navigating a way for ddp in residential care€¦ · important concepts for all staff = navigate...
TRANSCRIPT
Navigating a way for DDP in residential care
Dan Knight, Director
Dr Ben Gurney-Smith, Consultant Clinical Psychologist
Our story• This story is about relationships
• We would like to tell the story, co-created with key relationships, of the development of an approach at Clover Child Care Services in using DDP and informed practice
• We are based in Norfolk, we have three homes, 43 staff…11 children…a school
• We hope this will be informative to all but especially those working in children’s group care services
• We hope to tell you what we can in the time we have
• And by we I mean the Royal `we’…..
Acknowledgements and thanks
• Kath Laidlaw Director of Care, Clover Child Care Services
• Malcolm Pim
• Lesley Ashby
• Charlotte Granger
• Kim Golding and Sue Drake
• We could go on…
What we can and can’t say• We can say we have endeavoured to infiltrate DDP
throughout our organisation-hearts and minds• We can say we are really committed to DDP • We can say it has assisted us in retaining
relationships with children• We can say it has assisted us in retaining our
relationships with our staff• We can’t say we are successful all the time• We can’t say we won’t have a placement
breakdown• We can’t say we get it right all the time
About Clover now• Clover Childcare Services Ltd: Placement Outcomes 2008 –
present we have had:
• 20 Placements over 8 years: no placement breakdowns
• 11 children remain in placement currently
• 9 children & young people have experienced successful planned moves from the Homes…
• Of the 9 who have moved on, we remain in contact with 7 of the young people.
The original template (which fits with DDP)
Education
The kids
Health
Care and Accommodation
The triad for stability
Right staff
Right children
Right location
How we get the right staff
Dr Lesley Ashby
• Needs of children were clear cut but there was a mutual frustration regarding paucity of services
• Dr Lesley Ashby (retired) Consultant Child & Adolescent Psychiatrist, 20+ years’ experience in CAMHs
• Original Role to provide Consultation to identify any attachment, psychiatric or developmental issues & Promote Reflective Practice became Reflective/ Affective Consults….
• Lesley said: “you should read this book” became “The Katie Book”, Page 82, line 13………..Kath went on DDP Level one
• Need for consultation supported by common language of important concepts for all staff = Navigate training
Ben Gurney-Smith and Charlotte Granger
• Rationale- train all staff uniformly in key principles of DDP and apply the latest thinking to enhancing the outcomes for the children in their care.
• No published training for residential
• Five sessions, over five weeks
• Curriculum involved attachment theory, blocked care, PACE practice in the moment, mindfulness and compassion
Objectives (and measures) of Navigate training
• To enhance knowledge, skills and confidence in application of attachment theory to practice• Greater confidence and effectiveness
• To enhance and inform practice using attachment theory `in the moment’. Knowing and feeling it…..
• To improve ‘care-giver health’ through introduction to mindfulness practice and self compassion exercises• Greater mindfulness and self-compassion?• Mind-mindedness
The data
• All staff (n=29) received a five session training programme delivered over three cohorts (n-=10, 10 & 9) 2013-14 (and then 2015).
• Good returns on effectiveness ratings
• Fewer complete returns on mindfulness and compassion
• A `wait list’ control group was established and showed no changes
Overall effectiveness and confidence significant
7.36.9 6.7 6.5
8.5 8.47.9 8
Confidence and effectiveness by cohort
• Overall highly significant improvement on all
• Cohort 1-all significant positive change except Confidence in Application of Attachment which remained high-a more experienced or a `PACE’ group?
• Cohort 2 & 3 –all significant positive change
Mindfulness and Compassion
• Mindfulness-no significant post group change (25 & 21 pre and post observations)
• Self-compassion• Trend to improvement over group change but not
statistically significant (p=0.068)
• High already compared to population norms
• But change depends on tuition, practice…and may have other outcomes for staff
Mind-Mindedness (a quick look)
• Valence (positive, negative or neutral) measured about the minds of their key child
• Cohort 3-trend to more neutral and less negative but not statistically significant
• Important to look at reflective aspects of care-givers
(other?) Outcomes
• Raised awareness and a common language for staff
• Changed recording on children’s notes
• Provided a foundation for DDP informed practice and is part of staff induction
• Good preparation for DDP Level one and two training 2015-16
Kim Golding
• Kath’s question to Kim….
• Level one and two trainings with Kim and Sue
• DDP1- 20 staff: situation analysis, Parenting in the Moment
• DDP2- 15 staff: Parenting in the Moment 2; “What is DDP informed residential Childcare”
DDP Applications
1. In Practice: the Attitude (PACE), vocabulary- intersubjectivity, reflective-affective dialogue
2. DDP Therapy sessions
3. Key-working built around Pyramid of Need (Kim Golding) and in all reports
4. Recording- detailed records, reports. Reflective Log
5. Supervision
6. Psychiatric Consults
7. Team Meetings
8. Training Strategy
9. Recruitment Process
10.Disciplinary Process 11. Management Approach.
With the child
About the child
About child and adults
About adults
About adults and organisation
Epilogue
• We had an attitude which we now call PACE
• DDP DNA
• It is a relational thing, kids, staff outside agencies-valuing relationships key-we co-created this story with them
• Keeping DDP going requires investment in many structures
• The challenges in becoming a DDP informed organisation-four day training model is inaccessible to residential settings
• The kids have changed us…DDP has changed us….we have been open to this
