Under 5s Meeting Facilitated by Emily Durling (CYP IAPT Under 5s module lead) and Peter Fuggle (CYP IAPT Programme Director)
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 behaviorproblems 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 17
Anna Freud National Centre for Children and Families
VIPP video
http://www.vippleiden.com/en/professionals/welcome-professional
Presentation or section title here 18
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. AssignmentsModule 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
ReportWritten 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
SKILLSSession Reflection
Opportunity to show whole session
video tape in practice tutor group1h 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 PlanningWritten case report 3000 words 20% TBC 2018
Case Report II: Parent Infant
ObservationWritten 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 words20% 30.10.2017
Oral Presentation FormativeOral 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 words20% TBC 2018
Oral Presentation Formative TBC 2018
U5s: ACROSS UNITS (6ABC) Clinical Log2,000 word feedback report with
1,000 word reflective analysis3,000 words 20% 03.12.2018
Anna Freud National Centre for Children and Families
5. U5s Assignments
Module Assignment TitleAssignment
Elements
Word
Length
% of
Module
Assignmen
t Deadline
U5s:FUNDAMENTAL
PRINCIPLES (6A)
Case Report I:
Assessment and
Treatment Planning
Written case report3000
words20% TBC 2018
Case Report II:
Parent Infant
Observation
Written case report3000
words20% 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
words20%
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
or 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 report3000
words20% 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
words20%
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
5sContext, Evidence &
Issues of Measurement
Dr. Siobhan HigginsPAIRS, 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 InterventionOne to One
Parent Infant Psychotherapy
Group Parent-Infant Supportin 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 & ABSClinic/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 OutcomesAdult 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 OutcomesDevelopmental Outcomes Info from 20wk & 32 wk
scansAges & Stages
Psychological Wellbeing Ages & Stages SESDQ 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
59
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
60
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
outcome T1, T2 measure
or 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
of 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
62
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-
outcomes
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
63
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
64
Anna Freud National Centre for Children and Families
MORS items:
65
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
AlwaysVery oftenQuite oftenSometimesRarelyNever
543210
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/1oKqAeDQwE02fGZck6nesMg-amh4Bh4u4q9Yzc3Upw5o/edit?usp=sharing (this link will be distributed after todays meeting)
Thank you for coming!