The Art of Effective Communication: A Pilot Course in Video Enhanced Reflective Practice for Staff in a Residential Setting for Young People.


By Calum Strathie

Date Posted: Saturday, 12 December 2009

Calum Strathie is a Workforce Development Officer in the City of Dundee. He specialises in Video Interaction Guidance. In this article Calum analyses a unique training initiative piloted in Dundee in which young people from a residential resource participated in the training of the residential child care staff using Video Enhanced Reflective Practice.

Dundee is Scotland's fourth largest city with a population of 142,500.  It sits on the east coast overlooking the Firth of Tay in what is considered to be a spectacular location.  There are two thriving universities in the city - University of Dundee and  University of Abertay - and therefore a large population of students and academic staff from out with the city.  Both universities have world wide reputations in the fields of biomedical and life sciences and in the computer gaming industry.

Dundee also has an indigenous population that don't all quite share in the same rates of success as the two universities and the growing number of biotech companies.  Unemployment is higher than the Scottish average, and for those in work the mean household income in Dundee is about 17.5% less than the Scottish average, and 20% less than the UK average.  The rates of academic attainment in secondary schools in Dundee has been consistently low over the last few years in comparison with the rest of Scotland, and teenage pregnancy rates in Dundee are amongst the highest in Europe.

In the city there is a high, and growing, number of drugs and substance misusers some of whom are parents of babies and young children.  The numbers of children on the Child Protection Register or being accommodated by the Social Work Department has risen considerably in the last year since the murder of the toddler Brandon Muir.

Dundee City Council Social Work Department operates 5 Young People's Units that can accommodate up to 24 young people in total at any one time, and one respite unit that accommodates variable numbers.   Across the city there are 97 people employed in residential units - managers, senior SCOs (Social Care Officers), SCOs, night shift workers, sessional workers, cooks, domestics and admin staff.

THE PILOT PROPOSAL

After a  workshop presentation (Restoring Relationships in Difficult Situations) at the 2008 SIRCC Conference the presenters met with the Service Manager (Residential Services) and all the unit managers in Dundee.   This resulted in a request for a course in Video Enhanced Reflective Practice to be piloted in one of the YPUs.   

Within the unit selected for the pilot there is a staffing complement of:
Manager, 1 x resource worker, 4 x senior SCOs, 6 x SCOs, 2 x night shift workers,
4 - 5 sessional workers, handyman (p/t), domestic (p/t), and admin assistant (p/t).  At any one time there are four or five young people in residence and the period of residence can be anything from three months to three years.

The staff team work on a rota basis alternating between day shifts, evening shifts and sleep overs.   This requires a high degree of adaptability by all staff and does mean that at times there can be relatively long periods when staff don't have contact with each other or the contact can be minimal (at shift change-overs for example).  A demanding job and a demanding work pattern can be made even more so when there are vacant posts and high levels of absence.  In such circumstances there is an increased demand and requirement for staff to be even more adaptable and an increased reliance on the good will of available team members to change shift patterns at short notice.

In discussion with the Unit Manager it was recognised that, because of the demands mentioned above, the delivery of any training to a whole team would have to flexible to suit the needs of the unit and would likely have to be delivered to smaller groups for the duration of the course.  The mix of the groups would possibly change as well, but this wasn't seen as a problem, and in fact could be seen as an asset.

  • It was proposed that every member of staff, including support staff and the unit Manager, take part in the course to ensure that all staff had equal opportunities for reflective practice.   This was with the aim of:
    building whole team working. 
  •  to provide consistency and a 'shared understanding' in the team on how to effectively communicate with young    people and to develop empowering relationships with young people.
  • to build a 'reflecting team' approach once the course had ended.
    turning everyday conversations into learning conversations.


The proposal was for a short course using Video Enhanced Reflective Practice.  This would be delivered in five sessions over a 10 - 12 week period.  Because of limited capacity for the whole team to meet together for a full day the introductory day of the course was run over half a day in which there was some theoretical input, technical information and some group work based on analysis of video clips. 

The following three sessions were practice based reflective workshops for small groups.  In these workshops staff would bring short clips from video recordings that they had made of themselves in real practice situations with the young people.  The final day was a 'celebration' day in which participants would present and share their learning journey with each other.  This short course required work both on the course and in practice in the workplace. A log book was kept by participants and a reader was provided for optional reading.

Video Enhanced Reflective Practice (V.E.R.P.) requires high level meta cognitive skills in that it requires workers to reflect both on past interactions and to reflect in the moment while engaging in active listening and using the contact principles*.  Workers also have to be thinking about the direction and purpose of the interaction while coaching the young person to problem solve at a pace and in a direction that builds on a young person's knowledge and skills and wishes.  Staff undertaking this training also had the additional challenge of dealing with new and unfamiliar technology. 

*The Contact Principles are based on adult's responses to children's initiatives as observed in early interactions." - Trevarthen C. (1979) Communication and cooperation in early infancy: a description of primary intersubjectivity.

*The Contact Principles "summarise key notions such as the primacy of the child's initiative, the necessity of reciprocity, turn taking and shared meaning." - Simpson R. (1995) The use of the Contact Principles in Feedback. 

(Raymond Simpson on Video Interaction Guidance)

 

 The participants were given a brief introduction to learning theory, attachment theory and the theory of intersubjectivity.   Intersubjectivity is about - "how people come to know what others have in mind and how they adjust accordingly" (Bruner, 1996).   Another important aspect of the course is that the values of social work can be recognised and reflected on in practice.

Video Enhanced Reflective Practice is a method which aims to improve communication and relationships for participants.  It enhances and develops reflective practice while looking at the evidence of practice in the video.  It gives those involved the opportunity “to see oorsel’s as ithers see us” while thinking about our strengths, goals and working points (those things that we want to change, refine, or just do more of).  Participants can literally see themselves reach their goals through a stepped approach to change which gives them the opportunity to celebrate their success.  Just like the related intervention of Video Interaction Guidance(VIG) there is a belief "that change can be achieved more effectively and in a more empowering way in the context of a 'coaching' relationship, which is collaborative rather than prescriptive, empowering rather than deskilling and conveys respect for strengths and potential".  (Kennedy, H.A. - 2005)

V.E.R.P. also deepens observational skills.  This is useful in terms of assessment.   Analysis of our interaction with others inevitably means looking at our own perceptions, values and intentions.

V.E.R.P. is aimed at strengthening other therapeutic and pedagogical interventions already in place by refining and developing the skills required by the staff and the organisation.

EVALUATING THE PILOT

As this pilot course, using Video Enhanced Reflective Practice in a residential setting for young people, was certainly a first in Scotland, there was a great opportunity to learn a good deal from the experiences of this team and to make a subsequent contribution to practice in the residential sector for young people.

We proposed undertaking an in-depth evaluation involving the pre-course perspectives of participants that would give a base reference point against which post course evaluations could be measured.   The evaluation format that we devised enabled staff to self assess their qualities and skills in working with young people using scaling questions.  This would give us an indication of any changes in self perception, self awareness and confidence that had occurred through the course of the training.   However, we also wanted to gauge the impact of this training not just on the staff undertaking the course, but on the young people they work with.  So we asked them.  

Each resident was asked to assess every member of staff using the same questions that had been used in the self assessments, the only difference being the change from first person to third person.  This was designed to give us a much fuller picture of changes and perceptions from different perspectives.   It would also give us an opportunity to compare and contrast not only the 'before and after', but also the view of self with the view of self by others.

As well as assessing changes for individuals and the team as a whole we needed to evaluate the course and whether the course aims and objectives were met.  A simple and conventional format was used to rate different aspects of the course delivery and to invite comments on presentation, most useful/least useful aspects, and suggestions for improvements to the course.

To round off the evaluation process we asked the manager to write a report giving her overview of the training from a management perspective.  To complement the staff self assessments we asked the manager to give her assessment of the overall impact on the team in terms of confidence, communications and practice skills.

The involvement of young people in the evaluation of staff skills and qualities was something that caused a little bit of anxiety and uncertainty amongst some of the staff.  They were anticipating that if, at the time of the assessment, they were in conflict with any of the young people this would be reflected in lower scores for each of the scaling questions, and therefore would give a false picture.  The section on Evaluation Results will show if these anxieties and uncertainties were well founded.

 


ANTICIPATED OUTCOMES

When designing The Art of Effective Communication we had an expectation that staff participating in this course would manage to achieve:

  • Greater self-awareness of their strengths and skills.
  • Improved confidence.
  • Improved communication skills.
  • Greater team unity and mutual support through the use of a 'reflecting team' approach to group work.
  • Increased ability to deal effectively with conflict.
  • Strengthened relationships with young people.
  • Empowerment through seeing the positive impact of their interactions with young people.
  • Increased ability to coach by building on young people's initiatives.

We fully expected that the benefits to the young people would be:

  • Feeling that their thoughts and opinions are more fully understood.
  • A sense of empowerment through being involved in supporting staff to undertake this training and being part of the evaluation.
  • A more attuned relationship with staff.
  • Feeling more 'listened' to'.


DELIVERY

Delivering a course over five sessions within a three month period at the workplace to a team who work varied shift patterns, take holidays, are carrying vacancies, and have regular absences through sickness is not easy.  This then required a very flexible approach by the trainers - i.e. we fit in around the needs of the team.  Running the practice based workshop sessions in the workplace meant that we went to them and worker time was saved with no travel involved.  It also ensured that the working environment is also the learning environment.
  
In this approach to workplace learning practitioners are not receiving training but are learning while they practice, and from their own practice and each other.  Our belief is that Practice Learning is about learning from and reflecting on what we do in our own practice, rather than learning about practice, or how to practice, from others.

The case for practice learning in the workplace has already been well made by the Scottish Social Services Council (SSSC) in 'Promoting Workplace Learning' (Menmuir and Thomson).  In this research report there is strong support for the idea of learning cultures and learning organisations.   A Scottish Institute for Excellence in Social Work Education (SIESWE) discussion paper (Skinner, 2005) suggests that "continuing professional development.........is connected with the promotion of learning cultures within the workplace, the valuing of knowledge building and skills development and a commitment to evidence based activity."    The report also says that a key aim of the Scottish Practice Learning Project (SPLP) which is jointly run by SSSC and SIESWE is to "support the development of learning
organisations and continuing professional development in the social services sector."

In the case studies on which the research was based a number of benefits from workplace learning were identified:

Benefits for Organisations - more competent, confident and valued staff :  e.g. - staff thought that workplace learning led to greater motivation and confidence.   They were more likely to contribute positively in meetings and discussions.

Benefits for Staff - personal and professional development :  e.g. - people grew in confidence and felt more valued, and had a greater sense of professionalism.                                                                                               

Flexibility of approach : e.g. workplace learning could be managed more flexibly than sending people on courses and  employees can go at the pace that suits them.

Benefits for People who use Services - competence, consistency and responsiveness of staff.  e.g : everyone thought that service users benefited from the learning their carers were gaining. 

In the following section we will discover if any of these benefits have been achieved by the team of residential workers undertaking The Art of Effective Communication.


EVALUATING 'The Art of Effective Communication' - WHAT DID WE LEARN?

Before commencing with the introductory half day of this course all the participating staff and all the resident young people were asked to complete the following questionnaires.  It would be fair and proper to point out that the staff members only had one questionnaire to complete (their own) whereas each young person had to complete one for each of the thirteen participating staff who started the course (eleven completed).

 

STAFF QUESTIONAIRRE

YOUNG PERSONS' QUESTIONAIRRE

*Questions rated on a 1 - 5 scale: - 1 = not at all 5 = always

I am a good listener I feel that he/she listens to me.
I let the other person know that I have understood what they are saying. I feel that he/she understands what I'm trying to say.
I let the other person know that I understand their feelings. I think that he/she understands my feelings.
I ensure equal turns in the      conversation. I get an equal turn to speak.
I give information in a way that the young person will understand. I understand information that he/she gives me.
I feel that I can help young people at times of stress or upset. I think that he/she helps me at times of stress or upset
I encourage young people to find their own solutions to problems. I think that he/she encourages me to find my own solutions to problems.

 This exercise raised anxieties and doubts among the staff team that young people would not take this exercise seriously or would use it to 'get back' at anyone with who they had an axe to grind.  However, results were to prove otherwise.

In order to make some sense of the ratings without tying ourselves up in knots with numbers we averaged out the scores for the seven questions asked of each staff member and did the same with the equivalent questions asked of the young people.   This then gave us a single figure for a pre course score and a single figure to compare against for the post course score.

What emerged  from the pre course questionnaire was quite unexpected.  Across all eleven staff who were assessed the scores of the young people were consistently higher than the self assessed scores by staff.  In some cases the scores by the young people were considerably higher, especially where some workers had marked themselves in the lower half of the scale.  The relative low confidence or self belief indicated by some workers was clearly not recognised by the young people who were maybe recognising other strengths and qualities.  However, although the young people scored consistently higher, they also followed the pattern of staff scores - i.e. the lower scores were given to staff who scored themselves lower, and the higher scores were given to those who scored themselves higher.   It seems that the young people were able to reflect the relative grading of staff scores in their own (more positive)  assessments. 

What might this tell us?  Further, more in-depth research would have to be undertaken to find out what was behind these ratings as well as the differences between staff ratings and those of the young people.

But this is only half the story.

In the post course assessments the results again proved revealing.   With only one exception the staff consistently rated themselves higher overall than they had done in the pre-course self assessment.  Yet again, with only two exceptions, the young people also scored the staff higher in the post course assessment than the staff scored themselves.  Seven out of eleven staff were scored higher than their pre course scores, but even where the scores by the young people went down slightly from the pre-course scores they were still higher (with one exception) than the self assessed scores by staff.

So from this we can see that overall staff have improved their belief and confidence in their own skills of communication with young people.  Their lower scores in comparison with those given to them by the young people may reflect what can often be a natural tendency by workers in difficult situations to be self critical, but this again would have to be researched to establish the thinking behind their scores.

We can also see that overall the young people have improved their scores for staff over the course of the training, and have consistently given higher ratings both pre and post course.   The ratings given by the young people should be viewed against the context of what was going on in the unit in the weeks leading up to post course assessment.  At that time there had been a prolonged period of crisis and conflict, yet this seems not to have adversely affected the ability of the young people to score impartially and fairly.  Against this background these results seem even more impressive.

 

 

WHAT DID THE STAFF TEAM THINK OF THE COURSE?

A course evaluation was completed by nine out of the eleven staff who completed the course.

The aims and objectives of the course were either met:  well (6) or very well (3).

The delivery of the course (trainer delivery; pace; handouts; video; use of presentation materials; encouraging participation) was rated good to excellent  with the majority rating being very good.

Comments were invited  about:  the way that the course was delivered, most/least useful aspects of the course, and what changes could be suggested.  The following  are some typical views:

"Course was well presented but some difficulties did occur with organisation due to shift work."
"Well organised course and presented in a professional manner.  Would have liked more time in feedback."
"Maybe more detailed training on specific communication skills.  Probably more time required for this."
"I feel that we could have had extra training days.  Course presented well."

Most useful?
"Encouragement and support from trainers and flexibility shown re workshops."
"Debriefing of the video footage and actually seeing yourself interacting."
"Finding positives in my actions through video feedbacks."
"Seeing myself and how I communicate and gesture during interactions."
"Encourages effective dialogue and helps empower young people."
"To have the opportunity to observe yourself with a young person."

Least useful?
"It proved difficult to attend group sessions due to shift patterns."
"Trying to find time with the young people."
"…slightly false initially."
"Problems with recording.  My tapes did not have much sound and one got chewed up in the camera!"

Changes?
"A continued awareness of varied needs of staff due to shift patterns in residential child care."
"Try and make filming more natural - if possible."
"The course could be longer - more input and training."
"More time to learn more about applying skills to practice."
"More time at the start - input from trainers."

Themes that seem to emerge from this evaluation of the pilot course are that participants wanted more input and more time, which we take as a positive and encouraging response.  However, there were clearly organisational difficulties for some in trying to juggle time for training with the demands of shift working.  The changing shift patterns were anticipated in the pre course planning which was why we adopted a flexible approach to course delivery.  These are issues that we can address when planning future training in other YPUs in the city.

 

 

REFLECTIONS BY STAFF ON THEIR PERSONAL LEARNING JOURNEYS


The final part of the course was a celebration day involving the staff team making short presentations and sharing with each other their own personal learning journey using the best moments from their video clips to demonstrate the changes that they had made.  The following comments are drawn from the notes that staff used in making their presentations.


"Initially the thought of participating filled me with dread. I absolutely hate being filmed or photographed. The course has made me much more aware of initiatives and how I can show the young people clearly that I have picked up on these. I've learnt by doing this I can demonstrate to the young people that I have received them.  This in turn makes the young people feel valued and "heard". I am much more responsive to signs and gestures and not only to what is being said. The course has given me greater insight into my own abilities and how I can change elements of an interaction to enhance positive communication. The course has also taught me how to build on my strengths and to support change leading to empowerment. I can use my clips as a microscope and a mirror for a better understanding of what is happening for the young person and why some things don't work as well."

"The most important learning point has been to see oneself interacting with the young person and being aware of their feelings, body language and trying to react to these as well as to my own responses. Everyone has been able to observe their strengths and weaknesses and therefore been able to act on them."

"One of the other values that my training placed great emphasis on was participation, and this is also a prerequisite of VIG training.   For me this can mean helping to empower young people and to identify their needs. These needs have to be met if they are to develop their full potential and grow into participating, contributing adults."

"VIG training is a core aspect of developing relationships with young people and, as such, for the residential child care worker.  It provides participants with support which enables dialogue to take place. Interactions and effective dialogue encourages a two way process for learning/communication to occur rather than control being 'given' to the worker only. It optimises my learning ability and pulls together strands from different areas of my skills/knowledge and particularly my value base."

"From this single video I have learnt that I should be more aware about continuing conversations that the young person wanted to talk about.  For example, the young person wanted to talk about his medication; his body language changed, he appeared to perk up and was more alert, but I didn't notice these signs until we played the video back.  Therefore I missed the young person's feelings and this could have taken a weight off his mind and helped him settle and relax and have a more positive night or next day at school."

"The young person was anxious about being late and was becoming agitated. I felt that I was attentive towards the young person.   I had a friendly posture, I kept eye contact, I acknowledged her initiatives by giving her space and time, and I praised her for continuing to go about her usual routine.   Due to my communication and her seeing me calm I think this prevented her from 'letting of steam' at me".

 

 THE MANAGER'S PERSPECTIVE The manager of the unit was also a course participant, so she was able to uniquely experience this training both from the point of view of a practitioner and that of a manager.  From the outset she was very supportive and totally committed to the course.  She gave a very strong lead to her team and wasn't prepared to ask them to do something that she wouldn't do herself - i.e. record herself in an interaction with a young person.  When some team members were showing reluctance or uncertainty at times she would always encourage and prompt them to complete tasks. All of this had a great bearing on the successful completion and outcomes of the course.

In her report at the end of the course she made the following observations:

During and since the pilot I have observed a change in the attitude of most staff.
 
Staff appear to be more knowledgeable about communication and I have observed this being discussed both informally and formally in team meetings.  All staff have used the skills they developed with young people and transferred these to communicating with other professionals.  This has been reflected in level of confidence some staff have to communicate with professionals and the families of young people.

I have observed changes of behaviour in the team as a whole.  Staff appear to be more open and honest with each other. They appear to, not only listen, but try to understand and receive what each other are saying.  Some staff appear more confident in communicating with young people and others. 

There is also a significant improvement in staff's awareness of turn-taking with young people and each other.  This continues to be a working point for everyone  and I continue to observe this in team meetings and scenarios with young people.
 
It is my opinion that the VERP pilot has enabled both staff and young people to reflect and be more aware of their communication.

During an extremely difficult two months since the presentations I have been extremely proud of how the team have communicated and worked together to try to improve the quality of life for individual young people.
 
I would like to see VERP used further in Residential Units for Young People.  I would advocate that all the units use the concepts used during the pilot to help their staff teams and young people.  I think that it can be an effective tool not only to improve communication but to improve the quality of care we provide for our young people.

I would also like to see the VERP concept used to promote effective communication in team meetings and used as a tool to improve the quality of supervision for our staff.  As a professional I see effective communication as central to our work with young people and their families. I would support the use of VERP for all residential staff.

 
CONCLUSIONS

It was always anticipated that delivering an unfamiliar method of training to front line workers in a very difficult and stressful working arena would present some challenges, but that was not necessarily seen as a bad thing.  For the training to be effective and meaningful it had to challenge thinking and practice in a supportive and constructive way.  

We also planned for - and expected - strengths to be discovered and successes to be achieved for individuals and for the team as a whole.

Most of the challenges that were identified seemed to be mainly of a practical or organisational nature.  These can be summarised as follows:

Compressing the introductory day into half a day to meet operational requirements reduced the level of input.  In particular it didn't allow room enough for support to staff in learning the technical skills of video recording and editing.  More pre-course information delivered in advance would help with understanding some of the concepts.
Finding protected time within the unit for recording, editing and supervision seemed to be problematic for some, although the manager felt strongly that there was no good reason why this should have been so.
Variable shift patterns sometimes caused difficulty, but this was not insurmountable.  In many cases staff members would attend workshops out with their working hours which says much about their commitment.
While running the practice based workshops in the workplace helped to save worker time, it also meant that there could be interruptions from time to time.
There were anxieties initially about using video equipment and about being recorded.
The intention of including the admin worker, the domestic and the handyman did not materialise as they felt that the training was out with their roles, although the domestic worker did attend the introductory half day.  All three were assessed by the young people at the pre course stage and all came out with very high ratings, which confirmed the important role that non professional support staff have in contributing significantly and positively to the supportive and friendly atmosphere within the unit - even if they don't realise it themselves!  Next time we maybe need to be a bit more pro-active in involving these people who are important in the lives of the young people.


However, many of the successes and strengths achieved were as a result of personal challenges and the way in which the team faced up to those challenges.

While not being a primary aim, the course and the method of delivery did provide a whole team experience that served the function of team building and cohesion.
The experience proved that a flexible approach that is responsive to team and organisational demands can succeed.
The willing involvement of young people in the recordings and in the assessments was a major success.
Feedback from the staff team indicated that despite the challenges they felt that the training was enjoyable and had a relaxed feel about it.
Throughout the team there was a sense of having a 'shared understanding'  and a greater all round awareness of how each individual and each other was communicating much more effectively.
The course appears to have stimulated learning through video enhanced reflection on their own practice, and that, in turn, has been translated into enhanced practice.
The staff team are expressing greater confidence and belief in their own skills and strengths.
The enhanced communication skills were seen by the manager of the unit to be having a positive impact in day to day interactions between workers and young people.
Video Enhanced Reflective Practice (VERP) was regarded as  beneficial not only for improving communication and quality of care, but also as a method that can be applied in other areas of Social Work/Social Care activity such as supervision.


Overall this course in The Art of Effective Communication has achieved much for those who participated, and much learning has been gained from piloting a training course that matched a method (VERP) with the needs of staff in residential child care.   The interim results were presented to a group of YPU managers and to the service manager with responsibility for residential child care in the city of Dundee.  The response to this was positive with the result that further training is proposed for other units and that the learning from the pilot course will be built upon.

In evaluating this project a number of other questions and issues have been raised.  We are aware of gaps in the course delivery and in the evaluation process, but feel strongly that after running the course again in other YPUs there will be great potential here for research that will help explain more thoroughly why this approach can work in a residential setting.

Any comments, questions or discussions about this work and any points raised in this paper will be most welcome.

 

References

Bruner, J. (1996) - The Culture of Education

Kennedy, H.A. (2005) - 'Film Focus: improving adults' communication with children'
Article in Children in Scotland  (2005) accessed at www.childreninscotland.org.uk/cis

Menmuir, J., and Thomson, B.,  (2009) - Promoting Workplace Learning  Scottish Social Services Council

Simpson, R. (1995) The Use of the Contact Principles in Feedback.    

Skinner, K. (2005) 'Continuing Professional Development for the Social Services Workforce in Scotland, Developing Learning Organizations, Discussion Paper 1'.  accessed at www.sieswe.org (go to publications)

Trevarthen, C. (1979) 'Communication and cooperation in early infancy: a description of primary intersubjectivity' - in Bullowa, M.(1979) Before Speech    Cambridge  :  Cambridge University Press  

© goodenoughcaring.com and Calum Strathie :  December, 2009

 

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