Clinical Toolbox

ABLE PROGRAM CLINICAL TOOLBOX:

A Unique, Team-building Approach for
Assisting Special Needs Children
and Their Families

“There is safety in a multitude of counselors.”
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“It takes a village to raise a child.”
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“Some of the best parenting a parent can do is to allow someone else to help.”

• Case Study Background Information
• Collaborative Ways to Discover Family Resources

Most Utah children with disabling conditions are those with multi-problem learning-failure and multi-ambiguous loss bereavement histories. The behavioral-emotional syndromes are often subtle in their initial manifestations and usually accompanied by other equally disabling conditions that may affect the developmental, educational, emotional, behavioral and social functioning of the child. The Utah State Health Department programs for Children with Special Health Care Needs (CSHCN) and the ABLE all nested programs address the far-reaching needs of this large population. We foster an interdisciplinary, coordinated, multi-agency approach with family-centered assessment and treatment planning. We use a primary service-team model that includes the school and other community agencies and resources.

For the purposes of illustrating the principles and practices we use, we present a case study throughout this section of the web site (italicisized) of a child who has multiple problems and is failing in school. The case reflects a typical client-family scenario and is intended to demonstrate how we engage with children and their families and promote success in connecting them to personal and community resources and how we use the motivation of families to use their own assets. Our methods include narrative techniques, in which client-families “story” their experiences hopefully to perform them and, in this way, substantiate their ends, dreams and identities. See case study example.

Our Practices

What follows are ideas, principles and strategies for parents, professionals and others to help at-risk children and youths. These suggested practices include collaborative ways to find and use family resources and to develop lifelines, or support systems, from the environment. These Toolbox experiences may also be helpful for emerging wraparound and other child support teams We have purposefully sought a web and electronic medium for presenting these practice ideas rather than a manual or a book format to help people take bits and pieces to add what they already have done.

There are no simple solutions to these challenges and it’s through a multimodal application along with multi perspectives and views which are most likely to be helpful in managing these conditions.

Our solutions originate from several things we do with the help of the child and family:

1. We talk in a special way, using “heart-felt listening.”
2. We seek further understanding by using our minds to focus on risks and protections.
3. We emphasize taking action in a shared way, by walking together reconnects and brings parts into a whole.
4. We offer meaning-producing tools that allow understanding of, and give significance to, a person’s experience.

Collaborative Ways to Discover Family Resources,
Develop Solutions and Create Lifeline Tools

When we work with severely involved at-risk children and youth, two or more people are always congregated around the table. We believe this to be an essential tool and from the beginning advocate for families as well as ourselves when we can to seek at least one other to join us together and later if required add other both problem and solution defined members to the group. The most helpful people to gather are those caring people and representatives of helping systems already involved in the life of the at-risk child or adolescent. Eventually if required a core group often includes the parents, the child, the essential people from school, a representative of the health care community, and perhaps a family advocate. A plentitude of interested parties provides a safety net for the child, who is likely addressing multiple, interactive problems. This shared discussion approach recruits the power of the family and community and brings more resources to bear on the child’s problems than the child or family or community could bring independently. Throughout the discussion, the child’s problems are identified, named and externalized to safeguard his or her personal identity and sense of self, becoming a sentinel Tool useful immediately.

Throughout, we present a case discussion about a client we have given the pseudonym “Adam,” in order to better explain our practices and assumptions. “Adam’s” case represents one of the many wonderful client-families we partner with to help elicit potential—often overlooked—resources. Many good ideas arise spontaneously from our relationship with families; and from these experiences together we have assembled the following principles and practices. Many are attributable to the families’ resiliency, effort and oftentimes–tears.

Give a name to the child’s condition that depersonalizes it, so the child is not seen as the problem. This gives space to the child and family to deal with the problem and to negotiate with it relationally. For example, by renaming ADHD "The Antsies," “The Hypers," or “The Electron Exploders,” the therapist can convey the idea that the condition is something aside from the demands of a difficult child.

In Adam’s case, the dialogue went something like this:

Clinician: “Adam, I see that the teachers have reported you must have ants in your pants that require you getting up out of your desk so much. The Antsies seem to want you to go visiting other kids and they seem to have you asking to go to the bathroom or to the drinking fountain often. Let me ask your folks if they ever see The Antsies.”

Parents: “We see The Antsies almost every day after Adam comes home from school. There are fewer Antsies in the mornings than in the afternoons.”

Clinician: “Adam, do you ever feel The Antsies coming on?”

Adam: “Sometimes I get so Antsy I could just pop. Mornings aren’t as hard as afternoons, but afternoons are almost impossible.”

In this way, the therapist and family can focus on the problem itself and remove the child’s self-identity from being criticized or stigmatized. Otherwise, direct labeling of behaviors appears to the child and family as being rooted in the child’s global self.

There are several dozen Handouts embedded as Tools in the text as well as in the Appendices. We have found these scales, checklists, session feedback or family support charts as a vehicle and template for visualizing something new. We have included new learnings such as a few pages on Solution Oriented Practices in Part II or Procedures for Building Teams in Part III. The end of each chapter offers an enticing bibliography pertinent to the topics as well as several web sources to explore further tool making.

The Toolbox culminates in Part IV giving lots of ideas suggesting experiences in a number of life themes which help build emotional and developmental growth. These experiences also become the Tools for story themes giving opportunity to create new realities.