Drawing the Wisdom from the Past

The FCC Process
TOP
Abstract
The Project
The FCC Intervention
The FCC Process
Progress to Date
References

Although the family meeting represents the most visible component of the FCC, the intervention involves other stages that often are more important than the actual meeting. The FCC has six stages: referral, screening, engaging the family, logistical preparation, family meeting, and follow-up.

Referral
Referrals come from a variety of sources, including the Elder Protection program, Community Health Representative program, Housing Authority program, Domestic Violence program, Tribal court, Child Protection program, community members, and concerned family members. The majority of referrals are made because of concerns about exploitation, neglect, self-neglect, and child neglect. Many times referrals are related to the addiction of a family member who lives in the elder’s home, exploits the elder’s monthly income, or leaves young children in the care of a frail elder. Although some referrals are related to physical abuse, these are limited. In part this pattern may reflect the screening procedures, through which some referrals are deemed inappropriate.

Timeliness of response to referrals is an important concern. To address this concern, facilitators, along with the research team, developed guidelines that include making initial contact with family members within 3 to 5 days of referral receipt. Depending on the family’s schedule, but within 5 working days, the facilitator determines a tentative date for the family meeting. The facilitator, although cautious to maintain confidentiality, also notifies the referring person or agency that she has begun to work with the family. This helps maintain the credibility of the FCC project in the community.

Screening
Some referrals are inappropriate for the FCC intervention. These involve families who have a high potential for violence. These situations are referred to the Elder Protection program for further evaluation and action. Over the course of this project, facilitators have developed a strong working relationship with the Elder Protection program.

Engaging the Family
The pre-meeting preparation stage is crucial to the success of the FCC. At the beginning of this stage, it is important to have the family identify a primary contact. This person, who may or may not be related by blood, is someone trusted by the family and the elder. The primary contact is familiar with the family’s dynamics, and knows how to work within these dynamics. During this stage, the facilitator contacts family members and family-nominated service providers and invites them to participate in the FCC. Although they are careful to honor the wishes of the family when inviting participants, the facilitators at times sensitively inquire about family members whom they have not invited. In some instances, this provides the opportunity for the family to reconsider its decision.

The facilitator gives a verbal explanation and provides a descriptive brochure about the FCC to each nominated person. The facilitator emphasizes that the meeting will be a safe place for family members to gather to discuss their concerns. During the engagement stage, the facilitator helps to focus each family member’s attention on the concern at hand: the elder’s well-being and safety. This stage is complex, requiring communication skills that are nonjudgmental and sometimes therapeutic, including engaging, listening, encouraging, and giving information. Often a family member must address a multitude of feelings (such as stress, resentment, grief, shame, and anger) before he or she is able to commit to attending the FCC.

Many of the reservations in the Northwest are in rural areas, which can make contacting people difficult. Geographical distances necessitate traveling over back country roads, and severe weather may cause meetings to be rescheduled. Additionally, not all families have telephones; in such instances, the facilitator requests that another invited family member ask for that person to contact her.

Given the sensitive nature of the topic, face-to-face meetings between the family members and facilitator are preferred. This method of meeting allows for the development of trust and rapport and the expression of gentle caring. Yet it is important to consider geographically distant family members. When geographical distance precludes a family member’s attendance at the meeting, the facilitator brings his or her concerns to the meeting. Some distant family members choose to participate via a conference phone call.

Additional strategies ensure privacy during this stage. When facilitators attempt to make contact by phone, they are cognizant about not leaving messages that might violate confidentiality. Similarly, when meeting an individual family member face-to-face, facilitators find it is sometimes important to meet outside of the house, where other family members or visitors cannot hear what is being said.

Because of the small size of the communities, it is important to pay attention to relationships between the facilitator and some of the families who have been referred. To date, the project has addressed this by having more than one facilitator who can work with a family in which there are no close relatives or alliances. Community norms and status differentials and their effect on the facilitator–family-member relationships are important additional considerations. For example, a community norm is for younger people to show respect to elders. Although facilitators are middle-aged and older women who are accustomed to working with people in a helping relationship, there have been situations in which expectations related to the elder–younger role have been intimidating to facilitators who were slated to work with Tribal members older than themselves. In other cases, facilitators have been reluctant to intervene in families with prominent community members. In such situations, the monthly facilitator group meetings are helpful for discussing sensitive strategies for approaching these families.

Logistical Preparation
Once the facilitator has contacted all nominated family members, service providers, and other community members (as requested by the family), she determines a mutually agreeable meeting time. The facilitator sends each prospective participant a letter summarizing the purpose of the meeting and identifying the date, time, and meeting place. On the day prior to the meeting, the facilitator calls those family members who can be reached by telephone to remind them of the meeting and to check that they are still able to attend.

Sensitivity to the venue for the family meeting is also important. Some families prefer to have the meeting in their homes; others prefer to have it at a neutral, but private, place (often in a conference room at one of the agency offices). Because gracious hospitality is a strong community norm, the meetings usually involve the sharing of food. The facilitator prepares a few trays of healthy snacks ahead of time in accordance with any dietary restrictions family members may have. In keeping with the norm of sharing, family participants take home any remaining food.

Creation of a safe, inviting, and private space is important. In situations in which not all participants share proficiency in both the Native and English languages, it is necessary to have an interpreter. In these circumstances family members choose a person whom they feel is unbiased and whom they trust. Confidentiality remains crucial, particularly in a small community. It is important to think about maintaining privacy by drawing conference room window shades for meetings held in the late evening. Participants must take into consideration solutions to barriers to participation (such as making arrangements for child care or transportation, joining via conference calls, or sending letters) prior to the meeting. Because the length of the meeting may range from 2 to 5 hr, it is important to plan for breaks so people can move about, stretch, and use the facilities.

Family Meeting
The family meeting has the following components: beginning, information sharing, development of a plan, and closing.

Beginning
As people arrive, the facilitator acknowledges and greets everyone, often with a warm handshake or a hug. The agenda for the family meeting begins with a formal welcome, during which the facilitator thanks the family for coming together and for allowing the facilitator to be a part of its meeting. This recognizes the emotional vulnerability that some family members may experience in coming together to discuss sensitive aspects of their family. The meeting opens with a prayer offered by a chosen family member (such as an elder or the oldest participant) or a spiritual leader (if the family has invited one to attend the meeting). If needed, introductions are made and each participant explains his or her relationship to the elder. The facilitator then reviews the FCC format, briefly identifying the purpose of the meeting and describing her own role. At this time, the facilitator reminds people that the sharing of their stories will be held sacred. The group spends some time establishing group norms (e.g., one person speaks at a time; show respect for all; conflict without hostility can be good; no question is wrong; no side conversations; be considerate of confidentiality; and recognize the “spirit of intent,” i.e., the positive intentions of others). The facilitator writes these on a flipchart and posts them in the room. The facilitator orients people to the room and the facility and invites them to partake of the food.

Information Sharing
During this portion of the meeting, the people present identify their concerns. The facilitator reads letters from family members who, although unable to attend the meeting, would like to participate. The facilitator records all concerns on the flipchart and posts the pages in a prominent place in the room. Throughout this stage, the facilitator is careful to point out family strengths she has learned about through the process of engaging the family members. Because facilitators are from the communities, they are aware of the norm against self-promotion and recognize that family members may be hesitant to identify their strengths.

Development of a Plan
The family has the option of asking the facilitator and all other people who are not members of the family to leave the room so it may develop a plan in private. Prior to leaving the room, the facilitator reminds the family to choose a recorder from among the people present. If the facilitator leaves the room, she should not leave the facility in case the family has questions or would like to make use of her mediation skills. In this case, the facilitator should make periodic checks on the family members to see if they have any questions or needs. In our experience, families rarely request this private time, possibly because they developed a trusting rapport with the facilitator during the engagement phase.

When the family has developed its plan, the facilitator and service providers return to the room to help the family with the logistics related to implementing the plan. For example, this may include identifying resources that are available to family members, developing a timeline for the various parts of the plan, and identifying which family member will be responsible for each part of the plan. The facilitator makes a record of the plan that she will include in a letter to each family member in the week following the FCC. If the family has indicated they would like a follow-up meeting, the facilitator notes the date and time of this meeting in the letter.

Closing
At the end of each meeting, the facilitator asks for an evaluation of the entire FCC intervention. Using the format of “likes and wishes,” the facilitator asks what it was that people liked about the process and what they wish could have been done differently. The facilitator makes it known that wishes are as readily appreciated as likes. The facilitator records both on the flipchart. We had originally developed a written survey for FCC participants to complete immediately following the meeting; however, asking the more open-ended likes-and-wishes question elicits a wider variety of (and more descriptive) responses. Additionally, doing the likes and wishes as a group provides time for a shared family debriefing.

Follow-Up
The follow-up portion of the FCC is dependent on family needs and desires. Follow-up is not case management; however, at times the facilitator agrees to implement a part of the family’s plan, such as contacting a social service provider to arrange for a needed service. The facilitator carries through on this agreement and then makes certain the service is meeting the needs of the family. Follow-up meetings may be arranged when members of the family wish to meet together with a service provider (e.g., families might meet with people from housing to arrange a plan for complying with housing rules that will protect the elder while also finding suitable shelter for an addicted family member). Families may also schedule a date to get together to discuss how the plan is working and to modify it if necessary. Additionally, when family situations change, some families may reopen cases that have been closed, by requesting a second family meeting. Follow-up can provide the opportunity for positive encouragement. It is important to highlight the incremental progress that the family has made. Although family members may not have met their goals in their entirety, often they have taken steps toward their achievement. Or it may be that the family implemented an action that did not work. That, too, is progress with regard to both intent of good will and knowledge that something else must be tried.

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