The Greater Manchester (GM) i-THRIVE Programme team spoke with Dr Caroline White, Consultant Clinical Psychologist and head of the Children And Parents Service (CAPS) Manchester about how the service provides an integrated support pathway for families.
The National Institute of Health and Care Excellence (NICE) has highlighted Manchester Children and Parents Service (CAPS) as a model of best practice for Early Years Social and Emotional Wellbeing, and a service which is easily accessible, providing wrap-around support to families who need it.
The CAP service is a jointly commissioned, multi-agency partnership between health (Child and Adolescent Mental Health Services, CAMHS), Early Years (Manchester City Council), and 4 voluntary sector organisations: Family Action, Barnardo’s, Big Life, and Manchester Home-Start, providing early intervention services for pre-school children and their families. It has a long standing record of delivering effective Incredible Years (IY) Parent Programmes and Video Interaction Guidance (VIG) to a diverse population of families with children experiencing emotional and behaviour problems across Manchester. Recently the service has been commissioned to expand their Parent Infant Mental Health (PIMH) offer.
Image by Children and Young People Now:
How have you managed to successfully build a sustainable Child and Parent Service?
Dr Caroline White: The CAP service has been running for 21 years and has successfully survived austerity and public sector cuts. A number of factors have been responsible for the successful implementation of this service:
1. Using evidence based models and ensuring model fidelity
We already know what works in terms of early intervention, thus we ceased to expend our energy and resource looking for the next new thing or ‘home grown’ interventions. Instead we invested resources into what works and in particular, Incredible Years (IY) parenting courses. Numerous independent, randomised controlled trails provide supporting evidence for the IY courses.
As a team we made a real commitment to ensuring model fidelity of IY, with accredited video supervision of parenting course leaders and all practitioners achieving accreditation. These standards have been maintained throughout, despite many challenges regarding the costs of and access to accredited supervision from appropriately qualified IY practitioners, and the lack of understanding regarding its importance. We see accreditation as essential in ensuring that practitioners are delivering the programme with model fidelity so they achieve the same outcomes as in the research literature.
2. Having a collaborative approach
A multi-agency steering group was set up with representatives from all partners involved from the outset. This initially included CAMHS, Early Years, Family Action, local commissioners and strategic leads. The format of this group has changed many times over the years, however a collaborative approach has always remained.
3. Robust outcomes measure (ROMs) collection
We collect standardised and validated measures (Eyberg Child Behaviour Inventory, Beck Depression Inventory, Abidin Parenting Stress Index) from the outset, pre-intervention, post-intervention and at 3 months follow up to ensure the courses were successful. Data entry, data input and data analysis are regarded as service priorities for providing evidence of effectiveness. We continue to evaluate and publish written reports and data regularly so evidence of effectiveness is accessible and the learning is widely circulated.
4. Establishing a training hub
The service made an early commitment to becoming a training hub in the delivery of IY courses. This enabled a rapid expansion of the programmes and reduced cost in terms of training more people to deliver, and being able to provide in-house accredited supervision. Additionally, we provide ongoing training, supervision and consultation to the wider Early Years workforce; enabling the workforce to have strength based conversations and work collaboratively with families in ensuring shared decision making, a key principle of the THRIVE Framework for system change (Wolpert et al., 2019).
5. Having champions
We have found that having identified champions in services is essential, as they act as positive role models for effective change, advocating for evidence based practice. Dr White made it clear that for this to be successful, the champions must have the necessary influence and budget required to achieve effective change.
6. Access to high-quality supervision and consultation
Implementation research has long provided evidence on the role of supervision in quality assuring service delivery. In order to deliver an effective service and to achieve good outcomes, the workforce needs access to high quality supervision and consultation from specialist supervisors. This is at the core of the service, with continued investment in supervision, videoing, evaluation and audits of the supervision process.
Children and parent annual report
The service has a high staff retention rate, which is attributable to the high quality clinical supervision and investment in the workforce, including staff support, mentoring, and management supervision. This results in high job satisfaction, good job planning, support, and continued professional development with opportunities to progress with the level of IY training. Local commissioners should aim to support the development of their own accredited supervisors to enable cost-savings and service delivery by an experienced workforce, leading to greater sustainability across the system.
The service also offers supervision and consultation to the wider Early Years workforce to build capacity and further develop knowledge and skills to better support families.
How does the Children and Parent Service align with the THRIVE Framework for system change?
The Children and Parent Service is aligned with a number of the THRIVE Framework needs based groupings:
Getting Advice and Signposting
The CAP service aligns with the Getting Advice and Signposting needs based grouping by supporting families navigate services to support their needs. Supervision and consultation to the workforce allow professionals to think holistically about other services which families could benefit from.
IY and VIG fall within the Getting Help needs based grouping of the THRIVE Framework as they are evidence based interventions with clear aims and expected outcomes. Outcome informed practice is core to the delivery of intervention, with a range of goal based and outcome monitoring tools used to assess whether the aims are being achieved on an ongoing basis.
The service continues to offer ongoing specialist supervision from qualified supervisors to the wider Early Years workforce, supporting children, young people and their families in the Getting Help needs based grouping. This helps build greater capacity in the wider Early Years workforce in supporting children and their families.
What have been some of the challenges of implementing service?
Demand for courses has increased as the service has become more established, and whilst courses used to be actively advertised and recruited to, this is no longer required as demand exceeds the resource available.
What has been some of the impact of implementing service?
The Incredible Years (IY) programme has high parent retention rates, with around 81% completing the programme. Parent presenting symptoms of clinical depression fell by almost three quarters, from 68% to 19%, following completion of the programme. As well as reducing the prevalence of clinical conditions and the proportion of families at risk of their development, the programme has been found to additionally support parents in engaging with employment or education. Three months after course completion 24% of parents were back in work, 21% were attending college and 10% were doing voluntary work. To date, several parents who have completed courses have successfully gained employment within the CAPS team and are invaluable family support workers who co-deliver courses to other parents. Many of the parents going through the IY programme are involved in service improvement, recruitment, and coproducing communication resources for the programme.
These dramatic improvements in parent mental health and child behaviour problems represent significant cost savings to multiple agencies. The average cost of an IY parenting course per family is £1,500 as opposed to the cost of a behaviour support worker for one day a week for a year at the cost of £5,000.
YouTube video: Parent highlighting experience of use Manchester CAPS
If you would like further information, please contact Caroline White at email@example.com.
Edited by the GM i-THRIVE Programme Team and National i-THRIVE Programme Team.
Written May 2020.