Engaging parents and protecting children?

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  1. 1. 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 Bedfordshire Donald.forrester@beds.ac.uk
  2. 2. Overview S Exploring impact of training and supervision in Motivational Interviewing on skills and outcomes S Using this to explore what is good social work and how we achieve it S But also seeing whether we can do an RCT in frontline child protection work
  3. 3. 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
  4. 4. What is Motivational Interviewing (MI) S MI is a directive, client-centred approach to communication that attempts to elicit intrinsic motivation S MI Treatment Integrity (MITI) rates for: S Collaboration S Autonomy S Evocation S Averaged for a MITI score
  5. 5. 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
  6. 6. MI Skills Development Package S 2 days initial training S 1 day MI in CP work S 8 weeks hourly consultations S 1 day follow-up workshop S Monthly consultations
  7. 7. MI Skill Scores for Simulated Interviews S no statistically significant difference between the groups before training (t=1.05; df (57) p=0.137), S a significant impact of training (t=3.416, df (26) p=0.002) S mean goes from 2.46 to 3.0 in the MI group
  8. 8. Impact on MITI score in simulated interviews 0 2 4 6 8 10 12 14 16 18 20 1 1.33 1.66 2 2.33 2.66 3 3.33 3.66 4 4.33 4.66 5 Numberofworkers MITI score T1 T2
  9. 9. Data Collection: 610 families randomized S Follow up with families S Observation (2nd visit : T1) S Audio recording of meeting S Interview (T1 and 20wks T2) S Outcome measures reported here: parental engagement (Working Alliance Inventory), parent anxiety/depression/stress (GHQ-12) Referral and Assessme nt Children in Need team First SW visit 2nd or 3rd SW visit SW asks parent about observatio n Family enters study
  10. 10. 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 enteringwider dataset 193 295 488
  11. 11. 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
  12. 12. 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 workers rated MI skill in an interview with an actor 3-6 months before
  13. 13. What factors predicted parental engagement? Only two predicted parental engagement S Neglect = less engagement (t=-2.1, p=0.039) S High MI skill = more engagement (t=2.1, p=0.04)
  14. 14. Predictors of stress/anxiety Similar analysis for stress/anxiety (GHQ 12) Predictors: S Emotional abuse (higher) (t=2.56; p=0.012) S Social isolation (higher) (t=2.64; p=0.009) S MI skill (lower) (t=-2.31; p=0.023)
  15. 15. Did training make a difference? MI Non-MI Engagement (WAI) 61.5 61.8 Parent Satisfaction 5.6 5.6 Feelings about Childrens Services 3.5 3.3 GHQ 12.6 13.6 WAI Observed 57.5 58.0
  16. 16. Oh no!!!
  17. 17. Review S Training changed simulated practice S MI skills associated with: S Parental attitude to worker and services S Engagement of parents S Wellbeing of parent S But no training impact
  18. 18. Culture eats training for breakfast
  19. 19. A social model for evidence based practice S Practice is not primarily produced by individual workers being skilled or by training S It is produced by organisations that set themselves to produce certain types of practice S Local authorities therefore need a vision for the practice they want and then to create the organisation that delivers it