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SafeCare September 2020

In this issue:

Interview with Jackson Porter from Samaritans about delivery SafeCare

Jackson Porter

DCJ recently caught up with Jackson Porter, Casework specialist and SafeCare Coach with Samaritans, Newcastle. Jackson shares insights into his experience working with families and in particular, engaging fathers with the SafeCare program.

Could you introduce yourself and tell us a bit about who you are and your role at Samaritans, including your role in the delivery of SafeCare?

My first experience with Samaritans was a student placement in 2010 and I have been with Brighter Futures since 2013, followed by a break to work overseas between 2015 and 2017. When I returned in 2017, a few colleagues and I from Samaritans undertook the first round of SafeCare training in October 2017, so I have basically been there from the beginning. Last year I was fortunate enough to be trained as a SafeCare coach and have really enjoyed that role within the team.

This issue highlights the SafeCare Interim Evaluation Report Webinar which mentions fathers and their interaction with the program, could you explain how Samaritans SafeCare providers have involved fathers in the SafeCare program?

Samaritans SafeCare providers have done some outstanding work with fathers, whether it be single dads or as a partnership with the mother and family. We’ve been really mindful to work extremely hard at engaging dads in the SafeCare program; even if the initial engagement isn’t strong. There is an understanding within the team, due to prior experiences in the sector, that dad’s may be hesitant to engage initially and that we might have to work a bit harder with engagement, but that the rewards will be there if we do.

What do you perceive to be the benefits of fathers’ involvement in the SafeCare program?

This is hard to put into words; if a dad who has had a traumatic childhood can learn how to play with his kids in a way that builds a strong attachment, then that is really powerful. In my mind, there is a societal shift occurring from the traditional roles of fathers as the sole bread winner; the flip side is some fathers are learning how to parent in ways that they weren’t parented themselves which is really challenging. One of the Samaritan’s providers worked with a father who had been incarcerated for a significant time and had missed out on parenting his older children. He is a single dad and finished SafeCare. The changes made during the Parent Child Interaction (PCI) module were remarkable and he learnt lifelong skills about having warm interactions with his child. Measuring the importance of that skill attainment is hard to do!

What do you perceive to be the barriers to successful provision of the SafeCare program from a father’s perspective?

I think the biggest barrier to successful provision with fathers is the father’s prior experience with services. I have had very limited experience of being a service user as a dad and it wasn’t overly pleasant. Before our son was born, I made a big effort to attend all the GP appointments and scans and anything else that was happening. What I noticed was that dads can be pushed to the side and I felt a bit invisible despite being in the same room. Obviously the focus should have been on the mother but it was strange to be trying to get involved and not being able to. If this is a continuous theme for dads then it is understandable that they might want to slip into the background and not be involved. But I think this also adds extra impetus for us to try harder to engage fathers. And if it doesn’t work the first time, try on the next visit and the one after that; it might not happen straight away.

As a SafeCare coach and provider what strategies have you and/or the Samaritans, established to overcome these barriers?

All of the Providers at Samaritans have put a lot of work into the initial engagement of families, and fathers within those families. As a coach I have the pleasure of listening to a lot of the Provider’s sessions and have been impressed by the way that the Providers work to the needs of the family while upholding fidelity to the SafeCare model.

In your experience in delivering the SafeCare program, what benefits have you seen for families involved in the program?

One thing that comes up constantly from parents and providers is that SafeCare gives parents confidence. In Brighter Futures, unfortunately it’s common to hear parents speak about having a really poor experience of being parented as a child. As a result of this, the parents we are working with are starting on the back foot and don’t have the resources and knowledge that other parents might have. In saying that, the parents we work with often have great ideas and are doing so many things well, but don’t have that backing or reinforcement that they are doing a great job. An example of this is the cPat skills in the PCI module. Often, parents demonstrate these skills inherently but they also gain so much confidence from being shown the skills as practices they are already doing so well and then, being able to work hard on the skills that don’t come as naturally.

During the time you’ve been delivering SafeCare has there been a moment or memory that stands out for you?

I recently finished SafeCare with a family who were extremely engaged and had great outcomes. The family got so much out of the PII module and really struggled to know how to play with their baby and as a result avoided doing that. But, after going through the skills in the PII module they became really confident to play with their baby and started enjoying that process so much. Now they play with him all the time and really enjoy it.

What would you say to families who are considering being involved in the SafeCare program?

Definitely give it a go. It’s a program that can surprise you and often you get something out of it that you weren’t expecting. It’s a program that will give you confidence to keep using the skills that you already have and help you learn new skills.

Lastly, what inspires you?

Families that let us come into their home and be open about parenting differently. It’s such a personal thing and for families to let us into their homes and be open about what they are struggling with takes a lot of courage. A lot of the families that we meet are parenting in the context of intergenerational trauma and if we can intervene in any way that makes even a slight shift away from that ongoing trauma, then that’s so rewarding.

Engaging with Families during COVID

NSTRC is committed to the ongoing support of parents and young children during this difficult time. These times are unprecedented and we want to make sure that first and foremost we are keeping young children safe and healthy. We ask that your priority is to serve your families in the best way possible given their circumstances.

NSTRC Training Specialists will make themselves available to support some necessary adaptations. Fidelity is always a priority for the SafeCare model, but during this time, it is of higher importance that we provide continuity of care to some of the most vulnerable families in your community. We will be flexible about fidelity monitoring and accreditation during this crisis. Our goals are to offer the best customer service and not to add to your stress as you support families.

The following is general guidance for providing SafeCare sessions during the COVID-19 pandemic. Please keep in mind that things will continue to be fluid and the NSTRC will provide additional communications if there are other changes and recommendations. Of course, it is imperative that you first comply with your agency policies and funding requirements and then consider how these recommendations will fit within the context of your agency requirements.

Agencies should communicate with their funders to make sure that the adaptation is suitable and will be reimbursed. NSTRC can work with agencies to adapt to funder’s criteria if it is stricter than what is described in this document.

General Information to discuss with active and new SafeCare families:

  1. Providers should connect with their families to determine what kind of technology capabilities the families have (i.e., telephone, smart devicse, computer, internet access, data plans, etc.). This will determine what modifications are possible.
  2. Ensure families have all materials in advance of session. Please hold a discussion with the parent/caregiver to determine the best way of getting parent materials to them (e.g. electronic copies or mailing/dropping by a physical copy, or ordering from NSTRC website). Ordering the parent materials from the NSTRC website may be a convenient option for some agencies if their budget allows.
  3. Module Recommendations. If the Provider is not already engaged in a module with a family, that is if a Provider is just getting started with service delivery, carefully consider the order of modules to be delivered. We have two main suggestions for Providers who are just getting started with a family: 1) If possible, begin with Health, as these sessions are more conducive to tele-visiting. Prior to starting with Health module, it will be imperative to get the parent/caregiver materials. 2) While health is likely the easiest module to deliver via tele-visit, many parents may benefit most from PCI/PII to help address activities and positive parenting during a time when parents are likely with their children more often than normal.
  4. Consider holding some sessions at alternative times to minimize distraction, especially sessions that have a lot of Explain/Education components (i.e., before children wake).
  5. Consider that parent/caregiver focus may be shorter over the phone/video. Think about dividing or chunking each session into two parts as your schedule and agency allows.
  6. Consider follow up texts to maintain connection (we could come up with some examples, perhaps even with MI).
  7. Consider requesting that parent’s/caregiver’s send short video demonstrations of their practice between phone sessions. This can reduce the overall time of the session, and will have the benefit of ensuring parents are practicing skills between sessions.
  8. Agencies may choose to provide tablets or other smart devices to families if sufficient funds are available. Tablets can be pre-loaded with parent materials and skills modeling videos.

Module Based Adaptations/Augmentations for Social Distancing Delivery:

Health Module

Health is the most straightforward module to adapt.

Baseline:

  • If the Provider and parent/caregiver have video capabilities, follow protocol as normal.
  • If the parent/caregiver does not have video capabilities, the baseline can be completed with some preparatory work. First, ensure the family has a copy of the three health scenarios (ER, call the doctor, care at home). This will allow parents/caregivers who are more visual to see the information while talking through the SICC-P steps. Ask family to refer to each of the three scenarios, and follow the protocol as normal.

Training:

  • A large amount of material is covered in each Health session. Consider splitting the training sessions between two visits, to maintain the parent’s/caregiver’s focus.
  • Consider ways to help parents/caregivers navigate the Health materials, such as pre-labelling pages in the parent curriculum and/or including a small stack of post-its to flag pages. Keep in mind that electronic copies will be difficult for some people so physical copies of the curriculum may be preferred.

End of Module: Same protocol as session 1 (baseline).

Parent-Child Interaction/Parent-Infant Interaction Module


Baseline:

  • If the Provider and parent/caregiver have video capabilities, ask caregiver to position camera so the video captures the actions of both caregiver and child. Follow protocol as normal. This could even work to provider’s advantage if they are able to schedule it for the appropriate timed activity for PCI. For example, do play and mealtime observation, then call back during the bedtime routine to assess.
  • If the parent/caregiver does not have video capabilities, consider skipping the baseline assessment and just launch into the first training sessions of PCI/PII.

Training:

  • For Training Sessions, with or without video capabilities, “explain” and “feedback” portions of the session can be delivered without any changes to protocol.
  • If the Provider and parent/caregiver have video capabilities, be sure to position the camera so you can capture the activity as the Provider “models” and caregiver “practices” the iPAT/cPAT skills.
  • If the parent/caregiver does not have video capabilities, just offer the “explain” and provide a verbal “model” and ask the caregiver to practice the skills and report back at next session.

Creative Solutions:

End of Module: Same protocol as session 1 (baseline)

Safety

Baseline:

  • If the Provider and parent/caregiver have video capabilities, ask caregiver to hold camera and go clockwise around room capturing video of all spaces that are within the child’s reach.
  • There are different ways to conduct a baseline assessment if a parent/caregiver does not have video capabilities. You can have the caregiver:
    • Take a few pictures of each space and either text or email these photos to Provider who can “score them”; or,
    • Create a baseline test of knowledge on paper to assess their knowledge as a proxy for behavior. For example, Providers can print out pictures of messy rooms and ask the caregiver to identify the hazards as part of this assessment or as a practice activity; or,
    • The Provider may consider skipping the baseline assessment.

Training:

  • For Training Sessions, with or without video capabilities, “explain” and “feedback” portions of the session can be delivered without any changes to protocol.
  • If the Provider and parent/caregiver have video capabilities, be sure to position the camera so you can capture the activity as the Provider “models” and caregiver “practices” removing hazards from each room.
  • If the parent/caregiver does not have video capabilities, just offer the “explain” and provide a verbal “model” and ask the caregiver to practice the skills and report back at next session.

Creative Solutions:

  • Ask parents/caregivers to take a few pictures of rooms/spaces after they’ve organized/cleaned the spaces to show progress.
  • It may be an option to model the removal of hazards in a mock room that the Provider sets up. Provider can use FaceTime/Skype/WhatsApp to demo live or provide a recording to the caregiver.
  • Make a list with caregiver of safety devices needed for each space (i.e., latches, outlet covers, etc) – potentially securing these items after social distancing is lifted if the caregiver themselves are unable to.

End of Module: Same protocol as session 1 (baseline)

Research – Whitaker et al. PCORI paper Preventive Medicine

Research – Whitaker et al. PCORI paper Preventive Medicine

Effect of the SafeCare intervention on parenting outcomes among parents in child welfare systems: A cluster randomised trial

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Last updated: 28 Sep 2020