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ss triple helix - autumn 2007,  Parent training programmes

Parent training programmes

Key points

Parenting is a complex job. Children, families and society at large suffer when it goes wrong. Research has demonstrated that poor parenting can be improved through education.

There are several proven training programmes, each tailored to different circumstances – parents' backgrounds, cultural factors, and whether or not the children have special needs of any kind.

The author, a psychiatrist, also relates her experience of setting up and running programmes within a church setting in Tower Hamlets.

Parenting is a complex, demanding and vital job for which there are no qualifications, no training, little support and maximum opprobrium when it goes wrong. [1]

Hardly a day goes by without a news bulletin about uncontrollable ASBO kids, depressed and self-harming youngsters and violent teenagers. Why are our children in this mess, and what can we do about it?

It starts with the parents

Parents who form secure attachments with their infants will have children who are more socially competent, self-confident, popular, resilient and mature. Sadly the reverse is true of insecurely attached mother-infant pairs. [2] When parenting goes wrong, children suffer. Their development goes astray, resulting in emotional and behavioural difficulties.

Families characterised by conflict, aggression and cold relationships have children vulnerable to psychosocial problems, substance abuse and problems with biological stress-response regulatory systems. As well as increased risk for mental health disorders, this impacts on physical health as cardiovascular and immune system responses become over-taxed. Children become hyper-vigilant, unable to read social cues and poor at emotional self-regulation and reflection. [3]

Costly mistakes

Poor parenting is costly. Conduct disorder in childhood has a worldwide prevalence of around five percent and rising. [4,5,6] If untreated, as well as being more likely to abuse substances and leave school without qualifications, 40% of such adolescents will be repeatedly convicted of crimes. [7] As adults they continue offending, have domestic violence problems, poor employment records and fail to integrate into society. [8] Parents of such children tend to be harsh and inconsistent, though it is less clear whether this is cause, consequence or due to shared genetic predisposition; [7] they pay attention to unwanted behaviour whilst ignoring desirable behaviour. [9]

By the age of 28, those who had conduct disorder at age ten were costing society ten times as much (£70,019) as those with no behavioural problems (£7,423) in terms of excess use of public services. [10]

Help is at hand

Vast amounts of research have been done to look at the effectiveness of parent training programmes in the treatment and prevention of such problems.

Dretzke looked at 37 randomised controlled trials of parenting programmes for the treatment of children with conduct disorder and found them to be effective. [11] The resulting review built on a large body of research and earlier reviews done on aspects of the same subject. There was evidence of long term effectiveness on children's behaviour, positive effects on other aspects of children's mental health (eg self esteem) and on parents' wellbeing, attitudes and behaviour.

There was also some comparison of different types of parenting programme. Behavioural programmes were most effective in modifying children's behaviour. Other approaches (eg humanistic ones) may have important benefits such as on children's self esteem. Group-based trainings were more successful than individual approaches.

Parent training was found to be cost effective with costs per family ranging from £629 to £3,839 depending on the type of programme and setting. This compares favourably with the cost of dealing with individuals with conduct disorder.

There was not yet enough hard evidence to prove that parent training reduces child abuse but there was evidence that it improves some outcomes associated with physically abusive parenting. Some individual studies report success in this area. [1,12]

Which course to use?

The target group: what ages are the children? What are their diagnoses? Are you aiming to prevent or treat? What educational, language and cultural backgrounds do the parents have? Are there other family vulnerabilities such as substance abuse and child protection?

Resources available: how much do the resources cost? How easy is training to access? What level of staff competency is required? How much time do you have? Is a crèche or interpreter required?

Course specifics: is there evidence of its effectiveness? Is it appropriate for your target group? Is its presentation style accessible? How are families supported during the course?

A useful resource book is Parenting Programmes for Families at Risk, [13] a comprehensive review of the courses available. Courses in common use across the UK include:

Incredible Years series: a thoroughly researched, well-established and cost-effective series of programmes proved for use in treating and preventing conduct disorders and also designed to promote the social, emotional and academic competence of children. Teacher and child programmes are also available. [14]

Triple P (Positive Parenting Programme): a well-researched, proven programme based on enhancing parents' knowledge, skills and confidence. Different levels of intervention are available depending on need. [15]

Strengthening Families Strengthening Communities: a community based programme designed to help families develop strong cultural roots, positive parent-child relationships, life skills and the ability to access community resources. A relatively new course, it has little published evaluation.

The government is currently evaluating these three courses. Other popular UK courses include:

Mellow Parenting: a course designed to support families who have relationship problems with their under-five children. It has proved effective in engaging families with severe problems who would generally be considered hard to reach. Its research base is not wide because it is relatively new. An evaluation by the Department of Health shows it to be effective in improving maternal well-being, parent-child interaction, child behaviour and development.

Family Caring Trust series: Family Caring Trust provides materials for parenting and other courses. Evaluations so far show positive benefits for families and results from a rigorous study are due out this year. As an optional script is provided, facilitators do not need a high level of training.

Church parenting

At the Good Shepherd Mission, a church in the London Borough of Tower Hamlets, we started running parenting courses using Family Caring Trust materials alongside our parent and toddler group in 1999.

Our aim was improve the mental health of both children and parents, reduce risks of abuse and later antisocial behaviour, and promote happier, better functioning family lives.

We also adapted Family Caring Trust's optional session on children's spiritual development to suit our own approach and found it an excellent opportunity to engage in respectful discussion about spiritual matters with parents who were interested.

Eight years on, we now receive referrals from local GPs and health visitors and have developed a working relationship with the local Sure Start Centre. We now also use the Incredible Years programme for families with more severe needs. We have seen remarkable changes in the lives of many families: parent-child relationships have blossomed, children's behaviour has improved and parents have said how much less stressed they feel. In some, we have also seen spiritual change and growth. For us, these are very good recommendations for any church or other organisation wishing to serve its local community.

Sandra and Daisy

Sandra, a 38 year old single mother of 20 month old Daisy, attended one of our courses because of difficulty coping with Daisy's tantrums and with her behaviour in public places. Things had got so bad that Sandra's friends didn't want Daisy to visit anymore. Sandra felt absolutely desperate.

On the course Sandra learned how to communicate with Daisy and make time to have fun; about dealing with tantrums; and how to share consistency in discipline with significant others in Daisy's life.

Sandra now feels more confident as a mother. Daisy's tantrums are much less frequent and shorter in duration. Her concentration has improved, she responds to limit setting and they can now enjoy days out together.

  1. Puckering C et al. Child Abuse Review 1994; 3:299-310
  2. Bowlby J. Int J Psychoanalysis 1958; 39:350-373
  3. Repetti R et al. Psychological Bulletin 2002; 128:330-366
  4. Maughan B et al. J Child Psychol Psychiatry 2004; 45:609-621
  5. Fleitich-Bilyk B, Goodman R. J Am Acad Child Adol Psychiatry 2004; 43:727-734
  6. Collishaw S et al. J Child Psychol Psychiatry 2004; 45:1350-1362
  7. Farrington DP. J Child Psychol Psychiatry 1994; 36:929-964
  8. Rutter M et al. Antisocial behaviour by young people. Cambridge: CUP, 1998
  9. Patterson GR. Coercive family process. Eugene, OR: Castalia, 1982
  10. Scott S et al. BMJ 2001; 323:1-7
  11. Dretzke J et al. Health Technology Assessment 2005; 9:50
  12. Webster-Stratton C. J Consulting Clin Psychol 1998; 66:715-730
  13. Barrett H. Parenting programmes for families at risk. A source book. London: National Family and Parenting Institute, 2003
  14. Webster-Stratton C. The Incredible Years Training Series. Washington DC, USA: Office of Juvenile Justice and Delinquency Prevention, 2000
  15. Sanders MR et al. Parenting and Family Support Centre, 2003; monograph 1
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