Introducing the 5-step model to
Ireland
Richard Velleman
and
Alex Copello
5-Step in Ireland
In 2011 we were approached by the Family Support Network in Ireland (FSN
http://www.fsn.ie/), an NGO which supports the development of Family
Support Groups and Networks across all of Ireland.
They had read about our work and wanted to use it across Ireland
FSN are autonomous and non-judgemental,
their aim is to improve the situation of families coping with substance misuse
by:
• developing, supporting and reinforcing the work of family support groups
and regional family support networks,
• working for positive change in policy and practice and
• raising public awareness about the problem of drugs for families and
communities,
They have a strong community development ethos, and are committed to
promoting the empowerment, inclusion and participation of Family
Members.
We felt that this fitted well with our ideas within the ADF Group and how we
think about 5-Step. We were impressed with the emphasis on working over a
sustained period of time and commitment to robust evaluation of the work.
5-Step in Ireland
Two of them (Sadie Grace, CEO, and Megan O’Leary, Development Officer) came
over to meet us, we held discussions over a period of time, and Megan attended
our ADF International meeting in York in November 2011.
Over the course of this time, we developed ‘A Plan’: - it sounds clear, but in reality,
it is something that we gradually worked out, incrementally
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Train a group of practitioners in Ireland to do 5-Step
Get them to implement it, and record their sessions
We develop a way of assessing their competence and assess them
Once they reach competence, we train them to train others
Trained practitioners then train these others, who then get assessed, and
once competent, they deliver 5-Step across Ireland.
They develop peer-supervision, and we run refresher courses and tweak
their competencies.
We co-train others as trainers, who continue the model.
Soon, Ireland only needs us to do a once/year refresher and tweaking
session.
The model
• So our emphasis was from the start on
training as a way of helping FSN to develop
their own capacity to continue to deliver and
develop implementation of the 5-step across
Ireland with minimal support from us in the
long term
• Contrast to other pyramid models where
reliance on the experts is encouraged and
maintained
5-Step in Ireland
Where we have got to
• We have trained a group of 12 practitioners
in Ireland to do 5-Step.
• They implemented 5-Step, with (an)
individual and in (a) group, and they audiorecorded their sessions.
• We developed a way of assessing their
competence and of assessing them.
• Some have reached competence, others
have not. But we have run a further
training course, training them to train
others. [We are here]
5-Step in Ireland
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Issues arising
Length of time to assess (5 x 1 hour) x 12 potential trainers = 60 hours x 2
or 3 raters = 120-180 hours [x 10 trainees each = 1200-1800 hours!]
Quality of Audio recordings; quality of written submissions (Work Report
(see next page) and Log of Contacts (details of the person(s), nature and
length of contacts etc)
Assessment of Competence. Follow the lead of others. Who? Motivational
Interviewing? (no central accreditation programmes in MI, although some
people do offer them – not Bill Miller or Steve Rollnick. Pip Mason offers
an Advanced MI Practitioner course, and will assess a tape if people
submit one – half do)
So – do it ourselves! Developing and using an Assessment of Competence
measure. Decide on:
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?4? ?5? Key dimensions for each step (example, next page)
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rating scale – 3 point? 5 point? [1 = Very Poor. 2 = Poor. 3 =
Acceptable. 4 = Good. 5 = Excellent. Can use .5 scores as necessary
e.g. 3.5]
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Pass level? [Each section should mainly have 4’s/5s and not more
than one score of 3.]
Then have a 2nd table, for Counselling Skills – same scoring.
5-Step in Ireland
Work Report: For each session, complete:
• Preparation work completed.
• Information learnt.
• Level of engagement of family member (or
members if this is for a group).
• Aspects of the session that went well,
including practitioner skills
• Aspects of the session that could be
improved, including practitioner skills
• Information to research before next session
5-Step in Ireland
1
Step 1: Listen, reassure and explore concerns
Length
1.1
Allow family member to describe situation and tell their
story, listen to and ask about the FMs concerns and fears.
Use Q as necessary after FM has given a general description.
Summarise the situation to check if understood correctly.
Acknowledge emotions being expressed.
2.5
1.2
Identify relevant stresses and how the FM has been affected.
3
1.3
Identify relevant stresses and how others have been
affected.
3
1.4
Normalise the experience of FMs giving the FM an indication
that they are not alone with their experiences.
3
1.5
Beginning of session - introduce 5 step, confidentiality,
purpose of Step 1. Ending session - summarised the main FM
issues, use of handbook and next steps. Practical issues of
contact and date of next session.
1.6
Step 1: Total Score
FM described their situation. Counsellor asked questions
and listened but could have probed more to find out
concerns and fears. Could have acknowledged emotions
more. Needed to use more summarising - sometimes felt
like a chat.
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Try to summarise at least every 10 mins and say:
“have I understood correctly, the situation is…..”
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“I can hear you have been very upset and
anxious….this is very normal to feel like this, given
what you are experiencing”
Asked towards end effect on FM, again this could have
been focussed to identify exact stresses.
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Better to be more concrete eg “So your son’s
alcohol use affects you due to x” “ You feel
concerned as you worry about his health and you
are not sleeping properly”
Asked about general stresses. Needed to be more
focussed to find out specifics. Very general and not really
ask about how others affected.
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“So we have talked about how you are affected, are
there other people in the family who have been
affected”
Normalised a bit giving own experience but again could
have summarised more.
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“Your situation sounds very stressful and from
having talked to quite a lot of family members, your
feelings and reactions are very normal”
5-Step in Ireland
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Score: 1 = Very Poor. 2 = Poor. 3 = Acceptable. 4 = Good. 5 =
Excellent. Can use .5 scores as necessary e.g. 3.5
Table 1: 5 Step Skills Pass Rate = Each section should mainly
have 4’s/5s and not more than one score of 3. The total
score should be a minimum of 14 for each section (As a
percentage this is 70%). There may be unusual
circumstances where someone fails on a section but where
you still feel that they should pass overall - if so, add
explanatory comments.
Table 2: Counselling and Other Skills Pass Rate = 4 for each
item. Again, if an item is not relevant (e.g. use of handbook
for someone e.g. with literacy problems), it can be
discounted.
In summary at end, state Pass / Pass with reservations
(state how needs to improve) / In Progress (this will mean
that following feedback and training, there needs to be a
resubmission of a tape for the relevant section/s).
5-Step in Ireland
Issues arising (continued)
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Individual and Group
5-Step = deceptively simple
Trainer-Assessment. Self-Assessment. PeerAssessment
Cost of ratings
Appeals process
Generic skills versus specific skills
Context of the delivery of 5-Step and the
importance of non-specific factors
5-Step in Ireland
Key points for accreditation
 Individual report (person details and contacts)
 Work report log (reflect on work carried out and what needed for next
session)
 Record session. (volume)
 Self assess against criteria - see handout
 Experienced colleague to assess against criteria
 Submit to assessor only when self/colleague pass
 Upload onto Drop box
 Assessor reviews against criteria
 Assessment sheet returned to counsellor
 Can resubmit steps that do not pass and be reassessed
5-Step in Ireland
Conclusions
 Exciting development
 Challenging to work out Assessment of competence, Fidelity
to 5-Steps, plus Accreditation, all in one go and one process
 FSN are great to work with, and hence challenges become
solvable (very different experience to other National
organisations we have worked with!)
 Reaffirms how helpful the 5-Step method is to so many family
members