Academic and Research

Academic and Research Development Officer :
Professor Peter Stratton

*** For the Evidence Base and other recent documents to download see side panel

Additional material to go with the research column in Context June 2011

SCORE update

The SCORE is now established as a proven measure of family functioning and we are proceeding with assessing its value as a measure of therapeutic change. A full account of its development, and of the evidence we have that it is a viable measure of therapeutic change, has been published in the Journal of Family Therapy (Stratton, Bland, Janes & Lask 2010). The successive articles in Context describe something of the lengthy process of getting the SCORE to this point and you can access the final version of the SCORE 15 here. In the same issue of JFT Alan Carr’s team report a substantial independent investigation based on the SCORE 40 which provides further validation of our approach (Cahill et al, 2010).

We currently have something of a dilemma because, while we are enthusiastic about the way the SCORE has performed we are also aware that we have not yet got as far as proving that it does what it was designed for: to indicate therapeutic change. So we are making it available but do not want to give an impression that it can be presented to managers or in research, as a fully established instrument. For that we need active help from family therapists throughout the UK. We are very actively pursuing relationships with other research agencies to give a wider platform for SCORE. We have succeeded in becoming involved with the CAMHS Outcome Research Consortium (CORC) through Jan Parker’s good offices. Chip Chimera, John Burnham and I met with them and John is calling a meeting to consider adopting SCORE as a recommended outcome measure in CAMHS. Meanwhile we are negotiating with CORE-OM to have SCORE 15 included in their stable of measures. This would have the particular advantage that it will be easier to gather substantial data comparing CORE and SCORE.

SCORE is a self-report outcome measure designed to be sensitive to the kinds of changes in family functioning that systemic family and couples therapists see as indications of useful therapeutic change. It is intended to be serviceable in everyday practice; short, acceptable to clients and usable across the full range of our work: the full range of presenting problems, the clientele, and the formats of work: At least, individual, couple and family. It can be read in terms of second order change; structural change; change in the stories the family members have about their family; change in systemic processes within the family; in an orientation to solutions; improvements in relation to hopefulness, agency, hostility, risk, blaming, well-being, happiness and so on. All in 15 questions

The current achievement is that we have a short version of SCORE which has 15 descriptions of aspects of family life and process, along with other indicators of the state of the family. The research that created the SCORE 15 showed that the earlier 40 items were all useful so the SCORE 40 is also available as a more detailed, probably research, instrument. Meanwhile Alan Carr and his group in Dublin took the same SCORE 40 and have created a 29 item version that is entirely compatible with, but more detailed than our 15 item short form.

So we are now able to offer the SCORE 15 which fits on a single A4 sheet. It can be used as an overall measure of family functioning but will also generate ‘sub-scale’ scores from the 5 items on each of three dimensions:

• Strengths and adaptability
• Overwhelmed by difficulties
• Disrupted communication

 We are now proceeding to develop versions for children and for adults with learning difficulties while also developing versions in other languages. Judith Lask and Reenee Singh have charge of the work to create culturally sensitive versions of SCORE 15 for different cultural groups.  The French, Bengali, and Norwegian versions are primarily based in the UK, while 16 European countries, co-ordinated for EFTA by Mina Todoulou,  are engaged in their own translations and validation study using the same protocol as the UK project. So our main priority now is to complete the current study which will find out whether the SCORE is an effective indicator of change during systemic family therapy and can therefore be used to provide evidence for the effectiveness of our approaches. We urgently need data from use of the SCORE 15 at first, fourth and last sessions. Many clinics have already volunteered but data are slow to arrive, and we would welcome more therapists to join us.

We are very pleased to have Ewa Novotny join the team as a part-time research assistant who will be handling all enquiries. Please email her to say you are interested: ewa.nowotny@kcl.ac.uk  For other comments or queries, please email me directly: p.m.stratton@ntlworld.com

The SCORE project has so far been funded entirely by AFT as a major contribution to establishing a research base for Couple, Family and Systemic Therapy in the UK. We are pleased to say that, under the auspices of Julia Bland we have now obtained a 3 year grant from the South London & Maudsley NHS Trust to continue the work.

The SCORE development team is currently: Julia Bland (Principle Investigator), Peter Stratton, Emma Janes, Judith Lask, Chris Evans, Ewa Novotny and Annie Peppiatt.

References

Cahill, P. O’Reilly, K, Carr, A, Dooley, B, & Stratton, P. (2010) Validation of a 28-item version of the Systemic Clinical Outcome and Routine Evaluation in an Irish context: The SCORE-28. Journal of Family Therapy.  32, 210-231.

Stratton, P, Bland, J., Janes, E & Lask, J. (2010) Developing a practicable outcome measure for systemic family therapy: The SCORE. Journal of Family Therapy.  32, 232-258

Review of family, couples and systemic therapy outcome research 2000-2009

please see download in right hand column of this page

Peter Stratton, Emma Silver, Natasha Nascimento, Gwen Powell, Liz McDonnell and Ewa Novotny.

This is another research and academic support initiative that AFT has been supporting for a considerable time. It is now available as a set of Tables that are about to be posted on our website. These tables present the result of a systematic collation of 220 empirical studies of outcomes over 10 years of English language publication in refereed journals.

The Review is intended to be a resource for practitioners and researchers, as a readily available source of recent research publications on specific conditions. For this purpose a description of the main aspects of each study has been provided in a standard form. A full alphabetical listing of references is provided from page 98. A substantial further study, primarily by Emma Silver and Natasha Nascimento, and supported by funding from UKCP involves a detailed coding of each article so that we can report trends and patterns in the research. This project is currently being written up for journal submission. An account of the methodology will be provided in that publication.

Competences of fully trained systemic family therapists

Now to the competences work.

This project was one of those set up by Skills for Health to map competences of psychotherapists as a basis for the subsequent work on National Occupational Standards. They originally specified three therapy modalities as having a sufficient research base: CBT, psychodynamic, and systemic. A testament to AFT’s work in previous years to get family therapy taken seriously. Subsequently Humanistic-Integrative therapies were added and a parallel set of supervision competences was specified.

Full details of the process and outputs are available at the UCL website: http://www.ucl.ac.uk/clinical-psychology/CORE/systemic_framework.htm  . An account of the process is provided by Pilling, Roth and Stratton (2010) and there is a parallel paper for service users.

The listing of therapeutic competences was done by extracting them from Manuals that have been used for randomised control trials in which the systemic therapy was shown to be effective. The advantage is that it can be claimed that all of the competences were part of a successful application of systemic family and couples therapy. And if you look at the Map, it is an impressive list of what we can claim a fully qualified systemic therapist can do. There is more. If you go to the website and click on the boxes in the map, every one of them opens up to a detailed specification of what is involved in that competence. We are in the process of putting the full map onto the AFT website.

The process allowed for flexibility as the very capable committee adapted the research material to the realities of current practice so we hope you will find them to be a realistic and comprehensive listing.  There are three immediate uses for the Map.

First for practitioners to check their own competences and identify any gaps. Not just skills we do not have, but skills we have but have not kept in our active repertoire. One interesting outcome of the discussions was to discover that we are all using competences from the full history of systemic family therapy but for at least some of us, the process reminded us of techniques that had dropped out of our current practice.

Second, the mapping can be used to demonstrate the impressive specific competences that managers can expect when they employ a qualified systemic therapist.

Third, the material is available for training courses and students as a cross-check. Each therapist and course will develop specialised skills that go beyond this listing and they will not use all of those listed all of the time. But we would claim that every competence in the map and its background detail, should be available to all fully trained therapists to call on when needed. The analysis should also make it easier to specify which competences can be expected at earlier levels of training and which are only guaranteed by full qualification.

Reference:  Stephen Pilling, Anthony D. Roth, and Peter Stratton (2010) The competences required to deliver effective Systemic Therapies.  Background documents to the framework.

http://www.ucl.ac.uk/clinical-psychology/CORE/systemic_framework.htm

Membership of the Expert Reference Group

Peter Stratton (Chair); Eia Asen; Graham Bryce; Frank Burbach; Charlotte Burck; Rudi Dallos;  Ivan Eisler; Isobel Reilly; Judith Lask; Helen Pote; Janet Reibstein; Tom Sexton.

Your chance to influence NICE
about what matters to you

The National Institute of Health and Clinical Excellence, the body responsible for NHS clinical practice guidelines and health promotion, has a continual process of review. The process works by NICE first announcing consultations on the scope of what each set of guidelines will cover, then issuing draft guidelines for comment before announcing final recommendations. AFT has successfully influenced previous NICE activities to take more account of  systemic and family concerns. Invitations to contribute often come with short notice. AFT wants to be better prepared to respond quickly, and is creating a register of members with relevant expertise who are willing to contribute to NICE consultations . Jeni Webster is doing great work in keeping track of NICE announcements and initiatives and making these available through the AFT Google group lists.

This is an invitation for you join the AFT register, and to provide brief details of your areas of particular experience and interest. Please email your details to s.kennedy@aft.org.uk

Practitioner Research Networks

An essential objective of the ARC is to encourage family therapy practitioners to form Practitioner Research Networks (PRN's). Many practitioners would like to be involved in research but their context does not allow them to initiate projects on their own. By working collaboratively, a group of practitioners can create significant research findings and, because the project is designed by and for practitioners, these projects are likely to have direct clinical usefulness. Through the wonders of the internet, these networks do not even need to be confined to a single country.

Do contact Peter Stratton if you would like to be involved: p.m.Stratton@ntlworld.com.

Initiatives towards PRN's are being fostered by ARC, by the UKCP and EFTA research committees and we are attempting to make this an active issue in the AcSS. See information about all of these below.

Research initiatives

The ARC committee is keen to support research in every way it can. As an example, Chris Evans directed us to an NHS initiative to fund a trial of family therapy for adolescent self harm. The ARC supported the idea which was taken forward by David Cottrell and Allan House in Leeds and Ivan Eisler at IoP. A major proposal has been submitted and approved and is now underway led by Ivan Eisler at IoP and Paula Boston in Leeds. The ARC has a productive involvement with the National Centre for Family Therapy and Systemic Research which has been established at the Tavistock Clinic and is supported as a research centre by the University of East London. Do find out about this valuable resource at

http://www.uel-ftsrc.org/

If you know of availability of relevant research funding or of a project that might be more likely to get off the ground with support from ARC, please let us know.

ACADEMIC

The ARC continues to explore possibilities of establishing a Professorship of family therapy research. We have proposed to the Board that AFT might either directly support a post or fund some fund-raising towards the objective.

With support and guidance from Nick Child we now have a comprehensive collection of Google groups for different interests within family therapy. The lists continue to be a highly productive sharing of ideas and the international MultiJFTForum has taken the form of a continuous three-week cycle of discussions of journal articles, in place of the set-piece major discussion of one article from each of the three journals each year.

ARC also participates in the David Campbell  Fund for Creative Initiatives

WIDER PERSPECTIVES

AFT’s Professional Officers are working together to maximise our contribution and to have clear division of responsibilities. Peter Stratton, as Chair of the UKCP research committee is participating in the extensive review of the future of UKCP in the context of registration activities being taken over by a Government body. We are also involved wherever possible in the way the Increasing Access to Psychological Treatments (IAPT) project is developing.

We continue to work with the European Family Therapy Association (EFTA) especially through its research committee chaired by Peter Stratton and the Training and Membership Committee. Which connects back to the contribution of the UKCP research committee work on specifying standards for research training in psychotherapy.

The ARC continues to thrive with your help and support. We hope to meet with you and receive ideas for exciting new initiatives at the AFT Conferences. If you might want to join us in this work, either as a committee member or by supporting the ARC in a specific area of its work, please contact:

Peter Stratton, ARC Development Officer.

Top

Other Possible Activities and issues

If you have thoughts about any of them, do let me ( Peter Stratton) know.

• Increasing family therapy input to universities and establishing Chairs of Family Therapy.
• Getting adequate funding from Universities.
• Coordinated research in training courses and networked practitioner projects.
• Not letting ethics committee procedures prevent trainees and practitioners from undertaking research.
• To move towards having dissertations written in a form that facilitates conversion to a journal article, probably combined with electronic submission.

Top