Workshop 5: Relationship-based Practices

College of Education and Human Services

Center for Autism and Early Childhood Mental Health

Workshop 5: Relationship-based Practices

Overview of Topic

This session will help participants recognize the importance of supporting and

fostering the primary relationships in a child’s life. We will consider the importance of

relationships and emotional connections as fundamental to work with infants, young

children, and families. Participants will come to understand the importance of

understanding their relationship with the child and with the child’s family and how to

strengthen these connections on behalf of parent/child relationships. The implications

of relationship-based work including the concepts of parallel process and use of “self”

will be discussed. We will consider ways to build strong relationships in our work

while also maintaining professional and emotional boundaries.

The session will also include an introduction to the NJ Pyramid Model

Partnership which provides a framework for supporting the social and emotional

well-being of infants, young children, and families. The mission of this initiative is to create

an integrated approach which supports all who work with infants, young children, and

their families.

Recommended Duration: 3 hours

New Jersey Birth to Three Early Learning Standards

Domain I: Social & Emotional Development

Components: Relationships with Peers and Adults

Michigan Association for Infant Mental Health Competency Guidelines

Theoretical Foundations

Knowledge Areas: Infant/very young child & family centered practice

Relationship-focused practice

Family relationships & dynamics

Cultural competence

Learning Objectives

1.

Participants will learn to examine ways in which they form relationships with

young children and families.

2.

Participants will learn about the distinction between “how” we are and what

we “do” in our work with families, and learn ways to use your “self” in

relationship-based work.

3.

Participants will learn about the importance of establishing helping

relationships in which they can maintain professional and emotional

boundaries.

LITTLE JOE ACTIVITY

Reflect quietly and think about your fist impressions of this picture of a

man and an infant.

Break out in your small group and:

1. Describe your impressions of this man and infant with your group

2.

What do you want to know more about? What are you

“WONDERING”?

3.

How are you going to begin your working relationship with this

man and infant?

4.

Think about our 2 Key Questions for Reflection-



What about the baby?



What is being stirred up in me?

5.

What does this person need to know about you and the

agency/program you represent?

Adapted from: Touchpoints Faculty Level Training Curriculum

College of Education and Human Services

Center for Autism and Early Childhood Mental Health

Voice: 973-655-6685

Fax: 973-655-5376

WHAT WOULD YOU DO? Situations for Reflection

Situation 1

You are on a home visit. A mother is changing an infant’s diaper and seems not to

respond to the crying infant – then speaks harshly to the child saying, “What are you

crying for? I’m not killing you.”

Situation 2

You meet a dad for the first time and he is very agitated and upset. He tells you that he

has heard bad things about your program and wants you to know that he has heard from

other parents that he won’t get what his son needs, other programs give more services and

“you people don’t know what you’re doing”.

Situation 3

You see a parent in the supermarket and the parent asks you for a ride home. It is raining

very hard and almost dark out. The mother has her infant and 3 year old with her. You

will drive right by where the family lives on your way home. You agree and the parent

then invites you in for coffee and cake to thank you for the ride.

Situation 4

You are working with a family who is rebuilding their home following damage from

Superstorm Sandy. They are upset with the many delays and long waiting lists for help.

They have a 6 month old infant and an 18 month old toddler. The mother and father are

both stressed and anxious about the costs of rebuilding their home. The toddler has been

having tantrums and sleeping problems.

College of Education and Human Services

Center for Autism and Early Childhood Mental Health

Voice: 973-655-6685

Fax: 973-655-5376

l

Situation 5

A family you work with has a 3 year old boy who reminds you of your son at that age.

You enjoy working with him and his mother tells you he often talks about you. She

describes him as being “difficult and spoiled”. You notice she does not give him

attention unless it is to criticize or discipline him.

Situation 6

You are working with a mother who has children around the same ages as your own

children. You know the family is struggling financially since the father lost his job

following Superstorm Sandy. You have bags of children’s clothing that is in good

condition and you have been meaning to donate. Do you offer the clothing to this

family?

Situation 7

A family you are working with has a 2 year old who was in the room when his

grandfather had a massive stroke. His grandmother was his primary caregiver while his

parents worked. The grandmother now spends her days at a rehab center with the

grandfather. A neighbor is babysitting on a temporary basis. The 2 year old cries easily

and has started to hit the family’s dog.

•

How does this situation make you feel?

•

What do you think the parent is feeling?

•

What about the baby?

•

What can you do in this situation?

•

Can anyone else help?

College of Education and Human Services

Center for Autism and Early Childhood Mental Health

Questions to Help Us Wonder About Our

Feelings, Reactions, Responses in

Relationship-based Work

From: Parlakian, R. (2001). The power of questions: Building quality relationships

with families. Washington, DC: ZERO TO THREE.

•

How do I feel about this person?

•

What about this person rubs me the wrong way?

•

Who does this person remind me of?

•

Why do I identify with them so strongly?

•

How are we alike/different?

•

What is it like to be this person? What is his/her

experience?

•

What can I do to stop myself from immediately

reacting?

•

What does the request mean? (Does it mean the

College of Education and Human Services

Center for Autism and Early Childhood Mental Health

•

How does this request make me feel? Am I flattered,

uncomfortable, pleased?

•

If I fulfill this request, am I likely to feel differently

about the family (less objective)?

•

What would be the impact of the request if I fulfill it?

•

Given what I know about this family, what need is

the request fulfilling? Is it appropriate for me to be

the one to fulfill this need? Is there a way I can help

the family fulfill this need themselves?

In 2012, the Infant and Early Childhood Mental Health subcommittee of

the New Jersey Council for Young Children developed a goal to fund,

promote and implement The Pyramid Model statewide for ages 0-8

years old. This led to the creation of the New Jersey Pyramid Model

Partnership Team.

The Pyramid Model for Supporting Social-Emotional Competence in

Infants and Young Children is a conceptual model of evidence-based

practices for promoting young children’s social-emotional competence

and preventing and addressing challenging behavior.

Overview:

The project was started in 2009 with a

shared vision of increasing the social

emotional competency of infants and

young children across New Jersey through

the implementation of The Pyramid Model.

This evidence-based model represents a

sound framework for early care and

educator systems that was developed by

two national training centers:



The Technical Assistance Center on Social Emotional

Interventions for Young Children (TACSEI) funded by the Office

of Special Education Programs at USDOE and;



The Center on the Social and Emotional Foundations for Early

Learning (CSEFEL) funded by the Office of Head Start and the

Office of Child Care, Administration for Children and Families,

U.S. Department of Health and Human Services

The New Jersey Pyramid Model Partnership team is putting in place the

mechanisms required to adopt, implement, and sustain the Pyramid

Model in the state of New Jersey. The New Jersey Pyramid Model

Partnership will work closely with the New Jersey Association for

Infant Mental Health and other entities concerned about the optimal

development of infants and children, birth to age 8, their families, and

other caregivers.

Projected Results:



Increase self-regulation, social skills and positive behaviors in

infants and young children.



Enhance awareness of the significance of infant and early

childhood mental health.



Strengthen family participation in the development of

social-emotional competence in infants and young children.

New Jersey Pyramid Model

Partnership

New Jersey’s Vision:

All infants and young children

ages 0-8 in New Jersey will

have the opportunity to

develop social emotional

competence.

New Jersey’s Mission:

The Pyramid Model

Partnership of New Jersey will

create an integrated approach

using the Pyramid Model that

will support all who work with

infants and young children age

0-8 and their families to

develop social emotional

competence.

G

oals:

1.

To develop and maintain an

interagency, collaborative

state leadership team to

develop policies,

procedures, and other

mechanisms to plan,

implement, evaluate, and

sustain a standardized

professional development

system that supports the

use of The Pyramid Model

and practices;

2.

To provide the early

childhood community with

the support needed to

implement The Pyramid

Model with fidelity;

3.

To ensure families are

knowledgeable about and

have access to programs

that implement The

Pyramid Model; and

4.

To ensure that the public

and private funding

sources recognize The

Pyramid Model as an

evidence-based approach

that promotes the healthy

social and emotional

development of infants and

Relationship Based Practices

Part of a series funded by:

The New Jersey Department of Children and

Families

1

Developed by:

Gerard Costa, Ph.D.,IMH-E®IV, Clinical Mentor Director

Lorri Sullivan, M.Ed., IMH-E®IV, Research/Faculty Curriculum Coordinator

Kaitlin Mulcahy, LPC, IMH-E® IV, Clinical Mentor, Associate Director

No part of this material may be copied without the express permission of: The Center for Autism and

Early Childhood Mental Health

“Keeping Babies & Young Children in Mind” Workshop 1: In the Beginning – What Happens Early Matters Workshop 2: Infant & Early Childhood Development

Workshop 3: The Language of Behavior

Workshop 4: Encountering Early Stress and the Power of Meaningful Connections

Workshop 5: Relationship-based Practices Workshop 6: Me, My Family, My Community Workshop 7: Reflective Practices: Caring for Ourselves

A Developmental Perspective

4

Maintains that all development unfolds over time and is profoundly organized by the nature of attachment relationships.

Human development is patterned (stages of development have certain skills and characteristics that cluster together) and is sequential (follows an order of unfolding).

Development during earlier periods influences the course and outcome of later periods.

A Relational Perspective

5

Development occurs within the context of relationships.

These relationships influence who we become, and are becoming,on many levels, including: biological, emotional, and psychological.

The Main Point

6

All development in all

areas unfolds within

the

Context of

Group Activity

7

Discuss the meaning of the word:

NURTURING

8

Think about a nurturing relationship

in your own life - one that makes

you feel special.

Think about a time you spent

together.

NOTE THAT

9

Nobody said, “Someone who told

me what to do or someone who

gave me advice”

Nurturing, usually…..

10

does not involve skills development does not focus on problem-solving does not focus on weaknesses involves preparedness and support

provides a “holding environment” for growth addresses the first three points

-Based on Bernstein, 1998.

Parallel Processes in Relationships

11

Child/family

Worker

Affective Experiences can occur from the child and family to the worker, or vice-versa.

In Relationship-based work we must engage in

Active Listening

12

Using not just our ears, but our intellect, feelings, verbal and physical responses to give us information about the interaction Convey a sense of genuine connectedness -consider the concept of attunement

STOP LOOK LISTEN RESPOND

Relationship-building

13

Three Stages of Relationships in

Gentle Teaching PRESENCE PARTICIPATION SHARING OF VALUES

Projective Identification



The notion that another person can

“induce” in us, something about

what it feels like to be him/her.



“Resonance”

Relationship-based Practices

Based on the notions that:

• Life begins within the context of a relationship

• Families are supported by the nature of our

helping relationships

• The nature of our work must activate feelings within us that influence how we are and what we do - AND these must be attended to.

Implications of Relationship-Based Work

We must attend to the needs of the helper. All relationships are largely experienced, expressed

and enacted on non-verbal (even pre-verbal) levels.

The use of “Self”-WE ARE THE AGENTS OF

CHANGE.

G.Costa, Ph.D.

Three Major Influences on Adults who work with infants and young children

17

The nature of their our childhood.

Their ability to recallgood and bad events and

feel the feelings again.

Their ability to separate adult needs, problems, feelings and thoughts from those of the infants and children.

18

Little Joe Activity

19

 Adapted from: Brazelton Touchpoints Faculty Level Training

20

Partnership

21

1. The state of being a partner.

2. A relationship between individuals or groups that is characterized by mutual cooperation and responsibility, for the achievement of a specified goal.

From: The American Heritage Dictionary of the English Language, 4thEdition. Houghton Mifflin Company, 2000.

Mental Health Work and Our Subjective Experiences

22

Our subjective experiences and

feelings about the infants,

children and families we work

with, has a profound, but often

unexamined impact on our work.

Vote With Your Feet Activity

23

TOUCHPOINTS PARENT ASSUMPTIONS

24

1) The Parent Is The Expert On His/Her Child 2) All Parents Want To Do Well By Their Child 3) All Parents Have Strengths

TOUCHPOINTS PARENT ASSUMPTIONS

25

4) All Parents Have Something Critical To Share At Each Developmental Stage 5) All Parents Have Ambivalent Feelings 6) Parenting Is A Process Built On Trial

and Error

What Families Bring

A personal perspective & important information.

They usually know what works best or doesn’t work for their child.

Communication that is jargon free and helpful in

communicating across disciplines.

Knowledge & understanding of the strengths and

needs of family members-critical to the success or failure of any service plans.

From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together, 2000.

What Families Bring

An emotional investment over time-the family is the constant. Service providers may come and go. Ability to monitor progress or regressions. If they are satisfied consumers, families are the

best advocates an agency or professional can have.

From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together, 2000.

28

Thinking About Professionals

What Professionals Bring

29

A body of knowledge that draws upon well

established theories and approaches.

Legitimacy and sanction of their work via:

education, certification, licensing or credentialing.

From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together, 2000

.

What Professionals Bring

30

A code of ethics allowing them to set standards of behavior. These codes offer protections to families i.e.:

confidentiality, child abuse/neglect

Professionals can make the transformation to defining family members as included in their culture of “helpers”.

From: Learning from Colleagues: Family-Professional Partnerships Moving Forward Together, 2000.

Guiding Principles

1) Value and understand the relationship between you and the parent

2) Use the behavior of the child as your language

3) Recognize what you bring to the interaction 4) Be willing to discuss matters that go beyond your

traditional role

31

Guiding Principles

Value passion wherever you find it

 Focus on the parent-child relationship

Look for opportunities to support parental mastery

 Value disorganization and vulnerability as an opportunity…… 32 Practitioner Assumptions 33

•Each practitioner is the expertwithin the context of his/her practice setting

•Practitioners wantto be competent

•Practitioners need supportand respect of the kind we are asking them to give to parents

•Practitioners need to reflect on theircontribution to parent-provider interactions

Touchpoints-Relational Framework

to join with a parent to form a supportive alliance. Central to effective anticipatory guidance is

collaboration between the parent and the provider.

Interactions focus on parental strengths.

34

TOUCHPOINTS: PARALLELS BETWEEN PARENTS AND PROFESSIONALS

PARENT PROFESSIONAL KNOWLEDGE their child’s development and

individuality process of typical and atypical child development

ABILITY parenting skills nurturing ability observational skills reflective ability interpersonal communication skills observational skills reflective ability

CONTEXT nurturing history social support/stress in parenting

role

own nurturing history supportive/stressful work

environment

35

Bodies & Feelings Activity

Parallel Processes in Relationships

Affective experiences & transference can occur from the family to the work OR from the worker to the child/family

37

Parallel Processes in Relationships

REMEMBER………

Affective experiences & feelings can pass from the child/family to the provider

OR

From the provider to the child/family

Remember………..

39

“How you are is as important as

what you do”

Building Relationships with Parents

Look

Listen

Learn

40

Ways to Build Strong Relationships

41

Use what you

know

Point out the

positive

Take time to listen From: Lerner, C., Dumbro, A., Powers, S.

(2001). Learning and Growing Together Kit. Washington, DC: ZERO TO THREE Acknowledge parents’ feelings Refocus issues on the child Understand the parent’s view of their child

Ask for HELP

Questions to Ask-Wonder About Your

Reactions and Feelings

42

 How do I feel about this person?

 What about this person rubs me the wrong way?

 Who does this person remind me of?

 Why do I identify with them so strongly?

 How are we alike/different?

 What is it like to be this person? What is his/her experience?

Questions to Think About

43

What does the request mean? (Does it mean the family considers me a friend?)

How does this request make me feel? Am I flattered, uncomfortable, pleased?

If I fulfill this request, am I likely to feel differently about the family (less objective)?

What would be the impact of the request if I fulfill it?

Given what I know about this family, what need is the request fulfilling? Is it appropriate for me to be the one to fulfill this need? Is there a way I can help the family fulfill this need themselves?

From: Parlakian, R. (2001). The Power of questions: Building quality relationships with families. Washington, DC: Zero to Three.

44

Boundaries in Our Work

Notion of Boundaries

45

Our Goal:

To establish helping relationships where we can achieve optimal distance - being empathic and sensitive, without being too close or too distant in our relationship with families.

Notion of Boundaries Important Considerations

46

Privacy & Confidentiality

Self –Disclosure Respectful/ Non-intrusive/ non-judgmental posture Setting limits Intrusive/Invasive procedures

Parental Involvement & Shared roles

Expectations of colleagues & team members

Challenges posed by high

need, over-controlling, demanding families in difficult situations

47

Don’t “own” all the problems of the system

Maintain awareness that “transferences”

occur.

 Sometimes we are treated “as if” we were the problem, the hurtful other, when families have needs which are not being met.

W H A T W O U L D Y O U D O ?

Group Activity

What Would You Do?

49

How does this situation make you feel? What do you think the parent is feeling? What about the baby?

What can you do in this situation? Can anyone else help?

Consider the options and consequences……

Situation 1

50

You are on a home visit. A mother is changing an infant’s diaper and seems not to respond to the crying infant – then speaks harshly to the child saying, “What are you crying for? I’m not killing you.”

Situation 2

You meet a dad for the first time and he is very agitated and upset. He tells you that he has heard bad things about your program and wants you to know that he has heard from other parents that he won’t get what his son needs, other programs give more services and “you people don’t know what you’re doing”.

Situation 3

52

You see a parent in the supermarket and the parent asks you for a ride home. It is raining very hard and almost dark out. The mother has her infant and 3 year old with her. You will drive right by where the family lives on your way home.

You agree and the parent then invites you in for coffee and cake to thank you.

Situation 4

You are working with a family who is rebuilding their home following damage from Superstorm Sandy. They are upset with the many delays and long waiting lists for help. They have a 6 month old infant and an 18 month old toddler. The mother and father are both stressed and anxious about the costs of rebuilding their home. The toddler has been having tantrums and sleep problems.

53

Situation 5

54

A family you work with has a 3 year old boy who reminds you of your son at that age. You enjoy working with him and his mother tells you he often talks about you. She describes him as being “difficult and spoiled”. You notice she does not give him attention unless it is to criticize or discipline him.

Situation 6

55

You are working with a mother who has children around the same ages as your own children. You notice the children’s clothing is worn and does not fit well. You know the family has limited resources. You have bags of children’s clothing that is in good condition and you have been meaning to donate. Do you offer the clothing to this family?

Situation 7

A family you are working with has a 2 year old who was in the room when his grandfather had a massive stroke. His grandmother was his primary caregiver while his parents worked. The grandmother now spends her days at a rehab center with the grandfather. A neighbor is babysitting on a temporary basis. The 2 year old cries easily and has started to hit the family dog.

56

Red Flags

Indicators that the helpful

nature of your relationship with

a child/family, may be

compromised.

RED FLAGS

Frequently sharing

personal information and opinions

Providing home phone number for contact

Giving up personal time

to be with families or to attend to their needs

Your family expresses

anger, resentment or concern about the time spent with cases or the effects on your life.

The 2:00am agenda

Wanting to bring gifts, food, lend money or give rides.

RED FLAGS

• Unable to get notes or paperwork done.

• Rescheduling client appointments to accommodate elongated time with other clients

• Feeling personally distressed, “frazzled”, forgetful and in crisis

• Unable to change pace of intervention when needed or to be flexible or more available at times of true crisis or concern

• Showing up late for appointments or “no-shows”

• Avoiding phone calls, dread around phone

60 Blaming family for lack or progress Teaching and Advising primary mode of

communicating

Unwilling to accept refreshments or to meet other members of family

Feeling detached, bored, or burdened much of the time.

61

When Helping Relationships

Become Difficult

When Helping Relationships become Difficult 62

Acknowledge the difficulty. Comment on the obvious. This slows you down and helps establish reflection vs. reaction.

Pay attention to yourself. “Get in Cahoots with Yourself”…. If you are aware of very strong feelings, ask for a

momentary pause, or create a distraction for yourself.

Adopt a non-confrontational posture

Meet the child/family where they are. Avoid casting

relationships into “win” or “lose”

63

Actively listen. Focus on the emotion and belief behind the words and state those. Let the other take the lead for the moment. Listen, don’t interrupt. We all need to be heard.

Establish guidelines for discourse. State clearly and calmly that you do not want to be spoken to in harsh or threatening ways, but allow and accept every emotion expressed.

Recognize that under stress “fault lines appear” and we rely on our “character” more than our knowledge or skill.

64

•Show care & concern even in the face of mistreatment. (don’t dish back)

•Keep our word. Follow up if we say we will

•Acknowledge our mistakes & apologize

•Engage in respectful pursuit

65

What Can We Do to Support

Staff?

What Can We Do To Support Staff?

66

We should employ a variety of formal and informal – individual and group – methods to monitor our responses to clients and to

67

Clinical supervision– reflective, routine, consistent

Team meetingswith focus on case presentations and discussion

68

Planned conferences and workshops–

Education/Training

Collegial support– formal and informal gatherings (e.g. brown-bag lunch, networking with other agencies, phone support, etc.)

69



Mental health consultation

services

Take Home Messages

70

 Relationships are the key to development and often involve “parallel process”

 Helping relationships involve “optimal distance” and attention to “red flags”

 Relationships withy families may contain challenges that require thoughtful, principled responses

 This work engages our “minds” and our “hearts”

New Jersey’s Pyramid Model Partnership

71

•

A Framework for Supporting

the Social Emotional

Well-Being of Infants, Young

Children, and Families

NJ Pyramid Model Partnership

72



Vision:

All infants and young

children ages 0-8 in New Jersey

will have the opportunity to

develop social emotional

competence

NJ Pyramid Model Partnership

73

Mission: Utilizing The Pyramid Model, the NJ Pyramid Model Partnership will create an integrated approach to support all who work with infants and young children ages 0-8 and their families to develop social emotional competence

74 http://csefel.vanderbilt.edu

Anticipated Results

75

Increase self-regulation, social skills and positive behaviors in infants and young children

Enhance awareness of the significance of infant and early childhood mental health

Strengthen family participation in the development of social-emotional competence in infants and young children

Increase the number of high quality programs available to families of infants and young children

Center for Autism and Early Childhood Mental Health

Montclair State University

College of Education and Human

Services

1 Normal Avenue Montclair State University Montclair, New Jersey 07043

973-655-6685 Fax: 973-655-5376 Email: [email protected]

Website: www.montclair.edu