CONCEPTUAL CHANGE IN CONSULTATION AND ASSESSMENT. Ingrid Hylander Karolinska Institute, Centre for Primary Care, Stockholm Daffodil Winter Conference, 4th February 2010 Östersund, Sweden

OUTLINE Consultation Different models of consultation School consultation internationally and in Sweden

Conceptual change What is conceptual change? When does it occur? What are the necessary ground pillars?

A process model of conceptual change

EXAMPLE OF CONCEPTUAL CHANGE The teacher has a work problem with a client The teacher wants help from the consultant The consultant listens to the teacher’s view of the problem The teacher observes and collects information Interventions are implemented by the teacher The consultation is finished when the teacher thinks that the problem is solved. The solution of the problem is a change of the teacher’s conceptualising of the problem.

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OBJECTIVES OF SCHOOL PSYCHOLOGY To transmit psychological knowledge in such a way that the school can make use of it in its pursuit to give all children the best possible grounds for learning and development

Education

CONCEPTUAL CHANGE THROUGH DIFFERENT PROCESSES Training Supervision Supervision intervision CONSULTATION Consultee Client COLLABORATION

Ingrid Hylander 2007

Advocacy

TEAMWORK

CONSULTATION A process of interaction between two professionals, the consultant, who is a specialist and the consultee, who invokes the consultant’s help in a current work problem. (Caplan, 1970, Caplan and Caplan, 1993, p. 11)

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CONSULTATION RELATIONSHIP Non coercive relation Professional relation A relation between equals (two experts) Voluntary process

CONSULTATION (CCC) The goal of the consultation process is: the joint development of a new way of conceptualizing the work problem so that the repertoire of the consultee is expanded and the professional relationship between the consultee and the client is restored or improved. (2nd International Seminar on Consultee-centered Consultation in Stockholm, 1999)

CONSULTATION CASE

PROBLEM

ORGANISATION

Clinical Expert Client-centered Programcentred Administrative

CONSULTEE Psychological

Consulteecentered Case consultation

Process

Consultee-centered Administrative consultation

Ingrid hylander 2005

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WHO ASSESSES THE CLIENT Client centered consultation Consultant makes an assessment and gives a report to the teacher

Consultee centered consultation (ccc) Teacher (consultee) makes the direct interventions and assesments with the student. Consultant and teacher discuss and evaluate together

SCHOOL CONSULTATION INTERNATIONALLY

CONSULTATION IN SWEDEN Beginning of 1980 consultation by psychologists in pre-schools and day care (Guvå, G.) CCC approach During the 1980 interest for consultation grew in schools. Mixed models during 1990 From 2000 principals ask for consultation, Psychologists want to do more consultation but request for assessment takes most of their time Less work from psychologists in pre-schools and day care in favor of schools from 2000

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INTERNATIONAL COLLABORATION ON CCC International conferences and seminars on Consultee-centered consultation, 1995 Hasselbacken, Sweden 1999 Hasselbacken, Sweden 2001 San Fransisco, USA 2006 Chapel Hill, USA 2008 Boston, USA

TEXTS ON CCC Consultee-centered consultation, Improving the Quality of Professional Services in schools and community organizations 2004 Lambert, N., Hylander, I., Sandoval, J. Turning processes. The change of represen-tations in consultee-centered case consultation. (Hylander, 2000)

Consultee-centered Consultation A Special Double Issue of the Journal of Educational and Psychological Consultation Publicerad i May 14, 2004, Lawrence Erlbaum

THEORIES OF CHANGE IN CONSULTATION Several theories about organizational change but lack of theories of what the consultant is doing to promote change Several theories of client change but few theories of how the consultantconsultee relationship makes a change in the consultee-client change

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Behavioural theory (Bergan) Theory of social influence (Erchul) Psycho dynamic theory (Caplan) Conceptual change (several different theories)

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TWO MAIN APPROACHES TO CHANGE IN CASE-CONSULTATION Prescriptive consultation

Non-prescriptive consultation

The consultant has the solution to the problem usually client centered

The problem is solved in collaboration with the consultant and the consultee usually consulteecentered

CCC A NON-PRESCRIPTIVE METHOD Multiple theoretical framework Interactive approach Outcome - conceptual change Consultee AND consultant may change their representations and presentations of the problem

TOOLS IN CCC Voluntary process Questions (un-knowing perspective) Non-coercive - take or reject Focus on client

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PREREQUISITES FOR CCC IN PRESCHOOL Educare Involvement teacher-child Relational practice Responsibility for client Differentiating between area of responsibility and area of competence Inclusive

WHAT IS CONCEPTUAL CHANGE? Change of representations of the case what’s in the mind Change of presentation of the case what’s described and shown

PRESENTATIONS AND REPRESENTATIONS Cognition – how the student is described Affect – feelings in connection with the student Action orientation- what the teacher is prepared to do

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DIFFERENT TYPES OF CONCEPTUAL CHANGE IN CONSULTATION Turnings Turningpoints Shifts

DATA BASE 1. Six focusgroups with experienced consultants 2. Six audiotaped consultation cases (18 sessions), combined with interviews with consultants and consultees before and after 3. Survey n=100 consultees after completed consultation

HOW DO TURNINGS COME ABOUT? In a dialogical space Interaction between consultees’ and consultants’ representation and presentation

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TURNINGS Distinct turnings ”Magical” turnings Weathercock turnings False turnings Continous turnings

THE PROBLEM PRECEDING TURNINGS The consultee-client interaction is stuck Too close Too neutral Too far away

PROBLEMS AS PRESENTED AND REPRESENTED Closeness Representation – entangled interaction Presentation – distorted picture

Neutral Representation – formal interaction Presentation – Stereotype diagnose

Distance Representation – Alienated interaction Presentation – Diffuse picture

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CLASSIC PROBLEM-SOLVING STAGES Entry and contract Problem identification Collecting data analyses Intervention design Implementation Evaluation

CCC A consultation process, which oscillates between different modes of interaction

TWO MAIN APPROACHES TO THE PROCESS OF CONSULTATION Directive

Non-directive

The consultant is in charge of the process by Asking questions Structuring Focusing Giving suggestions

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The consultant listens to the consultee and avoids giving suggestions

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LEADING CONSULTATION Prescriptive - being in charge of the solution to the problem Directive - being in charge, of the consultation process

MODES OF INTERACTION IN THE CONSULTATION PROCESS 1. 2. 3.

Consultee Consultant Discharge Confirm Display Concern Discover Challenge

CCC PROCESS Approach

Confirm Discharge

Free neutral

Structure Describe

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Moving away

Challenge Discover

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CCC PROCESS Approach

Free neutral

Confirm Discharge

Bind

Moving away

Challenge Discover

Structure Describe

Break

Boredoom

WHEN THE CONSULTATION PROCESS IS STUCK Bind- too close Ct Pres= Ce Pres

Boredoom- too neutral Ct Pres and Repr = Ce Pres and Repr

Break - too far away Ct Pres = Ce Pres

BIND The nice party Walking in mud Hidden fight

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BOREDOOM The blind alley of neutral

BREAK Tug of war Mission impossible Interpreting

THANK YOU! Ingrid Hylander Docent, leg psykolog

Karolinska institutet Centrum för allmänmedicin Alfred Nobels Allé 12 | SE-141 83 Huddinge [email protected]

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