The Brighton Model: Health and Support Services provided by the Community Teams

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The Brighton ModelHealth and Support Services
provided by the Community Teams
Amanda Tombs Health Visitor/ Practice
Teacher Tracey Young Specialist Health Visitor
for disabled children
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Brighton and Hoves approach

• CYPT Trust formed in Oct 2006 and combines NHS
  community health and Local Authority childrens
  services
• Health Visitors work geographically in
  multi-disciplinary teams
• Some services remain city wide (Specialist CP
  services and child development centre services)
• Children and Young Peoples Plan sets out the
  priorities for childrens services and how
  services will work together to improve outcomes

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Setting the scene Under 5s - in Brighton and
Hove

• Total of 15,300 children under 5 in the city
• 2950 have targeted enhanced HV service
• City has areas of affluence and areas of high
  deprivation and need
• We have 6 full offer Childrens Centres in the
  city (in communities of highest need)
• There are 130 under 5s with a child protection
  plan, main category is neglect

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Locality Working in under 5s services

• Services organised within 3 localities, each led
  by a Sure Start Area Manager
• The Under 5s teams work geographically
• Teams are led by HVs and they manage the skill
  mix team members
• The HVs are all line managed by a Service Manager
  who has a HV qualification
• Every Under 5s team is linked to one or more
  Childrens Centres

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Teams led by Health Visitors

• HVs provide the universal service for under 5s
• Child Health Promotion Programme leads this work
• Early identification of needs early
  intervention
• Targeting services for hard to reach and those
  most in need
• Moving from health reviews to broader service
  addressing wider determinants of health
• Using CAF assessment for children with additional
  needs HV lead professional

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Our Childrens Centres model

• There are 16 Childrens Centres in the city 6
  full offer and 10 graduated gateway centres
• Citywide approach means that all families will
  have access to a local Childrens Centre
• The HVs and team members deliver the services in
  the Childrens Centres as well as offering home
  visiting support

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6 full Offer Childrens Centres

• Service provision has been directed by Central
  Government to be a full offer centre
• Early education and child-care provision
• Ante-natal and post-natal services, child health
  services and info on health issues
• Info on parenting support, access to groups and
  parenting education
• Information on employment, education training
  opportunities (job centre plus)
• Information and access to local child care (child
  minders etc)

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Gateway Centres

• Found in the less deprived areas of city
• Offer a graduated model of support, depending on
  the local needs of the community
• HVs are not based in the Gateway Centres, but
  attend to deliver services at certain times
• Provide information and/or sign post parents to
  other local services
• Some gateways are in local primary schools,
  community centres or libraries

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Wider locality links

• The team links with
• Midwives
• Area Social Care teams
• GPs
• Speech and Language Staff
• Family Information Service
• Early Years Consultants Child Care Development
  officers, PRESENS (preschool special educational
  needs service)

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Why we moved to a geographical approach to
service delivery

• Team members work from the Childrens Centres and
  provide services which support the local needs
• The team knows their patch and the other services
  that are available locally
• Identify community needs/profiling which means
  support services can be tailored and developed
• Form links with other local service providers
• Larger teams with larger staffing resource
  better cover for sickness/leave etc

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Challenges and changes

• GP feeling out of the loop
• Staff resistance and upheaval mass change on
  city wide basis
• Client expectation to service changes perceived
  service reduction for some
• Labour relations issues policy changes, council
  and health staff together, new organisation etc
• Skill mix and developing staff who are not from a
  health background
• Blurring of roles/boundaries
• City wide services vs area based working

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Successes

• Better for the families with the complex needs
  more staff resources and access to additional
  support
• Development of skill mix workforce
• Autonomy of staff to develop services and groups
  for their local community at the CCs
• HVs have more control over resource allocation
  (ie nursery places, respite care, deployment of
  skill mix)
• More opportunity for multi professional staff
  development
• Better links with other professionals in the area
  (ie SWs, MWs, SLTs)

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In summary

• Area based approach to service delivery
• Families have access to additional services via
  childrens centres (ie childcare early
  education, family support etc)
• Early identification of children and family needs
  which will have a co-ordinated plan to address
  these
• Reduction of health inequalities targeting
  resources and services to those most in need
• Building on HV service, adding other staff
• Working closely with other professionals

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The Solihull Approach
Mary Rheeston, Solihull Approach
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Solihull ApproachFocus on Families CPHVA
conference20-22 November 2008Harrogate
International Centre

• Speaker Mary Rheeston Solihull Approach
  Coordinator / Health Visitor

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What is the Solihull Approach?

• Integrated theory and practice for all
• agencies working with children,
• families and groups

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Solihull Approach Model
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What is the aim of the Solihull Approach?

• To provides a framework for thinking for working
  with families with babies, children and young
  people
• To improve mental health of children and
  positively support long term mental health
• To providing a shared language across child
  workers
• Focuses on health visitors but has extended to
  multi professional groups and multi agency

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The History of the Solihull Approach

• Began in 1996
• Initially a partnership between Health Visitors
  Psychotherapists in Solihull
• Led to an integrated model Containment,
  Reciprocity and Behaviour Management
• Also led to development of comprehensive resource
  packs and training and Solihull Approach
  Parenting Group

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Who has been trained in Solihull Approach?

• Training has now extended to multi agency groups
  in over 200 areas across the UK
• Professionals include health visitors, school
  nurses, paediatric community doctors, social
  workers, nursery nurses, teachers, support
  workers in schools and community, speech and
  language therapists, clinical psychologists,
  child care staff and many other professionals
• Trained 2 groups or professionals in Iceland in
  2007

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Containment

• Containment is where a person receives and
  understands the emotional communications of
  another without being overwhelmed by it and
  communicates this back to the other person. This
  process can restore the capacity to think in the
  other person.

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Containment so what?

• Helps parents and their baby to relate
• Helps the parent to think about their baby/child
• Helps the parent to help their baby cope with
  anxiety and emotion so that the baby is free to
  relate
• Helps the parent process some old emotions so
  that the parent can relate to the actual baby in
  front of them, not a projection of a baby/child

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Reciprocity

• Describes the sophisticated interaction between a
  baby and an adult where both the baby and the
  adult are involved in the initiation, regulation
  and termination of the interaction. Reciprocity
  also applies to the interaction between adults.

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Reciprocity So What?

• Helps parents and their baby to relate
• Tunes in the parent to think about their baby
• Increases the parents awareness of their childs
  needs
• Provides a way of feeding back to the parents
  about the interaction

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Behaviour management

• A process whereby parents help their child learn
  self-control and social rules.
• Behaviour communicates something (feelings,
  needs)

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Behaviour management

• Sensitive and effective behaviour management is a
  product of containment and reciprocity therefore
  placed at the end of the process
• Customised to parent child relationship

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What difference?

• Provides a model for intervening in attachment
  difficulties (links to containment and
  reciprocity)
• Early recognition of lack of reciprocity
• Early intervention
• Earlier referral to specialist services when
  required
• Can improve support for professionals
• Can improve links with specialists

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Why is it useful in practice?

• Provides a consistent approach amongst
  professionals and agencies
• Provides a shared language
• Workers and parents like it
• Experienced professionals can start to use them
  with minimal training
• But the concepts are rich enough to repay years
  of study and practice

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Solihull Approach Training

• Solihull Approach 2 day Foundation Training
• Solihull Approach 1 day Refresher Training
• Train the Trainer Foundation (for Cascade
  Training)
• Solihull Approach 1 day Parenting Group
  Facilitators Training
• Train the Trainers Parenting
• Early Years Foundation Stage Training
• Solihull Approach Fostering and Adoption
  Training
• Solihull Approach Peer Breastfeeding Supporter
  Training

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Solihull Approach Resources

• Solihull Approach Resource Packs
• The First Five Years
• The School Years
• Solihull Approach Parenting Group Resource Pack
• Train the Trainers Manuals Foundation and
  Parenting
• Early Years Foundation Stage Training Manual
• Solihull Approach Resource Pack - Fostering and
  Adoption (due to be published November 2008)
• Solihull Approach Peer Breastfeeding Supporter
  Training Manual
• Solihull Approach Antenatal Resource pack in
  planning stage

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Training Cascade System

• Solihull Approach training
• Has a structured programme of training that is
  manualised
• Uses a range of teaching styles and activities
  designed to be adapted to needs of individual
  training group
• Foundation training has 2 week between training
  days with practical observational homework to
  help link theory to practice

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Sustaining Changes in Practice

• Encourage follow on support session to facilitate
  reflective thinking
• Different models of ongoing support depending on
  needs of individual areas
• -e.g. multiagency or single discipline
  (mulitagency supports interagency working and
  shared language)
• - e.g.varying designs information giving, case
  discussion, workshops, conferences

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What has contributed towards Solihull Approach
being effective

• On reflection
• Shared vision and clear idea of what we want the
  Solihull Approach to represent/do
• Joint working sharing knowledge and experience,
  multi professional and agency approach
• Bottom up with managerial support initial and
  on going developments come from requests from
  practitioners so develops from the needs of
  practice

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What has contributed towards Solihull Approach
being effective?

• Solihull Approach model evolved gradually in
  response to feedback from professionals
• Brought together well established theories that
  were appropriate to practice
• Core Model provides a framework for thinking that
  can be adapted to many aspects of work e.g.
  Parenting Group, Fostering and Adoption, Early
  years Foundation Stage, Peer Breastfeeding
• Spread through word of mouth

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What has contributed towards Solihull Approach
being effective?

• Reflective model of working
• Manualised trainings
• Useful resource packs with theoretical
  information and leaflets for parents
• Developed cascade model with appropriate
  safeguards to retain quality
• Practitioners experience of effective change in
  their practice

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Why is it effective?

• Research
• Douglas Ginty (2001) Changes in
• Practice
• Increased consistency in practice
• No overall increase in time spent with families
  more time spent on initial contact and less of
  following contacts
• Increased job satisfaction / confidence
• Broader understanding of how difficulties develop

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Why is it effective?

• Research
• Douglas Brennan (2004) Effectiveness
• Measured symptom severity and parental anxiety
  pre, post and at follow up
• Very significant reduction in symptom severity
  and parental anxiety about the symptoms
• Average input 3 sessions

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Why is it effective?

• Research
• Whitehead Douglas (2005)
• Health Visitors/ Solihull Approach Trainers - In
  depth interviews
• - Focused more on emotions
• - More reflective and improved consistency
• - Useful with all families and in groups
• - Increased job satisfaction

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Why is it effective?

• Research
• Milford et al (2006) - A Pilot Evaluation Study
  of
• the Solihull Approach using control group
• Assess effectiveness of Solihull Approach
• Quantitative methods
• Showed statistically significant results
• Decrease in distress in favour of Solihull
  Approach group
• Increase parental perception of child difficulty
  in favour of Solihull Approach group
• Greater reduction in overall stress levels in
  Solihull Approach group

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Why is it effective?

• Research
• Bateson, Delaney and Pybus (2008)
• Solihull Approach Parenting Group 72 pre and
• post measurements
• Attendance at a Solihull Approach Parenting Group
• is associated with
• Significant decrease in behaviour problems
• Significant changes in parental anxiety

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CONTACT DETAILS

• Solihull Approach Office
• Address Vaillant Building, Dunster Road,
  Chelmsley Wood, Birmingham. B37 7UU
• Tel [phone]
• Email solihullapproach_at_solihull-ct.nhs.uk
• Website www.solihull.nhs.uk/solihullapproach

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DISCUSSION
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