A Model for Strengths Based Practice with Criminal Justice Offenders

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2 A Model for Strengths Based Practice with Criminal Justice Offenders Written by: Bobbie J. Herron-Boyer LISW, CCDC III-E, OCPS II Project Director: ACKNOWLEDGEMENTS Supported by Logo Many thanks to the following people for their contributions to this project:

3 Acknowledgements 1 Introduction 2 Frequently Asked Questions 3 APPENDIX A Flow Chart 85 References 86 CHAPTER 1 7 Reading List 87 What is Strengths Based Practice? 8 The Strengths Based Model 9 CHAPTER 2 10 What Works in Criminal Justice? 11 Social Development Strategies 13 Motivational Enhancement 14 Learning Organizations 15 Guiding Principles 16 CHAPTER 3 17 Preparing for Change 18 Initial Training Events 19 Systems Change 21 CHAPTER 4 22 Applications 25 Intake Process 27 Intake Resources 28 Diagnostic Assessment 30 Diagnostic Assessment Resources 32 Strengths Assessment 38 Strengths Assessment Resources 39 Planning 46 Planning Resources 48 Linking 63 Linking Resources 65 Advocacy 66 Monitoring 67 Monitoring Resources 69 Staff Supervision 74 Supervision Resources 75 1

4 INTRODUCTION This manual describes a strengths based practice model being used with substance abusing criminal justice offenders. The model is based on the premise that building on individual strengths is a solid foundation for encouraging positive life changes. Practitioners working in systems whose goal is to support behavioral change can benefit from applying the model as an enhancement to current programming. It is flexible and designed to work hand in hand with other best practice approaches. The manual is divided into four chapters. The first provides a brief description of strengths based practice and outlines four theoretical approaches that the model is built upon. The second chapter reviews principles for effectiveness with criminal justice offenders, based on the what works literature, social development strategies, motivational enhancement, and learning organization methodology. Chapter two finishes up with ten guiding principles that give direction to the model. Chapter three presents a strategy and recommended steps for implementing a strengths based approach within an organization. Chapter four depicts the application of the model in a specific project called Second Chance. The Second Chance project combines the TASC assessment and case management model with the strengths based approach. The TASC model has a long history of excellent outcomes with criminal justice. The chapter articulates how the strengths based focus can enhance each of the TASC functions: intake, assessment, planning, and case management. Examples of forms and other helpful tools for implementation are provided for each function. 2

5 Frequently Asked Questions Page 1 FREQUENTLY ASKED QUESTIONS. How do you deal with offender accountability issues? The strengths based approach does not negate the need for accountability with offenders. Public safety has to be number one when dealing with the criminal justice system. The approach or response may alter the manner in which the offender is held accountable. It is important to remember that a strengths based approach is a way of interacting. In the strengths based case management (SBCM) approach noncompliance is a signal to change strategies. (See Resources: Non-compliant behavior) How does this perspective affect a client's legal status and what is the consequence if a client has a positive urine screen during his/her involvement in the TASC program? Positive urines are obvious signs that the current plan is not working. A strengths based case manager would adjust the treatment plan at the first signs of continued drug use. The plan is adjusted with input from both the client and the criminal justice referral agency. The SBCM will advocate for the client when appropriate with the criminal justice agency, however the most successful work occurs when the CM and criminal justice representative build a collaborative relationship on behalf of the client. Perhaps the only difference in this situation would be that the SBCM might be more flexible with options for interventions, and persevere longer than some TASC programs that have stricter rules on sanctions. (See Chapter 4: Planning Resources: The Columbo Approach) How do I respond to missed appointments? Explore the barriers from the client s perspective and facilitate a solution. (See Chapter 4: Monitoring) What do you do if a client does not show for any appointments? Examine all means of outreach available, including letters, telephone messages, home visits, and notifying the criminal justice agency for assistance. Address any known barriers and then terminate if not successful. This is the one behavior that usually ends up in termination. You can t develop a relationship with someone if you can t get together. (See Chapter 4: Planning Resources: Noncompliant Behavior) What do I do when a warrant has been issued? The SBCM needs to assist the client with connecting with their PO at the earliest opportunity. The SBCM does not shield clients from natural consequences, but will advocate for a solution that makes sense to the individualized needs of the client. (See Chapter 4: Advocacy) Do I tell the PO about client s nonattendance at treatment? The importance of reporting timely information to the criminal justice agency does not change in a SBCM program. (See Chapter 4: Monitoring) 3

6 Frequently Asked Questions Page 2 How does the strengths based approach change my relationship with PO s. The SB approach emphasizes the need for the CM to build a positive collaborative relationship with the PO. That may mean that you spend more time encouraging them as individuals, recognizing their efforts, and making sure that they have the information needed to make good decisions. (See Chapter 4: Linking Resources) How do you deal with treatment agencies that are not functioning from a strengths based perspective while still maintaining your own strengths based approach with the client? Part of your role as a SBCM is to assist the client overcome barriers to their success. Many times, in this situation, the need for advocacy becomes primary. (See Chapter 4: Applications and Advocacy) What is the client's role in strengths based case management and how does it differ? The client is an equal partner in a collaborative process. Decisions are not made for the client, but with them. (See Chapter 4: Applications) Can I use a strengths based case management approach in a treatment setting and how? Anyone can use a strengths based approach in treatment settings, by applying the model to your individual work with clients. If the entire treatment agency chooses to implement such a model, it will work hand in hand with other best practices they may be using. (See Chapter 2: Learning Organizations) How often should we send clients to the lab? Drug screening needs to be determined by the individual drug history of the client and by collaborating with the criminal justice agency to make the best use of resources.(see Chapter 4: Monitoring) What is Strengths Based Case Management and how does SBCM differ from standard TASC case management, or what I have doing all along? Generally speaking, it is focusing on the offender s strengths rather than deficits. The SBCM approach views the relationship between the offender and the case manager as a collaborative partnership. The strengths assessment is the cornerstone for planning and interventions. Services are individualized and the use of empathy is employed rather than authority or power to motivate change. It also includes strategies such as client-centered decision-making based on the offender s readiness for change. Most strengths based programs strive for smaller caseloads to support the individualized approach, however, many aspects of the model can be used no matter what the size of the caseload. (See Chapter 1 and Chapter 2) 4

7 Frequently Asked Questions Page 3 What if a person has few or no strengths? A premise of the model is that all people possess a range of talents, abilities, capacities, skills, resources, and aspirations. Clients may not be able to identify their strengths without guidance and input from the case manager. It is up to the case manager to develop good strengths identification skills and have access to activities or tools for assisting the client. (See Chapter 3: Strengths Assessment Resources) How are strengths assessed? Assessing strengths is an ongoing process that occurs in the course of the developing relationship between the client and case manager. The case manager can use one of several different strengths identification tools. As strengths are identified, they are formalized into the documentation process and organized by life domains. (See Chapter 4: Strengths Assessment) How does SBCM work with client behavioral deficits? The strengths based approach does not deny the need for good clinical diagnostic procedures. When behavioral deficits are identified, the case manager will assist the client in determining appropriate best practice strategies designed to work specifically with the deficit. More importantly, the CM will help the client identify a plan that will use the client s strengths to overcome or improve the deficit. (See Chapter 2: What Works in Criminal Justice?) How does SBCM work with relapse to substance abuse? SBCM operates from the belief that relapse or recurrence of substance abuse is a normal part of the recovery process. The SBCM would respond by exploring with the client the meaning of the relapse and what thinking preceded the relapse. The client and CM would then decide a plan of action based on the client s readiness (or stage of change) to learn from the event and return to the recovery plan. (See Resources: Motivational Strategies for Each Stage of Change) How does SBCM work with criminal behaviors? The SBCM model can work alongside other best practice models, such as cognitive behavioral approaches that work with criminal behaviors. For example, the cognitive behavioral approach works best when delivered in the context of a good relationship between the client and provider. Most of the other principles that drive effective criminal justice practices are aligned with the strengths based approach as well. (See Chapter 2: What Works in Criminal Justice?) What is the role of sanctions in an SBCM approach? Sanctions are an important part of any work with criminal justice offenders. However the research indicates that the relationship between sanctions and incentives should be at least 4:1. Sanctions can help people learn what not to do, but do not shape new behaviors. Sanctions need to work hand in hand with a larger proportion of incentives, rewards and recognition for effort. The SBCM model places a major emphasis on recognition of client efforts and using incentives to encourage motivation to change. (See Chapter 2: What Works in Criminal Justice?) 5

8 Frequently Asked Questions Page 4 Can a criminal justice organization use SBCM practices? SBCM is a flexible model that can be used in any criminal justice setting. It is not a technique; it is a way of interacting. The SBCM model is built on some of the same principles that drive effective criminal justice programming. (See Chapter 2: What Works in Criminal Justice?) How is a CJ oriented TASC organization prepared to accept SBCM? Any organization that is contemplating a change to the SB model needs to develop a planned approach to prepare its staff. Preparing for this approach to service delivery requires a change in mindset for many and needs the full support of administration who understand it is not a quick fix. The training process needs to include methods to facilitate that change in mindset and build an environment conducive to learning for the staff team. It is also best to engage ongoing support from an experienced mentor to guide the process. (See Chapter 3) How does SBCM enhance motivation? A fundamental principle of the SBCM model is that the best way to stimulate growth is to emphasize the positive. The SBCM model also enhances motivation by developing a partnership relationship between the CM and client, individualizing programming based on the needs of the person, and using empathy rather than power and authority as the driving force. In addition, after discovering the client s personal beliefs and aspirations, they are related to the goal at hand when discrepancies are noted. (See Chapter 4: Planning Resources) How is client progress captured on an SBCM approach? Documentation includes the client s own words and continuous discovery of individual strengths. (See Chapter 4: Planning Resources) If a client if failing when do you give up using SBCM? You never give up using the approach, even if the client is revoked by the criminal justice system, a CM would not change their method of interaction with the client. As for how long you would allow them to continue in the program, for most, the rule of thumb is as long as they continue coming back. Most of the time if a client is showing up, there is hope for an alternate strategy that may bring results. (See Chapter 4: Monitoring) Are there conditions that are not recommended? There may be some correctional settings or populations that seem unresponsive to any and all interventions, let alone this one. However, there are few that could not benefit from a strengths based approach to interaction. One of the guiding principles of the SBCM model is that people have the knowledge and capacity to determine what is best for them when given the opportunity for meaningful involvement in the process. (See Chapter 2: Guiding Principles) 6

9 C H A P T E R 1 R E V I E W & D E S C R I P T I O N Introduction This section provides a brief description of Strengths Based Practice and outlines theoretical components providing support for the model design. S UMMARY OF C ONTENTS What is Strengths Based Practice? - Page 8 The Strengths Based Model Page 9 7

10 WHAT IS STRENGTHS BASED PRACTICE? Excerpts adapted with permission from Welcome Home? Examining the "Reentry Court" Concept from a Strengths-based Perspective by Maruna, S. and LeBel, T. (2003). Strengths based practice, simply stated means building on strengths, rather than correcting deficits. The world of substance abuse and mental health treatment, for example, is traditionally driven by pathology. Practitioners match treatment modalities to client problems and needs. Even though most systems have developed treatment plans that include a place to list client strengths, there is little consistency regarding how the idea of strengths are actually used to assist the client. The social work profession has led the way in the focus on client strengths. Variations of strengths based practice can be found in every form of social work practice in the United States (Saleebey 1997) and are slowly making their way into traditional criminal justice practice. (Clark 2000, 2001). Identical shifts are taking place in a variety of other disciplines including the focus on positive psychology, developmental resilience, appreciative inquiry (in the workplace), wellness research, solution-focused therapy, and asset-based community development. All of these share the same approach of building on strengths rather than correcting deficits. An example of a familiar strengths based strategy, that is being used more frequently, is strengths-based community service. This type of service varies from punishment based in that challenging tasks utilize the talents of the offender in useful, visible roles (McIvor 1998). Probation and parole projects where offenders produce things the larger community wants, such as gardens, graffiti-free neighborhoods, habitats for the homeless, have helped to build stronger communities. Strengths based approaches are thought to develop internal motivations toward helping behaviors. This helper principle is supported by the research and is consistent with the recent what works in corrections. Offenders are encouraged in prosocial behavior by using their strengths in activities while interacting with positive role models. Maruna and Le Bel (2003) note that informal social controls emphasized in social bonding, and social learning theories are the mechanism linking volunteer work experiences that inhibit antisocial behavior. The end result is beneficial to both the criminal justice offender and the local community. Communities need the offender s talents and abilities. Offenders need to overcome the stigma of their convictions. Strengths approaches offer an opportunity for offenders to make amends, demonstrate value and potential, and make positive contributions to their communities. 8

11 STRENGTHS BASED MODEL I N T R O D U C T I O N In the last decade, practitioners at the University of Kansas revived a long-term tenet of classic social work thought that is typically described as a strengths based perspective. Social workers at the University of Kansas successfully used this approach with people suffering from mental illness (Cohen, 1999). The approach is now receiving renewed attention within the profession around the world. This manual describes a strengths based practice approach being used with substance abusing criminal justice offenders. The model is based on four theoretical foundations including the what works criminal justice literature, social development strategies, motivational interviewing, and learning organization methodology. T H E O R E T I C A L F O U N D A T I O N S 1. What works literature Target known predictors of crime and recidivism Identify Static vs. Dynamic predictors of risk Target criminogenic needs (dynamic risk factors) Use behavioral programming and positive reinforcements Match services to individual learning style Intensive and lasting 3-9 months Community based interventions Well-trained staff 2. Integrated social development strategy Recognize that meaningful change occurs in the context of relationships Apply methods combining opportunities for meaningful involvement, skills development, and recognition Identify strengths using tenets from Risk/Protective, Asset Development, and Resiliency models 3. Motivational enhancement Express the importance of a collaborative relationship Demonstrate empathy and respect Focus on strengths Individualize strategies 4. Learning Organization Guide professional and compassionate interactions with identified values Support work teams and staff communities within the organizational structure Enable leadership that portrays commitment to the well being of staff Provide opportunities to reflect, experiment, and practice learning in safety 9

12 C H A P T E R 2 R E V I E W & D E S C R I P T I O N This section outlines theoretical approaches used as a foundation for the strengths based model described in the manual including: the what works in criminal justice literature, social development strategies, motivational enhancement, and learning organization methodology. Guiding principles are outlined for the model. S UMMARY OF C ONTENTS What Works in Criminal Justice? - Page 11 Social Development Strategies - Page 13 Motivational Enhancement - Page 14 Learning Organizations - Page 15 Guiding Principles - Page 16 10

13 W H A T W O R K S WHAT WORKS IN CRIMINAL JUSTICE The mission of criminal justice in the United States has changed little in the last 50 years. The focus remains on identifying and removing individuals from society whose behavior is a threat to public safety. However, the word, corrections, has undergone several interpretations. In the early years, it was understood that the mission of correctional institutions was to correct the behavior of its residents so they could be safely and successfully returned home. Since the 1970 s, this process came under attack and raised the question, Is it really possible to successfully rehabilitate offenders? T H E N O T H I N G W O R K S D O C T R I N E Most of the research over the last several years has focused on: The impact of coercion on treatment retention; Client characteristics; Program and therapist characteristics; Rewards and sanctions; Treatment readiness and motivation. The what works literature suggests that positive reinforcement should outweigh punishment by a 4:1 ratio. Rewarding success is a key component of strengths based approaches, contrary to criminal justice practices that focus on conformity, following the rules, and punishing failure. In 1974 Robert Martinson wrote an article entitled What Works? Questions and Answers about Prison Reform. In 1975 Martinson authored a book entitled The Effectiveness of Correctional Treatment. Both of these works studied the effectiveness of prison programming by examining several hundred studies of correctional programs published between 1945 and According to Martinson, very little, if anything, worked. He noted that the rehabilitation efforts had no appreciable effect on recidivism and went on to say that rehabilitation is a myth. Martinson s research led to the belief that nothing works to reduce recidivism. In the 1970 s and 80 s, this belief spread rapidly and became known by criminal justice practitioners as the Nothing Works Doctrine. Many beyond the criminal justice field accepted this doctrine, including legislators and the general public. As a result, a shift from rehabilitation toward a lock em up and punish them mentality began to occur. A closer look at the literature by others found that some strategies did seem to be working. More recently, a major longitudinal study of community-based drug treatment known as DATOS (Drug Abuse Treatment Outcome Studies) was undertaken in the 1990s. Data were collected on more than 10,000 clients in 96 treatment programs, and over 4,000 clients were followed post-treatment. Perhaps the most notable finding from this study is that the length of time in treatment was directly related to improvements in follow-up outcomes. Additionally, legal coercion has shown effectiveness for increasing mandated clients motivation to enter and remain in treatment. The research indicates that legal pressure is effective in retaining clients in treatment across a variety of types of offenders, supervision strategies, and program interventions. However, it appears that coercive methods are least likely to promote longterm change. 11

14 WHAT WORKS IN CRIMINAL JUSTICE R E C E N T F I N D I N G S In the mid 80 s a number of Canadian researchers (e.g., Don Andrews, James Bonta, Paul Gendreau, and Robert Ross) conducted comprehensive reviews of the research on correctional programs and found that many rehabilitative programs are effective in reducing offender recidivism. Their research, which continues today, offered a significant challenge to Martinson s nothing works doctrine. More than that, they identified principles of effective correctional programming. The Canadians are now well known for developing a theory of rehabilitation that draws on the research documenting predictors of recidivism: Antisocial attitudes, values, and beliefs; Pro-criminal peers and associates; Personality factors (such as, low self-control, impulsiveness, risk-taking, and aggression One of the key distinctions these researchers make is between static and dynamic risk factors as predictors of recidivism. They observed that some predictors of recidivism are static, and cannot be changed. An example of a static predictor of the risk of re-offending is an inmate s history of crime. More importantly, they found other risk predictors for recidivism to be dynamic. Dynamic factors are amenable to change and provide a target for intervention or programming. Examples of dynamic factors are anti-social values, social achievement, and substance abuse. If most predictors of recidivism were static, there would be nothing to change and rehabilitation would not be possible. As it turns out, according to the Canadians, the most important predictors of recidivism are dynamic, and therefore could be treated. They called these dynamic risk factors criminogenic needs. One of the most important principles driving the effectiveness of correctional programming is that such programs should target the criminogenic needs of high-risk offenders. I N T E R V E N T I O N P R I N C I P L E S The literature has identified a number of principles that drive effective correctional programming. These principles state that interventions should: Target the known predictors of crime and recidivism Identify both static and dynamic predictors of risk Target higher risk offenders with treatment interventions Match offender needs and characteristics with staff selection Match treatment approach to the specific learning style and personality of offenders Match services to the offender s stage of change or readiness for services Provide treatment services that are behavioral/action oriented in nature Reinforce positive behaviors Focus on current factors that influence behavior Use programs that are intensive, lasting 3-9 months and take 40-70% of offender s time Support community based interventions as they are more effective than those occurring in prison Use well-trained, adequately supervised staff and assure program integrity Provide structured relapse prevention Identifying risks and needs is not the only answer, however. When risk is the focus, control tactics become the response. When needs are primary, access to services and programs become the answer. Clearly, control tactics do not help participants to internalize new, moral values. In addition, policy makers will never spend the dollars to support all the criminogenic needs identified in offenders. 12

15 SOCIAL DEVELOPMENT STRATEGIES The strengths based model used here can be explained through one fundamental principle: change occurs in the context of relationships. As noted previously, the helper principal works because of the interaction between the offender and positive role models. The principles and strategies found in social learning and social development theories describe the development of healthy behaviors in children. Understanding these principles can help explain how these same strategies work for other relationships, including practitioners and criminal justice offenders. The Social Development Strategy is a model that describes how protective factors work to protect children against risks. This model indicates two essential keys to impacting youth. The first is healthy beliefs and clear standards set by parents, teachers, and communities. The strategy purports that when clear standards for behavior are widely supported, and when consequences are consistent, children are more likely to follow the standards (Hawkins 1992). The second key is that youth are motivated to follow healthy beliefs and clear standards in the context of strong relationships. When children and youth are bonded to adults who hold these standards, they do not want to jeopardize the bond by breaking them. An example of these conditions might be: involving children in dinner preparations, teaching them how to bake a cake, and giving praise and recognition for the results. When these conditions are in place, children are more likely to build strong bonds and in turn develop healthy beliefs and clear standards leading to healthy behaviors. The research shows that those who have strong relationships with at least three positive role models are less likely to participate in high-risk behaviors. Other related approaches include the asset development model, and the resiliency literature. The asset development framework places an emphasis on developing caring relationships with youth. The resiliency research concludes that children who bounce back from adversity turn to people they have grown to trust because they see them regularly, such as teachers, school counselors, ministers, grandparents, and friends. All of these theories include the central importance of relationships for increasing protective factors that help to offset other risk factors. in youth. INTEGRATED SOCIAL DEVELOPMENT MODEL H e a l t h y B e h a v i o r s Developed By: Bobbie J. Herron-Boyer H e a l t h y B e l i e f s a n d C l e a r S t a n d a r d s T H E SOCIAL DEVELOPMENT S T R A T E G Y E X P L A I N S T H A T B O N D I N G O C C U R S T O A N Y S O C I A L U N I T I N T H E F O L L O W - I N G C O N D I T I O N S: B o n d i n g A t t a c h m e n t C o m m i t m e n t Internal Assets Individual O p p o r t u n i t y S k i l l s R e c o g n i t i o n Capacity Building External Assets Community School Individual Risk Factors Community Family Peers 13

16 MOTIVATIONAL ENHANCEMENT So, how can the notion of strengths based approaches support offender rehabilitation? The strengths based model described in this manual combines key components from social development strategies, asset development, resiliency, and motivational change with the what works literature. Another theoretical approach that places an emphasis on relationships is based on the Transtheoretical Model of Change, developed by James Prochaska and Carlo DiClemente (Prochaska & DiClemente, 1983). This model is a strategy focusing on the decision making of the individual that can be modified in the context of relationships. The model affirms that one of the most important and most overlooked factors for enhancing motivation is personal relationship skills. According to the research, establishing a helping alliance along with good interpersonal skills were more important than professional training or experience. The motivational change model is based on the assumption that motivation can be modified. The model is not a technique or tool, it is a way of interacting. T H O S E U S I N G M O T I V A T I O N A L I N T E R - V I E W I N G N E E D T O B E A B L E T O : M O T I V A T I O N A L STRATEGIES OUT- L I N E D BY THE MODEL ARE: Focus on strengths Individualize programming based on the needs of the person Normalize, or shift away from labeling. Develop a therapeutic partnership Use empathy, not authority and power Communicate respect for and acceptance of clients and their feelings. Express empathy through reflective listening Establish a nonjudgmental, collaborative relationship. Be a supportive and knowledgeable consultant. Compliment rather than denigrate. Listen rather than tell. Gently persuade, with the understanding that change is up to the client. Provide support throughout the process of recovery. Develop discrepancy between client s goals or values and current behavior, helping clients recognize the discrepancies between where they are and where they hope to be. Avoid argument and direct confrontation, which can degenerate into a power struggle. Adjust to, rather than oppose, client resistance. Support self-efficacy and optimism: that is, focus on client s strengths to support the hope and optimism needed to make change. 14

17 LEARNING ORGANIZATIONS Strengths based approaches are being used by many individual practitioners in substance abuse treatment, mental health, and criminal justice settings. Some of these helping professionals come by it naturally and gravitate toward such methods because of their own personality profiles, belief systems, or experiences. Others have been mentored or trained in these types of strategies and/or programs built upon them. In contrast, it is rare to find an entire organization that has made a commitment and been able to transfer such technology to its entire staff. The results of an individual using strengths based strategies can be powerful. However, when an entire organization or unit of people takes on the approach, the results are much greater and tend to have a rippling effect on more than the clients served. Applying a strengths based model to an agency or organization is challenging and the implications are many. First of all, if staff is expected to work with clients from a strengths based perspective, it is necessary to build a work culture to support that value. For example, it is unrealistic for staff to maintain such a perspective with difficult clients, if their own strengths are not appreciated and reinforced by colleagues and supervisors. On the other hand, practitioners are skilled in identifying problems and deficits in people. Most social service and criminal justice work centers around diagnostic assessment and matching to services based on problems and needs. On the other hand, when asked to identify strengths in themselves or others, it is more difficult and the resulting list is usually much shorter. Changing the focus from pathology to strengths is a challenge that few have tackled with success at the organizational level. T R A I N I N G A P P R O A C H Over the past decade, a body of research and practice in Management Development has emerged, sparked by the work of Peter Senge s The Fifth Discipline and The Dance of Change, Albert Vicere and Robert Fulmer s Leadership by Design, and others. This body of work identifies a dynamic relationship between its leadership and its work force as a learning organization. Jack Welch, former CEO of General Electric has stated, the ability of an organization to continuously learn and rapidly convert learning into action is its ultimate competitive advantage 1 Learning occurs over time and in real life classrooms if long-term change with sustained results is the goal. 2 A primary responsibility of Supervisors and Managers is to create and maintain a positive work culture for the employees under their supervision. 3 A positive work culture is an essential foundation from which professionally competent work performance can be achieved and is defined by several factors: Thirdly, a systemic approach is necessary for success. When implementing a strengths based philosophy in an organization or system, the common ground becomes the offender. Communication from all parts of the system has to focus around the individual needs of the offender and providing quality services. The concepts of customer service and systems thinking are excellent tools for identifying and solving problems in such a complex process. 15

18 GUIDING PRINCIPLES The strengths based model provides a simple guide for approaching relationships and interactions with offenders as they travel through the criminal justice process. When these conditions are in place, offenders are more likely to respond positively to intervention opportunities. I N T H E C O N T E X T O F R E L A T I O N S H I P S: Offenders need to be given opportunities for meaningful involvement and contributions. Offenders need to be given skills to help them take advantage of the opportunities available. Offenders need to be recognized for their efforts. Foundation Stones Recognition Opportunity Skills Strengths Normalize Individualize G U I D I N G PRINCIPLES These guiding principles describe the philosophical foundation of the strengths based model. E v e r y o n e h a s s t r e n g t h s All people possess a range of talents, abilities, capacities, skills, resources, and aspirations. S k i l l s F o c u s o n t h e F u t u r e Human beings can benefit from learning new skills to enhance their capacity for growth and potential. M o t i v a t i o n a l The best way to stimulate growth is to emphasize the positive. O p p o r t u n i t y People have the knowledge and capacity to determine what is best for them when given the opportunity for meaningful involvement in the process. E m p a t h y Acceptance is based on the understanding that people are doing the best they can with their circumstances. P a r t n e r s h i p The helper role can be described as a knowledgeable consultant and collaborative partner. N o r m a l i z a t i o n Professional labels create barriers to understanding the individual person. R e c o g n i t i o n People need to receive recognition for their efforts. I n d i v i d u a l i z e Service delivery is focused around the person s individual strengths and needs. S y s t e m s C h a n g e A shift in philosophy needs to be followed by real changes in content and structure of service delivery. Partnership/Relationship 16

19 C H A P T E R 3 R E V I E W & D E S C R I P T I O N Chapter three outlines recommended steps for moving an organization toward implementation of a strengths based approach with substance abusing criminal justice offenders: providing training events, fostering a learning environment, creating a strengths based staff supervision process, and receiving technical assistance. Beginning talking points are given for administrators to introduce the process and prepare for organizational change. Training events and components necessary to support systems change are outlined. S UMMARY OF C ONTENTS Preparing for Change Page 18 Initial Training Events Page 19 Systems Change Page 21 17

20 I M P L E M E N T I N G T H E P R O C E S S PREPARING FOR CHANGE This change in direction will present dramatic challenges for all staff in the organization or work group. This manual is designed to support staff who are fulfilling roles primarily responsible for managing offender progress through the criminal justice and treatment systems. In a systems approach, the need for teamwork and awareness of the impact each individual person has on the result is imperative. When the administration introduces the process to staff, it is helpful to use these steps as talking points for facilitating discussion. S T E P O N E The first step toward a successful initiative will be to embrace the philosophy underlying the change. Take time to examine the central themes including beliefs that: offenders are individuals who have the capacity to succeed, given the right tools and support offenders have specific needs that need to be assessed and matched with interventions and services a systemic approach, (working together to capitalize on the sum total of the available resources) will have better results building partnerships with all stakeholders means knowing who they are and what benefits will motivate their involvement S T E P O N E Identify your personal vision and motivation for being involved in this process. It can be anything from the paycheck that puts food on the table for your family to a desire to make a difference. No personal motivation is better than any other. However, it is necessary to recognize your personal motivation so that you can stay centered during challenging or difficult times. S T E P T H R E E Make a commitment to learn and support a learning environment. Take an inventory of your strengths and skills along with desired areas for growth. Traditionally, most organizations have placed more emphasis on training rather than learning. Learning was viewed as something that happened at school, not at work. In the last few years, the emphasis has changed to a focus on developing learning organizations. One way to describe a learning organization is one that transforms itself by facilitating learning with all of its members. In a learning organization, both the individual and the organization as a whole is active in the search for new knowledge. In this initiative, it is essential for team members to recognize that the solution depends on each person maintaining an attitude of willingness to learn from each other and to risk sharing personal knowledge and insight with the team. S T E P F O U R Recognize the importance of your role as a change agent as you interact with offenders. When thinking about change in our own lives, it is safe to say that all change occurs in the context of relationships. Each of us can think of key individuals who influenced choices and direction taken at crossroads in our lives. As we have already noted, the literature on what works in corrections points to relationships as an integral component of any intervention. It is imperative for teams managing the criminal justice process to relate to the offender sensitively and constructively while modeling prosocial skills. A strengths-based approach communicating empathy, openness and warmth; along with social reinforcements of attention, praise, and approval; go a long way toward motivating change in offenders. 18

21 gaining understanding of the model and its concepts INITIAL TRAINING EVENTS A need for initial training events is necessary to implement such an initiative. This training needs to be facilitate a variety of experiences that will assist participants in. increasing awareness of personal perspectives that interfere with success practicing new skills in a safe environment, having fun with learning experiencing the benefits of the model The training sets the tone for creating a learning environment that will be carried over into the workplace setting. The trainer facilitates a process that is more important than the content. By modeling the values and beliefs of a strengths based approach, the trainer remains in a consultant role, assisting participants in self-awareness and reflection a precursor to a changed mind set. Participants learn from each other and begin to see how it feels to be motivated toward change in the context of their workplace relationships. T E A M B U I L D I N G This first training event uses the MBTI personality inventory as a self-awareness tool to improve staff team interaction. Individual participants increase self-awareness, learn to identify strengths in self and others, and apply the knowledge of personality type. Staff teams learn to identify team strengths, clarify team behavior, learn to match tasks to type, improve conflict management, and predict problem areas. The workshop is presented using a combination of lecture, group discussion, and experiential exercises. Increase self-awareness Discover normal differences in people Appreciate gifts in others and myself Learn to capitalize on strengths Apply the knowledge of personality type MOTIVATIONAL INTERVIEWING The second training is designed to introduce participants to the strengths based model and learn the fundamentals of motivational interviewing. This workshop examines change models and motivational interviewing strategies as they apply to assessment/case management functions for alcohol/drug involved criminal justice offenders. Participants engage in hands on application of the models through experiential exercises, role-play, and team discussions. Cultural applications of the model and dual-diagnosis issues are explored along with implications for staff supervision. Increase self-awareness Learn how to identify readiness for change Gain familiarity with motiational interviewing Practice communication skills Explore applications to offender assessment 19

22 INITIAL TRAINING EVENTS S T R E N G T H S BASED MODELS This training examines the strengths based models and their application to assessment/ case management functions for alcohol/drug involved criminal justice offenders. Participants engage in self-awareness activities and experiential exercises to apply strengths based approaches to client assessment, treatment planning, community resource utilization, and staff team interactions. Gain exposure to strength building models and approaches. Identify personal strengths in self and others Increase skills for utilizing available community resources. Learn strategies for applying a strengths based framework to assessment, case management functions, and offender supervision functions C A S E PLANNING Application of the strengths based approach to the planning process. This examines strengths based models and their application to case planning with alcohol/drug involved criminal justice offenders. Participants engage in practice activities and experiential exercises to apply strengths based approaches to the planning process. Increase self-awareness Reviewing strengths based models Learning how to apply strengths approaches to case planning Practicing case planning skills Exploring applications to assessment and case management 20

23 SYSTEMS CHANGE (Senge, 2000). After introducing the process for change and completing the initial training events, the organization creates a workplace culture that supports ongoing change and development. Staff are organized into small work teams or staff communities. Creating a learning environment is accomplished by using strengths based staff supervision and receiving technical assistance from experience mentors. (Senge) In order to be cost effective and produce the desired results, transforming an agency or work team into a unified strengths based such an initiative needs to be: 1 Developed as an ongoing process that is integrated into the culture and functioning of the organization or work group; 2 Applied in the context of day to day needs; and 3 Flexible enough to be individualized based on the site. Such an environment is rooted in an organizational structure and system, understood and supported by the administration. The administrative leadership needs to make a long-term commitment to the process, knowing that quick fixes do not change the culture of an organization. Such an initiative relies on its supervision process. Effective supervision takes place within the context of a positive work climate. After management has laid the foundation of such an environment, supervisors must be able to create the cultural climate and maintain it. Training is needed to help supervisors develop those abilities. They also need ongoing support and technical assistance for overcoming obstacles along the way. Changing an organization s focus to a strengths based approach takes time and commitment. Engaging the assistance of persons with advanced strengths based expertise to guide the process and assure the fidelity of the model will enhance the technology transfer. There also needs to be a method for managing its success. Quality assurance mechanisms, including activities such as record review, peer review, and satisfaction surveys all need to be examined. These activities are then revised to include strategies for measuring the quality of the strengths based process. A positive work environment is built upon a foundation of the following components: 1 Shared vision, a clearly defined mission, and values to guide professional and compassionate interactions 2 Structural framework supporting the operation of work teams and staff communities 3 Competent leadership committed to the well being of staff 4 Opportunities to reflect, experiment, and practice learning in safety 5 Understanding and ability to work within the flow of life as a system I M P L E M E N T A T I O N Training Events Learning Environment Strengths Based Supervision Technical Assistance 21

24 C H A P T E R 4 R E V I E W & D E S C R I P T I O N This section delineates the TASC assessment and case management process used in the Second Chance project. The model used in the project combines the TASC model with a strengths based approach. TASC guidelines for the intake, diagnostic assessment, case planning and case management functions (linking to referral sources, advocacy activities, and monitoring progress) are outlined. Strengths based strategies related to each of the TASC functions are described along with the staff supervision process. Examples of strengths based forms and tools are included for each function. S UMMARY OF C ONTENTS Applications Page 25 Intake Process Page 27 Diagnostic Assessment Page 30 Strengths Assessment Page 38 Planning Page 46 Linking to Resources Page 63 Advocacy Page 66 Monitoring Page 67 Staff Supervision Page 74 22

25 APPLICATIONS PARTNERSHIP / RELATIONSHIP hen using a strengths based perspective, the first priority becomes building rapport and establishing the partnership relationship. Sounds simple enough, but this step is typically the first to go, when faced with the pressure of so little time and so much to do. There will always be a need to complete paperwork and go over rules when working with clients in any setting. However, it is important to reframe perspectives and look at time differently. The sooner this process begins, the more time and energy will be saved in the long run. Within the context of time pressures, staff needs to prepare ahead and look for opportunities in the initial meeting and conversation to set the groundwork for the relationship. The client needs to recognize that something is different immediately. Using simple strategies that would be used when meeting anyone for the first time sets the stage. One example is to be welcoming. Level the playing field by using an open posture, (for example, no crossed arms), warm and enthusiastic gestures, eye contact, removing physical barriers, and personalized greetings. Using power signals (peering over an imposing desk, making the client do all the approaching, tight and closed body language, a reserved manner, or facial expressions that create distance) risk complete failure in establishing a partnership relationship. The initial meeting is getting to know you time, an opportunity to find something in common, express empathy, acceptance, and respect. This can occur in a few brief moments. Being welcoming has implications beyond the first meeting with the case manager or clinician. The physical environment in the waiting area, and in the office needs to demonstrate a warm caring environment. The waiting area should be clean and neat, have peaceful pictures with positive messages on the walls, quality magazines, and comfortable seating, for example. A live plant always brings a feeling of comfort as well. In the office setting, staff may bring in personal items to stimulate discussion and keep candy on the desk. The telephone demeanor of frontline staff, including office support can make or break initial impressions. They also need to understand the philosophy and their role in the process. It also helps to have hours of operation and flexibility of appointment times in response to client needs. Other goals for the first encounter include: clarifying roles, responsibilities and mutual expectations; informing of rights and responsibilities; and identifying interests and aspirations that may be evident. 23

26 APPLICATIONS D I A G N O S T I C ASSESSMENT In all encounters, staff continues to express empathy, acceptance, and respect. The diagnostic assessment process is predominately for identifying a diagnostic impression, problems and needs. However, there is ample opportunity to identify talents, abilities and resources as well. As interests are discovered, staff follow-up with when, where, and with whom questions to gain additional insight. These strengths are then added to the assessment and considered when recommending interventions. S T R E N G T H S ASSESSMENT Strengths based approaches use a specific strengths assessment to more fully articulate client strengths. Many clients have experienced a diagnostic assessment or similar bio-psycho-social history questions in prior settings. However, most are surprised and do not know how to respond to doing a strengths assessment. The client will probably not be able to list their strengths easily. The assessment needs to be viewed and communicated as an ongoing process to be worked on together. It is not the expert telling the client what their strengths are or expecting the client to recognize their strengths without any help. It is a collaborative effort that takes place over the course of time alongside the developing relationship. Strengths instruments vary greatly, have different goals and are found in many different settings. For example, vocational skills testing and personality inventories commonly used in employment readiness programs could be considered strengths assessments. The formats used in this context are less sophisticated, but just as useful for the purposes designed. Strengths based case management looks at the whole person and uses life domains as a framework to organize planning. When providing case management to offenders, it is important to identify and record strengths by life domain. Strengths should be written in the client s own words as much as possible and a mechanism for updating them on a regular basis is also necessary. Finally the case manager explains how the strengths assessment can be helpful to achieving personal goals. C A S E PLANNING In case management settings, the case plan is a living document that changes regularly and guides all interventions. The plan needs to be individualized. It is helpful to begin planning with a visioning activity to assist the client in identifying future aspirations. A key motivational strategy is developing discrepancy between client s goals or values and current behavior. This is accomplished by helping clients recognize the discrepancies between where they are and where they hope to be. The visioning activity can begin to identify goals and values that will assist when additional motivation is needed to stay the course. The case plan then includes personal goals as well as treatment goals around treatment and other interventions. In the case plan, the long-term goal reflects what the client desires and is developed from the visioning activity and the strengths assessment. Tasks and steps use the abilities and interests of the client. Goals and steps are written positively and in the client s own words. For example, instead of writing client will drop urines weekly, the plan might state I will document my sobriety by weekly drug screens. Goals are broken into small, incremental steps that have a high probability of success and accomplishments are acknowledged during every contact with the case manager. Steps are specific, measurable, achievable, and target dated. Tasks are written so that they may be accomplished by the next contact. 24

27 APPLICATIONS D O C U M E N T A T I O N Ongoing documentation of progress includes comments in the client s own words. Every contact not only reflects progress toward goals, but also records how strengths are being used, and additional strengths discovered together. Progress reports are sent to probation officers regularly. L I N K I N G T O RESOURCES One of the purposes of case management is to coordinate access to resources. A high priority goal is assisting the client in finding and building a positive support network within the community. In order to accomplish this, the case manager s relationship with staff managing resources is paramount. As the case manager develops and maintains these relationships, access to resources improves for the client. For example, administration needs to support opportunities for case managers to meet and greet staff from agencies and organizations who have resources that are regularly needed by the client population. and telephone relationships are not enough, and every effort should be made to meet face to face with these colleagues. Case managers working from a strengths based perspective understand the importance of recognizing the efforts of colleagues with kind words, notes of appreciation, and certificates. Strengths based case managers gain the curiosity and respect of their colleagues. Often they too will see that something is different and want to learn more.. A D V O C A C Y Strengths based case managers advocate for clients regularly. They attend court hearings, treatment staffing, and other meetings to provide support for the client. When a resource is needed, the case manager will do everything possible to make sure the need will be met. The denial of a needed resource is not acceptable. Many strategies are used including helping the provider understand why the client needs the resource, appealing denials, and making attempts to change agency policy and procedures, when necessary. Case managers also rely on coworkers to challenge their attempts and to receive ideas for other creative solutions. Strengths based case managers are committed to thinking outside the box and will challenge the system to change. Strengths based practitioners also understand the importance of having access to flexible funds that can be used for those needs that don t fit inside the current box of resources. M O N I T O R I N G Monitoring the offender s progress is important for success. The client will face many obstacles on the road to recovery. The case manager continuously looks for new strategies for motivating the client to continue the process. Increasing contacts with probation and other service providers, reframing requirements, and relating the plan to the client s personal beliefs and aspirations are all examples of strategies that a case manager may use. Sometimes the case manager s ability to consistently communicate their belief in the client s ability to be successful becomes the most important strategy of all. Case managers might send cards or invite the client to bring in examples of their successes and creativity, such as poetry, art, and music. The research with substance abusing criminal justice offenders clearly shows that the longer they remain involved, the more likelihood of success there will be. The case manager client relationship is key to motivating retention in the treatment process. 25

28 APPLICATIONS S U P E R V I S I O N Supervision is one of the support mechanisms that need to be in place for staff. Group supervision is even more important than individual supervision. It is in this setting that continuous learning is reinforced. Staff learns to work together as a team utilizing the strengths of their peers and supervisors. The supervision process needs to be structured, focused on client needs, and occur at least weekly for hours. Individual supervision also needs to be focused on strengths. (Let s talk about your most successful accomplishments since the our last contact. How can we build upon these and create new learning opportunities?) When beginning with a focus on success, the possibilities are endless. Staff also needs one on one time with a supervisor to facilitate additional learning opportunities. Supervisors need to take time to observe and coach the staff with clients, give feedback, model alternative strategies, and reinforce the notion of learning as an integral part of the day-to-day work process. It is clear that staff are getting it when the creative juices start flowing. As staff feels empowered, they will begin to find solutions to issues, instead of complaining about the problem. They will be more supportive of each other and take time to recognize the strengths of their peers. Their clients will bring in expressions of gifts and talents, like poetry, art, and music. When staff interact positively with other organizations and systems, resulting relationships increase successful collaboration on behalf of the client The following illustration depicts the TASC model and the added enhancements from the strengths based approach used in the Second Chance project. Intake Determine Eligibility Diagnostic Assessment Determine Acceptability Planning ü Identify Needs ü Identify Program Goals ü Outline Services S T R E N G T H S E N H A N C E M E N T S C A S E M A N A G E M E N T L i n k i n g A d v o c a c y M o n i t o r i n g 26

29 DESCRIPTION The intake process is the initial contact and examination to determine program eligibility. INTAKE PROCESS INTAKE T A S C M o d e l Objective Obtain necessary information to admit the person into the system. TASC PROCEDURES 1 Meet the client 2 Complete initial paperwork 3 Determine eligibility Intake Determine Eligibility STRENGTHS ENHANCEMENTS S t r e n g t h s B a s e d M o d e l Strategies Assure client feels welcomed and respected STRENGTHS ENHANCEMENTS 1 Create a user friendly, respectful environment in the waiting area, that is comfortable and visually pleasing; provide toys, markers, and books for children; assure that staff are timely with appointments and that the client is kept informed of any deviations in the schedule; offer snacks and drinks; keep a suggestion box with forms for customers to report satisfaction; use a bulletin board to display client rights, program information, and philosophy of the program. 2 Use simple language on forms 3 Welcome client warmly 4 Give flexible options for completing paperwork 5 Provide a written description of the philosophy and practice to the client Customer Service Satisfaction Form ü Welcoming and Respectful Environment ü Customer Centered Responses 27

30 I NTAKE INTAKE D ESCRIPTION 1. Customer Satisfaction Questionnaire Used to elicit feedback from customers on their experiences related to the value of establishing a welcoming, caring, and respectful environment. 28

31 OHIO SECOND CHANCE PROJECT CUSTOMER SATISFACTION QUESTIONNAIRE Date completed: Please take a few moments to complete this questionnaire and put it in the comment box. Your input will assist us in improving our services. All responses are confidential. Rate your satisfaction in the following areas by circling your response: Poor Fair Average Good Excellent 1. Office environment Length of time to get your first appointment Helpfulness of reception and front office staff 4. Overall satisfaction Feelings about recommending Second Chance services to others? 6. Assessment process Professionalism of staff Responsiveness to your individual needs Sensitivity to your racial, ethnic, cultural, or spiritual preferences Please check the closest description of your involvement with TASC: I am a current client I have completed the assessment process I have been a client for or more months. I am a family member of a person who is a current client I am a friend of a current client None of the above Other Open comments: 29

32 DIAGNOSTIC ASSESSMENT T A S C M o d e l DIAGNOSTIC ASSESSMENT DESCRIPTION Each person in the project undergoes a comprehensive face-to-face substance abuse assessment to determine the nature and extent of abuse, or addiction to alcohol and/or other drugs. Standardized forms are used to complete administrative intake and demographic information, review confidentiality issues, client rights, etc. and to confirm each potential client s agreement to participate in TASC programming. S t r e n g t h s B a s e d M o d e l Objectives Determine acceptability for services Strategies Establish rapport, build partnership Complete necessary assessment paperwork Begin strengths based assessment and list on the diagnostic assessment TASC PROCEDURES 1 Introduce yourself to the client, clarify roles, responsibilities and mutual expectations, inform of rights and responsibilities. 2 Review intake paperwork and obtain necessary signatures, etc. 3 Complete standardized assessment tool to identify the following information: a) Presenting problem and/or precipitating factors leading to the need for the assessment b) History of alcohol and other drug use by client, family members and/or significant others c) Current over-the-counter and prescription drugs d) History of treatment for alcohol and other drug abuse e) Medical history f) Allergies to include food and drug reactions g) Employment history h) Educational history i) Legal history to include pending charges and parole/ probation status j) Mental status screen including but not limited to, appearance, attitude, motor activity, affect, mood, speech and thought content k) Psychiatric history l) Family history m) Sexual history n) Religion/spiritual orientation o) Strength/Assets p) Weakness/limitations q) Degree of severity for the following dimensions: intoxication and withdrawal potential, biomedical conditions and complications, emotional/behavioral/cognitive conditions and complications, treatment acceptance/resistance, relapse potential, recovery environment and family or care giver functioning (youth only). r) Recommendations for treatment and levels of care according to ODADAS clinical protocols. s) Presenting problem and/or precipitating factors leading to the need for the assessment t) Behavioral/cognitive conditions and complications, treatment acceptance/resistance, relapse potential, recovery environment and family or care giver functioning (youth only). u) Recommendations for treatment and levels of care according to ODADAS clinical protocols. 30

33 DIAGNOSTIC ASSESSMENT 4 Review initial findings and recommendations including appropriate treatment and ancillary services and document in the case file. 5 If client is admitted for services, make a follow-up appointment with the assigned case manager. 6 When client is found inappropriate for admission, make a referral to a more suitable agency, if needed. 7 Determine diagnostic impression and record in each client s record within seven calendar days after admission. 8 Complete written assessment, outcomes, and recommendations. 9 Forward case file to supervisor for approval and sign-off. 10 Send copies of summary and recommendations to the referral source upon completion. STRENGTHS BASED STRATEGIES The diagnostic assessment is an opportunity to begin establishing the partnership relationship. Using motivational interviewing skills builds a solid foundation for the collaborative process between case manager and client. STRENGTHS ENHANCEMENTS 1. Build trust, ask permission to share recommendations, use empathetic responses 2. Communicate respect 3. Explore meaning of events leading to referral 4. Elicit perceptions 5. Offer factual information 6. Provide personalized feedback about assessment 7. Use open-ended questions and reflective listening 8. Clarify role as knowledgeable consultant 9. Establish collaborative relationship Diagnostic Assessment Determine Acceptability STRENGTHS ENHANCEMENTS Motivational Interviewing Assessment Results Feedback Tips Open ended Questions Listen Reflectively Sample Questions to Evoke self-motivational Statements ü Establish Rapport ü Build Partnership ü Motivational Interviewing 31

34 I NTAKE DIAGNOSTIC ASSESSMENT D ESCRIPTION 1. Motivational Interviewing Provides a reminder of motivational interviewing strategy components for staff 2. Assessment Results Feedback Tips Describes tips for use when eliciting feedback from clients related to the diagnostic assessment results and recommendations. 3. Open ended Questions Provides examples of the difference between closed and open questions. 4. Listen Reflectively Shows an example of a dialogue between case manager and client using reflective listening responses. 5. Sample Questions to Evoke Self-motivational Statements Presents questions that can be used with clients to gage their insight and personal motivation for change. 32

35 MOTIVATIONAL INTERVIEWING Reflective listening Communicate respect Collaborative relationship Knowledgeable consultant Compliment Listen Gently persuade Provide support Develop discrepancy Avoid argument Adjust to resistance Focus on strengths Support hope and optimism 33

36 ASSESSMENT RESULTS FEEDBACK TIPS H E L P F U L S T R A T E G I E S Establish rapport. Individualized results and scores. Express appreciation for efforts. Explain objectivity of the instrument, standardized, widely used, etc. Give written information. Compare to normative data. E L I C I T I N G F E E D B A C K Were there any difficulties? Sometimes people learn surprising things as they complete an assessment. What were your reactions to the testing? I m going to be giving you a lot of information. Please stop me if you do not understand something or want more explanation. What do you make of this? How do you feel about this? I guess this must be difficult because it confirms what your wife has been saying. This must be scary. I can see you are having a difficult time with this. A L C O H O L RELATED CONSEQUENCES The various alcohol-related problems you reported are checked below. When people stop or reduce heavy drinking these consequences will often decrease or disappear. YOUR CONSEQUENCES WHEN DRINKING ü Physical health problems ü Blackouts or memory problems ü Emotional problems ü Relationship problems ü Verbally abusive or physically aggressive ü Work/educational problems ü Legal problems ü Financial problems 34

37 MOTIVATIONAL INTERVIEWING CLOSED QUESTIONS OPEN QUESTIONS So you are here because you are concerned about your use of alcohol, correct? What is it that brings you here today? How many children do you have? Tell me about your family. Do you agree that it would be a good idea for you to go through detoxification? What do you think about the possibility of going through detox? First, I d like you to tell me some about your marijuana use. On a typical day, how much do you smoke? Tell me about your marijuana use during a typical week. Do you like to smoke? How has your drug use been this week, compared to last: more, less, or about the same? What are some of the things you like about smoking? What has your drug use been like during the past week? Do you think you use amphetamines too often? In what ways are you concerned about your use of amphetamines? How long ago did you have your last drink? Tell me about the last time you had a drink. Are you sure that your probation officer told you that its only cocaine he is concerned about in your urine screens? Now what exactly are the conditions that your probation officer wants you to follow? When do you plan to quit drinking? So what do you think you want to do about your drinking? 35

38 LISTEN REFLECTIVELY CM Client CM Client CM Client CM Client CM Client CM Client CM Client CM Client CM Client CM What else concerns you about your drinking? Well, I m not sure I m concerned about it, but I do wonder sometimes if I m drinking too much. Too much for? For my own good, I guess I mean it s not like it s really serious, but sometimes when I wake up in the morning I feel really awful, and I can t think straight most of the morning. It messes up your thinking, your concentration. Yes, and sometimes I have trouble remembering things. And you wonder if that might be because you re drinking too much? Well, I know it is sometimes. Youre pretty sure about that. But maybe there s more Yeah, even when I m not drinking, sometimes I mix things up, and I wonder about that. Wonder if? If alcohol s pickling my brain, I guess. You think that can happen to people, maybe to you? Well, can t it? I ve heard that alcohol kills brain cells. Um-hmm. I can see why that would worry you? But I don t think I m an alcoholic or anything. You don t think you re that bad off, but you do wonder if maybe you re overdoing it and damaging yourself in the process Yea. Kind of a scary thought. What else worries you? S U M M A R I Z E Periodically summarize Distilling the essence of what has been said, show that you have been listening carefully, and prepare the client to move on. Link positive and negative feelings about substance use. May provide insight into initial ambivalence and promote discrepancy. Begin and end session. Select what information should be included and what you want to leave out. Invite client to correct the summary. 36

39 SAMPLE QUESTIONS TO EVOKE SELF-MOTIVATIONAL STATEMENTS P R O B L E M RECOGNITION What things make you think that this is a problem? What difficulties have you had in relation to your drug use? In what ways do you think you or other people have been harmed by your drinking? In what ways has this been a problem for you? C O N C E R N What is there about your drinking that you or other people might see as reasons for concern? What worries you about your drug use? What can you imagine happening to you? How much does this concern you? In what ways does this concern you? What do you think will happen if you don t make a change? I N T E N T I O N T O CHANGE The fact that you re here indicates that at least part of you thinks it s time to do something. What are the reasons you see for making a change? What makes you think that you may need to make a change? If you were 100 percent successful and things worked out exactly as you would like, what would be different? What things make you think that you should keep on drinking the way you have been? And what about the other side? What make you think it s time for a change? I can see that you re feeling stuck at the moment. What s going to have to change? O P T I M I S M What make you think that if you decide to make a change, you could do it? What encourages you that you can change, could you do it? What encourages you that you can change if you want to? What do you think would work for you, if you needed to change? 37

40 STRENGTHS ASSESSMENT DESCRIPTION A strengths assessment describes the client s strengths, talents, capabilities, and resources that can be used to support the change process. TASC model Objective List strengths on assessment Update regularly during individual case management sessions TASC PROCEDURES 1 Identify and record strengths on the diagnostic assessment. 1 Engage client in a general discussion of strengths. If client has difficulty relating to the idea of strengths, use one of the strengths tools to assist with the discussion. Complete strengths assessment form with client 2 Facilitate discussion with client examining how identified strengths can assist the client with successful recovery, completion of the Second Chance program, and other personal aspirations. 3 Incorporate identified strengths into the case plan. 4 Engage clients in strengths identification and recognition of efforts during every contact. 5 Update strengths assessment form as new ones are discovered. Strengths based model Strategies Begin structured strengths based assessment STRENGTHS ENHANCEMENTS The strengths assessment process begins during the diagnostic assessment and continues through the client s involvement in the program. Strengths are documented on the strengths assessment form and organized by life domains: family, friends/associates substance abuse/mental health, health and safety, employment, functioning, attitudes/beliefs. 6 Document recognition of strengths and their application to the process of recovery in progress notes. Domain Checklist Strengths Assessment form Search Institute s 40 Developmental Assets The Resiliences STRENGTHS ENHANCEMENTS S T R E N G T H S A S S E S S M E N T ü Formal Strengths Assessment ü Detailed Strengths by Domain 38

41 I NTAKE STRENGTHS A SSESSMENT D ESCRIPTION 1. Domain Checklist Guides identification of client strengths and needs organized by life domains. 2. Strengths Assessment form Documents client strengths and needs by life domain and lists date of identification. 3. Search Institute s 40 Developmental Assets Gives staff another option to assist strengths identification using a framework of internal and external assets that is especially helpful for youthful clients. 4. The Resiliences Offers a simple strengths framework related to client responses to adversity. 5. Sample Questions for Strengths Discovery Depicts sample questions that can be used to help staff and client discover strengths. 39

42 DOMAIN CHECKLIST Employment Family Friends/Associates SA/ Mental Health Health & Safety Functioning Attitudes/Beliefs 1. Education 2. School Performance 3. Vocational Skills 4. Job readiness 5. Finances 6. Other 1. Spouse/significant other 2. Children 3. Parents 4. Grandparents 5. Other relationships 1. Activities 2. Community Involvement 3. Support Networks 4. Empowerment 5. Non-criminal associates 6. Other 1. AOD Abuse 2. AOD Dependence 3. Psych symptoms 4. Medication Compliance. 5. Crisis 6. Stress 7. Victim issues 8. Past institutionalization 9. Other 1. Physical Health 2. Diet & Nutrition 3. Housing 4. Neighborhood 5. Personal Safety 6. Other 1. Physical Skills/Mobility 2. Cognitive Skills 3. Problem Solving 4. Social Skills 5. Personal Care Skills 6. Household Skills 7. Literacy 8. Money Management 9. Leisure 10. Using Resources 11. Time management 12. Other 1. Spiritual involvement 2. Law abiding 3. Other 40

43 STRENGTHS ASSESSMENT Life Domain Problem Description Strength Description Date Identified Date Added to Plan Employment Family Friends/Associates 41

44 Life Domain Problem Description Strength Description Date Identified Date Added to Plan SA/Mental Health Health and Safety Functioning Attitudes/Beliefs Client Name Case manager Date 42

45 Search Institute s 40 Developmental Assets Support Empowerment Boundaries and Expectations Time Use External Assets Family Support Positive Family communication Other adult relationships Caring neighborhood Caring school climate Parent Involvement in schooling Community values youth Youth as resources Community service Safety Family boundaries School boundaries Neighborhood boundaries Adult role models Positive peer influences High expectations Creative activities Youth programs Religious community Time at home Educational Commitment Positive Values Social Competencies Positive Identify Internal Assets Achievement motivation School performance Homework Bonding to school Reading for pleasure Caring Equality and social justice Integrity Honesty Responsibility Restraint Planning and decisionmaking Interpersonal competence Cultural competence Resistance skills Peaceful conflict resolution Personal power Self-esteem Sense of purpose Positive view of personal future 43

46 THE RESILIENCIES Brief Definitions Insight: the habit of asking tough questions, which pierce the denial and confusion in troubled families. Independence: emotional and physical distancing from a trouble family, which keeps survivors out of harm s way. Relationships: fulfilling ties to others that provide the stability, nurturing and love that troubled families do not give. Initiative: a push for mastery that combats the feeling of helplessness troubled families produce in their offspring. Creativity: representing one s inner pain and hurtful experiences in art forms; building a new world on the ruins of the old. Humor: the ability to minimize pain and troubles by laughing at oneself. Morality: an informed conscience, which imbues the survivor, surrounded by badness with a sense of his or her own goodness. RESILIENCY PROTECTIVE FUNCTIONS RESILIENCE turns HARDSHIP into STRENGTH INSIGHT turns Denial confusion into Honesty, clarity INDEPENDENCE turns Co-dependency into Autonomy RELATIONSHIPS turns Neglect, alienation into Closeness, security INITIATIVE turns Helplessness, despair into Optimism, effectiveness CREATIVITY turns Ugliness, pain into Beauty HUMOR turns Deadliness into Liveliness, spirit MORALITY turns Badness, abuse into Goodness, compassion Drs. Steven & Sybil Wolin Project Resilience Washington, D.C. 44

47 SAMPLE QUESTIONS FOR STRENGTH DISCOVERY 1. What do you like to watch on television? 2. What are your favorite movies, books? Which celebrities do you like and why? 3. What are the best things about each of your children? Your parents? 4. What do you do for fun? 5. Who are your close friends and why are they special to you? 6. What kind of future do you hope to see for your children? Yourself? 7. What makes you mad? 8. What do you do to blow off steam? 9. How did you meet your spouse/significant other? 10. What is your neighborhood like? How long have you lived there? 11. What were you like as a kid? What do you want to do when you grew up? 12. What one thing do you do every week that you enjoy? 13. What was the best vacation you ever took? What made it the best? 14. How do you picture your life five years from now? 15. What makes you smile about your family at least once a day? 16. If you could accomplish one goal in your life in the next year what would it be? 45

48 PLANNING DESCRIPTION Develop a case plan with the client that addresses the progression of services to be provided over time, highlights treatment services anticipated and ancillary services needed, and indicates criminal justice requirements and responsibilities. PLANNING TASC model Objective Outline the range of services needed as determined by the assessment. Strengths based model Strategies Develop initial case plan focused on clients own aspirations TASC PROCEDURES 1 Write individualized case plan for each client within seven days of completing the assessment or at the time of the first face-to-face contact following the assessment. 2 Each plan shall be based on the assessment and include, at a minimum the following a. Client identification (name and identification number). b. Level of care to which client is admitted. c. Description of strengths or assets of the person served and how they will be utilized in achieving treatment goals. d. Problem(s) to be addressed. e. Measurable goals that address client s needs. f. Measurable treatment objectives with time frame for achievement of each objective. g. Frequency, duration and types of treatment services. h. Interventions utilized to achieve objectives, frequency and staff responsible. i. Original signature of the client, parent, and/or other significant others involved in the planning process. j. Date, original signature and credentials of the person who completed the plan and is qualified to provide alcohol and drug addiction services. 3 Complete progress note describing the client s response and participation in the development of the treatment plan including involvement from family, parent, guardian, or significant other. 4 Review and update plan periodically to reflect the client s changing clinical needs and response to treatment. 5 Write progress notes to reflect the implementation and evaluation of treatment plans for admitted clients. 6 Document each service delivered to the client with a progress note. Rely on plan to guide all interactions Update plan continuously 46

49 PLANNING STRENGTHS BASED STRATEGIES The strengths based case plan is developed as a collaborative effort, incrementally over time and is focused on the client s perspective and priorities. STRENGTHS ENHANCEMENTS 1 Continue building rapport and partnership relationship 2 Assist client in understanding the program, process, and opportunities. 3 Defuse labeling, identify, and support basic life needs 4 Review assessment with client 5 Determine stage of change 6 Complete case plan development form 7 Develop initial individualized plan based on strengths, needs, and stage of change. Include personal goals or aspirations as a focus for motivation. 8 Invite to orientation/graduation ceremony to learn about the program and meet successful graduates 9 Refer to treatment if in crisis Case Plan Development form Readiness Ruler Balance Scale Developing Discrepancy Futures Questions Personal Vision Activity Motivational Strategies for Each Stage of Change Planning ü Identify Needs ü Identify Program Goals ü Outline Services STRENGTHS ENHANCEMENTS ü Visioning Activities ü Personal Aspirations ü Stage of Change ü Incremental 47

50 I NTAKE PLANNING D ESCRIPTION 1. Case Plan Development form Use as the first stage of the case planning process. Can be given to client for homework or developed together. 2. Readiness Ruler Creates a visual for discussing readiness for change with clients. 3. Balance Scale Gives a visual option to assist clients in counting the cost and looking at the benefits of making changes in their lives. 4. Developing Discrepancy Outlines ideas and strategies for helping clients to see the discrepancy between their behavior and their values and beliefs. 5. Futures Questions Provides questions to use when encouraging a client to begin to envision a changed future. Can be used as a homework assignment or as a conversation with the case manager. 6. Personal Vision Activity Used as a homework assignment to help clients examine their vision for the future in life domain areas. 7. Motivational Strategies for Each Stage of Change Outlines strategies to guide staff interactions with clients at each different stage of change. 8. Case Plan Example 48

51 Case Management Plan Development Name Date Write down what your future might look like (say, in three years) if you make few changes in your life and continue on the path that you have been going on Write down what your future will look like (say in three years) if you decide to make some changes in your drug/alcohol use What are your strengths? What are your weaknesses? What problems are you having in your life? What do you need to help solve these problems? Goals Target Date Client Signature Case Manager Signature Date Date 49

52 READINESS RULER Stephen Rollnick and William R. Miller NOT READY UNSURE READY TRYING PRECON- CONTEM- DETERMINATION/ ACTION TEMPLATION PLATION PREPARATION Ask clients (or significant others) to Rate their readiness Use only the colloquial language line NOT READY UNSURE READY TRYING Instruments available for assessing stage of change, see Miller, W.R. and Tonigan, J.S., (1996) Assessing drinkers motivation for change: The stages of change readiness and treatment eagerness scale (SOCRATES) Psychology of Addictive Behaviors, 10(2), and The University of Rhode Island Change Assessment (URICA), McNeil, Prochaska, and Velicer, (1983) 50

53 BALANCE SCALE Good things about using Benefits of staying the same Not so good things about using Costs of staying the same Not so good things about change Cost of changing Good things about change Benefits of changing 51

54 DEVELOPING DISCREPANCY Developing awareness of consequences helps clients to examine their behavior. A discrepancy between present behavior and important goals motivates change. The client should present the arguments for change. THE COLUMBO APPROACH Sometimes I use what I refer to as the Columbo approach to develop discrepancy. In the old Columbo TV series, Peter Falk played a detective who had a sense of what had really occurred but used a somewhat bumbling, unassuming Socratic style of querying his prime suspect, strategically posing questions and making reflections to piece together a picture of what really happened. As the pieces began to fall into place, the object of Columbo s investigation would often reveal the real story. Using the Columbo approach, the helper plays the role of a detective who is trying to solve a mystery but is having a difficult time because the clues don t add up. The Columbo clinician engages the client in solving the mystery: Example #1 Hmm. Help me figure this out. You ve told me that keeping custody of your daughter and being a good parent are the most important things to you now. How does your heroin use fit in with that? Example #2 So, sometimes when you drink during the week, you can t get out of bed to go to work. Last month, you missed 5 days. But you enjoy your work, and doing will in your job is very important to you. In both cases, the helper expresses confusion, which allows the individual to take over and explain how these conflicting desires fit together. The value of the Columbo approach is that it forces individuals to grapple with discrepancies and attempt to resolve them. This approach reinforces the notion that individuals are the experts on their own behavior and values. They truly are the only ones who can resolve the discrepancy. If the helper attempts to do this instead of the individual, the helper risks making the wrong interpretation, rushing to conclusions rather than listening to the individual s perspective and perhaps most important, making the individual a passive rather than an active participant in the process. Cheryl Grills, Consensus Panel Member from TIP #35 52

55 NON COMPLIANT BEHAVIOR Often is thinly veiled expression of dissatisfaction with the process. Any occurrence gives an opportunity to discuss the reasons for the behavior and learn from it. Often continuing ambivalence and not ready to make a change. Tips 1. Explore the incident in a nonjudgmental problem-solving manner that probes whether it was intentional and whether a reasonable explanation can be found for the reaction. Could be because of a distressful treatment session or car breaking down. 2. How did the event affect emotions or anxieties about consequences? 3. Draw out client perception and interpretation of the event. 4. If you can get the individual to voice the frustrations, they will probably come up with their own answers. 5. Open ended question Hopefully will invoke dialogue and personal interpretation. Respond with reflective listening and add own interpretation or affirmation i.e., Individuals who come late to appointments often do not complete treatment or invoke a probation violation. Describe how others have solved the problem in the past. Commend individual for getting there. 6. Explore alternative responses that could have been employed. Noncompliance is a signal to change strategy. Strategies to increase engagement and retention Develop rapport Orientation Explore expectancies and determine discrepancies Normalize difficulties in the recovery process Investigate and resolve barriers to treatment Increase congruence between intrinsic and extrinsic motivation Examine and interpret noncompliance Reach out 53

56 FUTURES QUESTIONS TWO POSSIBLE FUTURES Write down what your future might look like (say, in five years) if you make few changes in your life and continue on the path that you have been going on.. Write down what your future will look like (say, in five years) if you decide to make some change in your drug/alcohol use. The Miracle Question (Adapted from the Miracle Method, S. Miller and I.K. Berg, 1995) The following questions are sometimes useful helping people to paint a picture of what life could be like if they made some changes in their life. This can be helpful in figuring out what some of your goals are. Suppose that one night, while you are asleep, there is a miracle and the problem that brought you here is solved. However, because you are asleep you don t know the miracle has already happened. When you wake up in the morning, what will be different that will tell you this miracle has taken place? Then, what else? Now imagine a time in the future when the problem no longer exists. What will it be like for you? How will your life be different? Who will be the first to notice? What will he/she do or say? 54

57 PERSONAL MASTERY ACTIVITY Drawing forth personal vision Set aside an hour of uninterrupted time for this exercise. Relax, get comfortable and prepare to be reflective. Step 1: Imagine achieving a result in your life that you deeply desire. Describe this experience in words or pictures as if it is happening in the present tense. What does it look like? What does it feel like? What words do you use to describe it? Step 2: Reflection. Pause to consider did you articulate a vision that is close to what you really want? Consider these potential reasons why this was hard to do. I can t have what I want I want what someone else wants. It doesn t matter what I want. I already know what I want I am afraid of what I want. I don t know what I want. I know what I want, but I can t have it at work. Step 3: Describing your personal vision Now answer these questions in the present tense. Imagine achieving the results in your life that you deeply desire. What would they look like? What would they feel like? What words would you use to describe them? Self-image: If you could be exactly the kind of person you wanted what would your qualities be? Tangibles: What material things would you like to own? Home: What is your ideal living environment? Health: What is your desire for health, fitness, athletics, and anything to do with your body? Relationships: What types of relationships would you like to have with friends, family and others? Work: What is your ideal professional or vocational situation? What impact would you like your efforts to have? Personal pursuits: What would you like to create in the arena of individual learning, travel, reading, or other activities? Community: What is your vision for the community or society you live in? What do you want to contribute to your community? Other: What else, in any other arena of your life, would you like to create? Senge, Peter (1994) The Fifth Discipline Fieldbook. p

58 Motivational Strategies for Each Stage of Change Stage of Change Pre-contemplation Not yet considering change or is unwilling to change Appropriate Motivational Strategies 1. Establish rapport, ask permission, and build trust. 2. Raise doubts or concerns about substance-using patterns Explore meaning of events leading to treatment Elicit perceptions of the problem Offer factual information about risks of behavior Provide personalized feedback about assessments Explore pros and cons Help a significant other intervene Examine discrepancies between perceptions of the behavior 3. Express concern and keep the door open Contemplation Acknowledges concerns and is considering the possibility of change but is ambivalent and uncertain. 1. Normalize ambivalence 2. Tip the decisional balance scales toward change by Elicit and weigh pros and cons of behavior and change Change extrinsic to intrinsic motivations Examine personal values in relation to change Emphasize free choice, responsibility, and self-efficacy for change 3. Elicit self-motivational statements of intent and commitment 4. Elicit ideas regarding perceived self-efficacy and expectations 5. Summarize self-motivational statements Preparation Committed to and planning to make change in the near future but is still considering what to do. 1. Clarify individual s goals and strategies for change 2. Offer a menu of options for change 3. With permission, offer expertise and advice 4. Negotiate a plan for change and behavior contract 5. Consider and lower barriers to change 6. Help enlist social support 7. Explore expectancies and roles 8. Elicit what has worked in the past for self or others 9. Assist in negotiating finances, child care, work, transportation, or other potential barriers 10. Ask for a public announcement of plans to change 56

59 Motivational Strategies for Each Stage of Change Stage of Change Action Actively taking steps to change but has not yet reached a stable state. Appropriate Motivational Strategies 1. Engage in treatment or other services and reinforce the importance of remaining in recovery 2. Support a realistic view of change through small steps 3. Acknowledge difficulties in early stage of change 4. Identify high-risk situations through a functional analysis and develop appropriate coping strategies to overcome them 5. Assist in finding new reinforcements of positive change 6. Help to assess level of family and social supports Maintenance Achieved initial goals such a abstinence and is now working to maintain gains. 1. Identify and sample healthy, drug-free sources of pleasure (i.e. new reinforcers) 2. Support lifestyle changes 3. Affirm resolve and self-efficacy 4. Help practice and use new coping strategies to avoid returning to behavior 5. Maintain supportive contact (explain availability to talk between appointments) 6. Develop a fire escape plan if individual returns to old behavior 7. Review long-term goals Recurrence Recurrence of symptoms and must now cope with consequences and decide what to do next. 1. Help to reenter the change cycle and commend willingness to reconsider positive change 2. Explore the meaning and reality of the recurrence as a learning opportunity 3. Assist in finding alternative coping strategies 4. Maintain supportive contact. 57

60 Cuyahoga County TASC Second Chance Project Created on 2/22/05 Individual Treatment Plan DIAGNOSIS Axis I : Cocaine Dependence Primary : Alcohol Dependence SUSTAINED FULL REMISSION : Cannabis Abuse SUSTAINED FULL REMISSION Axis II V71.09: No Diagnosis Axis III CLIENT REPORTS Axis lv Legal Client is on probation for one year Support system Client lacks sober support system Family Client is separated from his wife and estranged from his children Employment Client is working at a minimum wage job after over 20 years of gainful employment. Axis V Current GAF: 68 Treatment Referral Referral Date 4/1/2005 Admission Date 4/19/2005 Discharge Date 6/7/2005 Provider TASC Sobriety Group Level of Care Outpatient Outcome Success 58

61 Cuyahoga County TASC Second Chance Project Diagnosis : Cocaine Dependence Primary Problem statement Mr. Night s daily cocaine use contributed to separation from his wife, being estranged from his children, losing his job, being arrested for assault, and then sentenced to one year of probation. Goal Life area: Criminal Justice I want to make plan to change my life. Mr. Night wants to create a positive vision for his life. Measured by: developing a case plan outlining his goals by 3/30/05. Strengths I liked my life when I didn t get high. Mr. Night has enjoyed a quality of life that was positive and would like to return to that. Objectives Established on Objective Time Frame for Achievement 2/22/05 Mr. Night will complete a strengths assessment to 3/30/05 assist with treatment planning. Measurement Completed strengths assessment Established on Objective Time Frame for Achievement 3/3/05 Mr. Night will identify personal needs to be 3/30/05 addressed by the treatment plan. Measurement Self report. Established on Objective Time Frame for Achievement 3/3/05 Mr. Night will meet weekly to identify strengths, 3/30/05 needs, and draft treatment plan. Measurement Completed strengths assessment Established on Objective Time Frame for Achievement 3/3/05 Case manager will assist Mr. Night in developing 3/30/05 the plan at weekly case management meetings. Measurement Completed strengths assessment. 59

62 Goal Life area: Alcohol/Drug Mr. Night wants to live life being a sober person. Measured by completion of treatment, negative drug screens, and self report. Strengths Mr. Night has participated in Drug Court and other recovery activities in the community in the past. Mr. Night has a talent for drawing and used to enjoy expressing himself through his art. Objectives Established on Objective Time Frame for Achievement 3/17/05 Mr. Night will document six months of sobriety. 9/17/05 Measurement Negative drug screens Established on Objective Time Frame for Achievement 3/17/05 Mr. Night will complete recommended treatment. 9/17/05 Measurement Verification of completion certificate Established on Objective Time Frame for Achievement 3/17/05 Mr. Night will attend at least three self-help 9/17/05 meetings per week. Measurement Meeting attendance form. Established on Objective Time Frame for Achievement 3/17/05 Mr. Night will meet weekly with case manager to 9/17/05 discuss progress and any sobriety threatening issues. Measurement Progress notes in the case file Established on Objective Time Frame for Achievement 3/17/05 Case manager will assist with referral, linkages, 9/17/05 and monitor services. Measurement Progress notes Established on Objective Time Frame for Achievement 6/10/05 Mr. Night will begin attending a weekly art class to 7/19/05 help him explore his love of sketching as a hobby. Measurement Self report and bringing in artwork for viewing. 60

63 Goal Life area: Employment Mr. Night wants to get a better job. Measured by: a full time job or engagement in a vocation/job search program. Strengths Mr. Night worked at Food Lion for 11 years and Wonder for 10 years. Objectives Established on Objective Time Frame for Achievement 3/25/05 Mr. Night will go to the Source for help with job 9/25/05 placement Measurement Self report and case manager contacts with the Source or verification of a job. 61

64 Goal Life area: Relationships with Family and Associates I want to work on my family relationships. I need to figure out how to get back with my wife and be a good role model for my kids. Measured by: self-report Strengths Mr. Night is willing to work at improving his relationships. Objectives Established on Objective Time Frame for Achievement 4/19/05 Mr. Night will talk to his outpatient counselor about 7/19/05 setting up individual appointments to work on his marital issues. Measurement Self report and case manager contacts with counselor Established on Objective Time Frame for Achievement 4/19/05 Mr. Night will identify one activity per week that he 7/19/05 can do to spend quality time with his son. Measurement Self report Progress Note 6/7/05 Client was present at TASC for his case management appointment. Client presented his certificate for completion of TASC sobriety group. Client completed the group today. Client reflected that the group time went faster than I expected. Client remains in a sober environment and discussed that he is having conversations" with his spouse. Client will consider further counseling on an individual basis for issues he feels he needs to address in order to avoid relapse again. Client was presented with the notion that he has several options for ongoing supportive counseling. Client discussed he feels that he can have more of a positive impact on his younger son by spending time with him individually away from his spouse. I need to spend some 1 on 1 time with him. He discussed recent problems with his son and revealed good insight regarding his son s perspective. Client discussed that he feels he is not ready to return to the home and has a sober place where there is no pressure for him to leave. Client will further consider the housing referrals provided at an earlier appointment. Client was also provided with employment resources Towards Employment and the Cuyahoga county employment guide. Client will review the materials and discuss at our next appointment. Client shared that he had a discussion with his sponsor not to make any major decisions for at least one year. He agreed that there is "no rush" on his choices now that he has finished with the TASC group. Pointed out to client the strengths that he exhibited today in our appointment and added them to the strengths assessment form. Recognized client s strengths of: an increased commitment to his recovery process, his insight regarding his family relationships, and his signs of patience with the process. 62

65 LINKING DESCRIPTION Making referrals to services, and assuring continuity when client moves from one component to another in any system. LINKING TASC model Objective Refer to available resources based on the diagnostic assessment Strengths based model Strategies Match treatment and other support service needs with individual abilities and needs of the client TASC PROCEDURES 1 Determine the appropriate treatment modality based on assessment results and protocol criteria for level of care 2 Discuss treatment options with the client and obtain client signature on consent forms. 3 Make referrals to ODADAS certified agencies, according to the agency referral process and agreed procedures in the Memorandum of Understanding. 4 Referral to the recommended agency and acceptance of the referral must be made within forty-eight (48) hours of the assessment. 5 When immediate placement is unavailable, provide monitoring and support during the interim period. 6 Continue to employ planning, linking, monitoring, crisis assistance, and advocacy strategies as needed to facilitate successful engagement of treatment services 7 Identify needs for support services based on assessment results. 8 Discuss support service options with the client and obtain client signature on consent forms. 9 Make referral to agencies, according to the agency referral process and agreed procedures in the Memorandum of Understanding, when there is one. 10 Continue to employ planning, linking, monitoring, crisis assistance, and advocacy strategies as needed to facilitate successful engagement of ancillary services 63

66 LINKING STRENGTHS BASED STRATEGIES Linkage to community resources is individualized based on abilities and needs of the client. STRENGTHS ENHANCEMENTS 1 Make referrals based on strengths and needs of the client 2 Access to treatment needs to be as early as possible for success engagement and retention. The project has the availability of a full range of treatment options, including varying length and intensity along with primary, transitory, and aftercare services. 3 Involvement in twelve step, peer, and alumni groups is encouraged and expected based on individual needs. 4 Employment and educational services is a high priority service that is coordinated with the treatment process. 5 Opportunities that will encourage expression of talents and abilities are supported by the case manager along with other services. 6 Other support services that will assist with overcoming obstacles are sought with an attitude of whatever it takes to encourage success. Specialized support services -- Community Reentry, Winner s Circle Flexible funds Bus tickets STRENGTHS ENHANCEMENTS C A S E M A N A G E M E N T L I N K I N G Build Face-to-Face Relationships ü D e v e l o p A l t e r n a t i v e R e s o u r c e s ü C r e a t e F l e x i b l e F u n d i n g 64

67 I NTAKE L INKING R ESOURCES D ESCRIPTION 1. Specialized support services -- Community Reentry, Winner s Circle Using creative strategies to provide additional support is important when implementing a strengths based approach. The Community Reentry staff does outreach and intervention with clients in the community, when needed, to overcome barriers and engage them in the treatment change process. 2. Flexible funds Flexible funding is used to assist clients overcome barriers to service. 3. Bus tickets Transportation is a major barrier to successful treatment engagement. Bus tickets are helpful for increasing transportation options. 65

68 ADVOCACY DESCRIPTION Case managers and administrators advocate for identified service needs of clients. ADVOCACY TASC model Objective To overcome systems obstacles that prevent access to services. TASC PROCEDURES 1 Intercede on behalf of the client Strengths based model Strategies 2 Influence treatment and ancillary services to respond to the client s needs 3 Attend staffing, court hearings, and other meetings with client. Build strong relationships in the community to assist collaborative efforts. Develop alternatives to fill gaps in service needs. STRENGTHS BASED MODEL DESCRIPTION Building relationships with other community resources is a priority advocacy activity. STRENGTHS ENHANCEMENTS 1 Develop face-to-face relationships with providers 2 Set aside flexible funding mechanisms 3 Develop alternative resources 4 Influence a service agency to change in response to documented deficiencies in the system STRENGTHS ENHANCEMENTS C A S E M A N A G E M E N T A D V O C A C Y Build Face-to-Face Relationships D e v e l o p A l t e r n a t i v e R e s o u r c e s ü C r e a t e F l e x i b l e F u n d i n g 66

69 MONITORING DESCRIPTION Case managers meet regularly with the client to monitor progress and provide accurate reports to the referral agency. MONITORING TASC model Objective Monitor and report progress to criminal justice referral agency Strengths based model Strategies Monitor progress, support client with motivational enhancement strategies and report progress. TASC PROCEDURES 1 Case manager will monitor the individual s progress in treatment 2 Apply success and failure criteria to the progress 3 Regularly report progress and provide written monthly reports to the criminal justice referral agency 4 Reassess needs and develop new plans continuously 5 Document all activities in the case record 6 Complete termination report no later than seven calendar days after services have been terminated. The Termination report will include at a minimum the following information: a Client name and identification number b Date of admission c Date of discharge d Admitting diagnosis e Discharge diagnosis f Degree of severity at admission and at discharge for the following dimensions based on the ODADAS protocols for levels of care (youth and adult) for publicly funded clients: Intoxication and withdrawal Biomedical conditions and complications Emotional/behavioral/cognitive conditions and complications Treatment acceptance/resistance Relapse potential Recovery environment Family of caregiver functioning (for youth) 67

70 MONITORING STRENGTHS BASED STRATEGIES Case managers support clients with motivational enhancement strategies. STRENGTHS ENHANCEMENTS 1 Recognize even the smallest steps toward positive movement at every opportunity. 2 Send cards and visit while in residential treatment 3 When non-compliant, point out discrepancies between personal goals or values and behavior that is inconsistent 4 Roll with resistance 5 Explore the meaning of resistant behaviors 6 Change level of care when indicated 7 Keep trying new strategies as long as the client shows up and remains on probation 8 Collaborate with PO and judge. 9 Intervene using family members, friends, or other supportive persons 10 Note strengths and successes on progress reports 11 Provide mechanism to obtain client and referral source satisfaction feedback 12 Develop a continuing care plan at least 30 days prior to termination 13 Recognize success and strengths with certificates at a graduation ceremony Case Management Plan Review Monthly Report form Continuing Care Plan Development Client Satisfaction Survey Referral Source Satisfaction Survey STRENGTHS ENHANCEMENTS C A S E M A N A G E M E N T M O N I T O R I N G Opportunity S k i l l s ü R e c o g n i t i o n 68

71 I NTAKE MONITORING D ESCRIPTION 1. Case Management Plan Review Provides a format to assure client involvement in the monitoring and reporting process. 2. Monthly Report form Used to send monthly reports of client progress to criminal justice referral agency. 3. Continuing Care Plan Development Developed during the last phase of client involvement to develop an ongoing plan for recovery. This form is used as a hand-off to the Community Reentry staff to inform them of client s recovery plan. 4. Client Satisfaction Survey Gives client an avenue to provide input and feedback to the program and staff. 5. Referral Source Satisfaction Survey Used to gain input from referral sources to assist in improving program operations. 69

72 Case Management Plan Review Name Date Please note any changes in your contact information, i.e. address, phone, etc. What progress have you made toward your goals this month? How do you feel about your participation in treatment and/or other requirements? What obstacles are getting in the way of accomplishing your goals? What problems are you having in your life? What do you need to help solve these problems? Additional/Revised Goals Target Date Client Signature Case Manager Signature Date Date 70

73 1276 W. 3 rd St. Suite 325 Cleveland, OH Phone (216) OFFICE USE ONLY Date faxed Date mailed Reporting Period Monthly Report To: Name Organization Case Management Start Date Re: Name DOB Docket/Probation # Treatment Status Participation Referral made Outpatient Reported for all scheduled appointments Attending Intensive Outpatient Sporadic attendance Completed Detox Unable to engage in treatment Other Residential Other After Care Alcohol/Drug Screens Screens have not been initiated Yes No Sporadic compliance with screens Screens indicate drug free status Non-compliance with screens Recommend increased level of screens # Positive screens submitted Recommend decreased level of screens Medication Treatment Plan Treatment Issues Strong Promising Minimal Not Applicable Evidence Medications: 1. Overall Motivation 2. Abstinence (alcohol/drug) 3. Acceptance of Problem Dosage Schedule: 4. Involvement in self-help No change Decrease Increase 5. Family Support 6. Personal Insight Client Issues 7. Completes Assignments Employment 8. Progress School 9. Other Marital/Family Comments/Action Needed Friends/Associates Repeated absences at treatment Health and Safety Repeated absences for case management Housing Request case conference Personal/Community Functioning Request Jeopardy meeting Attitudes/Beliefs Request change in random drug screens from probation Other/Detail Nearing successful completion of treatment Tentative date Other Summary Strengths/Needs Case Manager Name Signature Phone # Date 71

74 OHIO SECOND CHANCE PROJECT CLIENT SATISFACTION SURVEY This section to be completed by the client Name SS # Date Permanent Address Permanent Phone Numbers Rate your satisfaction in the following areas Poor Fair Good Excellent by circling your response: 1. Office environment Length of time to get your first appointment Helpfulness of reception and front office staff 4. Feelings about recommending Second Chance services to others 5. Assessment process Professionalism of staff Responsiveness to your individual needs Sensitivity to your racial, ethnic, cultural, or spiritual preferences 9. Improvement while in TASC Assistance obtaining your treatment goals Overall Second Chance experience I would rate my effort in Second Chance as: What changes would you make to improve the effectiveness of the Second Chance program? 14. What part of the program was most helpful? Why? 15. What strengths do you have that will help you stay sober? 16. Open comment: 72

75 OHIO SECOND CHANCE PROJECT REFERRAL SATISFACTION SURVEY This section to be completed by the referral agent Client: Referral Agent: Who was the case manager in this case? Rate your satisfaction in the following areas by Poor Fair Good Excellent circling your response: 1. Referral process General program information received Helpfulness of reception and front office staff Feedback and reporting of client progress Overall satisfaction Assessment process Professionalism of staff Responsiveness to client needs Cultural competency of staff Please circle your response: 10. Did you receive monthly written reports? Yes No 11. Did you receive timely urinalysis results? Yes No 12. Was pertinent information communicated to you in a timely fashion? Yes No 13. Was there anything specific to this case that in your opinion could have been improved? 14. What is the current disposition of the client? 15. General Comments: Please have client complete reverse side of form and return to the Second Chance Project. 73

76 STAFF SUPERVISION DESCRIPTION Supervisor with appropriate credentialing, will facilitate a supervision process, including signing off on all required activities in the record, meeting with staff individually and in a group to review cases on a regular basis. STAFF SUPERVISION TASC model Objective Provide oversight to the clinical process Strengths based model Strategies Provide an emphasis on continuous learning opportunities and strengthening the team environment TASC PROCEDURES 1 At a minimum of once every two (2) weeks all direct service staff meet for case consultation, staffing, and review. 2 Provide an opportunity to each direct service staff member to present and receive feed back on client cases. 3 The clinical supervisor reviews all client assessments and recommendations. 4 Document presented cases on the Case Presentation and Review form. STRENGTHS BASED STRATEGIES Teams meet weekly presenting cases for review and input from supervisors and peers with an emphasis on quality services, advocacy, and continuous learning opportunities. Supervisors give staff meaningful roles in work processes and decisions, model skills, and provide ample recognition for efforts. STRENGTHS ENHANCEMENTS 1 Meet weekly for at least hours to review cases. 2 Document presentations on the Group Supervision Case Presentation Format 3 Incorporate strengths based measures into individual supervision and peer review process. Meeting Guidelines Group Supervision Case Presentation Format Supervision Plan Development Personal Assessment Peer Review S T A F F S U P E R V I S I O N Opportunity Skills Recognition 74