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Engaging parents and protecting children?
Results from a randomised controlled trial evaluating the impact of training in
Motivational Interviewing on parental engagement in child protection
Donald Forrester Professor of Social Work Research
Tilda Goldberg Centre for Social Work and Social Care
University of BedfordshireDonald.forrester@beds.ac.uk
Overview
Exploring impact of training and supervision in Motivational Interviewing on skills and outcomes
Using this to explore what is good social work and how we achieve it
But also seeing whether we can do an RCT in frontline child protection work
Can we improve the way workers talk to parents?
MI skills help
engage parents
Training improves
social worker
skills in MI
MI trained workers better at engaging parents
Engagement
associated with
better outcomes
What is Motivational Interviewing (MI)
MI is a directive, client-centred approach to communication that attempts to elicit intrinsic motivation
MI Treatment Integrity (MITI) rates for: Collaboration Autonomy Evocation
Averaged for a MITI score
Study Design: Double Randomization
Children in Need
Service
Team 1
1
2
Team 2
1
2
Team 3
1
2
Team 4
1
2
Team 5
1
2
Team 6
1
2
MI Skills Development Package
2 days initial training
1 day MI in CP work
8 weeks hourly consultations
1 day follow-up workshop
Monthly consultations
MI Skill Scores for Simulated Interviews
no statistically significant difference between the groups before training (t=1.05; df (57) p=0.137),
a significant impact of training (t=3.416, df (26) p=0.002)
mean goes from 2.46 to 3.0 in the MI group
Impact on MITI score in simulated interviews
1
1.33
1.66 2
2.33
2.66 3
3.33
3.66 4
4.33
4.66 5
0
2
4
6
8
10
12
14
16
18
20
T1T2
MITI score
Num
ber o
f wor
kers
Data Collection: 610 families randomized
Follow up with families Observation (2nd visit : T1) Audio recording of meeting Interview (T1 and 20wks T2)
Outcome measures reported here: parental engagement (Working Alliance Inventory), parent anxiety/depression/stress (GHQ-12)
Referral and
Assessment
Children in Need team
First SW visit
2nd or 3rd SW visit
SW asks parent about
observation
Family enters study
S
MI group
Control group
Total
Total families randomised 246 364 610
MI group
Control group
Total
Cases excluded for pre-defined reasons 36 56 92 Cases excluded due to manager overrule 17 13 30
Total cases excluded 53 69 122
Families excluded
MI group
Control group
Total
Total families entering wider dataset 193 295 488
Data collection
Main study sample – more than 2 visits, N=284 (58% of allocations)
256 parents asked (90%)
166 agreed to observation (65%)
132 agreed to research interview (80% of those observed, but 46% of whole sample)
89% had social worker questionnaires
100% had ICT data collected
What factors predicted parental engagement?
Abuse, physical Concerned about happy and secure
Parental, learning disability
Abuse, emotional from DV Parental concerns, depression or anxiety
Parental, social services involvement as a child
Abuse, emotional not DV Parental, personality disorder Social issues, financial problems
Abuse, sexual Parental, other mental health issues
Social issues, housing issues
Abuse, neglect Parental, alcohol misuse Social issues, social isolation
Concerned about learning well Parental, drug-taking Social issues, wider family relationship problems
Concerned about health and development
Parental, domestic violence Rating of overall concern for the family
The worker’s rated MI skill in an interview with an actor 3-6 months before
What factors predicted parental engagement?
Only two predicted parental engagement
Neglect = less engagement
(t=-2.1, p=0.039)
High MI skill = more engagement (t=2.1, p=0.04)
Predictors of stress/anxiety
Similar analysis for stress/anxiety (GHQ 12)
Predictors:
Emotional abuse (higher) (t=2.56; p=0.012)
Social isolation (higher) (t=2.64; p=0.009)
MI skill (lower) (t=-2.31; p=0.023)
Did training make a difference?
MI Non-MIEngagement (WAI)
61.5 61.8
Parent Satisfaction
5.6 5.6
Feelings about Children’s Services
3.5 3.3
GHQ 12.6 13.6WAI Observed 57.5 58.0
Oh no!!!
Review
Training changed simulated practice
MI skills associated with: Parental attitude to worker and services Engagement of parents Wellbeing of parent
But no training impact
“Culture eats training for breakfast”
A social model for evidence based practice
Practice is not primarily produced by individual workers being skilled or by training
It is produced by organisations that set themselves to produce certain types of practice
Local authorities therefore need a vision for the practice they want and then to create the organisation that delivers it
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