Consultation 2

Generic Model of Consultation

(1) Entry (2) Diagnosis (3) Implementation (4) Disengagement

Factors that Aid Adoption

-Compatibility - aids assimilation -Simplicity - Free of jargon, clear -Testability - Prove we/ evidence of effectiveness -Observability - what are the signs this is working? -Relative advantage - How will changes help org compared to traditional approach? often diversity implementation is LOW on compatibility, simplicity and observability, but HIGH on testability and relative advantage.

4 Stages of Change in Consultee's Problem

-Development (problem begins) --Maintenance (problem established) -Declining (problem gets worse) -Crisis stage (consultee in need of immediate assistance) -> Consultant must ask questions to figure out where consultee is

Methods for Gathering Information

-Documents / Records - records, written communication, free from response bias (but can also be incomplete) -Questionnaires + Surveys - typically standardized or modified slightly to needs, good b/c easy to survey large number, many administrative forms (but also can produce "canned" results) -Interviews - formal / informal, group interviews, structured / unstructured; are adaptive + provide detaield info, but also influenced by bias -Observation - naturalistic (observation with an environment) and systematic direct (using a standard method to measure behavior); advantage is that it has data on behavior vs reports of behavior, but only gives info at one moment in time + observer effect

Multicultural School Consultation (Ingraham)

-Domains for consultant learning and development (e.g., understanding cultural context for consultation) -Domains of consultee learning and development (e.g., avoiding overemphasis on culture) -Cultural variations in consultation constellation (e.g., taking into account cultural differences among consultant, consultee, and client system) -Contextual and power influences (e.g., minimizing power differentials between consultant and consultee) -Hypothesized methods for supporting consultee and client success (e.g., using consultation methods matched with consultee's style)

Summative Evaluation

-Evaluation of outcomes or products - assesses how well consultation worked out; consultees use summative evaluation to determine if the objectives of consultations were met

3 Steps in Formation of Evaluation Criteria

-Formation of Criteria - goals that will be used to assess consultation -Assessment of Attainment of the Criteria - systematically determining what, how, and by whom informaiton is gathered -Utilizaiton of results - disseminating results to appropriate parties, for decision making

Data / Information Types

-Genetic Data - easily accessible, common info (e..g mission statement) -Current Descriptive Data - describes org as currently exists, layout + structures -Process Data - involve the organizations methods, how decisions are made etc. -Interpretative Data - Subjective and emotional; believes, perceptions, relations -Consultee - Dynamic b/w client system + consultee -Client system behavior data - characteristics of client system

Biases in Evaluation Survey Measures

-Leniency bias -Strictness bias -Central tendency bias -Halo Effect -Contrast Effect

Elaboration Likelihood Model (ELM) model of Interpersonal Influence

-Offers a method to make sense of the antecedents and consequences of attitude change -Examining underlying assumptions of the consultant's informational; non-thoughtful processes rely on the idea that the inofrmation makes the consultee pleased or that consultee just does what the consultant wants -Consultant works best when consultees are involved and motivated to consider information reflectively

4 Goals of Team Building (per Beckhard)

-set goals or priorities -analyze or allocate the way work is performed members' roles and responsibilities -to examine the way the team is working - processes, policies, norms, decision-making, communications, leadership, problem-solving -examine relationships among the team members

Implementation Stage Phases

1) Choosing an Intervention 2) Formulating a Plan 3) Implementing the Plan 4) Evaluating the Plan

Phases of Disengagement Stage

1) Evaluating the Consultation Process 2) Planning Postconsultation / Postcollaboration Matters 3) Reducing Involvement and Following Up 4) Terminating

Phases of Diagnosis Stage

1) Gathering Information 2) Defining the Problem 3) Setting Goals 4) Generating Possible Interventions

Areas of Ethical Consideration (Summary)

1) the consultant-client relationship: a work-related focus,no dual relationships, freedom of choice, confidentiality, informed consent 2)Values: aware of your own? Aware of consultee's? Expect some differences. Going beyond "not imposing" to being culturally responsive. 3) Competence: qualified to offer these services? + personal limitations•Rights of Consultees: confidentiality and informed consent 4)Intervention areas: Individual vs. systems-level, Use of data, Empirical validity of interventions 5) Crisis Consultation: client system vulnerability, chaotic environment, culturally diverse reactions to disaster, loss, trauma

Instructional Consultation (Steps - EIOAPT)

1)Establishing collaborative relationship 2)Identifying problem 3) Observing classroom 4)Assessing curriculum-based learning 5)Planning instructional intervention 6) Terminating

Phases of Entry Stage

1. Exploring organizational needs 2. Contracting 3. Physical Enter System 4. Psychological Enter System

Phases of Change

1. Pre contemplation - not sure issue is problematic (skeptical about change, is it worth it, helpless to change) 2. Contemplation - some change talk, some maintenance change; ambivalent 3. Preparation - I want to engage in some change! 4. Action - make and implement 5. Maintenance - have modified plan and are able to keep it up 6. Relapse - aspects of the problem come back

Steps in Setting Goals

1. Specify task / object 2. Specify how task or objective will be measured 3. Specify the target or standard to be reached 4. Specify the time span involved 5. Prioritize possible goals 6. Rate goals w/ respect to difficulty and importance 7. Determine coordination requirements

Ethics: Questions to Assess One's Limitations

1. What can I do, given this situation? 2. What is the right thing to di in this situation? 3. Do I have the ability to do the right thing thing? 4. What is the right thing to do that is in the best interests of the consultee and the org?

Intervention

A force that attempts to modify some outcome

Team Building

A process by which a team's individuals attempt to improve the group's functioning through analyzing and evaluating their interactions; selected interventions to increase team cohesiveness and effectiveness

Definition of Mental Health Consultation (Caplan)

A process of interaction between two professional persons - the consultant who is the specialist and the consultee who invokes the consultant's help in reagrd to a current work problem... the work problem involves the management or treatment of one or more clients of the consultee, or planning orimplementation of a program to cater to such clients Generally: - assists consultee w/ psychological elements of work-related or care-giving problem - happens in short interviews - goal is to improve job performance - cycles of consultation continue indefinitely

Toporek et al

Advocacy competencies in counseling - "can be thought of as the ability, under-standing, and knowledge to carry out advocacy ethically and effectively." Client / student level of advocacy -empowerment: teaching self-advocacy skills, resources to respond to barriers (e.g. helping identify discrimination as a source of stress) -direct advocacy on behalf of client (e.g when a client has been trying to self-advocate but is denied) Community / school level of advocacy -community collaboration: actions in which the counselor and client community collaborate to address a problem and devise an advocacy plan -systems advocacy: the counselor focuses on identifying systemic problems, gaining information and implementing advocacy at a systems level (based on client system but does not necessarily directly effect) Public Arena -public info: the counselor and client community collaborate together in efforts to alert the public to macrolevel issues regarding human dignity. -social political advocacy: focuses on recognizing when a client or client community's problem must be addressed at a policy or legislative level

C-Group

Alderian consultation method - all forces begin with C (consultation, collaboration, clarification, confrontation, cohesion, commitment, changes, concern, caring, confidentiality, and communication) Alterantive to traditional staff development; 4-6 teachers that meet one a week, teachers present problems with individual students and discuss

What is backlash? How should you (as the consultant) respond?

Backlash will always happen to new ideas, it is fueled by fear of change. Should be proactive and prepared for; be wary of a pendulum swing back Do not focus too much on resisters, identify change agents, do not assume a stance of superiority

Martineau & Preskill Best Practices

Best Practices Include.. -Evaluation is an integrated component from the beginning of consultation -Perform evaluation in inquiry mode, with integration of results and then re-evaluation, rather than as a judgment of the OD interventions -Evaluation is both summative and formative -Evaluation captures both qualitative and quantitative aspects of change -Evaluation takes a systems approach -attends to overall process of learning and change throughout the organization as a result of the intervention -Evaluation is different for every OD intervention

Toporek - The Case of Mila

Client / Student Level - Empowerment + Advocacy: -Increasing Mila's awareness of power dynamics, institutional/social barriers -Recognize individual control, build allied support -Involved Mila in planning (respected wishes not to directly confront bullies) Community / School Level - community + systems advocacy: -Spoke with administrators -Made temporary plan to have staff member escort to bathroom -Learned from principle about insufficient resources -Held community fundraising events -Broad-based antibullying campaign Public Arena - public info + social political advocacy -

Instructional Consultation

Collaborative process in which problem is identified and interventions are selected and made Goal: increase student and staff performance regarding student academic and behavioral

Psychodynamic Approach to Mental Health Consultation

Considers.... -unconcious motivation -childhood experiences -symptom substitution (root of the problem not addressed)

Dual Relationships in Consulting

Consultant has more than one role with another person Common examples of secondary roles are counselor/psychologist and supervisor

Martineau & Preskill (why is it hard to evaluate?)

Consultants have a hard time evaluating their own work because of... -Lack of training/knowledge regarding evaluation -Approaches are too narrowly restricted to quantitative, experimental, and positivist designs -lack of inclusion of qualitative approaches that could add depth -Perceived lack of time and resources for evaluations -No request by client -Change is a moving target -Fear of responses -Lone ranger approach to ID (evaluation is best done collaboratively, and many consultants are not accustomed to that) -Fuzzy OD goals -Evaluation is not historically a central goal of OD

First contact

Dealing w/ preentry issues - e.g if consultant is the right person, disagreement on problem, etc. Initiated by either party, involves organizations contact person

Value Conflicts - How They Might Appear

Differences in Worldview - ex. different concept of the value of time, lateness as a sign of disrespect Differences in Views of Organization - ex. mental health consultant does not consider bypassing chain of command a huge deal; client, police force, does Differences in Views of the Client System - ex. administrator of substance-abuse program views clients as "welfare bums", consultant views as sick and in need of rehab

4 Classifications of MH Consultation (Caplan)

Divisions are by focus on... (1) a case (2) an administrative problem Primary goal... (1) giving a specialized opinion or recommendation (2) attempting to improve the problem-solving capacity of the consultee FOUR TYPES: Client-Centered Case Level: Case Target: Client Goal: Behavioral change in client Consultee-Centered Case Level: Case Target: Consultee Goal: Enhance consultee performance of services for client Program-Centered Administration Level: Administrative Target: Program Goal: More effective delivery of program Consultee-Centered Administrative Level: Administrative Target: Consultee Goal: Enhanced consultee performance in programming

Ecological Approach

Emphasizes that behavior is a function of the interaction of the characteristics of the environment + the individual

Stage 3: Physical Enter the System

First comes into contact with members of the organization; work site is important (different than psychologically entering the space, which is ongoing)

Third-Party Peacemaking

For small groups of dyads / tryads Consultant drives process of direct confrontation; consultant goal is to improve the manner in which they conflict

Alderian Consultation w/ Teachers

Four basic assumptions: -Teachers cannot take responsibility for student behavior -Teachers should be more involved with encouragement than with praise -Teachers cannot always prevent failure on part of student -Teachers need to try to meet affective AND cognitive

Stage 4: Psychologically Entering the System

Gradual acceptance of the consultant by members of the organization in which consultation is being performed; accepting organization's norms help

Motivational Interviewing

Helps identify self-efficacy, identify what is good, validate change take and ignore maintenance talk, non-verbals, listening, open-ended questions

Amatea (article)

How can counselors help include parents in the process? Rather than interact with families merely on an "as-needed"basis, counselors and other educator are proposing a co-expert or collaborative paradigm (no longer sole authority) - initially, no method to share info as a "two way street" Interventions: joint tme for problem solving, no fault parent meetings, redesigned parent-teacher conferences w/ more active student role

Fuqua & Hoffman

In addressing" "rule-driven approaches to compliance will, at best, only affect limited areas of functioning" instead, "fundamental structural and behavioral change in the character of the organization" 5 Moral Principles: a) Utilitarian principle: "What action will do the most good and the least harm for everyone who is affected?" (b) Rights principle: "What action do you have the moral right to take, that protects the rights of others, and that furthers the rights of others?" (c) Distributive justice principle: "What action produces a fair distribution of benefits and costs for all of the stakeholders?" (d) Caring principle: "What action cares for those people with whom you have special relationships?" (e) Virtue principle: "What action displays virtuous character traits?" Applications: Relationship development, problem explication, data collection, vision future / goal setting, evaluation Consulting process is an essentially moral process, moral matters + process matters are intertwined

Evaluation: individualized goal attainment measures, standardized outcome assessment devices, and consumer satisfaction surveys

Individualized goal attainment measures: tecniques where the efficacy of the service is measured according to criteria of the persons receiving service Standardized Outcome Assessment: measures accomplisment of goals through norm or critereion referenced device, checklists and rating scales Consumer satisfaction survey: assess opinions nad attitudes of the client or client system regarding the services and effects of the plan (subjective)

Assess for Treatment Integrity / Fidelity

Is the intervention being implemented as planned? Should be assessed for - treatment integrity is promoted by choosing high probability interventions (those that focus on key behaviors, are empirically supported, aceptable by client) 1st dimension how effectively the consultee carries out the intervention 2nd dimension is consultation procedural integrity (CPI) - Refers to how well the consultant carries out consultation process in which the intervention is embedded

Scanning

Looking over the big picture, including information about events and relationships within the organization's internal and external environment

Mandatory Ethics

Minimal standards of dos and don'ts

Kirmayer

Objectives: evaluates cultural consultation service (CCS) for mental health practitioners and primary care clinicians. CSS was designed to improve the delivery of mental health services in mainstream settings for a culturally diverse urban population including immigrants, refugees, and ethnocultural minority groups. Results: Cases seen by the CCS clearly demonstrated the impact of cultural misunderstandings: incomplete assessments, incorrect diagnoses, inadequate or inappropriate treatment, and failed treatment alliances. Clinicians referring patients to the service reported high rates of satisfaction with the consultations, but many indicated a need for long-term follow-up. Conclusion: The cultural consultation model effectively supplements existing services to improve diagnostic assessment and treatment for a culturally diverse urban population. Clinicians need training in working with interpreters and culture broker

Contract

Oral or written agreement that defines parameters and character of consultation relationship; provides self-protection; spelling out expectations 3 shared understandings: what to expect, investment of time, ground rules

Ways to Generate Possible Interventions

People - who might assist the consultee in achieving goals Places - Appropriate for implementing a plan (locations or retreat) Things - Lead to an easier way of accomplishing a goal (e.g. technology) Organizations - That sponsor or assist consultee in some ways (foundations) Prepackaged programs - whose goals are similar to the consultee's (book ex - stress management program for teachers) Consultee Resources

Nominal Group Techniques

Problem solving process specifically for members' involvement and creativity - problem solving meeting with a "one-person-one-vote" structure (superiors + subordinates have equal power) Helps to get everyone involved, stops from one person dominated Break into small groups (5-6 people), collect ideas sharing round robin, anonymous voting, each group reports to the whole

Consultee Factors

Readiness for change - assess using stages Resistance - push back (it's normal), not conscious Reluctance - hesitancy to engage

SMART Goals

S - Specific M - Measurable A - Attainable R - Relevant T - Time based

Work Teams

Small Groups of independent individuals who share responsibilities; consultantshelp facilitate the environment in which the team functions effective

Quality Circles

Small problem solving groups w/ members from same work area; enhance product quality; consultant's role is to educate and train is a small problem-solving group who meet together to discuss workplace improvement, and make presentations to management with their ideas,

Sullivan ()

Special education symptomatic of larger issues around difference; disproportionate representation of students from culturally and linguistically diverse backgrounds among students identified with disabilities. Shows need for SYSTEMIC CHANGE "Most of these efforts focused on individual attitudes and behavior or discrete practices (e.g., universal screening, pre-referral intervention, evaluation pro-tocols) - but not necessarily effective. Too molecular. Interventions that focus on the system are too narrow b/c do not address infrastructure. Systemic change: calls for education to be reconceptualized from the ground up, beginning with the nature of teaching and learning, educational relationships, and school-community relationships." Ecologically based educational consulting is consistent with systemic change - ecologically based model promotes understanding of exo-system and macro factors

Which interventions should come first?

Start with interventions w/ high probability of being successful (easy, realistic, short, cheap, acceptable)

Total Quality Management (TQM)

TQM is a management strategy aimed at embedding awareness of quality in all organizational processes. TQM has been widely used in manufacturing, education, government, and service industries, as well as NASA space and science programs. TQM provides an umbrella under which everyone in the organization can strive and create customer satisfaction at continually lower real costs. Focuses on only on quality of return (satisfy the needs of the shareholders), quality of products and services to satisfy some specific needs of the consumer but also QUALITY OF LIFE

Aspirational Ethics

The attempt to accomplish the maximum in moral and ethical outcomes

Transfer of Effect (MH Consulting)

What is learned should be able to be used for similar situations

Martineau and preskill

Why not enough eval? -not enough time for... should be planned for - may not be requested - fear of evaluation / poor performance - overwhelmed by who is involved in the process - different for every OD intervention - client does not ask for it - client may not feel like they have time - fuzziness / nature of OD What are best practices? -evaluation throughout -"inquiry based" model - includes staff + key members in investigative approach -formative and summative evaluation -all relevant aspects of change (qualitative and quantitative) -systems apporach - begins with objectives -no one method - eval must be customized to organization

5 Types of Relationships to Change in an Organization (Lodon)

innovators (2.5%): low level of perceived risk, creative, eager to explore and invent change agents (13.5%): low perceived risk, optimistic, likes to lead change, an opinion leader pragmatists (34%): moderate perception of risk, cautious, pragmatic, wants to belong, "show me" skeptics (34%): higher level of perceived risk, closed to personal exploration, image-conscious, relies on mainstream popularity and authority endorsements before accepting change traditionalists (16%): highest level of risk perception, denies seeing opportunities or challenges, pessimistic, wants to remain uninvolved, relies on the past, sees diversity as dangerous and seeks a return to the "good old days"

Evaluative Methodologies - Qualitative + Quantitative

quantitative -pre/post surveys (e.g., morale before and after) -group comparisons (use of a control group) -multiple time-series (effects of a intervention as a change over time) qualitative -case study -self-report instruments -focus groups -interviews -naturalistic observation

Rights of Consultee (Ethics)

•Confidentiality: Protecting the identities of parties involved in consultation (gets more complicated with groups and then with groups who have caseloads) •Informed consent: To inform consultees about the nature and goals of consultation, their right to privacy, the voluntary nature of participation and the complete freedom they have in following suggestions made by the consultant

Issues w. Consultee in MH Consultation

•Lack of Professional Objectivity -Simple identification: Identifies with client -Transference: Transfers onto client feeling and attitudes from key relationships in past -Characterological distortions: Personality problem that interferes with effective delivery of human services -Theme interference: Special type of transference in which consultee experiences an unexplainable "block" in progressing on case (I need the client to do this)

Important Features of Ethics in Consulting Relationship (5 bullets)

•a work-related (not personal or person-related) focus •no dual relationships: you can't be someone's counselor andconsultant •freedom of choice: it should be clear to clients that they are free to act on the consultant's advisement or not •confidentiality: complex, limited, and negotiated in the contracting phase •informed consent

Brown, Pryzwansky, & Schulte (2006): six general principles of ethics

•competence: gaining competence prior to practice, and maintaining competence •protecting the welfare of clients: "Consultants are to keep uppermost in their minds both the immediate client and others who might inadvertently be affected"e.g., families, institutions •confidentiality: immediate, plus foreseeable, uses of information •public statements: statements should be limited to credentials and services provided; do not imply that professional memberships imply particular skills; no testimonials; •social and moral responsibility: responses to own and others'ethical behaviors •relationships with other professionals: respect the expertise of other disciplines; no remuneration for referrals