What Works
in Parenting
Support?
Dr. Kirsten Asmussen
The Early Intervention Foundation
Wednesday 10 September 2014
@theEIFoundation
eif.org.uk
Aims of the presentation
•
A tale of two clearinghouses: The Commissioning
Toolkit and the EIF Guidebook
•
How do we know what does (and does not) work in
parenting support? Key messages from research
•
Three interventions that ‘work’
•
‘Do’s and Don’t’ for commissioners and practitioners
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What is a parenting intervention?
• Parenting interventions aim to support children’s
development through direct work with parents
• Parenting interventions include specific activities to
support the parent/child relationship and improve
children’s behaviour
• This definition is quite narrow in comparison to other
interventions that target parents, but do not give
them parenting skills. Such interventions might
include life coaching, couples therapy or individual
therapy
What Works in Parenting Support?
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A tale of two clearinghouses:
The Commissioning Toolkit
•
The DfE established the National Academy for Parenting
Practitioners (NAPP) in 2007 as a centre for excellence
in parenting research and practice
•
The Commissioning Toolkit was established to rate the
quality of parenting interventions against best practice
in four key areas
•
Ratings were applied against the criteria established
with the Parenting Programme Evaluation Tool (PPET)
What Works in Parenting Support?
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A tale of two clearinghouses:
The Commissioning Toolkit
•
The PPET criteria was informed by an exhaustive
review of the research literature, as well as other
internationally recognised rating systems
•
The PPET team evaluated parenting interventions
on a scale from 0 – 4 in terms of the:
•
•
•
•
Specificity of the target population
Theory and content
Training and implementation systems
Strength of the evaluation evidence
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
A tale of two clearinghouses:
The EIF Guidebook
• The Early Intervention Foundation (EIF) was established
in July 2013 to increase the use of evidence-based
programmes and practices
• In July 2014, EIF launched its Guidebook that provides
information on a wide variety of early interventions
• Currently, it provides the details of 50 interventions in
terms of their target population, content,
implementation systems and evidence
What Works in Parenting Support?
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A tale of two clearinghouses:
The EIF Guidebook
•
Interventions can be searched
by the children’s age, strength
of evidence or outcomes within
nine domains known to impact
children’s development
•
Information is also provided
about setting and workforce
requirements
What Works in Parenting Support?
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A tale of two clearinghouses
• The strength of evidence assessment is based on
internationally recognised standards of evidence:
4 Consistently positive, long-term impact through multiple
RCTs
3 A positive impact from one rigorously conducted RCT
2 A positive impact from a pre/post study with standardised
measures
1 Qualitative evidence or user satisfaction surveys
0 No evidence
-1 Harmful effects
What Works in Parenting Support?
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What works in parenting support?
1. A clearly specified target population
Parents will only benefit from
interventions if they are wellmatched to their needs
Children
in need
Targeted
Selected
Prevention
Universal
What Works in Parenting Support?
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What works in parenting support?
1. A clearly specified target population
• Parents attend parenting interventions for a variety
of reasons:
•
•
•
Parents want expert advice on normal child issues
Parents want validation for their own experiences
Parents want to understand their children better
• In a minority of cases, parents will need support
dealing with more serious, ongoing problems
• Examples of such problems include children’s
behavioral or emotional problems, parental mental
health or family-related problems
What Works in Parenting Support?
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What works in parenting support?
1. A clearly specified target population
• The best parenting interventions specify who the
programme is and is not for
• As a general rule, a one-size-fits all approach to
parenting support is not appropriate
• Parenting interventions should be developmentally
appropriate
• Effective parenting interventions also specify
parents’ level of need
What Works in Parenting Support?
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What works in parenting support?
1. A clearly specified target population
• Programmes targeting parents with complex needs
should be delivered by highly qualified practitioners on
an individual basis over a relatively long period of time
• Programmes targeting parents with everyday concerns
can be delivered by practitioners with lower
qualifications to groups of parents
• All parenting programmes should have systems in place
to understand parents’ needs and monitor their
progress
What Works in Parenting Support?
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What works in parenting support?
2. Evidence-based content
•
Effective parenting interventions are underpinned by content
which is based on scientifically validated theories
•
An example of a scientifically validated theory is Gerry
Patterson’s social learning theory:
Naturally
occurring
aggressive child
behaviour
Appropriate
reinforcement;
non-coercive
parenting;
appropriate
parenting
strategies
What Works in Parenting Support?
Decreases in
child aggression;
increases in prosocial behaviour
@theEIFoundation | eif.org.uk
What works in parenting support?
2. Evidence-based content
•
A second example of a scientifically validated theory is John
Bowlby’s attachment theory:
Parents respond
sensitively and
predictably to
their infant’s
cues
Children form a
positive
relationship with
the parent – i.e.
attachment
What Works in Parenting Support?
The child
becomes selfconfident and
has positive
expectations
about the world
@theEIFoundation | eif.org.uk
What works in parenting support?
2. Evidence-based content
• An example of a non-evidence-based, but popular theory of
parenting support:
Parents
lack
confidence
&
knowledge
Parents
confidence
increases
because
they attend
parenting
course
What Works in Parenting Support?
Improved
parent/child
relationship
Improved
child
confidence
&
behaviour
@theEIFoundation | eif.org.uk
What works in parenting support?
2. Evidence-based content
•
•
•
There are no quick fixes. Parenting programmes must provide
parents with a sufficient opportunities to learn new
behaviours
Parenting skills must be taught in a way that parents can
understand and retain
Effective methods of teaching parents skills include:
• Engaging content tailored to different learning styles
• Role-play and opportunities to practice new ideas with feedback from the
practitioner
• Homework
• Opportunities for discussion
• Opportunities for self-reflection through feedback and video observation
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What works in parenting support?
2. Evidence-based content
• Effective parenting interventions identify short-term
programme goals that are logically linked to longer-term
positive outcomes for children
Parents
learn skills
to reinforce
child’s prosocial
behaviour
Child’s
ability to
self
regulate
increases
What Works in Parenting Support?
Child selfregulatory
behaviour
is evident
at school
Child is
well-liked
by teachers
and peers
Child does
well in
school
@theEIFoundation | eif.org.uk
What works in parenting support?
3. Training and implementation systems
• All too often, practitioners adapt evidence-based programmes by
altering their length or changing their content
• Research suggests that this inevitably reduces the quality of the
programme and decreases its overall effectiveness
• It is therefore important for programmes to have training
systems in place to increase programme fidelity
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What works in parenting support?
3. Training and implementation systems
• Training processes that increase programme fidelity include:
• Good quality training that covers the theories underpinning the
•
•
•
•
•
programme
A clear and comprehensive training manual
Minimum qualification requirements attending training
A certification processs that ensures that the practitioner has
learned the programme content
Systems for maintaining programme fidelity
Specifications for ongoing supervision which are appropriate for
the needs of the target population and the practitioners’
qualifications
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What works in parenting support?
3. Training and implementation systems
•
•
•
•
•
Commissioners are interested in knowing if an effective
intervention can be made readily available to their community
This availability is often linked to the programme’s ability to
provide high quality training ‘at scale’
Effective parenting interventions are rarely reliant on one
individual or team to deliver training
Instead, they require well-developed systems for training other
trainers
They also provide post-implementation support to host
agencies to ensure that practitioners have the resources to
implement the programme effectively – in a word, licensing is
a key to programme success
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What works in parenting support?
4. Evidence that the programme works
• Those commissioning parenting interventions should have
evidence that their investment will consistently result in
lasting positive outcomes for children
• A growing body of evidence now also suggests that the widescale implementation of evidence-based parenting support
leads to improved child outcomes that can be observed at the
community level
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What works in parenting support?
4. Evidence that the programme works
• The community-wide implementation of Triple P has led to
significant reductions in rates of child maltreatment
• The Family Nurse Partnership consistently results in long-term
positive outcomes for teenage mothers and their children
• The universal implementation of Incredible Years is reducing
conduct problems and providing value for money
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
What works in parenting support?
4. Evidence that the programme works
• Effective interventions are also underpinned by an
ongoing programme of monitoring and evaluation
that carefully considers what works best for whom,
and under what circumstances
Review
Understand
Do
What Works in Parenting Support?
Plan
@theEIFoundation | eif.org.uk
Three of the best
1. Universal Support: Selected Triple P
•
Ideally suited for parents at transition points in their
children’s development, including entry into pre-school and
primary school
•
Groups of 20 to 30 parents attend three sessions that cover:
•
•
•
•
•
Strategies for encouraging positive child behaviour
Effective methods of discipline
Age-appropriate expectations
Creating an enriching learning environment
Taking care of yourself as a parent.
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
Three of the best
1. Universal Support: Selected Triple P
Why successful?
Population Specificity:
Theory and Content:
Training & Implementation:
Evaluation Evidence:
What Works in Parenting Support?
3 Has a clearly defined target population and
adequate systems for gathering information on
parents
4 Draws primarily from Social Learning Theory
4 Has a comprehensive package of training support
involving a tiered system for practitioners to
become trainers
2 Underpinned by a single study (Sanders, Prior
and Ralph, 2009) involving 244 parents completing
standardised pre and post programme measures.
Parents were assigned to the programme or a wait
list control group, but assignment was not fully
random.
@theEIFoundation | eif.org.uk
Three of the best
2. Selected Prevention: Family Nurse Partnership
•
Family Nurse Partnership is for young mothers expecting
their first child
•
Mothers enrol in the programme during their pregnancy and
receive visits from a Family Nurse on a weekly or fortnightly
basis until their child’s second birthday
•
During these visits, mothers learn about their young child’s
health and development, practice methods for playing with
their child and receive support for their own wellbeing
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
Three of the best
2. Selected Prevention: Family Nurse Partnership
Why successful?
Population Specificity:
Theory and Content:
Training & Implementation:
Evaluation Evidence:
What Works in Parenting Support?
4 Has a clearly defined target population and
highly detailed systems for gathering information
on parents, assessing and monitoring their needs
4 Social Learning Theory, Attachment Theory,
Ecological Theory & Self-efficacy theory
4 Has a comprehensive package of training
support, including implementation support to
comply with licensing requirements
4 Three RCTs suggest consistent positive short
and long-term outcomes for mothers and
children. These include significant reductions in
child maltreatment, mothers’ use of drugs and
alcohol, and long term improvements in
children’s school achievement.
@theEIFoundation | eif.org.uk
Three of the best
2. Targeted Intervention: The Incredible Years
•
Incredible Years Early Years (IYEY) is for parents
having difficulty with the behaviour of a child
between the ages of three and six
•
Parents attend 22 weekly group sessions. During
the first 12 weeks they learn strategies for
interacting positively with their child and
discouraging unwanted behavior
•
The following 10 weeks cover complex issues
within the parent, including parent anger
management and mental health issues
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
Three of the best
2. Targeted Intervention: The Incredible Years
Why successful?
Population Specificity:
Theory and Content:
Training & Implementation:
Evaluation Evidence:
What Works in Parenting Support?
4 A clearly defined target population and
detailed systems for gathering information
on parents, assessing and monitoring their
needs
4 Draws from Social Learning Theory,
Attachment Theory and Self-efficacy Theory
4 Has a comprehensive package of training
support, including comprehensive fidelity
and supervision requirements
4 Has evidence from over eight RCTs
demonstrating consistent short and long
term improvements in children’s behaviour
at home and at school.
@theEIFoundation | eif.org.uk
Do’s & Don’ts
•
•
•
•
•
•
•
Do carefully specify the target population. There is no one-sizefits all
Have systems for adequately assessing and monitoring parents’
needs
Draw from theories that have scientific evidence
Provide sufficient dosage -- There are no quick fixes
Programmes should have systems in place for ensuring fidelity
This means a clear programme manual, minimum practitioner
qualifications and sufficient supervision
Ideally, programmes should have some licensing arrangements in
place for host agencies, to ensure that implementation goes
smoothly
At the very least, interventions should have systems for
monitoring programme outcomes through the use of pre and
post measures. RCTs are ideal
What Works in Parenting Support?
@theEIFoundation | eif.org.uk
Where can I find out more?
More information about high quality parenting
interventions can be found at:
https://www.education.gov.uk/commissioning-toolkit
More information about effective early interventions
can be found at: http://guidebook.eif.org.uk/
Further reading about what can be
achieved through the commissioning of
evidence-based parenting interventions
can be found at:
What Works in Parenting Support?
@theEIFoundation | eif.org.uk