Research into parenting programmes: evidence-based policy or what?

Stephen ScottProfessor of Child Health and Behaviour, Kings College London

Director of Research, National Academy for Parenting Practitioners

DCSF Research conference 9 February 2010

Good Childhood Findings Many positive aspects of child life today:

Better physical health, better homes, more communication

More tolerant, more concerned environment

BUTUNICEF on GB: more out of education 15-19, income inequality

Rise in emotional & behavioural problems in last 30 years

Oppositional & defiant

Blamed by parents

Disliked by siblingsGets into fights

Rejected by peers

Low self esteemHard to control

Poor school achievements

Blames othersStealing and truanting

Deviant peer group

Antisocial attitudeCareer offender

Unemployed

Drug misuse0510155 years8 years11 years14 years17 yearsEscape1/51/51/54/54/54/54/5Continuity of anti-social behaviour from age 5 to 17. Source: Scott 2002% of all childrenNo past antisocial behaviour1/51/510%10%10%10%

Total extra cost to age 28 (Scott, Knapp et al 2001, BMJ)

Zone of impact of parenting programmes Abuseand it amelioration in Looked After Children

Inequalities in attainment

Socialisation and Antisocial behaviour

Clinical trial (Scott, Spender et al 2001, BMJ)141 children age 3-7 referred to CAMHSsevere, persistent antisocial behaviour (worst 1%) Incredible Years parenting programme:videotapes shown in group, 3 wks each of Playpraise & rewardssetting limitshandling misbehaviour

Long-term follow upFollow up 2005-07 7-10 years later of 94 children now aged 10-17 (mean 13)

Intention to treat, 74 allocated to IY, 20 controls

Parent SDQ total(p

Youth report home beh(p

An ounce of action is worth a ton of theory Friedrich Engels, 1860

TRAINERPARENTINGPRACTITIONERPARENTCHILDFeedback loops of research contribution

Page *The National Academy for Parenting Practitioners Training: over 4,000 practitioners trained in evidence-based programmes this year alone

Research: extensive programme researching what we do and finding out what works and how

Dissemination: events with stakeholders explaining what we are about, workshops for practitioners on new ways of working. Website with latest information on what works www.parentingacademy.org

Page *Research Parenting Programme Evaluation Tool & Training evaluation studies

2.TrialsFFTSPOKESHigh NeedFostered childrenCallous-unemotional children

3.Measures of Parenting & Cost-effectiveness

Example of Evaluation of a programme

Supporting Parents of children with autismElement 1: Target populationAims; Assist parents in managing childrens behaviour, increase parental knowledge about autism

Strengths: Well described characteristics of the target population, fairly well specified expected outcomes, appropriate programme classification: targeted and specialist

Weaknesses Lack of appropriate intake need assessmentLack of appropriate measures of programme expected outcomes

Self-rating: 4 Academy Rating : 3Element 2:Content and DeliveryStrengthsEvidence of some theoretical framework (behavioural, cognitive)Flexibility in delivering sessions & wide range of attractive resources

WeaknessesLack of major key autism specific theories (theory of mind, developmental milestones)Poor content (lacks consideration of communication difficulties)Poor balance between didactic component & active skill training, e.g. limited in role-plays and group exercises. Self-rating: 3 Academy Rating : 1

Implications for training & workforce development 1st Training Offer: Parenting groups implemented

1st Training offer: Implementation significantly correlated with practitioners level of qualificationImplications for training & workforce development

* Does not include SF Implications for training & workforce development1st Training Offer: Implementation significantly correlated with perceived relevance of the training

Implications for training & workforce development Stage 2: Parenting groups implemented* Phase 1*

(1) Use evidence-based programmes Effect sizes av 0.6 with EB progs (Barlow et al 2002) Effects 0-0.2 otherwiseEg Fort Bragg, Homestart,Oxford Home Visiting (Weisz et al 1998)

(2) Target accuratelyImprovement in antisocial behaviour, according to initial severity level (Scott 2005)Clinical trial worst 2%

SPOKES prevention trial targeting worst 20%

PALS prevention targeting by geographical area

(3) Be engaging!Percent initial enrolment (prevention) depends on trust & liking, and:AccessibleAvailableAffordableAt convenient time (after Pugh 1997)

(4) Keep attendance upChanges in Sensitive Responding according to number of sessionsAttended in PALS trial(Scott, OConnor & Futh inPress)

(5) Quality, quality, quality(Scott, Carby and Rendu 2007)

(6) Build in evaluation and reviewFor some areas, do Randomized Controlled Trials to answer questions eg how many sessions are enough, which programmes have which effects, etcNot to do so is to set out to sea without a mapThis is not a luxury, it is prudent and cost- saving

For all areas, collect pre-post data on effectiveness, measure whole population otherwise you dont know who you are excluding (already done as SATS)

Think Feel Do

The Press certainly seem to think parents are a live issue. In September these headlines were in papers I saw myself,.without searching. DM Brtiain is becoming the bad parent of the western world

Can parenting make a difference to any of this?

Generate emotional confidence and skills within the family: safe to care and have empathy, will be cherished and encouraged, limits set

Buffer and build resilience against influences outside the family

BUT NOT everything

Physical environment eg diet, neighbourhood Changes in society eg availability drugs, video gamesSchooling and peer pressures about eg drinking

Although not a panacea for all societys ills I think I can show you that parenting does have an important role to playInterestingly, whiles about half of early starters will not go on to become criminal, there are very few who start becoming serious ie repeat 0ffeneder after childhood thus 90% of recidivist offenders began being serious antisocial before the age of 10

Another study was the ILS of CD Michael Rutter. Was able to work with a HE, MK who worked at the IoP to do a study of the costs of CD.

Actual were 70k, but if added in expected from things we didnt measure, more like 250k each, since confirmed by Freidl and Parsonsage

Tantalising since if you could intervene effectively.

But raises what the mechanism is , and whether it can be changed?

IS it in fact all due to factors present at birth or soon after

poverty after all CD rates are about 3 ot 5 times higher in the most disadvantaged as opposed to the better off, or being a male, Can parenting make a difference to any of this?

Generate emotional confidence and skills within the family: safe to care and have empathy, will be cherished and encouraged, limits set

Buffer and build resilience against influences outside the family

BUT NOT everything

Physical environment eg diet, neighbourhood Changes in society eg availability drugs, video gamesSchooling and peer pressures about eg drinking

Although not a panacea for all societys ills I think I can show you that parenting does have an important role to playPolicy in England eg Ministry name, Every Parent MattersGraham Allen & Ian Duncan Smith: Early Intervention Only parents can deliver *******HOW with either the parent or the chidl shd you startby address ing thou8ghts = arugfe with them youll end oup inpriosn if you keep ding that if you dont so youre hoemwork youll neve get any GCSEs and then yousll stakc shelesce in Sainsbursy (if youa re luckly)

Feelings you shudl be ashmsaed of yourself You make me feel terrible when you steal formt eh shops or hit me. It supsets me or behaviour if you so that again, yure getting a slap/ we wont get akitten for Chrsitmas

70s and 80s Patterson very exciign imeedite envt chidl alomsotseen as abblack box no need to address thoughts or feelings