Solihull Approach Workshop

© Solihull Approach 1

Evidence Based Parenting Programmes and Social Inclusion Conference Middlesex University

Mary Rheeston – Solihull Approach ManagerThursday 20th September 2012

Solihull Approach


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


How the Solihull Approach developed

•Originally developed in Solihull between health visitors, psychologists and psychotherapists to help parents with children with sleep difficulties

• Focus on parent and child/baby interacted first, rather than behaviour management advice straight away

• Extended to other professional groups and agencies at the request of professionals e.g. School Nurses, Nursery nurses, Children’s Centre staff, Child Care staff, Midwives, Breastfeeding Coordinators, Education, Fostering and Adoption and Social Workers


How the Solihull Approach developed

• Developed resource packs and training for professionals across agencies with cascade training. E.g. First five years , School years, Fostering and Adoption, Antenatal for midwives and practitioners involved in antenatal period, Early year Foundation Stage

•Groups and group training. e.g. Antenatal Parenting 5 week Group, Solihull Approach 10 week Parenting group, , Peer Breastfeeding Supporter 6 week Training and Foster carer 12 week group training


The Solihull Approach - supporting family relationships to improve

outcomes

Psychoanalytic theory (Bion)

Behaviourism (Skinner)Child Development research (Brazelton)


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.


Containment

Toddler

Baby

Parent


Containment

Received/understood

Toddler

Parent

Baby


Containment

Parent’s head too full

Toddler

Parent

Baby


Difficult childhood experiences

Mental Health problems postnatal depression

Poor relationships with parents

Unprocessed birth historyFatigue

Fertility problems

Housing problemsFinancial

problems

Domestic violenceRelationship issues

/breakup Single parent

Day to day events

Coping with child with behavioural difficulties

Parent’s head too full


Containment

Parents head completely full

Toddler

Baby

Parent


Containment

Parallel Process

Parent

Toddler

Baby

worker


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


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

The Dance of Reciprocity

Peak of excitementAcceleration

State of attention Deceleration

Orientation

Initiation Withdrawal or turning

away/ lookaway

15


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


Behaviour management

Behaviour management is part of the ordinary process of normal development whereby parents teach their child self-control, thus enabling the child to participate in society. Parents in well-functioning families work together to place reasonable boundaries on the child’s behaviour. They encourage the child with attention and other rewards. Gradually, the child becomes able to internalise both the restraints and the satisfactions for himself. It also facilitates learning and development.


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


• 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

Using the Solihull Approach in practice


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 Antenatal Parenting GroupUnderstanding pregnancy, labour, birth and your

baby


• 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

Understanding your Pregnancy, labour, birth and your baby

Solihull Approach Antenatal Parenting Group


The 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




Session 1 Helping you and your baby through pregnancy and birthIntroduction Processing their own feelings relating to baby Learning about relaxation and breathing

Session 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 baby

Session 3 Midwife – You, your baby and the stages of labourThinking about their baby in labour and information about signs of labour




Session 4 Midwife - Helping you and your baby through labour and birthUnderstand the process of labour and pain relief and thinking about the baby Plan for support at home

Session 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,




Attending the group provided a containing experience where the mother’s capacity to think isclear. She is developing a relationship with her baby and has her baby in mind



I’m frightened about the labour and it will hurt but now I am looking forward to it because I can’t wait to meet my baby

A Mother

Reciprocity

Containment


Fat

Father understating his role in providing a containing experience for his partner and also being aware of his own needs



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 Father

Containment


Understanding your Child’s Behaviour


• 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

Understanding your Child’s behaviour Solihull Approach group for parents


The 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



Promote sensitive and effective parenting

Builds lifelong skill and reflective parenting style



Sessions1. 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



6. Parent-child partnership- Having fun together7. The rhythm of interaction and sleep8. Self regulation and anger 9. Communication and attunement- how to recover when things go wrong10. Celebration!



Data 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)

Evaluation


Changes in BAI scores

28% went up

10% stayed same

62% went down

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

Evaluation


Sessions……

Understanding your Child’s behaviourSolihull Approach Group for Parents

I feel a lot calmer and more in control

A Mother

Containment


Fat

Father has

Sessions …..

Understanding your Child’s behaviourSolihull Approach Group for Parents

Since doing the course I don’t think I have ever kind of hit the panic 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 that she likes to be close and touch. And its brilliant. I can pick up on that nowA Father

Containment

Reciprocity


Attendance 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

Evaluation


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


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


• This graph shows that parents understanding of their child increased over the 10 sessions (red line).

Parent Evaluation


• This graph shows how much the group enabled them to change (red line).

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?

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!

Parent Evaluation


‘Lots of things have changed like my son’s sleep routine and the way I ask the children to do something’

Evaluation of Solihull Approach Parenting Group

MAKING CHANGESCHANGES OF ATTITUDE, BEHAVIOUR OR ROUTINE

‘My outlook and attitude towards parenting have changed.’

‘I personally am a lot calmer’


‘It’s made me step back and look at the situation and relate it to the child’s age’


‘I’ve been able to look at different ways to approach things and look at ways how others feel’

INCREASED KNOWLEDGE (OF STRATEGIES, SOLUTIONS, AND CHILDREN’S DEVELOPMENT)



FEELINGS

‘I feel I have learnt a great deal about understanding feelings, my own as well as my child’s’

‘I have learned that anger is OK and that you can repair situations rather than leaving’



IMPROVED UNDERSTANDING

‘I feel I have learned more about understanding a child and looking at everything from a child’s perspective’

‘My understanding of my child’s behaviour is better.

My child’s tantrums are shorter and less often’



IMPROVED INTERACTIONS

‘I definitely listen to my child more and spend more time with them in terms of 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’


• Improving parenting improves the relationship with the child

• Relationships are central to the emotional wellbeing of children and can seriously impact on later adult mental health

The importance of the relationship to children in the UK


• 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

References


• Mary Rheeston- Solihull Approach Manager• Address: Kingshurst Clinic, Marston Drive,

Kingshurst, Birmingham. B37 6BD• Tel: 0121 329 1910• Email: [email protected]• Websites: For Professionals - www.communityservices.nhs.uk/solihullapproachFor parents - www.solihullapproach.com

Contact details

mailto:[email protected]

http://www.communityservices.nhs.uk/solihullapproach




http://www.solihullapproach.com/

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Solihull Approach Workshop