Transcript Which parenting programme?

Key features of effective parenting
programmes: what works and why
Claire Halsey, Consultant Clinical Psychologist
North 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
70,000
70,000
Mean cost £ 1998
60,000
50,000
40,000
24,300
30,000
20,000
10,000
10,400
0
No problems
Conduct
Conduct
problems
disorder
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?
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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
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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 adjustment
Strengths and Difficulties Questionnaire (SDQ)
Mean scale score (N=55)
10
8
PRE
6
POST
4
2
0
Emotional
Symptoms
Conduct
Problems
Hyperactivity/
Inattention
Peer Problems
Prosocial
Behaviour
Impact
Parenting Style pre-post Triple P
Stoke on Trent n=56
Parenting style
Parenting Scale for Adolescents (PSA)
PRE
Mean scale score (N=56)
7
POST
6
5
4
3
2
1
0
Laxness
Over-reactivity
Parent-adolescent conflict pre-post
Triple P n=55 (parents) n=11 (teens)
Parent-teenager conflict
Conflict Behaviour Questionnaire (CBQ)
Mean scale score
20
18
16
14
12
PRE
10
8
POST
6
4
2
0
Parent rating (N=55)
Adolescent rating (N=11)
Parental mental health outcome data
Stoke on Trent – teen data n=54
Parental adjustment
Depression, Anxiety, Stress Scales (DASS)
Mean scale score (N=54)
21
18
15
PRE
12
POST
9
6
3
0
Depression
Anxiety
Stress
RESPECT Parenting Practitioner outcomes
n=25
Teenager adjustment
Strengths and Difficulties Questionnaire (SDQ)
Mean scale score (N=25)
10
8
PRE
6
POST
4
2
0
Emotional
Symptoms
Conduct
Problems
Hyperactivity/
Inattention
Peer Problems
Prosocial
Behaviour
Impact
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
• [email protected]
• 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