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Evidence Based Parenting Programmes and Social Inclusion Conference Middlesex University
Mary Rheeston – Solihull Approach ManagerThursday 20th September 2012
Solihull Approach
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What is the Solihull Approach?
• It is an integrated theoretical model that can be used in practice
• It brings together 3 theories (Containment, Reciprocity and Behaviour Management) to provide a way of thinking about relationships
• It supports professionals in their work with families• It improves children’s and parents’ emotional relationship and
wellbeing• In supporting the parent-child relationship it affects brain
development (in particular emotional development) in the foetus and baby
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How the Solihull Approach developed
•Originally developed in Solihull between health visitors, psychologists and psychotherapists to help parents with children with sleep difficulties
• Focus on parent and child/baby interacted first, rather than behaviour management advice straight away
• Extended to other professional groups and agencies at the request of professionals e.g. School Nurses, Nursery nurses, Children’s Centre staff, Child Care staff, Midwives, Breastfeeding Coordinators, Education, Fostering and Adoption and Social Workers
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How the Solihull Approach developed
• Developed resource packs and training for professionals across agencies with cascade training. E.g. First five years , School years, Fostering and Adoption, Antenatal for midwives and practitioners involved in antenatal period, Early year Foundation Stage
•Groups and group training. e.g. Antenatal Parenting 5 week Group, Solihull Approach 10 week Parenting group, , Peer Breastfeeding Supporter 6 week Training and Foster carer 12 week group training
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The Solihull Approach - supporting family relationships to improve
outcomes
Psychoanalytic theory (Bion)
Behaviourism (Skinner)Child Development research (Brazelton)
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Containment
• Containment is where a person receives and understands the emotional communication of an other without being overwhelmed by it and communicates this back to the other person. This can restore the capacity to think in the other person.
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Containment
Toddler
Baby
Parent
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Containment
Received/understood
Toddler
Parent
Baby
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Containment
Parent’s head too full
Toddler
Parent
Baby
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Difficult childhood experiences
Mental Health problems postnatal depression
Poor relationships with parents
Unprocessed birth historyFatigue
Fertility problems
Housing problemsFinancial
problems
Domestic violenceRelationship issues
/breakup Single parent
Day to day events
Coping with child with behavioural difficulties
Parent’s head too full
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Containment
Parents head completely full
Toddler
Baby
Parent
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Containment
Parallel Process
Parent
Toddler
Baby
worker
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Containment and parenting
• Helps the parent to think about their child• Helps parents and their child to relate• Helps the parent to help their child cope with anxiety
and emotion so that the child is free to relate• Helps the parent process some ‘old’ emotions so that
the parent can relate to the actual child in front of them, not a ‘projection’ of a child
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Reciprocity
• Describes the sophisticated interaction between a baby and an adult where both the baby and the adult are involved in the initiation, regulation and termination of the interaction. Reciprocity also applies to the interaction between adults. Helps parents and their child to relate
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The Dance of Reciprocity
Peak of excitementAcceleration
State of attention Deceleration
Orientation
Initiation Withdrawal or turning
away/ lookaway
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Reciprocity and parenting
• Helps parents and their child to relate• Tunes in the parent to think about their baby• Increases the parents’ awareness of their
child’s needs• Provides a focus and a language for feeding
back to the parents about the interaction
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Behaviour management
Behaviour management is part of the ordinary process of normal development whereby parents teach their child self-control, thus enabling the child to participate in society. Parents in well-functioning families work together to place reasonable boundaries on the child’s behaviour. They encourage the child with attention and other rewards. Gradually, the child becomes able to internalise both the restraints and the satisfactions for himself. It also facilitates learning and development.
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How behaviour management relates to containment and reciprocity
• Containment and Reciprocity are the foundations for successful Behaviour Management
• Behaviour Management will be more effective for a child or young person and parent/foster parent if:– parental emotions are processed and their capacity to
think is restored within a containing relationship – parents are able to be part of a reciprocal relationship with
their child– behaviour management techniques are based on an
understanding of meeting the needs of individual parents and their children and adapted to suit their relationship
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• Offers a shared language that can be helpful across professions and agencies
• Gives a language for reflection and feedback• Parents notice when used as a whole team
approach
Using the Solihull Approach in practice
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Solihull Approach Parenting Programmes
• ‘Understanding you pregnancy, labour, birth and your baby’ (Antenatal Parenting Group)
• ‘Understanding your Child’s Behaviour’ (Group for Parents)
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Solihull Approach Antenatal Parenting GroupUnderstanding pregnancy, labour, birth and your
baby
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• Integrates traditional advice about labour and birth with developing a relationship with their baby
• Universal antenatal parenting group• 2 hour sessions for 5 consecutive weeks• Designed for parents to be, ideally to attend all
sessions • Puts in to practice the recommendations of
Preparing for Pregnancy, Birth and Beyond
Understanding your Pregnancy, labour, birth and your baby
Solihull Approach Antenatal Parenting Group
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The group aims to help parents:• Think about support that will be helpful throughout
the pregnancy and birth• Get to know the baby through pregnancy, labour,
birth and beyond• Understand information about pregnancy, labour and
birth and feeding • Understand the importance of their emotional
relationship with their baby
Understanding your Pregnancy, labour, birth and your baby
Solihull Approach Antenatal Parenting Group
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Session 1 Helping you and your baby through pregnancy and birthIntroduction Processing their own feelings relating to baby Learning about relaxation and breathing
Session 2 Getting to know your baby in the womb Getting to know their baby in the womb and the importance of developing their relationship with their baby
Session 3 Midwife – You, your baby and the stages of labourThinking about their baby in labour and information about signs of labour
Understanding your Pregnancy, labour, birth and your baby
Solihull Approach Antenatal Parenting Group
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Session 4 Midwife - Helping you and your baby through labour and birthUnderstand the process of labour and pain relief and thinking about the baby Plan for support at home
Session 5 Feeding your baby Information about feeding and the feeding experience for mother and baby and family. Supports Baby Friendly Initiative Other issues relating to when the baby is born,
Understanding your Pregnancy, labour, birth and your baby
Solihull Approach Antenatal Parenting Group
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Attending the group provided a containing experience where the mother’s capacity to think isclear. She is developing a relationship with her baby and has her baby in mind
Understanding your Pregnancy, labour, birth and your baby
Solihull Approach Antenatal Parenting Group
I’m frightened about the labour and it will hurt but now I am looking forward to it because I can’t wait to meet my baby
A Mother
Reciprocity
Containment
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Fat
Father understating his role in providing a containing experience for his partner and also being aware of his own needs
Understanding your Pregnancy, labour, birth and your baby
Solihull Approach Antenatal Parenting Group
I realise I need to talk to my mother in law if we are both going to support my wife when she is in labour and I need to make sure I am calm
A Father
Containment
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Understanding your Child’s Behaviour
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• 10 week x 2hour • Universal need to complex need – i.e. CAF
levels 1-3 years• Group suitable for children aged 0-18 years
- 0-4 years - 4-11years - 11-18years
Understanding your Child’s behaviour Solihull Approach group for parents
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The group aims to: Develop a framework of thinking about
parent/child relationships which can be developed into a lifelong skill
Give parents a strategy for repair when things go wrong
Understanding your Child’s behaviour Solihull Approach group for parents
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Promote sensitive and effective parenting
Builds lifelong skill and reflective parenting style
Understanding your Child’s behaviour Solihull Approach group for parents
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Sessions1. Introduction2. How are you and your child feeling?3. Tuning into your child’s developmental
needs4. Responding to your child’s feelings5. Different styles of parenting
Understanding your Child’s behaviour Solihull Approach group for parents
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6. Parent-child partnership- Having fun together7. The rhythm of interaction and sleep8. Self regulation and anger 9. Communication and attunement- how to recover when things go wrong10. Celebration!
Understanding your Child’s behaviour Solihull Approach group for parents
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Data from 72 completed pre and post measuresMeasures • The Child Behaviour Checklist (CBCL)
• The Strengths and Difficulties Questionnaire (SDQ)
• Beck Anxiety Inventory (BAI)(parental self report)
Evaluation
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Changes in BAI scores
28% went up
10% stayed same
62% went down
Evaluation
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• Interesting findings that while for most parents anxiety reduced just under a third anxiety increased
• Questions for further research or analysis to look at relevance of anxiety levels to parenting
• One suggestion is an increase in anxiety can be helpful for parenting.
• Parents may become more in tune with their child that leads to the parent being more aware of their child’s needs and therefore more anxious
• A degree of anxiety in parenting is protective for the child
Evaluation
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Sessions……
Understanding your Child’s behaviourSolihull Approach Group for Parents
I feel a lot calmer and more in control
A Mother
Containment
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Fat
Father has
Sessions …..
Understanding your Child’s behaviourSolihull Approach Group for Parents
Since doing the course I don’t think I have ever kind of hit the panic button like I used to …. I just didn’t know what was going on. I feel like I’m very much in tune with him now.And I really enjoyed that….. I feel like I’m more sensitive. I know now that she likes to be close and touch. And its brilliant. I can pick up on that nowA Father
Containment
Reciprocity
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Attendance at a Solihull Approach Parenting Group is associated with
• Changes in behaviour • Significant changes in parental anxiety• Statistically significant link between
changes in behaviour and reduction in parental behaviour
Evaluation
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Parent Evaluation
• 137 parents completed feedback questionnaires on their experience of each of the 10 sessions of the group
• We asked them:1. How relaxed they felt 2. How able they felt to share experiences 3. How much the group enabled them to understand their child and how much the
group enabled them to change
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Parent Evaluation
• The results show that parents found UYCB highly satisfactory as measured by a simple, non-literacy-based evaluation form• 98% of people felt that the group helped them
to relax and share experiences. The unexpected results happened with the next two questions
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• This graph shows that parents understanding of their child increased over the 10 sessions (red line).
Parent Evaluation
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• This graph shows how much the group enabled them to change (red line).
Parent Evaluation
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• Jane Barlow, University of Warwick, systematically reviewed parenting programmes for NICE and found that effective parenting programmes tended to consist of 10 sessions of 2 hours each. But why?
Parent Evaluation
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• Interesting! Understanding comes before change. And both increase over 10 sessions.
• This fits with social learning theory, that we learn from others in different ways, so its perhaps not surprising that it takes a bit of time for us to change our parenting.
• 10 sessions for most people!
Parent Evaluation
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‘Lots of things have changed like my son’s sleep routine and the way I ask the children to do something’
Evaluation of Solihull Approach Parenting Group
MAKING CHANGESCHANGES OF ATTITUDE, BEHAVIOUR OR ROUTINE
‘My outlook and attitude towards parenting have changed.’
‘I personally am a lot calmer’
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‘It’s made me step back and look at the situation and relate it to the child’s age’
Evaluation of Solihull Approach Parenting Group
‘I’ve been able to look at different ways to approach things and look at ways how others feel’
INCREASED KNOWLEDGE (OF STRATEGIES, SOLUTIONS, AND CHILDREN’S DEVELOPMENT)
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Evaluation of Solihull Approach Parenting Group
FEELINGS
‘I feel I have learnt a great deal about understanding feelings, my own as well as my child’s’
‘I have learned that anger is OK and that you can repair situations rather than leaving’
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Evaluation of Solihull Approach Parenting Group
IMPROVED UNDERSTANDING
‘I feel I have learned more about understanding a child and looking at everything from a child’s perspective’
‘My understanding of my child’s behaviour is better.
My child’s tantrums are shorter and less often’
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Evaluation of Solihull Approach Parenting Group
IMPROVED INTERACTIONS
‘I definitely listen to my child more and spend more time with them in terms of playing and “quality time”’ ‘I have learned how to communicate
with my child effectively. I’m more relaxed playing with the kids and I feel calmer and more organised’
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• Improving parenting improves the relationship with the child
• Relationships are central to the emotional well- being of children and can seriously impact on later adult mental health
The importance of the relationship to children in the UK
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• Bateson,K,. Delaney, J. and Pybus,R. (2008) Meeting expectations: the pilot evaluations of the Solihull Approach Parenting Group. Community Practitioner, 81, 28-31
• Johnson, R. and Wilson, H. (2012) Parents’ Evaluation of ‘Understanding Your Child’s Behaviour’, a parenting group based on the Solihull Approach Community Practitioner 85 (5) 29-33
• Barlow,J. et al. (2009) Birth and beyond: stakeholder perceptions of current antenatal education provision in England. Department of Health
• Preparing for Pregnancy, Birth and Beyond Department of Health
References
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• Mary Rheeston- Solihull Approach Manager• Address: Kingshurst Clinic, Marston Drive,
Kingshurst, Birmingham. B37 6BD• Tel: 0121 329 1910• Email: [email protected]• Websites: For Professionals - www.communityservices.nhs.uk/solihullapproachFor parents - www.solihullapproach.com
Contact details
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