MAC and Pulling Together Developmental support for children in cooperation with teachers and

parents using Marte Meo and a systemic perspective

INGEGERD WIRTBERGFamily Therapy and the Future

Turku, Finland 13-16 August 2014

PresentationOverview: Marte Meo and Coordination Meetings (MAC)

ingegerd.wirtberg@psy.lu.se, ulf.axberg@psy.gu.se

- Effect Study: 34 children

- RCT study: 100 children

- Financed by The Swedish National Institute of Public Health

- Presentation of a pilot project: Pulling Together - Financed by The Groschinsky Foundation

Background No evidence of the effects of Marte Meo

The responsibility for and the means to help the ”misbehaving child” was defined by the school (or other agencies) as being outside of its domain.

Responsibility fell between the school and the family – it was unclear who was responsible for helping the child

Marte Meo and Coordination Meetings: MAC

Marte Meo - Maria Aarts,

Video based intervention – to promote developmental support using dialogue (Bråthen), primary and secondary intersubjectivity (Trevarthen)

In MAC the primary intervention is in the school

If desired, an MM intervention can also be provided in the home

Coordination Meetings

Systemic intervention built on ”Open dialogue” and ”Reflecting processes” (Seikulla, Andersen)

Meeting between parents, teacher, MM consultant and (when required) MM therapist. The meeting is led by a Coordinator

The Coordinator’s only task is to invite people to, and then lead, the meetings

Inclusion criteria

4 -12 years of age

Inclusion criteria by category - at least one of following:

Social exclusion Rejection by peers, not invited to parties, not chosen to work and play with by other children,

rejected when they try to initiate contact etc.

Interaction problems Lack of social competence, difficulties in complying with and following rules, generally

”misbehaving” etc.

The childs own well-being Low self-confidence, generally unhappy, low school performance, learning difficulties, short

attention span etc.

Prevalence of behavioural management disorders

• 3-5% High-risk • 7-10% Risk

• 85-90% Normal

Risk and vulnerability

factorsAttachment

Family stress

Neglect

Scool failure

Individul factors

Genetic factors

Resiliance and salutogenic factors

Intelligence

Healthy family-

relations

Social support

Social competence

Managing school

Prevent

and

stop

Discover

Support

Create

Children’s psychosocial health seems to correlate with school performance

To manage school seems to be one of the strongest factors that we know of for children’s future psychosocial development (Vinnerljung et.al 2010)

Seems to be repeated in international research (Hattie 2009)

Teacher-Child relationship from Kindergarten to sixth grade: Early childhood predictors?

Do children develop internalised relationship models to teachers that are fairly stable over the years? (Jerome et al 2008

Early dependency on teachers predicted more conflict for boys, early closeness predicted less conflict in later years

Teacher-child relationship predicts academic outcomes (Hamre & Pianta et al., 2002)

Easier for teachers to relate to children who come to school with more developed ”academic” ability (Jerome et al., 2008)

”What did you learn in school today…”

Family and Network

Does the family ”bless” the school?

School

Does the school ”bless” the family?

The teacher thinks …

Mum said…

The Child is in the centre and the teacher’s question is, ”Will you let me help your child?”

Marte Meo in school Marte Meo Consultant

Teacherschild

Coordination MeetingCo-ordinator

Teachers, Parents, Marte Meo Consultant(Marte Meo therapist)

Marte Meo for the family(Marte Meo therapist)

Parents, children

The Child

What is the child’s need for developmental support?

Co-ordination meeting Filming in class-room

Reviewing with teacher

Intervention Procedure

1. Coordination meetingClarifying the child’s need of developmentSetting goalsStrengthen working alliances

2. Filming in the classroomEditing the film into sequences

3. Reviewing with the teacherFeedback - Feed forward

Coordination meeting: clarifying the change context – Systemic Practise

To clarify the purpose of CMs and the role of the Coordinator

To clarify the teacher’s request for help and establish clear goals

To provide a forum for ongoing evaluation

To coordinate when relevant interventions in school and home

To explore parent’s and teacher’s different ”stories” about the child from a

systemic perspective, and support the co-construction of new stories

To create a context in whch all share a common task – to support the child in her

development – the working alliance

T

To talk – To listen- a Systemic ModelTom Andersen, Jakko Seikkula

To know

To act To actTo feel

To feel

Toknow

To be in a continum?Susan Mc Daniel

Tolerance Coordination Cooperation

Does it work? Results from Effect study Axberg, Broberg, Hansson, Wirtberg: ”Schoolbased intervention - an open trial.“ Fam. Process, vol. 45:375-383

34 children were included

1 family dropped out before the first coordination meeting

33 started – all completed!

Pre-schoolers (age 4-6): 3 girls, 3 boys.

Early school-age (age 7-9): 2 girls, 13 boys

Middle-school age (age 10-12): 4 girls, 9 boys

Small (16) comparison group

Symptom – Parent ratings(CBCL)

* p < .05, ** P < .01 (CBCL N = 30, TRF N = 27 även vid ”Intent – to – treat”)

Symptom - Teacher rating (TRF)

* p < .05, ** P < .01 (CBCL N = 30, TRF N = 27 även vid ”Intent – to – treat”)

MAC – RCT study (One of three methods in a larger project)

Randomised study – MAC and TAU

MAC52 Children

TAU48 Children

Implementation – web-based interviews to all staff of Social Services and School Services.

RCT - StudyMAC – Marte Meo and Coordination meetings

Randomised study (RCT) – 100 children.

52 children MAC, 48 children TAU

In 4 sites

Results 2012-3013

Financed by The Swedish National Institute of Public Health and the Swedish National Board of Health and Welfare

Mean number Teachers: n =MM in school/preschool

Families: n=MM in the home

Films 5 (2-12) 3 (1-7)Review 5 (2-12) 3 (1-7)Coordination meetings

5 (2-12) -

Interventions in MAC – less is more?

Measures of disruptive behaviour at home: Mother’s ratings (2012)

Those who got MAC have 50 % - 25 % better chance to improve if the child has problem according to parents.

Mothers EBCI

Intensity: 84 % in MAC - 31 % in TAU = 53 % more in MAC

Problem: 55 % in MAC - 28 % in TAU = 27 %

Teacher’s ratings pre- and post- intervention: 2013

* p < .05, ** p < .01, *** p < .001

Statistically

significant interaction

effect between MAC and

TAU

Statistically

significant interaction

effect between MAC and

TAU

ConclusionResults promising and encouraging

It is possible to work effectively in a non-clinical setting

By developing a school-based intervention, we have been able to

meet and treat children with heavy symptom loads

It is possible to offer this support to children without their parent

seeking help for themselves

MAC should be used when the child has a clinical level of problems

ConclusionWhen teachers report having a child with externalising

problems it should be taken seriously

Interventions should preferably be commenced before the child’s normal support system breaks down

Even though the intervention has been carried out in the school context the mothers reported significant changes in the children’s behaviour at home.

Strong consumer validity

Present study – compare MAC and MM

Pulling together – a school-parents pilot project

Developmental support for children in cooperation with teachers and parents

ingegerd.wirtberg@psy.lu.se, christina.jonsson@edu.tibro.se

Cooperation between school and parents: starting points - Parents

Knowledge about what happens at school – school’s curriculum – home’s curriculum

PTM meetings are an established tradition where the parents receive information about how the teachers work and what they themselves can do at home – integrate to the home curriculum

Parents already go to PTM-meetings – a natural cohort

First PTM meeting:

information and consent

Brief introduction

to the programmewith film.

Filming in classroom

Analysis

Editing

Review:Marte Meo

(Every third week – once a month)

Successive PTM meetings:

Short lecture

Fruit and Film

Small group discussions

General info

Pulling together: an overview

Term 1. 3 meetings

Term 2. 2 meetings

Term 3. 1 meeting

Evaluation

Video supervision for teachers: aims (1)

To increase the teacher’s ability to support the child in her psychosocial development

To increase the teacher’s ability to see the child and support the child’s learning

To increase the teacher’s capacity to see the individual child’s level of development for social interaction and for learning

Video supervision for teachers: aims (2)

To strengthen the teacher in her role

To help strengthen management skills in the classroomTo identify the teacher’s existing communication skills

To help the teacher to use their communication skills in a systematic way to support children’s development

To use video to demonstrate how, step by step, one can support and lead children to desired outcomes

1. PMT-meetings: transfer knowledge, group discussions and fruit

Shared focus of attention

Confirmation

Waiting for the children’s reactions – start of turn-taking

Naming

Further turn-taking

Structure and leadership

Triangulation - to be with more than one

Ending and starting - Transitions

If it works, encourage!

Confirm and name what works!

A nod, a smile, an encouraging comment informs us that we are on the right track!

Naming is magic!

Gottman’s 5-1

Sometimes we forget to look…before we communicate…

Show, smile,

NAMEGOOD FACE!

The face asa safe mirror!

Thumbs up!

Group discussionsTopics:

• Reflections on the pictures• Questions• How to encourage children?• How could they use the transferred

information?

Evaluation

18 children when starting - 15 children when finished, one parent declined to participate

Focus group interview with teachers (3)

Questionnaire for parents (14)

Voices from parents (14)The classroom is quieter and there is a better environment

for learning (7)

Better cooperation in the classroom

My child is more confident (1)

My child has got friends (1)

The children get more encouragement which has increased their learning (4)

No difference for my child (6)

Experience of pt-meetingsSatisfied

Satisfied (12 comments)-Interesting to see films-Learned a lot-Good to see my child’s strengths-Good to see how the teachers make an effort-Fantastic to see the positive change in the classroom-You really see a difference

Room for development

Less satisfied (4)

-Too much talk

-The films are a bit boring

-More ideas of how to encourage children

-You could have introduced exercises to practise the ideas

-More conventional ptms.

Teacher’s voices (3)

Teachers and leadership changed during the process, only one teacher participated in the whole project.

Teachers extremely satisfied with the intervention - the new teachers were ”forced” to participate and were suspicious from the beginning

Teacher’s voicesThe children are now functioning group

This was a good education for us

Fantastic to be able to work over time

Has contributed to: Security, Participation and Stability in the classroom

Saves time

See things I never thought of

Why didn’t we learn this at teacher training

Life is full of transitions!

Next step – to implement the programme in all stages, from pre-school to high-school

Field and ResearchField Research

Research is systematic practice intended to increase knowledge, to utilise knowledge for further practise, and/or to develop new or better products, systems or methods.

Research and development is a term covering three activities: basic research, applied research, and experimental development.

(OECD)

Why should this happen to us?Who defines the field?

From twoto three – itis easy to feelmarginalised

Clinical research - The skills of systemic therapists are useful – there are many meetings with unknown outcomes…

• Alliance: Relationship alliance – Production alliance

• Communication skills: ”The meaning of my communication is the response I get”

• Dialogical perspective – turntaking – building on the other’s initiative

• Recognise the possibilities and risks inherent in the triad

• Solution focused – problems occur daily

• General process skills

Clinical research demandsImplementing clinical methods and research – Many need to

embrace the proposed ideas – not enough with a decision

Some/somebody who has the ”everyday power” to influence

Fidelity - fidelity to the model and to the research project

Passion – Some/somebody need to be strongly committed

”Rigidity” – where ”common sense” has to be ignored in order to explore the effects of doing something a certain way

What enables research as well as introduction of new clinical methods (Fixen, 2005)

Economical resources

Solidarity with the research project during the whole project

The attitude that evaluation is important

Have a solution focused

Don’t make premature decisions

Support from the people who have power in the organisation

THANKYOU!