1. 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 18 th September 2013 Email: j.hutchings@bangor.ac.ukj.hutchings@bangor.ac.uk

2. 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

3. 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

4.  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

5. 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

6. 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

7. 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?

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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.colorado.edu/cspv/blueprints/  www.education.gov.uk/commissioning- toolkiit

18. 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)

19. 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

20. 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)

21. 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

22. 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

23. Thanks for listening