Strategies to create change

Skills training for CTO staff

Factors that influence change

1. Outside”treatment”

2. Relationship

3. Placebo, hope, and expectancy

4. Model and technique

The effect of the different factors

Model and technique 15%

Placebo, hope, and expectancy

15%

Relationship30%

Outside-"treatment" 40%

1. Outside-treatment factors. (40%)

Includes, but is not limited to, the child’s strengths and resources, world view, existing social supports, and fortuitous events that weave in and out of their lives.

1. Becoming Change-Focused

2. Also making change in the future possible

3. Using the child’s outside world experiences

1.1.Becoming Change-Focused

• Empower the contribution of extra-”treatment” events by listening for, inviting, and then using the description of such fluctuations as a guide.

• Exploring what is different about better versus worse days, symptom free moments versus times when problems seem to get the best of them

1.2. Also making change in the future possible

• Help children see any changes, as well as the maintenance of those changes, as a consequence of their own efforts.

• Ask questions or make direct statements that presuppose the child’s involvement in the resulting change.

• Summarize the changes that occurred during the conversation and invite the child to review their own role in the change.

1.3. Using the child’s outside world experiences

• Most children will seek out and find support outside the formal “treatment” relationship.

• Facilitate this by listening for and then be curious about what happens in the child’s life that is helpful as well as actively encouraging children to explore and utilise resources in their environment.

2. Relationship factors. (30%)

1. Accommodating the child’s View of the Alliance

2. Accommodating the child’s Level of Involvement

2.1. Accommodating the child’s View of the Alliance

• Make the child’s goals the focus of treatment without reformulation along theoretical or diagnostic lines.

• Attend the child’s perceptions of the “Social Workert” and the relationship being offered.

2.2. Accommodating the child’s Level of Involvement

• Make sure that the treatment offered is congruent with the level of the child’s involvement

3. Placebo, hope, and expectancy factors. (15%)

1. Having a Healing Ritual

2. Having a Possibility Focus

3.1. Having a Healing Ritual

• Enhance by believing in and being confident that the procedures will be treatment.

• Show interest in the results of whatever technique or orientation they employ.

3.2. Having a Possibility Focus

• Of children changing, accomplishing or getting what they want, starting over, or succeeding or controlling their life.

• Aimed at improving the future adjustment of the child rather than understanding the past.

• Assisting children in describing the future they want tends to make that future more salient to the present.

• Enhance or highlight the child’s felt sense of personal control.

4. Model and technique factors. (15%)

1. Tailoring the Model or Technique to the child

2. Using Models and Techniques to Generate New Possibilities

4.1. Tailoring the Model or Technique to the child

• Make sure that the strategy capitalises on child’s strengths, resources, and existing social network, builds on the spontaneous changes that children experience while in “treatment”, is considered empathic, respectful, and genuine by the child, fits with the child’s goals for treatment and ideas about the change process, and increases hope, expectancy, and sense of personal control.

4.2. Using Models and Techniques to Generate New Possibilities

• Help adopt a different way to identify or approach the child’s goals, establish a better match with the child’s level of involvement in treatment, foster hope, capitalise on chance events and the child’s strengths, and utilise or become aware of environmental supports are likely to prove the most beneficial in promoting progress.

Finding the Path to Change: Learning the child’s Theory

• Best understood as an “emergent reality” that is unfolded through conversation structured by curiosity about the child’s perceptions of the presenting complaint, it’s causes and potential solutions, and ideas and experiences with the change process in general.

Steps

1. Ask the child what they think will work;

2. Tell them to do it.

Work together to implement the solutions or select ideas and techniques from available activities that are congruent with the child’s theory and provide possibilities for change.

Learning the child’s theory

• The process of learning a child’s theory of change begins with simply listening for and then amplifying the stories, experiences, and interpretations that children offer about their problems as well as their thoughts, feelings, and ideas about how those problems might be best addressed.

• Curiosity about children hunches not only provides direct access to their theory of change but also, by emphasising the child’s input, encourages more active participation in treatment.

Honouring the child’s theory.

• Fits with or is complementary to the child’s pre-existing beliefs about their problems and the change process.

• Unique for each child’s, there is no set recipe to follow when using the child’s theory of change to organize treatment.

• The key is insuring that the content of “treatment” conversations, any suggestions made by the “therapist”, even the degree of “therapist” involvement, are acceptable to the child.

• Honouring the child’s theory can be challenging, however, it is not the actual theory that is the problem but typically the way it is operationalized that is cause for concern

Reflection Exercise

• Individually, recall a difficult situation you faced during your childhood and an adult who was helpful:

• Identify the qualities which enabled you to confide in him/her and the responses which they found helpful.

• In small groups make a list of the qualities and attitudes of the people who were experienced as being helpful to them as children.

• In plenary review the lists and summarize key points

Identify the key qualities and skills needed to work with children

Interviewing Children

• Groups of 3 or 4 people. In each group, one person is asked to role-play a child, one the interviewer, and the rest act as observers. Choose from the role-play briefs provided.

• Take a few minutes to “get into role” and to decide on any additional background information relevant to the scenario: if appropriate, the observer may help the person playing the role of the child to decide on appropriate background information. Each participant should play the role of the child.

• Observers should give feedback to the ‘interviewer’ within the small group. Be ready to bring key points back to the plenary session.

Check list for observers;• How did the interviewer begin the conversation?• Comment on the seating arrangements for the conversation.

Were they appropriate?• What techniques were used to encourage the child to talk and to

express his/her feelings?• What kind of questions were used - closed, open, leading

questions?• Comment on the interviewer’s tone of voice - did it encourage the

child to talk?• How sensitive was the interviewer to the child’s non-verbal

behaviour - gestures, tone of voice, body language etc.?• How was the child affected by the interviewer’s tone of voice,

gestures and body language?• How did the interviewer convey interest, active listening, empathy

etc.? Did you notice clues or pointers from the child that the interviewer did not?