Essential Ingredients

I have enjoyed cooking and baking since I was a child. Before there were multiple channels on television dedicated to food, I was in the kitchen with lots of tiny bowls filled with ingredients. This year I have baked a lot of bread and cookies and tried out new recipes for my family and friends. Each time I make a recipe, I play with it a little bit. It doesn’t take long to figure out which of the ingredients and processes are “essential” and which can be adjusted to suit my tastes or the ingredients available to me in my pantry.

Just today I was reading one of my favorite cookbooks about breadmaking. I’ve tried to occasionally test a new bread recipe every few weeks or so. Today I was perusing the text trying to find the next bread I’ll try and noticed, as I have before, a pattern: bread has its own essential ingredients that make it work on a chemical level, that makes bread, well, bread. There’s a leavener, a sweetener, sometimes a fat, and something to provide the body. Then there’s extras—you can add ingredients to give it a more savory or sweet flavor. You can make the bread richer by adding egg. You can take the fat out of it and make it more lean. You can use whole wheat flour and flaxseed to improve its nutritional value. Sweeten it with molasses instead of sugar or add a bit of buttermilk to make it more tender. You see? If I want to make a loaf of bread, I’ll almost always use flour, water, yeast, and salt. But after that it’s up to me.

Essential ingredients should define structure, purpose, identity. Nothing more and nothing less. They should not be the place we stop but the place from which our creative decisions are made.

In human service professions, particularly complex programs like CSA, child welfare, or community mental health programs, we often struggle to understand the difference between what’s essential and what is left to our taste or discretion. In my consulting work I see folks grapple with ‘essential ingredients’ kinds of questions: “When we’re implementing family engagement, which elements of it are critical and which ones can we customize to fit our local culture or individual families?” Or, when starting a new program, an agency might ask, “what parts of this do we make policy—mandatory—and which parts do we leave to the discretion of our front-line workers?”

Whether you’re in a position to make rules or follow them (and my guess is most of you do both in your work), how do you decide what’s essential? How do you distinguish between those things that make the program what it is and the parts that just make it work best for a particular time or place or culture? What happens when you make the wrong things essential or the non-essential things seem imperative? In cooking and baking, confusing these two things leads to poor-tasting, often inedible items.

The beauty of the essentials is in their structure. The beauty of the flavor is its individuality. How have you mastered this chemistry in your work?

Guest Blogger, Ray Ratke: Is Transformation Over?

It's been months since you've heard from me! I've been doing some family engagement work, some child-specific consultation, and spending a lot of time on my newest project, findfamilyservices.com. I've also been working with Ray Ratke, former Special Advisor for Children's Services in Virginia. Ray retired in June and since then, he and I have been developing training curriculum and working with localities to do strategic planning. Many thanks to Ray for his contribution to my blog this month. Check it out and let us know what you think: Is the transformation over?

Is Transformation Over?

Raymond R. Ratke | August 5, 2010

I’ve gotten that question a lot over the last number of months. At first it was in response to the apparent lack of clarity on the part of the new administration in Richmond with regard to the initiative – would they make it a priority or would they not? But since I announced my retirement from state service I have repeatedly been asked; does this mean that the Transformation of children’s services is over?

Children’s Services System Transformation began with the idea that we needed to fundamentally change how services are provided to at-risk youth and families to achieve some basic goals – to keep kids and families together wherever possible, to help kids live and be successful in their home community and school, and to assure better life long outcomes for kids and families who come in contact with one of the child serving systems of social services, behavioral health, juvenile justice, and special education.

Achieving these goals appeared to require change in some essential ideas and ingredients in the basic practice of working with kids and families. Or did it? In fact, I believe that the Transformation of human services – for adults, children and families – more accurately involves returning to the roots of our respective professions. To a basic belief in and respect for the inherent goodness of people-even when they are at their most challenged and challenging. Starting where the person or family is. Actually listening to and developing service plans based on what people say they need – being truly person and family centered. Finding and building on strengths. Working in true partnership across systems. Living the ideal that people are best off when services and supports are provided as close as possible to an individual’s home, family, and community. Raising, rather than diminishing, hope.

These ideas are at the heart of the Practice Model that was developed as part of the Children’s Services Transformation. They are also at the heart of the “recovery” model in behavioral health, and the principles of services for persons with intellectual and developmental disabilities – self-determination, empowerment, and full participation in the life of the community. In fact, I believe they are the principles underlying of all areas of human services. We have made great progress – truly transformative progress – towards fulfilling the promise of the practice model. However, while there are certainly wonderful examples of transformed services in many localities across Virginia, it is also clear that we have a very long way to go. On a variety of fronts, the struggle to improve outcomes and help the people we work with lead better lives continues.

Recently, with the best intentions, many people have been congratulating me on my “retirement”. I have appreciated these good wishes but also admit to a sense of discomfort at the same time. You see, especially at this point in time in the struggle to improve outcomes for Virginia’s most vulnerable citizens, it is not the time to retire – it is not the time to be on the sidelines. In fact, it is time for increased action, for renewed dedication to implementing the values and ideals of the practice model, and for each of us to return to the same questions we asked since the beginning – do I care enough?, do I know enough?, am I doing enough?, and am I being persistent enough? It is time for a renewed sense of urgency and for renewed inspiration.

In this regard there is much reason for hope – for the power to provide services in a “transformed” way, the power to provide services that truly engage people, that expand hope and improves outcomes - lives in each of us. Instead of being over, “Transformation” is alive in every locality, every provider and in each person who commits to doing this work in a different way; to be truly person centered, to see the people we have the good fortune to work with as partners rather than adversaries, to stop finding only pathology and to start looking for strengths, to reach across human services agencies to work in true partnership, and to encourage hope and a bold vision of community inclusion and choice for all persons with disabilities. “Transformation” won’t be over until this is the rule rather than the exception and the power to achieve this vision rests in each of us.

Clear policy and direction from leadership at the top is important. But at its core Transformation has always been about culture and practice change in the actual work with people. While my role in influencing state policy is now limited, I am looking for opportunities to remain in the game and to continue to have a positive influence on the efforts of localities and providers to improve the lives of the people with whom they work. Toward this end, I have recently joined with a loose affiliation of consultants working in Virginia called, “Partners for Transformed Human Services (PaTHS). The mission of PaTHS is to improve life outcomes for people served in human services organizations through partnering with public and private providers, localities, state authorities, families, and advocacy organizations and by providing a comprehensive array of high quality professional consulting services that are based on core values and principles of Transformation. I invite you to check out Humanservicestransformation.com on the web and I look forward to the chance to join you once again in this very important work.

Lessons From a Farmhouse: Knowing Where to Start

In a few weeks my family and I will be moving from our current home (a small, fairly new, rural-suburban place) to an old farmhouse in the country on 50 acres of land. Before we can live there, the place needs some work: right now it has the ability to handle 60 amps of electricity, only has electrical sockets in one room, has no real working heat source and inadequate plumbing. The floors are bad: what was once beautiful hardwood has been covered up with layers of other things that are in bad shape. One of the upstairs bedrooms has a leak in the ceiling, the floors are crooked and unstable, the stairs a bit shaky. The front porch has no railing. It does have a bathroom—but that was just recently added in the room that used to be the kitchen pantry. We are in for it, aren’t we? Thankfully my job will be packing up this house—the farmhouse will be the place my husband (and a team of other people: electricians, plumbers, floor people, etc.) will spend time until everything is in good enough order. (Yes, I said good enough. This was not my idea but the reasons we’re doing this are best left for another blog.)

The first time we visited the house I was overwhelmed with how much there was to do. While I loved the place—it really is beautiful and has spectacular views of the Peaks of Otter—I couldn’t imagine having the time, money, expertise, or energy to do all that would be needed for it to be livable. Then I kept visiting. The more time we spent in the house, the more we understood about what it needed in order for us to be able to live there, to let our almost-two-year-old son actually sleep in it. We also began to understand where we should start. We knew what our own limits were (like we aren’t okay living in a house with no heat and only enough electricity to have one lamp on.) We can live with crooked floors and even the leaky ceiling upstairs (for now, we’ll live on the first floor), but the electricity and heat need attention. Now. Before we move in. Once all this is done, the painting, floor repair, and moving in can finally happen.

It is easy to get so overwhelmed by the enormity of something that we are unable to get started. It’s true with farmhouses, with families and it’s true with programs or systems. Families come to us with issues in what seem like all parts of life: they’re involved in the criminal justice system, they are abusing substances, the kids aren’t going to school, there is domestic violence and they are unemployed. Programs are ineffective: we have waiting lists, staff who lack proper training and support, inefficient processes, and poor outcomes (if we measure them at all). We begin to think mom is resistant, that our boss just sucks, and that nothing’s going to change.

“What looks like resistance is often a lack of clarity.” This quote was taken from a new book, Switch, which will hit the shelves later this month. It’s written by Chip Heath and Dan Heath and addresses how to change things when change is hard. The first chapter provides an overview of three surprises about change, one of them being that people aren’t so much resistant as they are unsure what to do next. They tell the story about researchers in West Virginia who wanted to persuade people to eat a healthier diet and knew that people were more likely to change behavior when they had clear expectations about what they should do next. To tell people to “eat a healthier diet” was not clear enough, they were sure. There are a million ways to eat healthier, to try to lose weight. They decided to start with milk: since most Americans drink milk and since milk is the single largest source of saturated fat in most people’s diets, it was a good place to start. They launched a campaign in two communities in West Virginia to convince consumers to switch to 1% or skim milk. They tried to change what folks bought, thus changing what they drank and their fat intake. It worked—before the campaign, the market share of low-fat milk was 18 percent. After, it was 41 percent. Six months later it held at 35 percent.

“What looks like resistance is often a lack of clarity. Before this study, we might have looked at these West Virginians and concluded they were the kind of people who don’t care about their health. But if they were indeed ‘that kind’ of people, why was it so easy to shift their behavior?” (p. 9)

Summary? If you want people to change, show them where to start. Me? I’m on my way to the ABC store: I hear they have great boxes for packing. J

Project Natal:How video games are helping me re-think our systems

I am a big fan of Xbox. I haven’t played it in a long time—in fact, we recently gave ours away. Of course, about a week after we got rid of it, my husband comes across this video featuring the next best thing for the system, for video games. It’s called Project Natal: The Innovation Journey. He was disgusted that we had gotten rid of ours because this new thing is pretty hip. Watch the video before you keep reading:

http://www.youtube.com/watch?v=-_UzcnTYqc4&feature=youtube_gdata

As I watched this, I thought about what we call individualized services for kids and families. Project Natal gives a wild example of how a system (one that may even be more complex than our departments—I know, long shot) can be created that will in fact fit the players and not require that the players fit it. You don’t have to stand on a special board or hold a special controller. You don’t have to be a certain weight or height. You just have to be there and the game system recognizes you, reflects you, allows you to play. It is a real-time connection between a human and a system that puts the player in charge of what happens next. Do you know how it does this? Did you hear? It collects trillions of pieces of data about the player every second—they get to know the player’s movements and measurements in real-time. The game becomes an expert on the player. Certainly expertise on technology and art and design and math was required to build such a system: but for the system to do its job, it had to figure out how to become an expert on the player.

“It’s 50% hardware, 50% software.” Part of what makes this system unique (and what will help it be successful, making lots of money for someone) is that it’s as much about the player as it is about the system. The software (the flexible, real-time, changeable, responsive stuff) carries the same weight as the hardware (the more rigid, structural stuff).

I believe that our success in improving outcomes for kids and families will depend a great deal on our ability to provide individualized, person-centered, culturally-competent care to folks in our communities. This video, this gaming system has just given me new ways to think about it and new questions to ask:

How do we re-form our systems to support professionals who become experts not only on diagnoses and treatment modalities, but on the people they serve?

How do we create hardware (budgets, policies, for example) that support the software (staffing patterns, training, the day-to-day work) and allow for real-time, meaningful interaction between the consumer and the system, actually reflecting our clients in our work?

How do we allow families to be in charge but still be responsible with our resources and ensure safety?

Project Natal is doing it—with a lot of smart people (with good hair, I might add), probably a dollar or two, and without a lot of fear. Stay tuned. If we end up with this gaming system, I may just have to have a Natal party and you’ll all be invited.

Sledding, anyone?

We got more than a foot of snow this weekend in Bedford—well across Virginia, it seems. It’s the beautiful kind of snow that began to stick with the first flake. It’s soft and packs together well enough to make a decent snow-person. It’s good and deep and kept people trapped in their homes all weekend. Stuck with me was an almost-two-year old little boy. We did a lot of reading, cookie-baking, soup-stirring, cartoon-watching and playing. We tried to ward off boredom by changing scenery--moving from room to room every so often, but our house is small and we ran out of rooms pretty quickly. We went outside some, but he did not enjoy the snow. He walked on it like it was some kind of poison. He tried to escape back into the house by going through the doggie door. So much for the ‘baby’s first snow’ photo op.

The babysitter called Sunday night to remind me about good strategies for getting in and out of her long, windy, gravel, snow-covered driveway and to tell me to bring extra clothes for Owen on Monday morning—they’d be going sledding down the big hill in her front yard. After getting stuck and unstuck in her driveway I happily (HUGE smile) dropped him off at her house with all the sledding attire a toddler would need. I also told her good luck—that he didn’t seem to be the biggest fan of the snow. She was sure that once he saw the other kids having fun in it he’d join in. She’s also big on giving kids choices and let me know about his other option if he did indeed refuse to play: There was a big bucket that he could just stand in and watch while the other kids had fun. It would keep him out of the snow, but in a safe enough place for her to keep an eye on him. I could just imagine pulling into her driveway later today and seeing him standing in a big bucket, thumb in mouth, watching everyone else scream in delight. It’s pitiful, isn’t it? (I also imagined it would be quite funny for some kid to go up behind him and sort of tap him down a hill, turning the safe bucket into a very fun sled.)

I just got back from a conference celebrating the success of work in Virginia that has been called “The Transformation.” (Learn more at www.vafamilyconnections.org.) It’s the name given to efforts to improve the child welfare and mental health systems, focused mainly around the primary value that kids should grow up in families in their own communities. The data was telling us that we weren’t doing a great job living up to this value as we’ve had too many kids put in too many places that don’t look anything like families or communities—all in the name of treatment.

I think lots of folks in the field would say that this transformation work has been good stuff so far—the majority of professionals agree with the reasons for it and with the values it embraces. There is less agreement the further down the strategic planning table you go: we don’t agree on all of its goals and certainly on its specific strategies. There is much grumbling underneath the polite clapping in the fancy hotel ballroom as awards are given to the works’ heroes.

Here’s the thing, though: Enough people are in it—they’re all decked out in their snowsuits, boots on, sleds in hand. Enough of the right people are heading down the hill together that anyone who doesn’t go is kind of like Owen standing at the top of the hill in the grungy bucket—unsure that the risk of stepping out will really be worth the reward of having gone.

I’m one of the folks on a sled heading downhill. I am, as they say, “on board” with the efforts happening statewide. I also recognize the barriers from multiple perspectives and understand the hesitation of many to jump in. This work, like sledding, is a make-the-path-as-you-go kind of work that has us only so prepared when we start it. There are lots of trees and rocks and other folks to watch out for on the way. The cool thing about sledding in groups is that those who go first make a path for the others—a path that ices overnight when left vacant too long, some would say making it more fun. I'm incredibly thankful for the work done by so many before me and hope that my work will make a nice path for another coming soon behind.

Here’s hoping your ride down the path comes at the right time and pace for you and that the rewards will leave you forgetting that old bucket. Happy holidays.

Gobble, Gobble: Lessons on Cultural Competency from Lane Stadium

I am a Hokie—sort of. For those of you unfamiliar with public colleges in Virginia, this means I graduated from Virginia Tech. It is difficult to attend VT without becoming a football fan but for the two years I spent working on my graduate degree in Sociology, I never stepped foot into Lane Stadium to watch the guys play ball. I did watch them play from a downtown bar with a beer in my hand from time to time. Apparently this does not “count.” So this year, two years after my graduation, I bought two tickets from my brother-in-law for the Boston College game.

I did not fit in and here’s why:

1. I did not look like a Hokie. I do not own any Hokie or VT clothing. I had on a tan t-shirt that I thought coordinated well with the maroon and orange. Apparently, simply coordinating is not enough. The dress code is simple: maroon or orange (or both). Two of my friends who also attended the game spent a great deal of time trying to convince me to go to the bookstore that day to purchase something—anything with the team colors.

2. I did not act like a Hokie. Sign #1? I jumped and looked around nervously every time the cannon went off. I did not know that a cannon would go off every time the home team scored points of any kind. Our seats were entirely too close to the cannon and the Hokies scored about 600 points that day, it seemed. While I was holding my breath looking around for missles, the people around me (in maroon shirts) were waving their arms around and screaming with delight. It wasn’t until the last quarter that I stopped being scared that we were under some sort of attack when this thing went off. Sign #2? I did not know the appropriate times to gobble like a turkey or really even how to gobble like a turkey. From time to time throughout the game, people would pull their keys out, shake them and gobble like turkeys. Maybe it was when we were on defense and we were trying to distract the other team? Either way, by the time I got my keys out and opened my mouth to attempt it, it was over.

3. I do not know the players or the team’s circumstances. While others around me were yelling out specific commands to specific players, I had no idea the names, numbers, positions, strengths or weaknesses of anyone on the team. They were a group of guys (very big guys) who all had on the same color—that’s about all I could figure out. Folks around me knew who they needed to beat in order to remain in their standing in their conference. They knew which teams would be difficult, which wins would be easy, and the history with each opponent. I was content to know the current score. Thankfully I was only a spectator and not the coach or trainer or even a reporter—I would have been useless in any decision-making capacity because I was culturally incompetent.

Sometimes in our work we mistakenly think of culture as a wide-lens matter: race, gender, social class and country of origin. Certainly there exist large-scale cultural norms—to use more sports analogy, football players all wear helmets and pads, regardless of their team. But the real richness lies in expressions of micro-cultures—things we eat, say, and wear, if and how we seek help, if and when we talk about our illness, and when it’s okay to let an outsider in.

Cultural expressions are like finger prints—a culturally-competent assessment is one that I can read and immediately identify the individual about whom you are writing. Let’s head back to football season for an example: If you lined up football fans in a row wearing team stuff, eating team food, chanting team sayings—you’d know which team they were pulling for fairly easily. You’d never call a lady in a navy blue sweater and orange chinos with pearls on screaming “Wahoo!” a Hokie, would you? (Google “Wahoo” if you do not watch football or do not live in VA).

Cultural competence in a system of care is about knowing your client’s own cultural norms—not just the demographic and diagnostic stuff that earns a place on service plans and assessments. In other words, providing culturally competent services means you provide individualized services, recognizing and building on what is normal for your client in their micro-culture.

Being culturally competent in your practice will take time. It also means you might have to change your sense of ‘normal’ (I certainly would not gobble like a turkey in any other setting) and accept the position of an outsider.

I stuck out like a sore thumb at the VT game. I got harassed and made fun of because I was a picture of cultural incompetence. But I totally made an effort. And you know what? I got invited back for the last home game of the season on one condition: I wear an orange shirt and learn how to gobble. I’m totally game.

Kicking the Bucket: How I do training

I was walking by our local middle school a few weeks ago and noticed the sign out front.  It said: "Education is not the filling of a bucket, but the lighting of a fire."  I guess they mean that school is less about obtaining knowledge and more about inspiring minds to learn.  At first I really thought that sounded great.  Then I decided I did not fully agree: certainly when I send my child to school I want him to have some energy and spirit about him--but I also really hope he learns how to multiply numbers, the history and heroes of the civil rights movement, and what makes the earth go around and around. 

Part of my job as a consultant is to provide training to staff and volunteers who work in the field of human services.  When people attend a workshop that I do, I want three things to happen.  And seeing that sign at my old middle school just gave me some fun ways of talking about it:

Fill the bucket:  No one should pay me money or attention if they attend one of my workshops and walk away knowing nothing more or different than before.  Generally people come into a particular training thinking of a set of concepts or skills they want to know (the bucket) and hoping that when they leave, they'll know them (fill it).  How do I create a strengths-based service plan for a family in this much trouble?  How can I help a family identify their own informal resources when they've burned so many bridges?  How do I supervise my staff in a way that supports the systems of care principles?  What does a good outcome report look like? 

Light the fire:  This is sometimes difficult to do when the participants are tired, under-appreciated social workers who, after the training, will return to a mile-high pile of paperwork on their desk that includes some of the worst stories of  child abuse and neglect you'll ever hear.  But doing that work better means having the energy and the spark to go back and think differently about it.  I have been to many a training where I was inspired while I was in the room and then all the steam ran out as soon as I got back to my car.  Which brings me to my third goal...

Stock up on tools:  This is an over-used figure of speech, this filling of the toolbox.  It makes sense, though.  I can know how to plant a garden, be inspired and motivated to plant a garden, but if I don't have a shovel, tiller, gloves and some seeds, then I won't get very far.  I want to give people the tools they need to sustain what they learn (the bucket) and their interest (the fire), helping them actually do what they're hearing about in the lecture hall or conference room.  I want to go with them after the training and work alongside them to help make it real every day.  I want the full bucket and the lit fire to linger in real life. 

 A bucket, a fire, a set of tools.  Training, anyone?