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“Small children – small worries…?”
A Mellow Parenting Multifamily Treatment of Developmental Disorders in Rotenburg, Germany
Dirk Meyer, Bernhard Prankel
The Clinic for Child and Adolescent Psychiatry in Rotenburg lies in a rural region between Hamburg, Bremen and Hannover with nearly one million inhabitants. It applies a family therapeutic concept based on a new and evidence based developmental model (Prankel, 2005). The setting comprises a tier 4 inpatient service with 20 day care and 20 stationary places and an out-patient service with about 100 clients per month. The clinic offers several rooms for parents to meet as well as overnight accommodation for parents of young in-patient clients. Parents can participate in a number of preventive and therapeutic family group therapies to improve their child rearing skills.
Financial funding in Germany relies on annual contracts between hospitals (operated by public, private or welfare organizations) and health insurances. Personnel consists of two CAP consultants, one pediatric consultant, one adult psychiatric consultant, a 7. post for out-patient service (mainly psychologists) and four multiprofessional teams for the wards, each including a doctor and a psychotherapist as case managers and several educational and nursing professionals.
General Setting: Due to financial restrictions within the health system family home treatment is more than limited. Social services are responsible for visiting families in their homes. In order to enhance the local collaboration between families, schools, medical (GPs, pediatricians) and social services, the clinic introduced a “co-op standard” based on (1) the new developmental model, (2) a regional training for medical, social and educational professionals including monthly supervision, and (3) a standardized (though not yet evaluated) assessment and documetation of risk factors, resources and affected developmental processes. This standard operational procedure improves the communication between professionals and saves on resources by avoiding multiple diagnostics and treatment measures by various institutions with overlapping tasks (health care, social service, school).
Mellow Parenting “Kleine Kinder – kleine Sorgen …?” (Small children–small worries…?): In 2004 we first introduced this family group therapy for families with children from age two to six years of age facing early developmental difficulties including attachment and autistic spectrum disorders. We adapted the Mellow Parenting Programme (MP) (Puckering,C., Mills, M., Cox, A., Maddiw, H., Evans, J. and Rogers, J. 1999) to fit the following setting: Twelve afternoons every other Tuesday from 1.30 to 5.30 pm. Coffee, tea, juices and cookies are catered. We invite mothers, fathers and their young children. The sessions are structured according to the MP:
- Parent group: Biographical work with parents (mothers and fathers while children are taken care of in the crèche by nursing staff, video recorded).
- Action group: Family interaction with staff support, video recorded.
- Parent workshop: Group video feed back, structured parent training, homework (children being taken care of in crèche by nursing staff).
- Breaks between groups are utilized for informal group exchange.
Participating families have previously been treated as out-patient families in our clinic. Prior to the group sessions we visit the families in their homes, video record family caretaking interactions and give individual video feed back using the MP dimensions (Mills, M. and Puckering, C. 1999). The team running the groups consists of one female and one male practitioner, a team of two nurses and two interns from our School for Social Pedagogics run the crèche. Individual family therapy sessions are scheduled additionally if needed. The educational and therapeutic methods contain a system(at)ic assessment of resources and risk factors allowing the development of processes and realistic goals for group participation. Interventions center around the new developmental model mentioned above with its basic concepts of attachment, resources and responsibility.
We have been running one group per year on average (seven so far), some with just mothers, some with mums and dads attending together. For coed groups it is essential that there is no evidence of actual domestic violence between the parents. The groups follow the core programme, with mums and dads working separately on gender specific issues at times. Providing this special gender specific space for both parents to talk about their individual experiences with possibly difficult issues (including pregnancy, birth, self perception, role modelling, domestic violence) from their very own perspective seems to facilitate subsequent sharing. In our experience mums and dads are more interested in hearing each others ”side of the story” after having their own space. Working together with both parents on the parenting workshops also seems to help them to effectively coordinate their parental strategies and support each other in the process of establishing changes in their daily structures. Feedback from mothers and fathers on these groups has been positive so far. Mums whose partners were not able to attend the group reported more interest in involving their spouses at home into the group process and we had more fathers participate in our extracurricular “family days” for mums, dads and siblings. On those occasions we ask the “participating at home” parents about what changes they are noticing, find out how they deal with new developments and confirm the importance of their support.
We intensified the exchange between crèche work and the parent workshop. Crèche staff members feed back helpful information and videosequences on childrens´ resources, social activities and helpful coping strategies directly in the parent workshop. Meanwhile one of the practitioners is joining the crechè in order to get a closer view of the children.
Future prospects: Several colleagues are now trained MP practitioners and one of our practitioners is now doing the training to train.
Lit.: Puckering C., Mills M., Cox A., Maddiw H., Evans J. and Rogers J. 1999. Improving the quality of Family Support: an intensive parenting programme: Mellow Parenting Programme. DOH London
Mills M. and Puckering C. 1999. The Mellow Parenting Coding Manual. ACPP. London and Department of Child Psychiatry, University of Glasgow
Prankel B.H 2005. Strukuren der Entwicklung. Ein integratives Modell für Reifungsprozesse. Familiendynamik 30: 145-183.
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"A great 3 days of some well worth while training that I feel will benefit the service as much as myself and parents"
