MAC and Pulling Together Developmental support for children in cooperation with teachers and parents using Marte Meo and a systemic perspective INGEGERD WIRTBERG Family Therapy and the Future Turku, Finland 13-16 August 2014
Jan 18, 2018
MAC and Pulling Together Developmental support for children in cooperation with teachers and
parents using Marte Meo and a systemic perspective
INGEGERD WIRTBERGFamily Therapy and the Future
Turku, Finland 13-16 August 2014
PresentationOverview: Marte Meo and Coordination Meetings (MAC)
[email protected], [email protected]
- Effect Study: 34 children
- RCT study: 100 children
- Financed by The Swedish National Institute of Public Health
- Presentation of a pilot project: Pulling Together - Financed by The Groschinsky Foundation
Background No evidence of the effects of Marte Meo
The responsibility for and the means to help the ”misbehaving child” was defined by the school (or other agencies) as being outside of its domain.
Responsibility fell between the school and the family – it was unclear who was responsible for helping the child
Marte Meo and Coordination Meetings: MAC
Marte Meo - Maria Aarts,
Video based intervention – to promote developmental support using dialogue (Bråthen), primary and secondary intersubjectivity (Trevarthen)
In MAC the primary intervention is in the school
If desired, an MM intervention can also be provided in the home
Coordination Meetings
Systemic intervention built on ”Open dialogue” and ”Reflecting processes” (Seikulla, Andersen)
Meeting between parents, teacher, MM consultant and (when required) MM therapist. The meeting is led by a Coordinator
The Coordinator’s only task is to invite people to, and then lead, the meetings
Inclusion criteria
4 -12 years of age
Inclusion criteria by category - at least one of following:
Social exclusion Rejection by peers, not invited to parties, not chosen to work and play with by other children,
rejected when they try to initiate contact etc.
Interaction problems Lack of social competence, difficulties in complying with and following rules, generally
”misbehaving” etc.
The childs own well-being Low self-confidence, generally unhappy, low school performance, learning difficulties, short
attention span etc.
Prevalence of behavioural management disorders
• 3-5% High-risk • 7-10% Risk
• 85-90% Normal
Risk and vulnerability
factorsAttachment
Family stress
Neglect
Scool failure
Individul factors
Genetic factors
Resiliance and salutogenic factors
Intelligence
Healthy family-
relations
Social support
Social competence
Managing school
Prevent
and
stop
Discover
Support
Create
Children’s psychosocial health seems to correlate with school performance
To manage school seems to be one of the strongest factors that we know of for children’s future psychosocial development (Vinnerljung et.al 2010)
Seems to be repeated in international research (Hattie 2009)
Teacher-Child relationship from Kindergarten to sixth grade: Early childhood predictors?
Do children develop internalised relationship models to teachers that are fairly stable over the years? (Jerome et al 2008
Early dependency on teachers predicted more conflict for boys, early closeness predicted less conflict in later years
Teacher-child relationship predicts academic outcomes (Hamre & Pianta et al., 2002)
Easier for teachers to relate to children who come to school with more developed ”academic” ability (Jerome et al., 2008)
”What did you learn in school today…”
Family and Network
Does the family ”bless” the school?
School
Does the school ”bless” the family?
The teacher thinks …
Mum said…
The Child is in the centre and the teacher’s question is, ”Will you let me help your child?”
Marte Meo in school Marte Meo Consultant
Teacherschild
Coordination MeetingCo-ordinator
Teachers, Parents, Marte Meo Consultant(Marte Meo therapist)
Marte Meo for the family(Marte Meo therapist)
Parents, children
The Child
What is the child’s need for developmental support?
Co-ordination meeting Filming in class-room
Reviewing with teacher
Intervention Procedure
1. Coordination meetingClarifying the child’s need of developmentSetting goalsStrengthen working alliances
2. Filming in the classroomEditing the film into sequences
3. Reviewing with the teacherFeedback - Feed forward
Coordination meeting: clarifying the change context – Systemic Practise
To clarify the purpose of CMs and the role of the Coordinator
To clarify the teacher’s request for help and establish clear goals
To provide a forum for ongoing evaluation
To coordinate when relevant interventions in school and home
To explore parent’s and teacher’s different ”stories” about the child from a
systemic perspective, and support the co-construction of new stories
To create a context in whch all share a common task – to support the child in her
development – the working alliance
T
To talk – To listen- a Systemic ModelTom Andersen, Jakko Seikkula
To know
To act To actTo feel
To feel
Toknow
To be in a continum?Susan Mc Daniel
Tolerance Coordination Cooperation
Does it work? Results from Effect study Axberg, Broberg, Hansson, Wirtberg: ”Schoolbased intervention - an open trial.“ Fam. Process, vol. 45:375-383
34 children were included
1 family dropped out before the first coordination meeting
33 started – all completed!
Pre-schoolers (age 4-6): 3 girls, 3 boys.
Early school-age (age 7-9): 2 girls, 13 boys
Middle-school age (age 10-12): 4 girls, 9 boys
Small (16) comparison group
Symptom – Parent ratings(CBCL)
* p < .05, ** P < .01 (CBCL N = 30, TRF N = 27 även vid ”Intent – to – treat”)
Symptom - Teacher rating (TRF)
* p < .05, ** P < .01 (CBCL N = 30, TRF N = 27 även vid ”Intent – to – treat”)
MAC – RCT study (One of three methods in a larger project)
Randomised study – MAC and TAU
MAC52 Children
TAU48 Children
Implementation – web-based interviews to all staff of Social Services and School Services.
RCT - StudyMAC – Marte Meo and Coordination meetings
Randomised study (RCT) – 100 children.
52 children MAC, 48 children TAU
In 4 sites
Results 2012-3013
Financed by The Swedish National Institute of Public Health and the Swedish National Board of Health and Welfare
Mean number Teachers: n =MM in school/preschool
Families: n=MM in the home
Films 5 (2-12) 3 (1-7)Review 5 (2-12) 3 (1-7)Coordination meetings
5 (2-12) -
Interventions in MAC – less is more?
Measures of disruptive behaviour at home: Mother’s ratings (2012)
Those who got MAC have 50 % - 25 % better chance to improve if the child has problem according to parents.
Mothers EBCI
Intensity: 84 % in MAC - 31 % in TAU = 53 % more in MAC
Problem: 55 % in MAC - 28 % in TAU = 27 %
Teacher’s ratings pre- and post- intervention: 2013
* p < .05, ** p < .01, *** p < .001
Statistically
significant interaction
effect between MAC and
TAU
Statistically
significant interaction
effect between MAC and
TAU
ConclusionResults promising and encouraging
It is possible to work effectively in a non-clinical setting
By developing a school-based intervention, we have been able to
meet and treat children with heavy symptom loads
It is possible to offer this support to children without their parent
seeking help for themselves
MAC should be used when the child has a clinical level of problems
ConclusionWhen teachers report having a child with externalising
problems it should be taken seriously
Interventions should preferably be commenced before the child’s normal support system breaks down
Even though the intervention has been carried out in the school context the mothers reported significant changes in the children’s behaviour at home.
Strong consumer validity
Present study – compare MAC and MM
Pulling together – a school-parents pilot project
Developmental support for children in cooperation with teachers and parents
Cooperation between school and parents: starting points - Parents
Knowledge about what happens at school – school’s curriculum – home’s curriculum
PTM meetings are an established tradition where the parents receive information about how the teachers work and what they themselves can do at home – integrate to the home curriculum
Parents already go to PTM-meetings – a natural cohort
First PTM meeting:
information and consent
Brief introduction
to the programmewith film.
Filming in classroom
Analysis
Editing
Review:Marte Meo
(Every third week – once a month)
Successive PTM meetings:
Short lecture
Fruit and Film
Small group discussions
General info
Pulling together: an overview
Term 1. 3 meetings
Term 2. 2 meetings
Term 3. 1 meeting
Evaluation
Video supervision for teachers: aims (1)
To increase the teacher’s ability to support the child in her psychosocial development
To increase the teacher’s ability to see the child and support the child’s learning
To increase the teacher’s capacity to see the individual child’s level of development for social interaction and for learning
Video supervision for teachers: aims (2)
To strengthen the teacher in her role
To help strengthen management skills in the classroomTo identify the teacher’s existing communication skills
To help the teacher to use their communication skills in a systematic way to support children’s development
To use video to demonstrate how, step by step, one can support and lead children to desired outcomes
1. PMT-meetings: transfer knowledge, group discussions and fruit
Shared focus of attention
Confirmation
Waiting for the children’s reactions – start of turn-taking
Naming
Further turn-taking
Structure and leadership
Triangulation - to be with more than one
Ending and starting - Transitions
If it works, encourage!
Confirm and name what works!
A nod, a smile, an encouraging comment informs us that we are on the right track!
Naming is magic!
Gottman’s 5-1
Sometimes we forget to look…before we communicate…
Show, smile,
NAMEGOOD FACE!
The face asa safe mirror!
Thumbs up!
Group discussionsTopics:
• Reflections on the pictures• Questions• How to encourage children?• How could they use the transferred
information?
Evaluation
18 children when starting - 15 children when finished, one parent declined to participate
Focus group interview with teachers (3)
Questionnaire for parents (14)
Voices from parents (14)The classroom is quieter and there is a better environment
for learning (7)
Better cooperation in the classroom
My child is more confident (1)
My child has got friends (1)
The children get more encouragement which has increased their learning (4)
No difference for my child (6)
Experience of pt-meetingsSatisfied
Satisfied (12 comments)-Interesting to see films-Learned a lot-Good to see my child’s strengths-Good to see how the teachers make an effort-Fantastic to see the positive change in the classroom-You really see a difference
Room for development
Less satisfied (4)
-Too much talk
-The films are a bit boring
-More ideas of how to encourage children
-You could have introduced exercises to practise the ideas
-More conventional ptms.
Teacher’s voices (3)
Teachers and leadership changed during the process, only one teacher participated in the whole project.
Teachers extremely satisfied with the intervention - the new teachers were ”forced” to participate and were suspicious from the beginning
Teacher’s voicesThe children are now functioning group
This was a good education for us
Fantastic to be able to work over time
Has contributed to: Security, Participation and Stability in the classroom
Saves time
See things I never thought of
Why didn’t we learn this at teacher training
Life is full of transitions!
Next step – to implement the programme in all stages, from pre-school to high-school
Field and ResearchField Research
Research is systematic practice intended to increase knowledge, to utilise knowledge for further practise, and/or to develop new or better products, systems or methods.
Research and development is a term covering three activities: basic research, applied research, and experimental development.
(OECD)
Why should this happen to us?Who defines the field?
From twoto three – itis easy to feelmarginalised
Clinical research - The skills of systemic therapists are useful – there are many meetings with unknown outcomes…
• Alliance: Relationship alliance – Production alliance
• Communication skills: ”The meaning of my communication is the response I get”
• Dialogical perspective – turntaking – building on the other’s initiative
• Recognise the possibilities and risks inherent in the triad
• Solution focused – problems occur daily
• General process skills
Clinical research demandsImplementing clinical methods and research – Many need to
embrace the proposed ideas – not enough with a decision
Some/somebody who has the ”everyday power” to influence
Fidelity - fidelity to the model and to the research project
Passion – Some/somebody need to be strongly committed
”Rigidity” – where ”common sense” has to be ignored in order to explore the effects of doing something a certain way
What enables research as well as introduction of new clinical methods (Fixen, 2005)
Economical resources
Solidarity with the research project during the whole project
The attitude that evaluation is important
Have a solution focused
Don’t make premature decisions
Support from the people who have power in the organisation
THANKYOU!