Parent-skills training in intensive home-based family support programs
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Marie Iannos, Greg Antcliff
The role of practitioners in intensive family support programs, which focus on keeping children safe in a "risky" environment, is complex and multifaceted. One important aspect of the worker's role is to assist parents develop the practical skills and knowledge required to meet their children's basic safety needs. This resource will present the evidence-based principles of parent skills training, which could be applied to support parents develop any child care or home care skill.
Vulnerable families at risk of abuse or neglect, or with substantiated abuse/neglect, have complex issues and needs. A range of intensive, home-based family support programs exist which primarily receive referrals from statutory child protection services. The goals of these programs are to reduce re-notification or re-substantiation risk, or to enable child protection to close the case without court involvement, prevent removal into care, or restore a child to their birth family. These programs aim to prevent child protection services involvement and increase the likelihood of children remaining within their families. It is not surprising that service providers in these programs face a challenging task.
An important component of the worker's role in these intensive family support programs is to assist parents to develop the basic practical skills required to meet their children's safety needs. Increasing safety is one of several core outcomes identified by the Resilience-Led Approach(Daniel, Burgess, & Antcliff, 2011), which can be used across all child protection work. Safety can be considered as the parent's capacity to provide physical safety (where children are kept safe from abuse/neglect and family violence), environmental safety (stable and secure housing which is hygienic and free from hazards), and adequate physical care (nutrition, hygiene, healthcare).
How do family support workers in these programs teach parents these practical skills? There is sound research evidence to suggest that the most effective programs for at-risk families have a strong emphasis on providing parent education and skills training based on behavioural and social learning principles. These involve giving explicit instructions, modelling, role-play rehearsal, providing constructive feedback, and setting homework exercises with clear performance criteria to assist parents develop the basic skills required to provide adequate safety and care (e.g., Filene, Lutzker, Hecht, & Silovsky, 2005; Kinney, Haapala, & Booth, 2004). The role of worker is not to simply "show them how", but to model and teach these skills in a supportive, non-judgemental way so that parents may develop a sense of self-efficacy and mastery so to be able to competently perform these tasks with confidence.
It is important to note that other important factors impacting on the family's level of risk - such as parent-child attachment, and parental issues such as mental health, substance abuse, financial stress and family violence - would also be addressed in parallel within these programs. Parent skills training would form one part of an overall case plan, and it is beyond the scope of this article to address these additional issues here.
Table 1 presents a generic practice guide which outlines the seven general steps involved in parent skills training, and are based on the seven step format of the Project SafeCareprogram (Edwards & Lutzker, 2008; Filene et al., 2005; Gershater-Molko, Lutzker, & Wesch, 2002; Lutzker, Doctor, & Kessler,1998). Based on social learning principles, this evidence-based eco-behavioural program is designed for families at risk of abuse or neglect, and provides structured skills training to parents in their own homes in the areas of infant and child health, home safety and cleanliness, and child behaviour management. The seven steps described in Table 1 could be applied to teaching any skill. Bathing a baby safely is used as an example. 1
|Skill: Safe infant care (bathing)
1. Describe the target behaviour or skill
Explain to the parent what the goal behaviours are using simple language - e.g., "we are going to learn how to bathe baby safely".
2. Explain the rationale for teaching the skill
Most skills involve a sequence of behavioural steps. For example, bathing a baby involves pouring the bath, testing the temperature holding and washing the baby etc. Clearly describe the target behaviour by breaking it down into its procedural steps - e.g., "we are going to learn how to pour the bath, how to wash the baby properly, and how to supervise her so she stays safe".
3. Model each behaviour (demonstrate desired behaviours)
Ask the parent to observe you demonstrate each of the behavioural steps. Explain each in detail as you do it. Repeat several times if required.
4. Ask the parent to practice behaviour
Ask the parent to demonstrate the skill immediately after you have shown them. Reassure the parent that the skills take practice, and it's ok not to "get it right" the first time. Encourage them to repeat the skill several times if required. Role-play the skill if appropriate.
Acknowledge and reinforce the parent's effort while they practice - e.g., "this bit is tricky and I can see you are really trying hard, great effort".
5. Provide positive feedback (point out positive aspects of performance)
Provide explicit praise for the aspect of each skill that the parent achieves successfully. Be specific - e.g., "I really liked the way you held baby while you were pouring the bath and tested the temperature before you put her in".
6. Provide constructive feedback (point out aspects of performance needing improvement)
During the learning process, it is expected that there will be aspects of the skill that a parent may find difficult to master. When providing constructive feedback, it is important to explicitly describe what the parent is doing well, and combine this with specific feedback about which behaviour they have not yet mastered or is struggling with, and what they can do to correct it. Focus on behaviour and avoid criticising the parent. Provide practical solutions using clear and simple language - e.g., "you are supervising the baby really well. One thing you could do to make her even safer is to hold her this way [demonstrate and explain]. Let's try it"
7. Review parent's performance
After the parent has practiced the skills under your supervision, set clear homework for them to continue practicing and consolidate the skill. Homework exercises should be clearly defined in behavioural terms and written down on a checklist - e.g., "fill bath, check temperature, bath baby and supervise every evening"
Record the parent's achievements on a checklist to ensure they master every step of the skill they are learning, to meet the skill attainment criteria.
Review and practice those skills at subsequent sessions until the skill is mastered.
Acknowledge and celebrate the parent's achievements as they develop and master skills.
Source: Filene et al., 2005. The SafeCare® Model is a registered trademark. For further information see National SafeCare Training and Research Center.
Teaching parents in at-risk families practical parenting skills to enhance safety, stability and security is an important and challenging task for workers in intensive home-based family support programs. Evidence based programs that emphasise parent education and skills training based on behavioural and social learning principles have been shown to be effective. These involve giving explicit instructions, modelling, role-play rehearsal, providing constructive feedback, and setting homework exercises with clear performance criteria to assist parents develop the basic skills required to provide adequate safety and care. The steps outlined in this resource are based on the seven steps of the Project SafeCare Program (Filene et al, 2005), which can be applied to the teaching of any practical parenting, homecare or childcare skill.
For further information on the SafeCare Model, visit Georgia State University Institute of Public Health, National SafeCare Training and Research Center.
- Daniel, B., Burgess, C., & Antcliff, G. (2011). Resilience practice framework. Paddington, Sydney: The Benevolent Society.
- Edwards, A., & Lutzker, J. R. (2008). Iterations of the SafeCare Model: An evidence-based child maltreatment prevention program. Behaviour Modification, 32(5), 736-756.
- Filene, J. H., Lutzker, J. R., Hecht, D., & Silovsky, J. (2005). Project SafeCare: Issues in replicating an ecobehavioural model of child maltreatment prevention. In K. A. Kendall-Tackett & S. M. Giacomoni (Eds), Child victimisation: Maltreatment bullying and dating violence. Prevention and intervention. Kinston, New Jersey: Civic Research Institute (pp. 18-20).
- Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2002). Using recidivism data to evaluate Project SafeCare: Teaching bonding, safety, and health care skills to parents. Child Maltreatment, 7(3), 277-285.
- Kinney, J. M., Haapala, D. A., & Booth, C. (2004). Keeping families together: The homebuilders model. New Brunswick, New Jersey: Aldine Transaction.
- Lutzker, J. R., Bigelow, K. M., Doctor, R. M., & Kessler, M. L. (1998). Safety, health care and bonding within an ecobehavioural approach to treating and preventing child abuse and neglect. Journal of Family Violence, 13(2), 163-185.