Centre for Parent and Child Support Our Work - The Royal ...

07/05/2013Centre for Parent and ChildSupportFamily Partnership ModelLandscape, dissemination and the lessons learntThe Royal Children’s Hospital, Flemington Road, ParkvilleMay 6 th , 2013Dr Crispin DaySouth London & Maudsley NHS Foundation TrustKing’s College, London1247Our Work• Family Partnership Model• Antenatal/Postnatal Promotional GuideSystem• Helping Families Programme• Empowering Parents,Empowering Communities• Health Services Research• ChASE• Bump Buddy• Adoption & implementationParents at the heart of effectivenessAn essential partnership‘I don’t want (them) to get in myface about my daughter. Don’ttell me to do things that I amalready doing! Instead, start byasking questions to find out whatI am doing and why I am doing it.“Understanding is like listening topeople and like knowing whattheir situation is like … if youcan’t understand someone orthey can’t understand you theycan’t help you ‘cos they don’tknow what you’re talking about”Kirkpatrick et al (2007), Barlow et al (2005), Day& Doherty (in prep) Jack et al (2005)• Help-seeking & engagementwith services• Use clinical knowledge andexperience (Stewart, 2001)• Shape interventions & effectivecare• Better reflect users concerns&priorities• Particularly important for excluded& marginalised service users• Significant discrepancies betweenparents & practitioners (Hawley & Weisz,2003; Yeh & Weisz, 2001)• Concerns about professional andmanagerial authority & autonomyPractitioner interpersonal qualities, skills,relationships and goals: Science and evidenceWhat do you see?:Practitioner and parent constructs“When I first started seeing the peopleat ......., I didn’t get on very well withthem because I felt that they talkeddown to me. And the woman she wouldtreat me like I was about five. “‘She talks to you like a human being,she doesn’t treat you like you don’tknow anything’Kirkpatrick et al (2007), Barlow et al (2005), Day &Doherty (in prep) Jack et al (2005)• Best predictors of child and youthoutcomes (Karver et al, 2006)• Engagement, drop-out &outcomes whatever theintervention (eg. Cahill et al., 2008; Garcia &Weisz, 2002,Karver et al, 2006; Kazdin, Holland &Crowley, 1997, Shirk, 2001,Shirk & Karver, 2003)• Structured interventions effectivefor clients with long standinginterpersonal/personalitydifficulties (Castonguay & Beutler, 2006)www.cpcs.org.uk1

07/05/2013Experiences, expectations & needs:Parents and practitionersPractitioner qualities, skills andpartnerships: Observations from practice• Active, feeling & thinkingpeople• Valued and respected• Beliefs, desires, motivations &priorities understood• Social & complexity gradient• Wider family and social circumstances(Kirkpatrick et al., 2007, Barlow et al., 2005; Jack etal., 2005; Day & Doherty, in prep)• Often not systematised inpractice – non-specific• Parents’ experiences vary frompractitioner to practitioner• Practitioners’ experiences varyform parent to parent• Assumptions aboutpractitioner skills and effects• Underestimates• Overestimates• Parents’ & family views notsystematically sought or actedupon in practice• Avoid drift and maintain focusFamily Partnership Model:Evidence-based, goal-orientated practiceThe Family Partnership ModelConcepts & Evidence• Multiple, personalised goals &outcomes• Ecological model of child and familydevelopment• Future, goal-orientated• Family hopes & aspirations withpractitioner expertise• Family strengths and expertise not blindoptimism• Explicit, structured helping process• Practitioner skills, qualities, roles &knowledge• Service & community context(FPM, Davis & Day, 2010)Family Partnership ModelFPM evidence base:Outcomes tested through research• Parents of children with severe andmultiple disabilities (Davis & Rushton, 1991), RCT110105InterventionPartnership• Parents of children with emotional andbehavioural difficulties (Davis & Spurr, 1998), CT1009590ComparisonHelper QualitiesHelper SkillsCharacteristics of Parents andChildrenHelpingProcessService & Community ContextOutcomesConstruction Processes• Preterm infants (Avon Premature Infant Project, 1998)RCT• Promotion of early parental adaptationand infant outcomes (Davis et al., 2005; Puura et al.,2005) CT• Prevention of childhood neglect andabuse (Barlow et al., 2003; Barlow et al., 2007; Brocklehurst etal., 2004, Kirkpatrick et al., 2007) RCT• Maternal Early Childhood SustainedHome-visiting (MECSH, Kemp et al., 2011) RCT857573716967656361595755Time 1 Time 2Time 1 Time 2CBCL Total ScoreInterventionComparison2

07/05/2013FPM Outcomes: A personalised &multi-dimensional approachThe FPM Helping ProcessCompensate wherenecessary, eg.riskEnable multiagencysupport/serviceinvolvementFacilitate family,social & communitysupportDo no harmChildren&FamiliesFoster resilience &problem anticipationFPM OutcomesClarify & manageproblemsBuild parents’strengths & abilitiesFoster development& well-being ofchildren• Applicable across differentproblems & difficulties• Reflects complexity of real lives• Numerous outcomes comparedwith a singular disorderapproach• Need to focus on key realisticoutcomes, hopes & aspirations• Clear about purpose of helping• Confident in strategies,progress and effectivenessPartnershipBuild & sustainExplorationUnderstandingGoal SettingStrategy PlanningImplementationReviewEndingOUTCOMESSpontaneousUnpredictedBroadOUTCOMESFocusedIntendedPlannedRelationships with parents:FPM partnership and rolesFPM Partnership in practice:Attitude, role & behaviour• Expert• Friendship• Dependent• Adversarial• Avoidant• Partnership• Being supportive• To sustain, encourage, care & shore up• Being connected• To hit off, hook up with and to get along• Being facilitative• To make possible, make easy, to makehappen• Being influential• To have some bearing on, to inspire and tochange• Being purposeful• To be focussed, determined and persistent• Active & mutual participation/involvement• ‘giving and receiving’ rather than‘knowing and telling’• Complementary influence, expertise &roles• Share open decision-making power notequal• Share aims and process of helping andintervention• Agreements and disagreements• Avoid shift to expert judgement(Davis & Day, 2009, 2010; Day & Davis, 2009)FPM: Essential qualities of the helper• Respect & acceptance• Empathy & understanding• Genuine warmth & enthusiasm• Humility & realism• Personal strength & integrity• Belief in and commitment toparents’ & children’s futures• Constructive & supportivejudgment• Emotional & intellectualattunement• Facilitate & influence rather thandirect & controlFPM: Skills of helpers• Listening, communication and partnershipskills• Concentration/active listening• Prompting, exploration and summarising• Empathic responding• Enthusing and encouraging• Ability to communicate openly & challenge constructively• Being purposeful and focused• Helping parents to change their feelings,ideas and actions• Generating hope and motivation• Exploring constructs• Prioritisation & goal setting• Strategy planning, selection & implementation• Review progress• Technical expertise• Use parents’ strengths & resources• Problem/disorder-specific intervention knowledge and skills• Sharing knowledge and expertise in understandable,meaningful and useful way(eg. Egan, 1990; Karver et al, 2006)3

07/05/2013Family Partnership Model:The underpinning skills and qualities• L• E• S• S• SFPM Skills & Qualities:In the eye of the beholder• Listened to and heard• Empathised with andappreciated• Summarise parent experiencesand priorities• Shared understanding ofstrengths, concerns, goals &process• Strategies and actionsplanned, implemented andreviewedFPM Training and sustained practiceThe Family Partnership ModelAdopting FPM Practice• FPM manualised evidence basedtraining• Foundation• Supervisor• Facilitator• Reflective practice handbook &practice tools• Strategic and operationalrequirements• UK Community of Practice• Close partnership with Australianstates and territories• 1000s of practitioners trainedBring FPM AliveAdoption in four steps (Kirkpatrick, 1994)FPM Foundation training:Research and evaluation outcomesChild and family outcomesDegree of theory‐practiceintegrationPractitionerknowledge acquisitionPractitionerreactionandsatisfaction806040200Know Confd Equip CommittPartnership building806040200Not at all Little Some Moderate Great dealBefore(0-100)After(0-100)• More than 90% recommendtraining (CPCS, 2008; Jackiewicz, 2004)• Sig. improvement in practitionerskills, qualities and self-efficacy(Rushton & Davis, 1991, Davis et al., 1997)• More accurate at identifying familyneeds (Papadopoulou et al, 2005)• Significant improvements in FPMknowledge, commitment &confidence (About FPM, p=.000, Day, 2007)• High levels of knowledgeacquisition in core FPM conceptsand skills4

07/05/2013What it takes• Engage the mind and the heart but nottake it personallyThe Family Partnership ModelPractice Integration, Challenges & Dilemmas• Redefine & manage professionalexpertise, for example:• Become a partner by relinquishing expert role• Listen and exercise restraintt• Facilitate the Helping Process rather than give adviceand solutions – the righting reflex• Personal strength to openly examinepractice:• Learn from doing, learn from practice, learn fromparents and learn from peers• Manage the desire to guard, protect and reaffirmexisting knowledge, constructs and skills(Fowler et al., 2012, Harris & Day, 2013, Rossiteret al., 2013, Hopwood et al, 2013, )FPM Practice: Challenges• Doubtful• Uncertain, hesitant, lackingconfidence• Reactive• Impulsive, instinctive,unconsidered• Laissez-faire• Ever-changing, unpredictable,improvised• Selective• Parts not whole• Fixed• Rigid, inflexible, unbending• Frozen• Stuck, trapped, frozen in pastexperienceLiving FPM Practice:Effective, quality, fidelity & enjoyment• Alive & alert• Flexible & considered• Confident, consistentconstructs & practice• Know practitioner strengths• Purposeful partnership andquick wins• Use FPM practice tools andReflective PracticeHandbook• Manage practice dilemmasDilemmas in FPM Practice:FPM Practice Tools:Sharing the tasks and the partnershipIt’s fun to benice but if youare ineffective,‘being nice’ isworthless. Youhave got to bemore than nice’• Influencing and challenging parentswithout risking the partnership• Relationship and capacity for changeconstrued as fragile• To go beyond ‘being nice’• Maintaining focus and momentumand still being parent led• The complexity of families’ lives &difficulties• Using practitioner expertise whileworking in partnership• Parent-led or practitioner led, trying not tobe an expert(Fowler et al., 2012, Harris & Day, 2013, Rossiteret al., 2013, Hopwood et al, 2013, )• Aim & Goal Stars• Exploration using PromotionalGuides• Strategy planning together• Implementation• Putting it into practice• Recipe for success• Review tools• Goal star• Parent feedback• Multiagency tools5

07/05/2013FPM Promotional Guide System:Guided exploration & understandingFPM Promotional Guide &Prompt CardsFPM Practice Tools: Sharing the tasks &living the partnership• Openness about FPM andhelping process from the start• Explicit reminder of content &process of FPM• Clear summary of key FPMcontent & process• Keep on track and reinforcepurpose• 3 rd space between parent andpractitioner• For parent and practitioner tokeepThe Family Partnership ModelSustaining living practiceGrowing and Sustaining FPM inPractice: Model features• FPM practice & serviceconditions are inextricablybound together• FPM has to be a clearlydescribed & replicable• Coherent methods fordissemination, adoption andsustained implementationnot train and hope• Training programmes• Practice tolls• Reflective practice handbook(Greenhalgh et al., 2004)6

07/05/2013FPM Reflective practicehandbook• Summarises FPM• Contact structure• Summary sheets andreflective practice sheets• Complete after everycontact• Personal/team reflection• Bring to supervision fordiscussionGrowing and Sustaining FPM inPractice: Service features• FPM has to have clear clinicaland service advantages• Resources & support for FPMthroughout the organisation• Practitioner time, resources &commitment,• Practice tools to supportimplementation• Support & supervision, peers& managers• Clear evidence of FPM value,outcome & effect• Multiple & varied evidence(Greenhalgh et al., 2004)Sustained implementation ofFPM: Practitioner views• Strong practitioner support for FPM• 87.0% FPM will make them moreeffective• 82.0% Families will benefit from FPM• 76.0% Practitioners will regularly useFPM• Practitioners are less certain aboutmanagerial support• 62.0% Active support from manager• 50.5% Senior manager championedFPM• 36.2% Manager allocated time andresources• 26.7% Receive regular supervisionFPM Sustainability: An example• 3 yr programme• Began with initial visit to meet seniormanagers• FPM Foundation training for seniorpractitioners• Multidisciplinary group with personaland professional impact• Trained FPM supervisors• High impact – set up reflectivepractice meetings• Trained FPM facilitators• High impact – identify key pracs totrain and organised plan forachieving take-up• Stories of impact disseminatedacross organisation• Open and non defensive approachby practitioners• Assistant Director champion• Support from senior clinicians• Consistent with policy and serviceaims• Identified resources and money• Set up Family partnership team• Change in documentation andprocedures of practice• Informal diffusion by AD and otherchampions• Training certificates handed out byCEO• Regular, active and goodrelationship with CPCS• Press coverageFPM Landscape & Dissemination:Lessons learnt• FPM is an effective evidencebased model• Explicit. open and sharedpractice• Achieves effective outcomes forfamilies• Excellent initial adoption andwell supported by practitioners• Requires sustained, collectiveorganisational cultivation to liveand be sustained7