Tuesday, August 13, 2013

Exploring the Ambivalence with Families in Children's Mental Health

When I was a beginning school social worker, I noticed that only half of the families showed up to their scheduled intake assessment appointment.

In school, 50% earns a failing grade.

So I ran to my clinical supervisor, Reevah Simon.  She schooled me about how what I said right over the phone might keep families away.  I changed my introductory rap and more parents started showing up to their appointments.  Eventually, I reached over 90% family engagement, even at the high school level.

Since then I've read family engagement in children's mental health is about 50% - across the country.  It turns out that I wasn't the only one failing.

Mary McKay, LCSW PhD, is pioneering research to improve family engagement in children's mental health (that's what happens when clinicians become researchers - studies with practical application that can improve our practice get done).

She developed a script based on structural family therapy principles that can be used at first contact - like when clinic staff schedule an appointment for families over the phone.  One of the elements in McKay's script reminded me of what Reevah taught me - explore the ambivalence.

Often we think we need lots of water under the bridge before we go there - what are your concerns, doubts, questions about coming in for this appointment?

Research and experience shows that if you don't go there in the phone conversation (granted, you may save it for the end of the conversation), then families are not likely to show up.  If you do go there, then they are much more likely to show up.

If it makes everyone feel better (and normalizing usually does), then add:  "families usually have concerns, questions or doubts about coming in for their first appointment - is this true for you?"

Exploring the ambivalence is one of those clinical tools that has helped me in every setting, with any client population and presenting problem.

In fact, it is so universal that I find myself exploring my own ambivalence when making decisions.  Thanks, Reevah.

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