1. Antonia Bifulco Professor of Psychology Centre for Abuse & Trauma Studies 2nd July 2013 2/7/2013 Swanwick, Derbys 1 The Q pack: measuring, monitoring & improving outcomes for young people in care National Children’s Commissioning and Contracting Training Conference Programme 1-2 July 2013

2. What is the Q pack? A pack of standardised questionnaires to assess life events, symptoms and attachment style Collated for use in St Christopher’s Residential Care homes for vulnerable young people To influence tailored support provided To monitor change 2/7/2013 Swanick, Derbys 2

3. An attachment vulnerability model Childhood Adversity (neglect/ abuse) Problem Peers Insecure Attachment style Life events Emotional Conduct Hyperactive problems Poor support VULNERABILITY (VASQ) PROVOKING AGENTS (RLE) DISORDER (SDQ)

4. Procedure 2/7/2013 Swanick, Derbys 4 The Q pack is administered in all St Chris’s children’s home in the UK and the Isle of Man, at entry to the homes and 3-6 month follow-up. Each pack is completed by the young person, separately by the carer and in some instances by a teacher/social worker. An analysis form is completed which interprets the scores of the Q pack in terms of observed behaviour and interactions. Commentary is made of change. Q packs can be shared with social workers, CAMHS and relevant services. Includes the Strengths & Difficulties Questionnaire (SDQ); a Life Events checklist; Vulnerable Attachment Style Questionnaire (VASQ)

5. Numbers of Q pack analysed 12/09/2012 SCF meeting 5 91 Q packs 59 baseline Q packs 22 Follow-up 1 Q packs 10 Follow-up 2 Q packs Reporters on the Q pack One reporter 10% 2 reporters 56% 3 reporters 34%

6. 12/09/2012 SCF meeting 6 How common is disorder and risk at baseline?

7. SDQ Disorder at baseline by reporter (total sample): 12/09/2012 SCF meeting 7 Carers report more disorder

8. Life events (28 LE - 4 school, 4 Leisure, 5 Close relationships, 2 housing, 3 employment, 6 health, 2 Crime, 2 Other) 2/7/2013 Swanick, Derbys 8 VariableYoung personCarer Average number life events (range) 11 (0-25)11 (0-38) Average number upsetting (range) 5 (0-18) 6 (0-21) Average number confided (range) 6 (0-17) 7 (0-24) YP and carers agree on LE information Only half the number of life events confided and Experienced as upsetting

9. Problem peer relations at baseline 12/09/2012 SCF meeting 9 Carers report more peer problems

10. Insecure attachment style Vulnerable Attachment Style Questionnaire, Bifulco et al 2003 12/09/2012 SCF meeting 10 The VASQ assesses problematic relating to close others. This involves degree of insecurity/mistrust (avoidance) and degree of proximity-seeking (anxious) attachment and secure. It also allows for an assessment of both avoidant + anxious styles (Dual/disorganised) Disorganised styles are known to be common in youth in residential care

11. VASQ type of insecurity: 12/09/2012 SCF meeting 11 Young people and carer give similar rates 46-52% Dual style rates confirmed by parallel ASI interview

12. 2/07/2013 Swanwick, Derbys 12 Comparing baseline and follow-up – any positive change? A safe haven

13. Life events at follow-up – No change 2/7/2013 Swanick, Derbys 13 CarerBaselineFollow-up 1Follow-up 2 Average number life events 11 10 Average number upsetting 666 Average number confided 866

14. SDQ Disorder baseline vs follow-up Average rates – all improve 2/7/2013 Swanwick, Derbys 14

15. Problem peer relations at baseline and follow-up - average rates - some improvement 12/09/2012 SCF meeting 15

16. VASQ baseline & follow-up Average rates – positive change 12/09/2012 SCF meeting 16

17. Summary change – Average rates % point difference baseline and follow-up 2 POSITIVE CHANGE

18. Emotional and behavioural symptoms Attachment model of change -stable, positive residential care Problem Peers Insecure Attachment style Life events Poor support Disorder & vulnerability Reduced mix of anger & Fear and insecurity Increased support through care staff Better interactions Reduced number; Better confiding and coping Increased wellbeing, Lower symptoms √ √ √ √ narrative accounts X

19. Advantages of using the Q pack Objective well validated measure of change/outcomes Multiple respondents including YP reflected Relatively simple, quick & inexpensive to use Aids in identifying need & monitoring cases

20. Contact a.bifulco@mdx.ac.uk Copy of presentation: www.cats-rp.org.ukwww.cats-rp.org.uk 2/7/2013 Swanick, Derbys 20 Thank you for your attention! A Bifulco & G Thomas, 2012 Routledge, London