Implementing Evidence-Based Parenting Programmes in a Small Sample of English Urban Local Authorities: Eligibility, Fidelity and Intensity

Implementing Evidence-Based ParentingProgrammes in a Small Sample of EnglishUrban Local Authorities: Eligibility, Fidelityand IntensityAnne West, Louisa Mitchell and Tony MurphyDepartment of Social Policy, London School of Economics and Political Science, London, UK

This article focuses on the implementation of evidence-based parenting programmes (EBPPs)

in a small sample of urban local authorities in England. The first part discusses the develop-

ment of government policy, guidance and implementation issues. The second part presents

findings from an exploratory study, which focused on the implementation of EBPPs in terms

of programme eligibility, fidelity and intensity in six urban local authorities. Implementation

was not necessarily in line with policy or guidance. Issues associated with programme fidelity

along with concerns about sustainability as a result of cuts in funding are discussed and

implications for policy and future research considered. � 2012 The Author(s). Children &

Society � 2012 National Children’s Bureau and Blackwell Publishing Limited.

Keywords: parenting, family, policy and practice.

Introduction

Over the past decade, the importance of parenting and the role of governments in supportingfamilies has been acknowledged at supranational and national levels. At a European level,the Council of Europe (2006) recommended that governments should adopt measures to‘acknowledge the essential nature of families and of the parental role and create the neces-sary conditions for positive parenting in the best interests of the child’ and take a ‘pro-activeapproach to promoting awareness of parenting issues and to normalising participation inparenting programmes’ (s. 3.ii).

In the UK, previous Labour administrations (1997–2010) introduced policies expanding theentitlement to free early year education for all three- and four-year-olds, subsidising child-care costs for those on low incomes and developing parenting support services. Emphasiswas placed on ‘the help parenting services can provide as a catalyst for social enhancement— as a resource to improve education, behaviour and long-term earning potential’ (Utting,2008, p. 4). The Prime Minister, David Cameron (2010), prior to his election in 2010, assertedthat politicians have a responsibility to ‘go beyond simply supporting families … to the com-plex territory of helping to develop parenting skills’ (p. 1).

The amelioration of parenting skills is a key feature of parenting programmes, which aredesigned to help parents ⁄ carers with children who have emotional and behavioural disorders(Barlow and others, 2005). Desforges with Abouchar (2003) noted that most were offered tothose in ‘dire’ straits (p. 83). However, since 2006, policy-makers in England have promoted

CHILDREN & SOCIETY (2012)DOI:10.1111/j.1099-0860.2012.00428.x

� 2012 The Author(s)

Children & Society � 2012 National Children’s Bureau and Blackwell Publishing Limited

the use of evidence-based parenting programmes (EBPPs) at a local level. Our focus in thisarticle is on issues surrounding implementation. The development of government policy isdiscussed, along with previous research. The research questions are followed by the methodsand findings that emerged in an exploratory study focusing on implementation in six Englishurban local authorities (LAs). The final section concludes and considers policy implications.

Government policy, parenting support and parenting programmes

In the UK, parenting has traditionally been seen as being a part of the private sphere of thefamily and not, except in extreme cases, a responsibility of the state. However, under previ-ous Labour Governments (1997–2010), policies focusing specifically on services and supportfor parents and families were introduced. The Green Paper, Every Child Matters (HM Treas-ury, 2003), stressed the need for a stronger focus on parenting and families, stating that thebond between a child and his or her parents ‘is the most critical influence on a child’s educa-tional development, behaviour and mental health’ (p. 39). It was also explicit on the neglectby public policy of parenting support. In a similar vein, The Children’s Plan asserted: ‘gov-ernment does not bring up children — parents do — so government needs to do more to backparents and families’ (DCSF, 2007, p. 5): indeed, evidence suggests that ‘most parentswelcome support, and stressed parents especially welcome it’ (Moran and others, 2004, p. 127).1

In England, many initiatives were introduced: parenting advisers in LAs, parent supportadvisers (PSAs) in schools, parenting support via Sure Start children’s centres2 and extendedschools, family intervention projects (to reduce antisocial behaviour), voluntary parentingcontracts (to improve children’s behaviour) and parenting orders for parents ‘unwilling toengage with improving their child’s behaviour’ (DCSF, 2007, p. 102). Support was also pro-vided under the auspices of the health service [especially child and adolescent mental healthservices (CAMHS)] (DCSF, 2007). To improve the ‘supply and quality of parenting supportdelivered to parents across England’, the National Academy of Parenting Programmes (NAPP)was set up (HC, 2008).

Under the Labour administrations, a high focus was given to using evidence across a widerange of policy areas (Cabinet Office, 1999; Glass, 2001), including the use of parenting pro-grammes: ‘Research has shown that the use of parenting programmes with a proven theoreti-cal base is an effective way to support the development of parenting skills’ (DCSF, 2010a,s. 7).

Evidence-based parenting programmes

Evidence-based parenting programmes are short-term interventions, aimed at improving par-enting skills, parents’ mental health and children’s behaviour (Asmussen and Weizel, 2010).They are manualised programmes underpinned by a strong research evidence base, generallyrandomised controlled trials (RCTs). Amongst the main EBPPs in use in England are Incredi-ble Years (IY) (Webster-Stratton and Hancock, 1998) developed in the USA; Triple P (Sandersand others, 2003) developed in Australia; and Strengthening Families, Strengthening Com-munities (SFSC) (Steele and others, 2000), adapted from the US programme, ‘StrengtheningMulti-Ethnic Families’ (see Klett-Davies and others, 2008).

Randomised controlled trials of parenting programmes have involved selecting children whoscored at a particular level on a screening test, assigning their parents to the intervention or

2 Anne West et al.

� 2012 The Author(s) CHILDREN & SOCIETY (2012)


control group and then testing the outcomes following the programme. Scott and others(2010) found positive effects for both parents and children following the IY programme. Asystematic review of RCTs found that parenting programmes for the treatment of children upto 18 years of age with conduct disorders (aggressive, antisocial, defiant behaviour) were aneffective means of treating such children (Dretzke and others, 2009).

Trials in community settings within the UK are limited. However, Gardner and others (2010)carried out an RCT of IY with pre-school children. Families in 11 socially disadvantagedareas with children who scored above the clinical cut-off on a behaviour inventory measur-ing conduct problems were recruited, with programme administrators being supervised forthree hours every week by a clinical child psychologist. Positive effects post-interventionwere found and change in ‘positive parenting’ was predictive of changes in conduct disorder.

Guidance

In 2006, the National Institute for Health and Clinical Excellence ⁄ Social Care Institute forExcellence (NICE ⁄ SCIE) published guidance on the use of parenting programmes for childrenwith conduct disorders. This recommended that all parent-training/education programmes,whether group- or individual-based, should be structured, and have a curriculum incorporat-ing learning opportunities reflecting social-learning approaches including skills rehearsal,role play, watching recorded vignettes to facilitate discussion of alternative parenting strate-gies, and homework undertaken by parents. They should offer an optimum of 8–12 sessionsdelivered by appropriately trained and supervised facilitators. Two parenting programmes, IYand Triple P, were cited as demonstrating these essential characteristics and being cost-effec-tive. The guidance noted that ‘programmes should demonstrate proven effectiveness … basedon evidence from randomised control trials or other suitable rigorous evaluation methodsundertaken independently’ (NICE ⁄ SCIE, 2006, p. 5).

Whilst the NICE ⁄ SCIE guidance is concerned with parenting programmes for children with con-duct disorders, the need for such programmes extends beyond this group. Patterson and others(2002) in a survey of parents of children aged two to eight years from three medical generalpractices in England found that a significant proportion experienced difficulties with their chil-dren’s behaviour. Problems were more prevalent amongst those from manual social classes, but‘need’ was high across all social groups: nearly 20 per cent reported that they had attended aparenting programme and nearly 60 per cent expressed an interest in doing so.

Subsequently, PricewaterhouseCoopers (2006) suggested that demand for parental supportservices was likely as

anecdotal evidence suggests that a significant level of unmet demand exists at the preventative endof the needs spectrum. Growth is also likely to be driven by a change in public attitudes and theincreasing acceptance of parenting support as a non-stigmatising service (p. 7).

However, funding was fragmented, coming from a range of central and local governmentand voluntary sector sources, making co-ordinated planning and delivery ‘extremely chal-lenging’ and ‘insufficient and insecure in the long and short term’ (p. 10).

The DfES subsequently provided guidance on parenting support. LAs were expected todevelop a strategic approach and view support as a continuum, from intervention and

Implementing Evidence-Based Parenting Programmes 3



prevention to enforcement measures. They were also asked to designate a commissioner ofparenting support services and to ‘commission parenting programmes that are evidencebased, drawing on relevant guidance…’ (DfES, 2006, p. 3). They were asked to undertake aneeds assessment on the basis of an analysis of data and the involvement of various stake-holders (e.g. parents, young people and commissioners).

In the same year, a community-based programme, the Parenting Early Intervention Path-finder, was set up in 18 LAs (Lindsay and others, 2008). Government funding was providedto implement one of three parenting programmes with parents of children aged 8–13 years:IY, Triple P and SFSC (Lindsay and others, 2007).3 This initiative was not focused on parentswith children with clinical levels of behavioural disorder, but tied in with a shift towardsprevention services within the community (France and Utting, 2005). The results of the eval-uation were ‘sufficiently positive to encourage the [DCSF]4 to try and implement parentingsupport more widely’ (Lindsay and others, 2011, p. 15). The evidence from the evaluationinformed guidance issued to LAs to help with delivery of the Parenting Early InterventionProgramme (PEIP) which involved a further 23 LAs from 2008 and all from 2009. This pro-vided funding to all LAs in England to deliver any of five DCSF-approved EBPPs (the threeused in the Pathfinder, the Strengthening Families Programme 10–14, and Families andSchools Together) (Lindsay and others, 2010, 2011). Funding came via the Think Familygrant (National Archives, 2010).5 Thus, from 2009, EBPPs were rolled out across England incommunity settings. The subsequent evaluation found that across the EBPPs used, parentingskills, mental well-being of parents and children’s behaviour improved; outcomes were main-tained one year after the programme had ended (Lindsay and others, 2011).

Implementation issues

Implementation becomes significant in the context of policies that are subject to interpretationat a local level. Specifically, in the context of parenting programmes, Moran and others (2004)noted that: ‘Process issues (aspects of delivery and implementation of a parent support service)form the critical, but sometimes hidden, backdrop to any assessment of an intervention’s effec-tiveness’ (p. 94). Significantly, how EBPPs are delivered may be as critical a factor in achievingpositive outcomes as their content (Moran and others, 2004). Thus, by not adhering to thedetails of the programme ‘its positive effects will be diluted’ (DCSF, 2010b, p. 46).

The NICE ⁄ SCIE (2006) guidance noted that research on implementation of programmes wasneeded: some has since been conducted. Barrett (2009) interviewed practitioners about theexperience of providing programmes, how they were made accessible to parents, monitoringand views of NICE ⁄ SCIE standards. Virgo (2009) explored delivery and coordination systemsin ten LAs. Klett-Davies and others (2009) examined how LAs assessed the need for parentingsupport, the extent to which needs were being met and the distribution of resources. AndLindsay and others (2008, 2011) explored aspects of implementation, including programmefidelity, in their evaluations of EBPPs.

The second section of this paper adds to this limited body of research on implementation ofEBPPs in England. Government guidance emphasised that LAs should develop parenting sup-port in a way that ‘reflects their local context’ (DfES, 2006, p. 12) and differentiates betweenlevels of support available. Our small exploratory study comprised interviews with LA andhealth service staff involved with parenting programmes in six LAs. We focused on threekey elements of EBPPs:6

4 Anne West et al.



Eligibility: The intervention’s target audience is appropriate, clear and known.

Fidelity: The active ingredients of the programme are rolled out without significant deviation.

Intensity: The amount and quality of support provided matches [sic] need (DCSF, 2010a, p. 20).

These themes underpin our main research questions: What is the target audience of EBPPs? Whatare the challenges to programme fidelity? Do the amount and quality of support match need?

Methods

This exploratory study formed part of the work programme of the Families and ChildrenResearch Group on services for disadvantaged families and children, funded by the LSE. Itaimed to provide insights into the ways in which EBPPs were being implemented in a smallsample of English urban LAs in regions with above average levels of child poverty. It wasimportant to include areas with different levels of ethnic diversity in the sample because oneof the programmes (SFSC) was designed for use with minority ethnic groups (Lindsay andothers, 2008). Two regions were selected from which to sample LAs: London and the NorthWest. London has the highest proportion of children in poverty in England (30%, HMRC,2009) and is ethnically diverse (41% of the population is not ‘White British’, ONS, 2011),whilst the North West has an above average proportion of children in poverty (23%), but isless diverse (12% is not ‘White British’). Our rationale for selecting the six LAs was that theyshould broadly reflect the region in terms of their levels of child poverty and ethnic compo-sition. Of the seven LAs approached in London, four agreed to participate as did two of thefour approached in the North West.7 The London LAs had higher levels of child poverty andwere more ethnically diverse than those in the North West; the ethnic composition also var-ied.8 The LAs cannot be considered to be representative of all English LAs, but valuableindicative insights may be gained from the findings.

We aimed to interview the commissioner of parenting programmes, the parenting coordina-tor responsible for overseeing parent support services (including EBPPs) and at least two pro-gramme facilitators in each LA. In each LA, either the commissioner ⁄ acting commissioner ora parenting co-ordinator was interviewed. Our final sample comprised 25 participants: 4 par-enting commissioners (including one acting commissioner), 6 parenting co-ordinators (one ofwhom was also a facilitator), 11 facilitators and 4 LA staff involved with parenting pro-grammes. Fourteen participants were interviewed one-to-one and face-to-face, using semi-structured schedules and nine were interviewed in groups; two were interviewed over thetelephone. Interviews were carried out between March and September 2010 and lasted30–120 min. They were recorded, transcribed and analysed thematically. The views of inter-viewees are given in the sections below. (LAs are identified by number and interviewees byletters (Com-Commissioner; Coord-Coordinator; F-Facilitator).)

Findings

Context

Whilst parenting programmes—evidence-based and ‘home-grown’—were already in use, theadvent of government funding for the training of facilitators9 for specific EBPPs resulted in




the six LAs offering at least one of three major programmes: SFSC (5 LAs), Triple P (5), andIY (4) (see Table 1).

Assessments of need for parenting support services had been carried out, and these informedeach LA’s parenting strategy; this, in turn, was associated with the choice of EBPPs: ‘We’vehad to try and commission those ones that we know will suit our needs’ (LA1 ⁄ Com). The eth-nically mixed London LAs had all selected SFSC, which was felt to ‘deal with diversity’(LA2 ⁄ Coord) and was the ‘most adaptable to different audiences, settings, cultures and faithswhich suits this borough’ (LA5 ⁄ Com). IY was selected by two LAs as it was already in use byCAMHS (LA3,5) so there were already people trained; and one LA was persuaded to adoptTriple P by NAPP (LA3 ⁄ Coord).

In the two northern LAs, the reasons for selecting EBPPs differed. In one case, SFSC hadbeen used by a voluntary organisation with one particular ethnic minority group for a num-ber of years, so it was decided to ‘build on what we had’ (LA4 ⁄ Com); it was also felt to suitthe needs of the LA. In addition, there were some workers trained and the ‘timeframes wewere given meant that we couldn’t really sit back for six months and think about it’ (LA4 ⁄ F).Triple P was selected because it could complement a home-grown programme (LA4 ⁄ Com). Inthe other northern LA, Triple P was the only EBPP on offer. This was because it offered dif-ferent levels, but a television documentary ‘Driving Mum and Dad Mad’ had influenced thechoice: ‘it had had an awful lot of media coverage … so when the free training offer cameout … we just went for that’ (LA6 ⁄ Com).

In all six urban LAs, the offer of free training meant that people to deliver EBPPs wereneeded: ‘You’ve got this free training and you get as many people on it as you can’ (LA4 ⁄ F);and ‘my remit was get those free training places and make sure they are used’ (LA3 ⁄ Coord).There was a significant issue of capacity with ‘an explosion in parenting support’ (LA6 ⁄ Com).Given the urgent need to find appropriate workers, it is perhaps unsurprising to find that adiverse range of people were trained to deliver EBPPs: social workers, PSAs, children’s centrestaff, health visitors, early years workers, family intervention project workers, youth offend-ing team workers, school staff, and education welfare officers.

Eligibility

The DfES guidance stated that LAs should ‘see support for parents as a continuum, fromearly intervention and preventative services through to the use of enforcement measures; thewhole range of services should be used as appropriate’ (DfES, 2006, p. 3).

Support for parenting via EBPPs was seen as a continuum in all six LAs, for example:

We have programmes that are relevant and appropriate to parents and their needs. Many are self-referral and have universal entry, but not all…SFSC, the main programme used, is open to all, TripleP is referral from social workers’ (LA5 ⁄ Coord).

In LA6, the only EBPP on offer was Triple P, which allowed for different levels of need to becatered for: ‘so we’ve got universal services and then we’ve got a continuum up to the heavyend, the sharper end’ (LA6 ⁄ Com).

Universal provision was felt to be important to ‘reduce stigma’ (LA2 ⁄ Coord). In one case, amix of parents—in terms of levels of need—was sought specifically so as not to stigmatise

6 Anne West et al.



Tab

le1:

Mai

nEBPPs

insi

xurb

anlo

cal

auth

ori

ties

Pro

gra

mm

e(L

A)

Age

range

Wee

ksLe

arnin

gm

ethods

incl

ude…

Theo

retica

lunder

pin

nin

gs

Com

men

ts

Str

ength

enin

gFam

ilie

s,Str

ength

enin

gCom

munitie

sLA

1,LA

2,LA

3,LA

4,LA

5

3–18

13

Inte

ract

ive

met

hods

with

par

ents

shar

ing

exper

ience

san

dval

ues

,pra

ctic

alac

tivitie

san

dhom

ework

Soci

alle

arnin

gth

eory

,beh

avio

ura

lth

eori

es

Cultura

lly

sensi

tive

univ

ersa

lpro

gra

mm

e.A

ims

tore

ach

bla

ckan

dm

inori

tyet

hnic

par

ents

and

mar

gin

alis

edco

mm

unitie

sTri

ple

PM

ulti-

level

and

multi-

var

iant

LA1,LA

3,LA

4,LA

5,LA

6

Dep

ends

on

var

iant

‘Sta

ndar

dTri

ple

P’

up

to12

Dep

ends

on

var

iant

‘Sta

ndar

dTri

ple

P’8–10

Dif

fere

nce

sac

ross

var

iants

and

level

s:in

cludes

med

iam

essa

ges

on

posi

tive

par

enting,did

actic

teac

hin

g,dis

cuss

ion,ro

lepla

y,hom

ework

Soci

alle

arnin

g,

cognitiv

e-beh

avio

ura

l,dev

elopm

enta

lth

eory

Aim

sto

incr

ease

posi

tive

par

enting,

self

-effi

cacy

and

confi

den

ce;

dec

reas

epar

enting

stre

ssan

dan

xie

ty;

dec

reas

ech

ild

emotional

and

beh

avio

ura

lpro

ble

ms

Incr

edib

leY

ears

pro

gra

mm

esM

ulti-

var

iant

LA2,LA

3,LA

4,LA

5

1–3

3–6

6–12

13–15

16–18

Var

ies

acco

rdin

gto

targ

etgro

up

Model

ling

of

par

enting

beh

avio

ur

thro

ugh

obse

rvat

ion

of

DV

Ddem

onst

ration

and

role

pla

y

Soci

alle

arnin

gth

eory

and

oth

ers

Aim

sto

pro

mote

posi

tive

par

enting

and

nurt

ure

par

ent–

child

rela

tionsh

ips

Sourc

e:CW

DC

(2011).




(LA6 ⁄ F). Having a variety of different families was also seen to be helpful showing that‘there are issues with everybody’ (LA6 ⁄ F). The normalising of EBPPs was demonstrated byaccessible venues being selected, including children’s centres and schools. Children’s centreswere seen to ‘really fit’ as they are ‘neutral environments which do not have any particularaffiliations’ (LA5 ⁄ Coord). Another LA was keen to de-stigmatise access so ‘having them inthe children’s centre where there was a creche available was a big thing’ (LA6 ⁄ Com). Com-munity centres were also liked ‘because they are often on estates, they are not in schools,which often parents don’t like to go to … they are in places that are familiar, easy to get to,have got great creches’ (LA3 ⁄ Coord).

Different types of targeting were identified—by parent group, by children’s needs and by cost.Thus, in some cases, targeting was to ‘reach certain groups ⁄ parents’ (LA2 ⁄ Coord), such asfathers, wider kinship groups and parents with English as a second language (LA5 ⁄ Com): ‘Themore marginalised the group are, whether it’s because of language issues or culture, the moreyou have to target it at single groups, in order to get them through the door’ (LA4 ⁄ F). There wasalso targeting to meet particular needs of children: in one LA, Triple P was used ‘where there isa perceived need to tackle behaviour’ (LA5 ⁄ Coord); and IY for those whose children hadbehavioural problems (aged two to six years): this was tied in with costs involved (LA2 ⁄ Coord).

For universal programmes — such as SFSC in the five LAs where it was on offer — parentscould self-refer. Referral was also via other routes — by general practitioners, health visitors,speech and language therapists, children’s centre nurseries ⁄ outreach workers, PSAs andschools. Parents were also referred by social care teams: ‘If a family is …coming away fromchild protection support…there will be a plan put in place and parents [will be] able toaccess a parenting programme’ (LA6 ⁄ Com).

This relates to the assessment of individual parents’ needs. This was only systematicallyaddressed in one LA in the context of determining the level of Triple P to which parentsshould be assigned (LA6 ⁄ Com). In another LA, it was noted that the Common AssessmentFramework was used ‘but we need to work on this because we need to make sure that this isthe central mechanism for identifying need and matching parents to the right programme orsupport’ (LA2 ⁄ Coord). In a similar vein, another interviewee acknowledged that there wasmore work to be done on assessing parents’ need to participate, but there was a challenge‘we don’t know where the parents are’; this was, in part, on account of the population being‘very mobile’ and there being no ‘assessment criteria’ (LA3 ⁄ Coord).

The appropriate matching of parents to programmes (cf. Barrett, 2009) was a concern in oneLA: it was reported to be ‘very hit and miss’ to find parents who were appropriate for differentprogrammes as there was no central allocation mechanism in the LA (LA3 ⁄ Coord). Moreover,matching did not always happen because of the need to ensure that there were sufficient par-ents in a group: ‘If I have a parent who wants to do my programme I am not going to turnthem away and suggest that they do a different one as I want to fill my programmes’ (LA3 ⁄ F).In the same LA, however, there was clear matching and targeting with children on parentingorders having priority for one-to-one programmes in the home (LA3 ⁄ Coord).

Fidelity

Fidelity is a key issue in the literature on programme implementation (Fixsen and others,2005; Durlak and DuPre, 2008). The NICE ⁄ SCIE guidelines recommend that programmes

8 Anne West et al.



‘adhere to the programme developer’s manual and employ all of the necessary materials toensure consistent implementation of the programme’ (NICE ⁄ SCIE, 2006, p. 29). However,whilst retaining the ‘active ingredients’ practitioners need to exhibit judgement, creativityand skill (Asmussen and Weizel, 2010).

The didactic style adopted in the manuals was a concern for some, and adaptations were onoccasion made: ‘[It] feels a bit lectury so there’s a lot of facilitator talking … we haveadapted it a little bit to allow parents to share some of their experience…’ (LA1 ⁄ F). Addi-tional materials such as handouts were also prepared to ‘enhance or illustrate to that particu-lar group of parents’ (LA5 ⁄ Coord,F).

There was no unanimous agreement about the accessibility of manuals (cf. Lindsay andothers, 2008): the SFSC manual was ‘wordy and complicated and can be very challengingfor workers who are first using it’ (LA4 ⁄ F). ‘[For Triple P there is] a big book and for someparents it’s very daunting … it relies very heavily on literacy’ (LA6 ⁄ Com). There were alsoconcerns about the language not being ‘brilliant, particularly for learners or parentswith learning disabilities’ (LA5 ⁄ Coord,F). However, where literacy levels were low, ‘theexpectation isn’t that they write anything down but we read through the information withthem and explain it’ (LA1 ⁄ F).

In one case, significant changes were made to meet parents’ needs, with SFSC being deliv-ered to a ‘group of non-English speaking Ethiopians who spoke two different languages …they didn’t understand each other, let alone English, so we did a modified version [compris-ing] about six or seven workshops’. This was exceptional, however, as ‘we generally dis-approve of modifying programmes at all’ (LA4 ⁄ F). One interviewee used some of her ownmaterials and translated them into Arabic (LA3 ⁄ F). Another explained that cartoons that hadbeen produced for parents with learning difficulties were used with Ethiopian families: ‘If wehadn’t had that, we’d have had to stop the whole course’ (LA4 ⁄ F).

In some cases, adaptations were different in kind: for example, with SFSC, one practitionerchanged the wording on spirituality ‘as either the family have a specific faith or have no realaffiliation to any’ and used ‘words like values and ethics’ (LA3 ⁄ F). Other possible challengesto fidelity were raised: ‘Things like looking at depression and suicide, political involvement,community involvement, I think a lot of facilitators don’t feel confident with that and shyaway from it’ (LA4 ⁄ F).

Modifications thus demonstrated creativity and flexibility but also, at times, significantdivergence from the programme, so challenging fidelity. One such threat is combining differ-ent programmes: there is a ‘big push in not mixing and matching’ (LA6 ⁄ Com). However, onefacilitator reported that she did tend to mix the programmes when suitable: ‘Regardless ofwhich one I deliver [Triple P or SFSC] there is always something about the other one that Iwill deliver because I am in a one-to-one situation so I can’ (LA3 ⁄ F).

A different threat to fidelity was raised in relation to staff expertise. In one authority, therewas a clinical psychologist10 who worked with other less qualified staff to deliver IY(LA2 ⁄ Coord). Such expertise was not necessarily found elsewhere and one interviewee raisedconcerns about the extent to which research in clinical units using more experienced andknowledgeable staff could be ‘truly replicated’ (LA4 ⁄ F).




Intensity

Intensity can be defined as the ‘amount of intervention parents receive … parents with morecomplex needs are likely to benefit from more intensive support from more highly qualifiedprofessionals’ (Asmussen and Weizel, 2010, p. 3). More intensive support is recommended foronly some families ‘where there are particular difficulties in engaging with the parents or afamily’s needs are too complex to be met by group-based parent-training ⁄ educationprogrammes’ (NICE ⁄ SCIE, 2006, p. 4). Such support can take place in the home.

Particular challenges in relation to intensity and fidelity were identified in one child protec-tion case; this involved one-to-one meetings with the father and took about a year to com-plete as he could only be seen every two or three weeks: ‘and you couldn’t do a wholesession … at once … because they are just going to switch off … I would normally chop thesession up into half, maybe into three’ (LA3 ⁄ F).

Intensity also relates to the duration of the intervention. Missing sessions was common, forexample, because of childhood illnesses (cf. Wilding and Barton, 2009). The duration of theindividual sessions could cause difficulties: ‘You might not have time to do all your role-plays.…You can’t drop anything that’s crucial … you just have to tag that into your nextsession’ (LA5 ⁄ Coord,F). Completion could also be difficult to ascertain, particularly in one-toone settings: ‘It isn’t always clear … we might cover two sessions in one week … so it mightlook like they haven’t done as many weeks as they should but we might have covered all thematerial’ (LA3 ⁄ F).

Another challenge is enabling the participation of parents who ‘could find it difficult to accessthese programmes and yet could have the greatest need’ (NICE ⁄ SCIE 2006, p. 5); one way toenable access is via creche facilities. Although taken on board, the costs were high: ‘We try veryhard to … overcome childcare issues, that’s very funding dependent though’ (LA4 ⁄ F).

Discussion

This article examined the development of parenting programmes in England and the imple-mentation of EBPPs in a small sample of urban LAs. The provision of central governmentfunding acted as an incentive for our sample of LAs to offer EBPPs. However, they wereintroduced in a short period of time, without the appropriate infrastructure being in place,which may account for some mismatches between guidance and practice.

The method of reaching those most in need was not structured or consistent (cf. Barrett,2009); there were different understandings of targeting and there were concerns aboutassessing parents’ needs and matching parents to programmes. Programmes were not alwaysdelivered as specified. Whilst creativity and flexibility were identified (cf. Lindsay and others,2011), more significant divergences were apparent at times.

These findings, although not generalisable across the country, raise issues that merit furtherinvestigation. Future research could explore whether the issues that emerged in our study arefound more generally across a representative sample of LAs, urban and rural, and if there areparticular issues that are applicable in the latter, where access issues are likely to be important.

The Conservative-Liberal Democrat Coalition Government, removed ring-fencing for EBPPsand a new Early Intervention Grant (EIG) replaced several funding streams including the

10 Anne West et al.



Think Family grant (DfE, 2010). The amount allocated through the EIG in 2011 was alsoreduced by 10.5 per cent. As one interviewee commented: ‘Grants have been slashed, we arelosing capacity’ (LA6 ⁄ Com).

Lindsay and others (2011) calculated that the average cost of funding a parent who started aPEIP parenting programme was around £1244, although this increased to £1658 taking intoaccount the 75 per cent completion rate found in the LAs providing data. The lowest cost —in an LA that had been operating the programme for three years — was £534 per parent.

LAs may thus choose not to prioritise EBPPs, given the reduced budget, even though theAllen (2011) report, commissioned by the Government, advocated that ‘the best and mostrigorously proven Early Intervention programmes should be pulled together … to promotetheir wider use’ (p. v); these include Triple P and IY.

In this context, it is significant that Lindsay and others (2008, 2011) found that the outcomesof different EBPPs were broadly similar, suggesting that ‘other home grown courses might beequally effective’ (2008, p. 12). If more cost-effective alternatives were to be found, it maybe that EBPPs will be less vulnerable in times of economic constraint. However, it is vitallyimportant that evidence of effectiveness is available: sound evidence for the effectiveness ofmore programmes—in addition to the major EBPPs—is needed.

This possibility is recognised by the Government (DfE ⁄ DH, 2011): ‘We want local commis-sioners to choose proven parenting programmes to meet local needs’ (para. 95) and is sup-porting the Commissioning Toolkit developed by the National Academy of ParentingResearch (see CWDC, 2011). Indeed, two of our sample LAs were either using newly accred-ited programmes or were planning to seek accreditation for their home-grown programmes.

Finally, Lindsay and others (2011) note that the notion of fidelity ‘might need seriousthought given the fact that similar outcomes are produced by very different programmes’(p. 13). Thus, effectiveness may not be as closely tied to following the EBPP manual as hasbeen supposed. Moreover, research in the field of implementation science suggests that betterimplementation can occur when providers make some adjustments. Given that adaptationsmight improve or undermine success, it is important that any adaptations—such as thoseidentified in our study—are monitored (Durlak and DuPre, 2008). Further research is thusneeded to examine the types of adaptation that might be beneficial and not negatively affectoutcomes and what the most appropriate mix of fidelity and adaptation might be.

Notes

1 Parenting support includes parenting programmes and interventions targeting couples ⁄ fa-milies ⁄ individual parents (Boddy and others, 2008).

2 Some Sure Start Local Programmes offered home-grown parenting programmes (Barlowand others, 2007).

3 SFSC was first evaluated in 2008 (CWDC, 2011).4 The DfES became the DCSF in 2007, and the DfE in 2010.5 From 2009 until 2010, Think Family replaced the Parenting Support Strategy grant, the

Respect Parenting Practitioner grant and the Family Intervention Project grants.6 Staffing issues are addressed in a separate paper.7 Reasons given for non-participation included staff non-availability ⁄ turnover and slow pro-

gress implementing EBPPs.




8 LAs are not distinguished further to preserve anonymity.9 For all three programmes, trainers often need to be accessed from the USA or Australia

(Lindsay and others, 2011).10 Thirty-seven per cent of facilitators held graduate qualifications (Lindsay and others, 2011).

Acknowledgements

The authors would like to thank all those who participated in this research, the referees fortheir comments, and Dr Philip Noden and Professor Jane Lewis for advice.

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Correspondence to: Anne West, Department of Social Policy, London School of Economics and Political Science,

Houghton Street, London WC2A 2AE, 020 7955 7269, UK. E-mail: [email protected]

Accepted for publication 23 December 2011




Documents

Implementing Evidence-Based Parenting Programmes in a Small Sample of English Urban Local Authorities: Eligibility, Fidelity and Intensity