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1 © Child and Family Training 2014 Ispcan workshop 2014 Hope for Children and Families A resource manual of modular systemic Interventions Empowering frontline practitioners to deliver evidence based approaches Arnon Bentovim -Child and Family Training UK Jenny Gray – President ISPCAN Marianne Bentovim – Child and Family Training -UK
2 © Child and Family Training 2014 What is the Hope for Children and Families programme? An approach to help make whole system changes to the delivery of children’s services through adopting evidence based approaches. Aimed at organisations and staff working with children and families to support and enhance the quality of direct work. Consists of resources for assessment analysis, planning intervention and reviewing progress. Provides an evidence based model of practice
3 © Child and Family Training 2014 Framework Assessment Approaches Analytic frameworks Intervention approaches Early help + + + Children in need ++ Contexts of child protection +++ Children looked after ++
4 © Child and Family Training 2013 Seven Stages in Assessment, Analysis and Planning Interventions Stage 1Identification of harm and initial safeguarding Stage 2Making a full assessment and creating a comprehensive chronology Stage 3Establishing the nature and level of harm and harmful effects Stage 4Safeguarding Analysis Stage 5Child Protection Decision Making and Care Planning Stage 6Developing a plan of intervention Stage 7Identifying outcomes and measures
5 © Child and Family Training 2013
6 © Child and Family Training 2014 Research background The approach to practice is based on two elements “Common practice elements” that cut across many distinct specialist treatment protocols, specific clinical procedures and processes. 43 common elements were ‘distilled’ from 26 gold standard research studies on ‘preventing the recurrence of abusive and neglectful parenting, and the impairment of children’s health and development’ ( Chorpita and Daleiden 2009 and Bentovim and Elliott 2014)
7 © Child and Family Training 2014 Research background The approach to practice is based on two elements “ ‘Common factors’ such as the personal and interpersonal components of all interventions independent of approach – systemic, CBT, or systemic: Alliance, client motivation, therapist/helper/practitioner relationship issues which are significantly responsible for effective intervention outcomes. ( Wampold 2010 )
8 © Child and Family Training 2014 Practice elements which emerged from distillation of the research Physical Abuse Over 37 were identified: 15 were targeted at parents, 7 at the family and 15 at children. Parents Psychoeducation about the harmful impacts of abuse Approaches to manage oppositional behaviour. Children Social skills training, communication skills, relaxation, personal safety skills and problem solving. Approaches to help children’s development, educational support, assertiveness training and anger management. Family interventions I Family therapy, motivational interview to engage family and marital and individual treatment for caregivers.
9 © Child and Family Training 2014 Practice elements which emerged from distillation of the research Neglect – fewer relevant studies Practice elements which emerged focused on facilitating professional family relationships, engaging families, providing a proactive management approach. Parenting approaches psychoeducation about the impact of severe neglect on children’s development, managing children’s behaviour, promoting positive interaction, safety and good care, helping children with personal safety skills, nutritional and medical care.
10 © Child and Family Training 2014 Practice elements which emerged from distillation of the research Victims of sexual abuse 15 practice elements were targeted at children and 6 at parents, which included: Psycho -education about the impact of sexual abuse. Cognitive behaviour skills in managing the exposure of traumatic thoughts, feelings and behaviour associated with abuse. Relaxation skills, problem solving and relationship building. Parents were also provided with psychoeducation, coping and parenting skills such as providing tangible and positive parenting skills.
11 © Child and Family Training 2014 Practice elements aimed at work with young people responsible for harmful sexual behaviour Young people responsible for harmful sexual behaviour. 11 practice elements were targeted at children and young people, 6 at parents including CBT to help children and young people manage harmful behaviour and develop personal safety skills, anger management, line of sight supervision.
12 © Child and Family Training 2014 Practice elements which emerged from distillation of the research Exposure to violence and mental health issues The practice elements which emerged included psychoeducation about the impact of violence or mental health difficulties, supporting parents to be able to listen supportively to their children and to improve their relationship and build rapport. Work with children included creating a trauma narrative of stressful traumatic events they had been exposed to, the development of safety, skills and social skills.
13 © Child and Family Training 2014 Integration to create the HfCF resource pack Integration into an intervention resource pack for practitioners A group of experienced practitioners brought all this information together and integrated it with practice knowledge which has developed including our own work at Great Ormond street, the Faithfull Foundation, SWAAY, The Maudsley We used the UK Assessment framework as a base to describe strengths and difficulties in Parenting, factors which were associated with abusive parenting, and the impact on children’s health and well being We then organised interventions ‘around the assessment triangle’ and made this the basis of the intervention ma
14 © Child and Family Training 2014 Assessment Framework A map of relevant data to be collected 14 Health Education Identity Family & Social Relationships Social Presentation Emotional & Behavioural Development Selfcare Skills CHILD’S DEVELOPMENTAL NEEDS PARENTING CAPACITY FAMILY & ENVIRONMENTAL FACTORS Basic Care Emotional Warmth Stimulation Guidance & Boundaries Ensuring Safety Stability Wider Family Housing Employment Income Family’s Social Integration Family History & Functioning Community Resources CHILD Safeguarding & promoting welfare © Child and Family Training 2011
15 © Child and Family Training 2014 Relevant Data
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22 © Child and Family Training 2014 Development of intervention approaches ‘The Hope for Children and Families Intervention Resource Pack’ This provides an accessible set of evidence-based approaches, resources and tools for direct work. The resources are available in hard copy and on line include: Practitioner briefings – summarising theory and research, guidance and advice for intervention. Modules that can be linked together in a plan and programme of work – ideas, approaches, outline for direct work sessions, scripts, hints and tips for effective intervention. Tools, instruments and direct work resources. Training approaches – work books, work shops, supervision of practice – 5 pilot sites
23 © Child and Family Training 2014 THEME 1 INTRODUCTION THEME 2 INITIAL STAGES OF WORK: ENGAGEMENT AND HOPE Engaging families, parents and children: Promoting hopefulness Goal setting THEME 3 WORKING WITH PARENTS: TARGETING ABUSIVE AND NEGLECTFUL PARENTING How abusive and neglectful parenting affects children’s development, emotional and physical; Psychoeducation Developing a capacity to identify and understand children’s physical and emotional needs. Parents coping with stress and the link with abusive and neglectful parenting Helping parents cope with negative perceptions of children Clarifying, sharing and reconciling the impact of abusive and neglectful parenting Library of modules
24 © Child and Family Training 2014 THEME 4 WOR KING WITH PARENTS AND CARERS: PROMOTING CHILDREN AND YOUNG PEOPLE’S HEALTH, DEVELOPMENT AND WELL-BEING Understanding development Promoting Development, Early Development Promoting Later Development Meeting children’s and young people’s safety and physical needs Ensuring safety and preventing harm. Providing good quality basic care Nutritional care :weight faltering and failure to thrive Shaping challenging behaviour Library of modules 2
25 © Child and Family Training 2014 Meeting children and young people’s emotional needs Promoting attachment, attuned responsiveness and positive emotional relationships: Younger children. Promoting attachment, responsiveness, positive relating with older children: One-on-one time. Positive parenting Positive parenting: managing difficult behaviour Praise The use of attention and ignoring Giving effective instructions Rewards Shaping challenging behaviour Library of modules 2
26 © Child and Family Training 2014 THEME 5 WORKING WITH CHILDREN AND YOUNG PEOPLE Working with emotional and traumatic responses – -Generic modules Developing a child-centred approach Psycho-educational intervention on the effects of maltreatment Safety planning Coping skills Relaxing and calming Describing and monitoring feelings Activity selection Problem solving Library of modules 3
27 © Child and Family Training 2014 -Problem–specific modules Working with anxiety problems: Helping children who experience excessive anxiety Working with mood problems: Helping children who present with persistent low mood or with depression Working with trauma problems: Helping children who experience traumatic responses Maintenance and building resilience Working with disruptive behaviour problems of children and young people Enhancing children’s competence: education, talent and the ‘good life’ Developing positive relationships with family and friends Coping with disruptive behaviour Assertiveness training Developing positive relationships with family and friends Library of modules 3
28 © Child and Family Training 2014 THEME 6 WORKING WITH FAMILIES Promoting healthy family functioning and problem solving skills Helpful techniques to manage conflict and dysfunction in family life Support networking for families THEME 7 WORKING WITH PARENTS AND CARERS TO SUPPORT CHILDREN WHO HAVE BEEN SEXUALLY ABUSED AND THOSE CHILDREN AND YOUNG PEOPLE WHO ARE RESPONSIBLE FOR HARMFUL SEXUAL BEHAVIOUR, Working with parents and carers to support work with children and young people responsible for harmful sexual behaviour Working with children under 12 who have displayed harmful sexual behaviour Working with adolescents (age 12+) who have displayed harmful sexual behaviour Promoting safety for children and young people who have been harmed sexually in the family or by a trusted member of the community Library of modules 4
29 © Child and Family Training 2014 Case Study: Bradshaw Family Frank Thomas 29 years James Smith 27 years Gina Bradshaw 27 years Annie 2 months Ben 5 years 6 months
30 © Child and Family Training 2014 Watching DVD clips of a family assessment. Home assessment of Ben Bradshaw, aged 5 years 6 months and his parents. Focus in particular on both parents Gina, Frank and Ben and Annie on thoughts, feelings, responses and consequences which resulted in potentially harmful actions Put yourself in the shoes of one of the 3 family members in first clip, and Gina and Ben in the second How did their responses affect each other and Ben Feed back from the perspective of each family member ‘I felt, thought and I did!! Parenting strengths and difficulties task
31 © Child and Family Training 2014 A situation Behaviour Consequences Thoughts Feelings Behaviour Parental/carer stress
32 © Child and Family Training 2014 Cycle of situations, feelings, thoughts, behaviour and consequences SituationFeelingThoughtBehaviourConsequences
33 © Child and Family Training 2014 Feed back from the perspectives of each participant Discussion of the interaction of these cycles What is the risk? Feed back observations
34 © Child and Family Training 2014 During the following assessment – An episode of inappropriate manhandling by Gina – Gina became angry as Ben had trashed his bedroom, she grabs him, pulls him upstairs – at the top of the stairs he struggled to break free fell down the stairs, Frank heard the shouting, sore ribs, insists on taking him to the Doctor. Fractured rib, and two old fractures on x-ray, rib and collar bone –aged 3 and 4 –no record Agree to Ben being placed temporarily and for them to work with the practitioner to address concerns - Safeguarding analysis
35 © Child and Family Training 2014 Use the diagram to note the profile of harmful parenting, impact on Ben’s health and development Discussion of individual and family factors which could account for the profile Then look at the profile of interventions – which would fit? Check the library of modules Discuss the profile of harm
36 © Child and Family Training 2014 Overall prospect for successful intervention. Ben has suffered physical, emotional harm, broken ribs. Strengths in several areas. Ben articulate, clear wanting his mother to stop smacking him. Gina blames Ben, does not understand her role. Parents want Ben home, willing to work with professionals. Acknowledge Ben was hurt whilst in their care – Ben provoked, it was an accident Gina acknowledges she needs help with Ben’s behaviour,- Future outlook for health and development
37 © Child and Family Training 2014 Gina’s negative attitudes have not changed despite move to grandparents. Gina remains dominant, Frank not challenging. Circular process of rejection and antagonism. Imbalance of couple relationships continue. Future outlook for health and development
38 © Child and Family Training 2014 Basic Principles To address whether parents feel Ben has been affected by harm he has experienced. To discuss his behaviour and responses and indicate they could be related to being exposed to harmful experiences, even when young. Psychoeducation: how abusive and neglectful parenting affects children’s development emotional and physical
39 © Child and Family Training 2014 This module focuses on stress as a key factor linking with abusive and neglectful parenting and the impairment of children. Using stress as a way to speak about the way stress affects behaviour which can include abusive and neglectful actions. A way of introducing a factor which is inherent for all parenting and which can be modified. Using CBT principles to manage stress and understand it is key to this module. Parents coping with stress and the link with abusive and neglectful parenting
40 © Child and Family Training 2014 Parents coping with stress and the link with abusive and neglectful parenting Activity – discussing the model of stress. Focussing on children’s temperament. Exploring situational stressors. Parental reaction to family of origin issues. Managing stress. Overview of modules - continuing
41 © Child and Family Training 2014 A situation Behaviour Consequences Thoughts Feelings Behaviour Parental/carer stress
42 © Child and Family Training 2014 View the video clips of Frank and Gina’s childhood. Discussion about how the abusive processes might be re- framed in a way which could help resolution Parental reaction to family of origin issues
43 © Child and Family Training 2014 Other relevant themes Modules from other themes need to be linked together to create an intervention that fits the needs of the particular family. This includes choosing modules from other key themes: Providing good quality care and safety. Promoting safety within the home and environment. Promoting secure attachment, attunement and positive emotional care. Positive parenting Addressing abusive and neglectful parenting, generic interventions for children improving safety, managing feelings, coping skills, problem solving and building resilience.
44 © Child and Family Training 2014 Building a picture of the child’s life and building a rapport with the child Get to know the young person- All about me/ my galaxy/ my world/ my life as an advert/ life as a song/ a rap Ask them their areas of interest/ hobbies/ favourite things e.g. animal/ food/ hobby/ TV program/ subject at school/ time of year/ sport etc. Bring humour/ playfulness/ a sense that you are really interested in getting to know them- what makes them tick/ what makes them sparkle?
45 © Child and Family Training 2014 This is an important module which can bring together work with parents and children individually to address abusive and neglectful parenting. Relieving the child of responsibility, parents taking responsibility and developing an approach for the future which will be safer. Clarifying, sharing and reconciling the impact of abusive and neglectful parenting
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