G.E.A.R. Parent NetworkGaining Empowerment Allows Results

• A Maine statewide parent-run organization established in 1992

• Support and empower parents/caregivers of children/youth w/emotional/behavioral health/substance use issues.

• We promote family-driven care

• 1:1 support, support groups, educational workshops, parenting education, social events/family activities, advocacy, and public awareness.

• Maine’s only totally parent-run organization

Funding Sources & Staffing

Staffing (all are part-time or

per diem):

• Director

• Training Coordinator

• Five Regional Parent Support Coordinators

• Parent Support Provider Team Leader

• Two Parent Support Providers

• Parent Volunteers

Funding:

• Children’s Mental Health Block Grant

• Maine Children’s Trust

• United Way

• Donations

The Importance of Parent Peer Support

No policy should be decided without the full participation of members of the group affected by that policy.

Parent Peer Support Provider Defined

“A person who is parenting or has parented a child experiencing mental, emotional, or

behavioral health disorders and can articulate the understanding of their experience with

another parent or family member.”

This person may be a:

• birth parent,

• adoptive parent,

• family member standing in for an absent parent, or

• person chosen by the family or youth to have the role of parent.

Parent Peer Support Provider FocusEmpowering parents and caregivers to parent and advocate for their child/youth with serious emotional disturbance or behavioral health related disorders.

The scope of the service involves providing emotional support and supporting family members to navigate through multiple agencies and human service systems.

It is strength-based and established on mutual learning from common lived experience and coaching that:

• promotes wellness, trust and hope,

• increases communication, informed decision making and self determination,

• identifies and develops advocacy skills,

• increases access to community resources and the use of formal and natural supports

• reduces the isolation that family members experience. and

• the stigma of emotional, behavioral and mental health disorders.

G.E.A.R. PSP Qualifications

Varied lived experiences and specific skills are needed to provide effective parent-to-parent support in a variety of settings.

PSPs must:

• have 5+ years of lived experience,

• successfully pass background checks, and

• be nationally credentialed as a “Certified Parent Support Provider” (CPSP) through the National Federation of Families for Children’s Mental Health Certification Commission within 2 years of employment.

CPSP Certification Requirements

Certified Parent Support Provider (CPSP) candidates must have:

• 88 hours of courses/training received that meet criteria in 11 specific domains,

• a documented minimum of 1000 hours related employment/volunteer experience in the 5 years prior,

• a documented minimum of 20 hours of supervision,

• an ability to articulate their lived experience,

• successfully passed the certification exam, and

• agreed to the code of ethics.

The Eleven Domains of Competence

1. Ethics

2. Confidentiality

3. Effecting change

4. Behavioral health information

5. Education information

6. Local resources

7. Communication

8. Parenting for resiliency

9. Advocacy in and across multiple systems

10. Empowerment

11. Wellness and natural supports

G.E.A.R. Training Offered

• Family-Driven Care

• Trauma-Informed Care

• Nurturing Parent Program

• Parenting with Dignity

• Parent Peer Leadership Institute

• Mandated Reporting/Rights

• Restorative Practices

• Suicide Awareness

• Overview of Mental Health Diagnoses

• Team Up for Your Child

Data Collection - Our Journey

In 2005, the G.E.A.R. Parent Network team discussed the importance of collecting data in a database to document the work we do.

Why Collect Data?

• Funding sources began requiring more than anecdotal evidence.

• We observed that many family organizations in Maine and across the country were closing their doors.

• Funding sources decreased, and the criteria to obtain funding was becoming more complex.

What Did We Do?

• In 2006, we asked our board of directors for the financial support to create a database.

• We defined the specific data to be collected and the reports we needed to generate.

• In Fall of 2006, our database was created, staff received training, and we began collecting parent data and recording outcomes.

• After 5 years of collecting data, we identified patterns, which prompted updates to data fields in the database and changes in the way we entered the data.

• We are committed to continuous quality improvement.

G.E.A.R. Database

Demographics & Progress Measurements

Database Contacts & TPA

Infusing Trauma-Informed Principles in a

Family Support Provider Program

Crucial to providing quality care to trauma survivors!

Adverse Childhood Experiences

• Adverse Childhood Experiences (ACEs) -Developed as a research program conducted by Kaiser Permanente and the Centers for Disease Control and Prevention (CDC), the ACEs study demonstrated how past childhood trauma correlates to physical health issues and social problems experienced as adults.

• The ACE questionnaire is a measure of the 10 types of childhood trauma studied.

• The ACE questionnaire helps parents/caregivers understand how past trauma affects their parenting.

Maine ACEs Data• 3,998 Maine adults were asked ACE questions in 2011• 63.5% of Maine adults reported experiencing at least one ACE; 18.6% reported

four or more • Females, those with less education, and those with lower income were more

likely to report experiencing three or more ACEs

36.5

22.8

22.1

18.6

ACEs, Maine Population (%)

No ACE experience

1 ACE experience

2-3 ACE experiences

4+ ACE experiences

29.8% of Maine

women reported experiencing 3+ ACEs

25.1% of Mainemen reported experiencing 3+ ACEs

Emily Morian-Lozano1, Erika Lichter2, Finn Teach2

1Maine Center for Disease Control and Prevention, 2University of Southern Maine

The ACE Score attributes one point for each category of exposure to child abuse and/or neglect. Add up the points for a Score of 0 to 10. The higher the score the greater the exposure and the greater the risk of negative consequences. While you were growing up, during your first 18 years of life:

1. Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you, or act in a way that made you afraid that you might be physically hurt?

2. Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you or ever hit you so hard that you had marks or were injured?

3. Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way or attempt or actually have oral, anal, or vaginal intercourse with you?

4. Did you often or very often feel that no one in your family loved you or thought you were important or special or your family didn’t look out for each other, feel close to each other, or support each other?

5. Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you or your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

6. Were your parents ever separated or divorced?

7. Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard or ever repeatedly hit at least a few minutes or threatened with a gun or knife?

8. Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

9. Was a household member depressed or mentally ill, or did a household member attempt suicide?

10. Did a household member go to prison?

Now add up your “Yes” answers: _______ This is your ACE Score.

What’s Your ACE Score?

Staff at All Levels Have Trauma TrainingParent Support Provider recognizes and responds to the

impact of both current and past trauma

Training includes:

• what traumatic stress is

• what vicarious trauma is

• how traumatic stress affects the brain and body and

• the relationship between mental health and trauma.

Measurement ToolsG.E.A.R. Parent Network utilizes the following evidence-based tools:

Targeted Parent Assistance (TPA) –

• monitors parent engagement

• identifies changes in attitude and behaviors. It identifies interventions and supports appropriate to each level of parent engagement,

• deepens engagement by offering connections to other families and

• information about larger issues, structures opportunities to promote increasing levels of parent voice and choice, differentiates services provided to parents engaged at various levels, and tracks effectiveness of interventions and supports.

Family Journey Assessment (FJA) –

A questionnaire that was developed to track families’ progress, identify

targets and benchmarks for individualized support and follow up, tailor the

type of supports given to families in need, and help families understand

how to resolve their challenges and address their unique needs.

Targeted Parental Assistance Continuum - 10 Levels

Understanding Stages of Engagement

TPA Descriptions• Behavior Management: Providing education/role modeling/discussions

around strategizing child behavior management needs or techniques.

• Committee/Policy Participation: Discussion about/participation in policy meetings or any committee where outcomes are related to advocacy or children’s behavioral health.

• Connect to Natural Supports: Discussion about and work completed in supporting family/caregivers/youth with connecting them to community and natural supports, including maintaining natural supports.

• Education/IEP: Discussion or meetings that occur around education/school-related issues: reviewing plans, education on IEP/504, supporting with preparation for IEP/school meetings. Discussion of youth school absenteeism.

• Emotional Support: Any conversation with actively listening and validating family/caregiver/youth and/or sharing of PSP lived experiences.

• FJA Started: Family Journey Assessment baseline has begun.

• FJA Completed: Baseline, 3/6/9/12 month progress measures are completed.

• Info/Resource Sharing: Information/discussions pertaining to resources.

• Legal: Discussions around any legal-related issues (guardianship, divorce, child custody, wills, bankruptcy, etc.) or reviewing legal paperwork, including discussion around informal adjustment or juvenile corrections.

Family Journey Assessment (FJA)The FJA measures parent progress and is completed in collaboration with family members.

Every 3 months, we talk with parents about how things are going in terms of:

➢ the support they are receiving,

➢ their work with others involved in their child’s care,

➢ making decisions,

➢ advocating for their child,

➢ getting things accomplished, and

➢ the strain they may be feeling.

During these discussions, the parent and PSP decide together what areas of our work together to concentrate on in the future. The goal of the Family Journey Assessment is to help us work effectively together to address parents needs, build upon their strengths, and, ultimately reach their goals.

FJA developed by Georgetown University Ntl Technical Assistance Ctr & Montgomery Cty Federation of Families for Children's Mental Health

FJA Progress Measurement Tool

1. Intensive Family member does not demonstrate knowledge & skill w/out active intervention from CPSP.

2. Moderate Family member needs extensive assistance & encouragement from CPSP to demonstrate knowledge & skill.

3. Supportive Family member needs limited assistance from CPSP to demonstrate knowledge & skill.

4. Empowered Family member demonstrates knowledge and skills without assistance from CPSP.

Rating Levels:

FJA Sample QuestionsFamily Member:

Understands and accepts the child's challenges.

See challenges in an objective way.

Recognizes child's strengths.

Recognizes own needs.

Is involved in decision making within the family.

Develops and maintains a daily routine.

Accesses and feels supported by natural supports.

Believes that own voice is important.

Handles crises effectively.

Communicates effectively.

Create An Evaluation Tool!

Activity

Family Vision DocumentFamily Vision

Where do you see yourself and your family 6 months from now, 1 year from now? What changes or goals need to be accomplished to get you there?

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Changes/Goals What needs to be done? Who is responsible? ------------------------------------------- -------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------ --------------------------------------------------------- ------------------------------------------------------------------------------------------ --------------------------------------------------------- ------------------------------------------------

Measurement Tools Inform Outcome

1. PSP’s goal is to help parents solve problems, manage day-to-day situations, AND develop specific skills. Work performed is documented in database.

2. When parent’s ACE score is shared, it informs PSP there is trauma that may not have been addressed. Helps PSP to understand that something has happened to get parent where they currently are at, their parenting style, and how to best support and empower the parent. PSP always offers resources for clinical support anytime ACEs and trauma are discussed with parent.

3. Targeted Parental Assistance (TPA): PSP scores parents in the database along the ten point continuum. This score does not decrease whenever a parent is in crisis with child/youth.

4. Family Journey Assessment (FJA): In collaboration with their supervisor, PSP learns to work with parents to assess and identify skills/traits most useful to them and work together to build those skills. The FJA then cues PSP to use activities/tools to promote skill development.

5. Supervisor reviews data and documentation to provide intensive coaching.

PSPs Have a Role in Decision Making

PSPs should share power and decision-making across all levels of an organization, whether related to daily decisions or in the review and creation of policies and procedures.

Individual PSP Supervision -Support & Self-Care

Regular weekly individual supervision includes:

• discussion of how to apply trauma concepts to real life work situations,

• discussion of ways to better respond to issues and practice of those responses,

• discussion of ways improve family’s own response to family members,

• recognizing vicarious trauma,

• monitoring job frustration and prevent burn-out,

• promoting safety, and

• encouraging staff to have self-care routines.

Group PSP Supervision -Support & Self-Care

Regular monthly group supervision/coaching includes:

• creating a sense of shared ownership of the program,

• review and revision as needed of program policies, protocols, and staff responsibilities,

• ongoing discussion about how can we do this work in the most efficient and cost-effective manner,

• ongoing skill development and sharing of opportunities to receive free to low cost education/training in the community, and

• review of trends.

What Have We Learned?

• PSP interview process is critical to hiring qualified and passionate staff.

• Hire PSPs with a minimum of 5 years lived experience.

• Orientation period is a good indicator of PSP’s engagement and passion.

• Highly recommended that PSP supervisor have lived experience.

• Supervisor needs to accommodate different learning styles.

• Important to learn if parent had childhood trauma.

• Developing a family vision is an important tool to engage families.

• Data outcomes should be reviewed as a team/group.

• Must be responsive to data collection changes and adjust data measurements if needed.

• Work needs to continue toward PSP role becoming an evidenced-based practice.

• Continuing education of PSPs is essential.

Is Parent Support Effective & How?

Data Outcomes:

• Parent engagement rate was 63%.

• 75% met Family Journey Assessment goals.

• 83% met Target Parent Assistance goal of Level 2 or higher.

• Outcomes of surveys and overall service satisfaction rate is 90%

or higher.

• PSPs better able to respond to what parent needs now.

• Increased parental self-sufficiency and family resiliency factors.

• Improvement in parental skills, including self-advocacy, child

behavioral management strategies, and emotional wellness/self-

care tools.

• Low use (16%)of crisis services.

What Happens If We Are Not All on the Same Page?

Any Questions?

Contact G.E.A.R. Parent Network:

www.gearparentnetwork.org

www.facebook.com/gearparentnetwork

Cindy Seekins, CPSP, Director

207.441.7216 or cseekins@crisisandcounseling.org

Diane Bouffard, CPSP, Regional Parent Support Coordinator

207.612.8996 or dbouffard@crisisandcounseling.org

Administration: 10 Caldwell Rd, Augusta, Maine 04330

Resources

• ACEs Connection - http://www.acesconnection.com

• Centers for Disease Control and Prevention -https://www.cdc.gov/violenceprevention/acestudy/index.html

• Maine Alliance of Family Organizations -https://www1.maine.gov/dhhs/ocfs/cbhs/family/mafo/index.shtml

• Maine Department of Health and Human Services, Office of Child and Family Services - http://www.maine.gov/dhhs/ocfs

• Maine Resilience Building Network - http://maineaces.org/index.html

• National Federation of Families for Children’s Mental Health -https://www.ffcmh.org

• Substance Abuse and Mental Health Services Administration -https://www.samhsa.gov