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The essence of CDP program visits
Some key features of interaction between parents and visitors:
• discussing matters of mutual interest to parent and visitor
• exploring illustrated material selected for the visited family
• encouraging parent's ideas on meeting her family's needs
How the programs 'work'

The visitng framework of the Child Development Programs (CDP) facilitates the program`s empowerment goals, avoiding home visiting methods that attempt to guide parents on how to overcome their problems.

New visiting structures which have been pioneered and developed for the CDP include the following:




Support principles

Parents should be empowered rather than advised or guided. They should be encouraged to resolve their own problems and set their own targets to do that, rather than being advised what to do.

Support methods should raise parents` self-esteem and sense of achievement rather than demonstrating to parents how to play or interact in other ways with their children - demonstrating is usually disempowering.

Support protocols are designed to foster wide-ranging development in the children rather than prescribing specific developmental and age goals, given that most children achieve these goals naturally.

Serious developmental or behavioural problems are referred for professional diagnosis and treatment.

Organisation

There is close collaboration with health, social, educational or other authorities in any area in which the CDP is set up, with details of the planned training of the home visitors being negotiated in advance. In some situations experienced program home visitors, professional or para-professional, may be selected to work with the Parent and Child Empowerment Organisation (PCEO) in providing part of the training.

In every area where a program has been set up, the most suitable among the newly trained home visitors is selected by management for additional training as the coordinator and ultimately as the trainer of the local team of program visitors.

This reflects the basic aim of the PCEO to establish self-administering programs with the training capacity to continue on their own after the PCEO trainers have completed their training schedule. The full schedule usually takes between two and two and a half years, although actual home visiting begins within a few months of the start of training in an area.

Professional barriers?

Wherever the CDP operates, program visitors do not cross professional boundaries unless this is specifically agreed. Thus para-professional home visitors recognise that their work should not intrude on areas where health visitors have clinical responsibility. Families reporting health concerns during a program visit are immediately urged to call on the health visitor, GP or accident and emergency services.

Likewise if home visitors, professional or para-professional, become aware of situations seriously affecting or potentially affecting the safety and well-being of children or of one of the parents, they refer the matter for urgent attention by the responsible social or other services.

In practice there are seldom if ever cases of professional boundaries being breached, as the training of visitors emphasises the limits of the visitors' program work.

Target communities

The primary targets for CDP program visiting are those communities based in less advantaged residential areas. Any parents within such areas can be offered program visits, ensuring that there is no `labelling` of visited families within those communities.

Mothers giving birth for the first time are the most important group to whom home visiting support is offered.

Other parents of young children up to school-going age, in families where there are concerns about the welfare of the children or the competence (or other problems) of the parents, are also offered program support. Single parents are always a special focus for that support. All parents faced with learning difficulties are visited in the normal way and every attempt is made to encourage a sense of achievement and self-esteem in such people.

Visiting criteria

Home visits to each family on the program normally take place every month. More frequent visits can be made for a limited period if a parent needs additional support. Visits are always made by appointment with the parents.

Parents who are pregnant at the time of recruitment to the program are normally offered one ante-natal visit. This is an important, semi-structured visit which enables the program visitor and the mother to get to know each other before the birth.

Visitors believe that the time spent on that pre-birth visit is worth while; it puts the mother at her ease so that when the first program visit takes place after the birth, the visitor and parent already know and value each other. It also gives the visitor an opportunity to discuss the advantages of breast-feeding. This visit does not intrude on the skilled ante-natal support provided for all pregnant mothers by their midwives.

Confidentiality

The normal rules and conventions of confidentiality apply; any threat to the well-being of a child cannot be kept confidential by a program visitor and needs referral to professional services, but all other issues affecting the parents are matters for trust and non-disclosure, unless a court order requires otherwise.

Local protocols may lay down the procedure to be followed if one of the parents discloses that she or he is the subject of domestic violence or other serious threats.

Visitor training

Anyone selected as a program home visitor will undergo a full training course within their own working environment; different forms of training are provided for professional and para-professional programs. Qualified visitors will have the right to use program resources within their own visiting work.

Following the completion of training, visitors will be expected to attend regular seminars and undertake other forms of updating. The quality of home visits in an area needs to be monitored at intervals by a PCEO trainer, to avoid the slow decline in quality which occurs with most programs where there is no external scrutiny.




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The home visiting strategies

temper not rewarded

Changes in families and society have led to significant changes in state policies and services. Most parents in earlier generations were cocooned within the security of a fairly large extended family. Today few families still have that level of support, and nuclear and single-parent families struggle to survive and cope.

Numerous parent support programs attempt to compensate for the loss of support from the extended family. Such programs are usually staffed by professionals such as health visitors, psychologists, social workers and education welfare officers. More rarely these programs are staffed by selected volunteers or community parents, drawn from the communities where the home visiting support is offered.

A recent innovation in parent support has been the training of para-professionals to undertake home visiting.

The key methods used

time good behaviour

Visiting strategies in the Child Development Programs (CDP) cover every aspect of parenting. There is no narrow targeting of behavioural, health or other issues - specific issues are dealt with as part of the overall program. The main focus is on the children, but the well-being of the parents is also discussed because of its importance to family functioning. Wherever possible fathers are involved; much of the illustrated information material features fathers as parents.

Training people who are close or belong to the visited communities, to work as home support visitors, is now becoming recognised as a valuable form of support. This is not to deny the overwhelming contribution of professionals to such programs; indeed most of the early development and pioneering of the CDP involved professionals, especially health visitors who in the UK were for many generations the main parent support workers. Recent changes in the National Health Service have however altered the health visitors' status to give them a leading role in primary health care teams, while restricting their direct work with families.

As a result, more para-professionals are now recruited to provide support for families. There is a positive psychological impact of being visited by someone close to oneself in social status, but many aspects of para-professional work require require highly focused training, different from that given to professional home visitors. The Parent and Child Empowerment Organisation (PCEO) is giving particular attention to the development of the new program, based almost entirely on para-professionals. (An evaluation of the Parent and Child Empowerment Program appears in this website on the research outcomes page.)

How families are supported

breast feeding confidence

The program model aims to empower those who are the least empowered in society - people with limited education, low-paid jobs or unemployed, or whose life experiences emphasise their modest status. Enabling and empowering such people can be life-enhancing, helping them to take more control over their children's and their own lives; it can also mean that they no longer face the anarchy of trying to cope with child-rearing in situations where they are unable to define meaningful boundaries for their children or positively influence their development.

The difficulty with this model is that people faced with serious disadvantage and disempowerment are quick to relate to any support workers who offer instant `solutions` to their problems. The parents soon learn that this form of helping increases their dependence, because the solutions come from outsiders, not themselves, and are usually not an adequate solution to their own particular situation.

This is also the reason why the CDP has never taken on group work with parents. Valuable work can be done in groups of confident parents who support each other and relate well on an equal social footing to the professionals who set up such groups. In disadvantaged communities the parents most in need of support seldom attend such groups, relying instead on peers who in many cases face the same problems as they do; alternatively they retreat into social isolation.

A strong feature of this program model is that there is no helping element. Home visitors do not offer to approach the social or other services on behalf of those they are visiting, unless someone’s health or safety is at stake. Instead parents are encouraged to make their own approach to the services, enabling them to become more empowered.

Encouraging parents to work out their own ways forward is a slow process. Parents cannot be empowered overnight. The realisation that they have power and can control their own lives comes as a revelation after a period of extended support in these programs. Relating to parents on an equal basis and winning their trust can be difficult and time-consuming for the program visitors. Parents need to make up their own minds on whether to accept this radically new form of support - especially as so much is demanded from the parents themselves. They are not offered solutions to their problems and have to think up their own answers.

The focus of program visits

borrowing book library

Although these programs deal with a range of topics, the home visitors are trained to give special (though not exclusive) attention to issues raised by the parents. For the parents their own issues are dominant, but the program visitors help the parents to see wider possibilities in the other topics that are also introduced in order to keep pace with the children’s development.

It is assumed that the awareness and common sense of the home visitor and the parents’ own interest in their children’s development will ensure that most topics are dealt with when appropriate. Unlike many parenting support initiatives, the CDP programs do not attempt to lay down the sequence and pace of development to be achieved by the child; the goal is to empower the parents to aim at all-round development.

Among the themes to which regular attention is given are nutrition, health, language, education, cognitive and social development. Nutritional awareness is a particular focus in view of its importance for the health of children and parents, and especially for the children’s brain development.

For pregnant women and new mothers, the possibility of breast-feeding is given special attention in view of its significant benefits to health and its aiding of the bonding process. One of the CDP’s key publications is an attractive illustrated booklet dealing with every aspect of breast-feeding.

The flow of ideas

relaxing with baby

Program visitors have at their disposal a large volume of 200 illustrated leaflets in which many themes are dealt with light-heartedly. A guidance note is provided with each cartoon, to indicate ways in which it can be used.

Most of these leaflets (often described as “cartoons”) contrast positive and negative approaches to each particular topic, rather than being too didactic about what parents should do. Other leaflets include over 40 popular recipes that are easy to follow. Examples of different cartoon sequences are pictured on the linked page (see below "Click to see selection . . ." ; these can be enlarged for better viewing. A small number of cartoons are selected in advance by the visitor and given to parents on each visit, for discussion and as a way of introducing new ideas.

The cartoon sheets are useable even when parents have limited literacy, provided the home visitors explain the drawings and content. Nearly all parents welcome this material, whatever their educational levels. They need the information and appreciate the enjoyable and light-hearted way in which the material is presented. While these cartoon sequences are based on sound principles within each of the fields covered, they are only available for use by home visitors who have been trained to employ this material in an empowering and non-judgemental way.


Click to see selection of cartoon sequences


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