Workshop Presentation from the Evidence Based Parenting Programmes and Social Inclusion conference held at Middlesex University, 20th September 2012

1. Solihull Approach
Mary Rheeston – Solihull Approach Manager
Thursday 20th September 2012
Evidence Based Parenting Programmes and
Social Inclusion Conference
Middlesex University
© Solihull Approach 1

2. What is the Solihull Approach?
• It is an integrated theoretical model that can be used in
practice
• It brings together 3 theories (Containment, Reciprocity and
Behaviour Management) to provide a way of thinking about
relationships
• It supports professionals in their work with families
• It improves children’s and parents’ emotional relationship and
wellbeing
• In supporting the parent-child relationship it affects brain
development (in particular emotional development) in the
foetus and baby
© Solihull Approach 2

3. How the Solihull Approach developed
•Originally developed in Solihull between health visitors, psychologists
and psychotherapists to help parents with children with sleep
difficulties
• Focus on parent and child/baby interacted first, rather than behaviour
management advice straight away
• Extended to other professional groups and agencies at the request of
professionals e.g. School Nurses, Nursery nurses, Children’s Centre staff,
Child Care staff, Midwives, Breastfeeding Coordinators, Education,
Fostering and Adoption and Social Workers
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4. How the Solihull Approach developed
• Developed resource packs and training for professionals across
agencies with cascade training. E.g. First five years , School years,
Fostering and Adoption, Antenatal for midwives and practitioners
involved in antenatal period, Early year Foundation Stage
•Groups and group training. e.g. Antenatal Parenting 5 week
Group, Solihull Approach 10 week Parenting group, , Peer
Breastfeeding Supporter 6 week Training and Foster carer 12
week group training
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5. The Solihull Approach -
supporting family relationships to improve
outcomes
Psychoanalytic theory (Bion)
Child Development research Behaviourism (Skinner)
(Brazelton)
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6. Containment
• Containment is where a person receives and
understands the emotional communication of
an other without being overwhelmed by it
and communicates this back to the other
person. This can restore the capacity to think
in the other person.
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7. Containment
Parent
Baby
Toddler
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8. Containment
Received/understood
Parent
Baby
Toddler
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9. Containment
Parent’s head too full
Parent
Baby
Toddler
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10. Coping with
Day to daychild with Domestic
events behavioural violence
Relationship issues
Single/breakup difficulties Housing
parent Financial problems
Fertility
problems problems Unprocessed
Mental HealthFatigue birth history
problems postnatal Poor relationships
depression with parents
Difficult childhood
experiences
© Solihull Approach 10
Parent’s head too full

11. Containment
Parents head
completely full
Parent
Baby
Toddler
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12. Containment
Parallel Process
worker
Parent
Baby
Toddler
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13. Containment and parenting
• Helps the parent to think about their child
• Helps parents and their child to relate
• Helps the parent to help their child cope with anxiety
and emotion so that the child is free to relate
• Helps the parent process some ‘old’ emotions so that
the parent can relate to the actual child in front of
them, not a ‘projection’ of a child
© Solihull Approach 13

14. 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. Helps parents and
their child to relate
© Solihull Approach 14

15. The Dance of Reciprocity
Peak of excitement
Acceleration
State of attention Deceleration
Orientation
Initiation Withdrawal
or turning
away/
lookaway
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16. Reciprocity and parenting
• Helps parents and their child to relate
• Tunes in the parent to think about their baby
• Increases the parents’ awareness of their
child’s needs
• Provides a focus and a language for feeding
back to the parents about the interaction
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17. Behaviour management
Behaviour management is part of the ordinary
process of normal development whereby
parents teach their child self-control, thus
enabling the child to participate in society.
Parents in well-functioning families work
together to place reasonable boundaries on the
child’s behaviour. They encourage the child with
attention and other rewards. Gradually, the child
becomes able to internalise both the restraints
and the satisfactions for himself. It also
facilitates learning and development.
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18. How behaviour management relates
to containment and reciprocity
• Containment and Reciprocity are the foundations for
successful Behaviour Management
• Behaviour Management will be more effective for a child or
young person and parent/foster parent if:
– parental emotions are processed and their capacity to
think is restored within a containing relationship
– parents are able to be part of a reciprocal relationship with
their child
– behaviour management techniques are based on an
understanding of meeting the needs of individual parents
and their children and adapted to suit their relationship
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19. Using the Solihull Approach in
practice
• Offers a shared language that can be helpful
across professions and agencies
• Gives a language for reflection and feedback
• Parents notice when used as a whole team
approach
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20. Solihull Approach Parenting
Programmes
• ‘Understanding you pregnancy, labour, birth and
your baby’ (Antenatal Parenting Group)
• ‘Understanding your Child’s Behaviour’ (Group
for Parents)
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21. Solihull Approach Antenatal Parenting Group
Understanding pregnancy, labour, birth and your
baby
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22. Understanding your Pregnancy, labour,
birth and your baby
Solihull Approach Antenatal Parenting Group
• Integrates traditional advice about labour and
birth with developing a relationship with their
baby
• Universal antenatal parenting group
• 2 hour sessions for 5 consecutive weeks
• Designed for parents to be, ideally to attend
all sessions
• Puts in to practice the recommendations of
Preparing for Pregnancy, Birth and Beyond
© Solihull Approach 22

23. Understanding your Pregnancy, labour,
birth and your baby
Solihull Approach Antenatal Parenting Group
The group aims to help parents:
• Think about support that will be helpful throughout
the pregnancy and birth
• Get to know the baby through pregnancy, labour,
birth and beyond
• Understand information about pregnancy, labour and
birth and feeding
• Understand the importance of their emotional
relationship with their baby
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24. Understanding your Pregnancy, labour,
birth and your baby
Solihull Approach Antenatal Parenting Group
Session 1 Helping you and your baby through pregnancy and birth
Introduction
Processing their own feelings relating to baby
Learning about relaxation and breathing
Session 2 Getting to know your baby in the womb
Getting to know their baby in the womb and the
importance of developing their relationship with their baby
Session 3 Midwife – You, your baby and the stages of labour
Thinking about their baby in labour and information about
signs of labour
© Solihull Approach 24

25. Understanding your Pregnancy, labour,
birth and your baby
Solihull Approach Antenatal Parenting Group
Session 4 Midwife - Helping you and your baby through labour
and birth
Understand the process of labour and pain relief and
thinking about the baby
Plan for support at home
Session 5 Feeding your baby
Information about feeding and the feeding experience
for mother and baby and family. Supports Baby Friendly
Initiative
Other issues relating to when the baby is born,
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26. Understanding your Pregnancy, labour,
birth and your baby
Solihull Approach Antenatal Parenting Group
Containment
I’m frightened about the
labour and it will hurt but
now I am looking forward to
Reciprocity it because I can’t wait to
meet my baby
A Mother
Attending the group provided a containing
experience where the mother’s capacity to think is
clear. She is developing a relationship with her baby
and has her baby in mind
© Solihull Approach 26

27. Understanding your Pregnancy, labour,
birth and your baby
Solihull Approach Antenatal Parenting Group
Containment
I realise I need to talk to my
mother in law if we are both
going to support my wife
when she is in labour and I
need to make sure I am calm
A Father
Fat
Father understating his role in providing a containing
experience for his partner and also being aware of his own
needs
© Solihull Approach 27

28. Understanding your Child’s
Behaviour
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29. Understanding your Child’s behaviour
Solihull Approach group for parents
• 10 week x 2hour
• Universal need to complex need – i.e. CAF
levels 1-3 years
• Group suitable for children aged 0-18 years
- 0-4 years
- 4-11years
- 11-18years
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30. Understanding your Child’s behaviour
Solihull Approach group for parents
The group aims to:
 Develop a framework of thinking about
parent/child relationships which can be
developed into a lifelong skill
 Give parents a strategy for repair when things
go wrong
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31. Understanding your Child’s behaviour
Solihull Approach group for parents
 Promote sensitive and effective
parenting
 Builds lifelong skill and reflective
parenting style
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32. Understanding your Child’s behaviour
Solihull Approach group for parents
Sessions
1. Introduction
2. How are you and your child feeling?
3. Tuning into your child’s developmental
needs
4. Responding to your child’s feelings
5. Different styles of parenting
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33. Understanding your Child’s behaviour
Solihull Approach group for parents
6. Parent-child partnership- Having fun
together
7. The rhythm of interaction and sleep
8. Self regulation and anger
9. Communication and attunement- how to
recover when things go wrong
10. Celebration!
© Solihull Approach 33

34. Evaluation
Data from 72 completed pre and post measures
Measures
• The Child Behaviour Checklist (CBCL)
• The Strengths and Difficulties Questionnaire (SDQ)
• Beck Anxiety Inventory (BAI)
(parental self report)
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35. Evaluation
Changes in BAI scores
10% stayed same
28% went 62% went
up down
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36. Evaluation
• Interesting findings that while for most parents anxiety
reduced just under a third anxiety increased
• Questions for further research or analysis to look at
relevance of anxiety levels to parenting
• One suggestion is an increase in anxiety can be helpful
for parenting.
• Parents may become more in tune with their child that
leads to the parent being more aware of their child’s
needs and therefore more anxious
• A degree of anxiety in parenting is protective for the
child
© Solihull Approach 36

37. Understanding your Child’s behaviour
Solihull Approach Group for Parents
Containment
I feel a lot calmer and more
in control
A Mother
Sessions……
© Solihull Approach 37

38. Understanding your Child’s behaviour
Solihull Approach Group for Parents
Containment
Since doing the course I don’t think I
have ever kind of hit the panic
Reciprocity button like I used to …. I just didn’t
know what was going on. I feel like
I’m very much in tune with him now.
And I really enjoyed that….. I feel
like I’m more sensitive. I know now
Fat
that she likes to be close and touch.
And its brilliant. I can pick up on that
Father has now A Father
Sessions …..
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39. Evaluation
Attendance at a Solihull Approach Parenting
Group is associated with
• Changes in behaviour
• Significant changes in parental anxiety
• Statistically significant link between
changes in behaviour and reduction in
parental behaviour
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40. Parent Evaluation
• 137 parents completed feedback
questionnaires on their experience of each of
the 10 sessions of the group
• We asked them:
1. How relaxed they felt
2. How able they felt to share experiences
3. How much the group enabled them to
understand their child and how much the
group enabled them to change
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41. Parent Evaluation
• The results show that parents found UYCB
highly satisfactory as measured by a simple,
non-literacy-based evaluation form
• 98% of people felt that the group helped them
to relax and share experiences. The
unexpected results happened with the next
two questions
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42. Parent Evaluation
• This graph shows that parents understanding
of their child increased over the 10 sessions
(red line).
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43. Parent Evaluation
• This graph shows how much the group
enabled them to change (red line).
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44. Parent Evaluation
• Jane Barlow, University of Warwick,
systematically reviewed parenting
programmes for NICE and found that effective
parenting programmes tended to consist of 10
sessions of 2 hours each. But why?
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45. Parent Evaluation
• Interesting! Understanding comes before
change. And both increase over 10 sessions.
• This fits with social learning theory, that we
learn from others in different ways, so its
perhaps not surprising that it takes a bit of
time for us to change our parenting.
• 10 sessions for most people!
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46. Evaluation of Solihull Approach
Parenting Group
‘Lots of things have changed like
my son’s sleep routine and the
way I ask the children to do
something’
‘My outlook and attitude
towards parenting have
changed.’
‘I personally am a lot calmer’
© Solihull Approach 46

47. Evaluation of Solihull Approach
Parenting Group
‘It’s made me step back and look
at the situation and relate it to
the child’s age’ ‘I’ve been able to look at
different ways to approach
things and look at ways how
others feel’
© Solihull Approach 47

48. Evaluation of Solihull Approach
Parenting Group
‘I feel I have learnt a great
‘I have learned that anger is
deal about understanding
OK and that you can repair
feelings, my own as well as
situations rather than leaving’
my child’s’
© Solihull Approach 48

49. Evaluation of Solihull Approach
Parenting Group
My child’s tantrums are shorter
and less often’
‘My understanding of my child’s
‘I feel I have learned more about
behaviour is better.
understanding a child and looking
at everything from a child’s
perspective’
© Solihull Approach 49

50. Evaluation of Solihull Approach
Parenting Group
‘I definitely listen to my child more and
spend more time with them in terms
of playing and “quality time”’ ‘I have learned how to communicate
with my child effectively. I’m more
relaxed playing with the kids and I feel
calmer and more organised’
© Solihull Approach 50

51. The importance of the relationship to
children in the UK
• Improving parenting improves the relationship
with the child
• Relationships are central to the emotional
well- being of children and can seriously
impact on later adult mental health
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52. References
• Bateson,K,. Delaney, J. and Pybus,R. (2008) Meeting
expectations: the pilot evaluations of the Solihull Approach
Parenting Group. Community Practitioner, 81, 28-31
• Johnson, R. and Wilson, H. (2012) Parents’ Evaluation of
‘Understanding Your Child’s Behaviour’, a parenting group
based on the Solihull Approach Community Practitioner 85
(5) 29-33
• Barlow,J. et al. (2009) Birth and beyond: stakeholder
perceptions of current antenatal education provision in
England. Department of Health
• Preparing for Pregnancy, Birth and Beyond
Department of Health
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53. Contact details
• Mary Rheeston- Solihull Approach Manager
• Address: Kingshurst Clinic, Marston Drive,
Kingshurst, Birmingham. B37 6BD
• Tel: 0121 329 1910
• Email: solihullapproach@heartofengland.nhs.uk
• Websites:
For Professionals - www.communityservices.nhs.uk/solihullapproach
For parents - www.solihullapproach.com
© Solihull Approach 53