Imagine engaging in a conversation with yourself. Complete the following worksheet to better appreciate who you are and how to nurture your well-being and advocate for your needs in a self-respective and self-protective way in various aspects of your life. 

1. What do I most appreciate about myself? What else?
2. What am I most proud of accomplishing in my efforts to care for my own needs? What else?
3. What have I done this past year, month, week, and today that maintained or improved my well-being physically, mentally, and emotionally? What else have I done?
4. What do I know have been the most helpful ways I have taken care of myself? What else do I know?
5. Who would notice that I am taking care of myself? Who else would notice?
6. What would they appreciate about me taking care of myself? What else?
7. Is it different how well I cared for myself, or is this something I have always been able to do?
8. Was it helpful for me when I took care of myself?
9. How was it helpful for me? How else was it helpful for me? 
10. How did I decide to take action to care for myself? How else did I choose to take care of my own needs? 
11. Consider the following domains and scale how well you have been doing from 1-10 (10 being the best and one the opposite):
    1. How well have I nurtured myself with kind words, healthy activities, and meaningful relationships?
    2. How well have I been taking care of my physical health, including regular medical appointments, exercise I enjoy, and prioritizing rest and sleep?
    3. How satisfied am I with the boundaries I am setting for myself?
    4. How satisfied am I with the quality of my relationships?
    5. How satisfied am I with giving myself space for creative outlets that are generative for me?
    6. Suppose I asked people who I know care about me; how well would they say I can take care of myself from 1-10? 
    7. Is their number higher, lower, or the same? What accounts for their number?

Ask yourself each of the above questions: Working the Scale

1. What is a “good enough number”?
2. What keeps the number from being lower? What else?
3. What is one thing I could do to raise my number by one point?
4. How confident am I from 1-10 that I will take one small step to increase my number by one point? 
5. What keeps my number from being lower? What else?
6. Is it a good enough number in terms of confidence?

Self-compassion involves treating yourself with the same kindness, concern, and support you would show to a good friend. It is the desire to alleviate suffering within yourself with gentleness, care, and empathy.  In caring professions, the culture often emphasizes kindness to others rather than ourselves. By embracing yourself with compassion and empathy, you surround yourself with acceptance instead of criticalness. Instead of comparing yourself with others, self-compassion allows you to simply care.  

Greater self-compassion has been linked to less anxiety and depression, improved mental health, enhanced relationships with others, positive coping, the capacity to frame your situation within the larger human perspective, the ability to seek and accept social support, and improved overall well-being (MacBeth & Gumley, 2012; Neff & Dahm, 2015). How can you nurture self-compassion? How can you approach uncomfortable and painful feelings with kindness and a sense of shared humanity? How can you learn to affirm your emotions,  appreciate what you have already done to cope, and harness the passion of your feelings, whether comfortable or uncomfortable,  to empower you to thrive?  

Drawing on the writings of Buddhist teachers, Neff (2003) has described self-compassion as consisting of three main elements: Kindness, Common Humanity, and Mindfulness. 

• What does self-kindness mean to you? What have you done and said to yourself that is kind and nurturing? Who would notice when you are being kind to yourself? What would they notice you doing? What else would they notice you doing? Supposing you were writing a letter to a close friend in distress, what do you know would be kind actions and words to appreciate how they are doing the best they can given their situation?

• What does a common humanity mean to you? What do you most appreciate about our shared human experiences? What have you noticed you do when you recognize your common shared humanity with others? What else have you done? Consider how we are all imperfect and experience setbacks, mistakes, pain, grief, fear, love, loneliness, connection, and joy. What are common human experiences that you share with others? What else?

• What does mindfulness mean to you? What do you know has helped you remain open to the present moment without judgment?  How have you been able to approach uncomfortable thoughts and emotions with acceptance and self-compassion? How else?

Reflect on a time when you experienced a situation that felt like it was barely tolerable for you. It can be helpful to remind yourself that emotions are temporary and that change is the only constant in life. Shrinking the time increments of coping strategies to brief moments can help make things more bearable for you. Sometimes, tolerable or bearable is good enough. For many people, 10 minutes is a tolerable time frame. For others, it may be 30 minutes or 5 minutes. 

What do you know is a time frame that is tolerable for you when reflecting on difficult and uncomfortable situations that you have experienced? Ask yourself the following questions. 

PAST 10-minute time: 

“For Me” statements are a way to provide empathy for yourself. They are not selfish; rather, they are much-needed ways to be compassionate with yourself. Start by writing down some “for me” statements when considering your challenging situation. For example, it was very stressful and worrying for me to see my partner struggle with his health condition. It was scary for me not to know what would happen after getting an abnormal mammogram. It was frustrating for me to work so hard and not get the help I needed from my family. 

PAST 10-minute time:

• What do you know helped make things even a little more tolerable or bearable for you in the past 10 minutes? What else?
• What were you doing that helped make things a little more bearable for you? What else were you doing? 
• Who would notice when things are more bearable for you?
• What would they notice you doing when things are even more tolerable for you? What else would they notice you doing? 

FUTURE 10-minute time: 

• What do you know you need to make things even a little bit more tolerable or bearable for you in the next 10 minutes? What else?
• What would you be doing in the next 10 minutes that would make things even a little bit more tolerable for you? What else would you be doing? 
• Who would notice when things are more bearable for you?
• What would they notice you doing when things are slightly more tolerable for you? What else would they notice you doing? 

SCALING your confidence 

• Supposing ten is you are very confident that you can do something to address your needs that would make things even a little bit more tolerable, and one is the opposite; where would you say you are now?
• What would be a good enough number?
• What have you been doing that keeps the number from being lower? What else?
• What would you be doing when the number goes up by one point? What else would you be doing?

REFERENCES

Neff, K. D., & Dahm, K. A. (2015). Self-compassion: What it is, what it does, and how it relates to mindfulness. Handbook of mindfulness and self-regulation, 121-137.

Neff, K. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and identity, 2(2), 85-101.

Mache, S., Bernburg, M., Baresi, L., & Groneberg, D. A. (2016). Evaluation of self-care skills training and solution-focused counseling for health professionals in psychiatric medicine: a pilot study. International Journal of Psychiatry in Clinical Practice, 20(4), 239-244.

Beauchemin, J. D. (2018). Solution-focused wellness: A randomized controlled trial of college students. Health & social work, 43(2), 94-100.

Beauchemin, J. D., Facemire, S. D., Pietrantonio, K. R., Yates, H. T., & Krueger, D. (2021). Solution-focused wellness coaching: a mixed-methods, longitudinal study with college students. Social Work in Mental Health, 19(1), 41-59.

Eads, R., & Lee, M. Y. (2019). Solution Focused Therapy for trauma survivors: A review of the outcome literature. Journal of Solution-Focused Practices, 3(1), 9.

Franklin, C. (Ed.). (2012). Solution-focused brief therapy: A handbook of evidence-based practice. Oxford University Press.

Franklin, C., Moore, K., & Hopson, L. (2008). Effectiveness of solution-focused brief therapy in a school setting. Children & Schools, 30(1), 15-26.

Franklin, C., Guz, S., Zhang, A., Kim, J., Zheng, H., Hai, A. H., … & Shen, L. (2020). Solution-focused brief therapy for students in schools: A comparative meta-analysis of the English and Chinese literature.

Franklin, C., Ding, X., Kim, J., Zhang, A., Hai, A. H., Jones, K., … & O’Connor, A. (2023). Solution-Focused Brief Therapy in Community-Based Services: A Meta-Analysis of Randomized Controlled Studies. Research on Social Work Practice, 10497315231162611.

Franklin, C., Streeter, C. L., Webb, L., & Guz, S. (2018). Solution-focused brief therapy in alternative schools: ensuring student success and preventing dropout. Routledge.

Garner, J. A., Kim, J., & Hopson, L. Solution-Focused Accountability Schools for the Twenty-First Century: A Training Manual for Gonzalo Garza Independence High School.

Gong, H., & Hsu, W. (2017). The effectiveness of solution-focused group therapy in ethnic Chinese school settings: A meta-analysis. International Journal of Group Psychotherapy, 67(3), 383-409.Hsu, K. S., Eads, R., Lee, M. Y., & Wen, Z. (2021). 

Hsu, K. S., Eads, R., Lee, M. Y., & Wen, Z. (2021). Solution-focused brief therapy for behavior problems in children and adolescents: A meta-analysis of treatment effectiveness and family involvement. Children and Youth Services Review, 120, 105620.

Kim, J. S., & Franklin, C. (2009). Solution-focused brief therapy in schools: A review of the outcome literature. Children and Youth Services Review, 31(4), 464-470.

Kim, J., Brook, J. & Akin, B.A.  (2018). Solution-focused brief therapy with substance-using individuals: A randomized controlled trial study. 

Kim, J. S., Brook, J., & Akin, B. (2021). Randomized controlled trial of solution-focused brief therapy for substance-use-disorder-affected parents involved in the child welfare system. Journal of the Society for Social Work and Research, 12(3), 545-568.

Kim, J. S., Brook, J., & Akin, B. A. (2018). Solution-focused brief therapy with substance-using individuals: A randomized controlled trial study. Research on Social Work Practice, 28(4), 452-462.

Kim, J. S., Akin, B. A., & Brook, J. (2019). Solution-focused brief therapy to improve child well-being and family functioning outcomes with substance-using parents in the child welfare system. Developmental Child Welfare, 1(2), 124-142.

Kim, J., Jordan, S. S., Franklin, C., & Froerer, A. (2019). Is solution-focused brief therapy evidence-based? An update 10 years later. Families in Society, 100(2), 127-138.

Lehmann, P., & Patton, J. (2012). The development of a solution-focused fidelity instrument: A pilot study. Solution-focused brief therapy. A handbook of evidence-based practice, 39-54.

Medina, A., Beyebach, M., & García, F. E. (2022). Effectiveness and cost-effectiveness of a solution-focused intervention in child protection services: A randomized controlled trial. Children and Youth Services Review, 106703.

Neipp, M. C., & Beyebach, M. (2022). The global outcomes of solution-focused brief therapy: A revision. The American Journal of Family Therapy, 1-18.

Park, J. I. (2014). Meta-analysis of the effect of the solution-focused group counseling program for elementary school students. The Journal of the Korea Contents Association, 14(11), 476-485.

Wallace, L. B., Hai, A. H., & Franklin, C. (2020). An Evaluation of Working on What Works (WOWW): A Solution-Focused Intervention for Schools. Journal of Marital and Family Therapy, 46(4), 687-700.

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Drawing on the writings of Buddhist teachers, Neff (2003) has described self-compassion as consisting of three main elements: Kindness, Common Humanity, and Mindfulness.

1. Solution-Focused Reflections on Self-Kindness

• What does self-kindness mean to you?
• What have you done and said to yourself that is kind and nurturing?
• Who would notice when you are being kind to yourself?
• What would they notice you doing?
• What else would they notice you doing?
• Supposing you were writing a letter to a close friend in distress, what do you know would be kind actions and words to appreciate how they are doing the best they can given their situation?

2. Solution-Focused Reflections on A Shared Common Humanity

• What does a shared common humanity mean to you?
• What do you most appreciate about our shared human experiences?
• What have you noticed you do when you recognize your common shared humanity with others?
• What else have you done?
• Consider how we are all imperfect, experience setbacks, mistakes, pain, grief, fear, love, loneliness, connection, and joy. What are common human experiences that you share with others? What else?

3. Solution-Focused Reflections on Mindfulness

• What does mindfulness mean to you?
• What do you know has helped you remain open to the present moment without judgment?
• How have you been able to approach uncomfortable thoughts and emotions with acceptance and self-compassion? How else?

Many of you may have endured dark times over which you had no control. Children and adults who were physically or sexually abused, neglected, experienced homelessness, food insecurity, racism, suicidal thoughts, and severe substance abuse. I am so inspired by my clients’ courage and strength to do their best to forge on despite the traumas they have endured. There was a woman I had the privilege of working with who suffered severe physical and sexual abuse and was the child of her grandfather and mother. She sustained broken bones and terror growing up as a child and now was coping with severe depression and anxiety. During our conversations, I asked her about several decisions that I noticed she had recently made that were compassionate choice points in her life. She finally got herself a primary care provider and was seeing a physical therapist to assist her with the back pain she had endured since childhood after being pushed down the stairs by her mother. She had found a therapist she could connect with. She began a small container garden on her porch. She was enjoying the relationships with the children she was helping through her volunteer work at the local community center. She acknowledged that these recent decisions over the past few months were very different and helpful for her. We discussed how she decided to make these choices and surround herself with activities and relationships that were reciprocal and generative for her. She acknowledged that this was the first time she had considered her needs and comfort rather than pleasing others. We began to map out other compassionate choice points, and she made a visual map of these important moments in her life. This led to her intentionally choosing to make more decisions that nourished herself with care and compassion. She began to notice her severe anxiety had become more tolerable, and her depression decreased.

We all have decisions and choices we have made in our lives. Reflect on your past decisions.

• What decisions did you make that nurtured self-compassion, kindness, and care for you?
• Were those decisions helpful for you?
• How were they helpful for you?
• How did you decide to make them?
• Consider creating a map of your uniquely personalized compassionate choice points that you decided to make.
• How did your decisions cultivate nurturing and generative relationships, joy, and a sense of calm in your life?

Nourishing yourself with self-compassion is one of the greatest gifts you can give to yourself. Each of you gives and receives gifts in your unique way. Think about some of the most meaningful gifts you have both given and received. It is often the most intangible gifts, such as a kind word, a meaningful conversation in which you felt deeply listened to, the joy of laughter, and a loving glance, that are most treasured.

Gift-giving and receiving can present challenges for many people. Accepting a gift is to be open to nurturing and love from another. If you have trouble receiving gifts, it may reflect difficulties accepting your need for support and care. When we present a gift to another, we often say, “This gift is for you.” The receiver of the gift may say “for me”? “You didn’t need to do that.” “ You shouldn’t have.” There are often good reasons that accepting gifts may be difficult for you. Receiving gifts may protect you from greater intimacy, and the connection you fear may be lost. When accepting a gift, you may feel vulnerable, selfish, undeserving, and in someone’s debt. You may feel uncomfortable receiving gifts if strings were attached growing up, and you may have only received compliments when you accomplished outward achievements. You are worthy and deserve to relish and enjoy one of life’s most important gifts, the gift of self-compassion. Below are three solution-focused gifts to nurture self-compassion.

1. The Language of Empathy: “For you” and “For me” statements
2. The Indirect Compliment: The linguistic vehicle to enhance your agency
3. Solution-Focused 10-Minute Time

The Language of Empathy: “For you” and “For me” statements

A solution-focused language technique that can help you speak compassionately with yourself is to integrate the words “for you” within statements and questions. These two simple words can help to validate and affirm your intense emotions. For example, it must be exhausting for you to manage anxiety and depression while trying to get your children off to school. It must be frustrating for you that your partner does not understand how depression affects you.

For many, it can be easier to provide “for you” statements to others rather than ourselves. Reflect on a recent intense emotional experience. Write a letter to yourself from the perspective of a caring and nurturing friend. Write as many kind and loving “for you” statements from the perspective of your friend to you. 

For example, consider a single mother coping with the stressors of providing for her two children while learning that her mother was just diagnosed with cancer. She has been trying to keep herself together at work but recently lost her patience with her supervisor, who knew what she was going through yet continued to micromanage and criticize her work. What “for you” statements could you give to her?

• It must be so exhausting for you to sustain the mental load of caring and providing for your children and navigating your mother’s needs and newly diagnosed cancer.
• It must be so frustrating for you to have a boss that does not appreciate your work despite all your efforts to do a good job while knowing what you have been going through. 

A corollary of the empathic gift of “for you” statements is “for me” statements. Saying “for me” out loud may feel like you are being selfish and entitled, but this is not the case. You are valuing yourself as a fellow sentient being among your shared humanity.  

For example, consider a middle-aged man who discovered that his company is downsizing and he may no longer have a job. He and his partner have both been working to barely make ends meet to pay their rent and food and continue to work on paying off their student loans. He began experiencing unpredictable panic episodes,  depression, and difficulties sleeping. His partner noticed an increase in his irritability, which only compounded the stress in their home. What for me statements could he give to himself?

• It is scary for me to be thinking about how our family will be able to manage without a dual income just to get by.
• It has been exhausting for me not sleeping, getting through the daily grind, and not knowing how we will manage if I lose my job.
• It has been hard for me to stay calm and positive through all this stress.

In the solution-focused approach, the gift of “for you” and “for me” responses are paired with compliments. Compliments are the solution-focused linguistic tool to enhance your agency. Compliments provide clues to potential solutions that are already working in your life. In the solution-focused approach, there are two types of compliments, direct and indirect. Direct compliments are an explicit expression of praise, appreciation, or admiration. Most of you are fluent in what is known as the direct compliment. Direct compliments may include commending individuals on their coping abilities, congratulating their achievements, and acknowledging their skills at work, perseverance, passion, honesty, and determination. Examples include: I am impressed with how you reached out for help instead of isolating yourself at home. It’s impressive how you managed to cope with your immense challenges while still caring for your loved ones.

Indirect compliments are in the form of the following question: How did you do it? Most people are less familiar and fluent with the indirect, implicit compliment. It takes practice to build fluency in using indirect compliments. Notice the question is not “Did you do it?” Instead, “How did you do it?” The word “how” communicates in what manner and by what means? The verb did (past tense) conveys that you have done it before and thus can do it again. The second verb to do (accomplish, perform, manage, endure, stop, think, decide, choose) highlights the actions you have already taken to achieve your goals.

Reflect on when you experienced a situation that felt barely tolerable for you. It can be helpful to remind yourself that emotions are temporary and that change is the only constant in life. Shrinking the time increments of coping strategies to brief moments can help make things more bearable for you. Sometimes tolerable or bearable is good enough. For many people, 10 minutes is a tolerable time frame. For others, it may be 30 minutes or 5 minutes.

• What do you know is a time frame that is tolerable for you when reflecting on difficult and uncomfortable situations that you have experienced? Ask yourself the following questions.

PAST 10-minute time:

• What do you know helped make things even a little more tolerable or bearable for you in the past 10 minutes? What else?
• What were you doing that helped make things a little more bearable for you? What else were you doing?
• Who would notice when things are a little bit more bearable for you?
• What would they notice you doing when things are a little bit more tolerable for you? What else would they notice you doing?

FUTURE 10-minute time:

• What do you know you need to make things even a little bit more tolerable or bearable for you in the next 10 minutes? What else?
• What would you be doing in the next 10 minutes that would make things even a little bit more tolerable for you? What else would you be doing?
• Who would notice when things are a little bit more bearable for you?
• What would they notice you doing when things are a little bit more tolerable for you? What else would they notice you doing?

SCALING your confidence

• Supposing ten is you are very confident that you can do something to address your needs that would make things even a little bit more tolerable, and one is the opposite; where would you say you are now?
• What would be a good enough number?
• What have you been doing that keeps the number from being lower? What else?
• What would you be doing when the number goes up by one point? What else would you be doing?

Buranasompob, P., Chantagul, N., & Mohanan, S. A. (2020). The efficacy of integrated SFBT intervention on self-compassion, self-determination, and solution-focused mindset among high school students in Bangkok, Thailand. Scholar: Human Sciences, 12(1), 144-144.

Ewert, C., Vater, A., & Schröder-Abé, M. (2021). Self-compassion and coping: A meta-analysis. Mindfulness, 12, 1063-1077.

Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: an evolutionary analysis and empirical review. Psychological bulletin, 136(3), 351.

MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical psychology review, 32(6), 545-552.

Neff, K. D., & Dahm, K. A. (2015). Self-compassion: What it is, what it does, and how it relates to mindfulness. Handbook of mindfulness and self-regulation, 121-137.

What is possible in brief conversations? How can we harness hope in even short interactions that happen on a daily basis? In schools that run at a fast pace with ever-changing dynamics and crises, brief may present as a 2-minute conversation with a student in the hallway who appears distressed from a recent peer conflict as chaos ensues during period changes. It may mean a 5-minute conversation with a parent concerned their child is making poor decisions and failing academically. It may mean a 10-minute conversation between two teachers figuring out how to manage curriculum demands while feeling pressured to complete numerous college recommendations, grade volumes of assignments, and prepare for the next class while dealing with the pressures of the administration’s demands to address rising achievement gaps with fewer available resources. It may mean a 5-minute classroom conversation about how confident students are that they are prepared for an exam from 1-10 (10 being the most confident). It may include a conversation about students’ best hopes for the class so they can say it was fun and they learned something.

One of the most important features of life is conversation. Some conversations enhance hope and possibility, while others diminish it. How can educators, parents, clinicians, nurses, coaches, lunchroom staff, and others who care for our children foster hope, agency, confidence, and success? How can they help cultivate conversations that nurture positive change, harness new knowledge and meaning, and encourage children to make choices that create positive differences in their lives?

Consider the following brief conversations.

Mr. Jones was working with a group of 2nd-grade students and felt frustrated with how to help one boy who frequently refused to do his work and complained about stomachaches and his need to go to the nurse. Mr. Jones kept a stack of index cards on his desk and observed his students for things the class and students were doing well each day. Perhaps it was the 5 minutes Damien was able to sit and focus on a math lesson, or the time Sarah, who was often shy and reclusive, had a conversation with a peer for a few minutes, or the time Jimmy got his notebook out and did some of his work. Mr. Jones would write these observations on individualized notecards, place them quietly on the students’ desks, thank them for their hard work, and ask them to write how they did those things on the card. At the end of the week, he would talk with the students about the week’s successes and inquire how they were accomplished. He would then scale with them from 1-10 how satisfied they were with school for the week from 1-10 (10 being the most satisfied), whether that was good enough, what kept the number from being lower, and what they could do to keep up the good work and increase the number if it was not good enough.

Mrs. Smith, a middle school math teacher, was teaching a lesson on geometric figures. The class presented with varying abilities, making meeting all of their needs challenging. Mrs. Smith made a point that when a shy student raised their hand and asked a question to appreciate what a good question they had, many other individuals likely had a similar question and curiously asked what they knew about the concept they were inquiring about appreciating their prior knowledge.

Mr. Snow, the school guidance counselor, was asked by the French teacher to meet with Destiny. Destiny is a 10th-grade student who was chronically late for class, missed several days of school a week, and was constantly on her phone when she did come. She was failing French. Her French teacher was concerned she appeared depressed, so she referred her to the counseling office. She would often miss school entirely due to significant anxiety following the loss of her grandmother, her primary caregiver, during the COVID-pandemic.

Mr. Snow acknowledged that it must have been challenging for her to make it to French class and asked her how she decided to come to school today. Destiny responded, “I don’t know – I was forced to.” Mr. Snow was curious and asked her who was concerned about her that thought her coming to school was this important. Destiny responded that it was her aunt. Mr. Snow asked what her aunt knows about her so that she can be successful at school. Destiny stated, “ I don’t know – ask her?” Mr. Snow stated that, of course, her aunt knows best, but she knows her aunt well and asked her gently again what her aunt knows about her and that she will be successful in school.

Destiny ignored the question and proceeded to only focus on her phone, understandably causing some frustration in Mr. Snow; however, Mr. Snow was able to ask a few more solution-focused questions to keep the conversation productive. Mr. Snow asked Destiny her “good reason” to be on her phone. She stated that she wasn’t good at French and it wouldn’t make any difference in her life. Mr. Snow appreciated how frustrating this must be for her and asked her how she has been able to tolerate French, given how annoying it is for her to be here. Destiny stated she knew that she had to pass French to graduate. Mr. Snow asked Destiny what else she knows she needs to do to graduate. Destiny responded by stating to get a D or above in French and showing up enough times to meet the requirements. Mr. Snow appreciated her candor about the requirements to graduate, as well as how frustrating this must be for her to take a class that she does not think will make a difference in her life.

He then asked her what her best hopes are after she graduates. Destiny stated she already was working part-time for her uncle, creating graphic design promotional material for his business, and wanted to pursue doing more graphic design. Mr. Snow asked her about the graphic designs she had created, and Destiny went on to show him the artwork she had created to advertise her uncle’s upcoming promotional event. Mr. Snow asked her how she learned all these artistic skills, and she talked about going to “YouTube University” and spending hours learning art skills during COVID while dealing with the chaos in her home. Mr. Snow appreciated these skills and then asked if she would be willing to share her designs at the end of the week with the class after tolerating French in a good enough way to pass so she could fulfill her goal of graduating.

Mr. Snow asked her how confident she is from 1-10 (10 being the most confident) that she will be able to do what is needed this week to reach her goal of passing French class. She stated a 5. Mr. Snow asked if this was a “good enough” number for now, and she said yes. Mr. Snow asked her what keeps the number from being lower, and Destiny stated knowing that she has had success with her uncle’s business and that graduating would help her with her goals moving forward. They agreed that Mr. Snow would do a “scaling check-in” weekly, or more often if needed, to monitor how confident she is from 1-10 that she is doing what she needs to do to graduate. 

Children spend more time in school than anywhere else except at home. Educators are well-positioned to identify and address student mental health concerns and are at the frontlines of the child mental health pandemic. School staff typically engage with students 6 hours/day, five days per week for 30 weeks a year, while also placing academic demands on them daily. They are ideal for recognizing struggles among their students. Although teachers are not mental health clinicians, they are often the professionals helping youth manage stress, problem solve, and manage daily challenges and frustrations. Schools provide structure, routine, peer interactions, social connections, support, and opportunities to engage in fun, stimulating social, emotional, physical, and cognitive activities. Solution-Focused techniques assist in delivering mental health services to youth and could be adapted and scaled sustainably while prioritizing equitable access across diverse populations.

Solution-focused conversations can help identify and support indigenous persons and resources with schools, as they are the critical agents needed to sustain positive change. The most obvious change agents in schools are teachers, who influence the classroom climate, nurture relationships, and are critical to children learning. Training teachers in solution-focused conversations can effectively improve classroom management, which strongly predicts children’s future success.

Teacher and behavioral health workforce shortages combined with an increased demand for services for children have required educators, schools, mental health professionals, health care providers, parents, and communities to devise innovative service delivery and training strategies. Qualified teachers are the backbone of education that drive schools and classrooms. Few issues threaten the nation as seriously as the growing teacher shortage ( Zhang, G., & Zeller, N. (2016). Unfortunately, fewer people are enrolling in this career, and new teachers are quitting at an alarming rate. A nationwide teacher shortage exists, and reports indicate that there are 250,000 teaching vacancies annually across the United States, and teacher education enrollments have declined by 35% (Sutcher, L. et al. 2019). Teacher shortages exacerbate the inequitable distribution of qualified teachers to schools serving low-income individuals and individuals of color (Sutcher L. et al., 2019).

In the United States, comprehensive school mental health systems are emphasized. These include universal mental health promotion activities for all students, early intervention services for at-risk students, and treatment for students with severe impairments. This requires collaborative partnerships between school systems and community partners. In education, this is referred to as a multi-tiered system of support (MTSS). Multi-Tiered Systems of Support (MTSS) include universal schoolwide support, known as Tier 1, 2, and 3. Solution-focused brief conversations can be incorporated into all levels of a multi-tiered system of support.

Solution-focused conversations can be implemented within the naturalistic school environment without adding yet another requirement for teachers to add to their already overwhelming demands. There is a need to optimize and enhance educational goals rather than superimposing a new set of programs and responsibilities on beleaguered schools. Mental health staff can be considered “educational enhancers” who assist teachers in providing effective instruction by embedding them within natural settings such as classrooms. ( Atkins et al. 2010).

Many federal and state agencies have adopted the concepts of competencies within their definition of a mental health condition. Solution-focused conversations facilitate identifying and assessing children’s functioning and competencies in their natural settings. Focusing on improved functioning rather than symptom reduction cultivates a child’s agency and aptitudes, creating a better alignment between educational and mental health policy. This includes enhancing interactions between teachers and students, teachers and parents, educators and peers, and providing an effective model for integrating social-emotional learning within the school environment.

The COVID-19 pandemic has highlighted the importance of social and emotional learning and schools’ critical role in supporting other aspects of children’s development beyond numeracy and literacy. Social and emotional learning (SEL) refers to the process by which youth and adults acquire and apply intrapersonal, interpersonal, problem-solving, and decision-making skills essential for school success. Social-emotional learning (SEL) generally captures three broad areas, including the ability to regulate and manage one’s emotions, the ability to set and achieve goals, and the ability to develop interpersonal skills that are essential for school, work, and success in life (Yorke et al., 2021). SEL has been shown to influence an individual’s achievement and outcomes, including the level of education, academic progress, pathways beyond education, entry into the labor market, and future earnings.

Students engaged in social-emotional learning demonstrate an increase in academic test scores and promote students’ social and emotional competence (Durlak et al., 2011). Educators trained to implement SEL curricula report lower depression and job-related anxiety, higher quality interactions with students, and greater perceived job control than those not trained in SEL (Schonert-Reichl, K. A. (2017). Training in SFBT provides a practical approach that educators can use to promote SEL. This includes building the capabilities of students to collaborate with others, developing their agency, responsibility, empathy, critical and creative thinking, navigating conflict, and addressing prejudice and bias. Solution-focused conversations can assist educators in bonding with their students, facilitating positive peer experiences, and promoting respectful relationships and equality, all of which can promote SEL (International Commission on the Future of education, 2021).

Solution-focused conversations (SFC) are trauma-informed and support people in crises by providing a safe and reassuring therapeutic relationship. They enhance an individual’s resilience, decrease distress and minimize the potential risk of re-traumatization. Trauma-sensitive schools refer to a schoolwide approach to understanding and addressing trauma. Solution-focused conversations can assist in creating safe, supportive, and culturally responsive schools that prevent school-related trauma and foster thriving and transformative learning opportunities. SF conversations assist in counterbalancing intense emotions, collaboratively supporting people in developing meaningful coping strategies, cultivating competencies, and navigating gradual next steps for the immediate future. This belief in the client’s resilience and capacity is harnessed throughout the conversation and can be productively utilized to help cope with the aftermath of a crisis and build a healthy, satisfying future (Dolan, 1998; Froerer et al., 2018).

This belief in client resilience has the added benefit of educators experiencing vicarious resilience instead of vicarious trauma. Vicarious trauma (secondary trauma) has been defined as the transformation that occurs in the inner experience of the worker that comes about as a result of empathic engagement with the trauma material (Pearlman & Saakvitne, 1995, p.31). Vicarious resilience is a complex collection of elements contributing to the empowerment of workers through interaction with stories of resilience (Hernandez et al., 2007). These elements of witnessing and reflecting on human beings’ remarkable capacity to heal can result in the worker reappraising the significance of their own challenges and generating new possibilities and hope on the part of the worker. Integrating solution-focused conversations within a school’s organizational context can increase vicarious resilience.

Solution-focused conversations are individualized and adaptable in differing contexts within and across schools. Educators must collaboratively create yearly goals for students, including those with complex needs on Individualized Educational Plans (IEPs). Solution-focused conversations afford a practical approach that can assist educators, parents, and students in writing goals that can be integrated successfully into the student’s educational plan. Identifying incremental goals through scaling questions can be integrated within IEPs. Solution-focused conversations in schools may be delivered in a variety of different modalities, including individual, group, family, and even organizational-level interventions, and has the potential to serve universal, secondary, and tertiary prevention purposes (Metcalf, 2021). Solution-focused conversations can help educators enhance active parent involvement while providing tools to provide strategic support for families, such as specialized outreach programs.

Providing resources and skills for teachers and other school staff to manage high-need children, especially in high-poverty communities where student-to-staff ratios are high, and technology or other resources are scarce, is critical. Solution-focused techniques can be embedded within classroom-wide programming for normal events, such as transitions through the school day or class-wide routines.

Solution-focused conversations can be applied within academic counseling, college applications, sports and coaching, and group interventions with individuals with academic and emotional challenges. Regardless of the setting, several specific techniques are used in an SFBT intervention or programs that are universal to the therapeutic model.

School climate has a profound impact on students’ mental and physical health. Solution-focused conversations can contribute to a positive school climate by enhancing feelings of safety, social relationships, and teaching and learning practices. Enhancing individuals’ academic mindsets and confidence in their ability to learn and develop skills in decision-making, relationship-building, and self-management can foster a student’s well-being and confidence. These skills can improve students’ willingness to engage, attend, and remain in school and improve their academic achievement. Interventions that promote a positive school climate may reduce the risk of victimization and adverse mental health outcomes in lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Research has highlighted high levels of perceived school connectedness as an essential protective factor for mental health (Parodi et al., 2022).

One in five children is adversely impaired by a mental health condition (Merikangas et al., 2010). However, less than half of these children will receive treatment (Kataoka et al., 2002), and of those who do, most receive fewer than four sessions of care in community mental health settings. For youths living in poverty or racial-ethnic minority groups, access to mental health treatment is even more limited, with many of these youths being managed in the juvenile justice system (Skowyra & Cocozza, 2007).

Schools are an optimal setting to identify, manage and sustain progress for children with mental health needs increasing access, adherence, and participation in treatment, decreasing stigma, and promoting positive effects on academic and social-emotional functioning. Approximately 75%-80% of youth receive mental health services in schools (Masonbrink & Hurley, 2020). School mental health models provide a context to provide transdisciplinary teams of support for children in their natural developmentally appropriate context and the opportunity to provide universal support in an accessible and comfortable environment. Comprehensive school mental health systems integrate education, mental health resources, and expertise to improve youth’s academic and social-emotional outcomes (Hoover & Bostic, 2021). Brief evidence-based interventions can help as they can be delivered widely.

Schools have many competing demands and forces with changing priorities, administrations, and mandates. There is strong evidence that school mental health positively influences students’ academic and social functioning, but sustaining the resources in these changing contexts can be very challenging. For many reasons, implementing evidence-based, sustainable, cost-effective mental health prevention and interventions still lag within schools. Schools often are driven by competing and changing priorities and not informed by data. Education and mental health systems have operated in separate silos, partly because of youth and families concerns about seeking mental health in schools. Mental health systems do not easily navigate the delivery of school services, including reimbursement. Unfortunately, the impetus for school mental health arises in crises such as school shootings, suicide, natural disasters, and other incidents of violence.

Teacher and behavioral health workforce shortages combined with an increased demand for services for children have required educators, schools, mental health professionals, health care providers, parents, and communities to devise innovative service delivery and training strategies. Qualified teachers are the backbone of education that drive schools and classrooms. Few issues threaten the nation, as seriously as the growing teacher shortage ( Zhang & Zeller, 2016). Unfortunately, fewer people are enrolling in this career, and new teachers are quitting at an alarming rate. A nationwide teacher shortage exists, and reports indicate that there are 250,000 teaching vacancies annually across the United States, and teacher education enrollments have declined by 35% (Sutcher, L. et al. 2019). Teacher shortages exacerbate the inequitable distribution of qualified teachers to schools serving low-income individuals and individuals of color (Sutcher L. et al., 2019).

Looking at the results of children not attending schools during the COVID-19 pandemic demonstrate with great clarity how critical teachers and schools are for children and families. The COVID-19 pandemic created the largest disruption of education systems in human history, affecting nearly 1.6 billion learners in more than 200 countries. Closures of schools, institutions, and other learning spaces impacted more than 94% of the world’s student population (Pokhrel & Chhetri, 2021). There is clear evidence of a negative effect of COVID-19-related school closures on student achievement. The effects of remote learning were similar to those achieved when no teaching was implemented during summer vacation. Younger children and children from low-SES families were disproportionately affected by COVID-19-related school closures (Hammerstein et al., 2020). A systematic review and meta-analyses of 23 studies and a total of 57,927 participants provide evidence that 28.6%, 25.5%, 44.2%, and 48.0% of children and adolescents experienced depression, anxiety, sleep disorders, and posttraumatic stress symptoms, respectively, during the COVID-19 pandemic (Ma et al., 2021).

An estimated 5 million to 7.5 million US students miss nearly a month of school yearly. This lost instruction time exacerbates dropout rates and achievement gaps. Students who reduce absences can make academic gains (Ginsburg et al., 2014). Students who miss more school than their peers score lower on educational progress testing, which holds true for all social-economic groups.

The USA has had 57 times as many school shootings as all other major industrialized nations combined (Rowhani-Rahbar & Moe, 2019). Guns are the leading cause of death for children and teens in the USA, with children ages 5–14 being 21 times and adolescents and young adults ages 15–24 being 23 times more likely to be killed with guns compared to other high-income countries. Furthermore, Black children and teens are 14 times, and Latinx children and teens are three times more likely than White children to die by guns (Muir, M.S.P., 2021). Children exposed to violence, crime, and abuse face a host of adverse challenges, including abuse of drugs and alcohol, depression, anxiety, post-traumatic stress disorder, school failure, and involvement in criminal activity (Cabral et al., 2021; Everytown Research and Policy, 2022b; Finkelhor et al., 2016).

Technological tools are used for various purposes in many areas of daily life, such as connecting to the internet, accessing social media, listening to music, playing games, shopping, taking photos, and navigating. Using a smartphone is a characteristic feature of today’s youth. Smartphones are nearly ubiquitous among younger adults, with 92% of Americans aged 18-29 owning one (Pew Research Center report, 2017). Cellphones and tablets have become more frequent at schools and universities in their spare time and during class. Multi-tasking in technology (emailing, texting, and Facebook) negatively correlates to the capability to learn effectively, as demonstrated by lower test scores (Wood et al., 2012). Students often overestimate their ability to multitask. There is clear evidence of the negative relationship between smartphone usage and academic performance, are a source of distraction in classrooms and other settings dedicated to studying, and that, on average, the difference between reported use of phones and the actual rate may be as high as sevenfold (Felisoni & Godoi, 2018).

Although many features of smartphones can positively affect human life, their excessive and uncontrolled use can cause social, physical, and psychological problems. The term NOMOPHOBIA or NO MObile PHone PhoBIA describes a psychological condition when people fear being detached from mobile phone connectivity (Bhattacharya et al., 2019). It has been described as an “over-connection syndrome” as it reduces the number of face-to-face interactions adding additional challenges to youth health. Studies among high school students have shown that with the increase in smartphone use, the degree of nomophobia increases, leading to increased anxiety and loss of self-control over their life (Bartwal & Nath, 2020).

The US Surgeon General’s Advisory acknowledges that our healthcare system is ill-equipped to support our children and youth’s mental health and well-being. The advisory exhorts us to reimagine addressing, managing and preventing mental health challenges. It urges recognizing the need for trauma-informed care with youth facing adversity and educating a wide range of professionals who work with children, such as schools, child care, justice, social services, and public health sectors. Solution-focused brief therapy and conversations can successfully be applied in schools dissolving conventional disciplines’ boundaries to foster children’s mental health.

This course, Solution-Focused Conversations in Schools: An Integration of Education and Mental Health, attempts to reimagine how solution-focused brief trauma-informed practices can be practically implemented in a transdisciplinary way within schools. Our goal is to make a positive difference in the lives of children, families, and the myriad of dedicated professionals working daily to foster success for all our collective children. This course includes a written component, video lectures, demonstration videos, case examples, and individual and group practice exercises demonstrating how Solution-Focused conversations are developed. Multiple classroom exercises are included within the course to assist teachers with practical tools for embedding social-emotional learning in their daily work. Our best hope is that at the end of this course, you can implement these skills in your daily life, classrooms, educational settings, and all the contexts that support children’s educational, academic, and social-emotional success.

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Bhattacharya, S., Bashar, M. A., Srivastava, A., & Singh, A. (2019). Nomophobia: No mobile phone phobia. Journal of family medicine and primary care, 8(4), 1297.

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Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child development, 82(1), 405-432.

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Felisoni, D. D., & Godoi, A. S. (2018). Cell phone usage and academic performance: An experiment. Computers & Education, 117, 175-187.

Finkelhor, D., Vanderminden, J., Turner, H., Shattuck, A., & Hamby, S. (2016). At-school victimization and violence exposure assessed in a national household survey of children and youth. Journal of school violence, 15(1), 67-90.

Froerer, A., von Cziffra-Bergs, J., Kim, J., & Connie, E. (Eds.). (2018). Solution-focused brief therapy with clients managing trauma. Oxford University Press.

Ginsburg, A., Jordan, P., & Chang, H. (2014). Absences Add Up: How School Attendance Influences Student Success. Attendance Works.

Hammerstein, S., König, C., Dreisörner, T., & Frey, A. (2021). Effects of COVID-19-related school closures on student achievement-a systematic review. Frontiers in Psychology, 4020.

Hernández, P., Gangsei, D., & Engstrom, D. (2007). Vicarious resilience: A new concept in work with those who survive trauma. Family process, 46(2), 229-241.

Hoover, S., & Bostic, J. (2021). Schools as a vital component of the child and adolescent mental health system. Psychiatric services, 72(1), 37–48.

Kataoka, S. H., Zhang, L., & Wells, K. B. (2002). Unmet need for mental health care among US children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159(9), 1548-1555.

Kim, J. S., & Franklin, C. (2009). Solution-focused brief therapy in schools: A review of the outcome literature. Children and Youth Services Review, 31(4), 464-470.

Kim, J., Jordan, S. S., Franklin, C., & Froerer, A. (2019). Is solution-focused brief therapy evidence-based? An update 10 years later. Families in Society, 100(2), 127-138.

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Parodi, K. B., Holt, M. K., Green, J. G., Katz-Wise, S. L., Shah, T. N., Kraus, A. D., & Xuan, Z. (2022). Associations between school-related factors and mental health among transgender and gender diverse youth. Journal of school psychology, 90, 135-149.

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Think about this past year. What did you most enjoy doing?

• Was it different how you were able to enjoy those experiences?
• How was it different for you?
• Was it helpful for you?
• How was it helpful for you?
• How did you foster those moments of joy?
• Who would notice when you are enjoying your life?
• What would they notice you doing?
• On a scale from 1-10, where ten is you are confident that you can continue to create moments of joy and one is the opposite, where are you now?
• What would be a good enough number?
• What keeps the number from being lower? What else?
• What would you be doing when the number goes up by one point if the number is not good enough?
• What do you want to keep doing to keep the number from going lower?
• Supposing you asked your VIPs (those relationships that are most important to you) how confident they are that you can create moments of joy in your life from 1-10, what number would they give you?
• What keeps their number from being lower?

What are your best hopes so at the end of the year, you can say it was a satisfying, meaningful, and joyful year?

• What would you be doing?
• What else would you be doing?
• What would others notice you doing?
• Suppose ten is you are very confident in your skills to achieve your best hopes, and one is the opposite; where are you now?
• What keeps the number from being lower? What else?
• What would be a good enough number?
• What would you be doing when that number goes up by one point?
• How confident are your VIPS that you can achieve your best hopes?
• What do they know about you that you can achieve your best hopes?

Think about a challenging event you experienced. Practice asking the following questions with a colleague and also with clients. There is no need to get details of the event. Instead, begin with the following questions.

• How did you cope/endure/manage?
• How else?
• What was most helpful for you in moving forward?
• Who helped you?
• Who else?
• What did you learn from this?
• What else?
• On a scale from 1-10, where ten is you are satisfied with how you coped, and one is the opposite, where would you rate yourself?
• What would be a good enough number?
• What is the highest it has been? Has the number gone up, down, or stayed the same?
• What keeps it from being lower? What else?
• How would you discover when it goes up by one point? How else?
• How would your VIPs rate how well you coped from 1-10?
• Could any of this challenge be viewed as a gift? If so, what aspect of my current situation might I view as a gift to be treasured?
• How does it benefit me or others?

We are thrilled to share an exciting research study by Antonio Medina, Mark Beyeback, and Felipe E. Garcia on the effectiveness and cost-effectiveness of a solution-focused intervention in child protection services. This article became available as open-source online on October 27th, 2022. I know Insoo Kim Berg and Steve de Shazer would be thrilled to hear of the positive results of this very important study. Thank you to Antonio Medina, Mark Beyeback, and Felipe E. Garcia for this very important contribution. Below is a summary of the findings of the article.

Medina, A., Beyebach, M., & García, F. E. (2022). Effectiveness and cost-effectiveness of a solution-focused intervention in child protection services: A randomized controlled trial. Children and Youth Services Review, 106703.

This research aimed to evaluate the impact of solution-focused principles and intervention techniques in the local child protection service on the island of Tenerife, Spain.

Solution-focused Brief therapy is a collaborative and empowering approach that offers clients choice, voice, and speaking the client’s language. This approach builds on parents’ competencies and agency and emphasizes family capacities. The solution-focused approach can be combined with more traditional problem-focused models, including Solution-Focused Trauma-Informed care.

There has been limited empirical evidence on solution-focused training and its effectiveness in child protection. This study aimed to address this need.

The aim of this quasi-experimental design was to evaluate the impact of a solution-focused approach to child protection by comparing the performance of a group of workers who received training in SFBT with that of child protection workers who employed treatment as usual.

1. What is the impact of solution-focused practice on goal achievement and subjective well-being as perceived by workers, parents, and children?
2. What is the impact of solution-focused practice on child welfare outcomes such as referral for further intervention, child placement, or recidivism?
3. What is the cost-efficiency of solution-focused practice compared to treatment-as-usual in terms of length of the intervention, number of sessions used, and number of additional resources deployed (home assistance, daycare, specialized mental health services, etc.)?

A quasi-experimental design was followed. Two equivalent blocks of child protection teams were created and randomized to the control or experimental group.

Child Protection Workers:

The experimental group received free solution-focused training and supervision. Workers in the control group were offered solution-focused training after completing the study. There were no significant differences between workers in the experimental and the control group in relation to age, professional degree, and gender. Participants had received no previous training in SFBT. The training included two months of training and six months of supervision in solution-focused brief therapy. This included initial training in SFBT, 30 hours distributed over two 15-hour workshops, taught two months apart to the experimental group. The workers also received another 30 hours of group supervision consisting of monthly -five-hour sessions with the experimental group over six months. The emphasis was on integrating the SF approach in their interventions while fulfilling statutory obligations such as assessing children’s risk and safety and monitoring intervention plans.

Families:

477 families serviced by the child protection teams during the duration of the study accepted to participate and consented according to the Helsinki declaration. All 477 families filled in the Time 1 pre-test measures. 329 families filled in the Time 2 Post-test measures when the cases were closed or at study termination. The attrition rate in the control group was 36% and 25% in the experimental groups, which was statistically equivalent. No statistical differences were found between the families that dropped out of the study and those that did not.

1. The Solution-Focused Treatment Fidelity Questionnaire (SFTFQ) measured the use of solution-focused principles and techniques. The SFTFQ is an 18-item questionnaire that asks workers how frequently they perform a number of solution-focused practices in their work with users.
2. Goal achievement as rated by workers was measured by asking workers to rate on a scale from 1-10 to what extent goals had been met during the intervention (1 not at all and 10 completely)
3. Parents’ well-being was measured using the Outcome Rating Scale (ORS) using a visual analog scale to assess individual well-being (personal well-being), interpersonally well-being  (family, close relationship), social well-being (work, school, friendships), and an overall general sense of well-being.
4. Children’s well-being was measured with the Child Outcome Rating scale.
5. Referral to risk teams was registered in child protection services case records and is an indicator of the deterioration of safety in a family.
6. Child removal was registered in the case records.
7. Recidivism was defined as the re-referral of the family to child protection after the case had been closed.
8. The length of the intervention was operationalized as the difference in the month between the records beginning of the team intervention with any given case and the termination of the intervention.
9. The number of sessions was recorded in the case reports.
10. The number of additional resources activated was recorded in the case reports and included such things as daycare, specialized mental health services, family mediation, and in-home assistance.

1. The use of SF practices became significantly higher in the experimental group, almost tripling the SFTFQ value of the control group, a very large effect size (η2p= 0.88).
2. In the four-goal attainment variable, at post-test, parent well-being was higher in the experimental than in the control group with a large effect size (η2p=0.19)
3. Children’s well-being also increased in the experimental group with a large effect size (η2p=0.23).
4. Goal attainment was higher in the experimental group than in the control group, as rated by parents and workers.
5. In the experimental group, there were significantly fewer child removals from home (1.10% in the experimental group and 4.83% in the control group) a large effect size (η2p = -0.60).
6. Recidivism was also significantly lower in the experimental group (1.80% in the experimental group and 6.97% in the control group), a large effect size (η2p = 0.41).
7. The number of sessions was almost 40% lower in the experimental group (on average, 14.48 sessions per case) than in the control group (22.12 sessions per case).
8. The number of complementary resources that had to be allocated to cases was significantly lower in the experimental group than in the control group.
9. The length of the intervention in months was three times shorter in the experimental group than in the control group.

1. Child protection workers who received training and supervision changed their self-reported practices in a solution-focused direction.
2. This study demonstrates the feasibility of disseminating solution-focused principles and techniques in a child protection system. The cases in the solution-focused group achieved superior outcomes, including higher goal achievement rates from both caseworkers and parents.
3. Importantly, children removals had dropped to one-fourth of the initial figure in the experimental group and that child protection teams in the solution-focused group became more able to help families without having to remove children from their homes. This is the first time a positive effect on this variable is documented for an SFBT intervention.
4. The superior outcomes of the experimental group were achieved with significantly fewer sessions than those of the control group providing initial support for the cost-efficiency of a solution-focused child protection practice.
5. The experimental group allocated fewer additional social services resources to the families which may be related to the holistic, family-centered perspective of the solution-focused approach.

This study adds to the evidence of the effectiveness of solution-focused child welfare practices in child protection settings. This study shows that solution-focused practices can be disseminated at a low cost and provide cost-efficient treatment, reducing the number of sessions and the number of complementary resources that had to be deployed. This is important for policymakers in promoting the training of child protection workers in solution-focused practices to provide better services to their users.

Embedding solution-focused documentation templates within electronic health records could help build solution-focused fluency, sustain solution-focused practices within organizations, and improve care coordination, communication, and client outcomes.  Thank you for reading this article on solution-focused documentation, which I would venture to say is not the most exciting topic. How did you decide to take the time while working tirelessly on the front lines of the mental health pandemic, given how staying up to date on notes is the miserable bane of our daily grind?  As my colleagues used to say, a “note is just a note” and “a done note is a good note,” but notes (documentation) now serve so many additional purposes, including accountability to reimbursing third parties, accreditation agencies, legal records of care, informing clinical decision supports and creating a repository of information for clinical research and quality improvement initiatives. Medical and mental health professionals are required to complete all sorts of documentation such as comprehensive psychological intake assessments and ongoing documentation to determine whether a client is appropriate for counseling,  what types of treatment are indicated, formulating treatment plans, coordinating care with multiple providers, documenting when clients are ready to complete or  “graduate” from discrete treatment episodes, and whether a higher level of care is indicated, such as in emergency and crises. However, little empirical attention has been given to this intake and subsequent paperwork (Richmond et al., 2014), and there is little evidence in the literature to guide the selection of specific data entry methods according to the type of data documented (Wilbanks 2018). 

Primary care and behavioral health clinicians often differ in their reporting requirements, codes, regulations, and language. Working with clinical teams to create solution-focused customized shared templates that are unique to each practice context is essential. Providing practitioners within organizations the opportunity to review their current documentation forms, get input directly from clinicians, and test out the forms with practitioners is essential for successful implementation.  Incorporating solution-focused questions within semi-structured data entry by creating text narratives and structured data entry could harness positive aspects of electronic records (Janett & Yeracaris 2020). 

At the end of this article, there are solution-focused documentation examples for an intake evaluation, a progress note with a case example, and a solution-focused safety assessment (SFSA).

Solution-Focused Brief Therapy entails a paradigm, order, and language shift. These components can be easily integrated into documentation templates to enhance practitioner fluency and assist in sustaining the solution-focused brief therapy approach within organizations. 

Documentation is considered static and unchanging; however, what questions are asked, how they are asked, and when they are asked all make a difference in the narrative created.  The solution-focused practitioner harnesses hope by assisting clients in developing a narrative in which they can recognize their agency and resources while developing an action plan moving forward. Solution-focused documentation can help clinicians and clients develop a hopeful report while making record keeping a little more tolerable and bearable for practitioners. 

Solution-focused brief therapy (SFBT) is fundamentally a linguistic therapeutic approach. Questions are constructed to convey confidence in the client while simultaneously recognizing their agency, strengths, and resources and creating a collaborative treatment plan with the client.  Questions are formulated to help clients articulate what has worked, what is working, and what their best hopes are so they will be confident and have the necessary “good enough” skills to graduate from defined treatment episodes.  The solution-focused practitioner attempts to highlight positive language while simultaneously conveying a belief and confidence in their client. Solution-focused documentation templates can provide friendly reminders and cues for clinicians to ask hopeful questions.  What questions we ask, what we listen to, what we ignore, how we construct questions, and what order we ask questions matter. 

Imagine if the following questions were part of an electronic record semi-structured document. 

• • “What are your best hopes?”: conveys the assumption that they do have best hopes.
  • “What has been better since we last met?: conveys something has been better and looks for positive differences/exceptions.
  • “What has been happening that you want to continue to happen?” conveys some things have been working.
  • “What do you know about your condition?”: conveys that they do have knowledge and expertise. 
  • “What do you know about your child that they will succeed in life?”:  conveys a belief that they do know their child will succeed. 
  • “Supposing ten is you are confident that your skills are good enough to graduate from this treatment episode, and 1 is the opposite; where are you now?”: conveys clients have the capabilities to develop skills and graduate from discrete treatment episodes.

Traditional intake and follow-up paperwork have relied on a medical model that requires a detailed description of the client’s problems. Problem-oriented approaches require a complete understanding of all the symptoms to make a diagnosis and then treat the client. Solution-focused brief therapy (SFBT)  stands in sharp contrast. SBFT is the only therapeutic modality not requiring a complete understanding of the problem for clients to move forward with their goals. SFBT starts by revealing a detailed understanding of the client’s best hope for their future and collaboratively looks for client-related resources, actions, and agency that build this outlook. The focus is on detailing what a client will do when their problem is solved rather than diagnosis and symptom exploration. Based on the premise that people have the necessary resources to solve their problems, SFBT amplifies these strengths and abilities by building a shared dialect that focuses on what has worked and is working in a client’s life.  

Resource activation and therapeutic interventions that reinforce the client’s agency and abilities play a central role during successful treatment (Gassmann & Grawe 2006).  Therapists who create an environment where clients perceive themselves as well-functioning and activate their resources early in the session have more successful outcomes (Gassmann & Grawe 2006). Research was done to test problem-focused versus solution-focused intake questions on pre-treatment change and compared a standard written intake form with problem-focused questions to a solution-focused brief therapy intake form (Richmond 2014). Clients answering the solution-focused questions described significantly more solutions and fewer problems than the comparison group. Clients in the SFBT intake interview improved significantly on the Outcome Questionnaire before their first therapy session, whereas those in the traditional diagnostic intake did not. This study demonstrated that intake procedures are not neutral information gathering and that strength-based questions have advantages (Richmond 2014). 

The following is a brief example of a case and one possible way to incorporate solution-focused documentation. Of course, there are many different mandates and requirements; this example only provides one. All documentation templates need input from staff and organizations to ensure they meet requirements.

Karl is an 18y/o transgender male (preferred pronoun is he) who presented to the emergency department following a motor vehicle accident. He reportedly was texting his friends about meeting to hang out with them while driving when he didn’t realize the car in front of him had stopped. The car was totaled. Karl sustained a broken leg and back injury. He was hospitalized due to the severity of his injuries and the need for surgery on his leg. While awaiting surgery, Karl was reporting suicidal thoughts and wanting to die. Karl’s father was out of town caring for his elderly parents on the car accident day and had not yet arrived back home. Karl had a difficult time when his father was away and had a prior overdose attempt six months ago while his father was caring for his elderly parents. Karl’s mother died from cancer when Karl was 12 years old, and Karl spent much of his youth witnessing her treatments, decline, and death. The following is an excerpt from Karl’s crisis evaluation while in the hospital medical unit.

Tx: Hello Karl – is that how you like to be called?
Karl: Yes
Tx: Thank you for taking the time to meet with me. My hope is that I will be helpful to you. I will do my best. Would it be ok if I asked you a few questions in hopes of being helpful for you? Some questions may be a bit challenging.
Karl: Ok
Tx: Thank you. It must be difficult for you to be here; how have you been holding up these past few days?
Karl: It’s been hard. It’s loud, and I can never get any rest. I just want to go home.
Tx: Of course. It must be so frustrating for you to be here. What do you know has helped make things even a little bit bearable while you are here?
Karl: Getting pain medication.
Tx: How has getting pain medication been helpful for you?
Karl: It was bad after the accident. I was in so much pain. All I could think of was killing myself just to relieve my agony.

The therapist sets the tone by thanking Karl and confirming how he wants to be called, as well as providing consent for the conversation to follow. The therapist also provides plenty of “for you” responses followed by coping questions that activate Karl’s individual resources early in the conversation.

Tx: I’m glad the medications are being helpful for you. How well would you say you are tolerating your pain from 1-10 (10 being the best)?
Karl: Probably a 5.
Tx: What would be a good enough number?
Karl: A 7.
Tx: What keeps the number from being lower than a 5?
Karl: I’m able to get some sleep.
Tx: What else keeps it from being lower?
Karl: It’s gone up from a one, and I’m hoping the surgery will help even more.
Tx: What have you done that has helped the medication work, even a little bit?
Karl: I just try and distract myself by playing video games. The nurses have brought me some games, and that helps a bit.

The therapist attends to his pain and how well he is tolerating it demonstrating concern about his wellbeing. Scaling how well Karl is tolerating the pain and how helpful the medications are from 1-10 is a more constructive way to assess pain. It promotes his agency in managing his pain.

Tx: I’m impressed with how you are handling this. I wonder if you know whose idea it was for me to come and see you today?
Karl: I think it was the nurse.
Tx: What do you know the nurse was concerned about that asking me to come to see you would be helpful for you?

Asking Karl whose idea it was for the therapist to come and framing this as concern can be helpful in exploring important VIPs in Karl’s immediate social context. Notice that the therapist did not ask “why” rather instead what the nurse was concerned about guiding the narrative to one of care and compassion.

Karl: I don’t know. (Pause) Probably because I said I wanted to die and couldn’t take it anymore.
Tx: What do you mean by “take it anymore”?
Karl: My father is in Arizona, and when he comes back, he will be furious with me. I know he will take away my driving privileges, and driving to see my friends is the only thing that helps me feel any better.

Karl was able to identify the reason for the consultation – that he wanted to die. Exploring the meaning of his words provided more about Karl’s concerns and his reasons for distress. Although, it may seem to slow the conversation down, exploring the clients’ meaning often paradoxically moves the conversation forward more quickly as the therapist and client negotiate a shared understanding.

Tx: That must be very difficult for you to think about while also dealing with your pain and upcoming surgery. How have you been enduring all of this?
Karl: It’s been hard. My father is still in Arizona and won’t be home until tomorrow.
Tx: Of course, this must be hard for you. Is your father an important person in your life?
Karl: Yes. I don’t know what I would do without him.
Tx: What do you most appreciate about your father?
Karl: He’s always there for me – even when I do stupid things. He doesn’t give up on me.
Tx: What has he done to always be there for you?
Karl: He and I are close. After my mother died, we went through a lot. We helped each other.
Tx: It sounds like your father loves you a lot. Suppose I were to ask him what he most appreciates about you, what would he say?
Karl: That I’m strong, and I can deal with a lot.
Tx: What do you mean by “deal with a lot”?
Karl: My mother died when I was 12 years old, and it was so hard.
Tx: That sounds incredibly challenging. What would your father say you have done to deal with this?
Karl: He’d say that I kept going to school and kept caring about people – that I am strong.
Tx: What would he say you have done that you are strong?
Karl: That I care about people.
Tx: You both sound very strong. I’m wondering, who else are the important people in your life?
Karl: My mother. Even though she died, I think of her a lot and know she is with me.
Tx: What do you suppose your mother most appreciates about you?
Karl: She knows how much my father and I care and help each other. She would be proud of that.
Tx: What else would she say she appreciates about you?
Karl: That I don’t give up.

Taking the time to ask who the most important people in Karl’s life and what they most appreciate about him is critical in highlighting his relationship resources. It is often these meaningful relationships that are protective and stop people from acting on thoughts of suicide.

Tx: Supposing I asked your mother and father what their best hopes would be for you so they would know you are safe to go home, what would they say?
Karl: My father would want to make sure I don’t do anything unsafe.
Tx: What would he hope you do instead?
Karl: He would want me to let him know if I was upset and reach out for support.
Tx: What else would tell him you can keep yourself safe?
Karl: That I wouldn’t be driving and getting into accidents and wanting to end my life. I don’t want to die; it’s just sometimes I get so upset that all I can think of is the relief of being together with my mother.
Tx: Of course. These are very intense emotions you are experiencing. I’m wondering, what are your reasons for living?
Karl: I want to go to college and become a nurse.
Tx: Wow. That is impressive. Have you always wanted this, or is this different?
Karl: I’ve wanted to be a nurse for a long time. Ever since seeing how they helped my mother and our family.
Tx: Wow – you are strong. Where do you get this determination from?
Karl: Probably my father. He doesn’t give up. He keeps trying to help his parents and me.

Often clients experiencing intense emotions are more able to answer what their best hopes are from the perspectives of their VIPs. This is another reason to have some knowledge of who are the most important people in your clients’s life. Karl was able to answer what his parents’ best hopes were quite easily – to stay safe. Following this, every question or response was focused on activation of his resources including exploring his reasons for living. This is in contrast to exploring why he wants to die. Exploring his reasons for living uncovered additional resources and opportunities to compliment Karl and explore positive differences with him.

Tx: Sometimes, I ask number of questions to help me help you. Would that be ok?
Karl: Ok
Tx: Suppose ten is you are confident that you can keep yourself safe and one is the opposite; where are you now?
Karl: about a 5.
Tx: And what would be a good enough number?
Karl: A 6
Tx: What keeps the number from being lower than a 5?
Karl: Knowing that my father will be here soon.
Tx: What do you know about your father being here for you soon is helpful?
Karl: I just need to have him nearby. He knows how to calm me down.
Tx: What else keeps the number from being lower?
Karl: That I wouldn’t do anything. I wouldn’t want to hurt my father. It would kill him.
Tx: Suppose I asked your father how confident he is in terms of your ability to keep yourself safe from 1-10; what would he say?
Karl: I don’t know.
Tx: You know your father best. There is no right answer. I’m just wondering what you think?
Karl: Probably a 3
Tx: What do you think is the reason your number is a 5 and not a 3?
Karl: I think he would say he’s scared that I had another accident and did the same thing a few months back. He would probably say he’s scared that I could’ve died.
Tx: of course – I’m sure that must be frightening for him to know you could have died. What do you suppose keeps his number from being lower than a 3?
Karl: That I’m here and getting help.
Tx: What else do you think keeps his number from being lower?
Karl: That he’s on his way and will be here soon.
Tx: I’m wondering, Karl, what would you be doing when your confidence is just a bit higher, at a 6?
Karl: I would have a plan for when I leave the hospital.
Tx: What do you mean by a plan?
Karl: That my father and I would talk, and I would have someone to talk to.

Scaling confidence in Karls’ ability to stay safe and “working the scale” is an effective way to develop a collaborative safety plan. Even though his parents were not present in the session, their perspectives could easily be incorporated into the conversation. Numbers limit language confusion and allow for a clear plan moving forward in small manageable steps. Numbers often help clients manage the intensity of their experiences safely, as working the scale provides further opportunities to highlight their agency and a plan. And Hope = agency + plan!

These document examples are provided as PDFs.

Karl Progress Note case example

Solution-Focused Progress Note

Solution-Focused Adult Intake Questionnaire

Solution-Focused Safety Assessment Tool

Beyebach, M., Neipp, M. C., Solanes-Puchol, Á., & Martín-del-Río, B. (2021). Bibliometric Differences Between WEIRD and Non-WEIRD Countries in the Outcome Research on Solution-Focused Brief Therapy. Frontiers in Psychology, 4926.

Gardner, C. L., & Pearce, P. F. (2013). Customization of electronic medical record templates to improve end-user satisfaction. CIN: Computers, Informatics, Nursing, 31(3), 115-121.

Gassmann, D., & Grawe, K. (2006). General change mechanisms: The relation between problem activation and resource activation in successful and unsuccessful therapeutic interactions. Clinical Psychology & Psychotherapy, 13(1), 1–11.

Janett, R. S., & Yeracaris, P. P. (2020). Electronic Medical Records in the American Health System: challenges and lessons learned. Ciencia & saude coletiva, 25, 1293-1304.

Richmond, C. J., Jordan, S. S., Bischof, G. H., & Sauer, E. M. (2014). Effects of solution-focused versus problem-focused intake questions on pre-treatment change. Journal of Systemic Therapies, 33(1), 33.

Wilbanks, B. A., & Moss, J. (2018). Evidence-based guidelines for interface design for data entry in electronic health records. CIN: Computers, Informatics, Nursing, 36(1), 35-44.