(En inglés)

Open Doors

Chapter 11c: Reflective Practice Experience It

Lillian Sugarman: There was a second role play that Rebecca and her group did about a home visitor who had a mom who wouldn't consistently let her in the door. The home visitor was venting about this experience with Rebecca as her reflective supervisor, and Rebecca validated her feelings of frustration and used a role-reversal strategy to help the home visitor problem-solve how she might address the situation. The group went through this exercise and then talked about it. So let's take a look at this. 

Rebecca: You're coming with one agenda. 

Kia: Mm-hmm.

Rebecca: She wants some relief.

Kia: Mm-hmm.

Rebecca: So, we have to find a bridge from where she is to where you are, and that bridge may take some time.

Kia: Yeah.

Rebecca: What do you say when you call?

Kia: I say, "Hello, this is your home visitor. We have an appointment scheduled for tomorrow. Will you be available?"

Rebecca: And then I'd say, "Yeah, I'm going to be home."

Kia: Yes. 

Rebecca: "Where else am I going to go?"

Kia: Right. If she picks up, she says, "Yeah, so I'll be here." And if she doesn't pick up, then of course I leave a message similar to that and ask her if she will call me back. 

Rebecca: Okay, so let's take a deep breath. I'd like you to pretend that you are her, and I'm going to be you for a minute, and I'm going to make that phone call. I'm going to try to pretend to be you. 

Kia: Okay. 

Rebecca: Okay. And I'd like you then to hear it and tell me what I could have said on the phone that might get you to open the door. I want you to hear me from a critical point of view. 

Kia: Okay.

Rebecca: Okay. Hello, Jennifer?

Kia: Hi.

Rebecca: Hi. This is your home visitor, and I just want you to know that we have an appointment. I want to remind you that we have an appointment tomorrow at 2:00. Are you going to be home? 

Kia: Yes, I'll be home.

Rebecca: Okay. So I'll see you around 2:00 then.

Kia: Okay.

Rebecca: Okay. Thanks a lot.

Kia: All right. Bye.

Rebecca: Bye-bye.

Rebecca: How do you feel?

Kia: It's kind of funny. It's kind of like you're just calling me, because you have to. You're just coming to the house because you have to, not because you want to see me and you want to spend time with my children. You were just doing your scheduled visit like you do with everybody else that you have to interact with.

Rebecca: Is that true about why you want to go?

Kia: No, not at all.

Rebecca: What's true?

Kia: The truth is I really care about this family, and I really am deeply concerned.

Rebecca: Okay. So there's -- we're identifying something really important, that there is a gap between what you feel and intend and what she's likely to be understanding. So, we need to build a bridge. We can't change her right now. 

Kia: Right.

Rebecca: So, I'm going to call you up again. And you're Jennifer, and I'm going to say... Okay. Okay, so... Hello, Jennifer? Kia: Hello.

Rebecca: Hi. This is Rebecca.

Kia: Hi, Rebecca. How are you?

Rebecca: Hi. I'm well. I've been thinking about you.

Kia: Oh, really?

Rebecca: Yeah. How are you doing?

Kia: Oh, I'm good.

Rebecca: Yeah?

Kia: Yeah, I'm doing well.

Rebecca: I was thinking about you and how hard you're working and I'm calling to just let you know that we have an appointment tomorrow, and I'm wondering if that's convenient for you. 

Kia: Tomorrow's not really convenient. I don't -- I don't think I can make the appointment tomorrow.

Rebecca: Uh-huh. What would be better for you?

Kia: Can we reschedule maybe for later on in the week?

Rebecca: Mm-hmm. Hang on. Let me just look at my calendar.

Kia: Okay.

Rebecca: Could Friday work?

Kia: Yes, I think Friday could work.

Rebecca: Around what time would work?

Kia: Could you come around, 11:00?

Rebecca: Mm, I can't do 11:00, but I could do 1:00.

Kia: Okay. Okay.

Rebecca: That would be okay?

Kia: Mm-hmm.

Rebecca: Okay. Is there anything I could pick up for you on the way?

KIA: Oh, um, no, no, there's nothing I need at the moment, but thank you for asking.

Rebecca: You're welcome. Okay, would you like me to call and remind you, or you think you'll remember?

Kia: I'll remember.

Rebecca: Okay. All right, then. See you on Friday.

Kia: Thank you.

Rebecca: Bye.

Kia: Bye.

Rebecca: So, how did that feel?

Kia: It felt like you actually cared about what was, one, convenient for me, two, how I was feeling, and then you went the next step and actually asked if I needed something.

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(En inglés)

Open Doors

Chapter 11b: Reflective Practice Experience It

Kraig: I would say that we have built a system around home visitors to be very supportive. In the last couple of years, particularly since ARRA, we have reduced our supervisor-to-staff ratio. Before, it was me and one other person for 12 people. Now, the ratio is about one supervisor for four. We've also spent a lot of time building teams, so that they can talk to each other and put them in offices together and said, "You have to have office time and access your supervisor." The other part of that is we've built a management team that's very responsive.

I'm available from an administrative perspective, but we also have health staff that are available and social work staff that are available and mental health staff and nutrition staff, so if they have questions that -- and that's the other thing we've been very honest about is if you don't know the answer then don't make anything up. [Chuckles] You know, be honest and call and tell the parents you don't know the answer and find the answer, and if that's us, then that's us, but then find the answer you can get back to them. So, we've built in a lot of that kind of very basic support, but I think the families or home visitors dealing with, you know, we've got a pregnant mom and she's spotting, then, that's something that needs to be dealt with now, and we have somebody that right then can deal with that and can make a call and say, "Yeah, this is what needs to happen." And home visitors have gotten comfortable now in resourcing that and have learned, you know.

For new home visitors, it's very good to have that. The older ones now understand that, okay, if this is what's happening, this is my recommendation, this is what I need to do. And so, it's kind of a capacity building all the way up from, you know, new employees that are coming in that don't have a lot of skills, all the way up to, you know, the management level being able to articulate and get that information out.

I think some of the things that the home visitors face today are very different. 

We have home visitors that have exposure to violence. We have home visitors that are exposed to substance use and home visitors that have to deal with some significant mental health issues. And some of that is working with the courts, and some of that is reporting and, you know, maltreatment of minors and neglect, minors and neglect, and they deal with issues of children that are not developing for a lot of different reasons, and mostly it's environmental. You know, and we routinely have those discussions with families. You know, if there's not food in the house and the child isn't growing, we have people that are looking in cupboards and saying, "Okay, what's going on here? We need to address this."

You know, and the same can be said for moms that moms or dads -- and that's the other piece, is there are dads I mean, we have dads in the program we try to include them, but if we're in a house and there's domestic violence and it's you can see it and it's going on, there's referrals, and things have to happen. Sometimes, that happens on the walk out to the car, because you don't want to do that in front of other people. You know, and substance use is the same thing if you're in a house and you're smelling things or you're seeing things, those are things that we report and have to deal with. And, of course, all of that is done up front.

You know, parents know that we're reporting that we have to report, and I make that very clear to staff that this is part of your job, and you don't want to lose your job, because you didn't do something because you didn't do something and, you know, it's somebody else's job to figure out what  that is, you know. I can talk about teen moms and we have teen moms that really love their kids, they don't have any idea what parenting is or how to raise children and those are things that you really have to spend time with, so much so that you have to, you know talk about changing diapers. It's an importa -- I mean, very basic kinds of things that, you know, most folks won't even think about, but it's like, "Okay, it's time." It's not how to change, but it's time, and it's time to give a bath and it's time to feed so it's very basic things. And we've started building in supports around mental health for that.

You know, part of that is we've done training around DC Zero to Three and recognizing -- staff recognizing that children that are not sleeping, that are not sleeping with any amount of time that have eating issues, have elimination issues all of those things in infants and toddlers can be clues to a lot of serious kind of issues that are in the house and issues that, you know if you've worked with parents you can deal with some of those things, before they become bigger things you know, bigger problems.

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