Theoretical frameworks guiding the programme development

In reviewing recent literature on programme development, various theoretical models were identified that could serve as a general conceptual basis for intervention in the current study (e.g. psychodynamic, cognitive-behavioural, systems, community, narrative and psychosocial models). The researcher, however, decided that the most effective therapeutic model for the design and development of the social support programme would be psycho-education and adult education, grounded in a family resilience orientation. The reasons for this decision will be highlighted in the discussion below.

6.2.1 Family resilience

A family resilience framework has been found to provide valuable conceptual guidelines for interventions aimed at supporting and strengthening vulnerable families (Walsh, 2002). The framework can be used with a variety of intervention models and has been applied to crises such as serious illnesses, disability and loss (Walsh, 2003). The framework is suitable for this specific study as it provides a map to describe and target the central family processes (as discussed in Chapter 2) that have been found to lower the risk for dysfunction and promote healing and growth following the diagnosis of a child’s hearing impairment (Walsh, 2002).

The advantages of using the family resilience framework in the present study are numerous.

Firstly, the framework focuses on strengths rather than on deficits and thereby provides a positive and empowering form of intervention. Secondly, it provides guidelines for developing an intervention for a specific target group, as it acknowledges that all families are unique and no single model will be appropriate for all families. Thirdly, it acknowledges that family functioning varies over time and across the family’s life cycle (Walsh, 2002).

6.2.2 Psycho-education

Psycho-education is an evidence-based practice that combines multiple strategies of intervention drawn from well-established theories and practices (Brendto & Long, 2005).

Psycho-education as a framework was influenced by various psychological theories, the most prominent being the existential-humanistic models, behavioural and cognitive models, and general systems theory (Fouche, 1995). Having drawn knowledge from various theories has ensured that psycho-education is integrated, holistic, systemic, comprehensive and functional and can be implemented across cultures (Wood, Brendtro, Fecser & Nichols, 1999).

In practice, the facilitator focuses on prevention rather than cure, and on the development of the client’s potential rather than the elimination of pathology (Fouche, 1995), thereby reinforcing the strength-orientated paradigm in the current study. Clients are viewed as advocates in their own learning and recovery, rather than as passive beings, reinforcing the concept of empowerment. The learning experiences are designed in such a way as to bring about behavioural, emotional and interpersonal change over time (Marshall, 1990).

The premise for using psycho-education in the current study was based on Walsh’s (1996) finding that multifamily psycho-educational groups are suitable for enhancing family resilience. Psycho-educational family interventions have already been implemented successfully with children suffering from asthma, diabetes and cystic fibrosis (Goldbeck &

Babka, 2001). In addition, psycho-educational programmes can provide families with skills that have found to be especially important for families who have a child with a hearing impairment, namely practical information, problem-solving skills and social support (Walsh, 1998; 2003). Research has also shown that psycho-education can be used successfully in enhancing the acceptance of an illness or disability, promoting co-operation with treatment, and enhancing the parents’ sense of dignity and self esteem (Hayes & Gantt, 1992; Swanson, Pantalon & Cohen, 1999).

Roos, Kunzman, Prinsloo and Alant (2000) proposed a number of steps that need to be followed in order for any psycho-educational intervention to be successful, namely:

1. Problem-identification 2. Situation analysis

3. Development of the intervention 4. Evaluation

5. Implementation

6. Re-evaluation and adaptation

Since the intervention was aimed at the parents of children who have a hearing impairment, cognisance had to be taken of how adults learn. As a result, the principles of adult education were explored and it was found that the model developed by Roos et al. (2000) correlates closely with the models proposed by adult education theorists. In addition, the adult education paradigm is embedded in the philosophy of psycho-education (Greeff, 2003). As a result, the principles of psycho-education and adult education were merged in the current study in order to plan, design and implement the social support programme. A discussion of adult education follows below.

6.2.3 Adult education

Most research on programme development has been conducted in the field of adult education, with researchers such as Tyler (1949), Houle (1996), Knowles (1990), Sork (2000) and Caffarella (2002) playing key roles in developing models that guide programme planning.

Sork and Caffarella’s (1989) model for systematically planning educational programmes links well with the steps proposed by Roos et al. (2000). The six steps of Sork and Caffarella’s (1989) model are: (1) analyse planning context and client system; (2) assess needs; (3) develop programme objectives; (4) formulate instructional plan; (5) formulate administrative plan; and (6) design programme evaluation.

Caffarella (2002) expanded on the above six steps to develop a comprehensive, interactive model, based on the evaluation of previous programme planning models. Caffarella’s (2002) interactive model of programme planning was applied in the present study, as it allows for the merging of theories, provides a clear mission and has been researched. The model is embedded within seven major assumptions, namely:

1. The focus is on learning and how this learning results in change.

2. Recognition of the non-sequential nature of programme planning.

3. Discernment of the magnitude of context and negotiation.

4. Attendance to preplanning and last-minute changes.

5. Heeding and honouring of diversity and cultural differences.

6. Acceptance of different ways of working when programmes are planned. No single method of planning ensures success.

7. Understanding that programme planners are learners too; reflection and evaluation will strengthen individual abilities (Caffarella, 2002; Marshall, 1990).

Caffarella (2002) illustrates her model with a concentric spherical graph that includes 12 spokes that highlight the building blocks required for effective programme planning (refer to Figure 13). The steps are cyclic in nature and interdependent, and can at any time influence each other or cause a change of direction in the process. Due to the cyclic nature of the model, steps can be skipped temporarily, or work can be done on several tasks simultaneously.

Interactive Model

Figure 13. Interactive model of programme planning (Caffarella, 2002).

Figure 13 above highlights the twelve tasks involved in effective programme planning, namely: (1) discerning the context; (2) building a solid base of support; (3) identifying programme ideas; (4) sorting and prioritising programme ideas; (5) developing programme objectives; (6) designing instructional plans; (7) designing transfer of learning plans; (8) formulating evaluation plans; (9) making recommendations and communicating results; (10) selecting formats, schedules and staff needs; (11) preparing budgets and marketing plans; and (12) coordinating facilities and on-site events.

The above tasks guided the development and implementation of the social support programme, which will be discussed in greater detail below and is attached in Addendum E and F.