Exploring the essence of helping.

In a compelling speech, by turns self deprecating, humorous and touching, London-based child psychologist Hilton Davis outlined his understanding of "helping" and the family partnership model he has developed to ensure effective help is delivered to children and families. Professor of child health psychology at King's College London, he agrees with Lebanese-American poet, Kahlil Gibran, that When you give of yourself, then you truly give. "This is the essence of helping. So often, as health professionals, we have been told 'you mustn't get involved'. I find that rather difficult. It is a deficit model and we should be operating from a strengths-based model. We can get close to those we work with, but not too close," he told the 500-strong audience of Plunker clinical staff.

Now the head of the Centre for Parent and Child Support at Guy's Hospital, early in his career he worked with children with disabilities and chronic conditions. He became concerned that there were many people "working with bits of the child, but nobody was concerned about the whole child. I wondered how the child was feeling about dying and how the parents were feeling."

Such questioning has propelled him throughout his career and fuels his desire to seek the "essence of helping".

A recent UNICEF report had the United Kingdom (UK) at the bottom of the affluent world in the education, mental, psychological and social well-being of children. Ten percent of children in the UK had a psychosocial problem severe enough to warrant a diagnosis, and family breakdown was the major cause of difficulties for children, he said. Psychosocial problems were the most important cause of childhood disorders. These impaired a child's functioning, were related to the future development of youth offending and were predictive of adult mental health problems. There were significant long-term financial costs associated with conduct disorder ("naughty people"), with such people costing [the State] ten times as much as "non-naughty people", Davis explained.

Services face huge problems

Services for families and children in the UK faced huge problems. "There are high dissatisfaction levels, high refusal and drop-out rates in most services, practitioners with poor communication skills, and families, especially the most needy, distrust professionals," Davis said. Prevention was the only thing that could make a difference. This raised further questions: What is helping? How do you help people? Why does it work sometimes and not others?

"For every research study that proves home visiting works, I can show you a study that shows it doesn't. What's the inconsistency here? I've thought about this for years and have been asking questions for years."

Three degrees in psychology had not told him how to help people. But after ten years of working with people, he realised "the best tool available was me". He gave examples of situations where particular people had been "powerfully helpful" through empathy, through their ability to convey their genuine interest in those they were with, through taking time to establish trust, through simply allowing people to talk and "pour out their issues".

The importance of trust

"I once visited a five-year-old child ten times. I was using behaviour modification and nothing seemed to be working, but on the last visit the child's mother said 'I think I can trust you' and told me her story of prolonged sexual abuse." He also told of a Bangladeshi woman interpreter he had worked with, who was the reason the family he was working with got better. "This woman was not a professional but she was a very effective helper. Why? Because when she asked those people 'How are you?' she meant it in the whole of her being, and they told her. When somebody conveys that they are interested in you, you feel better."

Describing helping as an activity, he said it was a series of complex, different tasks. Helping was not just about "fixing it" but about "being with people in a way that enables them to feet better about themselves".

Out of his questioning, observations and practice, Davis developed a model of helping. "What are the ingredients? Maybe if I put them down on paper it might help me do it," he explained. The resulting family partnership model is essentially "a simple model, accessible to people" and has wide application.

The model details the tasks of helping, the helping process, and helper skills and qualities. The tasks of helping included forming a relationship, doing no harm, enabling parents to identify, clarify and manage problems so they could enable the development and well-being of children, and facilitating social support and community development.

The "inherent human qualities" of the helper were crucial, Davis said. Helper qualities included respect--"believing people can change"--genuineness, empathy and humility. He conceded including such qualities in job descriptions would buy trouble with unions and those involved in equal employment opportunities. The helping process--"it is the nursing process in some sense"--included relationship building, exploration, understanding, goat setting, strategy planning, implementation, review and ending. Relationship building--partnership--was not easy. It included sharing decision making, recognising complementary expertise and roles, negotiating disagreement, mutual trust and respect, openness and honesty, and clear communication.

When services used the model, support for staff was absolutely crucial. Training in the model was not didactic, rather it was "based on Socratic questioning", and modelled the process of helping. Those who had participated in the training in a number of European countries had expressed high levels of satisfaction with it.

Model has wide application

The family partnership model was also a model for parenting and for supervision. Its applications were wide and included childhood and adult disability, follow-up for very low birth-weight babies; pre-school emotional and hehavioural problems; promotion of child mental health; and prevention of abuse and neglect. Davis ended his 90-minute presentation with a quote he felt conveyed the essence of helping: "Suffering is not a question that demands an answer; it is not a problem that demands a solution; it is a mystery that demands a presence." Further information on the family partnership model can be found on www.cpcs.org.uk.

* Sixty-seven Plunket staff and 47 staff from other organisations have so far undergone training in the family partnership model.