The Art and Science of Effectively Engaging, Guiding and Supporting

Parents

Dr Crispin DaySouth London & Maudsley NHS Foundation Trust

King’s College, London

UNICEF UK Baby Friendly Initiative Annual Conference

GlasgowNovember 28th

2013

Health & well-being

Parent-infant care & interaction

Family & social support

Couple relationship

Developing parents & infants

Antenatal/Postal Promotional Guide System: Early development & transition to parenthood

AN/PN Promotional Guides: Primary Prevention & Early Intervention

European Early Promotion Project (Puura et al., 2005;

Roberts et al., 2005)

Oxford Home Visiting Study (Barlow et al, 2001)

Maternal Early Childhood Sustained Home-visiting

(MECSH, Kemp et al., 2012) Healthy Child Programme (2010) & DfE/WAVE Trust

(2013) DH ‘Birth and Beyond’ & UNICEF Baby Friendly

Initiative

FPM Antenatal/Postnatal Promotional Guides

Promote and protect early development & transition to parenthood

Better informed decisions about family needs

At least two contacts From viable pregnancy antenatally 6-8 weeks postnatally

Pilot use in prep for parenthood groups

FPM Antenatal Promotional Guide Topics:Structured, flexible & consistent

Your feelings about your pregnancy Your family & friends Changing family life & relationships Looking after yourself & your baby Your unborn baby Your labour & your baby’s birth Becoming a mum/dad, becoming

parents Caring for your baby Your circumstances & community Recent and & life events Your priorities, plans & support

FPM Postnatal Promotional Guide:Ten topics

Your labour, birth & recovery Your emotional wellbeing Becoming a mum, dad & family Your family & friends Your baby’s development Caring for your baby Baby cues, getting to know your

baby Your circumstance & community Recent & past life events Your priorities, plans & support

Antenatal/Postnatal Promotional Guides & Prompt Cards

AN Topic 5: Your unborn baby

What's your baby like at the moment? What's happening in relation to his/her growth and development?

How do you feel when you think about your baby? What are the things that you enjoy, and the things that worry or upset you?

What do you think your baby is going to be like?

PN Topic 5: Your baby's development

How is your baby doing? In what ways has s/he changed and developed since s/he was born?

What have you learnt about your baby so far? What sort of person is s/he?

How do you feel about your baby at the moment? What sort of bond do you have?

AN Topic 8: Caring for your baby

How do you feel about the practical and emotional aspects of feeding your baby? (Baby Friendly Initiative, UNICEF, UK)

What is your experience of looking after young babies?

How do you feel about other aspects of caring for your new baby, such as settling, comforting, bathing, playing?

PN Topic 6: Caring for your baby

What has it been like caring and looking after your baby, such as feeding, settling, comforting, bathing, playing?

How is feeding going? What have you and your baby learnt about feeding so far? (with Baby Friendly Initiative, UNICEF, UK)

How is your baby sleeping? How are you coping with broken

nights? How do you cope when your baby cries a lot or is difficult to settle?

The FPM Antenatal/Postnatal Promotional Guides

A Guided Conversation

A sleep-deprived single Mum right on the edge because her young 4 year old won’t ever go to bed wants to use sweets as an immediate reward for her child, who has a sweet tooth, if the child settles to bed without undue fuss.

The MOST appropriate response would be to:a) Gently encourage the Mum to think about the effects on the child’s

teeth.

b) Share your experience with the success of star charts.

c) Suggest that you could look at a range of options together.

d) Ask encouragingly which types of sweets she was thinking of using.

37/150

Parents’ experiences

‘They just came and told me stuff, but I didn’t really take it in… I just didn’t think about it that much, I didn’t really listen to what they told me because I wasn’t interested in it’

“You really do feel like they intimidate ‘cos you’re a Mum, ...they try and like, just pushing it down you’re throat till like it makes you feel like more of a bad parent.”

‘I don’t want (them) to get in my face about my daughter. Don’t tell me to do things that I am already doing! Instead, start by asking questions to find out what I am doing and why I am doing it.

‘I always want to say and do the right things in front of (her) because I’m not sure what will happen if I don’t’

Kirkpatrick et al (2007), Barlow et al (2005), Day et al (2006), Jack et al (2005)

Parents’ experiences

‘She talks to you like a human being, she doesn’t treat you like you don’t know anything’

‘They are not just listening to what you say, they are hearing what you’re saying as well as listening although they sound very much the same …. They are not.‘

“ I think the most important thing is that you work together. Not them coming in and saying ‘This is what we do’, or the parent saying ‘This is what I want you to do’ “

“Understanding is like listening to people and like knowing what their situation is like … if you can’t understand someone or they can’t understand you they can’t help you ‘cos they don’t know what you’re talking about”

Kirkpatrick et al (2007), Barlow et al (2005), Day et al (2006), Jack et al (2005)

Practitioner qualities, skills, relationships & goals: Science & evidence

• Best predictors engagement, drop-out & outcomes whatever the intervention (eg. Cahill et al., 2008; Karver et al, 2006; Shirk & Karver, 2003)

• Structured interventions effective for clients with complex & long standing difficulties (Castonguay & Beutler, 2006)

“When I first started seeing the people at ......., I didn’t get on very well with them because I

felt that they talked down to me. And the woman she would treat

me like I was about five. “

‘She talks to you like a human being, she doesn’t treat you like

you don’t know anything’

Kirkpatrick et al (2007), Barlow et al (2005), Day & Doherty (in prep) Jack et al (2005)

www.cpcs.org.uk

What do you see?:Practitioner and parent constructs

Parents and practitionersActive, feeling & thinking people

• Valued & respected• Beliefs, desires,

motivations & priorities understood

• Social & complexity gradient

• Assumptions about practitioner skills & effects - Underestimate- Overestimate

(Kirkpatrick et al., 2007, Barlow et al., 2005; Jack et al., 2005; Day & Doherty, in prep)

Family Partnership ModelRelationships and roles

Expert

Friendship

Dependent

Adversarial

Avoidant

Partnership

Promotional Guides in Partnership: Guided exploration & understanding

‘Supportive & connected’

rather than ‘knowing &

telling’

‘Facilitate & influence’ rather

than ‘direct & control’

Share parent & professional

knowledge & expertise

Common purpose

Promotional Guides in Partnership: Communication style (Davis & Day, 2010; Day & Davis, 2009)

Listening closely attentively

Matched agendas

Open, exploratory prompts

Shared decisions, goals & actions

Open agreements & disagreements

Balance ‘guiding’, ‘leading’ &

‘following’

Avoid shift to expert judgement

FPM: Essential qualities of the helper

Respectful Empathy Warmth Humility & realism Strength Constructive &

supportive judgment

Family Partnership Model: Engage, guide and support

L E S S S

Promotional Guides in Practice:In the eye of the beholder

Listened to and heard

Empathised with and appreciated

Summarise parent experiences and priorities

Shared understanding of strengths, concerns, goals & process

Strategies and actions planned, implemented and reviewed

FPM Antenatal/Postnatal Promotional Guides: A conversational topic guide

Not to ‘interview’ parents in a question and answer format

Nor a ‘tick list’

Engage and guide effective relational and goal-orientated contacts between practitioners and families

The FPM Antenatal/Postnatal Promotional Guides

Dissemination and spread

Antenatal/Postal Promotional Guide System: Early development & transition to parenthood

Extensive dissemination across England

Approx. 1500 health visitors trained in last 18mths

Cascade system of trainers 2-day introductory training Management

implementation guidelines

Item %Highest ranking

Enthusiastic facilitation 88.3(Very much so)

Felt respected 75.3 (Very much so)

Listened to 71.9 (Very much so)

Useful to day-to-day practice 67.6(Very useful)

Skills and knowledge about the Antenatal Promotional Guide

80.3(A great deal)

Skills and knowledge about Postnatal Promotional Guide 73.0(A great deal)

Skills and knowledge about Strengths & Needs Summary 59.4(A great deal)

Recommend the course to other colleagues 68.9(Highly)

Promotional Guide Training: Training feedback & evaluation

Item %Strongly/Very strongly

Agree

I have the key qualities, skills and knowledge to use the Promotional Guides effectively in practice

84.7

The Promotional Guides will help me to be more effective with families 79.6

Families will benefit from my using of the Promotional Guides with them 76.9

The Promotional Guides are an appropriate approach for the families with whom I work

76.5

My colleagues are enthusiastic and encouraging of my using of the Promotional Guides in my work with families

43.2

I will be involved in regular organised discussion with colleagues about how I am using the Promotional Guides with families

23.9

My manager has offered me time and resources to make sure that I have put the Promotional Guides into practice effectively

19.3

I will be regularly supervised on my use of the Promotional Guides with families

15.9

Promotional Guides in Practice: Personal and organisational investment

AN/PN Promotional Guides

Commissioning/Service priority

Practitioner qualities & skills

Engaged mothers & fathers

Effective additional early support

A sleep-deprived single Mum right on the edge as her young child who won’t ever go to bed wants to use sweets as an immediate reward for her child, who has a sweet tooth, if the child settles to bed without undue fuss.

The MOST appropriate response would be to:

a) Gently encourage the Mum to think about the effects on the child’s

teeth. (Undermines and implies criticism of Mum’s efforts)

b) Share your experience with the success of star charts. (Practitione-led and potential for expert role)

c) Suggest that you could look at a range of options together. (Getting there but still implicit criticism of Mum’s thinking)

d) Ask encouragingly which types of sweets she was thinking of using.

‘I don’t want (them) to get in my face about my daughter. Don’t tell me to do things that I am already doing! Instead, start by asking questions to find out what I am doing and why I am doing it’.

•Listen. empathise and appreciate, (LESSS)•Support and connect (Roles)•Partnership, exploration & understanding•Goal setting and strategy planning