Podcast: Steps to Safety programme

Podcast transcript

Introduction:
Welcome to NSPCC Learning, a series of podcasts that cover a range of child protection issues to inform, create debate, and tell you all about the work we do to keep children safe. At the heart of every podcast is the child's voice, and how what they tell us, informs the work we do.

Ali:
Hi and welcome to the latest NSPCC Learning podcast. This week, we’re discussing our Steps to Safety service. This was an early-intervention programme that we piloted between 2017 and 2018, which aimed to help families living with domestic abuse and help parents with young children reduce stress, respond calmly to conflict and respond more sensitively to their children.

Helen Munn, our Head of Online Services, sat down and had a chat with Paula Telford, one of our Development and Impact Managers, Roberta Neill, one of our Child Service Practitioners and Nicola McConnell, one of our Senior Evaluation Officers, all of whom worked closely on the development, practice and evaluation of the service.

They provide an overview of Steps to Safety, discuss what it was like working with children and their families when delivering the service. They discussed some of the delivery decisions that were made during development and they talk through the outcomes of the feasibility study - what the NSPCC has learnt from this service and how we’re taking this learning forward. And as always, we talk about how the voice of the child was considered at each stage.

There is a focus on a technique called Video Interaction Guidance in the podcast which is called VIG throughout and we do explain what this is in the episode.

Helen began by asking Paula to give an overview of Steps to Safety.

Paula:
Steps to Safety is a programme for families where they are expecting a baby or have a child under five and where there are issues and concerns about domestic violence. To say a bit more about that domestic violence, it's for those families where they see a need to change their behaviour in terms of parental conflict.

It is perhaps where there is situational violence, so things arising out of situations where parents have difficulty in regulating their emotions and that spells out in behaviour. So that might be as a result of their experiences growing up or past trauma. Or for families where parents… where it's bidirectional, where it might be parents being abusive to each other. It is not for families where it's reached a critical threshold of escalating abuse or where it involves coercive power control over one parent - from one parent to another.

Helen:
So, it sounds like it's quite an innovative service. Why did the NSPCC decide to embark on such a programme?

Nicola:
I think we'd gained a lot of experience with services that were delivered before. So, there was a DART service, Domestic Abuse Recovering Together, which is where we’re supporting mother and children once they've separated from the perpetrator and trying to rebuild that relationship which would have possibly been damaged by what they've had to live through.

We had also delivered a service called Caring Dads which tried to address men who had perpetrated domestic abuse, but tried to change their behaviour by thinking about getting them to think about their fathering and how you can't be a good father if you're being abusive to your partner. I suppose it was just recognising that there was a sort of gap there and that some of the fathers who attended Caring Dads had partners who… could have done with some support about how they were parenting their children. And then I suppose for DART… you were very conscious that there was someone missing and no one was addressing his behaviour.

I suppose Steps to Safety was based on a lot of research that was undertaken on looking at what factors led people to be more likely to be a perpetrator of abuse. And also, there was research done on what interventions were most effective in changing behaviour. And so, Steps to Safety was based on, well, putting together what was known to be effective interventions for that situation.

Helen:
And Roberta, as one of the practitioners who works with children and their families to deliver Steps to Safety, can you talk us through the programme?

Roberta:
Certainly. By design, I suppose, the Steps to Safety programme was quite an intensive intervention. It comprises of a four-week assessment and then if that assessment concludes it's the right programme for the family, then we move through into five modules of work which are spread over 26 weeks.

Now to do that, you would be working two sessions per week. And, you know, as we found out, families need a bit of flexibility around that. So probably the shortest time you could have completed the programme in was six months. But with many of our families, most of our families, that did take a bit longer.

So the Steps to Safety assessment was done individually with each parent and it considered the intensity of their aggression, the function of their aggressive behaviour, childhood trauma that could be why the behaviour is happening and the motivation of the parent to make changes and make things better.

And it was all held together with safety planning which was essential in terms of moving forward into the work - that we had a good robust safety plan in and around that family, so that if things did change or take a turn for the worst, we knew exactly what action they needed to take.

Helen:
How about the sessions themselves? How do they work?

Roberta:
Well moving through into the modules then you would have had the first module which would have been joint sessions with both parents and that would have been introducing the core skills that ran throughout the programme.

So, you were introducing your emotional thermometer, your calmness plan, your mindfulness. These were the core that really, every session, for the rest of the programme had elements of this in it. We looked at support networks and we looked at goals. Setting up some personal goals, some couple goals, and then some goals for the work. So that progressing on into the work, they're fairly clear what the family hoped to gather from it and how we could achieve that.

Module two then would have been the VIG which we could have used antenatally. We considered then each parent with the child, so we would have done some individual work with each parent on the child. Then we would have done some work with the couple together and the child and then we got the couple to look at their own interactions with each other through VIG. So that kind of took possibly eight to ten sessions working through that and the intention being to increase the sensitivity and attunement.

Helen:
I'm sorry, Roberta, you mentioned VIG there. For our listeners, could you just explain what VIG is please?

Roberta:
Yes, Video Interaction Guidance is a very strengths-based, video-based service. We video parent and child interactions. We look at those interactions, pick out where the parent is really attuned to the child, where they're doing something that's really affecting how the child is interacting with them with them. So really increasing parents’ awareness of how their behaviour affects our children and what that will bring out in the children.

It's really about being sensitive to the initiatives the child is making and how the parent can respond in a very attuned way to those. It’s strengths-based, so we’re looking at the good interactions and from that, that kind of opens up the parent to a bit of reflection in terms of how some of their other behaviours may affect the child as well. And that can be a good and a real motivator for change.

We've found that parents identifying that for themselves are more likely to start using strategies and using some more of the positive behaviours. So that would be VIG in a nutshell.

Helen:
And how did the families respond to using VIG?

Roberta:
Families loved it. A little bit of anxiety, I suppose, at the onset about being videoed, but we are in an age now where people are kind of more savvy with doing that, you know, with social media and Facebook.

So once families got the idea of what was happening, they seemed to really, really get a lot from that VIG session. I think, because those VIG sessions, because they are positive and strengths-based, they're a bit of confidence building as well. And they're kind of moving people on to a place where they can maybe start to look at things that are a bit more difficult, because they've got a little bit more confidence in themselves.

Helen:
That sounds really great and really interesting and I'm sure it's really beneficial to all the families. So, you've talked about some of the modules - are there any others that you want to talk about that were particularly interesting or beneficial to the families involved?

Roberta:
Yeah. I think with the VIG module on its own - under module three - ran alongside each other, so you were sticking to the design of the programme. You're meant to do a big session a week and a module three session, which was Affect Regulation sessions, so that they were kind of balancing each other out.

But with families, you know, families are busy, people are busy. We had to be a bit flexible about that. But the module, the third module, which was the Affect Regulation, was really working about identifying emotions, looking at primary and secondary emotions, the physical sensations and the emotions and the behaviours that might result because of those.

We looked at managing rejection, anger and jealousy. Looked at triggers for aggressive behaviour and then the strategies for managing some of those feelings that are behind the aggressive behaviours. So those would have been sort of DBT-based strategies, radical acceptance, distraction, distress, tolerance. And we would have done a bit of crisis management with that and encourage active listening. Those sessions, a lot of families did find those very useful as well in terms of beginning to think about their behaviours and to get strategies that they could put in place and use.

Helen:
Thanks, Roberta. Can you give us your perspective as a practitioner? How did you feel when you were delivering the service?

Roberta:
Confident in VIG because I was a fully accredited practitioner and was training for my supervisor. I know the strength and the value of VIG as a service. Some of the other work with the Affect Regulation was new, so I think I was learning with the family. But that was actually quite nice because it was more collaborative, in that we were all kind of learning through the programme together.

Again, there was a lot of having to kind of work out, is this right for the family? Do I need to focus on some of these, you know, manage and rejection, manage and jealousy, is that relevant for this family? We just needed to use a little bit of professional judgment in terms of what might be the right thing for the family because it was a long programme and it was quite demanding on our families in terms of time.

I think what I learned from doing the training to actually implementing the programme was that we just needed to really be flexible and hear from the family what they could do and what they couldn't do and really kind of just be available to work with them around the things that they needed. Which is quite difficult when you're doing a pilot study and you're wanting to kind of evaluate different elements of the programme. And I know that caused some tension. But by and large, you know, the families that I had managed to get through the programme were really positive about it and did feel that it was very useful and very helpful for them.

Helen:
That sounds like it was a learning point in its own right - the need to have that flexibility, to take the individual needs of the family and the children into consideration.

Paula, can you talk a bit about the delivery decisions that were made when developing the service?

Paula:
Yes. This was a service that was quite a long time in delivery, in development, sorry. It had its roots in the previous themes' work, so it had its roots in high-risk families and under 1s. And also, because it's a preventative service, it was decided that it would be for those parents who were expecting a child or had a child under five. So, in order to try and make the changes we needed to make in how the parents were behaving with each other, in order to reduce the effects of the parental conflict on the child as early as we possibly could – so that's why it was that age group.

To think about how we delivered it safely, there are measures built into the service which are partly for evaluation, but also there are quite a few measures in this service that were to do with delivery of practice. And so, there were functional assessments which we decided to change the name of because it didn't make much sense to people. And we started to call it - why is this behaviour happening? What's the meaning of the behaviour?

We had to understand from the outset what the function of the behaviour was. We had to understand, so parents were seen together and separately to make sure that we weren't getting two very conflicting versions of what the violence was and to make sure that we thought it was safe to proceed. And we did risk assessments for that too.

An interesting thing cropped up during the delivery in terms of having safety plans for parents because we'd written in a safety plan which we took from Women's Aid, which of course, was designed predominantly for women who were trying to flee violence. And here we had a programme which could be a woman being violent to a man or bidirectional violence, and so we had to rewrite something that was suitable for a man if he was trying to flee violence as well.

Helen:
And one of the things we talk about in all of our podcasts is the voice of the child. When you made those decisions about delivery, how did you factor in the voice of the child, especially considering that you were talking about under-fives here?

Paula:
Well going back probably to a lot that Roberta has already talked about, I think when you're talking about children that young, you're not relying on communications, you're not relying on direct verbal conversation with them.

We did see the children as part of the programme, but you didn't...rely on information that comes from referring agencies as to how the child is, how they're reacting and how you see the child react in the situation. So, if there is anything about their behaviour or their demeanour that would suggest that they were not okay or behaving differently than normal.

Helen:
So, it comes back to professional judgment again?

Paula:
And observation. I'd just like to add here that actually it was a learning point for us that sometimes we were receiving referrals that were of a much higher threshold than we had expected. And that resulted in a number of child protection referrals being made outside of the organisation and resulted in children being more safely cared for.

Helen:
Okay. If we move on to talk about the feasibility study, Nicola, can you talk us through what the NSPCC has learnt from the service and how we're going to take that learning forward?

Nicola:
I suppose, as Roberta's suggested earlier, what we did find out was that families who went through the programme, they really spoke positively about it in the interviews. The evaluation was led by a team at Oxford University, Jane Barlow and Anita Schrader-McMillian. But the feedback from families was that they spoke really positively about the relationships that they built with the practitioner, but also what they'd learnt from the programme.

But there's a big caveat to that statement, in that, for all the referrals we received very few of those families actually got through the assessment and actually went onto the intervention properly. And there's a number of reasons for that.

Part of it is about probably the level of risk that was residing within the families who were referred. So, we think that over half of the referrals came from social care, social services and once those families, once the team started working with those families, often the level of risk either between the couple or to the child was such that it was clear that Steps to Safety was not appropriate for that family and a different sort of intervention would be needed.

I think VIG was really good at just showing what was actually happening in a really quick way which perhaps conversations or standardised measures would not pick up. But the assessment process and how that was developed by the practitioners to include VIG within that was a really strong way of identifying risks to children and the teams recognising that other interventions was needed.

Helen:
So VIG really is something that has improved practice and has worked really well.

Nicola:
Yeah. It was initially just part of the intervention but what became quite clear, because we were getting lots of people dropping out of the service, was that the assessment process needed to be more engaging and the practitioners recognised that actually if we use VIG as part of the assessment, that's a nice way of actually enabling parents to see the benefit of what Steps to Safety could do at a very early stage. So they would be more motivated but it was also providing information for the practitioners very clearly on the screen about what dynamics were happening within the family.

And I think that's something that has been used in the family, drug and alcohol courts as well, VIG has been used in that way, so it was really good to actually change the intervention during the feasibility study. But I mean, that's the purpose of feasibility - does this intervention work? We found out that actually in its current form, Steps to Safety needs to be changed. But there was an opportunity to make… if we were going to run a similar service in the future, we learned things that should be done differently.

Helen:
And can you give us a bit more detail about that? What do you think would need to change in the future?

Nicola:
I think what Roberta was saying about the intensity of the service. You know, it's really demanding, at least two sessions a week. For some families… they've got busy lives and they couldn't be fitted in. It's actually really demanding for the practitioners as well having to fit around the family, perhaps have a really long day where you're go to visit the family in the evening because that's the best time for the family. And some of our practitioners would have to travel miles before they would actually be doing the work. So that was a really long, intensive way of working for them.

And also, not uncommon with families who were experiencing domestic abuse, working with people who've often had very traumatic lives. So, the assessment process is very draining for the family, for the parent and the practitioner because sometimes people were discussing things about what happened in their childhood. And having to manage that and do the work safely, but also in a way that was considering the needs of a parent - that's really challenging, demanding work.

And we could tell from the data that we were getting from the referral in the assessment, that we were working with families with a high level of need. We had 7% of the parents had been looked after children, so they had grown up in care themselves. That's an indicator of a lot of childhood adversity going on.

When we used measures to look at, so there's a depression, anxiety and stress scale, two-thirds of parents had anxiety, a third of them had depression, 20% of them were reporting stress, 39% were reporting problems drinking. And that's all issues on top of, we already know that there's conflict and abusive behaviour going on. So, you know, really high levels of need and sometimes we've had services where if there's a parent, where there's substance misuse, we won't work with them because we want to focus on a particular thing. Or alternatively we had a service where we were trying to address substance misuse and we were saying if there was domestic abuse, we couldn't work with that family, but actually, Steps to Safety recognised that actually often these things co-occur. So, we're going to try and work with all of that and try and make a difference with that family.

Helen:
Roberta, picking out a point about the demands and the practitioner, what do you think that you learned from delivering this service?

Roberta:
I think I learnt the value of good support - good peer support. And as a team, I suppose here in Belfast, we would have had regular practice meetings where we sort of tried to create that safe space to maybe explore some of the feelings that were around for us as practitioners. It was very intense. And I mean, I suppose in terms of numbers of referrals that we got in Belfast, we weren't overloaded with work but at the same time, there was a degree of intensity with the work that was quite demanding and obviously, then you've got your recording, the agency expectations on top of that as well.

So, it was quite pressured and it was quite intensive. And sometimes families did need a practitioner who could be more flexible than maybe the practitioner was able to be. There was something in that in terms of not everybody's able to do out of hours working. They've got their own commitments and that at home and you know, there were a lot of things like that that had to be considered.

Travel, again, was a big thing in terms of doing this within Northern Ireland. There were a lot of challenges, I found a lot of challenges in terms of holding the casework and managing the sessions, the regularity of the sessions. Families go on holiday, so you were left with a big gap, so it was challenging in terms of the demands of trying to keep to a schedule through the modules of the work.

But again, when we started to be a bit more flexible with that and being able to kind of really develop that VIG assessment, that was really rewarding to be able to kind of tweak and make those adjustments and consider what actually might make this a bit more dynamic for the families and engage them a bit more. So, there was a lot of thinking as well in terms of how to deliver the service.

Helen:
Great, thank you. And Paula, a similar question - what would you say the NSPCC as an organisation has learned from the service?

Paula:
A lot. I think we've already touched on how intensive the service was. I'm not sure whether we've touched on actually the way in which the intervention was delivered. So, after the family was assessed, they then received - if they went on to undertake the intervention period - they were given all of the modules of the intervention and in fact they didn't need all of it.

With some families, we could have said from the very beginning that actually because of how they were, how they came across in their VIG film clips, they didn't need emotion regulation. But because it was part of the intervention, we delivered all of the modules. In hindsight, we would say now that if we were to do it again, it would be a tailored, bespoke intervention as to what parents needed.

I think the other thing was, I suppose going right back to the other end of the continuum, is when we were developing this and I have already said that it was a long time in development, we could have done more market analysis of what the appetite was for the service and who were the best people to refer.

So thinking about the referrals that came from children's social care, which were very often quite high threshold, had we gone to other organisations perhaps say housing where we picked conflicts up earlier from out of hours services etcetera.

Had we done that market insight analysis that we now do - we've learned we need to do - we'd have known which were the best referrers to target, which were the best areas in terms of localities to reach out to, depending what was in their joint service needs analysis plans. We would have engaged our partners and our customers more thoroughly really… and I think we do that as an organisation now, we've learned from that but remember, this is going back quite some time, the development of this service.

Helen:
So, a learning curve for everyone involved.

Nicola:
One of the good things about this service was, it was designed to address domestic abuse in all different types of families. So, the materials, the leaflets, the folders, the images that we used were trying to get away from stereotypes around domestic abuse and they were appropriate for same sex couples.

I think that our aim to make sure that it was accessible to a wider range of families - that was successful.

Helen:
Thanks to Nicola, Paula and Roberta for talking to us about the Steps to Safety service. If you’re interested in reading the feasibility study, then the link is on the webpage.

(Outro)

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