achievement/Grades

• Parent Partnership

• Friendships and Peer Relations

• Citizenship and Conduct

• Teacher/Student Fit

• Cultural Acceptance

• Recognitions

• School Health Care Plan

• After school programs

Community and Culture• Language• Beliefs and Customs• Cultural Heritage and Identity• Safety Issues• Community Working Together• Religious Supports• Resource Availability• Political/Economic Realities• Providing Public Health and other

community needs as safe places to play and re-create

• Collaborative local systems of care responding and pulling together on behalf of individual families with their child in school/preschool/headstart or early intervention

Family Health Promotion Plan(Pulls from the listed resources)

O th er

D e n ta l

G e ne tics

O rtho

N e u ro lo gy

O u ts ideS u b -spe c ia lty

R e fe rra ls

In su ra n ce

H u m an S erv ices

P a rks a ndR e c rea tion

V o ca tio n a lR e ha b ilita tion

M e nta l H e a lth

O th erC o m m u n ityR e so u rces

O th er

L e g a l C en ter

P a ren t Ce n te r

L IN K S

P a re ntA d voca cy a nd

S u pp o rtG ro u ps

R e so u rceD ire c to ry/W e b s ite

H a n do u ts

P u b licR e la tio ns

T e amM a in te na n ce

C a re Te a m s

C a reC o ord ina tion

S ch o o lC o n fe re nce s/H e a lth P lanC o m p o ne nt

IE P M e etin gs

S cho o l a ndC o m m u n ity

C o nsu lta tion

C o ord ina tionw ith

M e d ica l H o m e

Family Health Promotion P lan

Follow-up and Outcome Assessment

• Are we better off from what we are doing?

• Scaling• YOQ• Other Psych. Measures• School Performance• School and Clinic

Attendance• Team Management

Form• Parent Outcome Rating

Scale

-7-FAMILY RESILIENCY

FROM RISK TO THRIVING

The Process of Moving from Despair to Hope

Family Past and Present Realities

• Stressful Challenges• Problems• Vulnerabilities• Losses and Pain• Adversities• Traumas• Disappointments and

resentments

Just Making It

• Toxic Environments• Hollow Successes• Inflexible• Overly Defensive• Abuse Prone• Strained Relationships• Personality Disorders• High Dependence on

Society’s Safety Net (Resource Supports)

Life Threatening

• Ineffective-Coping

• Adaptive Dysfunction

• Psychopathology

• Antisocial

• Destructive Narcissistic

• Violence and Lawlessness

ADAPTIVE COPINGLeads

to Increased Personal and Family Assets and Increases Protective

Factors

Need for family LIFELINESBeliefs and Values Systems

Organizational Patterns

Communication -

Problem Solving

New Meanings Flexibility/Open Open Dialogue

Reframing Balanced Roles Open Feelings

Make things Normal Respect Differences

Listen to Others Opinions

Give Proper Perspective

Connectedness & Forgiveness

Share & Respect Goal Differences

Positive Hopes Social Supports Have Empathy

Increased Skills O.K. Economics Honesty/Humor

Need for THRIVING abilities in Children and Families

• People become winners when they start using sufficient protective factors for themselves and their families.

Need for individual and family FUTURE REALITIES AND

VISIONS

• Personal and Family Well-being

• Wellness• Improved Health

Status• More Adaptablity• Salutogenic (healthy)

Outcomes

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INTERCONNECTIONS and RECONNECTIONS

Useful Relationships for All Providers and Families to Help Achieve Positive

Family Outcomes• 1. Relationships with Schools

• 2. Relationships with Medical Providers

• 3. Relationships with our Social networks

• 4. Relationships to Community Support Systems beyond our extended family and friends

• 5. Relationships to Educational Resources

• 6. Relations with leisure and recreation