Donna M. Pence Practice Improvement Consultant Pence-Wilson Training & Consulting, Inc.

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Transcript of Donna M. Pence Practice Improvement Consultant Pence-Wilson Training & Consulting, Inc.

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  • Donna M. Pence Practice Improvement Consultant Pence-Wilson Training & Consulting, Inc
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  • 3 Key decision points in child maltreatment investigations Styles of decision-making Errors in Decision-making Influence of personal and professional biases on decision- making Benefits of MDT case staffing and supervisor consultation on decision-making Importance of thinking about your critical thinking skills
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  • Basic Components of the Investigative Process Child Maltreatment Investigation Components Cross Reporting & Coordination w/ Other Investigative Agency Reviewing History & Gathering Background Information Investigative Planning Child Interviewing Adult Interviewing Evidence Identification & Collection: Medical/ Physical/Verba l Critical Thinking- Evaluation of Information & Evidence Consultation & Decision-Making 4
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  • Critical thinking is the intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action. In its exemplary form, it is based on universal intellectual values that transcend subject matter divisions: clarity, accuracy, precision, consistency, relevance, sound evidence, good reasons, depth, breadth, and fairness. The Critical Thinking Community http://www.criticalthinking.org
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  • The habit, based on intellectual commitment, of using those skills to guide behavior. A set of information and belief generating and processing skills
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  • Go down a list Choosing between various categories Each question narrows the choice Fails to grasp the importance of context Fails to recognize that actions are mediated by circumstances that change over time and place 14
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  • Complexity = increased chance of something going wrong!
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  • Information Gathering Application of Rules or Criteria that is applied Discussion Feedback Decision/Professional Judgment Reassessment 17
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  • Activity 19
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  • Jumping to conclusions Entering into power struggle with client Accepting parental withdrawal/ closure Sticking to the same case plan (Reder, Duncan & Gray, 1993) 20
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  • Are we asking the right questions? Are we correctly understanding the information? What are the criteria we use to inform our response? Misinterpretation or misdiagnosis of risk 21
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  • Who, What, When Where, Why, How Considerations in Documentation Evaluating the source of information 22
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  • Interview Protocols A good investigation requires an orderly, structured procedure in the gathering of sufficient information to determine if maltreatment took place and to develop a coherent investigative plan. 23
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  • Near Misses: Something could have gone wrong but have been prevented Something did go wrong but no serious harm was caused 27
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  • The prioritization of cases Professionals not having an accurate or full picture of what is happening Decisions made by other teams and agencies 28
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  • Some holes due to active failures Other holes due to latent conditions Successive layers of defences, barriers and safeguards Hazards Losses System defences 29
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  • Preconditions - The Dirty Dozen 1. Lack of Communication 2. Complacency 3. Lack of Knowledge 4. Distraction 5. Lack of Teamwork 6. Fatigue 7. Lack of Resources 8. Pressure 9. Lack of Assertiveness 10. Stress 11. Lack of Awareness 12. Norms Set the person up to make the active error Are often a combination of more than one of the Dirty Dozen Preconditions To a Human Error 30
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  • Models help us to reduce the complexity of a situation by enabling us the suppress most of it and concentrate on what is most important. Models do not define what or how we should think; they are the result of an active thought process. 32
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  • Investigative Plan Questioning Plan Interviewing Plan 33
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  • If they can get you asking the wrong questions, they dont have to worry about the answers. Thomas Pincheon
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  • Questions to ask yourself: What is the immediate threat? What is the nature of the harm to a child? How severe are or could the consequences be What is the vulnerability to the child? Who imminent is the possibility of harm? 36
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  • The hidden 4 letter word 37
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  • Three Critical Concepts Confirmatory Bias Reasonable Alternative Hypothesis Source Monitoring 39
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  • The more important the decision, the greater the need to reduce dissonance by overemphasizing the correctness of the decision. Once we make a decision, we feel we must justify and rationalize it, even if we dont really have strong empirical support for it. Why we dont accept our decisions being questioning 42
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  • 43 Other explanation for statements, injuries, behaviors which should be evaluated by the investigator during the investigative process.
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  • Source Monitoring Determining how the information being provided was acquired by the person sharing it. Did they experience it, see it, hear it? Were they told about it, saw something suspicious and have drawn conclusion based on that? Source Confusion Confusing an event that happened and the details. Other people provided details, time delay, telling and retelling, embellishing. 44
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  • You see what you want to see and you hear what you want to hear. The Point, 1972 47
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  • Skew Perceptions o See what we want to see and hear what we want to hear. Influence Clinical Judgment o Confirmatory bias Professional Personal Subvert Accurate Documentation o Good facts and Bad facts Affect Decision-Making o Viability, Credibility, Logic, Optimism-Pessimism, Attribution of Responsibility, Weight to Evidence and Expert Opinion (Munro, 1999) 48
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  • (Munro, 1999) 49
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  • Confirmatory Bias Trap Case Theory Question Design/ Evidence Collection Interpretation of Evidence/ Answers to Questions Quality Consultation? Confirm Theory 50 Case Planning
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  • GOOD FACTS Those pieces of information or evidence which support my working hypothesis BAD FACTS Those pieces of information or evidence which do not support my working hypothesis or directly refute it. 51
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  • Identify Reasonable Case Theories Trauma/ Culturally- Informed Case Planning Question Design/ Evidence Collection to Explore All Reasonable Theories Interpretation of Evidence/ Answers to Questions Validate Most Reasonable Theory 52 Theory disproved New Theory developed Determine Action/s MDTMDT Consultation w/ Supervisor, peers, MDT, experts Theory discarded
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  • OUR MIND PROCESSES SATISFICING Selection of the first identified alternative that appears good enough. AVAILABILITY Ease by which previous examples come to mind. Recent & vivid events easy to recall. FRAMING The presentation of information influences its interpretation. Implies information is understood within a context. 53 Minimum Sufficient Level of Information Experience Knowledge & Experience
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  • Truth Evaluation 55
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  • Denial or Admission 56 Decision many of us make frequently as we are confronted with our behaviors or beliefs. What is it we re being asked about? What has been our past experience/s? Who is doing the questioning? Can I convince you you re wrong? How guilty am I feeling?
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  • Its sounds plausible It fits my experience They wouldnt lie about something like this Their body language didnt indicate deception Their story has been consistent Ive worked with them before and I know them 57
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  • The death of a child or adult on the workers caseload Investigating a vicious abuse or neglect report Frequent/chronic exposure t