The Solihull Approach Dr Hazel Douglas

1. The Solihull ApproachDr Hazel Douglas

2. The Solihull Approach:The power of parentingis in the relationship!

3. The relationship Video (scene:brain development, The First Years Last Forever)

4. Plan for today Solihull Approach and parenting Quick look at the SA model and how concepts relate to parenting Underpinning attachment Parenting, anxiety and performance

5. Parenting and the Solihull Approach 1:1 work with parents Group work with parents: the Solihull Approach Parenting Group�.in Solihull called �Understanding your child�s behaviour�

6. Solihull parenting strategy Solihull Approach Parenting Group for universal upto those in moderate difficulty Mellow Parenting for those in severe difficulty Solihull population 200,000 Aiming for a population effect, increasing SAP groups from 12 per year to 120 per year. Mellow Parenting from 3 to 9 a year.

7. More parenting support from Solihull Approach Peer support for breastfeeding training (training for parents to support other parents, using the Solihull Approach model). Completed. Antenatal parenting group (bringing the relationship into midwives� parentcraft classes). In development. Antenatal resource pack for antenatal team (supporting parents from conception). Half done. Early Years Foundation Stage training now integrated with SA model to support parents through good childcare. Completed.

8. Solihull Approach and attachment Solihull Approach is a vehicle for changing relationships and attachment. Containment and reciprocity underpin attachment

9. Solihull Approach model Containment: psychoanalytic concept (Bion 1959) Reciprocity: child development concept (Brazelton, 1974) Behaviour management: behaviourism (Skinner, 1938)

10. 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.

11. Containment and the brain

12. Containment and the brain Received/understood

13. Containment and the brain Head full

14. Containment and the brain Parallel process

15. 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

16. 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.

17. Dance of reciprocity Initiation Orientation State of attention Acceleration Peak of excitement Deceleration Look away

18. 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

19. More on reciprocity Rupture and repair Chase and dodge

20. Attachment Video 2 (scene: Bonding and attachment, The First Years Last Forever)

21. Attachment and the Solihull Approach Attachment is a descriptive theory Describes the attachment: secure, insecure, disorganised Doesn�t tell you how to change the quality of an attachment As recently as 1999 no interventions based on attachment theory (Lieberman and Zeanah, 1999)

22. Attachment and the Solihull Approach 2 Containment and reciprocity are the building blocks underpinning attachment Robert Marvin�s Circle of Security (Marvin et al, 2002) explicitly cites reciprocity and object relations theory

23. Circle of Security: rupture and repair �The idea that smooth interactions between children and their caregivers are often disrupted and need �repair��.it is this ability to repair a disruption that is the essence of a secure attachment, not the lack of disruptions. This repair requires clear cues from each other, and clear understanding of, and responsiveness to, each other�s signals� (Marvin et al, 2002 pg 109)

24. Circle of Security: containment � Each caregiver is guided at her or his own pace toward increasing skill in reading the child�s cues, reflecting on the child�s (inferred) thoughts and feelings, and reflecting on her or his own feelings, plans and behaviour� (pg 116).

25. Neurobiological evidence �The right hemisphere contributes to the development of reciprocal interactions within the mother-infant regulatory system and mediates the capacity for biological synchronicity, the regulatory mechanism of attachment� Schore, 2001 pg 23.

26. Attachment Evidence cited that containment and reciprocity underpin attachment . Interventions (e.g. Marvin�s Circle of Security) Neurobiological (Schore)

27. Parenting, a secure base and containment A secure base is established through parenting via containment and reciprocity (and other concepts)

28. Parenting, anxiety and performance It may be thought that the concept of containment indicates that parents need to be at a low anxiety level to be able to contain their own children and be in an attuned, reciprocal relationship. But it is probably more complicated than that.

29. Containment and the brain I think, therefore I am (Descartes) The old anxiety/performance curve

30. Parenting and anxiety 1 Marga Thome, Prof Nursing, Iceland. Research on the effect of telephone counselling with parents (telephone used because of the distances involved and remoteness of some communities). Some parents anxiety went down but some went up.

31. Parenting and anxiety 2 Solihull Approach Parenting results. Very strong correlation with a change in anxiety using BAI. But although the trend was down, some parents went up.

32. Parenting, anxiety and performance There are many studies now that show that stress in the antenatal period can negatively affect child development. However, too little stress may also be maladaptive. DiPietro et al, 2006 showed that a moderate amount of stress is better than too little or too much for a child�s development. DiPietro JA, Novak MF, Costigan KA, Atella LD, Reusing SP. (2006) Maternal psychological distress during pregnancy in relation to child development at age 2. Child Development, 77, 573-587.

33. Zone of optimal functioning Research from sport. The zone is different for everyone. Some need more anxiety to perform well. Some need less.

34. Zone of optimal functioning for parents I think this explains Marga Thome�s results, Solihull Approach Parenting results and DiPietro et al.�s results. Being in tune with your child may raise your anxiety if you weren�t in tune before

35. Conclusion The Solihull Approach model is used to support parenting Containment and reciprocity, concepts within the model, can be used to work with the attachment Supporting some parents may mean raising their anxiety. For others, it is about lowering their anxiety.

36. Video (scene:brain development, The First Years Last Forever)

37. Research Results: effect of training 1 Douglas, H. and Ginty, M. (2001) The Solihull Approach: changes in health visitor practice. Community Practitioner, 74, 222-224. Whitehead, R. and Douglas, H. (2005) Health visitors' experience of using the Solihull Approach. Community Practitioner, 78, 20-23.

38. Research Results: effect of training 2 Lintern, J. (2005, unpublished study) A follow-up evaluation of the Solihull Approach training, Middlesbrough. Lowenhoff, C. (2004) Practice development: training professionals in primary care to manage emotional and behavioural problems in children. Work Based Learning in Primary Care, 2, 97-101.

39. Research Results: effectiveness Douglas, H. and Brennan, A. (2004) Containment, reciprocity and behaviour management: preliminary evaluation of a brief early intervention (the Solihull Approach) for families with infants and young children. International Journal of Infant Observation, 7 (1), 89-107. Milford, R., Kleve, L., Lea, J. and Greenwood, R. (2006) A pilot evaluation study of the Solihull Approach. Community Practitioner, 79, 358-362.

40. �Ghosts from the nursery� �From the waters of the womb to the arms of the caregivers to the walls of the family home, when the shelters in which we harbour our children are inadequate or destructive, the final shelter our society provides will often be the cement walls of a prison cell� Karr-Morse and Wiley, 1997

41. �Ghosts from the nursery� �Our challenge is to move this information into the mainstream to create a critical mass of people who know and who care who will over time enable this information to move from understanding to practice� Karr-Morse and Wiley, 1997.

42. Risk Factors: child Specific learning difficulties Communication difficulties Specific developmental delay Genetic influence Difficult temperament Chronic physical illness Academic failure Low self-esteem

43. Risk Factors: from the family Overt parental conflict Family breakdown Inconsistent or unclear discipline Hostile or rejecting relationships Failure to adapt to a child�s changing needs Physical, sexual or emotional abuse Parental psychiatric illness Parental criminality, alcoholism or personality disorder Death and loss-including loss of friendship