Joined up services: making services work for families
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Transcript of Joined up services: making services work for families
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: [email protected]
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