Solihull Approach Workshop

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Workshop Presentation from the Evidence Based Parenting Programmes and Social Inclusion conference held at Middlesex University, 20th September 2012

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Solihull Approach Workshop

  1. 1. Solihull Approach Mary Rheeston – Solihull Approach Manager Thursday 20th September 2012Evidence Based Parenting Programmes and Social Inclusion Conference Middlesex University © Solihull Approach 1
  2. 2. What is the Solihull Approach?• It is an integrated theoretical model that can be used in practice• 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• It improves children’s and parents’ emotional relationship and wellbeing• In supporting the parent-child relationship it affects brain development (in particular emotional development) in the foetus and baby © Solihull Approach 2
  3. 3. How the Solihull Approach developed•Originally developed in Solihull between health visitors, psychologistsand psychotherapists to help parents with children with sleepdifficulties• Focus on parent and child/baby interacted first, rather than behaviourmanagement advice straight away• Extended to other professional groups and agencies at the request ofprofessionals e.g. School Nurses, Nursery nurses, Children’s Centre staff,Child Care staff, Midwives, Breastfeeding Coordinators, Education,Fostering and Adoption and Social Workers © Solihull Approach 3
  4. 4. How the Solihull Approach developed• Developed resource packs and training for professionals acrossagencies with cascade training. E.g. First five years , School years,Fostering and Adoption, Antenatal for midwives and practitionersinvolved in antenatal period, Early year Foundation Stage•Groups and group training. e.g. Antenatal Parenting 5 weekGroup, Solihull Approach 10 week Parenting group, , PeerBreastfeeding Supporter 6 week Training and Foster carer 12week group training © Solihull Approach 4
  5. 5. The Solihull Approach - supporting family relationships to improve outcomes Psychoanalytic theory (Bion)Child Development research Behaviourism (Skinner) (Brazelton) © Solihull Approach 5
  6. 6. Containment• Containment is where a person receives and understands the emotional communication of an other without being overwhelmed by it and communicates this back to the other person. This can restore the capacity to think in the other person. © Solihull Approach 6
  7. 7. Containment Parent BabyToddler © Solihull Approach 7
  8. 8. ContainmentReceived/understood Parent Baby Toddler © Solihull Approach 8
  9. 9. ContainmentParent’s head too full Parent Baby Toddler © Solihull Approach 9
  10. 10. Coping with Day to daychild with Domestic events behavioural violence Relationship issues Single/breakup difficulties Housing parent Financial problems Fertility problems problems Unprocessed Mental HealthFatigue birth history problems postnatal Poor relationships depression with parents Difficult childhood experiences © Solihull Approach 10Parent’s head too full
  11. 11. ContainmentParents headcompletely full Parent Baby Toddler © Solihull Approach 11
  12. 12. ContainmentParallel Process worker Parent Baby Toddler © Solihull Approach 12
  13. 13. Containment and parenting• Helps the parent to think about their child• Helps parents and their child to relate• Helps the parent to help their child cope with anxiety and emotion so that the child is free to relate• Helps the parent process some ‘old’ emotions so that the parent can relate to the actual child in front of them, not a ‘projection’ of a child © Solihull Approach 13
  14. 14. Reciprocity• Describes the sophisticated interaction between a baby and an adult where both the baby and the adult are involved in the initiation, regulation and termination of the interaction. Reciprocity also applies to the interaction between adults. Helps parents and their child to relate © Solihull Approach 14
  15. 15. The Dance of Reciprocity Peak of excitement Acceleration State of attention DecelerationOrientationInitiation Withdrawal or turning away/ lookaway © Solihull Approach 15
  16. 16. Reciprocity and parenting• Helps parents and their child to relate• Tunes in the parent to think about their baby• Increases the parents’ awareness of their child’s needs• Provides a focus and a language for feeding back to the parents about the interaction © Solihull Approach 16
  17. 17. Behaviour managementBehaviour management is part of the ordinaryprocess of normal development wherebyparents teach their child self-control, thusenabling the child to participate in society.Parents in well-functioning families worktogether to place reasonable boundaries on thechild’s behaviour. They encourage the child withattention and other rewards. Gradually, the childbecomes able to internalise both the restraintsand the satisfactions for himself. It alsofacilitates learning and development. © Solihull Approach 17
  18. 18. How behaviour management relates to containment and reciprocity• Containment and Reciprocity are the foundations for successful Behaviour Management• Behaviour Management will be more effective for a child or young person and parent/foster parent if: – parental emotions are processed and their capacity to think is restored within a containing relationship – parents are able to be part of a reciprocal relationship with their child – behaviour management techniques are based on an understanding of meeting the needs of individual parents and their children and adapted to suit their relationship © Solihull Approach 18
  19. 19. Using the Solihull Approach in practice• Offers a shared language that can be helpful across professions and agencies• Gives a language for reflection and feedback• Parents notice when used as a whole team approach © Solihull Approach 19
  20. 20. Solihull Approach Parenting Programmes• ‘Understanding you pregnancy, labour, birth and your baby’ (Antenatal Parenting Group)• ‘Understanding your Child’s Behaviour’ (Group for Parents) © Solihull Approach 20
  21. 21. Solihull Approach Antenatal Parenting GroupUnderstanding pregnancy, labour, birth and your baby © Solihull Approach 21
  22. 22. Understanding your Pregnancy, labour, birth and your baby Solihull Approach Antenatal Parenting Group• Integrates traditional advice about labour and birth with developing a relationship with their baby• Universal antenatal parenting group• 2 hour sessions for 5 consecutive weeks• Designed for parents to be, ideally to attend all sessions• Puts in to practice the recommendations of Preparing for Pregnancy, Birth and Beyond © Solihull Approach 22
  23. 23. Understanding your Pregnancy, labour, birth and your baby Solihull Approach Antenatal Parenting GroupThe group aims to help parents:• Think about support that will be helpful throughout the pregnancy and birth• Get to know the baby through pregnancy, labour, birth and beyond• Understand information about pregnancy, labour and birth and feeding• Understand the importance of their emotional relationship with their baby © Solihull Approach 23
  24. 24. Understanding your Pregnancy, labour, birth and your baby Solihull Approach Antenatal Parenting GroupSession 1 Helping you and your baby through pregnancy and birth Introduction Processing their own feelings relating to baby Learning about relaxation and breathingSession 2 Getting to know your baby in the womb Getting to know their baby in the womb and the importance of developing their relationship with their babySession 3 Midwife – You, your baby and the stages of labour Thinking about their baby in labour and information about signs of labour © Solihull Approach 24
  25. 25. Understanding your Pregnancy, labour, birth and your baby Solihull Approach Antenatal Parenting GroupSession 4 Midwife - Helping you and your baby through labour and birth Understand the process of labour and pain relief and thinking about the baby Plan for support at homeSession 5 Feeding your baby Information about feeding and the feeding experience for mother and baby and family. Supports Baby Friendly Initiative Other issues relating to when the baby is born, © Solihull Approach 25
  26. 26. Understanding your Pregnancy, labour, birth and your baby Solihull Approach Antenatal Parenting Group Containment I’m frightened about the labour and it will hurt but now I am looking forward toReciprocity it because I can’t wait to meet my baby A Mother Attending the group provided a containing experience where the mother’s capacity to think is clear. She is developing a relationship with her baby and has her baby in mind © Solihull Approach 26
  27. 27. Understanding your Pregnancy, labour, birth and your baby Solihull Approach Antenatal Parenting Group Containment I realise I need to talk to my mother in law if we are both going to support my wife when she is in labour and I need to make sure I am calm A FatherFatFather understating his role in providing a containingexperience for his partner and also being aware of his ownneeds © Solihull Approach 27
  28. 28. Understanding your Child’s Behaviour © Solihull Approach 28
  29. 29. Understanding your Child’s behaviour Solihull Approach group for parents• 10 week x 2hour• Universal need to complex need – i.e. CAF levels 1-3 years• Group suitable for children aged 0-18 years - 0-4 years - 4-11years - 11-18years © Solihull Approach 29
  30. 30. Understanding your Child’s behaviour Solihull Approach group for parentsThe group aims to: Develop a framework of thinking about parent/child relationships which can be developed into a lifelong skill Give parents a strategy for repair when things go wrong © Solihull Approach 30
  31. 31. Understanding your Child’s behaviour Solihull Approach group for parents Promote sensitive and effective parenting Builds lifelong skill and reflective parenting style © Solihull Approach 31
  32. 32. Understanding your Child’s behaviour Solihull Approach group for parentsSessions1. Introduction2. How are you and your child feeling?3. Tuning into your child’s developmental needs4. Responding to your child’s feelings5. Different styles of parenting © Solihull Approach 32
  33. 33. Understanding your Child’s behaviour Solihull Approach group for parents6. Parent-child partnership- Having fun together7. The rhythm of interaction and sleep8. Self regulation and anger9. Communication and attunement- how to recover when things go wrong10. Celebration! © Solihull Approach 33
  34. 34. EvaluationData from 72 completed pre and post measuresMeasures• The Child Behaviour Checklist (CBCL)• The Strengths and Difficulties Questionnaire (SDQ)• Beck Anxiety Inventory (BAI) (parental self report) © Solihull Approach 34
  35. 35. Evaluation Changes in BAI scores 10% stayed same28% went 62% wentup down © Solihull Approach 35
  36. 36. Evaluation• Interesting findings that while for most parents anxiety reduced just under a third anxiety increased• Questions for further research or analysis to look at relevance of anxiety levels to parenting• One suggestion is an increase in anxiety can be helpful for parenting.• Parents may become more in tune with their child that leads to the parent being more aware of their child’s needs and therefore more anxious• A degree of anxiety in parenting is protective for the child © Solihull Approach 36
  37. 37. Understanding your Child’s behaviour Solihull Approach Group for ParentsContainment I feel a lot calmer and more in control A Mother Sessions…… © Solihull Approach 37
  38. 38. Understanding your Child’s behaviour Solihull Approach Group for Parents Containment Since doing the course I don’t think I have ever kind of hit the panicReciprocity button like I used to …. I just didn’t know what was going on. I feel like I’m very much in tune with him now. And I really enjoyed that….. I feel like I’m more sensitive. I know now Fat that she likes to be close and touch. And its brilliant. I can pick up on that Father has now A Father Sessions ….. © Solihull Approach 38
  39. 39. EvaluationAttendance at a Solihull Approach Parenting Group is associated with• Changes in behaviour• Significant changes in parental anxiety• Statistically significant link between changes in behaviour and reduction in parental behaviour © Solihull Approach 39
  40. 40. Parent Evaluation• 137 parents completed feedback questionnaires on their experience of each of the 10 sessions of the group• We asked them: 1. How relaxed they felt 2. How able they felt to share experiences 3. How much the group enabled them to understand their child and how much the group enabled them to change © Solihull Approach 40
  41. 41. Parent Evaluation• The results show that parents found UYCB highly satisfactory as measured by a simple, non-literacy-based evaluation form• 98% of people felt that the group helped them to relax and share experiences. The unexpected results happened with the next two questions © Solihull Approach 41
  42. 42. Parent Evaluation• This graph shows that parents understanding of their child increased over the 10 sessions (red line). © Solihull Approach 42
  43. 43. Parent Evaluation• This graph shows how much the group enabled them to change (red line). © Solihull Approach 43
  44. 44. Parent Evaluation• Jane Barlow, University of Warwick, systematically reviewed parenting programmes for NICE and found that effective parenting programmes tended to consist of 10 sessions of 2 hours each. But why? © Solihull Approach 44
  45. 45. Parent Evaluation• Interesting! Understanding comes before change. And both increase over 10 sessions.• This fits with social learning theory, that we learn from others in different ways, so its perhaps not surprising that it takes a bit of time for us to change our parenting.• 10 sessions for most people! © Solihull Approach 45
  46. 46. Evaluation of Solihull Approach Parenting Group ‘Lots of things have changed likemy son’s sleep routine and theway I ask the children to dosomething’ ‘My outlook and attitude towards parenting have changed.’ ‘I personally am a lot calmer’ © Solihull Approach 46
  47. 47. Evaluation of Solihull Approach Parenting Group‘It’s made me step back and lookat the situation and relate it tothe child’s age’ ‘I’ve been able to look at different ways to approach things and look at ways how others feel’ © Solihull Approach 47
  48. 48. Evaluation of Solihull Approach Parenting Group‘I feel I have learnt a great ‘I have learned that anger isdeal about understanding OK and that you can repairfeelings, my own as well as situations rather than leaving’my child’s’ © Solihull Approach 48
  49. 49. Evaluation of Solihull Approach Parenting Group My child’s tantrums are shorter and less often’ ‘My understanding of my child’s‘I feel I have learned more about behaviour is better.understanding a child and lookingat everything from a child’sperspective’ © Solihull Approach 49
  50. 50. Evaluation of Solihull Approach Parenting Group‘I definitely listen to my child more andspend more time with them in termsof playing and “quality time”’ ‘I have learned how to communicate with my child effectively. I’m more relaxed playing with the kids and I feel calmer and more organised’ © Solihull Approach 50
  51. 51. The importance of the relationship to children in the UK• Improving parenting improves the relationship with the child• Relationships are central to the emotional well- being of children and can seriously impact on later adult mental health © Solihull Approach 51
  52. 52. References• Bateson,K,. Delaney, J. and Pybus,R. (2008) Meeting expectations: the pilot evaluations of the Solihull Approach Parenting Group. Community Practitioner, 81, 28-31• Johnson, R. and Wilson, H. (2012) Parents’ Evaluation of ‘Understanding Your Child’s Behaviour’, a parenting group based on the Solihull Approach Community Practitioner 85 (5) 29-33• Barlow,J. et al. (2009) Birth and beyond: stakeholder perceptions of current antenatal education provision in England. Department of Health• Preparing for Pregnancy, Birth and Beyond Department of Health © Solihull Approach 52
  53. 53. Contact details• Mary Rheeston- Solihull Approach Manager• Address: Kingshurst Clinic, Marston Drive, Kingshurst, Birmingham. B37 6BD• Tel: 0121 329 1910• Email: solihullapproach@heartofengland.nhs.uk• Websites:For Professionals - www.communityservices.nhs.uk/solihullapproachFor parents - www.solihullapproach.com © Solihull Approach 53
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