Team Consultation Model: Alcoholism and Drug Abuse Training for Head Start S t a f f Karen IL B u e t e n s

CASPAR Alcohol and Drug Education Program, Somerville, Massachusetts Eileen Sullivan

Somerville TobaccoControl Program, Somerville, Massachusetts

The authors present two training approaches used in assisting Head Start staff to increase the effectivenessof their work with families affected by substance abuse. The Workshop Model and the Team Consultation Model evolved from feedback from the participants and demonstrates the willingness of the consultants and Head Start administration to collaborate to find effectivemethods of training on substance abuse and related issues.

ABSTRACt.

This paper describes a model found to be very effective in training Head S t a r t staff on the identification and referral of families affected by substance abuse. The focus will be on two phases of a three-year project. The first phase of the project (Workshop Model of Training) provided interactive/didactic training for Head S t a r t staff. After the first phase of training, the feedback from staff included requests for more relevant and practical information to apply to their work. The second phase (Team Consultation Model) was developed from a combination of feedback from Head Start staff and a critical incident which provided the notion for the model. The critical incident consisted of classroom teachers requesting t h a t the consultants provide suggestions in addressing two case situations. Both of these situations involved Head Start students talking about or re-enacting family members' use of drugs. The first section of this paper will describe the Head S t a r t project in general, followed by a description of the development of the two Correspondence should be addressed to Karen K. Buetons, CASPAR Alcohol and Drug Education Program, 226 Highland Avenue, Somerville, MA 02143. This project was supported by the Administrationfor Children and Families, U. S. Department of Health and Human Services, Grant #90CD078/03. Child & Youth Care Forum, 25(6), D e c e m b e r 1996 C 1996 Human Sciences Press, Inc.

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phases of the project. The advantages and disadvantages of each model will also be described.The final sectionincludes recommendations for other programs interestedin utilizingsimilarmodels.

Program Description The Somerville Family Case Management Project was funded by a grant received by the Community Action Agency of Somerville (CAAS) in January 1991. The original proposal for this project was written by C A A S in collaborationwith the Cambridge and Somerville Program for Alcoholism and Drug Abuse Rehabilitation, Inc. (CASPAR, Inc.) and several other community agencies. The purpose of this projectwas to provide intensiveservicesto Head Start families in several problem areas including substance abuse. A Case Manager was hired by Head Start (CAAS) to provide leadership to the project, coordinate individualcases, work with existingstaff,and be the liaison to the C A S P A R consultants. The consultants for this project consisted of a designated staff member from each of two independent components of CASPAR, Inc.: the C A S P A R Alcohol and Drug Education Program and the Women's Program of CASPAR. The C A S P A R Education Program provides education, assessments, groups, and other intervention programs for youth. The Women's Program of C A S P A R provides outpatient and residential services for women. Both programs provide troining and consultation services to schools, agencies, and the community. Although C A A S and C A S P A R have worked on various community and advocacy projects, this grant provided the firstformalized working relationshipbetween the two agencies. The initialgoals of the substance abuse component of the project focused on C A S P A R consultants providing extensive training for Head Start staffon substance abuse information. In addition, other activitiesoutlined in the grant included consultationfor staff,workshops for parents, and serving as a referralresource for parents with substance abuse problems or family members with substance abuse problems. At the time the grant was awarded (January 1991) it was estimated that 35% of the familiesin Head Start had problems with substance abuse. Although it was hoped that many such families would be identifiedearly in their involvement with Head Start, the C A S P A R consultants advised that intensive training would need to occur before staffwould feelcomfortable identifyingfamilies.

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P h a s e I: W o r k s h o p M o d e l

The initial year of the grant focused on training for the entire staff, including administrators, family advocates, bus drivers, and teachers. All staff completed a two-day workshop (referred to as Basic Training) and several months later an additional two days of training (referred to as Intensive Training.) The overall goals for the first four days of training were: 1. To provide a common framework through information]education to discuss alcohol and substance abuse issues. 2. To facilitate a process by which staff could examine societal and personal attitudes toward use and abuse of substances. 3. TO increase participants' knowledge of signs and symptoms of substance abuse in families. 4. To assist staff to explore effective intervention strategies for working with families. 5. To provide information about and access to community resources. 6. To build trust and establish credibility with the staff and reduce resistance to addressing substance abuse issues. All workshops employed a variety of teaching techniques including didactic information, interactive discussion and activities, brainstorms, role plays and the use of films. The response to the initial four days of training was very positive. The consultants found the Workshop Model a useful approach for efficiently providing extensive information to a large group of participants. After the initial four days of training, the CASPAR consultants provided two additional full-day workshops based on interests expressed in previous workshop evaluations. The first day of additional training included information on family alcoholism; pregnancy and substance abuse; women's issues; and relapse prevention. The second day of additional training included information on illegal drugs and prescription drugs along with information on how to respond effectively to young children raising substance abuse concerns. Although the initial four days of training were received well, the feedback from Head Start staff indicated that many were not enjoying the additional workshops. Concerns were identified regarding the effectiveness of the workshop model for future trainings: First, there was a significant range of knowledge and learning styles among staff. Several staff were very knowledgeable from both personal and previous training experiences, while other staff needed to learn more basic information. Thus, it was

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difficult in a large group to adapt material to individual needs and learning styles. Second, it became clear that these pre-school teachers were used to moving around the classroom and many felt that formal, classroom-style teaching was tedious and boring to them. Third, the first four days of training were in groups of 15 to 20. Because of scheduling constraints the additional training days were with the entire group of 42. Within the large group format, staff found it difficult to ask questions and share comments. Fourth, there were significant differences in staff comfort regarding substance abuse issues. In many instances, individual staff members' own history and/ or family history of substance abuse impacted their attitude toward the material and their openness to this sensitive topic. Finally, there were differences in how staff perceived their responsibilities regarding intervening with families as well as differences in staff attitudes towards appropriate use of alcohol and other drugs. Several staff disclosed current concerns or questions about their own use of substances and many others shared family substance abuse issues. Other staff acknowledged being in recovery from substance abuse and felt more committed to helping others. The CASPAR consultants continuously evaluated the training formats and methods of training. While the consultants explored alternative training models, a critical incident occurred. A situation was identified in April 1992 in which two teachers asked for some assistance in their classroom. Two separate and unrelated occurrences had concerned the teachers. One consisted of a child disclosing that her mother was using needles and the other was a child in the classroom pretending that he was playing with drugs. In response to this situation, Head Start contacted the CASPAR consultants to provide consultation with the two teachers, the family advocate for that classroom, the case manager and the education coordinator. This request gave the consultants the opportunity to educate the staff on relevant drug information as well as develop some specific strategies for both helping the students in the classroom and for intervening with the parents. Both the staff and the consultants felt very positive about the resolution of this situation. The consultants began exploring with the Head Start administration the possibility of future training being conducted with individual classroom teams.

P h a s e H: T e R m C o n s u l t a t i o n

Model

After the first year of the project, the CASPAR consultants proposed a shift in the training modality from a formal half day or day of training to a one and a half hour consultation with individual class-

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room teams. After the critical incident, positive feedback reached Head Start administration which created strong support for CASP A R s proposal for a team and case focus. Beginning with September 1992, this new model was implemented. The primary training consisted of individual team meetings. Each classroom had an existing team consisting of teacher, assistant teacher and family advocate. The case manager and one of the coordinators also attended each team meeting. Having a coordinator present allowed for 1) administrative input related to policy issues and crisis situations; 2) emergent team concerns to be easily delivered to the appropriate Coordinator and Directors; and 3) visible administrative support for the workshop goals. These team meetings were scheduled twice during the course of the year, with follow up meetings as necessary. The goals of these consultations were to: 1. train Head Start staff to increase knowledge and improve skills in identifying and addressing substance abuse and other related concerns; 2. increase relevancy and therefore interest in addressing substance issues through use of specific case examples and/or scenarios; 3. develop specific action plans to intervene with families; 4. provide a safe forum to answer questions regarding substance abuse issues (both personal and professional); 5. develop a better working relationship with Head Start staff through a smaller group forum and more personal interaction. The team meetings were held in each of the ten classrooms. This allowed the consultants to "get a feel" for the classroom environment and the teachers' style. This was particularly critical for this project since there is a lot of variety in the classroom sites. It appeared to the consultants that the teachers were proud of the work they were doing and appreciated the visiting consultants being interested in their classrooms. As the teachers and consultants began to know and work together in this less formal setting, there was a definite increase in the collaboration and trust between the Head Start staff and consultants. During the initial team meetings, the consultants framed the meeting as "the staff's time to obtain information on substance abuse issues relevant to their work with students and families." It was reinforced by the consultants that Head Start staff were the experts in their work and in their relationships with Head Start families. As a result of this improved collaboration, the Head Start staff shared more concerns about the families they worked with, and together the Head Start

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staff and consultants examined options for each case and collaborated in developing successful action plans (Bacon and Doughtery, 1992).

Substance Abuse Training in the Team Consultations Although the format was less formal than in the previous workshop model, the consultants clearly expected to continue training Head Start staff in identifying and intervening with substance-abuse-related issues. During the consultations, C A S P A R consultants offered to listen to any questions or concerns staffhad about a family or child in relation to substance-abuse issues. C A S P A R consultants were careful to inform Head Start staffthat showing concern and discussing a family did not mean a diagnosis or accusation of alcoholism or drug addiction. Rather, the goal was to assist Head Start staffto determine appropriate actions and/or techniques in discussing particular concerns with family members regarding substance abuse. The consultants also worked with the teachers to develop strategies that would support children in the classroom. Because there was a range in Head Start staffs'ability to identify substance abuse concerns, the C A S P A R consultants developed a series of sample cases that could be used as examples if the teachers and family advocates were not able to identify any such situations or concerns. At eight of the ten sites, staff identified cases they wanted to discuss. The other two classrooms insisted they had no families with problems. However, a teacher from one of these classrooms did eventually identify a family with concerns while working on one of the sample cases. The case appeared to serve as a catalyst for identifying possible substance abuse. The following are examples of case scenarios that were created to train and initiate discussion on relevant issues. M a n y of the scenarios incorporated concerns previously raised by Head Start staff. The scenarios were designed to contain a variety of situations including 1) children's behavior in the classroom, 2) children's verbalizing concerns about their parents and/or other family members, 3) staff identifying concerns, and 4) issues involving alcohol, use of illegal drugs, prescription drugs and other related concerns.

Scenarios Scenario 1 Danny is 4 years old. During free play time in the house area, he pretends to drink several glasses quickly and staggers to the teacher.

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This scenario was used to review with staff ways to engage the child in further play which would allow the child to feel comfortable in expressing issues of concern, while also helping the teacher to attune to issues that may need further involvement if the child's safety is threatened. Also, suggestions on how to help provide appropriate information for the child and discuss concerns with the parents were given.

Scenario 2 The teacher observes Maria, age 4, at the sandbox making "lines" with the sand and offering these to other children. This example illustrated the need for teachers to remain calm and continue to engage the child in play. Issues of child's safety needed to be addressed, as well as ways to confront parents about concerns of illegal drug use (the lines assumed to be cocaine.) Scenario 3 Laura is the mother of three children ages 9, 7 and 4. When the family advocate made the initial home visit and completed the needs assessment, Laura said that her father drank a lot when she was growing up. She also says that her ex-husband used drugs but it hasn't affected her children. The children stay with their father every other weekend. Laura says she doesn't have a problem with alcohol or other drug abuse. The family advocate tries to follow up on this information and Laura says she doesn't want to discuss it. The focus of this scenario is on the effects of family alcoholism. The mother appears in denial of family members use. There are safety issues regarding children's visits with father. Discussion focused on identifying resources and "planting a seed" that help is available. Scenario 4 You are sitting with a group of children who are eating breakfast. One child says "Daddy drank beer and hit Mommy." This scenario addresses the connection between alcohol and other drug use and violence. Issues of denial around both issues were discussed as well as concerns about the safety of spouse and the children. Scenario 5 A mother of a Head Start child has been late on several occasions to pick up her child. The teacher has noticed that she often appears dis-

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oriented and distracted. She recently told the family advocate that when she feels stressed and anxious, she takes pills her doctor gave her. This scenario addressed the issue of abuse of prescription medication. It provided the oppertunity to discuss intervening with a parent by using examples which illustrate changes in behavior. Scenario6 At an art table, a child is rolling paper into "snakes. ~ The teacher asks the child what she is doing and the child says "I'm making cigarettes like Mommy. ~ The teachers have noticed that the mother's clothes smell like marijuana but have never said anything to the mother. Marijuana is an illegal drug which some people considered "socially acceptable. ~ This scenario allowed for the opportunity to discuss attitudes towards marijuana and provided staff with additional facts about the drug. Again, this scenario provides the opportunity to practice intervening with parents. It also provides an opportunity to help the parent to understand the important role of demonstrating positive behaviors for children. Throughout the team meetings, other issues addressed included the responsibilities of each staff member to a particular case, improving communication between the team members and other staff, clarifying confidentiality and privacy issues, and resolving ethical dilemmas (i.e., obtaining information based on rumors from other parents). In several situations, the case examples and scenarios helped to bring about policies and procedures regarding agency response to the abuse of alcohol and other drugs by Head Start family members.

Evaluation

of the Team Consultation

Model

The response by the Head Start staff was overwhelmingly positive to the Team Consultation Meetings. Although they were reserved and anxious during the first several meetings, they became more open as they realized the benefits. Gradually, they began greeting CASPAR consultants with more enthusiasm as experience demonstrated mutual respect and useful content. When CASPAR returned in the spring for the second team consultation, the majority of the teachers expressed that they were looking forward to the consultation. The advantage of this model is best illustrated by some of the comments from the teachers' evaluations which included: I "like the smaller groups much bettor; more private and can talk more about

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individual cases"; I feel "more comfortable discussing cases in the small group"; "I feel we were able to get concrete ideas to use immediately"; "I enjoyed it immensely. Ill use the suggestions we talked about today." All of the participants said they preferred the team consultation model to the workshop model, 92% said they benefited from the team meeting, and 93% said they believed it helped them to deal with current and/or future alcohol and drug related situations. The C A S P A R consultants also received a great deal of verbal feedback. Some of the teachers expressed that they feltmore comfortable asking questions and expressing opinions within the small group. They also enjoyed the opportunity to talk about these issues with other team members. M a n y of the teachers enjoyed the support and positive feedback they received at the team meetings. For other programs considering this type of model, the consultants believe that possible disadvantages include: 1) The Head Start staff first need a solid foundation of training on basic substance abuse information before the staff could benefit from the Team Consultation Model and be effective in intervening with families. 2) There were significant differences between teams in interest, skill, willingness to confront parents with their concerns, etc. This m e a n t each team meeting had a slightly different emphasis and level of investment from the staff. The consultants had to be skilled in order to "begin where the client is." This required the consultants to be open-minded and flexible with the scheduled agenda. 3) The consultants needed to be able to identify the needs of the individuals and the team as a whole in addressing the sensitive subject of alcoholism and drug abuse. Also, to be effective, consultants needed experience confronting parents and knowledge about working with young children.

Conclusion

This paper presented two types of training approaches used in assisting Head Start Staff to increase knowledge and skillsin identifying and intervening with substance abuse issues among families. The firstphase of the model (Workshop Model) provided formalized education on substance abuse to all staffthat was essential to developing a solid foundation and c o m m o n framework in substance abuse and related issues. Ai~r the completion of the first phase, more training was needed to assist Head Start staffto implement the intervention

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strategies and techniques provided during the training. However, the challenge the consultants faced was in developing a model of team consultation that met the individual needs of the Head Start teams (Cohen & Osterweil, 1986). The second phase of this project, the Team Consultation Model, used a case consultation format. This model was successful in creating a more collaborative and interactive approach to training Head Start staff in substance abuse identification and intervention. This paper has presented the advantages and disadvantages of two training models and demonstrated the process by which the training approaches evolved. Also highlighted is the willingness of consultants and staff to find a solution to addressing training needs and concerns of individual members of the Head Start staff.

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