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02.12.2015
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Theory is an important component of robust nursing informatics knowledge, a fact that is sometimes overlooked in both education and practice. Kurt Lewin’s Change Management Theory, is a time-tested, easily applied field theory that is often considered the epitome of change models, suitable for personal, group and organizational change. The first stage involves finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. Unfreezing the present Forces that maintain current behavior are reduced through analysis of the current situation. The second stage involves a process of change–in thoughts, feelings, behavior, or all three, that is in some way more liberating or more productive than doing things the old way.
Having analyzed the present situation, new structures and processes are put in place to achieve the desired improvements. Lewin extended his theory by including “force field analysis” which offers direction for diagnosing situations and managing change within organizations and communities.
Driving forces are forces that influence a situation, pushing in a particular direction: they tend to initiate a change and keep it going. Restraining forces are forces that act to restrain or decrease the driving forces – they make it difficult to move a change forward. Equilibrium is the status quo or the present level of productivity, and can be disrupted or fortified by changes in the relationship between the driving and the restraining forces. So before a change occurs, the force field is in equilibrium between forces favourable to change and those resisting it.
For change to happen the status quo, or equilibrium must be upset – either by adding conditions favorable to the change or by reducing resisting forces. Kurt Lewin proposed that whenever driving forces are stronger than restraining forces, the status quo or equilibrium will change. The force field analysis integrates with Lewin’s three stage theory of change as one works towards unfreezing the existing equilibrium, moving towards the desired change, and then freezing the change at the new level so that a new equilibrium exists that resists further change. The goal of the change agent(s) is to support the driving forces to move beyond equilibrium and outweigh the impact of any restraining forces. Figure 2 illustrates a model adapted from Keller (2005) that applies Lewin’s change theory stages to the process of implementing information systems and technologies.
Beyond a basic intake, the first response is to ensure that the youth has something to eat, clothes to wear and is able to get some rest.
Attachment Theory is a means of understanding how early childhood development, especially in the first two years of life, determines how a child will interact with peers, adults and even future romantic partners, as they mature through adolescence and adulthood.
John Bowlby, the ‘father of attachment theory’ described attachment as a “lasting psychological connectedness between human beings”. Secure Attachment – a healthy attachment where the child knows a parent will respond appropriately, consistently and promptly to their needs. Ambivalent Attachment – wherein the child does not view their parent as a secure base because the caregiver gives little or no response to a distressed child and discourages crying while encouraging independence. Avoidance attachment is developed through inconsistency between appropriate and neglectful responses.  The child does not seek comfort or contact from their parents and may in fact avoid them.
Covenant House uses Attachment Theory as a basis for developing a working relationship with youth. At Covenant House Vancouver, a discussion of Attachment Theory forms part of the initial meetings between a youth and their Case Manager.
By teaching youth about Attachment Theory it lets youth know that conflict is normal and helps them understand how to resolve it.
Stages of Change, also known as the “transtheoretical model” is a means of examining the various stages that someone goes through while dealing with an addiction and working to change their addictive behaviour. Most people who are trying to end an addiction or change a specific behaviour go through the various steps in the Stages of Change model many times before they are able to successfully end their addictive behavior. While the youth themselves may not always be aware of the theoretical models being used, they are impacted by them. Confidence - Kids need to recognize their strengths, so they can develop the confidence to find their place in the world, think creatively and recover from setbacks. Competence - When we notice what young people are doing well and we give them opportunities to develop skills, they feel competent. Connection - Feeling connected is the single most important factor in overcoming challenges. Contribution - When youth contribute to the well-being of others, they receive gratitude instead of condemnation.
Coping - Young people who have developed a range of healthy coping skills will not turn to higher risk “quick fixes” like drugs or self-harm.
Control - When youth understand that privileges and freedom gradually increase as they demonstrate responsibility, they learn to make better choices.


Motivational Interviewing (MI) is a style of working with a client that focuses on allowing the client to direct the change rather than telling the client what they need to do. In MI the goal is to work with the client in a partnership rather than the case worker seeing themself as the expert. At Covenant House, staff use motivational interviewing techniques when working with youth, particularly in the development of case plans. As mentioned in the Covenant House Toronto and Vancouver Overview section many of the youth involved in the two agencies have experienced extensive trauma, which in many cases led to their homelessness. All of these experiences mean that staff and volunteers working with this population need to develop and implement trauma-informed services to provide the best support possible for their clients.
Like Motivational Interviewing, a key component of trauma-informed services is to “meet people where they are at.”  It also involves recognizing that often the very work aimed at helping people tends to re-traumatize them. Both CHT and CHV provide many opportunities for youth to have input into their individual case plan (including full development of the plan in later steps at CHV), as well as the workings of the house. While some of these theories may sound very academic and confusing, the reality is that most youth-serving agencies and non-profits tend to use many of them in day-to-day operations, even if they did not know what they were called. If you have an existing program and do not know what theories are in place, consider partnering with a local university or researcher.
The theories you need to develop will be informed by your clientele and their presenting needs. The most recent homelessness research, news, events, blogs, and multimedia features directly to your inbox. Sign up to receive the weekly Homeless Hub newsletter, featuring the most recent Canadian research delivered directly to your inbox.
XSign up to receive the weekly Homeless Hub newsletter, featuring the most recent Canadian research delivered directly to your inbox. The novice to expert model was featured in my editorial in our last issue, Volume 5, Number 4. Kurt Lewin, (1890 – 1947) a Gestalt social psychologist, has been acknowledged as the “father of social change theories” since several contemporary models are at least loosely based on Lewin’s work. This is the stage where the desire to change occurs, or at least the recognition that change is needed. Imperatives for change are realized through dialogue and re-educational activities such as team building, personal development, and brain-storming. During this stage, the people involved (change target group) are convinced that the new way is better than the old. This is the most time-consuming, costly, yet productive stage as far as tangible results go. Without some process of refreezing, it is easy to backslide into the old ways of doing things.
This is done by establishing supportive mechanisms such as policies, rewards, ongoing support, and a solid orientation to the new system for incoming personnel. Lewin assumed that in any situation there are both driving and restraining forces that influence any change that may occur. In terms of improving productivity in a work group, pressure from a supervisor, incentives, frustration with the current way of doing things (such as paper documentation) and competitive or social demands are examples of potential driving forces. Apathy, prohibitive cost, hostility, technology illiteracy and poor maintenance of equipment are examples of restraining forces which can inhibit change and may restrict productivity.
Equilibrium is reached when the sum of the driving forces equals the sum of the restraining forces.
Lewin spoke about the existence of a quasi-stationary social equilibrium, which needed to be shifted during the change process, but then reestablished at a new level once the change had been refrozen. Successful change is achieved by either strengthening the driving forces or weakening the restraining forces.
This provides support in moving through the unfreezing – changing – refreezing stages of change.
Although Lewin’s change management theory was developed decades ago, it continues to offer a reliable and viable model for informatics-related changes. So the state of maturity to a large degree reflects the prevailing dominant corporate culture. Where you and your organisation sit on these maturity models is one of the key factors in leading change that will determine your chances of success.
Moving into the Rights of Passage programs moves them further up Maslow’s hierarchy by giving them more than just safety and security but also a sense of belonging.
Secure Attachment is considered positive while the other types of attachment (ambivalent, avoidance, disorganized) are all forms of insecure attachment and usually cause a variety of behaviours. The child is able to separate from their parent but prefers their caregiver to a stranger and shows distress when left alone. Children in this kind of relationship often feel anxious because their parent’s behaviour and availability is inconsistent.
The child does not respond well to affection, has low self-esteem and may act out negatively. They feel that understanding what type of attachment a youth has will allow them to improve their working relationship with that youth by better understanding the specific behaviours a youth exhibits.


The policy on Change of Case Managers states “CHV follows the principles of Attachment Theory.
When a conflict arises between the Case Manager and the youth (or a conflict with any other staff) the young person will hopefully be better prepared to deal with it in a healthy way.
The originators of the theory James Prochaska and Carlo DiClemente also identify 10 processes of change, which are used throughout the stages. Obviously, the young person may not know about or understand the model himself or herself, but the staff use it to help evaluate an individual’s readiness for change, so that appropriate interventions are used as effectively as possible. The Outcomes Star and The Youth Engagement Scale (discussed in the Evaluation chapter) tie in this theory to the way in which a youth’s progress is measured. Kenneth Ginsburg, Director of Health Services at Covenant House Pennsylvania and an adolescent medicine specialist.
When we don't allow them to recover from mistakes themselves, we undermine their sense of competence. Other people, schools and community groups give youth the validation and confidence to pursue their goals. Kids discover that it feels good to contribute to others and they are more likely to ask for help without fear or shame. It includes meeting the client “where they are at” (also a key component of harm reduction) and recognizing that a client brings many strengths to the table. Creating a case management system that avoids someone having to continually tell their story is helpful. Have them observe your case management practice and examine your program and evaluation methods. A theory focus continues in this issue with a look at the oldest, simplest, yet robust and applicable change management theory, Kurt Lewin’s Change Theory.
He is also lauded as the originator of social psychology, action research, as well as organizational development. An example is moving from a paper based documentation system to an electronic system, in an organization where paper trails have become unmanageable and archaic. The more transparent and inclusive the process is, the more readily people move through the unfreezing stage. Rewards, support, and champion leadership continue to be important through this stage, which is essentially ongoing until the next major change is needed. The life skills training and support provided by staff help them move through other stages as well.
Not, ‘this kid swore at me I need to discharge him’ but ‘what is this youth telling me through this behaviour’.
Prochaska and DiClemente state, “we have determined that efficient self-change depends on doing the right things (processes) at the right time (stages)”. This means that program milestones, youth engagement markers and other indicators of success are not based only in the need for evaluation measures but in a concept that explains and elaborates upon a youth’s behaviour. We’re not here to judge you, we’re just here to help you’.” — “Kevin”, 26, former ROP participant, Covenant House Vancouver. His evidence-based model uses the principles of Covenant House to help staff manage relationships with youth. Helping the client recognize their own abilities and therefore the opportunity to make choices for themselves is a key component of motivational interviewing. Homeless youth also experience a high level of violence – physical and sexual – during their homelessness. Providing a space that is structured and secure yet flexible, allowing for input from the affected individual, providing opportunities for the development of safe and trusting relationships and recognizing that “one-size-does-not-fit-all” are keys to developing trauma-informed services. These forces can be positive, urging us toward a behavior, or negative, propelling us away from a beneficial behavior as illustrated in Figure 1. There may be role confusion where the child takes on roles that are typically associated with the caregiver (they take care of an alcoholic parent for example).
This conflict resolution better equips youth to handle stressful situations by empowering them, ultimately increasing their independent living skills. The youth here, when we work with them we can definitely see when there’s some struggles going on. It allows staff to more fully understand why a youth does something, what that behaviour would look like at each stage and to guide the youth in a more positive direction.
It is usually considered to be “a person-centered, goal-oriented, guiding method to enhance motivation to change” (t3 website). Even when someone has not directly had a traumatic background, research is emerging that shows the experience of homelessness itself can be considered traumatic. Focus on Trauma: Recognizing trauma, tools to use with clients, and self-care for front-line workersLinks1.



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