Using Brain Science to Help Transitional Workers Attain Goals & Progress Toward Self-Sufficiency

Transcription

1 Using Brain Science to Help Transitional Workers Attain Goals & Progress Toward Self-Sufficiency Richard Guare, Ph.D. D-BCBA October 26,

2 Goals and Agenda Goals: Attendees grasp the rationale, principles, and basic mechanics behind a clientdirected approach toward goal attainment Understand what it looks like in practice Articulate the similarities and differences from their current practices Attendees are stimulated to think about whether and how this approach and associated practices can fit within their program design. Agenda: Introduction Executive Skills Goodness of Fit Client-Directed Coaching Short Time Horizons Goal Attainment Principles Reflection Wrap up Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 2

3 Goal Achievement and Goodness-of-Fit A goal is achievable to the degree that it is a good fit for the person. What determines goodness-of-fit? Four major factors: 1.Preferences 2.Skills and or aptitude 3.Executive skills behaviors. 4.The availability of ongoing support. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 3

4 How Do We Assess Preferences, Skills, and Aptitudes? Review client s background and history Interview client about these areas Use a questionnaire that specifically asks about these areas Coaching tool: Getting to Know You Questionnaire Use vocational/aptitude assessment(s) Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 4

5 How Do We Assess Executive Skills? Have the client self-administer the Executive Skills Questionnaire (ESQ), or by working with the client to complete it. Coaching tool: Executive Skills Questionnaire (ESQ) Discuss the results with the client to determine how these executive skills manifest themselves in the specific day-to-day behaviors they engage in. Coaching tool: Executive Skills Behavior Checklist Review the client s history and observe the client s behaviors in the context of the program and comparing these with the client s ESQ profile and ES checklist. Note: There is a distinction between Executive Skills and Executive Skill behaviors. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 5

6 Executive Skills and Effect of Trauma, Stress, & Poverty Executive skills are: Used to get things done Used to organize and plan Determine how we react to things People draw upon executive skills to set and achieve their goals Everyone has some executive skills that they are better at than others. Trauma, stress, and poverty can negatively affect the ability to use executive skills and interfere with the ability to overcome problems and challenges successfully It requires more effort for those experiencing stress to: Self-regulate and control their behaviors Persist in completing a task or goal Identify and weigh options and implications Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 6

7 Executive Skills Profile and Goodness-of-Fit Non-profit or SE Leaders Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 7

8 Executive Skills Profile and Goodness-of-Fit Transitional Workers Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 8

9 The Relationship of ES to Goals: Goodness-of-Fit The executive skills required to attain particular goals depend on the goals that the person has chosen and the environment where those skills will be employed. If a person has strengths in the executive skills most required to meet the goal in the target environment, there is a good fit with the goal. If the person has significant weaknesses in the executive skills required to attain the goal, there is a mismatch The weak executive skills may be an obstacle to goal attainment. This obstacle is addressed during coaching including using ES strengths to compensate for weaknesses. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 9

10 Ongoing Support Coaching and scaffolding that fade over time Scaffolding: Process of breaking tasks into smaller steps and providing tools and supports to help an individual achieve each step Reduces initial demand (real or perceived) on a person and their executive skills when beginning a new task May also involve environmental modifications to compensate for weak executive skills or allowing a person to practice her skills in an environment that facilitates success Coaches have succeeded when they re no longer needed Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 10

11 Coaching in an Executive Skills Informed Model (Guare & Dawson) Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 11

12 What is an Executive Skills-Informed Approach to Coaching An intervention strategy in which a coach works collaboratively with a person to set and achieve goals (long-term, short-term, and daily). The model is designed to enhance executive skill behaviors which lead to improved self-regulation and facilitate goal attainment. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 12

13 The Coach s Approach in the Client s Goal-Setting Working with clients in a way that is collaborative rather than prescriptive, honors the person s autonomy and self-direction, and is more about evoking than installing. This involves at least a willingness to suspend an authoritarian role, and to explore client capacity rather than incapacity, with a genuine interest in the client s experience and perspective. (Stephen Andrew re: MI, 2015) Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 13

14 Motivational Interviewing (MI) and Coaching Motivational Interviewing Both Coaching If a participant is ambivalent about change and commitment to a goal, MI is the person-centered approach used to elicit and strengthen motivation for change. Integral components of the model relate to participant s readiness for and commitment to change. Both are consistently person-centered. When the participant reaches the point of readiness for change, coaching is the personcentered approach used to facilitate change and goal attainment. Coaching and traditional case management are not the same. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 14

15 Develop SMART Goals Begin with the client s current situation to establish the starting point. If prerequisites need to be met (e.g., child care), then establish SMART goal for the prerequisites. If there are no immediate prerequisites, establish SMART goal for the first milestone. Time frame for SMART Goal: Two to Four Weeks Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 15

16 Break Down SMART Goal into Action Plans Time frame for action plans should range from one day to one week. Establish the following with client: Method, i.e. what specific actions client will perform When action step will be initiated Frequency and time of check-ins, method and who will initiate (client or coach) Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 16

17 Example SMART Goal I will search online for Personal Care Attendant jobs and by Friday of this week, identify four possible jobs that I am in interested in. I will apply for those jobs by Monday of next week. Action Steps Start online search for jobs by tomorrow (Wednesday) at 10am, keep searching until I find two possible jobs and save the applications Start searching for the other two jobs on Thursday at 10 am, keep searching until I find two more jobs and save the applications Contact my three references for permission to use them by 4 pm Friday Complete the four job applications by Sunday night at 6pm and submit them Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 17

18 Example: Single Day Time Horizon SMART Goal I will make a healthy dinner for my family tonight. Action Steps By 1 pm today, I will decide on what I want to make for dinner. I will catch the #24 bus at 3 pm to the grocery store to buy what I need, including a green vegetable. I will take the #32 bus and pick up the kids at the sitter s on the way home from the grocery store by no later than 4:30 pm. I will start preparing dinner by no later than 5:30 pm. I will have my son help me set the table while dinner is cooking. We will sit down to eat no later than 6:30 pm. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 18

19 Incentives: Modify the Relationship Between the Task & Incentive Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 19

20 Decrease Task Demands Or Increase the Incentive Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 20

21 The Coaching Process: Overview An eleven step model describing the session-by-session collaborative work that the participant and coach engage in to facilitate successful attainment of the participant s goals. Each step may involve one or more sessions, depending on the pace the participant is comfortable with. 1. Conduct the initial interview 2. Identify the prerequisites for goal pursuit 3. Determine goodness-of-fit 4. Identify potential obstacles that are deal-breakers 5. Revise or firm up the long-term goal 6. Establish the activities 7. Develop SMART goals 8. Develop daily and weekly action plans 9. Techniques to enhance success: environmental modifications, incentives, and cognitive rehearsal strategies 10. Review and assess action plan completion 11. Fade the coaching process More Information in Appendix and Manual Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 21

22 Goal Attainment Principles Goals serve the role of motivating and individual to action, so long as the individual values the goal and the probability of success is high. In order for an individual to successfully complete a task, the effort required to complete the task needs to be consistent with the actual or perceived benefit of completing it. Intermediate (SMART) goals that have a short time horizon can help sustain motivation to achieve a longer-term goal Incentives that offer an immediate reward can help individuals to maintain the effort and motivation needed to work towards achieving a longer-term goal Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 22

23 Goal Attainment Principles (2) Environmental modifications can be extremely effective and often are the easiest and cheapest way to help individuals overcome barriers to success Executive skills behavior strengths can be used to compensate for ES behavior weaknesses, thus it helps to know an individual s ES skill behavior profile before making decisions about how to help an individual overcome roadblocks to success? Goodness-of-fit between an individual s current ES behaviors and the environment where they need to apply them is critical for success Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 23

24 Goal Attainment Principles (3) When an individual s ES behaviors needed to complete a task are weak, a coach can use his or her ES behaviors to facilitate development or learning of the behavioral skills, but the coach should provide the minimum support necessary and maintain it only as long as necessary Building ES behaviors takes time and practice Identifying and reducing the most immediate stressors in the person s life is a critical first step for helping an individual achieve their goals Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 24

25 Reflection What would embracing the goal attainment principles look like and entail for your organization? Goodness-of-fit Client directed Short-time horizons Reducing immediate stress Incentives and environmental modifications Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 25

26 Appendix: Steps in the Coaching Process Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 26

27 Step 1: Conduct the Initial Interview Collect background information Assess executive skills Identify tentative long-term goal Determine if coaching is appropriate Documents Getting to Know You Survey Executive Skills Questionnaire Long-Term Goal Setting Form Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 27

28 Step 2: Identify Prerequisites Housing needs Child care needs Transportation needs Schooling/training needs Tuition/funding needs Executive Skills (?) OTHER: Prerequisites checklist Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 28

29 Step 3: Determine Goodness of Fit Record client s current baseline/starting point: look at match between preferences, prior experience/training, ES behavior profile and the tentative long-term goal. Given the pre-requisites, are supports available to address them? Goodness-of-Fit Profile, Part 1 Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 29

30 Step 4: Identify Potential Obstacles and Determine If Any Are Deal Breakers Insufficient supports Learning challenges Criminal history Drug/alcohol record Mental health Physical status OTHER: Goodness-of-Fit Profile, Part 2 Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 30

31 Step 5: Revise or Firm Up Long-Term Goal Based on Results from Steps 2-4. If client makes a revision, is some type of related goal that fits client s preferences an option? If answer is yes, determine if prerequisites need to be revised. If no revision is an option, begins goal-setting process again. Long-Term Goal Setting Form Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 31

32 Step 6: Discuss and List the Prerequisites and Milestones to be Accomplished to Reach the Long-term Goal. Long-Term Goal Setting Form Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 32

33 Step 7: Develop SMART Goals Begin with the client s current situation to establish the starting point. If prerequisites need to be met (e.g., child care), then establish SMART goal for the prerequisites. If there are no immediate prerequisites that must be met, then establish SMART goal for the first milestone. Time frame for SMART Goal Two to Four Weeks SMART Goal Form Resources Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 33

34 Step 8: Break Down SMART Goal into Action Plans Time frame for action plans should range from one day to one week. Establish method, i.e. what specific actions client will perform. Establish with client when action step will be initiated. Establish frequency and time of check-ins, method and who will initiate (client or coach) Action planning form Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 34

35 Step 9: Discuss with Client if There is an Incentive to Help Achieve Action Plans Incentive can be program-based or first-then contingency based on client preferences. Rehearse cognitive-behavioral simulation of client successfully completing the goal using implementation intentions, mental contrasting and mental simulation. Strategies form Document Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 35

36 Step 10: Review and Assess Action Plan Completion If successful, make new Action Plan. If unsuccessful, evaluate why and revise action plan and/or SMART goal. If repeatedly unsuccessful, return to Motivational Interviewing see manual for varying details in this step depending on client performance. Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 36

37 Step 11: Fade Coaching Fading process begins when the client is able to generate and carry out the next action steps and SMART goals on their own with only check-ins or occasional cues from the coach. (Supports and Scaffolding) Richard Guare, Ph.D. D-BCBA at Retreat 2017 PAGE 37