Documentation and Engagement:Putting it All Together

April 21, 2017

Agenda

Review of engagement strategies Understanding behavior Understanding my reaction Motivational interviewing skills

Group role play: intake Group role play: follow-up meeting

Review: Engagement Skills

Beyond mere compliance, engagement creates investment in services

Engaged family members actively participate in and shape the process

Engagement is both a process and an outcome

Documentation and Engagement: A Balance

RegulationsRequired Paperwork

Medical NecessityCompliance

CollaborativePerson-CenteredStrengths-Based

Transparent

Tools for Creating and Maintaining Engagement

Understanding behavior

Motivational interviewing skills Exploring ambivalence Rolling with resistance

Understanding Behavior

Behavior serves a purpose Seek to understand not only what a

person is doing, but also why they are doing it

Ask yourself: What do they gain from this behavior?

Understanding Behavior

Acknowledging that behavior serves a purpose: Removes blame Demonstrates understanding of the

family member’s perspective Equips us to find meaningful

alternatives

Understanding Your Reaction

As we seek to understand our families, we must also understand how we react and respond to them.

When family members react emotionally to us, we react emotionally to them!

Our reactions impact how we will further engage with the individual, which in turn will impact: Relationship development Outcomes!

Understanding Your Reaction

Self-awareness allows us to acknowledge and validate our own needs first. This frees us up to be more present to our families.

In other words, being aware of our own reactions allows us to respond more effectively.

Motivational InterviewingW.R. Miller and S. Rollnick, 2009

A collaborative, person-centered form of guiding to bring out or strengthen motivation for change

Not just a series of techniques but a way of being with people that improves with considerable practice over time

Motivational Interviewing Skill:Exploring Ambivalence

Ambivalence is “being stuck” because a person is holding a balanced view of the positive and negative feelings about change (achieving a goal).

If you argue for one side, an ambivalent person is likely to defend the other

As a person defends the status quo, the likelihood of change decreases

Methods to Address Ambivalence

Open-ended Questions

Affirmations

Reflective Listening

Summaries

Motivational Interviewing Skill:Rolling With Resistance

Resistance is what happens when we expect or push for change when the family/youth is not ready for that change.

Family/youth who exhibit resistance are less likely to change.

When resistance emerges, there are good reasons the family/youth is not ready to change the way we are asking. The reasons may not be clear to us or to the

family/youth, but they exist. Ignoring them gets us nowhere.

Types of Resistance

Relational Resistance Has to do with the relationships between

you and the family/youth There is discord in the interactions You can tell this by comments made:

“You don’t understand.” “You can’t help me.”

Issue Resistance Related to any goal families/youth set with

you

Strategies to Use with Relational Resistance

Respect the resistance and roll with it.

Sometimes may have to apologize or shift the conversation.

Always express empathy.

Avoid arguing!

Let go of “expert mode”.

Strategies to Use with Issue Resistance

Express Empathy Develop Discrepancy

Develop discrepancy between family/youth’s goals/values and their current behavior.

Focus their attention on how current behavior differs from ideal or desired behavior.

Support Self-Efficacy Promote belief in their ability to gain the

skills needed. Focus on part successes, skills, and

strengths the family/youth has or can easily learn.

Strategies to Use withIssue Resistance

Use Change Talk1. Desire: Statements about preference for change.2. Ability: Statements about capability.3. Reasons: Specific arguments for change.4. Need: Statements about feeling obliged to

change.5. Commitment: Statements about the likelihood

of change. The verb is will.6. Taking Steps: Statements about an action

taken.

Relational Resistance? Issue Resistance?

Ambivalence? Oh My!

What’s the Strategy?

Role Play: Intake

Keep in mind: What information do I need to write an

effective intake note? To write goals and action plans?

What techniques do I have to engage family members?

Intake Debrief

Three main takeaways? What issues did you experience in

engaging the family member? What ideas did your group come up with to address this?

Share intake notes, goals, and action plans What issues did you experience in writing your

documentation? How did your group address these?

Role Play: Follow-Up Meeting

Keep in mind: What information do I need to write an

effective progress note? What are the family member’s goals

and action plans?

Follow-Up Meeting Debrief

Three main takeaways? What issues did you experience in

engaging the family member? What ideas did your group come up with to address this?

Share progress notes, goals, and action plans What issues did you experience in writing your

documentation? How did your group address these?

SOAPDSOAP-D Definition

Strengths observed

Connect parent/youth’s strengths and progress back to goals. Was there a way to use the strengths identified in the intake to remind the parent/youth of their ability to achieve their goals?

Objective account of the interaction

Summary of the meeting that includes factual statements and does not include subjective comments (personal opinions, feelings, or emotions).

*Objective statements make it clear to any reader what happened.

Assessment of thesituation/ individual

This can be a mini-plan review. Are there any barriers/challenges? Are services useful? Why does the youth/parent need to continue participating in FRC services?

Plan (progress toward specific goal)

What has the youth/parent achieved since the last session? Achievement of a goal?

Data or new information gathered

Were there any major life events that occurred which should be included in the progress note?

Follow-up on issues identified in previous documentation.

Progress Note Check SheetProgress Note Elements Fully Partially Absent Notes

Includes clear link to goals and action plans.

Describes progress made and/or lack of progress in achieving action plans and/or goals.

Includes a summary/discussion of meeting, recent services and interventions provided since the last note.

Identification of any necessary changes to the goals/action plans.

Documentation of any significant life events (successes and/or barriers).

Addresses any outstanding issues from previous progress note.

Strengths observed.

Date of service, time spent, and location.

Progress note is signed and dated.