Transcript Joined up services: making services work for families

Joined up services: making
services work for families
Professor Judy Hutchings OBE
Centre for Evidence Based Early
Intervention, Bangor University
Children in Wales: Parents’ Week
Conference
Engaging parents in family and
parenting support services
Cardiff 18th September 2013
Email: [email protected]
WHAT WE KNOW
Much thinking about this issue arises from
child protection inquiries:
Maria Colwell’s death in 1973 set up child
protection registers but Victoria Climbie,
Baby Peter show that problems of coordination still exist
But the other issue is the quality of
information and the level of evidence for
the intervention
Types of challenges
 Mismatch of policies between or within
different departments at central or local
Government level
 Problems around joint information
sharing and need to know decisions
 Philosophical differences – illness
versus learned behaviour
 Lack of agreement about what
constitutes risk
 Lack of knowledge about what works
and how ro select evidence based
interventions
 Failure to deliver evidence based
interventions properly so that they work:
staff skills, resources, etc.
 Lack of training in behaviour change
principles despite everyone wanting to
see behaviour change
 Lack of managerial systems to detect
bad practice
 Lack of knowledge about what other
staff are doing and why
Differing philosophies
 Diagnosis versus learning or learning
failure
 Medicalisation is a major problem in
the USA with insurance based health
care and medication of children
 Misunderstandings about the extent to
which the diagnosis explains the
behaviour
Engaging and retaining
vulnerable families
 Challenges in identifying families
 The need for relationship building in
order to engage families in services
 Problems of people feeling criticised if
told/asked to go on a parenting
programme
 Problems if other parts of the service
say things that don’t match what
parents are learning in the programme
The need for consistency
within environments
 Training nursery staff in consistent
child management principles that
match those that the parents are
learning eg how to deal with swearing –
ignore, tell off, use a naughty chair
 Training in teaching alternatives – eg
using friendly words
 Problem with a contact visit – contact in
a fun centre! What are our goals for a
contact visit?
Keeping other people
informed about what and why
 Example – a contact session supervisor
telling a parent off for ignoring a child. But
said the Mum I was ignoring a behaviour
not the child
 Solution – train contact staff in the
intervention- ideally have them attend with
the parent so as to coach them during the
contact visits
Ensuring that all know why the
person is receiving the
intervention
 Example – parents required to attend a
parenting programme (child protection)
 What is required of attendance, what is
perceived as the risk, what benefit will
attendance achieve for the family
 Example – parent said I am doing what
they asked and coming but there had
been no clarification of why or what
was expected by attendance
How much is needed to
achieve changes at home
 Example: a parent with learning
difficulties attending a parent group
 Goal is changed behaviour at home
 Achieved by home coaching by a
support worker who also attended the
parent group with her
The relevance of different
evidence sources
 A child on the register because of
hygiene concerns
 But the parent-child bond was strong
as shown in video evidence
 A plan to help the mother to learn what
the risk was and improve hygiene
 Plan involved her getting the support of
a neighbour in monitoring hygiene
Working with foster carers
 Conflict between philosophies: attachment
versus behavioural management*
 But placements break down due to
behavioural challenges
 The pocket money issue
 Who to share information with and the need
for the service to be involved
 *Scott research showing that the IY
programme independently improves parentchild attachment
Fidelity issues – sources of
support
 The Society for Prevention Research
(2004) standards of evidence: criteria
for efficacy, effectiveness and
dissemination
www.preventionresearch.org
 The NICE guidance (2009) How to use
NICE guidance to commission highquality services
Fidelity in parenting programmes
 Access – how to address recruitment of
families that most need the service
 Content – social learning theory, all of
the key ingredients of the programme
 Collaborative delivery – and ensuring
that the programme meets parents’
goals
 Supervision, accreditation, etc.
Fidelity challenges
 Ensuring that people have sufficient
training
 Ensuring that leaders have skills to
work with the target population and will
be able to help the parents set realistic
and achievable goals
 Ensuring that the programme is
‘adapted” in terms of pace and time
spent on particular challenges faced by
the target population
Recruitment challenges – the
service users that need it most
don’t engage!
 Teaching referrers about the intervention
 Training referrers in strategies to engage
parents - you have a child that is perhaps a
little harder to parent, you are the person
that can help your child most
 A DVD to show parents talking about the
programme
 An opportunity to meet a parent that has
attended the programme
Conclusions
 Services need to choose evidence
based programmes
 Staff need to be trained in interpreting
evidence or use advice sources
 The Geek Manifesto (Henderson 2012)
 Test, learn, adapt (the Cabinet Office)
 www.colorado.edu/cspv/blueprints/
 www.education.gov.uk/commissioningtoolkiit
Resources
 People need skills, training in the
specific intervention, resources,
supervision
 Resources are needed to support
access
 Appropriate background knowledge for
the target population (Mihalic et al.,
2002)
Other people involved in work
with the family
 must know about the content of the
programme
 must provide all resources needed
including access to supervision
 must work with the service provider to
ensure that there is clear agreement
about why the intervention is being
offered to the family and what are
organisational goals
Underpinning knowledge
 Everyone is trying to change behaviour,
GPs, nurses, social workers, teachers
 We all need to know about the principles
of behaviour change
 There are 70 years of work on the
principles of behaviour change and
social learning theory (Malott and
Trojan, 2007)
 Motivational interviewing (Rollnick et al.
2007)
General conclusion
 Our population is facing many lifestyle
problems
 Life expectancy for the younger
generations is expected to fall
 35% of children in Wales are
overweight
 19% are obese
 Smoking is our biggest killer
 Type 2 diabetes is overwhelming the
NHS
Solutions
 Choose evidence based programmes
 Ensure that they are delivered with
fidelity
 Train all staff in the theoretical
underpinnings of interventions
 Train everyone in the principles of
behaviour change – we need to learn
how to be more effective at managing
our own behaviour
Thanks for listening