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Family Goal Planning Part 1

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Matt Maynard

on 4 April 2014

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Transcript of Family Goal Planning Part 1

Family Goal Planning Part 1

Morning's Objectives
We want to...
Explore some theories of change
Discuss the benefits of goals for the families and the FSS
Explore the ingredients and strategies that have been shown to create stronger goals
Examine the role of support staff in the change process, and with goals
Discuss some of the barriers and challenges to the change process
Theories of Change
Understanding what motivates people to change and having a working knowledge of the theories of change can support you in helping families come up with effective plans.
Training Objectives
During today's training our goals are to...
Look at why we create goals
Discuss the change process
Exploring theories behind change in our lives
Recognizing the steps in the process
Describe the process by looking at motivation and strategies to help people achieve goals
Look at the actual tools involved the Healthy Families Goal Setting Process
Apply ideas and items learned about the change process to the IFSP
Piece-by-Piece breakdowns
Technical Components of the tools
Practice creating effective goals
Cycle of Change
The Strengths Based Approach
What it Is...
A conversation
A collaboration
A Partnership
Building on existing strengths
and capacities
Knowing and Respecting
individual and family values
Knowing what is working and
knowing how to use it
Uses past success to launch forward
Benefits to Creating Goals...
Benefits for us...the staff!!!
Having Goals:
Promotes a collaborative relationship with the families
Provides you with a road map for interventions
Helps define your role with the family, and also what isn't
Provides opportunities to celebrate and build on family successes
Allows for the tracking of progress
Goal setting is a proven method in of change motivation
Benefits for the families!!!
Goals support Families:
To combat powerlessness and instill hope
To develop a road map for future successes
Feel empowered to move ideas into actions
Develop their critical thinking and problem solving skills
Re-orders and re-wires connections in the brain
To not get caught in the day-to-day preventing losing sight of long term goals
Value of planning
How to take thoughtful and purposeful actions
Rewiring the Brain
We know that if our early environment was:
Negative
Abusive
Neglectful
Chaotic
Chronically Stressful
Then this impacts the trajectory of infant brain development and
interferes with a person's ability to effectively solve problems, think critically and develop futuristic thinking as an adult
Providing Opportunities to develop those skills by setting and working towards goals actually supports the re-wiring of an adult brain.... think about learning a second language...
What are some benefits to writing goals?
Theories of Change
TOOLBOX
So Why Do We Even Create Goals?
Getting what you want out of life is not easy
It requires planning, dedication, persistence, and self-discipline.
Goal planning challenges people to take charge of their lives
Families may have never had the chance to expect, make, and be cheered on regarding changes in their lives
Afternoon Objectives
Introducing the Family Goal Plan
Looking at the tools bit-by-bit
Preparing for the FGP... the WHOLE Goal Process
Practice Writing of an FGP
Exploring how Staff can get in the way
Documentation of the and on the FGP
Tips and Tricks
Let's look at our goals for today...
Morning Session


Afternoon Session


The Toolbox
Pre-Contemplation
Goal planning has been proven to be one of the most effective methods in creating motivation and to illicit change!
Strengths Based Strategies
Major focus should be on the wants, needs, and values of an individual; not what they need to fix or what is missing
Supporters assist others in making changes, not make changes for them
Celebrate their successes and accomplishments
Discuss challenges as they arrive
Consistent check-in and follow-thru
What? Me Worry?

What it looks like
Not interested in change
Unaware or unconcerned with problems
Given up due to multiple failures
Often seen as in "denial"

A supporter role:
Empathetically engage in thoughts of change
Cognitive Dissonance
Provide Information about the existence of a problem

Raising awareness that current behavior is contrary to what a Family or Individual has expressed as a want or even more importantly a value.
Cognitive Dissonance
Contemplation
Finding Motivation
What it looks like
Ambivalence to change
Recognizing behavior is harmful or that a need for change exists
Unmotivated towards change
Weighing of Pros and Cons
Doubt for the ability to change
A supporter role:
Engage in building the desire to change
Avoid trying to convince the existence of a problem to ellicit change
Cost Benefit analysis
Exploring the rewards

What Motivates People?
Extrinsic Rewards
Describes desiring to to engage in an activity because of external tangible rewards or pressures
Rewards are very powerful
Will only last as long as the rewards
Great tools to get things started
Intrinsic Rewards
Come from within
Desire comes from activity being enjoyable or interesting
Continue long after rewards have gone
Forms of Intrinsic Rewards:
Succes
Competence
Enjoyment
Opportunity to exercise one's capabilities
Forms of Extrinsic Rewards:
Money
Material goods
Praise
Tips for Change:
Initial motivation should be tied to extrinsic rewards
A strong relationship can turn a home visitor's benefits to family from extrinsic to intrinsic
Extrinsic - "I like how you did that" approval
Intrinsic - "You really figured that out" focused on the parent as person to build self-esteem
A home visitors approval and support can become prime motivators
Cost-Benefit Analysis
Weighs the benefits and costs of making a change, or staying the same
Benefits of staying the same vs. Benefits of Changing
Costs of Staying the Same vs. Costs of Changing
High Chances for change:
Benefits of staying the same are low and cost of staying the same are high (Best)
Benefits of changing are high and cost of changing low
When the cost of staying the same is high and benefits of changing are high it may seem this is the best, but often this feels over whelming. Remember extrinsic is the initial motivator

Preparation
Before Taking Action

What it looks like
Decision to change in the near future is made
Experiments with small changes and steps
Change may still seem out of reach

A supporter role:
Encourage the discussion and addressing the barriers to change
Take an inventory of strengths, supports, and resources
Work more on behaviors vs motivation
Assist in the actual planning

Resources and Support People
Identify resources and people to help (external)
Inventory personal strengths
Reframe as many resources as possible into strengths
As a last resort share your observations
Often resources are easier for people to identify than strengths
Action
Just Do It!

What it looks like
The person is beginning to implement change
Self-Efficacy is key
Need to commit to step 1

A supporter role:
Do not rush change
Explore any remaining ambivalence
Provide lots of praise and admiration
Help build self-efficacy
Celebrate each step - Be Specific

Self Efficacy
The belief in our own ability to carry out specific actions or plans that will get us where we want to be
Two-Components:
Knowing - the behaviors that will get us where we want
Believing - we can actually do them
More on Self Efficacy
Self- Efficacy Develops in:
Past Accomplishments
Social Comparisons
Verbal Persuasion
Positive Experiences
Shared Information
Assets and Strengths
Maintenance
Keep At It!
What it looks like
Stabilized change
Actively keeping up the change
Incorporating ideas and changes for the long haul
May need to cycle back through due to lapse or relapse
A supporter role:
Continued support and celebration
Discuss limited discouragement over occasional slips
Encourage the seeking of support

Tips for Change:
Maintaining will be the most difficult part
Your role:
help the family stay focused
remind them of their successes
encourage them to seek support
encourage self forgiveness
do not allow them to give up on their goal if they have made it this far
Maintained Change
Relapse
Back to the Beginning

What it looks like
A complete return to behaviors prior to the change, often results in the process needing to be restarted all the way back to pre-contemplation

A supporter role:
Explain that successes were had
ie steps completed, knowledge gained, different pieces of self
Shift the focus off failure

Lapse
What it looks like:
A brief return to how things were in a prior stage
Often occurs multiple times during the change process

A Supporters role:
Slip-ups do not indicate failure
Promote problem solving

Final Thoughts on the Cycle of Change
Know/Assess where each family is in the cycle regarding the respective goal
Goals Written During:
Preparation, Action, Maintenance - are more likely to succeed
Pre-contemplation, Contemplation - will often lack follow through and commitment
Pre-contemplation - no problem exists
Contemplation - maybe; ready to look at how a change might help
Preparation - made a decision to change...now for the steps...?
Action - The journey of a 1000 steps starts with a single one
Maintenance- Keep at it!
What it is Not....
Seeing "only" positives with
no attempt for balance or
accuracy
Telling people what they
must do
Creating false positives
Focusing on what is missing
Worrying about hypothetical
causes
Using one's own values to
make judgements
Strengths Based Assumptions
People want to be the best at what they are doing
No matter what environment people find themselves in, individuals and families possess many strengths that can be used to improve the quality of their lives and create change
Not discussing your concerns as a support person regarding change denies others the opportunity for growth
People can achieve only when they are actively involved in determining their own course of action
Everyone is capable of changing, learning, and growing
Putting Ideas To Paper
One of the most important things that can be done during the change process is...create a goal plan

Writing out a goal plan helps with:
Checking in on progress
Managing future and current challenges
Getting support people involved
Keeping the goal fresh and alive
Writing Effective Goals
Writing Effective Goals
Research has shown that effective goals contain these pieces:
Underlying understanding that a change is needed/wanted
A goal statement
Assessment of possible challenges, strengths, and current or available resources
Identification of extrinsic and intrinsic rewards; benefits
Small-steps, or sub-goals
Recognition of who can help support the goal and its change
Check-In
Matching language to where a person (or family) is in the change process
Goal Statements
Not only is having a goal statement important, but we have learned that not all goal statements are created equal when working to illicit change.
Goal Statements to be effective should be:
Specific
Contain time frames
and discuss what a person really wants to accomplish
Ineffective goal statements:
"Child Development "
At the 1yr well child check, Baby will have met all expected milestones
"Improve Team Passing"
Complete 8 passes during each of the next 3 practices
"Want to be a good reader"
Read 3 chapter books of at least 100 pages by May 15th
Writing Effective Goals
The SMART model
Using this technique helps create stronger more effective goals
It provides a framework for reminding us of the pieces that are needed for an effective goal
Both goals and steps should follow this model
- S -
Specific - Goals should be straight forward and highlight what one wants to happen
It's the what, Why, and How
It focus efforts
Clearly defines what we are going to do
- M -
Measurable - Choose a goal with track-able and specifically measurable progress steps
If you can't measure it, you can't manage it
Concrete criteria
Meet target dates
- A -
Achievable - Goals Should stretch you slightly, so that it is a challenge but you have the knowledge that it can be achieved
Feelings of success helps to keep people motivated towards change
Visualize changes that can be made
Set the bar high enough the achievement is satisfying
Action-oriented verbage
- R -
Relevant - The Goal in question should fit with all of the other higher priorities in my life.
Should match Family and Individual values
Fits where ones is at in the moment
Available resources and support people in proximity
- T -
Timely - Goals should have specific time frames
End points give clearer targets to work towards
Times must be measurable, attainable, and realistic
Barriers to Creating Change...
Denial - People are unable to cope with or deny that a prospective change will last
Fear and Uncertainty
Lack of future planning
Feeling the future won't be any different than the past
Remedy - experiences with tangible results that things can change

Anger and Resistance- criticism with respect to change often manifested by anger response
May last indefinitely if not handled/supported effectively
Remedy - lots of support; empathetic response to feelings of anger; guidance/leadership to work through feelings of anger
Exploration and Acceptance - less of a focus on anger, but people often still unsure or ambivalent to the change
Remedy - allow for doubt and exploration; emphasis on planning to obtain results; praise participation

Commitment - think about maintenance
Continuing - lots of praise; understanding of lapses; understand not every aspect of the change will be endorsed

Criticism and Impatience - from staff
Often met with defensiveness and entrenching of the problem
losing patience and forcing/pushing a change can stunt progress
Remedy - work on acceptance, tolerance, and praising of personal change; personal reflective work
Rewiring the Brain
We know that if our early environment was:
Negative
Abusive
Neglectful
Chaotic
Chronically Stressful
Then this impacts the trajectory of infant brain development and
interferes with a person's ability to effectively solve problems, think critically and develop futuristic thinking as an adult
Providing Opportunities to develop those skills by setting and working towards goals actually supports the re-wiring of an adult brain.... think about learnign a second language...
Goal planning has been proven to be one of the most effective methods in creating motivation and to illicit change!
End of Morning
Preparing for the Family Goal Plan
How will you prepare?:
The FGP process is a multi-visit process
Staff should:
Review tools and assessments
Identify Strengths, needs, and challenges
Embrace the strength based beliefs
Review where the family is in the change process
How do we get there?
FSS have a number of tools at there disposal, many should be included in the IFSP process as both a tool to support the families and to support the staff:
Parent Survey
FSS 5a, FSS 5b
FSS 3a (what I'd Like for My Child)
FSS 6a (IFSP Supplement Sheet)
FSS 18 (use your strengths)
FSS 19 (values)
Assessments
ASQ, ASQ S/E, HFPI, Edinburgh, others?
Prior Home Visit Notes
GGK/GGF
Exploring the GGK Further
Modules
Parental Expectations
Learning About Family Values
Becoming a Stronger Family:
Family Values
Supporting Parents Working
Towards Goals
Daily- Dos
E-Parenting
Brain Builders
Body Builders
Character Builders
Play-By-Play
4 Steps to Success
Intorducing The FGP
The FGP provides us with a framework of services with a family
When introducing the FGP a staff should:
Take your Time....S-10; When is it due?
Encourage families to think about their dreams for
Themselves
Their children
The entire family
Remember that setting goals can be overwhelming
Keep it simple!
Help families keep their goals personal
Focus on a few key SMART goals
Intorducing The IFSP (cont.)
Choose an appropriate time to discuss goals; a family in crisis may not be prepared for such an overwhelming task

Work to answer the 5 W's
Who: is involved
What: needs to be accomplished
When: will steps be taken? will the goal be completed
Which: identify requirements and constraints
Why: is this what you want to accomplish
Let's Take a Look
Breaking It Down The Technical Aspects
Family Name
Child's Age
(My Family's Goal For:)
Date
Goal Statement, Benefits for My Child/Family, Personal Strengths, and What could get in the way boxes
Steps, Routines, Date, How did this go boxes
What we learned from/outcome of the goal
Developed
Parent Signature(s)
FSS Signature
Sup Initials
Let's Take a second look
Breaking It Down
The Five Components: A Road map to Change within the FGP
Change Outcome
What the person wants

Strategy
Who will do what, why, and how?

Activity
What a person needs to do

Time
By When

Evaluation
What happened
Change Outcome
This is a detailed description of what the family wants. If the world was perfect what would their life look like?
"Based on What We have discussed so far, one specific goal I want for my child/family is:
SMART
Controllable
Describes a Change in Behavior
"Benefits for my child/family? (Why do I want to reach this goal?)":
Can often sound like a "goal"
Should be tangible
both intrinsic and extrinsic
Be detailed
dig into the why
Strategy
This who will do what, why, and how. It is important the parent setting the goal understands they can only be responsible for their own behavior.
"Personal Strengths, family and community resources (including HFAz) that can help our family with this goal (strengths):
Internal and External
Brainstorm and Explore
Don't Be afraid to discuss your own views
"What could get in the way of achieving this goal? How could you handle this challenge?"
Nothing - is nothing
Explore and predict future challenges
Always include ways to combat them (can be steps)
Don't Be afraid to discuss your own views
"Routines" (on child/parenting goal)
Use existing routines from family's/child;s daily life
Specific times
This is a when question
Activity
This is the description of the steps needed to achieve the family's goal. What needs to be done to get there?
"What I/we will do to get there...steps to take, over the next 6 months:" "Steps:"
Should also be SMART
Should build on each other, ie be sequential
A minimum of 3 must be included
May reduce challenges or references strengths
Time
When will the various steps be completed? When will the goal be achieved?
"Date (when this will happen):"
Target Dates
For Tasks -> completion date
For skills/routines/continued steps -> when this will be something routine
Can be dates of significance
Should build on each other
Chronological
Extend the family towards the completion time frame
Evaluation
After the specified amount of time, evaluate the goal with the family. Did it happen? Why or Why Not? Is it still important? what other goals would be of interest?
"How did this go?"
Relates to the Activity component
New Challenges that come up
Did this step lead to creating new steps or reorganizing?
"What we learned from/outcome of the goal"
Relates to the goal process in its entirety, the change outcome
Record successes and celebrations
"What we learned" -> what skills is
the family/child taking away from
the process
"Outcome" -> was it completed?
Why? or Why not?
Involve the family in this discussion
Let's Practice
Things to Ponder
Is your FGP...?
A Match between steps and goal statement
Controllable
SMART
Inclusive of ALL technical aspects
Sequential; building on itself
Internal and External benefits?
Internal and External strengths?
Connections to your tools?
Our Role
Being Present and Expecting Change
When we enter into a relationship with a parent we want to give them our best by being emotionally present
We need to honor the opportunity to support each family and do our best to be with them in a way that supports growing their openness to this process of change and self acknowledgment
Studies have shown that being present AND expecting success are the 2 keys to positive change
When you expect more...you get more!

Remember to consider the developmental stage of the parent
What stage is the parent in emotionally, physically, and chronologically
Introduce processes and concepts to match
No matter what age we are, all can grasp cause-and-effect
Maintenance
Remember the FGP is a framework for services. It is a living document that is not disregarded. Encourage families to keep them alive, by keeping them alive. Check-in on process and continue to remember when new goals are written. Forgive slips!
Precontemplation
Remember parents may not be ready or aware to change
Use the tools at your disposal:
Parent Survey, Intake Plans, GGK/GGF, Plan Worksheets, Assessments
Action
Support the family as the work their plans! Be supportive and maintain celebration and also discussions of new challenges!
Contemplation
This stage is about helping the family to decide on what change is possible and reachable for them. Its about moving them towards motivation.

Don't stumble on language!
Preparation
This is where you get to begin to help the family in the writing process you job is too:
Link goals to family values and wants.
Make sure the goal is something the family REALLY wants
Assist families in SMART process
The FGP and Change Process
Tools of the Trade
Motivational Interviewing
An approach to support people through change by increasing the internal motivation
Increases discrepancy, Empathy, Self-Efficacy
OARS
Open ended questions
Affirmation
Reflective Listening
Summarizing
Re-framing the Language
Make sure we are speaking in the ways that are culturally sensitive and not scary
We use the words...Plan or FGP
To the Families it could be said:
An area of focus over this 6 months
A direction we will take in our work
Something that is important to you that I can support you with
A way I can support you in making your life better/easier/less stressfull
We say Parent or Family Goal
To the families we could say:
What do you want to accomplish over the next few months
What is an area of your life that you would like to improve
What change over the next few months would make areas of your life easier/better/less stressful
We say Child Goal
We could say to families:
Here are some things your baby is ready to learn...which one stands out for you?
Is there an area of your baby's development that you are concerned about
Is there something that you baby struggles with that you would like to work on
Is there something new you would like to learn that would improve how you relate to your baby
We say Strengths
To families we could say:
What is already working for you/your family
What are some things you are proud of
What would you best friend say
What skills have made you stronger
Something I have noticed that stands out about you and your family is
We say steps/actions
This could be said to families as:
Here are some things you might consider doing - where would you like to start
What is the first thing you might do
Who will do what
What will help you get there
what resources might help you in the process
what can I do to help in this process
We say strategy and time frame
This could be said as:
How often will this happen
When are you most likely to make this happen
When will that be completed
Who else in your family might help with this
When is the best time of day to do this
We say evaluation, outcome, and follow-up
We could say:
Did this happen
How did this go
Is this goal still important
What did you learn from this
Where would you like to go now
Tips and Tricks
Write it down!
Steps should follow same criteria as the overriding goal...SMART ones
Explore that the goal is something the family really wants
Think Positive
Goals should be written and framed in the positive, highlighting what someone will and can do vs what they need to fix, can't do, or need to stop
Review Goals Often
Encourage families to review daily
Goals are not written in stone; frequent reviews should cause them to be living pieces of the change process
Ensure that family desires are linked to the components of the goal
Be sure to address challenges and difficulties within the context of the goal
Encourage the use of supports in accomplishing
Parenting vs Child's goals
Staff in the Way
People are more apt to take responsibility for solving problems when they are engaged in the process of choosing what it is they would like like to work on and figuring out the steps to get there
What do we do as staff that can get in the way of the change and goal processes:
Forget our values
Who is this goal for?
Repeatedly educating
Not appreciating barriers
Does the family really want this change
Failing to understand a person or family's readiness to change
Controlling the voice
Focusing on failure
One size doesn't fit all
Promising improved outcomes
Getting lost in the forms - the goal is not check off the form, but for families to experience success and see value in purposeful planning
Being uncomfortable with the process
Brainstorming too many ideas
Ignoring family and cultural contexts
Thinking too narrowly
Ignoring previous information
interests, daily routines, resources
be sure to tie all the pieces you can together
Results of the IFSP Process
Goal setting is not a magic bullet, nor does it carry any guarantees. However, when families are successful at setting and achieving goals, they learn that they really are in charge of their lives and that they can chart a course to success, they learn that they can plan for and achieve the things they want. It encourages families to explore options and develops probelm solving skills. They learn to take thoughtful, purposeful actions to get what they want.In the end it is our goal that families feel empowered and in control of their lives.
Remember self efficacy? That is what happens during the IFSP process. Families will learn how to plan for what they want and they learn that they CAN achieve their goals
Remember to pick up your certificate

Please be honest on your evaluations!
Thank You!!!!!
Documenting the IFSP
On the FGP
"Evaluation" should occur no less frequently than the target dates
Outcome and Learned, should both be discussed at goal completion or termination
On the Note
FGP discussion should no less than monthly
Discussing the process is more valuable than the progress
though progress has its place
Be sure to document any changes or adjustments to the FGP, including new steps, new challenges and new strengths

Lets Explore the GGF
What Modules, or sub-sections could you build a goal for
Take a few minutes with your group to find place where goals could be built
Intake Plan and Transition Plans
Intake Plan -
Developed by FAW
Taken From Parent Survey
Parents initial want from life/program
How can it be used to develop first FGP

Transition Plan -
Developed by FSS with SUP
Used to support family no longer having Healthy Families
3 months, when possible
When we know of coming closure
Full transcript