Joined up services: making services work for families

Joined up services: making services work for families Professor Judy Hutchings OBE Centre for Evidence Based Early Intervention, Bangor University Children in Wales: Parents’ Week Conference Engaging parents in family and parenting support services Cardiff 18th September 2013 Email: j.hutchings@bangor.ac.uk

What we know Much 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 exist But 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

Joined up services: making services work for families