Benefits and Challenges of Partnership Working

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Benefits and Challenges of Partnership Working

• Jane Rolfe Practice Development Facilitator
  (Health Visiting)
• Maggie Fisher Practice Development Facilitator
  (Child Protection)

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Background

• In April 2000 community staff from 3 Trusts came
  together into the newly formed Mid Hampshire
  Primary Care Trust (MHPCT)
• The PCT restructured the Primary Care Directorate
  to facilitate practice development in line with
  current government priorities
• The Health Visiting Team was brought together
  under one Development Manager

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Map of Mid Hampshire PCT
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Next Steps

• In April 2002 a series of away days and workshops
  were held so staff could participate in the
  development of the Health Visiting Strategy for
  MHPCT
• The aim of these workshops was fourfold
• To identify priorities
• To share good practice
• Develop a PCT wide approach
• To develop a common core service

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Andover Town Centre St Marys Church
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Formation of Task groups

• Five areas identified as core work and task
  groups where formed around these areas-
• Antenatal Task Group
• Post Natal Distress Task Group
• Children in Special Circumstances
• Positive Mental Health
• Health Education and Promotion

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The Process

• Task groups had to identify service provision
  delivery using an evidence based process
• Consultation with stakeholders and service users.
  
• National and local drivers had to be reflected
• Had to meet regulatory and clinical governance
  guidance
• Innovative practice had to fit above criteria

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Family Partnership Model

• Provides a framework for assessing potential
  risks to a childs psychosocial development and
  provides effective support to vulnerable and at
  risk families.
• This Partnership Model aims to intervene during
  pregnancy to promote parent/infant interaction
  and family relationships.
• It allows scant resources to be targeted quickly
  where they are most needed in a needs led
  primary health care approach.

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Family Partnership Model

• There is excellent evidence from the Early
  European Project to support the effectiveness of
  this approach
• Early intervention had been identified as an
  issue in the ante-natal, post-natal distress and
  positive mental health task groups

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Outcomes and Recommendations

• Both the Antenatal Task Group and Positive Mental
  Health Task Group recommended Family Partnership
  Training (5 days) with Early Parent/Infant
  Interaction Module (3 days)
• This training would enable staff to use a
  structured promotional interview for ALL pregnant
  women with postnatal support visits offered as
  required.

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Parent Advisor Model

• All the evidence underpins the importance of
  evolving relationships, secure attachment and the
  effects of environmental influences on the mental
  health of young children
• Evidence from Finland and the UK highlighted
  positive effects in-
• Establishing mutually trusting relationships
• Establishing early identification of need and the
  opportunity for effective appropriate early
  intervention.

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Training in Andover April-June 04

• 10 health visitors, one community staff nurse
  (with a mental health background) and one primary
  mental health worker were trained from across the
  PCT
• The primary mental health worker from the CAMHS
  was to be our supervisor after training
• Training was conducted over 8 weeks from 9.30 am
  5 pm at weekly intervals

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Phoenix Centre Andover where training took place
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Feedback from the training

• This was mainly positive
• Quote from evaluation form An excellent course,
  well planned facilitated. My aims of refreshing
  challenging practice and adopting new methods
  have been met. Look forward to using promotion,
  prevention early intervention on the unhappy
  mums babies who seem to have lost their way.
  Well done
• One health visitor dropped out after week 2 due
  to ill health. 11 participants completed the
  training.

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The Benefits of Using Partnership Working in
Practice.

• All staff report that they can use the model in
  all contexts
• The training and this way of working heightens
  staff awareness of the way they work and
  communicate with clients
• Staff report they feel increased confidence in
  summarising information and giving feedback about
  what they (client and HV) may be thinking, this
  sharing of ideas is very helpful

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The Benefits of Using Partnership Working in
Practice. Early Intervention

• Staff find that often just asking one question
  causes information to snowball, for example in
  the ante-natal promotional interview
• All staff say that they feel the prompts used are
  excellent, in both the ante-natal post natal
  promotional interviews
• Staff note that the questions open parents
  sub-conscious to areas they may not have
  reflected on before

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The Benefits of Using Partnership Working in
Practice

• Health visitors report that it changes practice
• It enables health visitors greater clarity about
  the reasons for contacts/visits
• It is a very respectful way of working that staff
  feel comfortable with
• It allows the clients and the worker to be more
  open and honest about concerns they have and why
  they are visiting
• It challenges assumptions we make about clients

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The Benefits of Using Partnership Working in
Practice

• Staff find it helpful to suspend judgement and
  really listen to what clients are saying
• Health visitors report that by using the
  ante-natal promotional interview it reduces work
  post-natally
• Health visitors have also noted that partnership
  working reduces caseload work as visits are more
  effective - e.g. not hanging on to clients but
  signposting to other services

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The Benefits of Using Partnership Working in
Practice

• Increased job satisfaction
• Through using the early intervention strand staff
  now feel confident in their skills and knowledge
  to enhance parent/child interaction
• Useful model in child protection supervision both
  as partnership working and encouraging staff who
  have been trained in this model to use with their
  complex families

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Practical tips for enhancing parent/infant
interaction
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The Challenges of Using Partnership Working in
Practice

• Supervision is very important-we had the wrong
  person in that role, this person has now moved on
• We are now using a peer supervision model that is
  working well
• Equity of service is important-not everyone has
  had the opportunity to be trained in use of this
  model

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The Challenges of Using Partnership Working in
Practice

• Some health visitors who did the training are
  unable to use the promotional interviews as they
  are facing severe staff shortages.
• The clients personality, some clients are very
  private and do not wish to share information.
• Remembering it all and the recording of it all
  afterwards-especially if a lot of information has
  been shared
• Time to explore identified problems-time is often
  an issue for stressed/overloaded staff

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The Challenges of Using Partnership Working in
Practice

• Hard to use in some environments for example when
  another person is present
• Potential is there for the model to work but it
  doesn't always-this is when regular supervision
  becomes crucial to learn from these experiences.

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The Challenges of Using Partnership Working in
Practice

• Time to commit to supervision and travel
  distance.
• Need to keep skills honed and use regularly
  otherwise forget to use it.
• Some staff not open to this way of working

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The Future

• Funding issues preventing further training 10
  Million deficit in PCT
• HVs facing staff cuts and grade mix
• PDFs exploring possible ways of funding further
  training through Professional Development Awards
  other funding streams

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The Future

• At supervision we are exploring ways of using the
  early intervention strand with the young mums2B
  Group
• We are also examining ways of using the Social
  Baby information and snippets of the video in
  1-2-1 settings and groups both ante-natal and
  post-natal

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Wish List

• Ideally would like to train all the HV teams who
  would like to be trained
• We would like to be able to secure funding for
  the PND supplementary module.

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Partnership working

• We all feel this is an excellent way of working
• It increases job satisfaction
• Parents and staff value this approach