Working in Partnership with Families: The Ingredients of Successful Intervention. Professor Hilton Davis

Transcription

1 Working in Partnership with Families: The Ingredients of Successful Intervention Professor Hilton Davis

2 Helping Don t just do something, stand there and pay attention. Pawl & St John (1998)

3 Plan of Presentation Family Partnership Model Implications Illustrate the evidence base

4 Need for a Model Few models easily accessible to all. Implicit expert models widespread. Psychosocial problems extremely prevalent. Service dissatisfaction. Most vulnerable have least service access.

5 Need for a Model High refusal rates. High drop out rates. Low adherence to advice. Prevention/promotion crucial by all workers.

6 Theoretical Basis of Partnership Model Davis H, Day C & Bidmead C (2002). Working in Partnership with Parents: The Parent Adviser Model. London: Pearson Assessment. Davis, H. & Day, C with Bidmead, C, Ellis, M & MacGrath, M (2009). Family Partnership Foundation Course: Facilitator Training Manual. London: Pearson Assessment.

7 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

8 Intended Outcomes of Helping Do no harm Help parents identify, clarify and manage problems. Enable parents (e.g. self-efficacy). Enable development and well-being of children. Facilitate social support and community development. Enable service support. Compensate where necessary. Improve the quality of care.

9 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

10 The Helping Process RELATIONSHIP BUILDING EXPLORATION UNDERSTANDING GOAL SETTING STRATEGY PLANNING IMPLEMENTATION REVIEW END

11 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

12 Partnership Working together with active participation/involvement Sharing decision making power Recognition of complementary expertise and roles. Sharing and agreeing aims and process of helping Negotiation of disagreement Mutual trust and respect Open communication

13 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

14 Helper Interpersonal Skills Attention/Active listening Prompting and exploration Empathic responding Enthusing and encouraging Enabling change in ideas Negotiating Problem management

15 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

16 Helper Qualities Respect Genuineness Empathy Humility Quiet enthusiasm Personal integrity Technical expertise

17 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

18 Parent Characteristics Nature of problems Parent perceptions Interpersonal skills Personal qualities Relationships Socioeconomic circumstances Culture

19 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

20 Service and Community Context Management culture Leadership Communication Support for innovation and training Service coordination and stability Resource availability

21 Parallel Processes: Platinum Rule Do unto others as you would have others do unto others. Pawl ( )

22 Family Partnership Model Partnership Helper Qualities Helper Skills Helping Process Outcomes Family Characteristics Service Context Construction Processes

23 Construing People construct a model in their heads. Derived from past experience. Enables them to anticipate whatever happens to them and determines how they react. Each person s constructions are unique. Constructions are not necessarily conscious or easily verbalised. Constructions are constantly changing. Social interaction is determined by constructions of the other s constructions.

24 Implications of Model Personnel selection Training Management/supervision Manager selection and training Service design Process research

25 Family Partnership Courses Foundation Course: 10 sessions Add-on modules: 6 sessions Supervisor Course: 10 sessions Facilitator Course: 12 sessions Trainers Course: 12 sessions

26 Family Partnership Training: Style Designed on the Partnership Model Reflecting/demonstrates the Partnership Model Conceptual and skills focused Interactive throughout Based upon Socratic questioning

27 Family Partnership Training: Structure Two facilitators 12 Participants 10 half-day sessions At weekly intervals

28 People Trained Health Visitors, Paediatric and School Nurses Therapists: Speech, Physios, & OTs Paediatricians, Psychologists, Psychotherapists Teachers: All Ages and Special Needs Early Years and Child Care Staff, Youth Workers Social Workers and Educational Welfare Officers Parents and Voluntary Agency Staff

29 Family Partnership Model Applications Childhood Disability Adult Disability SCBU Follow-up for Very Low Birth Weight Preschool Emotional & Behavioural Problems Promotion of Child Mental Health Prevention of Abuse and Neglect School and Community Development

30 EEPP Satisfaction with Training (n=54) Mean (sd) Style (1-4): 3.6 (0.4) Content (1-5): 4.2 (0.4) Confidence (1-4): 3.3 (0.5) Skills gain (1-5): 4.3 (0.5) Total satisfaction (1-5): 4.5 (0.6)

31 Foundation Course Feedback To what extent would you recommend the course to other colleagues? (n = 674) Highly recommend: 60% Recommend: 31% Not sure: 8% Unlikely to recommend: 1% Would not recommend: 0%

32 Foundation Course Feedback To what extent did you feel respected during the training? (n = 674) Very much so: 76% A lot: 22% A little: 2% Not at all: 0%

33 Effects of Training: Self-efficacy Trainees (n =26) Pre-training mean 55.2 Post-training of 19 items changed significantly. (p<0.0001) Controls (n =15) no change over same period 0 items changed significantly. (Rushton & Davis, 1992)

34 EEPP Families In Need (UK) HV Judgment Research Judgment Intervention 62 (55%) 77 (68%) Comparison 25 (24%) 73 (71%)

35 Frequency Rated by Trained and Untrained Health Visitors Trained Untrained Mental health problems (p< 0.001) 19 3 Marital discord (p= 0.008) 23 6 Social isolation (p< 0.001) 30 4 Financial problems (p< 0.001) 19 1 Adverse life events (p= 0.041) 15 6

36 Accuracy of Need Identification Intervention Comparison Cyprus 55% 67% Finland 61% 68% Greece 78% 32% Serbia 53% 47% UK 66% 32% Total 62% 49%

37 Mothers Satisfaction with EEPP Service Intervention Comparison p Cyprus Finland Greece Serbia UK Total Average effect size= 0.4

38 Random Parent Survey (%) n=50 Pre-Training Post-Training (80% of staff) Parent felt Very much: Respected Understood Supported Listened to Important [Response rate of approx 33%] Rose Kruze (2007) Personal communication. Child, Youth and Family Health, Townsville, Queensland.

39 Random Parent Survey (%) n=50 Pre-Training Post-Training Professional Very: Honest Interested Trustworthy Relationship: Mutually respectful Partnership Helpful Met needs Rose Kruze (2007) Personal communication

40 12 month Outcomes Only 3% drop out. Higher maternal sensitivity and infant cooperativeness in Intervention Group. Majority of standardised measures favoured Intervention Group. Increase in protection proceedings (6% vs. 0%) One death in controls (open verdict) Barlow, J., Davis, H., McIntosh, E., Jarrett, P., Mockford, C. & Stewart-Brown, S (2007). Archives of Disease in Childhood, 92,

41 Health Visitor Views Very positive about intervention. Better skilled at relationship building. More empathic towards the families. Better at identifying relationship problems. Weekly supervision crucial. Intervention had beneficial effects. Brocklehurst, N., Barlow, J., Kirkpatrick, S., Davis, H., & Stewart-Brown, S. (2004). Community Practitioner, 77,

42 Themes from Oxford Post-Service Interviews Strong initial reservations about the service. But positive first impressions improving quickly. Relationships developed and deepened. Benefits: self-confidence, helpful advice, parenting skills, leaving violent relationships, more in control. Improved attitudes and relationships with other professionals. Kirkpatrick, Barlow, Stewart-Brown & Davis (2004)

43 Parenting Stress Index Pre Post Intervention (p=0.0001) 87.7 Comparison (p=0.65) Effect Size: 0.59 Clinical caseness cut off: 90+ See Davis & Spurr (1998)

44 Maternal Self-Esteem Pre Post Intervention 1.92 (p=0.008) 1.63 Comparison 2.15 (p=0.65) 2.42 Effect Size: 1.00 See Davis & Spurr (1998)

45 Child Behaviour Checklist Pre Post Intervention 70.5 (p=0.0001) 59.5 Comparison 73.1 (p=0.2) 68.8 Effect Size: 0.79 Clinical caseness cut off: 64+ See Davis & Spurr (1998)

46 HOME Inventory Pre Post Intervention 26.9 (p=0.0001) 32.5 Comparison 28.1 (p=0.15) 26.0 Effect Size: 1.04 See Davis & Spurr (1998)

47 Suffering Suffering is not a question that demands an answer; It is not a problem that demands a solution; It is a mystery that demands a presence. Anon.

48 For Further Information Centre for Parent and Child Support South London & Maudsley NHS Trust Guy s Hospital Snowsfields London SE1 3SS UK Tel: