Get documents about "Seminar 4 - Family-centred practice - handout
Document Sample
EARLY CHILDHOOD INTERVENTION AUSTRALIA (VIC)
Seminar on Family-centred practice
OUTLINE
13th August 2010
• Importance of relationships
RELATIONSHIP-BASED PRACTICES: • Neurobiology of interpersonal relationships
ROLE, RATIONALE, AND IMPLICATIONS • Rationale for family-centred practice
FOR TRAINING AND PRACTICE • Practice issues
• Family-centred practice skills and implications
Tim Moore for training
Centre for Community Child Health
• Conclusions
Royal Children’s Hospital
IMPORTANCE OF RELATIONSHIPS IMPORTANCE OF RELATIONSHIPS (cont)
Relationships matter
Relationships affect other relationships
There is strong evidence that the relationships of all
types have a significant impact on the development and Parallel processes operate at all levels of the chain of
well-being of those involved. relationships and services, so that our capacity to relate
to others is supported or undermined by the quality of
● This applies to the relationships between parents and our own support relationships.
children, caregivers and children, parents and caregivers
with children who have disabilities, teachers and children, ● Thus, there is a flow-on effect, in which relationships
professionals and parents, managers and staff, staff and influence relationships
colleagues, and trainers and trainees. ● This flow-on effect can be seen in the relationships
● It also appears to be true of relationships between between early childhood professionals and parents of
professional agencies and communities, and between young children: we model for parents how to relate to their
government and professional agencies or service young children by the way we relate to them
networks.
PARALLEL PROCESS
‘People learn how to be with others by experiencing how
others are with them – this is how one’s views and feelings
(internal models) of relationships are formed and how they
may be modified. You need to have an experience with
Therefore, how parents are with their babies (warm, someone first - then you can
sensitive, responsive, consistent, available) is as important reproduce it.
as what they do (feed, change, soothe, protect, teach).
Similarly, how professionals are with parents (respectful, Gerhardt (2004)
attentive, consistent, available) is as important as what they
do (inform, support, guide, refer, counsel).’
Gowen and Nebrig (2001)
1
PARALLEL PROCESS: IMPORTANCE OF RELATIONSHIPS (cont)
THE ‘PLATINUM RULE’
Relationships form a cascade of parallel
Do unto others as you would have processes
others do unto others The commonalities that we find in all the different types of
relationships suggest that parallel processes operate across
the full spectrum of relationships, not just in the relationship
between professionals and parents.
Jeree H. Pawl (1994-1995)
They can be seen as forming a cascade of parallel
processes
THE CASCADE OF PARALLEL PROCESSES
CHALLENGES TO THE CASCADE HYPOTHESIS
GOVERNMENT ● The ability of parents to relate effectively to their children
is obviously not solely dependent upon (or even primarily
dependent upon) the nature of the support they receive
SERVICES AND
MANAGERS from professionals
● On the contrary, the most important forms of support
SERVICE usually come from their personal networks (family and
PROVIDERS friends) rather than from formal services.
● However, the supportive capacity of their personal
support networks are in turn dependent partly upon
PARENTS
cascade effects
CHILD
THE CASCADE OF PARALLEL PROCESSES
CHALLENGES TO THE CASCADE HYPOTHESIS
GLOBAL
● Some practitioners and managers are able to deliver truly
GOVERNMENT
responsive and family-centred services despite not
SOCIETY
working in a service or environment that supports or
parallels those qualities.
SERVICES AND
MANAGERS COMMUNITIES ● The ability of professionals to support parents effectively
is dependent not only upon the nature of the support they
SERVICE PERSONAL receive from their superiors, but also from their
PROVIDERS NETWORKS colleagues and their own personal networks.
PARENTS
CHILD
2
THE CASCADE OF PARALLEL PROCESSES IMPORTANCE OF RELATIONSHIPS (cont)
SERVICES AND Effective relationships at all levels share
MANAGERS common characteristics
There are nine key characteristics: attunement /
engagement, responsiveness, clear communication,
COLLEAGUES SERVICE PERSONAL managing communication breakdowns, emotional
PROVIDERS NETWORKS
openness, understanding one’s own feelings,
empowerment and strength-building, moderate stress /
challenges, and building coherent narratives
PARENTS
These features appear again and again in the evidence
regarding the qualities of effective relationships of different
types
CHILD
EMOTIONAL COMMUNICATION
Our feelings and emotions are communicated to others in
conscious and unconscious ways
● Conscious communication of feelings is done by
THE NEUROBIOLOGY OF telling others what we feel
INTERPERSONAL RELATIONSHIPS ● Our ability to do this effectively depends upon our
‘emotional intelligence’, that is, our ability to register and
Why you can’t fake relational and articulate our feelings
participatory practices ● Unconscious communication of feelings is done
nonverbally through facial expressions, eye contact, tone
of voice, gestures, posture, and the timing and intensity of
response
EMOTIONAL COMMUNICATION (cont) HORMONAL & NEUROCHEMICAL REACTIONS
● We are constantly communicating our feelings in these
unconscious ways, and constantly (albeit unconsciously) ● Hormonal / neurochemical reactions are involved in all
registering such expressions in others aspects of brain development and functioning
● Tuning to each other's internal states links us in a state of ● When we are babies, the positive looks and smiles we see
emotional resonance that enables each person to ‘feel in our parents trigger the release of pleasurable
felt’ by the other neurochemicals (opiates) that actually help the brain to
grow
● There are three aspects of brain functioning that make
unconscious communication of emotion between people ● Relationships can also protect young children from the
possible: damaging effect of toxic hormones and neurochemicals.
- hormonal and neurochemical reactions, ● Children whose relationships are insecure or disorganized
have higher stress hormone levels which may alter the
- cortical and sub-cortical pathways, and development of brain circuits and make them less capable
- mirror neurons. of coping effectively with stress as they grow up
3
CORTICAL AND SUBCORTICAL PATHWAYS: CORTICAL AND SUBCORTICAL PATHWAYS:
THE ‘HIGH ROAD’ AND THE ‘LOW ROAD’ THE ‘HIGH ROAD’ AND THE ‘LOW ROAD’ (cont)
We take in information about others via two routes:
‘The low road traffics in raw feelings, the high in a considered
● The low road involves subcortical neural circuitry that understanding of what's going on. The low road lets us
operates beneath our awareness, automatically and immediately feel with someone else; the high road can think
effortlessly, with immense speed. Most of what we do about what we feel. Ordinarily they mesh seamlessly. Our
seems to be piloted by massive neural networks operating social lives are governed by the interplay of these two
via the low road – particularly in our emotional life. modes.’ (Goleman, 2006)
● The high road, in contrast, runs through cortical neural ‘The two roads register information at very different speeds.
systems that work more methodically and step by step, The low road is faster than it is accurate; the high road, while
with deliberate effort. We are aware of the high road, slower, can help us arrive at a more accurate view of what's
and it gives us at least some control over our inner life, going on. The low road is quick and dirty, the high slow but
which the low road denies us. mindful.’ (Goleman, 2006)
MIRROR NEURONS
● Mirror neurons are found in various parts of the brain and
function to link motor action to perception: they fire if you
watch someone else doing something intentionally, and
will also fire if you do the same action. RATIONALE FOR FAMILY-
● These neurons don't merely fire in response to any action
seen in another person: the behaviour must have an CENTRED PRACTICE
intention behind it.
● Mirror neurons show that the brain is able to detect the
intention of another person, that is, to ‘read’ other people’s
minds
● Mirror neurons also enable us to ‘read’ (and share) other
people’s emotional states: when we perceive another's
emotions and intentions, even though we do so
automatically and unconsciously, that emotional state is
created inside us.
RATIONALE FOR KEY PRINCIPLES RATIONALE FOR KEY PRINCIPLES OF
OF FAMILY-CENTRED PRACTICE FAMILY-CENTRED PRACTICE (cont)
● If service providers and families work ● If service providers and families work as
collaboratively to identify family goals and partners to determine what action should be
priorities, then services are more likely to taken, then there is a greater probability that
address families’ most salient needs. the desired outcomes will be achieved.
If professionals determine what the goals of If decisions about goals and actions are made
intervention should be, then the issues that are by professionals, then they are less likely to be
most important for families and have most realisable in the circumstances in which the
impact on their lives are likely to be overlooked. family lives.
… cont. … cont.
4
RATIONALE FOR KEY PRINCIPLES OF RATIONALE FOR KEY PRINCIPLES OF
FAMILY-CENTRED PRACTICE (cont) FAMILY-CENTRED PRACTICE (cont)
● If service providers listen to families and ● If service providers support family decision-
establish good working relationships with making, then families are more likely to
them, then parents are more likely to listen to develop the confidence, competence, and
what the professionals have to say and to ability to make decisions about their child and
make better use of professional services. family over their lifetime.
If families feel that the professionals do not really This is important because support services for
understand their views or their circumstances, families drop away significantly as the child gets
then they are less likely to trust and listen to what older, and families need to become more self-
the professionals have to offer. reliant.
… cont. … cont.
RATIONALE FOR KEY PRINCIPLES OF RATIONALE FOR KEY PRINCIPLES OF
FAMILY-CENTRED PRACTICE (cont) FAMILY-CENTRED PRACTICE (cont)
● If service providers and parents share and ● If child and family needs are met solely or
respect each other’s knowledge and primarily through professional sources of
expertise, then better solutions for the child help, then families are more likely to become
and family are likely to be found. dependent upon professional services.
If parent knowledge of the child and family is If service providers help families identify and
ignored, then the intervention strategies are less mobilise family and community sources of help,
likely to be effective. then their dependence on scarce professional
resources is reduced.
… cont.
RATIONALE FOR KEY PRINCIPLES OF
RATIONALE FOR FAMILY-CENTRED PRACTICE (cont)
FAMILY-CENTRED PRACTICE (cont)
● If a major goal of early childhood intervention services is
to promote the capacity of these environments to provide
children with disabilities with the experiences and support
Key principle: they need to participate meaningfully, then a key issue
becomes how to do this successfully – how to share our
How programs are delivered is as knowledge with those who live and work with children in
such way that it will be taken up by them and become part
important as what is delivered of their everyday practice.
● This is one of the effects that family-centred practice has:
it increases the likelihood that what you have to offer will
be used and will be useful.
5
PRACTICE ISSUES
● Is family-centred practice important in all
circumstances for all people?
PRACTICE ISSUES ● Under which circumstances and for what people
is it particularly important?
● Managing strong emotions in others
● Managing one’s own emotions and reactions
● Mindful practice – the relationship with oneself
● Building self-efficacy beliefs in parents
● Measuring family-centred practices
EXPANDED MODEL OF HELPGIVING PRACTICES
(Trivette & Dunst, 2007)
FAMILY-CENTRED PRACTICE SKILLS AND
THE IMPLCATIONS FOR TRAINING
Elements of effective Training needs
helping
Technical knowledge Pre-service training in discipline-specific
and skills knowledge and skills FAMILY-CENTRED PRACTICE:
Ongoing professional development training
in discipline-specific knowledge and skills CONCLUSIONS AND
Ongoing supervision, mentoring and support
TAKE-HOME MESSAGES
Relational practices Training in communication and helping skills
(eg. Family Partnership Model, ECIA two-day
courses)
Ongoing supervision, mentoring and support
Participatory practices Training in family-centred practice (eg. CCCH
professional development module)
Strength-based training (eg. St Lukes,
Bendigo or Bernadette Glass courses)
Ongoing supervision, mentoring and support
6
FAMILY-CENTRED PRACTICE: CONCLUSIONS CONCLUSIONS (cont)
● How services are delivered is as important as what ● Adopting family-centred practice does not have to
is delivered involve more time or resources - it is a question of
how professionals choose to spend their time
● Family-centred practice is a way of working that
has a powerful rationale and proven benefits for ● What professionals talk about and do when they
children with additional needs and their families are with families indicates what their values and
priorities are
● Family-centred practice is not just a specialist
approach for working with families of children with ● Professionals need to think of their relationship
additional needs, but a universal approach with the family as part of the intervention, and their
applicable across a wide range of human services helping skills as therapeutic tools
…cont. … cont
CONCLUSIONS (cont) CONCLUSIONS (cont)
● To close the gap between the rhetoric of our ● To become truly family-centred, professionals and
stated policies and the reality of service delivery, agencies need be self-reflective, making time for
professionals and services need to seek regular ongoing discussion and review of service delivery
feedback from families
● To become truly family-centred practitioners,
● Services need to beware of ‘professional drift’ - professionals need to become self-aware, in tune
the tendency to drift back into providing services with their own feelings, beliefs, values, and what
that are more for the benefit and convenience of makes them uncomfortable or defensive. Only if
professionals than of families we are fully in touch with our own feelings can we
● Adopting a family-centred approach is a process, become attuned and responsive to those of
not an endpoint others.
… cont
Dr. Tim Moore
Senior Research Fellow
Centre for Community Child Health,
Murdoch Childrens Research Institute,
The Royal Children’s Hospital, Flemington Road,
Parkville, Victoria, Australia 3052
Phone: +6139345 6150
Fax: +6139345 5900
Email: tim.moore@mcri.edu.au
Websites: www.rch.org.au/ccch
www.ecconnections.com.au
7
