CANS in WISe: Empowering Youth and Family Voices Nathaniel Israel and Danijela Zlatevski The Praed Foundation WISe Symposium, July 2017

Acknowledgements Organizers for this invitation Practitioners for their dedication and commitment Families and Youth for their courage and persistence

Content Today’s conversations: Organizing and Amplifying youth and family stories Rating patterns and Individualized Planning Profiles to identify and grow sustainable success Ongoing CANS support and learning community opportunities Learning and Problem-Solving calls for Supervisors TCOMConversations.org Post-discussion recommendations

Structure: Repeating Pattern Introduce a common scenario Describe strategy used by practitioners, families and youth Discuss use of strategy in WISe Identify how to use and improve the strategy in your context

Scenario 1: Organizing Stories for Change A person’s story contain nearly infinite points of potential action How do we help understand how to come to a common understanding of the story being told? How do we think about, introduce, and work towards both short and long term goals?

Scenario 1: Organizing Stories for Change CANS helps us describe our common understanding of needs, strengths, and priorities How is the CANS introduced to the youth, family, and team? With whom does the youth first rate the CANS? What is your process for reviewing and insuring that CANS ratings are consensus ratings shared across the WISe team?

Scenario 1: Organizing Stories for Change Stories include a lot of information and possible priorities for action Youth and children in WISe, at the Initial assessment have an average of 10 actionable treatment needs (B/E Needs, Risk Behaviors, and Functioning domains) alone How do we help people come to a common understanding of how these make sense together, and create a story ready for change?

Scenario 1: Organizing Stories for Change Youth have told us that successful planning is about “Helping me become what I want to be” How are you getting to what you want to become? What strengths are well-developed? What strengths can we develop? What concerns are current barriers to becoming? Where can we develop your supporters? How do we keep everyone safe?

Scenario 1: Organizing Stories for Change Levers of Change Expected Relief and Outcomes Sustaining and Growing Change Becoming: 1. Background Needs / Considerations Though we often focus on behavioral health levers of change to drive symptom relief, ultimately reducing behavioral helth symptoms does not get a person to what thye want to become. It simply makes it less difficult for the person to act on what they want to become. Environmental and community supports help a person develop into what they want to become. On the CANS these supports are found in the Strengths domain. Progress towards becoming what you want to become is seen both in the Functioning domain and in the Strengths domain. Address Needs Build Strengths

Scenario 1: Organizing Stories for Change Understanding the story together: How do you ensure that the youth has the first chance to organize their story of becoming? What do you do ahead of a Wrap meeting? What do you do in a Wrap meeting? How do you ensure that key people in the child or youth’s life have a stake in, and common understanding of, the story?

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning We can learn across the stories of youth and families to check for and pay attention to important details Certain patterns of ratings indicate other concerns to check for and strengths which may be important to develop

Scenario 2: Learning Across Stories Practitioners and Supervisors: How can we learn from the collective stories of youth and families? What are some insights which we can take from these other stories to inform our practice? How can we make sure that we ‘first do no harm’?

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning These rating patterns are easily identifiable by hand They include: Trauma-Affected Mood, Angry Impulsivity, and Psychosis

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Trauma-Affected Mood Criteria: total score of Mood Disturbance, Anxiety and Adjustment to Trauma items is ‘6’ or greater Critical Needs: Suicidality (triples; 14%); Danger to Others (doubles; 27%); School Attendance (increases by half; 34%); Caregiver BH Concerns (doubles; 30%) Underdeveloped Strengths: Family (drops by a quarter); Community Life (drops by a fifth)

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Trauma Affected Mood Does your agency have specific resources and treatments to address needs in this area? Are there people who specialize in addressing this need? What informal supports may be particularly critical?

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Angry Impulsivity Criteria: total score of Oppositional, Emotional Control, Impulsive / Hyperactive, Conduct Problems items is ‘8’ or greater Needs to Assess/Address: School Attendance (doubles; 43%) Danger to Others (triples; 57%) Suicidality (~doubles; 8%) Caregiver BH (~doubles; 23%)

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Angry Impulsivity Criteria: total score of Oppositional, Emotional Control, Impulsive / Hyperactive, Conduct Problems items is ‘8’ or greater Undeveloped Strengths: Interpersonal (drops by one-third; 43%) Community Life (drops by one-quarter; 43%) Spirituality / Religion (drops by one-quarter; 45%)

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Angry Impulsivity Does your agency have treatments to address a youth’s parent and peer support needs in this area? Are there people who specialize in addressing externalizing or dangerous behaviors? What community supports may be particularly critical to ensure are in place?

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Psychosis Criteria: total score of Psychosis item is ‘3’ Needs to Assess/Address: Suicidality (quadruples; 24%); Substance Use (nearly doubles; 21%); Caregiver BH Concerns (doubles; 30%) Undeveloped Strengths: Interpersonal (drops by a third) Community Life (drops by a quarter)

Scenario 2: Learning across Stories: Rating patterns and Individualized Planning Psychosis Does anyone at your agency have training in, or protocols which are used, to detect early signs of psychosis? Is there a program available which specifically addresses early psychotic symptoms / first breaks? What informal supports may be particularly critical in reducing youth and family stress and detecting concerns in reality testing?

Scenario 3: Acting on Population Profiles How do we understand insights, growth opportunities, and successes across all stories? How do we think about large-scale successes, supports, and priorities for change?

Scenario 3: Acting on Population Profiles Who do you serve? What are the youth in your location’s most prevalent Strengths and Needs? How routinely do youth experience relief from their barriers to becoming? /Short-term success/ How routinely are youth’s Strengths developed? /Long-term success/

Scenario 3: Understanding Populations How do you review these data? Who is involved? How do you make sure that Youth and Families help make sense of WISe practice and its effects at your location? Who do you serve?

Scenario 3: Understanding Changing Profiles of Needs How do you review these data? Who is involved? How do you make sure that Youth and Families help make sense of WISe practice and its effects at your location? How routinely do youth experience relief?

Scenario 3: Understanding Changing Profiles of Strengths How do you review these data? Who is involved? How do you make sure that Youth and Families help make sense of WISe practice and its effects at your location? How routinely are Strengths developed?

Aligning Our Efforts to Expand Success We can use similar processes to understand stories of ‘becoming’ at every level of the system These processes of becoming include both growth of an individual youth and their supports, and growth of people formally serving youth and families These stories become powerful when we learn to act together to help each other become effective and happy in our environments How do you review these data? Who is involved? How do you make sure that Youth and Families help make sense of WISe practice and its effects at your location? How do we insure that we act systematically and consistently on the stories of youth and families?

Thank you!