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

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Research into parenting programmes
evidence-based policy or what?

• Stephen Scott
• Professor of Child Health and Behaviour,
• Kings College London
• Director of Research, National Academy for
  Parenting Practitioners
• DCSF Research conference
• 9 February 2010

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Good Childhood Findings

• Many positive aspects of child life today
• Better physical health, better homes, more
  communication
• More tolerant, more concerned environment
• BUT
• UNICEF on GB more out of education 15-19, income
  inequality
• Rise in emotional behavioural problems in last
  30 years

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Continuity of anti-social behaviour from age 5 to
17. Source Scott 2002
Escape
of allchildren
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1/5
1/5
Oppositional defiant Blamed by
parents Disliked by siblings
1/5
4/5
Gets into fights Rejected by peers Low self
esteem
1/5
4/5
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Hard to control Poor school achievements Blames
others
1/5
4/5
Stealing and truanting Deviant peer
group Antisocial attitude
4/5
Career offender Unemployed Drug misuse
5
10
10
10
10
0
5 years
8 years
11 years
14 years
17 years
No past antisocial behaviour
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Zone of impact of parenting programmes

• Abuse
• and it amelioration in Looked After Children
• Inequalities in attainment
• Socialisation and Antisocial behaviour

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Clinical trial (Scott, Spender et al 2001, BMJ)

• 141 children age 3-7 referred to CAMHS
• severe, persistent antisocial behaviour (worst
  1)
• Incredible Years parenting programme
• videotapes shown in group, 3 wks each of
• Play
• praise rewards
• setting limits
• handling misbehaviour

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Long-term follow up

• Follow 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

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Parent SDQ total(plt0.003)
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Youth report home beh(plt0.038)
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An ounce of action is worth a ton of theory
Friedrich Engels, 1860
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Feedback loops of research contribution
TRAINER
PARENTING PRACTITIONER
PARENT
CHILD
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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
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Research

• Parenting Programme Evaluation Tool
• Training evaluation studies
• 2. Trials
• FFT
• SPOKES
• High Need
• Fostered children
• Callous-unemotional children
• 3. Measures of Parenting Cost-effectiveness

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Example of Evaluation of a programmeSupporting
Parents of children with autism

• Element 1 Target population
• Aims 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 assessment
• Lack of appropriate measures of programme
  expected outcomes
• Self-rating 4 Academy Rating 3

• Element 2Content and Delivery
• Strengths
• Evidence of some theoretical framework
• (behavioural, cognitive)
• Flexibility in delivering sessions wide range
  of attractive resources
• Weaknesses
• Lack 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

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

• 1st Training offer Implementation significantly
  correlated with practitioners level of
  qualification

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Implications for training workforce development
1st Training Offer Implementation significantly
correlated with perceived relevance of the
training
Does not include SF
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Implications for training workforce development
Stage 2 Parenting groups implemented

Phase 1
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(1) Use evidence-based programmes

• Effect sizes av 0.6 with EB progs (Barlow et al
  2002) Effects 0-0.2 otherwise
• Eg Fort Bragg, Homestart,
• Oxford Home Visiting (Weisz et al 1998)

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(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
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(3) Be engaging!

• Percent initial enrolment (prevention) depends
  on trust liking, and
• Accessible
• Available
• Affordable
• At convenient time
• (after Pugh 1997)

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(4) Keep attendance up
Changes in Sensitive Responding according to
number of sessions Attended in PALS trial (Scott,
OConnor Futh in Press)
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(5) Quality, quality, quality (Scott, Carby and
Rendu 2007)
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(6) Build in evaluation and review

• For some areas, do Randomized Controlled Trials
  to answer questions eg how many sessions are
  enough, which programmes have which effects, etc
• Not to do so is to set out to sea without a map
• This 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)

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Think

• Feel Do