The Art and Science of Effectively Engaging, Guiding and Supporting Parents

1. The Art and Science of Effectively Engaging, Guiding and Supporting Parents Dr Crispin Day South London & Maudsley NHS Foundation Trust King’s College, London UNICEF UK Baby Friendly Initiative Annual Conference Glasgow November 28th 2013

4. Health & well-being Couple relationship Family & social support Parent-infant care & interaction Developing parents & infants

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

6. 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

7. 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

8. 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

9. 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

10. Antenatal/Postnatal Promotional Guides & Prompt Cards

11. 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?

12. 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?

13. 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?

14. 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?

15. The FPM Antenatal/Postnatal Promotional Guides A Guided Conversation

16. 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

17. 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)

18. 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)

19. 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

20. What do you see?:Practitioner and parent constructs

21. Parents and practitioners Active, 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)

22. Expert Friendship Dependent Adversarial Avoidant Partnership Family Partnership ModelRelationships and roles

23. 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

24. 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

25. FPM: Essential qualities of the helper • Respectful • Empathy • Warmth • Humility & realism • Strength • Constructive & supportive judgment

26. Family Partnership Model: Engage, guide and support • L • E • S • S • S

27. 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

28. 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

29. The FPM Antenatal/Postnatal Promotional Guides Dissemination and spread

30. 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

31. Promotional Guide Training:Training feedback & evaluation

32. Promotional Guides in Practice:Personal and organisational investment

33. AN/PN Promotional Guides Engaged mothers & fathers Practitioner qualities & skills Commissioning/Service priority Effective additional early support

34. ‘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 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.