Engaging parents and protecting children?

S

Engaging parents and protecting children?

Results from a randomised controlled trial evaluating the impact of training in

Motivational Interviewing on parental engagement in child protection

Donald Forrester Professor of Social Work Research

Tilda Goldberg Centre for Social Work and Social Care

University of BedfordshireDonald.forrester@beds.ac.uk

Overview

Exploring impact of training and supervision in Motivational Interviewing on skills and outcomes

Using this to explore what is good social work and how we achieve it

But also seeing whether we can do an RCT in frontline child protection work

Can we improve the way workers talk to parents?

MI skills help

engage parents

Training improves

social worker

skills in MI

MI trained workers better at engaging parents

Engagement

associated with

better outcomes

What is Motivational Interviewing (MI)

MI is a directive, client-centred approach to communication that attempts to elicit intrinsic motivation

MI Treatment Integrity (MITI) rates for: Collaboration Autonomy Evocation

Averaged for a MITI score

Study Design: Double Randomization

Children in Need

Service

Team 1

1

2

Team 2

1

2

Team 3

1

2

Team 4

1

2

Team 5

1

2

Team 6

1

2

MI Skills Development Package

2 days initial training

1 day MI in CP work

8 weeks hourly consultations

1 day follow-up workshop

Monthly consultations

MI Skill Scores for Simulated Interviews

no statistically significant difference between the groups before training (t=1.05; df (57) p=0.137),

a significant impact of training (t=3.416, df (26) p=0.002)

mean goes from 2.46 to 3.0 in the MI group

Impact on MITI score in simulated interviews

1

1.33

1.66 2

2.33

2.66 3

3.33

3.66 4

4.33

4.66 5

0

2

4

6

8

10

12

14

16

18

20

T1T2

MITI score

Num

ber o

f wor

kers

Data Collection: 610 families randomized

Follow up with families Observation (2nd visit : T1) Audio recording of meeting Interview (T1 and 20wks T2)

Outcome measures reported here: parental engagement (Working Alliance Inventory), parent anxiety/depression/stress (GHQ-12)

Referral and

Assessment

Children in Need team

First SW visit

2nd or 3rd SW visit

SW asks parent about

observation

Family enters study

S

MI group

Control group

Total

Total families randomised 246 364 610

MI group

Control group

Total

Cases excluded for pre-defined reasons 36 56 92 Cases excluded due to manager overrule 17 13 30

Total cases excluded 53 69 122

Families excluded

MI group

Control group

Total

Total families entering wider dataset 193 295 488

Data collection

Main study sample – more than 2 visits, N=284 (58% of allocations)

256 parents asked (90%)

166 agreed to observation (65%)

132 agreed to research interview (80% of those observed, but 46% of whole sample)

89% had social worker questionnaires

100% had ICT data collected

What factors predicted parental engagement?

Abuse, physical Concerned about happy and secure

Parental, learning disability

Abuse, emotional from DV Parental concerns, depression or anxiety

Parental, social services involvement as a child

Abuse, emotional not DV Parental, personality disorder Social issues, financial problems

Abuse, sexual Parental, other mental health issues

Social issues, housing issues

Abuse, neglect Parental, alcohol misuse Social issues, social isolation

Concerned about learning well Parental, drug-taking Social issues, wider family relationship problems

Concerned about health and development

Parental, domestic violence Rating of overall concern for the family

The worker’s rated MI skill in an interview with an actor 3-6 months before

What factors predicted parental engagement?

Only two predicted parental engagement

Neglect = less engagement

(t=-2.1, p=0.039)

High MI skill = more engagement (t=2.1, p=0.04)

Predictors of stress/anxiety

Similar analysis for stress/anxiety (GHQ 12)

Predictors:

Emotional abuse (higher) (t=2.56; p=0.012)

Social isolation (higher) (t=2.64; p=0.009)

MI skill (lower) (t=-2.31; p=0.023)

Did training make a difference?

MI Non-MIEngagement (WAI)

61.5 61.8

Parent Satisfaction

5.6 5.6

Feelings about Children’s Services

3.5 3.3

GHQ 12.6 13.6WAI Observed 57.5 58.0

Oh no!!!

Review

Training changed simulated practice

MI skills associated with: Parental attitude to worker and services Engagement of parents Wellbeing of parent

But no training impact

“Culture eats training for breakfast”

A social model for evidence based practice

Practice is not primarily produced by individual workers being skilled or by training

It is produced by organisations that set themselves to produce certain types of practice

Local authorities therefore need a vision for the practice they want and then to create the organisation that delivers it