Development of a conceptual model for restorative approach in family service provision

Knowledge of ‘what works’ in early-intervention family services has prompted moves away from approaches which see varied services working autonomously with individual family members, towards provision of multi-agency cross-sector programmes working at a family level. Latterly, some such programmes have adopted Restorative Approach in the belief that delivering services using a more participatory relationship-based framework will support families more effectively. To consider this shift towards use of a Restorative Approach this article explores the concepts and theory that underpin the approach, reflects on how these relate to recommended UK early-intervention family service practice, and constructs a model of family service provision based on the approach. The aim of this article is to consider whether adoption of Restorative Approach has the potential to improve early-intervention family service effectiveness and ultimately have a positive outcome on families

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Together (KAT) Programme

Background Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme - Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes. Methods Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation. Results KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours. Conclusions KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery

Creating safe places: an exploratory evaluation of a school-based emotional support service

School-based interventions for young people with emotional/mental health problems are often provided by external practitioners and their relationship with host schools is a key influence on implementation. Poor integration within school systems, schools’ tendency to define interventions around pupils’ behaviour and teachers’ control over access, may undermine therapeutic relationships. This study examines how one school-based intervention—Bounceback—addressed these challenges. Methods comprised interviews with programme staff, school staff and service users. Bounceback sought to develop therapeutic relationships through creating a safe, welcoming place and maximising pupils’ choice about how they engaged with it. To ensure Bounceback was delivered as intended, staff developed five conditions which schools were asked to meet: adhering to referral criteria, ensuring that attendance was voluntary, appropriate completion of referral forms, mechanisms for contacting pupils and private accommodation to maintain confidentiality. Pupils reported high levels of acceptability and described relationships of trust with Bounceback staff. Although pupils had choice about most aspects of Bounceback, teachers controlled access to it, partly in order to manage demand. The study highlights the need for external agencies to communicate their aims and needs clearly to schools and the importance of peripatetic practitioners being well integrated within their parent organisations

Recruitment and group composition strategies for family-based substance misuse prevention interventions: an exploratory evaluation

Purpose – This paper aims to report findings from an evaluation of the Strengthening Families Programme 10-14 (UK) (SFP 10-14 UK), focusing on the strategies used to recruit families into a universal prevention intervention, the approach taken to group composition, and the experiences of participating families. Design/methodology/approach – Methods comprised interviews with programme coordinating team members, a focus group with programme facilitators, focus groups with parents and young people, observation of programme sessions and coordinator visits to families, and analysis of programme questionnaires. Findings – Paying attention to group composition and the needs of families with challenges holds promise in terms of reach and acceptability, delivery fidelity, enabling intended psycho-social programme processes and promoting positive changes in parenting and family communication. Originality/value – First, the paper examines the development of strategies for recruiting participants, which has been identified as a key implementation challenge. Second, it explores approaches for managing group composition and dynamics in family-based programmes. While much has been written about the development of group norms and peer learning processes in interventions for young people, less has been written about how group dynamics work in programmes involving both parents and young people and the implications for implementation fidelity

Improving relationship-based practice, practitioner confidence and family engagement skills through restorative approach training

Restorative Approach (RA) is an ethos and process that has been linked to a reduction of interpersonal conflict and improved relationships in various service settings but whose use is little explored in family services. This paper describes the findings of an evaluation of a training programme; The Restorative Approaches Family Engagement Project that was delivered to voluntary sector family practitioners across Wales with the intent of increasing the use of RA amongst practitioners and agencies, raising practitioner confidence when working with vulnerable families, and improving the extent to which and how practitioners engage with families. The study employed mixed methods. Quantitative measures investigated pre- and post- training practitioner perceptions of confidence, levels of family engagement, and organisational attitudes to RA. Post-training focus groups explored practitioner opinion of RAFEP and perceived changes to service delivery and receipt. Findings suggest RAFEP training promoted practitioner understanding of RA and increased perceptions of confidence when working with families in four specific aspects: developing positive relationships with service users, increasing communication, identifying service user needs/goals, and facilitating change. Qualitative data indicated that practitioners attributed the increased confidence to the service delivery framework engendered by the training and associated tools which facilitated its use and improved family engagement. Whilst host organisations were generally supportive of practitioners attending RAFEP training there was little evidence that knowledge and use of RA had been fully integrated into practitioner host agencies unless the organisation had previously used a restorative ethos

Exploratory studies to inform full-scale evaluations of complex public health interventions: the need for guidance

No abstract available

Renegotiating inter-professional boundaries in maternity care: implementing a clinical pathway for normal labour

This article presents findings from a study of a clinical pathway for normal labour (Normal Labour Pathway) implemented in Wales, UK. The study was conducted between 2004 and 2006. The pathway aimed to support normal childbirth and reduce unnecessary childbirth interventions by promoting midwife-led care. This article focuses on how the pathway influenced the inter-professional relationships and boundaries between midwives and doctors. Data are drawn from semi-participant observation, focus groups and semi-structured interviews with 41 midwives, and semi-structured interviews with five midwifery managers and six doctors, working in two research sites. Whereas some studies have shown how clinical pathways may act as ‘boundary objects’, dissolving professional boundaries, promoting interdisciplinary care and de-differentiating professional identities, the ‘normal labour pathway’ was employed by midwives as an object of demarcation, which legitimised a midwifery model of care, clarified professional boundaries and accentuated differences in professional identities and approaches to childbirth. The pathway represented key characteristics of a professional project: achieving occupational autonomy and closure. Stricter delineation of the boundary between midwifery and obstetric work increased the confidence and professional visibility of midwives but left doctors feeling excluded and undervalued, and paradoxically reduced the scope of midwifery practice through redefining what counted as normal

Steps Towards Alcohol Misuse Prevention Programme (STAMPP): a school-based and community-based cluster randomised controlled trial.

OBJECTIVES: To assess the effectiveness of a combined classroom curriculum and parental intervention (the Steps Towards Alcohol Misuse Prevention Programme (STAMPP)), compared with alcohol education as normal (EAN), in reducing self-reported heavy episodic drinking (HED) and alcohol-related harms (ARHs) in adolescents. SETTING: 105 high schools in Northern Ireland (NI) and in Scotland. PARTICIPANTS: Schools were stratified by free school meal provision. Schools in NI were also stratified by school type (male/female/coeducational). Eligible students were in school year 8/S1 (aged 11-12 years) at baseline (June 2012). INTERVENTION: A classroom-based alcohol education intervention, coupled with a brief alcohol intervention for parents/carers. PRIMARY OUTCOMES: (1) The prevalence of self-reported HED in the previous 30 days and (2) the number of self-reported ARHs in the previous 6 months. Outcomes were assessed using two-level random intercepts models (logistic regression for HED and negative binomial for number of ARHs). RESULTS: At 33 months, data were available for 5160 intervention and 5073 control students (HED outcome), and 5234 and 5146 students (ARH outcome), respectively. Of those who completed a questionnaire at either baseline or 12 months (n=12 738), 10 405 also completed the questionnaire at 33 months (81.7%). Fewer students in the intervention group reported HED compared with EAN (17%vs26%; OR=0.60, 95% CI 0.49 to 0.73), with no significant difference in the number of self-reported ARHs (incident rate ratio=0.92, 95% CI 0.78 to 1.05). Although the classroom component was largely delivered as intended, there was low uptake of the parental component. There were no reported adverse effects. CONCLUSIONS: Results suggest that STAMPP could be an effective programme to reduce HED prevalence. While there was no significant reduction in ARH, it is plausible that effects on harms would manifest later. TRIAL REGISTRATION NUMBER: ISRCTN47028486; Post-results

Assessing the impact of specialist home visiting upon maltreatment in England: a feasibility study of data linkage from a public health trial to routine health and social care data

Background Follow-up for public health trials may benefit from greater use of routine data. Our trial of a home-visiting intervention for first-time teenage mothers assessed outcomes to the child’s second birthday. To examine its medium-term impact, particularly upon maltreatment outcomes, we designed a study using routine records. Methods We aimed to establish the feasibility of our study design, which combines trial data with routine health, social care and education data using a dissent-based linkage model. Trial participant identifiers were linked to routine health, social care and education data if women did not dissent. Data were forwarded to a safe haven and further linked to de-identified trial outcome data. The feasibility study aimed first to establish the acceptability of data linkage through a discussion group of young mothers and by levels of dissent received by the research team. Second, we assessed levels of accurate linkage to both health (via NHS Digital) and education and social care (both via National Pupil Database, NPD). Third, we assessed the availability of data and levels of missingness for key outcomes received for a sample of target study years. Results Of 1545 mother-child dyads contacted, eight women opted out. The engagement exercise with stakeholders found support for the principle of data linkage, including in the context of maltreatment. Some contributors preferred opt-in consent. Most (99.9%) health records were matched on either three or all four identifiers. Fifty participants were not matched to any health data. Primary outcome data from NPD are derived from any one of three fields, all of which were satisfactorily returned and provided an indication of cases for analysis. Missing data for secondary outcomes varied from 0% (Child looked after status) to 70% (Anatomical Area A&E diagnosis) however when combined with other variables the levels of missingness for outcome decrease. Conclusions Through study set-up and in this pilot, we provide evidence that the main study is feasible, satisfies governance requirements and is likely to generate data of sufficient quality to address our main research questions. Observed levels of missingness or low event rates are likely to affect some secondary analysis (e.g. state transition modelling) although overall were satisfactory