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!