Judith Liddell, M.B.A.; Beth Melka Sanchez, Ph.D.; Breanne Liddell
The establishment of a collaborative relationship with the professional has been identified as the critical factor in empowering the family and the individual with a disability. Families and individuals that are empowered have an increased sense of competence, efficacy and control in their lives. As Bruner (1991) states, collaboration is extremely time consuming and process intensive. It occurs among people, not among institutions. It requires creative problem-solving skills. Ideally this is what everyone strives for, but often is not what transpires.
There are many factors that get in the way of true collaboration. Each of the parties brings to the table different attitudes and experiences. Teachers are trained primarily to work with children, therapists look for individual or family pathology, parents often look to the professional to solve the problem and adolescents with both a developmental disability and a mental illness are often discounted. People with developmental disabilities and mental health issues and their families have been viewed as patients, which by definition means treated by or passively affected.(Websters New World Dictionary - Second College Edition) This kind of relationship prescribes their role as taking recommendations from professionals.
The collaborative process can be compromised further when families and professionals come from different cultural, socioeconomic or ethnic backgrounds. Age differences or unique personality or communication differences between the parties may trigger issues that affect the ability to develop a true partnership. Added to this are external time constraints. Educational personnel have a school contract which spells out their working hours, while therapists have the demands of all of their clients schedules and the urgency for a fast solution imposed by managed care. Family members work hours may make it difficult to fit into the professionals work schedules, and adolescents often feel they have no say in when meetings are scheduled.
It becomes apparent why the collaborative relationship often fails to develop; however, despite these impediments, the literature is clear that taking the time and doing the necessary work is well worth the effort. (Battle, et. al, 1998, Singer, 1996, Turnbull, 1991).
What is Collaboration?
In addition to collaboration, there are two other words that are often used interchangeably when referring to the collaborative process: cooperation and partnership. Partnership embodies the principles of collaboration; whereas, cooperation implies that there is no common goal merely a willingness to help each other reach respective goals. Collaboration requires a sense of equality among the parties and a flexible sharing of responsibility between co-equals. There are no senior partners. In a collaborative relationship, the parties mutually develop a shared mission and goals for the relationship. Even if the original purpose of the relationship is legally established, e.g. requirements of educational system, imposed by court action, mandated by law or policy, it is still possible to develop a common goal for the working relationship. It is important that none of the parties feel manipulated or under threat of retribution.
Prerequisite Values and Attitudes
Two of the most important values are mutual respect and trust. This may be colored by the parties experiences in other relationships in which they were not valued: a professional who violated confidentiality or was intimidating, a parent who was defensive or apathetic, or an adolescent who stone-walled or was angry. When mutual respect and trust are present, there is respect for differences, open communication, reciprocity and value of the unique knowledge and expertise of each of the parties. In a collaborative relationship each party is allowed to take responsibility for their choices and is viewed as the primary source of information about their own needs. Parties in a collaborative relationship ask each other what they need and want.
A collaborative partnership is respectful of cultural differences. The pace of the relationship needs to recognize the ways in which individuals from different cultural backgrounds get to know each other and share information. From a cultural perspective, it is important to know who needs to be involved in a decision, i.e. a mother may not feel comfortable committing herself to a specific course of action concerning her child, until she consults her mother. Parties to the relationship need to be aware of how each other views time and be willing to talk about it. Families may have different views of the roles of professionals, ranging from viewing someone with suspicion to viewing someone with veneration. The role of adolescents within a culture may also affect the collaborative process. (Sileo, 1996)
Steps in Developing a Collaborative Relationship
George H. Singer proposes a developmental framework for establishing a collaborative relationship: 1) Getting to know each other, 2) Establishing the purpose and roles, 3) Establishing ground rules, 4) Testing the relationship, and 5) Modifying the relationship norms. (Singer, 1993)
Getting to Know Each Other - The first interaction sets the tone for the relationship and can either ease or intensify anxieties. A number of actions, however incidental, can serve to inhibit mutual respect and trust, did the parent drop in unannounced at school? Was the family kept waiting in the professionals office? Did the professional direct all of their communication at the parent? Did the parent wait several days to respond to the professionals initial phone message? Did the professional feel pressured to arrive at a treatment plan at the end of 50 minutes?
At a planned first meeting, there are strategies which the professional can use to facilitate the development of a collaborative relationship: Allowing adequate time to get to know the family members and adolescent, sharing information about how the professional works, eliciting concerns from family member and adolescent, and helping them to identify the strengths they bring to the partnership. Families and adolescents can respond with openness. During this introductory phase, the relationship may stay on safe ground and not go too deeply into anything which might stir up conflict..
Establishing Purpose and Roles- It is important to identify the goals of each party, for the parents, it initially might be Fix my kid, while an adolescent might frame his desire as Get my parents off my back. The professional might have as his/her agenda to figure out the family pathology. Since these are divergent goals that dont initially lend themselves to collaboration, it will take time to facilitate a process of coming up with a mutual goal to improve family problem solving. If a common agenda is to be developed the parties cant stay on safe ground at this juncture,.
The professional needs to be flexible and willing to assume non-traditional roles, becoming the learner, listener and question poser rather than authority. The parent may need to be the teacher, sharing with the professional what has worked and what has not worked. The adolescent may also need to be a leader through sharing preferences. Through the collaborative process each of the parties may take turns at establishing a meeting time that best meets their needs.
Establishing Ground Rules - These will set the norms for the relationship. Each of the parties needs to provide one another with information about how they want to interact. How often does the parent want to hear from the teacher? Will the therapist keep the family waiting to take a phone call? How much floor time will each of the parties have when they meet together? If these are not discussed openly, patterns become established and a norm set implicitly, which may not be agreed upon by everyone.
Testing the Relationship - Eventually a demand is placed on the relationship that tests its established ground rules. Normally this arises out of a crisis, e.g. The adolescent acts out at school, the professional got called out on an emergency with another client and was not in the office when the family came for its visit, The adolescent refuses to participate in a meeting. These kinds of situations test the limits of the relationship and each parties ability to be responsive and may result in one or more of the parties becoming either aggressive or submissive. How an individual responds may be affected by situational, cultural, socio-economic and personality factors. Communication often becomes defensive and is emotionally charged before constructive solutions are developed.
Modifying Norms - As the life cycle of the relationship progresses, there will undoubtedly be a number of stresses as well as periods of partnership. Over time, the ground rules will become more explicitly defined. George Singer concludes that When professionals make collaboration a priority in their relationships with parents, they take care to act in ways to demonstrate to parents their commitment to a strong partnership that not only accommodates a high degree of parental demands, but can grow sufficiently strong, efficient, and reliable over the course of its development. (Singer, 1993)
Teaching Skills to Families and Adolescents to Facilitate Communication
Parents and adolescents can often benefit from formal and informal training in communication skills and self-advocacy to enable them to be collaborative partners.
Informal - Professionals can model communication skills. This can take the form of statements e.g. We each have a different view of what is important. Sean, you know how you want to fit in at school and want to be treated. Mrs. Smith, you know what overwhelms Sean at home, as well as knowing his strengths, and Sean, I have seen how you react to things at school. I am interested in finding out what each of you think is important and what you hope I can do to be helpful. I hope we can find ways to combine our interests, so that we each feel satisfied with our efforts.
Formal - Parents can benefit from specific training which can enhance their feelings of confidence in utilizing effective communications skills. For example, communication skills were an integral part of a class for parents titled, How To Be An Effective Advocate For Family Members With Autism. The parents were asked prior to the class to complete a questionnaire indicating which topics to be covered in the class were of particular importance to them. Only forty-six percent checked improving conflict resolution skills. However, in a follow-up survey in which participants were encouraged to check items that they had decided were important after taking the class, the percentage increased to eighty-five percent. (Liddell, unpublished survey, New Mexico Autism Program, 1998)
Likewise, adolescents can benefit from opportunities to practice skills prior to participating in collaborative planning meetings. The Vermont portfolio project describes the process used to teach students to be full participants in student-teacher-parent conferences (Battle, Dickens-Wright and Murphy, 1998). Students practice discussing their strengths and needs on a regular basis. Through this process the students learn how to give themselves and others feedback.
Acknowledging Strengths of the Collaborative Partners
Professionals bring their knowledge of the adolescent developmental process, communication skills, task analysis, learning theory, and knowledge of specific disabilities. Families know how their son/daughter performs at home, what overwhelms them, their strengths, how they have learned specific tasks and what strategies are possible given their family circumstances. Adolescents know their interests and preferences, what motivates them, and what their non-negotiables are.
Barriers to Collaboration
Competency - Many family members and adolescents may not be aware of the strengths they bring to the collaborative process and assume that the professionals are more knowledgeable than themselves. They may feel a stigma that is attached to their son/daughters diagnosis and worse yet, they feel blamed if their adolescent has received a label such as non-compliant. This is often perpetuated because the mental health diagnosis does not become clear until adolescence. A teen may have been labeled as oppositional-defiant for his/her refusal to participate in group activities while the neuro-biological basis of this behavior has been ignored. These situations may have contributed to families feeling that they have been incompetent in their parenting.
Feelings of incompetence can also arise on the part of adolescents and their families when they do not understand professional jargon or acronyms. They may also lack an understanding of one or more of the systems which is involved in their lives.
Professionals may also struggle with feelings of incompetence. A teacher who has not taught a student with schizophrenia, may either ignore the schizophrenia and teach the student as if he/she only had a developmental disability or want the student transferred out of the class. Professionals may not have had training in person and family centered planning.
Competency may also be affected when one of the parties has antiquated information.
For instance, if there is not a familiarity with the neuro-biological theories of mental illness, strategies may center exclusively on a behavioral approach to problem-solving and not look at medications or environmental supports which may be important.
Lack of Empowerment - Lack of empowerment occurs when an individual does not feel competent. It can also occur when he/she is not viewed by the others as competent. If adolescents are viewed as incapable of participating equally in problem-solving, they will not feel empowered to advocate on their behalf. If family members detect they are viewed as pushy, angry, denying or anxious, this may affect their ability to participate as equal partners.
If professionals are not supported in their own organization, they will be handicapped in their ability to empower families and adolescents. This may cause them to attempt to get their needs met through such actions as competing with parents for the loyalties of the adolescents.
Lack of Flexibility - If any of the parties does not have the freedom or willingness to be flexible in meeting times, length of meetings, or place to meet, it will place a feeling of inequality on the relationship.
Lack of commitment - Occasionally, one of the parties may be so defensive, that they are not able or willing to take an equal role in the collaborative partnership.
All parties benefit and more positive outcomes transpire, when a collaborative partnership is developed. For Families, participation in a collaborative relationship with their adolescents and with professionals increases their understanding of the needs of their son/daughter and how to extend positive effects into their home. Through this type of process they can increase their competency in problem-solving and how to help their adolescent learn.
Adolescents increase their self image through collaborative problem-solving and learn to take responsibility for themselves. They also learn how to make choices and how to self-advocate.
Through a collaborative partnership, professionals gain a greater understanding of the needs and desires of both the adolescent and the family. They increase their repertoire of strategies through learning what works and doesnt work at home and they are able to build upon both the strengths of the adolescent and of the family in helping them develop strategies.
Battle, D. A., Dickens-White, L. L.., Murphy, S. C., (1998). How to empower adolescents: guidelines for effective self-advocacy, Teaching Exceptional Children, 30, 28-33.
Bradley, Valerie, John Asbaugh & Bruce Blaney, (1994) Creating Individual Supports for People with Developmental Disabilities: A Mandate for Change at Many Levels. Baltimore:Brooks.
Bruner, C., (1991) Thinking collaboratively: ten questions and answers to help policy makers improve childrens services, Washington, D.C.: Education and Human Services Consortium.
Sileo, Thomas, (1996).Parent and professional partnerships in special education: multi-cultural considerations. Intervention in School & Clinic, 31, 145-53.
Singer, G. H., (1993) Families, Disability & Empowerment, Baltimore:Brooks Publishing.
Singer, G. H., (1996) Redefining Family Support: Innovations in Public-Private Partnerships. Baltimore: Brooks.
Turnbull, A. P., (1991) Families, Professionals and Exceptionality: A Special Partnership. Columbus, OH: Charles E. Merrill.
For further information contact:
Judith Liddell, MBA
Center of Development and Disability
University of New Mexico
Albuquerque, NM 87131