Joined up services: making services work for families

Professor Judy Hutchings OBECentre for Evidence Based Early Intervention, Bangor University

Children in Wales: Parents’ Week Conference

Engaging parents in family and parenting support servicesCardiff 18th September 2013

Email: j.hutchings@bangor.ac.uk

WHAT WE KNOWMuch 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 co-ordination still existBut 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 parent-child 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 high-quality 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/commissioning-

toolkiit

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