Understanding readiness to change

Dawn Hodson talks about how crucial an individual's capacity to change is in service assessment

counsellingWhen working on Thriving Communities, a framework for preventing and intervening early in child neglect, it became apparent to me that understanding an individual’s readiness, motivation and capacity for change were crucial.

If parents have the motivation and ability to change, it can improve the outcomes for a child.

But how do you measure an individual’s readiness and capability to change?

I wanted to highlight how we’ve adapted an existing model to analyse change, to help practitioners and improve assessment for neglect.


Importance of change

Helping parents engage is part of the core skill set for professionals working with families.

Engagement is about the relationship between parents and professionals. It’s an attitude, rather than a technique, letting the family know the professional understands them. It involves trust, honesty and compassion.

Part of this engagement is to understand how behaviour change takes place. When practitioners can do this, they can support the parent to make changes and judge their readiness to engage in assessments and interventions.

Prochaska and DiClemente’s trans-theoretical model (TTM) sets out change over time, including a parent’s contemplation, preparation, change itself and relapse, used to highlight that the process of parental engagement is not straightforward.

Change over time

Using an existing model is often easier for practitioners as they’re already aware of it. It’s accepted as the norm.

Harnessing theories of counselling and behaviour change, Prochaska and DiClemente’s TTM uses 6 stages of change:

  1. pre-contemplation: not ready for change
  2. contemplation: getting ready for change
  3. preparation: ready to take action in the immediate future
  4. action: specific lifestyle modifications have been made within the past 6 months
  5. maintenance: specific lifestyle modifications have been made and they're working on preventing relapse
  6. termination: individuals have complete self-efficacy and are sure they won't return to unhealthy habits as a way of coping.

 

The addition of insight

The Prochaska and DiClemente model, used by professionals around the world, is accepted as a successful way of looking at change within the areas of alcohol and substance abuse.

But there are challenges using any existing model outside the context it was developed in - and we needed to know if this model could be used safely within the field of child protection.

The key area we identified as problematic was the lack of insight.

To move forward successfully, parent and practitioner need to be in agreement about the issues being faced. It’s vital the practitioner is confident that the parent understands these issues and the impact on their children. The hypothesis is that if someone is insightful, they’re more likely to change: understanding and comprehending the issues can reduce apathy and ambivalence, often apparent in neglectful parents.

In several works, Bentovim (Bentovim et al 1987; Bentovim 2004) argues that parents’ failure to take responsibility for their children’s maltreatment, their dismissal of the need for treatment, their failure to recognise their children’s needs and the maintenance of insecure - or ambivalent - parent–child attachments are key indicators of a poor prognosis following maltreatment.

To help practitioners truly understand where parents are in their readiness for change, we added a qualifying statement on insight for practitioners to use.

Along with using the model, practitioners ask whether parents truly understand why professionals are worried, if they accept their parenting is having a detrimental effect on their children, and if they can see what needs to change and why.

This insight can be explained to parents to help them understand and explore why things need to change, moving them through the change cycle.

Readiness to change

Understanding where parents are in their readiness and capability to change is important for the practitioner, as well as the parent. The model we have introduced recognises this.

We have also changed the wording, as “capacity” has connotations around size of change. The preferred term is now “capability” to change.

Motivation plays a big part in whether parents are able to improve their caregiving. Motivation is internal (driven by the parent), or external (brought about by outside pressure or support). But real and lasting change, however it is instigated, only comes when a parent can see that the benefits of engaging with help outweigh any losses.

Crucially, if a parent isn’t ready for change, that doesn’t mean you can’t help them.

This model helps practitioners recognise that you should never assume people don’t have the ability to change. Supporting, motivating and encouraging insight into the issues can help parents move from pre-contemplation to action and, with the right ongoing support, achieve long-term change.

Just because they’re not ready, it doesn’t mean they can’t move towards change – practitioners need to target their advice and support to reflect that.

This is why understanding that change is a complex issue, involving readiness, motivation and capability, is so important in child protection.

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References

  1. Bentovim, A et al (1987) Prognosis for rehabilitation after abuse. Vol.11, Iss.1 pp 26-31

  2. Bentovim, A. (2004) Working with abusing families: general issues and a systematic perspective.