2018 Janson Piloting a novel capacity building tool with early intervention practitioners ADVANCE PRE PROOF

Abstract Background: Despite the increasing uptake of family capacity-building theory in past decades, there is a dearth of practical tools to support its implementation in Early Intervention, alongside traditional discussion or assessment-based goal setting. We therefore expanded on earlier co-design with parents raising a child with disability or developmental delay, and tested a practitioner experiential training. Method: Thirty practitioners trained with a new tool, designed to engage participants to create an inspiring vision from which they develop authentic goals for their child, their family and/or themselves, and visualise their active part in achieving their goals. Results : Practitioners rated this experience favourably and registered signiﬁcant training impact and post-training increases in empowerment. Conclusions: Training to facilitate such novel visioning and planning experiences oﬀers practitioners a unique opportunity to build family capacity, disrupting a recognised power imbalance by empowering families with agency and setting the foundations for more eﬀective family-driven relationships with practitioners.


| INTRODUCTION
Families raising young children with disability engage in planning processes to create progress and initiate funding mechanisms.Answering the call for evidence on how families can take a more active role in planning, we have embedded family empowerment into the design of a radically novel visioning and planning practical tool for families to lead and piloted a training program for practitioners to facilitate such sessions.
Professional interventional styles have evolved along a continuum from professional-centred to family capacity-building models (Dunst & Trivette, 2011).Family-centred and strength-based approaches strive to engage parents in 'participatory' experiences (Dunst, Bruder & Espe-Sherwindt, 2014).Moore, Fong & Rushton (2018) however, highlighted that practitioners have been challenged to consistently apply these practices resulting in some families feeling beholden to professionals and experts (Lee, 2015), focusing on increasing interventions and therapy (Mahoney & Perales, 2011) or experiencing low confidence in their decision making (Gatmaitan & Brown 2015;Kearney & Griffin, 2001;Lee, 2015;Pang, 2011).Swanson, Raab and Dunst (2011) stated that the Parenting Capacity Building empowerment paradigm creates opportunities that support and strengthen a sense of confidence and competence in parents.Empowerment has been defined as "a person's (1) access to and control over needed resources, (2) decision-making and problem-solving abilities, and (3) acquisition of instrumental behavior needed to interact effectively with others to procure resources" (Dunst, Trivette, & Deal, 1988, p. 3).Empowerment research contends that some of this new knowledge is created through self-reflection, experimentation and negotiation (Yeh, Wu & Tung, 2018) and also informs formal and informal participation (Akey, Marquis & Ross, 2000;Gauthier-Boudreault, Couture & Gallagher, 2018).
How then can practitioners facilitate parents' participatory experiences?Practitioner-lead tools can result in latent bias or parents referring to professionals to suggest goals (Rodger, O'Keefe, Cook & Jones (2012), and increasing research warns that planning conversations to assemble Family Service or Education Plans have only weakly delivered on meaningful outcomes for parents (Matich-Maroney, Gregory & Corcoran, 2018).
We addressed the dearth of practical tools, which support strength-based approaches to goal setting.This pilot trained practitioners in the use of a process into which parent empowerment is embedded, measured practitioners' personal insight into such visioning processes, and appraised the extent to which they may transfer this learning to their work with families.

| Participants
Thirty Early Intervention professionals (Allied Health) took part in the training.

| Procedure
Practitioners trained over 2 days using Pictability TM , a game-like tool for parents to create their positive strength-based vision for their child, family and themselves.Participants: • Select images to represent their child's strengths • Choose images, ranging from concrete to abstract, from which they • Formulate and write goals for their child, families and themselves • Assemble these long term aspirational goals on a Vision Board • Select one goal per category; formulate first steps to achieve each • Assemble these short term goals onto an engaging 'Action Board', clearly delineating focus and action points Pictability TM visuals were co-designed with families to build capacity and inspire wellbeing and flourishing (Adler & Seligman, 2016) and informed by evidence about how parents used Individualised Funding to achieve their goals (Mahmic & Janson, 2018).The tool includes multiple cards and boards designed to support parents expanding on ideas to create deeper and more meaningful (i.e.developmental, social, learning) children goals as well as family and personal goals for themselves.The visioning experience lasts about 1 hr.

| Data collection and analysis
2.2.1 | The Beach Center Psychological Empowerment Scales includes 32 items rated on a 1-5 Likert scale.The Cronbach reliability scores of the scales range between .76 to .96(Akey, Marquis & Ross, 2000).It is divided into four subscales: (a) attitudes of control and competence, (b) cognitive appraisals of critical skills and knowledge, (c) formal participation in organisations, and (d) informal participation in social systems and relationships.The latter two subscales represent participatory behaviours.

| Partners in Outcome
Measures (PCOMs; Duncan & Reese, 2015) measure the impact of interventions along 4 subscales: individual, interpersonal, social and overall engagement.PCOMS is a transparent and robust evaluation methodology used that assesses their engagement levels through repeated measures in over 20 countries, with over 1.5 million administrations in its database.

| To complement their survey answers, participants rated (and commented on):
Q1. How would you rate your organisation's follow up on goals designed during your planning sessions?[From: Very inadequate (0) to Very comprehensive (7)] Q2.With what level of commitment do you think a parent will "own" Pictability goals and work on them?[From: Very committed (0) to Very uncommitted (7)] Q3.To what extent do you think your role in facilitating this experience will differ from that of leading a conventional planning session?[From: Very similar (0) to Very different ( 7)]

| Experiential learning and empowerment
Participants' average overall empowerment score before (Mean=3.28) is higher than after (Mean=3.81) the visioning experience, with this difference representing a 10% increase towards a possible total of 5 points.Participants registered psychological empowerment gains as per Figure 1 below:  Table 1 displays participants' responses to Q1 outlined the weakness of current goal setting processes.Their responses to Q2 showed confidence that the visioning process can, not only support parents designing more meaningful goals, but also goals that they would subsequently be committed to working on.The 28.6% difference [Q1,Q2] provides an indication of the capacitybuilding value that trained professionals attribute to this process.Responses to Q3 assert the advantage that Pictability TM facilitators can step back and oversee, rather than lead, parents engaging in participatory activities.

| Planning Insight
Participants mostly used participatory examples to describe their Vision and Action Boards: Practitioners reached powerful insights.One for instance alluded to a recurring worry about future financial contributions for her daughter and how working through the visioning experience helped her unravel worries and possible actions, leading her to take action after getting home from the visioning experience.She described the value of their experiential learning as follows: One of the things I learnt is that some actions can be taken right off the (Action) Board.I set up automatic payments […] so by the time she needs it, the money will be there and I don't have to stress about it […] and this is something I could do right away! Easy to understand, efficient, effective

| Professional roles
A Repeated measures ANOVA showed that participants' average engagement levels after (Mean-8.3)were significantly higher than before training (Mean=7.5)measured through the Partners in Change Outcome Management scales (Figure 2).The ANOVA registered only this main effect (F=20.6; df=1; p<.001), and no other between-scales or interaction effect.Trainees' insights into potentially new aspects of their roles clarified the advantages of "facilitation" over that of "interviewer" role, as during a conventional planning session: […] The Vision Board is extremely powerful to help people unpack their bigger visions and goals into small pieces so they can start achieving right away.It just gives a sense of hope, that "I can do this."It also begins to shift power between practitioners and parents: when we plan with parents, we sometimes take that control on and they give it up to us".It was a really good way to reverse that and get into the place and the spirit where parents are in control and are thinking about the children's future, can see it, and we're not disempowering them from step one.Holding on to power wears practitioners down.

| DISCUSSION
Enabling parents participatory experiences may paradoxically lead professionals to un-learn old and adopt new roles, such as gently guiding (facilitating) or coaching (Graham, Rodger & Ziviani, 2015), raise empathy levels (Davis & Day, 2010) or the 'art of practice' (King and Chiarello, 2017).
Experiential learning differs from the traditional verbal/discussion-based goal-setting or assessment sessions, which professionals have had to lead.The piloted tool was designed to catalyse engagement -hence practitioners can stand back and let parents' experience unfold.Pictability TM sets the stage for parents to formulate goals that inspire them.When developing this visioning process, we fundamentally re-thought the initial planning sessions between families and professionals.To ensure that families indeed take a lead role in goal planning, we co-designed the process with families over two years (Mahmic & Janson, 2018).This capacity-building tool is set up to ignite parents' activity from the start: reflecting, choosing, selecting, writing goals, prioritizing and composing Vision and Action Boards.That short-term experiential goal-setting activities can have immediate empowering results is supported by a wealth of positive psychology interventions.Feldman and Dreher's (2011) for example detailed how even a 90 minutes intervention identifying a specific goal and then working on it improves people hope, a central tenet of Hope Theory (Feldman & Snyder, 2005) and subsequently the ability to predict goal attainment.The training indicated that action and agency can be embedded into the design of a tool -enabling inspiring goals to emerge.These experiences will underlie the crucial actions for families to take as they become empowered as stressed by Kendrick, Ward and Chenoweth (2017), and start fresh conversations with professionals.
Practitioners experienced first hand how these design elements create commitment to action towards goal implementation.These principles were trialed for the first time in early intervention.This pilot shows that professionals can indeed experience such empowerment and transfer their learning into their work with families.These results also indicate that practitioners support experiential visioning enabling families creating a different space to re-engage with their dreams for their child, articulate meaningful goals.Further, results about Informal Participation gains suggest that this experience can build awareness about the importance of the participatory experiences described by Dunst, Bruder and Espe-Sherwindt (2014).
A new balance needs to be stricken: on the one hand, to implement family-capacity building best practice, professionals must critically reconsider their role, embrace a family's expertise and perspective, and forgo some of the power they have wielded until now (Allred, 2015).On the other, families must build capacity to grow their agency and self-confidence and form partnerships with practitioners, on the other.Moore (2012) stressed that it is important that these conditions be fulfilled simultaneously; else we perpetuate a systemic in-balance.
While these findings begin to help us understand how agency can be embedded into the design of a planning tool, care should be taken when generalising to other tools and delivery formats because assessing the effects of different goal setting methods is complex (Levack et al. 2015).However, the details provided about the perspectives of these practitioners should enable us to draw parallels about the relevance of these results to other such training, while at the same time offering insights into the implementation of this program.Findings reported about this relatively small group of professional are congruent with those reported for 157 other parents who participated in a similar program (Heyworth, Mahmic & Janson, 2017;Moore, Fong & Rushton, 2018) and with the recognition it received as the 2017 Early Childhood Early Intervention New South Wales Excellence Award.Future longitudinal research is needed to appraise the sustainability over time of the observed changes and understand their long-term implications.
Gallagher (1998) asked: "How comfortable would we be with 'empowered' parents?" (p.371).Increasingly however, practitioners recognise unique potential learning insights (Aujoulat, d'Hoore & Deccache, 2006) as positively engaged families fill new participatory and partnership roles with practitioners (Gauthier-Boudreault, Couture & Gallagher, 2018).Equipped with new strength-based tools and personal knowledge on their impact, practitioners can facilitate new engagement processes with parents.The challenge is to simultaneously orchestrate these three 'active ingredients', lest one reverts to the missing link in this chain: strength-based tools that can elicit authentic visioning as a basis for commitment to goals, facilitation knowledge to enable engagement, and parents empowered with the participatory knowledge to act where they can or seek practitioners' advice.Past interventions have focused on these separately -this initiative is about benefiting from their cumulative impact.
The author would also like to recognise the thought leadership of Christine

Figure 1 :
Figure 1: Empowerment domains before vs. after Pictability trainingA Repeated-measures Analysis of Variance shows a significant (F=98.27;df=1; p<0.001) main effect of the experiential session, and that interaction between the four Empowerment domains is significant (F=4.88;df=3; p<.001) confirming that the highest gain occurred in the scales measuring informal participatory activities.A post-test was carried out (General Linear Hypotheses) to clarify the nature of the interaction results.It showed that the increase in Informal Participation and Relationships is greater than the increase inAttitude (t=3.35;Se=.151; p<.005)   and that the increase in Skills and Knowledge (t=3.27;Se=.151; p<.005) after the experiential learning session.

Figure 2 :
Figure 2: Increases in PCOM measures after the visioning experience training

Table 1 : Descriptive scores and participants' further answers to Q1 to Q3 [out of 7 points]
Scott, CEO; Cathy Anthony, Community Engagement Coordinator; Gareth Williams, Director Family and Children's Services, Kinsight, Coquitlam, Vancouver, BC.Working group members Stacey Touma, Project Manager and Peer Hub Leader; Melo Kalemkeridis, Lead Peer Facilitator and Sylvana Mahmic, CEO Plumtree, Marrickville, Sydney, NSW.Special thanks to Steven Miller, Senior Lecturer Statistics, Computing and Mathematical Sciences, University of Waikato, Hamilton, New Zealand for his input with and insight in the statistical analyses.