Meeting Facilitated by Emily Durling (CYP IAPT Under 5s module lead) - - PowerPoint PPT Presentation

Under 5s Meeting

Facilitated by Emily Durling (CYP IAPT Under 5s module lead) and Peter Fuggle (CYP IAPT Programme Director)

Introductions

Agenda

1pm Registration and networking 1.30pm Quick stop tour of the collaborative Tash Byrne 1.40pm Summary of Under 5s CYP IAPT training Emily Durling 2pm Service Evaluation (inc Q&A) by Siobhan Higgins- Lambeth Early Action Partnership (LEAP) CYP IAPT Training measures Emily Durling 3pm Logic model workshop 3.30pm Measures workshop

Quick Stop Tour of the Collaborative

Tash Byrne – Assistant Psychologist for the Programme Team

https://prezi.com/rjbagyuncqzf/what-is/

Anna Freud National Centre for Children and Families

PG Diploma in CYP IAPT Therapy 2017: U5s Under Fives An Introduction

15th March 2017

Anna Freud National Centre for Children and Families

Course Development

• Under fives - new module 2017
• Existing modules: Systemic Family Practice (SFP), IPT, Parenting, CBT
• ASC/LD also new 2017
• Collaboration between AFC, UCL and Kings

National Curriculum

• Provides framework
• Shaping course is an iterative and collaborative process with students

and sites Students 2017

• 10 students, range of professional backgrounds
• Students form an MDT with specialisms and areas to develop

Anna Freud National Centre for Children and Families

1.2 Module Structure The CYP IAPT Under Fives programme is made up of 60 credits and is split into three units: 6A: Fundamental Principles of Working with Under Fives 6B: Intervening to Enhance Attachment in Vulnerable Groups: Video Intervention Feedback to Promote Positive Parenting and Sensitive Discipline (VIPP-SD) (2017) 6C: Interventions for Existing Diagnosable Problems in Children aged 1.5 to 5 years: Incredible Years Parenting Programme (2018) Students on all 6 modules also undertake 60 credits within a core skills module to reach the 120 credits for the PGDip

Anna Freud National Centre for Children and Families

VIPP

Aim of VIPP-SD VIPP-SD is a preventive intervention aimed at increasing sensitivity and improving adequate discipline strategies of caregivers in order to encourage positive interaction between caregiver and child, and to prevent or reduce behavior problems in children aged 1 to 6 years. To reach this goal, the intervenor works on:

• increasing the observational skills of caregivers
• increasing caregivers’ knowledge about the upbringing and

development of young children

• increasing the capacity of caregivers to empathize with

their children

• making caregiving behaviour more effective by using

sensitive responsiveness and sensitive discipline.

Presentation or section title here

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Anna Freud National Centre for Children and Families

VIPP video http://www.vippleiden.com/en/professionals/welcome- professional

Presentation or section title here

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Anna Freud National Centre for Children and Families

1.3 Case Requirements

Unit Case Requirement 6A 8 families

• Range of ages
• 4 children 0-1.5yrs
• 4 children 1.5-5 yrs
• Cultural diversity

6B 4 cases for VIPP

• At least 3 completed cases (5+ sessions)

6C TBC (2018)

• Minimum numbers needed to meet academic

requirements, not something to aim for

• Service paid to protect at least 1 day of clinical time – 88

days (allowing for AL)

Anna Freud National Centre for Children and Families

1.4 Supervision

Practice Tutor Groups

• 6A Fundamental Principles and Core Skills:
• Emily Durling, Jessica Elmer, Jane Alderton
• 6B VIPP:
• Rachel James and Paul Dugmore
• PT groups most weeks
• Groups 3-5 students
• Present video material of clinical work
• Not a substitute for clinical supervision
• Practice Tutors arranging 3 way meetings to

support site supervisors

Anna Freud National Centre for Children and Families

1.4 Supervision cont.

Clinical supervision

• Clinical oversight required within students work

base

• Minimum 1 hour per fortnight – weekly at first

preferable

Personal tutor

• Personal tutor groups approx. twice during year
• Contact personal tutor as soon as possible if any

personal, placement or clinical issues that might impact on you meeting course requirements

• Can request 1:1 meeting

Anna Freud National Centre for Children and Families

• 5. Assignments

Module Assignment Title Assignment Elements Word Length % of Module Assignment Deadline CORE SKILLS Client Participation Project Written reflective analysis and 15 minute oral presentation based on two semi-structured interviews with clients. Oral Presentation + 1,000 words 25% 25.04.2017 (timing of oral presentation to be communicated) (OPTIONAL) FORMATIVE CORE SKILLS Core Skills Theory-Oriented Case Report Written case report 3,000 words None 10AM on 23.05.2017 CORE SKILLS Competency Case Report Written Case Study, demonstrating core CYP IAPT competencies using modality approach. 3,000 words 25% 4PM on 30.06.2017 (OPTIONAL) FORMATIVE CORE SKILLS Session Reflection Opportunity to show whole session video tape in practice tutor group 1h videotape None 11.07.2017 (during practice tutor groups) CORE SKILLS Session Reflection Submission of whole session tape and a written reflective analysis that focuses on part of the session. Session demonstrates use of core skills in a modality therapy session. 1h videotape + 2,000 words 25% Reflective Analysis: 4PM on 29.09.2017 USB containing videotape: 10AM on 03.10.2017 CORE SKILLS Theory Orientated Case Report Written Case Report, to include review of the evidence base and rationale for use of specific modality. 4,000 words 25% 4PM on 01.12.2017 U5s:FUNDAMENTAL PRINCIPLES (6A) Case Report I: Assessment and Treatment Planning Written case report 3000 words 20% TBC 2018 Case Report II: Parent Infant Observation Written case report 3000 words 20% TBC 2018 U5s: VIPP (6B) Whole session recording and reflection 1h Session videotape with selected 5-7 minute clip and Reflective Analysis Video + 1000 words 20% 30.10.2017 Oral Presentation Formative Oral Presentation 14.11.2017 U5s: PARENTING PROGRAMME (6C) Whole session recording and reflection 1h Session videotape with selected 5-7 minute clip and Reflective Analysis Video + 1000 words 20% TBC 2018 Oral Presentation Formative TBC 2018 U5s: ACROSS UNITS (6ABC) Clinical Log 2,000 word feedback report with 1,000 word reflective analysis 3,000 words 20% 03.12.2018

Anna Freud National Centre for Children and Families

• 5. U5s Assignments

Module Assignment Title Assignment Elements Word Length % of Module Assignmen t Deadline U5s:FUNDAMENTAL PRINCIPLES (6A) Case Report I: Assessment and Treatment Planning Written case report 3000 words 20% TBC 2018 Case Report II: Parent Infant Observation Written case report 3000 words 20% TBC 2018 U5s: VIPP (6B) Whole session recording and reflection 1h Session videotape with selected 5-7 minute clip and Reflective Analysis Video + 1000 words 20% 30.10.2017 10am Oral Presentation Formative Oral Presentation TBC U5s: PARENTING PROGRAMME (6C) Whole session recording and reflection 1h Session videotape with selected 5-7 minute clip and Reflective Analysis Video + 1000 words 20% TBC 2018 Oral Presentation Formative TBC 2018 U5s: ACROSS UNITS (6ABC) Clinical Log 2,000 word feedback report with 1,000 word reflective 3,000 words 20% 03.12.2018 10am

Anna Freud National Centre for Children and Families

1.5 Clinical log

Case ID (Unit & No.) Child Demographics (Age in months, ethnicity code) Approach

• No. of sessions seen for

assessment/treatment Outcome measures e.g. B1 (or if counted towards both modules AB1) e.g. 20, A3 e.g. assessment, VIPP e.g. assess (2), treatment (6) e.g. GBM1:T1 (3),T2 (6)

• Throughout the two years of the course students keep

a log of all cases seen in the following format (handbook p.22)

• Standardised ethnicity codes in handbook

Anna Freud National Centre for Children and Families

10.3 Client Summary Sheet (One per case)

Session Number Date of Session Who attended? (e.g. child, mother, health visitor etc.) Learning Points and Reflections Supervised by University

• r Agency supervisor?

(live/retrospective). Actions and Learning from supervision.

• In addition to the clinical log a clinical record should be completed to show

the progress of each assessment or intervention. One clinical record should be completed per case seen. Case ID (from clinical record): Age: Main presenting problem:

• Both your clinical log and client summary sheets should be submitted to your

Practice Tutor at the end of each term. Practice Tutors may also ask to review your clinical log at regular intervals to support your development through the course.

Anna Freud National Centre for Children and Families

8.1 VIPP (6B): Whole session recording and reflection

U5s: VIPP (6B) Whole session recording and reflection 1h Session videotape with selected 5-7 minute clip and Reflective Analysis Video + 1000 words 20% 30.10.2017 10am Oral Presentation Formative Oral Presentation 14.11.2017

• Credits: 12
• Part I: Whole session tape with reflective analysis
• Whole session video tape evidencing key VIPP competencies
• Reflective analysis (1,000 words)
• VIPP specific documentation
• Part II: Oral presentation
• 5-7 minute clip selected from the tape
• Formative for CYP IAPT Diploma – required to move towards

VIPP accreditation

Anna Freud National Centre for Children and Families

Parent Infant Observation

U5s:FUNDAMENTAL PRINCIPLES (6A) Case Report II: Parent Infant Observation Written case report 3000 words 20% TBC 2018

• 5 parent infant observations over 6 months on a child <2
• Reflective case report developing own stance as an observer

Anna Freud National Centre for Children and Families

Clinical Log Assignment

U5s: ACROSS UNITS (6ABC) Clinical Log 2,000 word feedback report with 1,000 word reflective analysis 3,000 words 20% 03.12.2018 10am

• Final assignment will be based on clinical log
• Will need to show have met minimum clinical requirements
• Importance of keeping clinical log and client summary sheets

as you go along

Service Evaluation for Under 5s

Context, Evidence & Issues of Measurement

• Dr. Siobhan Higgins

PAIRS, Lambeth CAMHS

Overview

• LEAP & Work of the PAIRS team
• Challenges of Measurement & Evaluation
• Plan for the future

• Funded by A Better Start
• Cross Service
• Collaboration
• Parents as Partners

LEAP - Lambeth Early Action Partnership

• AIMS
• Comprehensive & Universal Service
• Service Transformation & Systems Change
• Community based & flexible
• Outreach for “Hard to Reach” families
• 10 year program
• Independently evaluated

LEAP - Lambeth Early Action Partnership

LEAP - Lambeth Early Action Partnership

PAIRS: Levels of Intervention

One to One Parent Infant Psychotherapy Group Parent-Infant Support in the community Universal – e.g. integrated into Baby Massage/Stay & Play Community - Attachment principals promoted in the community

• Clinical Work
• Training
• Consultation
• Supervision

PAIRS: 1:1 Service

Parent- infant psychotherapy Focus on:

• Parental representations of the baby
• Maladaptive patterns of interaction
• Baby’s inner world
• Relationship fit between parent & infant
• Use of 5 session model with reviews

PAIRS: Group work

PAIRS: Group work

• Universal
• Children’s Centres
• Watch, Wait & Wonder
• “Together Time”
• Age specific groups

Developing an evaluation structure?

• How are such interventions evaluated?
• What factors influence change?
• What measures are available?

Attachment - Interventions assumptions

Attachment - Measuring change

Approaches to measurement

• Structured observation – given a task/specific toys
• Unstructured observation in natural environment
• Semi structured Interviews
• Task based e.g. Q sort
• Questionnaires
• Definitions & Concepts of Attachment
• Categories vs Constellation/Interactive Concepts

Measuring Change

Attachment as a key outcome?

• Ainsworth’s model

Measuring Change

• The Strange Situation

Measuring Change

Attachment as an outcome?

• Crittenden’s Model

Measuring Change

• Care Index
• Parenting Behaviours
• Sensitivity
• Control
• responsiveness
• Child Behaviours
• Cooperativeness
• Compulsiveness
• Difficulty
• Passivity

Measuring Change

• Attachment Q-Sort
• Adult Attachment Interview
• MORS – Maternal Object Relations Scale

Measuring change

Focus areas in research & clinical interventions

• Adult mental health
• Parental Confidence/Sense of Competence
• Reflective Functioning
• Parental Sensitivity
• Parental Bonding
• Quality of Parent-Infant Relationship
• Child’s Attachment Style
• Infant Development
• Infant’s Psychological Wellbeing

Measuring Change

• Unclear picture

– no holy grail

Measuring Change

• Measurement Challenges
• Mismatch between constructs & measures
• Clinical evaluation often on proxy measures
• “Good” measures difficult to use routinely
• Gap in theory?
• Exact link between specifics of parenting

behaviours & child attachment unclear?

Measuring change

Challenges for a busy clinic & at population level

• Training & reliability meetings
• Cost
• Time
• Validity
• Age range
• Who measured? Parent, child or parent & infant

together

• Family participation pre & post intervention?

Thoughts so far……

Potential Measures for PAIRS & ABS

Clinic/Population Clinic/Population Parent Measures Antenatal 0-4 Reflective functioning Fonaghy’s Reflective Functioning Scale Leuven’s Parental Reflective Functioning Scale Parental Sensitivity PIRGAS (as a proxy)? NICDH Sensitivity Scales? Quality of Parent Infant Relationship Health Behaviours (as a proxy) PIRGAS Parent Outcomes Adult Mental Health GAD 7 & PH9 GAD 7 & PH9 Confidence/ Competence Rosenberg Self-esteem scale Parenting Sense of Competence Scale Parental bonding Mueller’s Prenatal Attachment Scale Maternal Object Relations Scale Child Outcomes Developmental Outcomes Info from 20wk & 32 wk scans Ages & Stages Psychological Wellbeing Ages & Stages SE SDQ post 18 months

www.leaplambeth.org.uk

Parent & Infant Relationship Service

Contact us:

PAIRS Team

020 3228 6771

Evidence Base

• Cochrane review of Parent Infant Psychotherapy (Barlow et

al 2015)

• 8 RCTs including 846 parent-infant dyads (infants 0 – 24

months)

• Key findings
• Significant improvement in child’s attachment style
• Best and quickest outcomes achieved when Mum & Baby in the

room

• Little change in child’s developmental functioning, parental

mental health

Anna Freud National Centre for Children and Families

CYP-IAPT U5s

Routine Outcome Measures (ROMs) to use with Under Fives

15th March 2017

Anna Freud National Centre for Children and Families

Areas of Measurement

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Area Sub-areas Context Child Parental Emotional Wellbeing Parent-Child Relationship Parental representation of child Parental reflective functioning Parental sensitivity Family Context Goals Session Experience of Service

Anna Freud National Centre for Children and Families

Summary of Measures – trialled London, Manchester, Exeter

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Area Sub-areas Context Current View (0-5) Child SDQ(2-4)/ORS (0-5)/ASQ Parental Emotional Wellbeing GAD-7/PHQ-9 (0-5) Parent-Child Relationship Parental representation of child MORS-Baby (0-2), MORS- Child (2-4) Parental reflective functioning Parental sensitivity Family Context Score-15 (0-5) Goals GBO (&Tracker) (0-5) Session SRS (0-5) Experience of Service CHI-ESQ (0-5)

Anna Freud National Centre for Children and Families 61

Area Measure 0 < 2 Measure 2 ≤ 5 Link Overview/Context Current View Current View www.corc.uk.net/outcom e-experience-measures Child Outcome Rating Scale (ORS) (used as proxy outcome T1, T2 measure or as session by session measure), ASQ (paid for measure trialled by Manchester) Strengths and Difficulties Questionnaire (SDQ) & Outcome Rating Scale (ORS) (used as proxy

• utcome T1, T2 measure
• r as session by session

measure) www.corc.uk.net/outcom e-experience- measures/outcome- rating-scale www.corc.uk.net/outcom e-experience- measures/strengths- and-difficulties- questionnaire Parental Emotional Wellbeing PHQ-9 (Patient Health Questionnaire-9), GAD-7 (Generalised Anxiety Disorder-7) PHQ-9 (Patient Health Questionnaire-9), GAD-7 (Generalised Anxiety Disorder-7) www.corc.uk.net/outcom e-experience- measures/generalised- anxiety-disorder- assessment www.corc.uk.net/outcom e-experience- measures/psychological- health-questionnaire

Anna Freud National Centre for Children and Families

Parent- Child Relationship Parental representation

• f child

Maternal Object Relations Scale- Short Form (MORS-SF) – My baby Maternal Object Relations Scale- Short Form (MORS-SF) – My child Not on CORC, available from U5s course team Parental reflective functioning Unmeasured Unmeasured Parental sensitivity Unmeasured (NICHD/PIIOS/Car e Index proposed for 2018 cohort) Unmeasured (NICHD/PIIOS/Care Index proposed for 2018 cohort) Family Context Score-15 Score-15 www.corc.uk.net/outcom e-experience- measures/systemic- clinical-outcome-and- routine-evaluation

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Anna Freud National Centre for Children and Families

Goals Goal Based Outcome (& Tracker) Goal Based Outcome (& Tracker) www.corc.uk.net/outcom e-experience- measures/goal-based-

• utcomes

http://mhpss.net/?get=2 6/1301651242- Goals_Initial_Form_En.p df Session How was this meeting? – Session Rating Scale (SRS) How was this meeting? – Session Rating Scale (SRS) www.corc.uk.net/outcom e-experience- measures/session- rating-scale Experience of Service Commission of Health Improvement – Experience of Service Questionnaire (CHI-ESQ) Commission of Health Improvement – Experience of Service Questionnaire (CHI-ESQ) www.corc.uk.net/outcom e-experience- measures/experience-of- service-questionnaire

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Anna Freud National Centre for Children and Families

MORS: Maternal Object Relation Scale - renamed My baby/child and I

• Developed by John Oates – open university
• Measure of object relations - subjective perceptions of

child likely to be linked to own experiences of others from own life experiences

• Developed from 234 interviews with parents which

suggested two orthoganol (non-overlapping) factors (areas) linked to dimensional descriptions of attachment

• Warmth
• Invasiveness

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Anna Freud National Centre for Children and Families

MORS items:

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My baby… Domain

• 1. … smiles at me

Warmth

• 2. … annoys me

Invasion

• 3. … likes doing things with me

Warmth

• 4. … ‘talks’ to me

Warmth

• 5. … irritates me

Invasion

• 6. … likes me

Warmth

• 7. … wants too much attention

Invasion

• 8. … laughs

Warmth

• 9. … gets moody

Invasion

• 10. … dominates me

Invasion

• 11. … likes to please me

Warmth

• 12. … cries for no obvious reason

Invasion

• 13. … is affectionate towards me

Warmth

• 14. … winds me up

Invasion Rating Score Always Very often Quite often Sometimes Rarely Never 5 4 3 2 1

Anna Freud National Centre for Children and Families 66

Colour Meaning White No concern Light Grey Low concern Mid Grey Moderate concern Dark Grey High concern

Logic Model Workshop

Measures Workshop

Collaborative Under 5s measures document

• A work in progress…
• Collation of information about 53 different measures that

might be considered by Under 5s services

• Information gathered from:
• London and South East CYP IAPT Under 5s implementation group

clinicians

• corc.uk.net (for CYP IAPT dataset inclusion and cost),
• National Clinical Content Repository (for Licensing information),
• MHSDS User Guidance v2.0 ( for MHSDS inclusion),
• Robin Balbernie ‘Assessment and evaluation for early intervention

services’ document (quotes from this in blue),

• Michelle Sleed 'Assessing the parent-infant relationship: A review of

measures and methods' (quotes from this in green),

• Individual product websites for training and cost

Editable google sheet - Please contribute! https://docs.google.com/spreadsheets/d/1oKqAeDQwE02fGZ ck6nesMg-amh4Bh4u4q9Yzc3Upw5o/edit?usp=sharing (this link will be distributed after todays meeting)

Thank you for coming!