Parenting programmes

Parenting Programmes

Many different approaches to parenting support have been developed and trialled, and the research literature on parenting interventions is very large. Most trials and evaluations have been carried out with mothers, but effective programmes for fathers are now beginning to appear. This literature is now being summarised in reviews of reviews. (1) (2)

A database of programmes available in the UK and the evidence to support them has been developed by the National Academy for Parenting (3). Two NICE reviews have been produced - one relating to parenting programmes to prevent and treat conduct disorder (4) and one in relation to supporting social and emotional development in the vulnerable under fives. (5)

The following programmes now have a clear evidence base.

Infancy

Universal infant programmes include programmes offered in the context of antenatal care and programmes offered at birth to help all parents develop sensitivity to their infants. These help parents 'read' their infants better and are also more adept at addressing their own mental health needs. They show parents what infants are capable of, help them to identify temperamental differences, provide them with knowledge of child development, and the management of infant behaviours like sleep and crying.

Promotional interviewing - an approach which focuses on the positive, and aims to empower and support parents as well as identify needs - is now recommended in the English Child Health Promotion Programme during pregnancy and the postnatal period.

Targeted infant programmes cover high risk groups, typically teenage mothers. These are usually offered on a one-to-one basis through home visiting. They may need to be intensive, providing weekly visits for up to two years starting before birth. They may be combined with centre-based care. They can be tailored to parents' needs, addressing a wide range of parenting support including infant attachment and parental mental health. The best known example of this approach is the Family Nurse Partnership which is currently being trialled in the UK.

Programmes to address postnatal depression cover prevention in high risk groups and intervention in mothers with established depression. They include cognitive behavioural and person-based counselling, both of which are equally effective if the practitioner can establish a trusting relationship with the mother. Universal approaches to prevention of postnatal depression are not effective and screening is inefficient as there are no reliable instruments.

The optimum approach to identification is through sensitive case finding in the context of universal provision of health visiting support.

Parent infant psychotherapy describes one-to-one therapy available in some parts of the UK to disturbed families. It may include video interaction guidance and approaches like Watch Wait and Wonder. It may address the parent's mental health needs.

Older children

Parenting programmes for toddlers and older children. A great many programmes have been developed for this age group. Most target families where children have or are at high risk of developing behaviour problems, but universal programmes are available. They almost all address behaviour management principles: pay attention to good behaviour, where possible ignore bad; set clear boundaries and use positive discipline to reinforce. They vary in the extent of relationship building they provide.

Programmes with a greater emphasis on parent and child wellbeing and relationships may be more appropriate for preventing mental illness as opposed to behavioural disorders. The evidence base for the latter is, however, much weaker. Parenting programmes are often group-based with parents meeting weekly for 10-12 weekly sessions of two hours, but may be one-to-one. Effective programmes are manualised (i.e. a description of the programme, each session and how to facilitate the programmes is available in a manual for use by facilitators), involve experiential learning and set 'homework' for parents between sessions.

Most parenting programmes are strengths-based - identifying and building on what parents are getting right rather than on problems. Some programmes can be offered at different levels by facilitators with different levels of training. Programmes are also available for parents of teenagers, addressing parenting in the context of teenage issues such as drugs, alcohol and sex.

Examples of these programmes include Incredible Years (IY), Triple P, Mellow Parenting, Strengthening Families Strengthening Communities, and Family Links Nurturing Programme. IY was developed in the US and has been extensively trialled in targeted settings including in the UK. Triple P is a suite of programmes from universal media based through to intensive one-to-one support for families where children have clinical level problems.

Two large trials of Triple P offered at all levels (6) (7) are among the few studies to have demonstrated impact of a universal and targeted approach combined; the first (1) is one of a small number of studies to have shown any effect on abusive parenting. Other studies of universal programmes have struggled to show impact, possibly because of the problems of applying randomised controlled trials (RCTs) in such settings.

Even highly evidence-based programmes like Triple P can prove ineffective in some settings. (8) Implementing these evidence-based programmes effectively requires considerable attention to detail, high levels of staff training and supervision, and strong backing from local child health and education services.

Parenting advice lines can provide targeted support confidentially to parents who are in distress. (9)

Internet based parenting support is now freely available and serves a valuable educational function, facilitates social networking and access to local facilities. Several parenting programmes are now offered online with some with telephone support. (9)

Peer support. A variety of peer support projects have been developed to support parents and parenting. Properly run, with good training and supervision of volunteers, these programmes are popular with parents and increase confidence, social networks and engagement. Highly trained volunteers can run parenting programmes successfully, but most peer support volunteer schemes do not impact on parenting.

Prevention of abuse and neglect. A small number of one-to-one programmes have been shown to help prevent abuse and neglect in very high risk families, (10) and one programme has shown some success with families in which parents abuse drugs and alcohol. (11)

References

1) Stewart-Brown S, Schrader-McMillan. Home and community-based parenting support programmes and interventions. Report of the Workpackage Two of the DataPrev Project. 2010

2) Barlow J, McMillan AS, Kirkpatrick S et al. Health-led parenting interventions in pregnancy and early years. Department for Children, Schools and Families, 2008.

3) The National Academy of Parenting research at Kings College London produces a commissioning tool kit identifying evidence based parenting programmes available in the UK .

4) NICE Guidance: conduct disorders in children and young people (CG158)

5) NICE Guidance on the promotion of emotional and social development in vulnerable under fives.

6) Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR: Population-based prevention of child maltreatment: the U.S. Triple P system population trial. Prevention Science 2009, 10:1-12.

7) Zubrick SR, Ward KA, Silburn SR, Lawrence D, Williams AA, Blair EM, et al. Prevention of child behaviour problems through universal implementation of a group behavioural family intervention. Prev Sci 2005;6:287-304.

8) Little M, Vashti B, Morpeth L, Blower S, Axford N, Taylor R, Bywater T, Lehtonen M, Tobin K. The Impact of Three Evidence-Based Programmes Delivered in Public Systems in Birmingham, UK International Journal of Conflict and Violence. 2012;6:,

9) Advice lines and web based support for parents

10) Hunter JK, Schmidt Fl, Keyes CLM. Well-being in the workplace and its relationship to business outcomes: a review of Gallup Studies; 2003.

11) Parenting under Pressure