The practice of multi-family work began when Laqueur et al (1964) started working with hospitalized clients who were diagnosed as being schizophrenic and their families in New York. Over the past 30 years this systemic framework has also been adopted as an approach to working with children and adolescents who are experiencing difficulties within educational settings.Â
Multi-Family Groups (MFGs) involve putting 6-8 families together on a regular basis to form a therapeutic community which facilitates change and learning from one another. The purpose is twofold, firstly to support the child with their difficulties and secondly to support the parents. The leader in UK multi-family work is the Marlborough Service, who have recently developed a Multi-family group model (Asen, 2001). This model has been identified as a framework for "bridging the gap which often exists between social work practices and the clinical work of psychiatrists and psychologists. Â It is a multi-disciplinary model which combines key elements and best practices from both social work and psychiatry/ psychology" (Asen, 2002). When applied to Primary level children, the group model clearly demonstrates part of what was outlined in the Green Paper, Every Child Matters (Department for Education and Skills, 2003) which aims to protect and support children and their parents from being marginalized or excluded.
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The efficacy of school-based multi-family groups appears promising, as the Marlborough Service report over 90% of the children referred are maintained in mainstream school (Asen, 2008). Further positive effects include improved academic achievement and attendance and a reduction in anti-social behaviour. Parents were also found to have improved parenting competencies as a result (e.g. clear boundaries & communication) and there was a development of trust with professional service providers and improved family/school relationships (Asen, 2008).
This project aimed to evaluate how two fairly new MFGs (started in 2005 and 2006) have been developing in south London  . The groups follow the format of the Marlborough model (see Appendix D for details) and their primary objective is to support children and parents with their referral 'problem' (e.g. disruptive behaviour,Â difficulty with reading) and the curriculum. Despite a brief pilot report of one group in 2006, little is known about the positive or negative outcomes of the groups or what elements are particularly beneficial for families.
The aim of this project was to provide a snapshot evaluation of the effectiveness of two MFGs from the perspective of teachers and parents. It was hoped the results would be useful in assisting the service to develop; in relation to the structure of the service and the methods of evaluation that are currently in place.
This project is a cross-sectional study, which adopts a mixed-method approach and a between subjects design. Change could not be assessed by statistical analysis because:
The question content of the pre and post measures did not match
The pre and post measures were not all completed by the same people (not matching pairs)
The groups are held at two schools in South London and the school profiles can be found in Appendix F. The groups are run once a week for two hours by a Family therapist who is employed by Social Services, a behaviour support worker and an inclusion worker who is employed by the school. Members of staff are linked with a Clinical Child Psychologist in the local NHS child psychology service. The project itself was conducted outside the schools for logistical reasons.
Demographical information about the child and family was achieved from completed referral forms, which are completed by the teachers.
Data was in the form of completed (so retrospective) pre and post-group questionnaires (see anonymised examples in Appendix C). These are issued to parents/carers and teachers upon starting and finishing the group. Both questionnaires include a mixture of structured, likert-style questions and open-ended questions. The pre-group questionnaire was designed to provide a basis for comparison and focuses on the hopes and views of the parent about their child's' needs and difficulties. The post-group questionnaire was designed to elicit evaluative feedback from the parents. The questionnaires were constructed by the MFG staff team and their validity is unknown.
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The final sample used in this project is presented below.
Pre-group questionnaires 17 18
Post-group questionnaires 8 9
This study fell within the remit of service evaluation; therefore it was not necessary to involve an ethics committee. All the completed questionnaires and referral forms were securely kept at each respective school and consent was achieved from the Head Teachers to use the school-related data (Appendix B). All families were sent an information sheet about the project with an opt-out form (Appendix A) as retrospective data was used. All participant information remained anonymous and confidential.
The ordinal data (derived from all the likert-style questions) from the measures were inputted into a datasheet and descriptive (percentages) were calculated. The quantitative aspects which were measured were levels of hope about the groups (parents and teachers), views about the school/family relationship (parents and teachers) and the impact of the MFGs on parenting (parents only).
The questionnaires also included a number of open-ended questions. Thematic Analysis was used to analyze these (as prescribed by Braun and Clark, 2006) as the data was not wedded to a particular theoretical model or framework. Given that a good thematic analysis is "transparent" about its position (Braun and Clark, 2006), it is noted here that the themes were formed from a critical, evaluative position after familiarity with leading Multi-family-group models. Themes and sub-themes were checked for their formative reliability by re-applying them to the data and are developed or changed further if required.
Demographic information (see below) derived from the completed referral forms. A number of these referral forms were incomplete which meant a complete picture of the sample was not possible. Despite the missing data, it is clear that the majority of children referred to the group were boys (41.7%) and at least a third of the sample came from single parent families. The length of time spent in the MFG ranged between 2 to 24 months, with an average stay of 10.5 months.
Length of time at MFG
Gender of children
Children on SEN register
Children from single parent family
Pre group results
Levels of hope regarding the MFGs
Overall both teachers and parents were hopeful that their childs' difficulties would improve (see Figure 2), although by reading the question it is unclear if 'hope' is directly related to the MFGs or just hope 'in general'. This finding possibly suggests families who participate in the groups are highly engaged in the work.
Figure 2 - Levels of hope of parents and teachers about the effects of participating in the multi-family groups
Post group results
The qualitative analysis allowed several main themes to emerge from the data, which encapsulate the perceived positive effects after the MFGs from teachers and parents. Teachers generally reported the groups encouraged a positive learning experience where the children's behaviour in class and learning skills improved after the groups. They also noticed several changes for the child, including the child having more confidence and being happier. Parents reported similar positive changes in the child, but also reported their child having more motivation and an improvement in schoolwork. A more prominent theme for parents was how MFGs provided an opportunity for parental growth, in allowing bonding to take place and creating a feeling of empowerment for the parents. A breakdown of the main themes and sub-themes and relevant examples are shown in the following table.
Figure 3- Primary themes and sub-themes derived from thematic analysis of the post-group questionnaires from both teachers and parents
Themes from teachers
Examples from data
Positive learning experience
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Childs learning has improved
Better relationship with family
Changes in the child
Child is happier
Child has more confidence
"**** is more organised in class now" (N1, Q2)
"the target book helped start conversations with **** about how she was doing" (M1, Q3)
"..she seems happier within herself" (K1, Q2)
"**** is now more mature and responsible in school and her confidence has also increased" (K1, Q2)
Themes from parents
Examples from data
Changes in the child
Child more motivated
School work has improved
Child has more confidence
Child has better concentration
Opportunity for parental growth
Child-to parent bond
Intimate support network: parent-to-parent bond
Parent affiliation to school
Empowerment of parent
"he tries to do tasks now and is more motivated" (J1, Q1)
"**** focusing on his key targets and reflecting honestly on his achievements each day" (D1, Q2)
"**** has grown in confidence during her time with the group" (C1, Q1)
"..he has gained a better attention span but his problems and difficulties will stay with him" (M, Q2)
"**** and I have been able to communicate better about school" (M1, Q2)
"being able to chat to other parents and not feeling alone" (D1, Q4)
"Working with the School was great for both of us. We are really on the same side and I feel we have more respect for each other, but at the same time we like each other" (D, Q3)
"I feel able to take parental control, but allow my son to approach me without being controlled. We talk more but I'm firm" (D, Q2)
Figure 4 shows how 75% of teachers and 44% of parents responded that relationships between them were good. Interestingly more parents described the relationship as excellent than teachers did (34% in comparison to 25%). However, no teachers or parents described their relationship with each other as poor.
Figure 4 - Teachers and parents views of the school-family relationship after child has attended a MFG
Impact on parenting
Parents reported finding the MFGs helpful (52%), with smaller percentages finding it very helpful (30%) and a few who reported no change at all (9%). For the small percentage of parents who found the groups very unhelpful (9%), no further explanation was given as the question is structured as a scale.
Figure 5 - Parents views of the impact of the MFGs on their parenting skills
Overall this project suggests the MFGs were positively viewed by both parents and teachers and numerous positive effects were reported. The findings resulting from the qualitative analysis of the post-group questionnaires revealed parents and teachers felt positive changes had taken place as a result of attending the groups. These results are in line with most of the aims of the Marlborough Service MFG model. A common theme for parents in this project was the opportunity the MFGs provided for bonding, with other parents, their child and with the school. Most parents reflected briefly on how this led to greater understanding of their child and how to support them with their difficulties. Asen (2008) argues this understanding and development of skills is key to improving early attachment difficulties between parent and child. A theme common to parents and teachers was the notable changes in the child after attending the MFGs. Children were reported to be more confident, more able to concentrate, more settled, motivated and generally happier in and out of class. Teachers also reported improvements in the children's learning and school work. These perceived changes may also provide evidence for predictions to be made about families' potential for permanent change. Whilst change tends to be a slow process for families who have usually been entrenched in chronic relationship problems (Asen, 2007), families progression in MFGs can be a good indicator of how change can occur when they are given appropriate support.
With regards to the feedback, the Marlborough Service place emphasis on the importance of getting feedback from Head Teachers and children (Dawson and McHugh, 1994) as a way of obtaining a different perspective on any changes that are experienced. For example, they report Head Teachers have noted that certain teachers have altered their teaching style and attitude to parents after participating in the groups. They attribute this to a breakdown of the adversial nature of the family/school relationship which is part of the MFG process. Similarly, the feedback from children participating in the groups is noted as important in group effectiveness. Dawson and McHugh found children reported to feel normalised after participating in the groups, rather than feeling like a 'problem-child'. Given this, it may be useful for the two groups in the present project to consider ways of obtaining similar qualitative feedback with a means to obtaining a 'complete' picture of any changes which occur.
There were high levels of similarity between teachers and parents views about how positive school-family relationships were, and not one family described their relationship with the school as poor (pre or post the groups). This is an encouraging finding, However it may not be truly representative of all relevant school-family relationships because families who choose to participate in the groups are the most likely to engage well (Cooklin et al, 1983). Therefore it would be interesting to gain an understanding of the reasons why some families choose not to participate in the groups.
Interestingly, about 9% of families in this project reported experiencing no change after the MFG, possibly indicating that some families have multiple and potentially longitudinal needs which are not best met my MFG-work. Given this, families could have an assessment of need session before starting the group, as some may have difficulties which require specialist support or individual family therapy work. Asen (2007) suggests convening a 'network meeting' prior to undertaking the actual MFG work which involves parents, all the different professionals and school representatives involved in the child's care attending. Asen denotes that such meetings ensure parents can respond and define what their own concerns and needs are and allow a 'map' of all the people involved in the child's care to be drawn which allows understanding and bridges connection between individuals.
Limitations and recommendations
Due to the word-limit constraints associated with this report, only the main difficulties encountered in this project are discussed here. The major limitations of this project relate to the measures that were used and the design that was imposed. Although both questionnaires yielded some interesting feedback data, they were not particularly effective in providing outcome data. Many of the questions on the post-group questionnaire involved ambiguous language and gradients of change which were not standardised; meaning people had different interpretations of the question.
"What impact do you think group has had on your parenting?
[Please circle] "Very helpful/helpful/no change/unhelpful/very unhelpful"
(Post-group parent questionnaire)
Gillham, 2008 states such questions should be clear, succinct, and unambiguous, where the goal is to eliminate the chance that the question will mean different things to different people. Therefore an improvement would be to use quantifiable and specific language which account for a wide range of responses from the questionnaires, and it would be helpful to pilot the questionnaire before implementing it.
Furthermore, the questionnaires were designed to only elicit positive feedback, with no questions which prompt thinking about more difficult aspects of the group. This information would be equally as useful to gain, as it would provide an insight into the challenges of multi-group working and help the staff be aware of the individual needs of each family. Moreover, the majority of questions on the forms ask about quite sensitive issues and relationships, and there is no indication of who will see what is written. It may be useful to include a transparent statement on the questionnaires about exactly how the information could be used and who will see it, as this may alter the type of comments that are written (Gillham, 2008).
At the present time, there is little empirical research documenting the outcomes of MFGs in the UK. In order to document group effectiveness, the leaders in American MFG work (Families and Schools Together; FAST) stipulate a need for appropriate measures. "A major strength of FAST is that every aspect of the programme has been specifically built on a strong evidence-base and each of these is measured individually" (McDonald, 1998). The programme routinely measures six outcomes (Family functioning, Family Social Isolation, Parent Involvement at School, Child Behaviour at Home as rated by parent, Child Behaviour at School as Evaluated by the teacher and Family-consumer rating of the FAST experience) using standardised instruments with established viability and reliability. Given this, an alternative recommendation from this project would be to consider using similar standardised outcome measures.
Summary of recommendations
A summary statement for the service documenting the key findings and recommendations of this project can be found in Appendix G.
Dissemination of the results
This report will be given to the staff team from both MFGs and the Clinical Psychologist who supervised the project (field supervisor). In addition, three presentations about the project are scheduled to take place between August and October:
1. At the Multi-family group steering group meeting - includes staff from both groups and lead Clinical psychologist
2. To the Local Education Authority (LEA) - as requested by the staff team
3. To the families who participated in the project and in current groups
To conclude, this project provides a snapshot evaluation of two MFGs which are based on the principles of the Marlborough Model. The findings suggest the groups have had many positive effects for families and educational staff, however there were several flaws in the design and measures currently in place which prevented any powerful conclusions to be made from the results. This project has identified a strong need for effective outcome measures in the service which assess outcomes relevant to the aims of the intervention. Finally, recommendations for rewording the pre and post-group measures and honing data collection methods are suggested.