Geoff Lindsay: University of Warwick Seminar


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Seminar Presentation from the Evidence Based Parenting Programmes and Social Inclusion conference held at Middlesex University, 20th September 2012

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  • SFP 10-14 relatively poorer than Triple P for parenting behaviours & satisfaction, Triple P particularly effective for reducing child conduct problems
  • Geoff Lindsay: University of Warwick Seminar

    1. 1. UK evaluation of evidence basedparenting programmes: Past and future Geoff Lindsay Evidence based parenting programmes and social inclusion Middlesex University, 20 September 2012
    2. 2. overview• Developing EB parenting programmes – local level• National policy driven – Parenting Early Intervention Programme 2006-11• From targeted to universal parenting programmes: CANparent trial 2012-14• Future?
    3. 3. 1. Initial developments• Development of a programme – Key role of the developer – Theoretical rationale and parents aimed at – Initial studies: try–out leading to randomized controlled efficacy trial – More trials – Trials by independent researchers – Effectiveness trial(s) in real life community settings – Scaling up • Opting in by individual organisations • Local, regional, national policy
    4. 4. Developments in UK• England has implemented national policies of supporting parents through EB parenting programmes• 3-stage process to develop EB practice – Literature review (Moran et al. 2004) – Parenting Early Intervention Pathfinder (Lindsay et al. 2008, 2011a) – Parenting Early Intervention Programme (Lindsay et al 2011b)• Scaling up• Evaluation of both outcomes and processes
    5. 5. 2. The PEIP evaluation 2006-11• Government initiative, LAs funded• Pathfinder 2006-8 in 18 LAs, – 3 EB programmes – Focus children 8-13 years with or at risk of developing behavioural, emotional and social difficulties• Study of effectiveness across 18 LAs? – Are there different effects for different programmes?• What influence successful implementation on this scale?• Implications for policy and practice?
    6. 6. Pathfinder evidence 2006-08• Positive parent outcomes – All 3 programmes were effective – Parents rated them highly• Process factors also important – LA variations in efficiency and cost effectiveness – Importance of the organisations support to implement• On basis of positive evidence: government funded a national roll out across all LAs in England
    7. 7. The PEIP evaluation 2008-11• Government initiative, all LAs funded• Can evidence-based parenting programmes be implemented effectively when rolled out across a whole country? – Are there different effects for different programmes?• What factors influence successful implementation on this scale?• Implications for policy and practice?
    8. 8. Purpose of the PEIP evaluation• All PEIP recognised programmes were evidence- based (in controlled conditions- efficacy trials)• Pathfinder showed the effectiveness of the three programmes (across 18 LAs)• PEIP explored national roll out across England – Impact on parent and child outcomes – LA and organisational factors in implementation – Differential effects by parents/programme?• One-year follow up• Cost effectiveness
    9. 9. The programmesFive main programmesPathfinder 2006-08 (Wave 1):• Triple P• Incredible Years• Strengthening Families Strengthening CommunitiesPEIP 2008-11 (Waves 2 & 3) – above plus:• Strengthening Families 10-14• Families and Schools Together (FAST) – Insufficient data from FAST for the main quantitative analyses – Similarly for Parent Power, STOP and Parents Plus (added later in the PEIP)
    10. 10. Quantitative data• Pre-course questionnaires – 6,143 parents – Attending 860 groups – In 43 LAs• Post-course questionnaires – returned by 3,325 (54%) of original sample.• Change from pre-course to post-course in scores on key parent and child measures • Is there improvement? • If so, how much?
    11. 11. Parent mental well-being: Warwick Edinburgh Mental Well-being Scale 14 items, e.g.: - Ive been feeling optimistic about the future - Ive been feeling useful - Ive been feeling relaxed•Each item rated 1-5 (none to all of the time) score range14–70, highly reliable (alpha=0.94), national norms•Looking for increase in score
    12. 12. Parenting Laxnesse.g. 1 71. When I give a fair threat or I always do I often dontwarning .... what I said carry it out I back down2. If my child gets upset when I I stick to and give in tosay No .... what I said my child•Each item scored 1-7, score range 6-42,•Good reliability (alpha=.77).•High scores represent less effective practice so looking for areduction in score.
    13. 13. Parenting Over-reactivitye.g. I raise my I speakWhen my child misbehaves .... voice or yell calmly to my child things build Things dontWhen theres a problem with up and I do get out ofmy child .... things I dont hand mean toEach item rated 1-7, score range 6-42, good reliability(alpha=.72). Looking for reduction in score.
    14. 14. Did PEIP target the ‘right’ parents?- ‘disadvantaged’ Yes• 91% biological parents to the target child, 85% female• Wide range of minority ethnic groups (19% vs 8% nationally)• High proportion single parents (44% vs. 24% national statistics) two-thirds living in rented property (63% vs. 27%)• 54% no qualifications or only some GCSEs, but 20% with HE qualifications and 11% with degrees• High levels of support needs: 49% had seen GP in last 6 months and 21% had seen a social worker• Low levels of mental well-being: 75% scored below the national median as started their programme.• So, skewed to disadvantaged but note also the range
    15. 15. Parents’ mental well-being at start
    16. 16. Did PEIP target the right children? Yes• Mean age 8.6 years (but wide range: 37% age 0-7; 54% age 8-13; 9% age 14+)• 62% boys• 49% entitled to Free School Meal (16% nationally)• 12% - statements of SEN (3% nationally)• 31% - additional educational support in school• High % had behavioural, emotional and social difficulties with a negative impact on everyday life
    17. 17. Strengths & Difficulties Questionnaire (SDQ)• 25 items, each rated on 3 point scale (not true, somewhat true, certainly true)• E.g. My child: – Often has temper tantrums or hot tempers – Often fights with other children or bullies them• UK national norms from parents of a sample of 10,000+ children aged 5-15• About 5-6 times higher prevalence of behavioural problems than the norm
    18. 18. SDQ at pre-course (% above clinical cut-off)SDQ Scale National% PEIP%Emotional symptoms 11.4 39.2Conduct problems 12.7 60.7Hyperactivity 14.7 48.3Peer problems 11.7 44.7 SDQ Total difficulties 9.8 56.5Prosocial scale 2.3 18.8Impact score 8.8 60.4p < .001 in all cases
    19. 19. Did the parent and child outcomes improve after the groups? • All effects are statistically highly significant • Large effect sizes for parent gains • Effect size is a standardised way of presenting the change in outcomes: <0.2 small, 0.5 medium; 0.8+ large. • Parent outcomes show the largest effects because directly targeted
    20. 20. Were there different effects by Programme?• Four programmes had sufficiently large samples to support comparison:• All programmes were effective in improving outcomes, but some (relatively small) differences in favour of Triple P compared with SFP 10-14 – Taking into account pre-group scores to look at change/improvement – Controlling for a range parent and child background factors (gender, housing, education, ethnicity, child age etc.) – Including fixed effects for LA
    21. 21. e.g. Comparison of programme effects relative to Triple P
    22. 22. How did parents rate the parenting group?• Generally very positive for all programmes• Two factors – Group leader style • made me feel respected (98%); • understood me and my situation (98%); • I could be honest about my family (98%); • interested in what I had to say (98%) etc. – Helpfulness of the programme • has been helpful (98%); • helped me personally to cope (95%); • helped me deal with child’s behaviour (96%); • I have fewer problems than before (84%).
    23. 23. Helpfulness ofGroup leaders’ style programme• SFP 10-14 significantly lower ratings - possibly because mean pre-course scores for SFP 10-14 were particularly low
    24. 24. One year follow upMental well being Parenting Child difficulties 48 Mean score with 95% confidence interval 46 44 42 40 38 36 34 32 30 Pre-course Post-course Follow-up • Parent mental well-being fell back somewhat, but still better than at pre-course • Improvements in Parenting Scale scores and child outcomes completely maintained
    25. 25. Quantitative data: conclusions• Clear evidence of success of the PEIP – Parent and child improvements across a range of important dimensions – Parents very positive about the group experience (those who completed) – Maintained positive outcomes one year later• Some variation between programmes in gains – On these particular measures – Programmes do have different foci – No random allocation to treatment
    26. 26. Qualitative data• 429 interviews with – LA strategic leads and/or operational leads – other professionals involved in parenting support, e.g., parenting experts – parenting group facilitators – school representatives – parents
    27. 27. LA factors & quality outcomes• Strategic leadership & operational co- ordination combined supported roll-out of the PEIP in LAs.• Where these were not in place, the PEIP was less efficient in organising groups & reaching parents – Strategic leadership, including the existence of a parenting strategy, helped establish the PEIP and support it through the roll out – Strategic leadership meshed the PEIP with existing priorities & infrastructure.
    28. 28. LA factors & quality outcomes• Operational co-ordination helped PEIP to be delivered across an LA.• Models differed – some LAs had one central co- ordinator & others divided the co-ordination role on a geographic basis. – Each model could be effective
    29. 29. Qualitative data conclusions• PEIP roll-out across LAs was not an easy task, but• Possible to achieve positive outcomes with a diverse workforce & in a range of settings• Facilitators needed to be able to engage parents, be well trained, to deliver with fidelity & to have access to supervision• Strategic & operational management & leadership necessary for successful LA roll-out.
    30. 30. So,…• Overall PEIP was effective on all our measures – And improvements were maintained one year later• All 4 programmes were effective – with some differences between them• Large variation between LAs in numbers of parents supported - cost effectiveness varied as a result• Strategic and operational leadership and management were crucial• Use of a wide range of facilitators possible• Very successful government initiative and clear evidence supporting use of these programmes
    31. 31. 3. CANparent trial• Change of government – and policy focus• From targeted to universal parenting classes• 3 trial areas – Camden, High Peak Derbyshire, Middlesbrough• 14 providers of parenting classes – All met criteria shown by research to be characteristics of effective parenting programmes • But lower level of evidence than PEIP
    32. 32. • Aim: to examine whether a market can be developed so – no need to subsidise (at all? partially?) – Providers will want to develop their provision across England/UK• Parents receive £100 value vouchers to ‘purchase’ a parenting programme they choose from those available in that trial area• 4th non-voucher trial area - Bristol
    33. 33. The CANparent study• Strand 1: Supply side – How the programme providers develop over the trial• Strand 2: Survey research and impact evaluation – Penetration surveys: in trial and comparison areas • parents attitudes to parenting classes, awareness and take up. – Participating parents • 2000 parent sample: improvements in mental well- being, satisfaction and sense of effectiveness as a parents, dealing with daily hassles • All parents: satisfaction survey• Strand 3: cost effectiveness
    34. 34. 4. future?• Importance of both targeted and universal support?• Parental choice?• Funding?• ‘Evidence based’ concept• Will providers welcome opportunities o develop large scale?• Infrastructure?• Support for implementing? For facilitators? Maintenance of fidelity?
    35. 35. ConclusionsMore information: information about the CANparent evaluation