Parenting Education Parenting Education for for

Parents of Young ChildrenParents of Young Children

Dr Shirley Leung SLDr Shirley Leung SLMB,BS(HK); MPH(Auckland); FHKAM(Paed); FRCP(Glasg)MB,BS(HK); MPH(Auckland); FHKAM(Paed); FRCP(Glasg)

Principal Medical & Health OfficerPrincipal Medical & Health OfficerFamily Health ServiceFamily Health ServiceDepartment of HealthDepartment of Health

Parenting Programme in Parenting Programme in Maternal & Child Health CentresMaternal & Child Health Centres

Aim: Aim: To equip parents with the necessary To equip parents with the necessary

knowledge and skills to bring up healthy knowledge and skills to bring up healthy and well-adjusted childrenand well-adjusted children

The Universal Programme:The Universal Programme:

To provide Anticipatory Guidance To provide Anticipatory Guidance to all parents on the physical & to all parents on the physical & psychosocial care of the child, psychosocial care of the child, through various modes & channelsthrough various modes & channels

Psychosocial IssuesPsychosocial Issues

Preparing to be parentsPreparing to be parents

Building parent-child Building parent-child relationshiprelationship

Promoting child Promoting child developmentdevelopment

Improving parenting skills Improving parenting skills & efficacy& efficacy

Managing behaviour in Managing behaviour in children…..etc.children…..etc.

Anticipatory Guidance to ParentsAnticipatory Guidance to Parents

Physical IssuesPhysical Issues

Newborn careNewborn care

BreastfeedingBreastfeeding

NutritionNutrition

Home safetyHome safety

Oral HealthOral Health……. etc.. etc.

Happy Parenting Workshops

Universal Programme: Delivered through Universal Programme: Delivered through various Modes and Channelsvarious Modes and Channels

Individual Interview

Leaflets AV resources

WebsiteTelephone

hotline

Community-based Promotion ActivitiesCommunity-based Promotion Activities

Roving exhibition

Baby Expo

API and poster campaign TV seriesAdvertising in mass

transit system

Targetted Programmes:Targetted Programmes:

Breastfeeding Breastfeeding – CoachingCoaching– Management of complicationsManagement of complications– Support groupSupport group

Child behaviour managementChild behaviour management – Positive Parenting Programme (Triple P)Positive Parenting Programme (Triple P)

Triple P: Principles & StrategiesTriple P: Principles & StrategiesPrinciple: To foster self efficacy & self-regulation of Principle: To foster self efficacy & self-regulation of

parents in child behaviour managementparents in child behaviour managementUnderstanding the causes of child behaviour Understanding the causes of child behaviour problemsproblemsSetting goals for change in parent’s own & child’s Setting goals for change in parent’s own & child’s behavioursbehavioursKeeping track of parent’s own & child’s behaviour Keeping track of parent’s own & child’s behaviour (Behaviour diary/graph)(Behaviour diary/graph)Acquiring the knowledge & skills of Acquiring the knowledge & skills of – 10 positive parenting strategies (enhance parent-child 10 positive parenting strategies (enhance parent-child

relationship; encourage desirable behaviours, etc)relationship; encourage desirable behaviours, etc)– 7 strategies to manage behaviour problems7 strategies to manage behaviour problems

Application of the above to solve current problems Application of the above to solve current problems and prevent future ones and prevent future ones

Role Play

Group discussion

Group Triple P

Phone follow up

Mini-lecture

FictionFiction FactFactDoes not address Does not address

relationship or valuesrelationship or values

Directed & controlled by Directed & controlled by professionalsprofessionals

A western product A western product suited for western suited for western cultureculture

A programme for A programme for middle-class parentsmiddle-class parents

Emphasizes building of a positive Emphasizes building of a positive parent-child relationshipparent-child relationship

Respects parent’s own valuesRespects parent’s own values

Empowerment of parentsEmpowerment of parents

Facilitate self-regulationFacilitate self-regulation

Build self-efficacyBuild self-efficacy

Programme effectiveness has been Programme effectiveness has been proven in local Chinese families (RCT)proven in local Chinese families (RCT)

Larger magnitude of improvement in Larger magnitude of improvement in low income level & new immigrantslow income level & new immigrants

Universality of human psychology & Universality of human psychology & GlobalizationGlobalization

Need to respect diversity & be Need to respect diversity & be culturally sensitive during service culturally sensitive during service provisionprovision

The EvidenceThe Evidence Leung C, Sanders MR, Leung S, Mak R & Lau J. Leung C, Sanders MR, Leung S, Mak R & Lau J. An outcome evaluation ofAn outcome evaluation of the implementation of the implementation of the Triplethe Triple P P

- Positive Parenting Program in Hong Kong. Fam Process - Positive Parenting Program in Hong Kong. Fam Process 2003; 42:531-44.2003; 42:531-44.

A randomised controlled trialA randomised controlled trial 69 parents with children 3 to 7 years 69 parents with children 3 to 7 years

– Intervention group 33Intervention group 33– Control group 36Control group 36ResultsResults– Increase in parenting sense of competence Increase in parenting sense of competence – Decrease in dysfunctional parenting practicesDecrease in dysfunctional parenting practices– Decrease in child behaviour problemsDecrease in child behaviour problems– Decrease in marital conflicts Decrease in marital conflicts

Directions & Approaches Directions & Approaches to Family Educationto Family Education

The Scope of Family EducationThe Scope of Family EducationFamily members at different life stages:Family members at different life stages:– Different needs (difficulties & problems)Different needs (difficulties & problems)

Programmes of different levels:Programmes of different levels:– Universal programmeUniversal programme

Anticipatory guidanceAnticipatory guidancePreventivePreventive

– Targetted programmeTargetted programmeAddress special needs / problemsAddress special needs / problems

Early interventionEarly intervention (primary care level)(primary care level)

Treatment & remedialTreatment & remedial

Provided by professionals of various Provided by professionals of various disciplines in different sectorsdisciplines in different sectors

Universal Programme

Primary Care Intervention

Secondary Care Intervention

Tertiary Care

Common Ground for all Common Ground for all Professionals: Professionals:

Evidence-based PracticesEvidence-based PracticesThe Cochrane Collaboration – Established in 1993Established in 1993– A global research networkA global research network– Aims toAims to improve healthcare decision-making through improve healthcare decision-making through

systematic reviewssystematic reviews of the effects of healthcare of the effects of healthcare interventions interventions

– Published in the Cochrane LibraryPublished in the Cochrane Library– [A systematic review aims to sum up the best available [A systematic review aims to sum up the best available

research on a specific question. It uses transparent research on a specific question. It uses transparent procedures to find, evaluate and synthesize the results procedures to find, evaluate and synthesize the results of all relevant research]of all relevant research]

Common Ground for all Professionals: Common Ground for all Professionals:

Evidence-based PracticesEvidence-based PracticesThe Campbell CollaborationThe Campbell Collaboration– established in 2000established in 2000– an international research network that an international research network that

produces produces systematic reviewssystematic reviews of the effects of of the effects of social interventions in the areas of social interventions in the areas of

educationeducationcrime and justicecrime and justicesocial welfare social welfare

– Published in the Campbell LibraryPublished in the Campbell Library– to to better inform policy and practice, and better inform policy and practice, and

ultimately improve people's well beingultimately improve people's well being

Cochrane LibraryCochrane LibraryParenting interventions for the prevention of unintentional injuries in Parenting interventions for the prevention of unintentional injuries in childhoodchildhoodDenise Kendrick, Jane Barlow, Amanda Hampshire, Leon Polnay, Sarah Denise Kendrick, Jane Barlow, Amanda Hampshire, Leon Polnay, Sarah Stewart-Brown; 2007Stewart-Brown; 2007Group-based parent-training programmes for improving emotional and Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old childrenbehavioural adjustment in 0-3 year old childrenJane Barlow, Jacqueline Parsons; 2003Jane Barlow, Jacqueline Parsons; 2003Individual and group-based parenting programmes for the treatment of Individual and group-based parenting programmes for the treatment of physical child abuse and neglectphysical child abuse and neglectJane Barlow, Isabelle Johnston, Denise Kendrick, Leon Polnay, Sarah Stewart-Jane Barlow, Isabelle Johnston, Denise Kendrick, Leon Polnay, Sarah Stewart-Brown; 2006Brown; 2006Individual and group-based parenting programmes for improving Individual and group-based parenting programmes for improving psychosocial outcomes for teenage parents and their childrenpsychosocial outcomes for teenage parents and their childrenEsther Coren, Jane Barlow; 2001Esther Coren, Jane Barlow; 2001

Campbell LibraryCampbell LibraryGroup-based parent-training programmes for improving emotional and Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children (Social welfare) behavioural adjustment in 0-3 year old children (Social welfare) Jane Barlow Jane Barlow and Jacqueline Parsons; 2005and Jacqueline Parsons; 2005Parent-training programmes for improving maternal psychosocial health Parent-training programmes for improving maternal psychosocial health (Social welfare) (Social welfare) Jane Barlow, Sarah Stewart-Brown and Esther Coren; 2005.Jane Barlow, Sarah Stewart-Brown and Esther Coren; 2005.Parental involvement and the academic performance of elementary school Parental involvement and the academic performance of elementary school children (Education) children (Education) Chad Nye, Herb Turner and Jamie Schwartz; 2006.Chad Nye, Herb Turner and Jamie Schwartz; 2006.

Systematic Reviews on Parenting ProgrammesSystematic Reviews on Parenting Programmes

The Evidence-based Intervention The Evidence-based Intervention Programme Development ModelProgramme Development Model

Needs Assessment

Programme Design

Efficacy Testing

Effectiveness Testing

The condition

•Distribution

•Determinants

Biological /

Socio-behavioural

Research

RCT Field trials

Programme Diffusion

Training

Quality management

Ongoing Evaluation

Effectiveness and Efficiency: Random Reflections on Health Services (1972) – Resources are always limited – should be used to provide forms of

health care which has been shown in properly designed evaluations to be effective – the importance of using evidence from randomised controlled trials (RCT's)

"It is surely a great criticism of our profession that we have not organised a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomised controlled trials." (1979)

Professor Archibald Leman Cochrane CBE FRCP FFCM (1909 - 1988)

Source: The Cochrane Collaboration.

Source: Cochrane CollaborationSource: Cochrane Collaboration

The Hierarchy of Evidence(of causality)

Level 1: Randomised controlled trials– Results from a systematic review (& meta-analysis) of trials– One or more individual trials

Level 2: Cohort & case-control studies– Results from a meta-analysis of such studies– One of more individual studies

Level 3: Other comparative studies

Level 4: Case series, descriptive studies. Professional experiences