Results from a randomised controlled trial evaluating the impact of training in Motivational Interviewing on parental engagement in child protection Donald Forrester Professor of Social Work Research Tilda Goldberg Centre for Social Work and Social Care University of Bedfordshire

1. S
Engaging parents and protecting
children?
Results from a randomised controlled trial evaluating
the impact of training in Motivational Interviewing on
parental engagement in child protection
Donald Forrester
Professor of Social Work Research
Tilda Goldberg Centre for Social Work and Social
Care
University of Bedfordshire
Donald.forrester@beds.ac.uk

2. Overview
S Exploring impact of training and supervision in
Motivational Interviewing on skills and outcomes
S Using this to explore what is good social work and how
we achieve it
S But also seeing whether we can do an RCT in frontline
child protection work

3. Can we improve the way
workers talk to parents?
MI skills help
engage
parents
Training
improves
social
worker skills
in MI
MI trained
workers
better at
engaging
parents
Engagement
associated
with better
outcomes

4. What is Motivational
Interviewing (MI)
S MI is a directive, client-centred approach to communication that
attempts to elicit intrinsic motivation
S MI Treatment Integrity (MITI) rates for:
S Collaboration
S Autonomy
S Evocation
S Averaged for a MITI score

5. Study Design: Double
Randomization
Children in
Need Service
Team 1
1
2
Team 2
1
2
Team 3
1
2
Team 4
1
2
Team 5
1
2
Team 6
1
2

6. MI Skills Development
Package
S 2 days initial training
S 1 day MI in CP work
S 8 weeks hourly consultations
S 1 day follow-up workshop
S Monthly consultations

7. MI Skill Scores for Simulated
Interviews
S no statistically significant difference between the
groups before training (t=1.05; df (57) p=0.137),
S a significant impact of training (t=3.416, df (26)
p=0.002)
S mean goes from 2.46 to 3.0 in the MI group

8. Impact on MITI score in
simulated interviews
0
2
4
6
8
10
12
14
16
18
20
1
1.33
1.66
2
2.33
2.66
3
3.33
3.66
4
4.33
4.66
5
Numberofworkers
MITI score
T1
T2

9. Data Collection: 610 families
randomized
S Follow up with families
S Observation (2nd visit : T1)
S Audio recording of meeting
S Interview (T1 and 20wks T2)
S Outcome measures reported here: parental engagement (Working
Alliance Inventory), parent anxiety/depression/stress (GHQ-12)
Referral
and
Assessme
nt
Children
in Need
team
First
SW
visit
2nd
or 3rd
SW
visit
SW asks
parent
about
observatio
n
Family
enters
study

10. S
MI
group
Control
group
Total
Total families randomised 246 364 610
MI
group
Control
group
Total
Cases excluded for
pre-defined reasons 36 56 92
Cases excluded due
to manager overrule 17 13 30
Total cases excluded 53 69 122
Families excluded
MI
group
Control
group
Total
Total families enteringwider
dataset 193 295 488

11. Data collection
Main study sample – more than 2 visits, N=284 (58% of
allocations)
256 parents asked (90%)
166 agreed to observation (65%)
132 agreed to research interview (80% of those observed, but
46% of whole sample)
89% had social worker questionnaires
100% had ICT data collected

12. What factors predicted
parental engagement?
Abuse, physical Concerned about happy and
secure
Parental, learning disability
Abuse, emotional from DV Parental concerns, depression or
anxiety
Parental, social services
involvement as a child
Abuse, emotional not DV Parental, personality disorder Social issues, financial problems
Abuse, sexual Parental, other mental health
issues
Social issues, housing issues
Abuse, neglect Parental, alcohol misuse Social issues, social isolation
Concerned about learning well Parental, drug-taking Social issues, wider family
relationship problems
Concerned about health and
development
Parental, domestic violence Rating of overall concern for the
family
The worker’s rated MI skill in an interview with an actor 3-6 months before

13. What factors predicted
parental engagement?
Only two predicted parental engagement
S Neglect = less engagement
(t=-2.1, p=0.039)
S High MI skill = more engagement
(t=2.1, p=0.04)

14. Predictors of stress/anxiety
Similar analysis for stress/anxiety (GHQ 12)
Predictors:
S Emotional abuse (higher) (t=2.56; p=0.012)
S Social isolation (higher) (t=2.64; p=0.009)
S MI skill (lower) (t=-2.31; p=0.023)

15. Did training make a
difference?
MI Non-MI
Engagement
(WAI)
61.5 61.8
Parent Satisfaction 5.6 5.6
Feelings about
Children’s
Services
3.5 3.3
GHQ 12.6 13.6
WAI Observed 57.5 58.0

16. Oh no!!!

17. Review
S Training changed simulated practice
S MI skills associated with:
S Parental attitude to worker and services
S Engagement of parents
S Wellbeing of parent
S But no training impact

18. “Culture eats
training for
breakfast”

19. A social model for evidence
based practice
S Practice is not primarily produced by individual
workers being skilled or by training
S It is produced by organisations that set themselves
to produce certain types of practice
S Local authorities therefore need a vision for the
practice they want and then to create the
organisation that delivers it