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

1. UK evaluation of evidence based
parenting programmes: Past and
future
Geoff Lindsay
Evidence based parenting programmes and social
inclusion
Middlesex University, 20 September 2012
Geoff.lindsay@warwick.ac.uk

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. 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. 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. 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. 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. 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. 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. The programmes
Five main programmes
Pathfinder 2006-08 (Wave 1):
• Triple P
• Incredible Years
• Strengthening Families Strengthening Communities
PEIP 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. 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. Parent mental well-being: Warwick
Edinburgh Mental Well-being Scale
14 items, e.g.:
- I've been feeling optimistic about the future
- I've been feeling useful
- I've been feeling relaxed
•Each item rated 1-5 (none to all of the time) score range
14–70, highly reliable (alpha=0.94), national norms
•Looking for increase in score

12. Parenting Laxness
e.g. 1 7
1. When I give a fair threat or I always do I often don't
warning .... what I said carry it out
I back down
2. If my child gets upset when I I stick to
and give in to
say '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 a
reduction in score.

13. Parenting Over-reactivity
e.g.
I raise my I speak
When my child misbehaves .... voice or yell calmly to my
child
things build
Things don't
When there's a problem with up and I do
get out of
my child .... things I don't
hand
mean to
Each item rated 1-7, score range 6-42, good reliability
(alpha=.72). Looking for reduction in score.

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. Parents’ mental well-being at start

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. 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. SDQ at pre-course
(% above clinical cut-off)
SDQ Scale National% PEIP%
Emotional symptoms 11.4 39.2
Conduct problems 12.7 60.7
Hyperactivity 14.7 48.3
Peer problems 11.7 44.7
SDQ Total difficulties 9.8 56.5
Prosocial scale 2.3 18.8
Impact score 8.8 60.4
p < .001 in all cases

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. 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. e.g. Comparison of programme effects
relative to Triple P

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. Helpfulness of
Group leaders’ style programme
• SFP 10-14 significantly lower ratings - possibly because mean pre-
course scores for SFP 10-14 were particularly low

24. One year follow up
Mental 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. 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. 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. 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. 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. 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. 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. 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. • 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

34. 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

35. 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?

36. Conclusions
More information: http://www2.warwick.ac.uk/fac/soc/cedar/
Geoff.lindsay@warwick.ac.uk
For information about the CANparent evaluation
http://warwick.ac.uk/canparent