Sharing Good PracticeInteragency approaches

Cathy McLaughlinMidwife & Antenatal Education Co-ordinator

WHSCT(Altnagelvin Area Hospital)

And

Margaret FisherMidwife on secondment to SureStart by WHSCT

Development of The Infant Mental (IMH) Health Strategy

How it affected midwifery practice

Other aspects of care that have married into this approach

Improving Outcomes–What Changed our Approach.

Antenatal education classes

SureStart community based services delivered by midwives and health visitors in partnership with others

HypnoBirthing & Aquanatal exercise

Solihull approach

UNICEF Baby Friendly Initiatives

Weigh to a Healthy Pregnancy

What we do

Nurturing parents

Baby brain development

Early Relationship building

Parenting skills

Aims of these models

SureStart

Family Nurse Partnership / Teenage Pregnancy Coordinator

Regional Obesity Project

Maternity Services Liaison Committees

Breastfeeding Peer Support Project

Health Improvement Department

Community & Voluntary Sector Agencies

Interagency Approaches

What supports good brain development?

Good antenatal care

Positive interactions

Security & stability

Needs being met consistently, physically & emotionally

Good quality stimulation & experiences

7

It is an integrated theoretical model

It brings together 3 theories (Containment, Reciprocity and Behaviour Management) to provide a way of thinking about relationships

It supports professionals in their work with families

children’s and parents’ emotional relationship

parent-child relationship as it affects brain development (in particular emotional development) in the foetus and baby MF

What is the Solihull approach?

1. To increase knowledge of the underpinning evidence and theories in:

I. Baby brain development

II. Containment

III. Reciprocity

IV. Behaviour management

V. How the above links to Attachment Theory

2. To think about how each area can help in your approach to working with families and children

3. To use understanding of above to increase effectiveness of interventions & outcomes for children

MF

Learning Outcomes

SureStart Edenballymore

• Covers 7 electoral wards Derry City Council Area-urban

• 1241 currently registered adults

• 1158 children registered on SureStart Database

•All SureStart wards fall within top 10% most deprived electoral wards in Northern Ireland

•1 in 5 births are to teenage mothers

•40% of babies born to mothers who smoke

Services OfferedCommunity Drop in Service for

pregnant womenAnte & Post Natal Aqua-

AerobicsBaby MassageBaby Yoga Baby ReflexologyBaby Aqua

Increased attendance at classes and sustained attendance

Increased use of HypnoBirthingtechniques

Unicef Baby Friendly Re accreditation

Solihull training for staff in WHSCT

Evidence

Qualitative –UNICEF BFI Initiative feedback from parents stated that 85%of them were happy with their care.

10,000 voices – showed a very good result from local Maternity experience

Continuous patient evaluation via Trust Facebook and ‘Twitter’.

Evidence to support we are on the right track

Continue to implement the IMH Strategy in our practice

Funding for other initiatives ,e.g. Post natal aqua aerobics

Antenatal Nurturing Programme within SureStart initiatives

EITP –Early Intervention Transformation Programme

Where do we go from here

Thank you for listening

Questions/Comments

Working Together

Presented by Caroline Hanway and Tracy Barker

(PCFs in Tallaght West)

Parent/Carer Facilitator Role

• Engage with parents from first initial contact

• Support Parents in their vital parental role

• Identify individual needs and work together to accomplish goals

• Provide a bridge between Early years setting and home Environment

Effective ways to engage parents

• coffee mornings

• one to one sessions

• home visits

• drop-in service

• social media mechanisms.

Variety of formal supports

• Links to Public Health Nurse

• Links to SLT

• Links to Primary Health Care Team

• Link to community and family support agency

Varity of informal supports

• Parent and toddler groups

• Parents Plus Community course

• Come dine with me

• Guest speakers

• Adult Educational workshop

Strengthening links between Early years, home and

Primary school

• Sharing of information between home and Early years setting

• School Registration

• Transition to school programme

• Linking parents with Home-School Liaison officer

Benefits of Engaging Parents

• Parents actively involved in their child’s education

• Stronger links between Early years service and the home

environment• Building stronger positive

communication within the family

• Creating pathways to community awareness

Research

• significant improvements in the Home Learning Environment (HLE)

• a positive effect on family relationships and an improvement

in parenting skills

• especially in relation to other children within the family

Parental Comments

• “I felt I could go to (PCF) at any time to discuss things about my child, or just to

have a general chat”

• ‘‘Loved hearing everyone's examples and experience’’

• PCF ‘‘listened to each of us and gave great ideas to try at home’’

• ‘‘I found myself giving advise to my friends after doing the Parents Plus course’’

Conclusion

• positive parenting improves child outcomes

• this is only made possible through effective and quality

parental engagement

Thank You

Bibliography

http://www.twcdi.ie/images/uploads/general/CDI-Early_Years_Report_24.01-web.pdf).

Parental Comments.

Effective Inter-agency Working to Support Families & Children – The

Common Sense Parenting Programme

Liam White: PPFS

Mary O Malley: ADPHN

County Mayo

Presentation content

Background to Common Sense Parenting

Description of Common Sense Parenting

Contents of Common Sense Parenting

Effective Inter-agency Working implementing CSP

Background to Common Sense Parenting in Mayo

Local initiative in 2005 in relation to adopting a family

support programme from the Boystown organisation

in United States.

Boystown one of the largest child care providers in

the US. Residential, secure care, foster care, In-

Home Family Services and Common Sense

Parenting Programme.

Local research completed, reciprocal site visits.

Boystown model adopted and introduced in 2007

Background to Common Sense Parenting

Initially introduced the In-Home Family

Services Model or Family Preservation

Model in Mayo and Roscommon.

Staff specifically trained-up in use of model

which included specific skills, methods of

assessment, family service plans and model

fidelity checks

Programme named Mol an Oige

Background to Common Sense Parenting programme

In 2007/2008 began to roll out Common Sense parenting.

Immediate feedback from service users and practitioners was very positive and demand for the programme increased.

Now providing 15-20 CSP per year across Mayo

Description of the Programme

Two types of CSP programme.

2-5 yr old programme. This is rolled out by

Public Health Nurses ( 19 trained PHN`S)

6-16yr old programme. This is rolled out by

child care staff (30 STAFF)

CSP Programme Content

Two facilitators

Programme duration 6 x 2 hour sessions

Text Book

Personal parenting plan

Videos

Role play

Inter-active

Fee E20

CSP Programme content

Parent are teachers- describing behaviours and using consequences to change behaviours.

Encouraging good behaviours- giving children reasons, using effective praise

Preventing problems – social skills, using preventive teaching to set kids up for success

Correcting problem behaviour and teaching alternative behaviours.

Teaching self-control, Safety plans

Putting it all together – family meetings, routines and developing a plan for use of all skills

Effective Inter-agency working to implement CSP

Public Health Nurses deliver – 2-5yr

programme.

Also Joint programmes co-delivered with

Child Care staff.

A wide range of Child Care practitioners

deliver the 6-16 yrs programme

Effective Inter-agency working to implement CSP

Community Based Family Support Workers (Tulsa Funded, located in FRC`s)

Foroige staff

Child Care Leaders – Social Work Dept

Mayo Rape Crisis Centre

Juvenile Justice Project

Western Regional Drugs Task Force

Child & Adolescent Mental Health Service

CSP Programme content

Mayo Rape Crisis Centre – Six modules and one additional module that relates to their specific client group.

Western Regional Drugs Task Force – Six modules and one additional module that relates to their specific client group.

Developing CSP programme aimed specifically at traveller parents – this is to address issues where literacy might be a barrier.

CSP in context of Direct provision hostel.

CSP in context of a prison.

Benefits of effective inter-agency working to support families and children

Developed closer partnerships between disciplines.

Set up local inter-agency subgroup to oversee

implementation of CSP.

Common more integrated approach by a range of

services to supporting parents/families

Sense of shared professional strategy – all using the

same programme.

The Benefits of using CSP

CSP programme endeavours to provide support to all parents who require or request support.

CSP Programme is a preventative intervention –links in well with the development of LAPS and Meitheal –e.g could be part of a Meitheal plan.

It may be the case that some individual parents need more intensive input or referral on to another service.

Common Sense parenting and the 50 key messages to improve outcomes

Very strong on parent-child relationship.

Provides parents with a positive parenting

style.

Promotes positive role-modelling by parents

Assists parents to problem-solve

Feedback from parents is that they enjoy

programme and it helps them.

Common Sense Parenting

CSP currently being formally evaluated by the Child

and Family Research Centre, NUIG – This will

involve 300 parents in this evaluation.

Work towards modifying our programme and making

it more consistent with national parenting support

strategy and the 50 key messages supporting

parents to improve outcomes for children.

Routes of referral to CSP

CSP universally available across Mayo. This reduces stigma, preventative and can be beneficial – shared learning/role modelling.

Parents can self-refer.

Some targeted referrals; S.W, CAMH,PSY

Parents referred as part of child protection plan

Other agencies: FRC, Schools, JLO,

Thank you

Strengthening Families: An Interagency Approach to Supporting Parents and their

FamiliesCliodhna Mahony

Chair, National Strengthening Families Council of Ireland

Supporting Parents Conference, CES, February 2015

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Overview of SFP

Development

• Developed by Dr. Karol Kumpfer (Utah, USA) in 1982

• 1st research-based family programme for substance abusing parents and their children (6-11 years)

• Dissemination in 35 countries through Alta Institute (formerly LutraGroup) (USA)

• 1994 universal ages 10-14 (7 weeks, UK, “Iowa” model)

• 2004 at-risk ages 12-16• 2006 at-risk Ages 3-5

(effective with universal also) • 2012 – DVD for home use (8-16

years)

International Evidence• 8 Independent randomized

control trials

• 10 RCT’s

• Over 100 quasi-experimental

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What is SFP?

Description A 14-week skills

based programme for parents/carers and their teens / children

Booster session 3/6 months post programme

Internationally recognisedevidence –based family

prevention programme.

Aim• To prevent substance use

and other adverse behavioural outcomes.

• Improve parenting and family functioning

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SFP Structure• 1 evening per week 3 skills course: Parenting,

Teens/Children, & Family Skills

Family Dinner

1 Hour Simultaneously

+

1 Hour

Teen / Children Parents/Carers

Family Group

• Childcare (0-12 years)• Incentives• Transport

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SFP Outcomes (USA)Parent Skills :

• Improves: Parenting skills, efficacy, confidence, monitoring & supervision as well as parent-child involvement

• Decreases: negative child behaviour, overt and covert aggression and conduct disorders

Children's Skills

• Improves: school results, social competencies (communication, problem-solving, peer resistance, anger & behaviour control)

Family Skills:

• Improves: family attachment & bonding, harmony, communication, organisation, family strengths and resilience

All 3 together: 1)Reduces alcohol and drug use or initiation into.2) Improves protective factors and decreases risk factors

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SFP in Ireland

Unique Community Based Interagency

Model Utah Model –14 weeks

(dose effect)

Manual Adaptations

9 years (2007-present)

SFP 12-16**SFP 6-11

National SFP Council of Ireland

Supported by National Policy

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Estimated 60 SFP sites across Ireland

Family Support Levels 1-3

National Council MembershipName Organisation

1 Cliodhna Mahony (Chair) Ballymun LDATF2 Anne Conroy Le Chéile, Mentoring and Youth Justice Support

3 Sunniva Finlay Ballyfermot STAR4 Patsy Moran Addiction Response Crumlin5 Donna Butler (Vice Chair) Families Matter, Alcohol Forum6 Marie Lawless & Roisin Byrne Ballymun LDATF

7 Thomas O’Donnell Tusla, Child & Family Agency, Geraldstown House

8 Leona Scott/Emmett Lynch Derry Healthy Cities

9 Valerie Scully / Patricia Levins Foróige (Tallaght SFP)

10 Joan Bolger (Interim Vice Chair Regional Framework Support Agency

11 Rosemary Fox / Gemma O’Leary

Young Persons Probation (Cork SFP)/ Cork Local Drugs & Alcohol Task Force

12 Rachel Browne Empowerment Plus SFP Coordinator (Western Region)

13 Joe Slattery CSMT (Limerick)14 Cathryn O’Reilly Finglas / Cabra Resource Centre

15 Cathy Whelan / Patricia Egan Meath Community Drug and Alcohol Services (Meath SFP)

16 Miriam Galvin Kerry ETB17 Ciara Jubani Blanchardstown LDATF

18 Jacki Thompson Dublin North City and County RDATF

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Evidence / Reviews in Ireland

• Analysis of 200 high risk families (who completed SFP (12-16) across Ireland showed statistically significant positive results in all variables (parent, teen and family variables) (2012).

• Teen Gender Analysis (2008 – 2014) of 327 teens in Ireland, & compared to USA teens showed:• Statistically significant positive results for all variables (parent, teen

and family) (higher effect sizes than USA)• Boys and girls benefitted equally except:

• Boys benefitted more in overt aggression • Parents of boys benefitted more in Parental Supervision• Conflict reduced more in families with boys.

• SFP reviewed in CFA document “ What Works in Family Support” (2013)

• Numerous local outcome and process evaluations since 2007 (incl 3 year report, teen report…).

• Feedback anecdotally from communities, participants, agencies…

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Community Based Interagency Implementation –Ballymun

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Ballymun SFP

Funding

Evaluations

SFP Interagency

Team

Follow Up Support

Management Committee

Referrals and Process

Policies & Procedures

Programme Manager &

Site Coordinator

Ballymun Interagency

Network

National SFP Council of

Ireland

Benefits of Interagency

Benefits to agencies• Facilitates community

“buy-in”• Facilitates strong

relationships agency to agency (increases knowledge).

• Shared expertise.• Improved relationships

with families – strengths based approach.

• Integrates with current work

Benefits to Families• Reduces barriers to local

agencies.

• Increases connectedness with the community.

• Exposure to various expertise/resources on site and access further supports.

• Demonstrates community wide support – increased engagement with education, training and other community projects.

• Opportunity to increase skills.

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Ballymun Case Study• 7 Years completed (2015 – 8th year)

• 19 Programmes to Date

• 180 Families have Graduated

• 130 Local Agency Reps and Volunteers Trained (incl 2 parent graduates)

• 20-25 agencies involved in programmes in various roles.

• Parent Advocate Role Began in 2012

• 2 programmes per year

• Local SFP Trainers

• National SFP Council of Ireland

• Presented at international conferences 1st Family Based Prevention Conference, Slovenia & EUSPR in Majorca.

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Ballymun 7 year follow up (2008-2014)

SFP Parent Skills Always Sometimes Never

I communicate about drugs and alcohol 80.4% 17.4% 2.2%

I give clear directions to my teen 78.3% 21.7% -

I set clear boundaries for my teen 73.9% 23.9% 2.2%

I reward & notice good behaviour 67.4% 32.6% -

I communicate about relationships and sexuality 65.2% 30.5% 4.3%

I use good speaking and listening skills 58.7% 41.3% -

I set clear goals and objectives 50% 47.8% 2.2%

I use my skills to handle stress better 50% 47.8% 2.2%

I follow through on consequences

(e.g. punishment, removing privileges)

47.8% 43.5% 8.7%

I spend quality time with my teen 43.5% 50% 6.5%

I use problem solving skills 36.9% 60.9% 2.2%

I ignore bad behaviour (where safe to do so) 31.8% 52.3% 15.9%

I use behaviour change contracts 19.1% 47.6% 33.3%

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Sample Survey responses (adults)

58%

40%

2% 0% 0%

Helped improve my relationship with my family

Strongly agree Agree

Neither agree nor disagree Disagree

Strongly disagree

56%

38%

6%

0% 0%

Helped my family to communicate better

Strongly agree Agree

Neither agree nor disagree Disagree

Strongly disagree

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49%

38%

11%

2% 0%

Made my family stronger and better able to deal with

problems

Strongly agree Agree

Neither agree nor disagree Disagree

Strongly disagree

96%

2%2%

Has SFP made a difference in your life or that of your

family?

Yes No Unsure

What young people said:

• Young People:

• (Family life) “I didn’t think it was going to help because everyone was always arguing before and now we talk to each other. We don’t argue anymore. It is a lot quieter house now”

• “It got our family closer together than it actually was…ever since we are communicating better and going out together.”

• (School)“It helps you cop on more. If someone is messing with you, just step away and don’t get in trouble because someone is acting the eejit”.

• (Parents) “Me ma deals with things better than before”

• “I have great parents…instead of giving out to you they listen to both sides of the story and sort things out”

• (Linking in) “I got involved in Comhairle na nÓg. The programme made me realise I have to make something of my life…”

• “It teaches you how to respect them (neighbours) and not just your parents”

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Conclusion

• SFP is an effective evidence based programme to support parents and their families.

• Ireland has effectively and successfully implemented a unique interagency community based implementation model which has had positive ripple effects throughout each community.

• By involving children and parents together in a family process, family protective factors enhance the building of communication, bonding, attachment, love, support and reduce risk factors such as conflict, d&a use, and criminal behaviour.

• Challenges going forward will involve ongoing support for SFP locally and through the NSFPC; local community sustainability (buy-in, supply vs demand);

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References

• Kumpfer, K.L., Xie, J., O’Driscoll, R. (2012) Effectiveness of a culturally adapted Strengthening Families Programme 12-16 years for high risk Irish families. Child and Youth Care Forum, 41 (2), pp. 173-195 Sage Publications.

• Kumpfer, K.L., Xie, J., Cofrin-Allen, K., Lawless, M., Mahony, C. (2014). A teen gender analysis of SFP (12-16) in Ireland. (Presented on behalf of NSFPC at EUSPR Conference 2014, Palma Mallorca).

• Child & Family Agency. (2013). What Works in Family Support.

• Ballymun Local Drugs and Alcohol Task Force. (2015). A 7 Year Longitudinal Follow Up Study of SFP (12-16) in Ballymun.

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