Key features of effective parenting programmes: what works and why

Claire Halsey, Consultant Clinical PsychologistNorth Staffordshire Combined Healthcare NHS Trust First Steps Psychological Service

Overview

• The scale of the problem

• Why intervene early?

• Key features of effective parenting programmes

• Which programmes when

• Outcomes

The scale of the problem

Child and Adolescent Difficulties• 4 - 14% of children and young people show a

clinical level of conduct disorder or oppositional defiant disorder, these make up 50% of referrals for psychological help

• 60% of children with untreated conduct disorder go on to later difficulties– Poor educational attainment, difficulties with

friendships and relationships, anti-social behaviour and offending

• In Stoke-on-Trent, our service alone sees 425 children with conduct disorder annually. Age 2-12 our figures show 3622 children with conduct difficulty at a clinical level

Financial costs of of not intervening early

Costs to age 28

10,400

24,300

70,000

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

No problems Conduct

problems

Conduct

disorder

Mea

n c

ost

£ 1

998

Key features of effective parenting programmes

National Institute for Health and Clinical Excellence and Social Care Institute for Excellence: technologies appraisal for the treatment of conduct disorder say programmes must be:• Evidence based to random controlled trial level• Based on social learning theory• Have 8-12 sessions• Include role play and homework• Be provided by suitably trained staff• Follow the programme manual (no cherry picking)

Which parenting programme?

Three parenting programmes have been selected by government as meeting the criteria for best practice:

• Triple P – positive parenting program• Webster-Stratton Incredible Years• Strengthening Families, Strengthening Communities

There is no evidence at present that these differ in efficacy for different

populations or difficulties.

What is Triple P?

• Evidence based• Multi level parenting program• Strong theoretical basis• It can be brief or intensive • Can be delivered in group or

1:1 formats• Reliable and valid assessment

package• Delivery is not profession

specific • Versions for ages 0–16• Cost effective

Core characteristics of Triple P

• Respectful - not prescriptive- An options model not an advisory

model

• Principle of sufficiency

• Self regulatory Framework- Self-sufficiency: independence,

support - Self-efficacy: parents can create

change- Self-management: goals, self

evaluation- Personal agency: changes are as a

result of parents’ efforts rather than chance

- Problem solving: skills generalisation

Do parenting programmes work?

Teen conduct and emotional outcomes

Stoke on Trent n=55

Teenager adjustmentStrengths and Difficulties Questionnaire (SDQ)

0

2

4

6

8

10

EmotionalSymptoms

ConductProblems

Hyperactivity/Inattention

Peer Problems ProsocialBehaviour

Impact

Mea

n sc

ale

scor

e (N

=55)

PRE

POST

Parenting Style pre-post Triple PStoke on Trent n=56

Parenting styleParenting Scale for Adolescents (PSA)

0

1

2

3

4

5

6

7

Laxness Over-reactivity

Mean s

cale

score

(N

=56) PRE

POST

Parent-adolescent conflict pre-post Triple P n=55 (parents) n=11 (teens)

Parent-teenager conflictConflict Behaviour Questionnaire (CBQ)

0

2

4

6

8

10

12

14

16

18

20

Parent rating (N=55) Adolescent rating (N=11)

Mea

n sc

ale

scor

e PRE

POST

Parental mental health outcome dataStoke on Trent – teen data n=54

Parental adjustmentDepression, Anxiety, Stress Scales (DASS)

0

3

6

9

12

15

18

21

Depression Anxiety Stress

Mea

n sc

ale

scor

e (N

=54)

PRE

POST

RESPECT Parenting Practitioner outcomes n=25

Teenager adjustmentStrengths and Difficulties Questionnaire (SDQ)

0

2

4

6

8

10

EmotionalSymptoms

ConductProblems

Hyperactivity/Inattention

Peer Problems ProsocialBehaviour

Impact

Mea

n sc

ale

scor

e (N

=25)

PRE

POST

Triple P Lessons from Stoke on Trent April

2008“What a relief to know we’re not alone”

Parents comments after first group session

“I’m not shouting at the kids, I’m a lot calmer, everything has changed. You can see a completely different side to the kids.” Father after group session 2

“Having something to follow, I can refresh my memory by using the work book, I forget, so lots is there for you in black and white” Mother after group session 4

“Finding out about praise made the biggest difference to our family” Father after group session 4

“I think every parent should be able to do this course.” Mother in group

Resources

• Claire.Halsey@northstaffs.nhs.uk

• For more info about Triple P research contact www.pfsc.uq.edu.au

• For more information about Triple P training and resources contact www.triplep.net

• For more information about Triple P in Stoke on Trent contact www.firststepsstoke.co.uk

Your response and questions