What makes parenting programs effective

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There were significant main effects of time on each child outcome Table 4. This suggests significant gains after the intervention for all behavior problems and significant maintenance over 1 year for all behavior problems except emotional symptoms.

Effect sizes were estimated to represent improvement: e. Where the effect size is reported within , we refer to its absolute value disregarding the sign. Figure 1. Effect sizes of parent outcomes between pre and post upper chart and between pre and follow-up lower chart for Phase 1 and Phase 2.

Figure 2. Effect sizes of child outcomes between pre and post upper chart and between pre and follow-up lower chart for Phase 1 and Phase 2. Figure 1 presents the effect sizes demonstrating change in parent outcomes between pre and post upper part and pre and follow-up lower part. During Phase 2, the magnitude of change was moderate with effect sizes ranging from 0. Therefore, moderate gains in parenting and parental well-being experienced by parents who received parent training as part of regular service provision were significant, and of similar magnitude to gains reported by parents who attended courses offered during the effectiveness trial.

The lower part of Figure 1 focuses on parent outcomes pre to follow-up. These effect sizes indicate how well improvements were maintained over the period of 1 year. Effect sizes during the trial phase were small to moderate ranging from 0. However, the effect sizes during the sustained implementation phase were small from 0. Therefore, when parenting courses were delivered as part of regular service provision, the small gains in parenting and mental well-being after 1 year were not significant.

Figure 2 presents the effect sizes demonstrating change in child behavior between pre and post upper part and pre and follow-up lower part. The upper part of Figure 1 indicates small to moderate change across behavior problems in Phase 1, i.

Importantly, effect sizes were not significantly different between groups as suggested by overlapping confidence intervals , indicating that the magnitude of change pre to post was similar across groups.

The second part of Figure 2 focuses on change between pre-course and follow-up. Effect sizes in the trial phase were all significant. The latter was non-significant, suggesting that over the course of 1 year gains in behavior problems were not maintained when parenting courses had been provided as part of regular service provision. One-year maintenance of these gains, however, was only achieved when courses were delivered in the context of a research trial.

The present study was designed to address two questions: whether EBPPs not developed for children with SEN or a disability were as effective for parents of children with SEN as they were for parents of children without SEN; and whether their effectiveness could be maintained when they were delivered as part of regular service provision.

Children with SEN were reported as having significantly higher levels of behavior and emotional problems compared to the other children.

This supported previous research Dekker et al. Our findings support evidence that EBPPs are effective for children with SEN Beresford, ; Petrenko, ; Skotarczak and Lee, , but extend significantly the available evidence by indicating that EBPPs that have not been developed or adapted for children with disabilities are associated with significant changes in these families, similarly to other families.

In fact, weighted effect sizes for behavior problems for children with SEN Table A1 in Appendix during the trial phase were 0.

The content that is related to improvements in positive parenting and reductions in negative parenting that mediate the effectiveness of EBPPs on child outcomes; Gardner et al. While future research could directly compare the effectiveness of non-disability-specific EBPPs with adapted or disability-specific EBPPs for families with a child with SEN Beresford, , our study findings suggest that the needs of these two different groups of families can be met equally well by one type of EBPPs.

Brookman-Frazee et al. Interestingly, similar gains were experienced for parenting style, despite evidence of a differential parenting approach by parents with a child with disability less discipline use but more negative relationship; Totsika et al.

Similar gains were evident for parental mental well-being, an area that has received substantial research attention in families of children with disabilities. Evidence to date suggests that mental health problems depression, anxiety tend to be higher in mothers of children with developmental disabilities Singer, , but positive dimensions of mental health positive mental health, life satisfaction do not appear to be significantly different between mothers of children with disabilities and those without Totsika et al.

The current findings supported this lack of differences in positive mental well-being between groups and demonstrated similar improvements in well-being following EBPPs. Findings for the second research question suggested that the overall effectiveness of EBPPs for families of children with SEN was maintained during service-led implementation.

In particular, the ANCOVAs demonstrated that significant gains over time across phases trial and sustained implementation phase for SDQ scores, parenting laxness, and parental mental well-being. However, the effect sizes estimated using the ANCOVA-adjusted means added richer information to this question: pre to post gains in child behavior problems were of small to moderate magnitude and of similar strength across both phases.

Pre to post gains in parenting skills and parental mental well-being were of moderate to large magnitude, and again, of similar strength across the two phases. The move from research-controlled delivery to a service-controlled delivery is associated with a change in the process of delivery, particularly a change in fidelity, and that is considered crucial in the determination of effectiveness Fixsen et al.

In the present study, the comparison of effectiveness suggested that gains were of similar magnitude across the two phases whatever changes in delivery may have taken place over the 5 years of sustained implementation of EBPPs. The ultimate goal of implementation of EBPPs is to lead to demonstrable improvements in socially significant outcomes Ogden and Fixsen, Demonstrating that effectiveness of EBPPs can be maintained when they are delivered as part of service provision carries an important message for policy-related decisions regarding the promotion of EBPPs as a public health approach for families of children with disabilities Mazzucchelli and Sanders, Long-term effects in RCTs where children do not have a developmental disability or SEN have been summarized in meta-analyses as small for both child behavior and parenting e.

For children with a developmental disability, available meta-analyses have not examined long-term maintenance c. Medium-term maintenance of SSTP effects 3 months after training was achieved for child behavior problems, parenting style over-reactivity , and parenting confidence Sofronoff et al.

In our study, longer term maintenance 1 year was evident for both child and parent outcomes for families with a child with SEN in the trial phase. Effect sizes pre to follow-up suggested small gains for child behavior problems 0.

However, 1 year maintenance was not achieved in the sustained implementation phase: when families received EBPPs as part of regular service provision effect sizes for child behavior problems were near 0 or small ranging from 0. Program delivery during sustained implementation may have been associated with more variable gains as overall effect sizes tended to be smaller with wider confidence intervals; although they were not significantly different pre—post, the difference became more pronounced 1 year later when effects dissipated for the sustained implementation phase.

Taken together with the available SSTP evidence Plant and Sanders, , there are two possibilities: either EBPPs which are not disability specific do not maintain their gains in the long-term when their delivery is service led or in families where the child has a disability longer term maintenance is not likely. The practical implication in either case is that families with a child with SEN are likely to require more regular input from services to maintain reduced levels of child behavior problems and improved parenting outcomes.

It is important to note that all findings need to be considered in light of two significant limitations in the present study. The first is that identification of SEN relied exclusively on parental report, and while the study SEN prevalence was largely in line with national prevalence, the lack of further ascertainment or detailed measurement precluded examining effectiveness for specific disabilities.

The second limitation is the high levels of data missing at post and follow-up. The high levels of missingness did not render approaches such as multiple imputation appropriate, and we focused the analysis on available data only.

The implication of this is that the relevance of the results is limited only to families who provided data only. Early intervention, with a substantial parent training component, is currently an important component of policy and practice in the UK.

So, in most English areas, parents will be able to access one or more types of EBPPs, but these are not likely to be disability specific. The present study provides important information for practice as it indicates that EBPPs not developed for families of children with SEN will be as effective for these families as they are for families whose children do not have a disability. However, practitioners need to be mindful that significant gains are probably not maintained in the longer term and these families will likely benefit from more regular provision or ongoing monitoring.

EBPPs that have been developed without consideration of child SEN are no replacement for disability-specific or disability-adapted programs. However, disability-specific programs are not as widely available either because they are not yet evidence based or because services have not prioritized their provision.

While researchers and policy-makers should work to address these issues, families with a child with SEN could access non-disability-specific EBPPs in the knowledge they will benefit from those as much as other families. Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved VT, SM, and GL.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Arnold, D. The parenting scale: a measure of dysfunctional parenting in discipline situations.

Barlow, J. Although there is limited evidence on the sustainability of EBPPs with respect to individual outcomes, findings from small-scale studies that examined effectiveness during transition to service-led provision have provided indicative evidence of positive effects.

For instance, Price et al. Skar et al. Hence there is a general need to monitor the effectiveness during sustained implementation which extends beyond the requirements of a particular service provider: it should concern evidence-informed policy-making that is looking to maintain service provision and well-being levels of the population. A change in effectiveness during implementation may be considered likely, given the large number of factors that may influence sustainability of effectiveness Durlak and DuPre, Therefore, to support a public health approach to the promotion of EBPPs, the question concerning effectiveness applies not only to whether they are effective in trials, but also to whether they remain effective when provided as part of regular service provision across the targeted population.

The aim of the present study was to examine the effectiveness of EBPPs during a period of sustained implementation by services in England. The study responds to recent calls by the Society for Prevention Research Gottfredson et al. Our main research question examined whether effectiveness of EBPPs could be maintained during the phase of service-led sustained implementation as compared to an earlier researcher-led effectiveness evaluation phase.

Specifically, we examined whether changes in child behavior problems, parenting style and parental mental well-being were significantly different between service-led sustained implementation and the previous researcher-led effectiveness evaluation. In the present study, data were drawn from four LAs that participated across both phases. These LAs requested that the research team continued to collect data from parents enrolling during the sustained implementation phase.

Apart from providing annual reports of the analysis of their results, we took no part in the LAs implementation of the EBPPs that they had selected for delivery. The sustained implementation phase started in the school year following the last year of the trial implementation phase.

Parents were recruited to parenting programs through multiple routes, which were comparable in each LA. Local authorities were quite liberal with their inclusion criteria, including those parents who self-referred, and referrals from schools, social services, and health services, with the agreement of the parent.

No LA had formal inclusion or exclusion criteria. There were no inclusion or exclusion criteria for the research: all parents for whom pre-course data were available were included in the trial.

These criteria applied to both phases of the study. Characteristics of parenting program participants during the effectiveness phase and the sustained implementation phase.

A composite measure of socio-economic deprivation was developed by combining data on parental education level no educational qualifications vs.

Socio-economic deprivation scores ranged from 0 to 4, with higher values indicating more deprivation. Parents were asked to indicate whether they had contacted professional support for themselves over the past 6 months: medical practitioner, psychiatrist, counselor, social workers or other healthcare and support professionals.

We summed the number of contacts indicated to capture the level of support need of the parent. The SDQ contains 25 items, grouped into five scales 5 items per scale : conduct problems, emotional symptoms, hyperactivity, peer problems, and prosocial behavior. The first four scales are summed to give a total difficulties score. The SDQ is used extensively in research and clinical practice and has well-established psychometric properties Goodman, We used the 4—17 year-old version of the SDQ, though the SDQ has been validated for use with children aged 2—17 years old 1 with altered wording of three of the items for the 2—3 years group.

Here we present internal consistency data from the 4—17 years group, though findings were similar for the 2—17 year group. Peer problems and prosocial behavior subscales were not included in the present study as these are behaviors not directly targeted by parenting programs. The Parenting Scale — Adolescent Irvine et al.

The original item version of this questionnaire has been validated for use with parents of children aged 18 months to 16 years Arnold et al. Parents rate each item on a 7-point scale and the scores in each subscale are summed.

Parents rated 14 statements on a 1 none of the time to 5 all of the time scale. Total mental well-being score ranges from 14 to 70, with higher scores indicating higher mental well-being. The DfE funded LAs through the Parenting Early Intervention Programme to develop their infrastructure, including strategic and operational lead officers and staff who had been trained to be facilitators of the relevant programs the LAs chose to implement.

Training was provided by the program providers see Lindsay et al. During the sustained implementation phase, the LAs chose to continue with the programs. In the current study, providers of IY offered 18—22 weekly group sessions of 2—2. In the effectiveness trial phase, facilitators attended a 4 or 5 days manualised workshop and received supervision in the form of peer support meetings and monthly telephone consultations from accredited mentors.

The majority of facilitators had a higher education level qualification in an education or health and social care discipline. Forty-seven parents 3. The Triple P program Sanders et al. In the current study, providers of Triple P offered the Level 4 version which involves eight 2-h weekly sessions: four face-to-face small group sessions, three telephone sessions and one final group session. In the effectiveness trial phase, facilitators received a 3-day manualised training program with an accredited Triple P trainer.

The majority of parents attended Triple P: STOP Ministry of Parenting, was developed as an week program for parents of children aged 11— It aims to help parents to communicate better with their children and to support their development, through discussions, role play and feedback to develop more effective parenting techniques.

In the effectiveness trial phase, facilitators attended a 3-day workshop and received manualised training materials.

In the effectiveness trial phase, 7. During the sustained implementation phase, in addition to existing trained staff, new facilitators received the same training as those engaged during the effectiveness trial phase.

Both existing and newly trained facilitators received the same pattern of support and supervision as during the effectiveness trial stage. This criterion was employed by the LA services during both the trial phase Parent Early Intervention Programme and during the sustained implementation phase.

Facilitators completed a monitoring sheet after the final group session indicating those parents who had completed their course and also the reasons, if known, of parents who did not complete their course; these monitoring sheets were returned to the research team with the completed post-course questionnaires.

Procedure was the same during both phases. Parents completed a pre-test questionnaire booklet either at the start of the first session or at an introductory session before the parenting course commenced.

Post-test data were collected in the last session of the program. All pre and post measures were distributed by the program facilitator and posted to the research team for analysis. Twelve months following the pre-test measures follow up questionnaires were posted to parents directly from the research center. Data involved repeated measurements, which were also nested within LAs. With their focus on population average effects Hubbard et al. Missing data ranged from This high level of data loss is a common occurrence in community evaluations McWey et al.

We examined the association between missing data, initial levels of child behavior problems and participant characteristics, and we found no association analysis available on request. UCL Discovery. Enter your search terms. Downloads since deposit. Download activity - last month.