Proven Practice:effective parenting programmes

The  Social Care Institute for Excellence examines research into parenting programmes where children have behavioural problems

Conduct disorders are often characterised by repetitive and so-called antisocial patterns of behaviour. They may have a significant detrimental impact on health and place the child at higher risk of disadvantage through social exclusion, poor educational achievement, delinquency and crime and negative interpersonal relations.

There are of course training and education programmes for parents which aim to help them strengthen their relationships with their children and improve their children’s behaviour. Research into these programmes found many of them to be achieving these aims.

In 2006 the Social Care Institute for Excellence and the National Institute for Health and Clinical Excellence (Nice) published guidance making recommendations for good practice in the delivery of programmes for parents of children aged 12 or younger with conduct disorders. Among the core recommendations outlined was that the programmes should be group-based and that providers should make additional support available so that all parents could access the programmes.

A follow-up study to support the implementation of the Nice/Scie guidance on parenting programmes has now been published. Scie commissioned a practice survey, and talked to frontline practitioners about their experience of parenting programmes.

Accessibility and uptake

Further study into the effectiveness of parenting programmes identified a number of problems with access. These problems led to low levels of uptake and high levels of dropping out. The problems were particularly acute for socially disadvantaged families and children with more complex problems. The most common reason for patchy attendance was “competing commitments”, for example, being available for work to be eligible for benefits.

Additionally, there were issues with relationship-building, trust and lack of follow-up, often due to funding shortages.

Recruiting parents

Efforts to recruit parents to parenting programmes can be grouped into three areas:

● Publicity and marketing. This ideally takes a multi-pronged approach including taster sessions, leafleting, networking events and encouraging word of mouth. When sending out marketing materials professionals should consider their audience; for example is it going to parents or to professionals and will there be people who can’t read?

● Referrals can come from sources including the voluntary, community and public sector but haphazard referral routes undermine the effectiveness of this method of recruitment. This could be addressed by increasing understanding of the types of programme more widely.

● Creating a variety of routes into courses including through more general community activities helps parents to avoid feelings of blame or stigma.

Matching parents to programmes

Outreach is a valuable part of recruiting the right people for the right course. Preliminary sessions can help facilitators evaluate parents’ readiness to engage with the programme as well as ensure parents who are not suitable are not offered places.

Preparing parents for programmes

Careful preparatory work including preliminary meetings and taster courses can make parents feel more confident ahead of the programme, improves attendance levels and reduces dropping out. Pre-group preparation is especially useful for building trust among parents who have issues with authority.

Overcoming barriers

Before barriers can be surmounted they must be identified. Consulting local groups of parents can help to determine what hinders attendance. There may be:

● Physical barriers, which can be overcome by providing transport for a range of locations, for example, or facilitators in rural areas who may consider taking their programmes into communities.

● Psychological barriers – often the parents who are most likely to benefit do not feel they need support or are deterred from taking it because of the possible stigma.

Different approaches to addressing this include: considering the needs of parents first rather than focusing on improving skills and providing informal sessions before the programme begins.

Group dynamics

There should also be careful consideration of who to recruit to the group; some programmes target parents with specific shared experiences and most believe that men and women need time in same-sex groups.

Tailored programme

Many facilitators tailor content to the requirements of particular groups, while ensuring adherence to key elements of the programme. This tends to take the form of using different approaches, such as unstructured sessions for younger people or adapting materials for parents with special needs, or English as a second language

Additional support

Additional support during the programme has a significant effect on engagement and attendance. This can include phone calls between sessions, visits, and for parents with complex needs the involvement of other agencies can be valuable.

Strategically, increasing the accessibility and acceptability of parenting programmes requires the following activities:

● Increasing provision.

● Collaboration with other agencies.

● Offering a range of types of support

● Developing and training facilitators to improve their skills.

● Recruiting volunteers to help support parents in programmes.

● Monitoring the effectiveness of programmes.

Although it is recognised among facilitators that parenting programmes have value for parents and providers, it is important to evaluate effectiveness. This should include:

● Recording attendance and progress to create a thorough picture of the populations involved and to help with future recruitment to courses.

● Obtaining ongoing feedback from parents helps facilitators shape programmes. However, there are doubts about the effectiveness of questionnaires, especially after the programme has finished – the most common form of requesting parental comment. It may be better to collect information during the course of the programme.

● Impact assessment using standardised measures is used by some facilitators. However, for others there is concern that measures may not be sensitive enough and may not pick up changes which are seen as valuable by parents. This type of follow-up should also evaluate the long-term impact of the programme.

● Arranging external evaluations.

Practitioners’ messages

● Parental-training programmes can play an extremely valuable role in improving the behaviour of children with conduct disorders and improving parent-child relationships.

● Many of the parents who would benefit most from these programmes fail to join them. Positive approaches to reaching them pay real dividends.

● Marketing plays a valuable role in recruiting parents but it is essential that they are recruited to programmes which are right for them.

● Facilitators should make every effort to create a safe welcoming space for the course and address barriers to entry.

● Parents should be offered ongoing support throughout the course

● It is important to work closely with multiple agencies, offer a range of types of support and access to it and involve parents in tailoring some parts of the programme.

● Measures should be used to evaluate the success of programmes, including attendance, parental feedback and external evaluation.

Further information

● Report 21, follow-up work to support the implementation of NICE/SCIE guidance on parenting programmes

● Scie/Nice, Parent-training/education programmes in the management of children with conduct disorders.

Research abstracts

Author BAYLEY Julie, WALLACE Louise M, CHOUDHRY Kubra

Title Fathers and parenting programmes: barriers and best practice

Reference Community Practitioner, 82(4), April 2009, pp.28-31, ISSN paper 1462-2815

Abstract The apparent reluctance of fathers to engage in parenting services is recognised as a problem by health and social care practitioners, and the Department of Health identifies the engagement of fathers as a key service target.

This review gathers information on barriers to fathers’ engagement with parenting support services and identifies best practice for recruitment. The barriers identified were lack of awareness, work commitments, female-orientated services, lack of organisational support and concerns over programme content. Aspects of best practice included actively promoting services to fathers rather than parents, offering alternative forms of provision, prioritising fathers within organisations and taking different cultural and ethnic perspectives into account. Achieving greater engagement of fathers in parenting support programmes requires a greater understanding of the perspectives of fathers.

Author KANE G A, WOOD V A, BARLOW J

Title Parenting programmes: a systematic review and synthesis of qualitative research.

Reference Child Care Health and Development, 33(6), November 2007, pp.783-793

Abstract Parenting programmes are at the heart of intervention strategies for parents of children with emotional and behaviour problems. Systematic reviews and meta-analyses of randomised controlled trials have indicated that such programmes can improve many aspects of family life. However, there is currently a dearth of information concerning what it is that makes parenting programmes meaningful and helpful to parents. The aim of this paper was to examine parents’ experience and perceptions of parenting programmes using the meta-ethnographic method in order to sensitise policymakers and practitioners to the key factors that parents perceive to be of value. Based on the available evidence, five key concepts were identified as important when planning and delivering parenting programmes.

Author BARLOW J, PARSONS J, STEWART-BROWN S

Title Preventing emotional and behavioural problems: the effectiveness of parenting programmes with children less than three years of age

Reference Child: Care, Health and Development, 31(1), January 2005, pp33-42

Abstract Emotional and behavioural problems in children under three years of age have a high prevalence, and parenting practices have been shown to be strongly associated with their development. The aim of this review was to establish whether there is evidence from controlled trials that group-based parenting programmes are effective in improving the emotional and behavioural adjustment of children less than three years of age, and their role in the primary prevention of emotional and behavioural problems.

Article published in the 25 June 2009 edition of Community Care under heading ‘Parenting and conduct disorders’