Evaluación Narrativa en Casas de acogida (Narrative evaluation in foster homes)

Posted by on Feb 4, 2014 in Friday Afternoon Videos | 15 comments

Evaluación Narrativa en Casas de acogida (Narrative evaluation in foster homes)

En esta presentación, el terapeuta narrativo Carlos Chimpen, describe las formas de evaluación narrativa que está implementando en casas de acogida. Carlos ha ofrecido amablemente su presentación en inglés y en español. ¡Gracias Carlos!

Here, Spanish narrative practitioner, Carlos Chimpen describes the ways in which he is engaging with narrative evaluation in foster homes. Carlos has kindly offered this presentation in both English and Spanish. Thanks Carlos!

Evaluación Narrativa en Casas de acogida

En las casas de acogida y en las llamadas casas de cumplimientos de medidas judiciales, siempre se ofrece una evaluación de los chicos y chicas que viven allí, basada en el diagnóstico del déficit. En esta presentación, se ofrece una “contra evaluación” o lo que he denominado evaluación narrativa. Se basa en el rescate de la historia de los valores, fortalezas, sueños, expectativas, etc. para contrarrestar los efectos de la historia de los problemas en las vidas de estos adolescentes y ofrecer un enriquecimiento de sus historias alternativas.

 

Narrative evaluation in foster homes

In Spain, in foster homes and so-called ‘Homes of Judicial Measures’ (homes for young people who are under court orders), assessments of young people are conducted that involve diagnosing deficits. This video presentation provides a ‘counter-evaluation’ or what I have called ‘narrative evaluation’. It is based on rescuing the history of young people’s values, strengths, dreams, expectations, etc. in order to counteract the effects of a history of problems in their lives and to provide an enrichment of alternative stories of identity.

Forum discussion / Foro de discusión

Una vez que has visto el vídeo de Carlos esperamos que te unas al debate. Para unirte/leer el foro Click aquí.

Now that you’ve watched Carlos’ video presentation, we hope you will join the discussion! To join/read the forum Click here

Published on February 4, 2104

15 Comments

  1. Thank you SuEllen:

    I am going to buy two of your book, one for me and one for my Department of Psychiatry. I am sure will be helpful smile

    Warmly

    Carlos

  2. Hi, Carlos,

    I am glad you found my response helpful. Here is a link to my book, The Art of Narrative Psychiatry, on Amazon:

    http://www.amazon.com/The-Art-Narrative-Psychiatry-Strength/dp/019998204X

    Warmly,

    SuEllen

  3. Hi SuEllen:

    Thanks a lot for your deep reply. Of course it is helpful to me read and re-read what you has written and I am going to put in practice some of the ideas.

    Where could I find your book The Art of Narrative Psychiatry? Is it posible to buy it by Amazon?

    Thank you very much again, SuEllen, and if I get something new among my colleagues I will write you. I hope will be soon.

    Warmly

    Carlos

  4. Muchas gracias Diana por tu respuesta. No me dices dónde trabajas, en qué país y ciudad.
    La semana que viene tengo el taller con los educadores y otros profesionales que trabajan conmigo y podré contarte como perciben ellos este cambio de propuesta. Si lo perciben de forma positiva seguro que podemos ir profundizando en más conceptos narrativos. Si quieres que estemos en contacto y te cuente más “intimidades” de las luchas que sostengo para implantar esta forma de evaluación puedes escribirme a [email protected]
    Un saludo Diana y mucho ánimo en tu trabajo que por experiencia sé que no es fácil.

    Carlos

  5. Dear Carlos,

    I have had a range of experiences speaking with other psychiatrists about narrative practices.

    A key way that I share narrative practices is through the example of my own work, including my clinical notes and the language I use when discussing patients with colleagues. For example, I try to always introduce the person without the problem, use externalizing language when discussing problems, and express the ways in which the person is succeeding in limiting the effects of the problem, drawing on their skills and values. In addition, I ask questions to draw out stories of strength and meaning from my colleagues, such as asking a clinician who is referring someone to me, What do you appreciate about this person? In what ways have they been able to overcome the problem and live more as they prefer? Whose support has this person chosen to draw on for help? My colleagues have also been able to see the ways in which my work has been helpful to those who consult with me, and this sometimes sparks their curiosity.

    In my conversations with psychiatrists, I have also connected narrative practices with other initiatives that share similar values. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the US government that oversees mental health and substance abuse treatment, has been supporting the ideas of “Recovery” and “Trauma-Informed Care,” which share narrative principles of honoring the person’s strengths and values, collaboration with the person, identifying personal and community resources, avoiding traumatizing or disempowering practices and maintaining hope and a vision of recovery and wellbeing. Likewise, Motivational Interviewing shares many narrative values. I situate narrative practices as being consistent with these other movements in psychiatry, and I bring forward particular narrative practices as ways to more fully manifest “strengths-based and person-centered care.” I might ask colleagues questions like, So if we were to take a strengths-based, person-centered approach to treatment planning as SAMHSA recommends, what might this person identify as their vision of wellbeing? How are they succeeding in taking steps to make that vision a reality?

    Overall, I have found the most effective way to cultivate the values and practices of narrative therapy among psychiatric providers is to offer a workshop or training about narrative practice that includes vivid case descriptions and experiential exercises. When my colleagues hear about and try out narrative practices, the practices come alive and many people find them very inspiring and they want to hear more about them.

    The book I recently published, The Art of Narrative Psychiatry, offers a good introduction to narrative practices as they might be used in psychiatric contexts. I have had a number of psychiatrists and other therapists read the book and want to learn more, and I have offered a training in narrative psychiatry to psychiatrists and other psychiatric clinicians that was very well received.

    I also take a collaborative stance with my colleagues and honor the perspectives that they find helpful. For clinicians who find value in a psychodynamic model, I offer analogies to that model from a narrative point of view.

    “As narrative psychiatrists, we are just as curious as other psychiatrists and psychotherapists about our patients’ lives and characters and temperaments. We are listening with as much attention and nuance to their stories and body language and we are sifting through their experiences of their lives with them with as much subtlety and attunement, but instead of primarily seeking the source of their problems, we are seeking the sources of their strengths. These are the resources that will help them move their lives in the directions that they prefer.” (p. 60).

    For clinicians who value the use of psychotropic medication, I ask, What effects of the medicine does the person find helpful (if any) and what effects do they find unhelpful or disruptive? How might we better comply with the person’s preferences in making medication recommendations? What other resources might this person draw on to support their recovery?

    When I have the privilege of convening a meeting, I invite other psychiatric providers to consider speaking about our patients as if the patient were in the room with us, and to speak in ways that the patient would find respectful and hopeful.

    Sometimes I find myself in a conversation with colleagues in which they are speaking about someone who is consulting with them in ways that I find disrespectful or pathologizing. I try in those situations to gently speak up and say something like, I am a bit uncomfortable with this way of speaking about this person. I wonder if we could speak about this person in a way that is more respectful. However, when I speak up like this, if our group has not come to an agreement ahead of time about how we speak about those who consult with us, often the clinician is put off by my comment or becomes upset or defensive.

    I am heartened by the positive response that many of my colleagues have had to narrative ideas, and I encourage you to continue with your efforts as well!

    I hope this has been helpful. Good luck to you!

    Warmly,

    SuEllen Hamkins

  6. Hola Carlos,

    Me parece muy interesante tu trabajo y la propuesta que haces sobre un nuevo tipo de evaluación, tan diferente de lo que se está haciendo ahora mismo, sobre todo en los contextos institucionalizados.

    Trabajo en un equipo interdisciplinar con adolescentes que tienen problemas de conducta y con sus familias. Un contexto muy parecido al que tú describes. Por eso me parece tan interesante la propuesta de una alternativa al modelo cognitivo conductual de control de la conducta a través del manejo de contingencias.

    Me gustaría saber más sobre cómo desarrollar este tipo de evaluación y orientación para padres con niños y adolescentes que tienen problemas de conducta.

    Gracias por compartir con nosotros tu trabajo

    Un saludo

    Diana

  7. Hi Carlos,

    Thanks for sharing about those challenges. You seem to have used a lot of persistence in sticking to your ideals, demonstrating your intentions and implementing the changes. It is encouraging to know that this paid off, and more colleagues are supportive of this way of working. That is great news about the workshop! I can imagine that would make a big difference, to have everyone understanding more about the approach.

    I appreciate your encouragement to share more about our workplace. I’ll consider what my next step may be. Thanks for your offer of email exchange. I’m sure that will be helpful.

    Warmest wishes,

    Loretta

  8. Dear SuEllen:

    Thank you so much for your lovely feedback.
    Knowing that you are a psychiatrist, could I ask you a question?
    If you have had some conversations about narrative practice with your colleagues, how were those conversations? If not, what questions would you ask to them in order to promote narrative practice in a delicately way?
    I ask you this because I am a professor of Psychiatry and Psychopharmacology and I work with medical staff and psychiatrists in the University. Your answer can help me with my colleagues.
    Thanks a lot again.

    Warmly

    Carlos

  9. Dear Carlos,

    Thank you so much for your video presentation on bringing narrative practices to working with children in foster care, and for your comments in the forum.

    I so appreciate your efforts and successes in bringing narrative practices and values to your work in a context that is not organized around narrative principles and values. I love the ways in which you use the traditional word and concept, “evaluation,” not to objectify the child, but rather to evaluate the context in which the children lived and the discourses to which they were subjected, as well as to discover and evaluate the many, many skills, values and resources that the children bring to the challenges that they face.

    I also particularly appreciate the questions you asked of colleagues to help them learn to deconstruct diagnoses or treatment or behavioral approaches that have been imposed on children and to identify the skills and values that children are drawing on to survive and thrive. I have had a similar experience as you described in your comment to Loretta that it can be especially challenging to bring forward narrative practices and ideas when you are the only one in your agency working that way. I am so glad that you persevered! I think it is so important for those of us working all different kinds of contexts to keep trying to bring forward and adapt and apply narrative ideas and practices in our own contexts.

    The example you offer of noticing “The girl had asked herself to be in a foster home” as an opening to cultivate the narrative of her commitment to justice, as well as narratives that externalize the problem of “nerves” and support her to take action more in line with her own sense of justice as opposed to what the “nerves” wanted her to do (such as acting with violence)—this example reminds me very much of work that I do as a psychiatrist in the psychiatric contexts in which I have worked. Noticing and cultivating the “absent but implicit” and the “sparkling moments” that stand outside of the influence of the problem are key practices of mine and are so welcomed by the people who are consulting with me about extreme symptoms and experiences.

    Best of luck to you in your work and teaching!

    Warmly, SuEllen Hamkins

  10. Hi Loretta:

    I really appreciate a lot your post. It has given me enough strength to follow with this work and it has encouraged me to share my ideas with other narrative colleagues.

    I am working in a hard context where it is difficult to put in practice the narrative ideas. I was alone working so different that I thought by moments that it would be impossible to create something new in a context like Foster Homes. My first pressure was not my boss but my companions. They felt that I was trying to gain power into the Association and they saw me, from a very individualistic point of view, as a traditional Psychology trying to lead everything and everybody. Of course, that not was my intention and I had to demonstrate, step by step and little by little, that the first thing I had in mind was the children and their families. The president of the Association support me but he was in a distant situation, far away from the battle field (sorry for my war metaphor).

    After a year working in the Association I got one of the workers who understood what I was trying to do and he was a great support and motivation to follow fighting and he still is. A year ago another colleague did the course of Narrative Practice that I direct at the University of Extremadura. Now we are three people trying to offer a respectful approach making visible the hopes and dreams, and acts of resistance or responses of young people who have been labeled by the system.

    The last news is that the president has offered to me make a workshop of 10 hours to all the workers of the Association in order to explain how to work in the way I explain in the video presentation.

    Sorry for telling you my own story of resistance but I think it is good to know how difficult can be work in line with our values and offer hopes to another colleagues in a similar situation.

    Thanks a lot for telling me how you work at your context. You has offered me some interesting ideas to put in practice this new year. Maybe you could think in make a video presentation for Friday Afternoons at Dulwich and meanwhile, if you wish we can be in touch through email sharing ideas. My email is [email protected].

    Thanks a lot again.

    Warmly

    Carlos

  11. Hola Marcela:

    Tras las vacaciones de invierno y tras una pequeña infección viral que me ha dejado K.O. durante tres días, te escribo para darte las gracias por tu mensaje. Queda mucho por hacer y las reflexiones conjuntas desde diferentes contextos culturales pueden enriquecer nuestra labor.
    Nos vemos en breve y charlaremos largo y tendido de estas y otras ideas.
    Un abrazo y espero que no te llegue la ola de frío del norte de USA.

    Carlos

  12. Hi Carlos,

    Thanks so much for sharing your work. It is very encouraging for me to hear about your efforts to work in this way of making visible the hopes and dreams, and acts of resistance or responses of young people who have been labeled by the system. I work in a team where we are trying something similar with families who have been assessed by child protection services as the children being at risk of significant harm, and where the children may be put in foster care unless a service such as ours offers support and counselling. By the time we meet them, the family usually has a long list of labels from the mental health and school services, and the parents have the stigma of being seen as ‘bad parents’ by the community because they have child protection services involved. The parents have often experienced a lot of trauma themselves as children, and had hopes of things being different for their own children.

    We have been working on a way of meeting the needs of assessment and reporting to the child protection service, but doing it in a way that brings forward the skills and resources of the family, and works towards the hopes the family holds. Like you, we have found it rewarding and it nourishes us as workers when we work in line with our values. Hearing about your work reminds me that this is an important process to stick to, and gives me strength to embark on another year. Thank you!

    We use a three stage process too, and offer outsider witness sessions at review or closure with the family. The family collaborates with us on the reports to child protection, and the family receive a copy. If child protection has finished working with the family because of changes, and we no longer have to write reports, then we send the family a narrative letter summarising their skills and knowledges, and hopes for the future.

    I was wondering whether you have had pressure from your funding provider about using this process. Are they acknowledging the fruit from your work? Our co-ordinator has put a lot of work into explaining our philosophy to our management committee and to our funding provider. As one of the ways of demonstrating our work and also providing another witness response to the families’ stories, we offer people the opportunity to share their story at our annual general meeting and invite the management and also the funding person from the government to come. There is no pressure for the families to share. It is not a requirement. Stories are shared with permission, either anonymously (read out by the worker) or by the person themselves (via pre-recorded video or live interview) at the meeting. We also share collective documents from groups. Then the people at the meeting provide some level of response. It has been very satisfying for the families we work with, and they have said they felt proud of their stories, and moved emotionally that people would respond in a positive way.

    I really appreciated hearing about the girl who had asked to be in a foster home. You have reminded me to be really on the look out for these little phrases, which can easily go unnoticed in referral reports about acts of aggression or self-harm. I loved hearing about her value of justice. Thank you for the questions you offered. You have given me an idea for someone I am working with at the moment.

    Warmest wishes,

    Loretta

  13. Dear Georgios:

    Thanks a lot for your questions and for dedicate time to see my video presentation.

    In relation with your first question I have to say that I am still on the process of transform ways of work in the foster homes of our Association. It is a slowly but fructiferous journey. It is more difficult in the so called Homes of Judicial Measures (homes for adolescents who have committed some kind of acts of crime and that they have to comply with a court order) because in these cases the workers think these adolescents deserve to be punished for what they did.

    As you can imagine what prevails is the behavioral point of view. It is needed to work on the idea of rescue values and dreams, and facilitate that all of this should be seen by workers in order to break the stigma. Another future is offered to adolescents and workers could be proud of that. So I still need show how narrative perspective of work is effective and that is through everyday practice.

    In relation with your second question, why I separate the evaluation in three parts, this is because the process of reception and egress of a child in our Foster Home. In a first moment the child is derived by social services with a psychological record full of diagnosis (using DSM model). We never have received a child with a psychological record based on his or her strengths. This is the Initial Narrative Evaluation, the rescue of the unsaid.

    The second part is the everyday of the child and how we can make a difference with our diverse narrative techniques. Here is when I focused the work in connect adolescents with workers. Here I also use to practice therapy with the children and the adolescents.

    Finally, the third stage is when the child has to move to another social resource or finish the court order or the child reach the adulthood (18 years) and has to leave the Foster Home for that reason. Then is time to definitional ceremony or a farewell ceremony listening what the workers have learned of them in all the time their living in the Foster Home.

    I hope my answers have given you some response in some way to your questions. We could keep in touch if you need more information. Please do not hesitate to write me to: [email protected].

    Thank you again

    Carlos

  14. Hola Carlos,

    Es un gran gusto escucharte a través de tus ideas.

    Aprecio lo que para mi representan tus ideas: el respeto hacia las personas jóvenes y quienes trabajan con ellas como sus cuidadores.

    Me parece fantástica la práctica de incluir a éstas últimas en el proceso de trabajo en su posición de testigos. En el contexto de nuestra práctica en San Antonio, Tejas, es bastante común que trabajemos con personas jóvenes y sus familias quienes estan involucradas con el departamento de protección de menores. Madres y padres tienen adjudicada/os una persona trabajadora social quien esta a cargo del seguimiento de su caso para determinar, ante sus ojos, basadas en lo explícito y siguiendo la ley, cuáles son las mejores condiciones para la persona menor. Por circumstancias que tu bien mencionas, no es poco común que estas familias salgan bien libradas del estígma que representa estar en esas condiciones, a ésto se le agregan las complejidades migratorias de esta área.

    Tu trabajo de involucrar a las personas trabajadoras sociales, en nuestro caso, nos ofrece una plataforma para que colectivamente, tanto las familias como ellas, evalúen el efecto que estos estigmas culturales, sociales e históricos estan teniendo en su proceso, interponiéndose de esta manera en el propósito común del bienestar por las personas menores.

    Me has dejado además con una reflexión en mente: Si bien considero que las prácticas narrativas transitan fuera de la márgen de prácticas dominantes y “tradicionales,” éstas pueden migrar dentro de contextos tradicionales, ofreciendo alternativas para transformarlos en prácticas mas solidarias y respetuosas!!!

    Gracias por extendernos tu trabajo, Carlos!

    Quedo con ansias de conocer mas sobre tu trabajo…..Hasta pronto!

    marcela

  15. Dear Carlos,

    Thank you for the informative and inspiring presentation! When you talked about an “evaluation”, I thought you would offer some diagnostic procedure, which would not fit the narrative ideas that I know of.

    Listening to what you said, I found out that you are talking about a new way of approaching children and adolescents that is relevant not only to the children and adolescents but also to the people that work with them. I wonder if you met any obstacles in your efforts to change their views towards a narrative perspective. How did you deal with these?

    What stroke my curiosity is the fact that you split the process in three parts. I did not understand how you did that. I mean, in all three parts, you are doing many things. So what is the point of an Initial, a Continuous and a Final evaluation?

    Keep up the good work! We all try to smile.