This study examined the effectiveness of three evidence-based parenting programmes when rolled out on a large scale in community settings, as part of the Parenting Early Intervention Pathfinder (PEIP), and their relative effectiveness. The study found substantial improvements for all three programmes in parenting behaviour, parental mental well-being and reported behaviour of the child about whom the parent had most concern for displaying or being at risk of anti-social behaviour.
Initially the parents, most of whom were mothers, had low levels of mental well-being, and of both satisfaction and sense of efficacy as a parent. Their parenting style was characterised by high levels of impulsivity and over-reactivity. Prevalence of substantial behaviour problems was about six times the national average for their target child. Significant improvements were found for parenting skills and mental well-being following participation in one of the three programmes, with moderate to large effect sizes. Reported child behaviour also improved: conduct problems and SDQ total difficulties both reduced, although average effect sizes across programmes were lower than for the parenting measures. Other aspects of child behaviour, for example emotional symptoms and hyperactivity, showed less improvement, as expected, since these are not the main target of the programmes.
The significant improvements in both parents and children support previous studies. The magnitude of the effectiveness of the PEIP is encouraging given that this was a large scale roll out rather than a well controlled, smaller scale trial. For example, pre- to post-course improvements in child behaviour (SDQ conduct problems and total difficulties scores) for the Incredible Years sample are similar to those reported for a UK study of Incredible Years by Hutchings et al.
]. The results for Triple P are comparable to those from a meta-analysis of 55 studies reported by Nowak and Heinrichs [14
] for a within groups design (effect size range 0.45-0.57). Furthermore, the parents for whom we have post-course data are comparable on 13 of the 14 measures, indicating that the results are generalisable to the population from which the sample providing pre- to post-group comparison data was taken.
Comparison of the three programmes indicates that all were effective but there was a general trend for Strengthening Families Strengthening Communities (SFSC) to have lower effects than Incredible Years and Triple P. All three had been selected by the UK government as appropriate programmes to improve parenting skills and reduce children's behavioural difficulties; hence a three way comparison using measures selected to show improvements in the primary domains common to all three programmes is a reasonable analysis. However, in addition to these common aims, each programme had specific characteristics which were not examined in the study. It is not possible without more detailed research to determine with any certainty the reasons for SCSF being relatively less effective than the other two programmes. However, a possible explanation may be to do with the aims and content of SFSC being broader than Incredible Years and Triple P. For example, SFSC also emphasises concerns with the cultural, spiritual, ethnic and family issues related to child and family functioning and with the development of community involvement. The narrower focus of the other programmes on parenting and managing children's behaviour, with an emphasis on learning very specific practical skills in this area, may begin to explain the differences in outcomes.
The study was rigorous within the parameters of a large scale roll out of the programmes across 18 different local authorities (LAs). It comprised a large sample and appropriate measures of both parenting and child behaviour. There were, however, limitations. First, post-course data were available on only about half of the parents. This loss occurred partly because about a quarter of parents dropped out of their programme, a common phenomenon in parenting programmes especially when participants, as here, are subject to socioeconomic disadvantage and other adversities (e.g. Hutchings et al.
] loss of 17%; Scott et al.
] 19% in each study). However, at least a further 20% of the data was lost due to LA procedural errors, including failure to pass the measures on to, or collect them from, the parenting groups. While our analysis suggested few differences in pre-course scores between those who did or did not complete the post-course questionnaires, there were (small) differences in education and income demographics and the possibility of systematic bias cannot be eliminated.
Second, as a real world study, parents were not allocated randomly to the three programmes, possibly leading to bias. The government department funding the PEIP (Department for Children Schools and Families, now the Department for Education) selected 18 LAs judged to have more advanced practice in parenting support and allocated the LAs to programmes. Parents were recruited only to their LA's funded programme.
Third, unlike a trial, there was no information on the total population identified and the resulting drop out of potential parents before starting the parenting groups, for example refusal to participate. This can be substantial: from 240 to 153 (Hutchings et al.
]) and 279 to 112 (Scott et al.
]) in two recent UK studies. Local authorities recruited parents by various means, including referrals from other agencies and open advertisements. Consequently, there is the possibility of inappropriate recruitment of parents in less need. However, unlike a trial at a single time point, parents were recruited to a succession of groups over about 2 years.
Fourth, LAs varied in their effectiveness in organising the PEIP, including numbers of parenting groups. However, this reduced the overall impact of the PEIP compared with an analysis of the most successful LAs alone. Fifth, the measures are all parent-completed scales and parents' judgements may not reflect actual changes in their parenting styles and children's behaviours. However, previous trials of these programmes have found improvements on both the direct behavioural measures and parents' reports using standardised questionnaires such as the SDQ (e.g. [40
]). Sixth, there were no follow up data available on the parents, so preventing examination of the persistence of effects. However, a long term follow up study is currently underway.
There are important implications for practice, theory and policy from the study. Regarding practice, the study shows that well designed parenting programmes, with efficacy demonstrated by time limited controlled trials, can be rolled out across a large number of community settings and the process sustained over 2 years. They can recruit substantial numbers of parents in need of parenting support and deliver significant improvements in parenting skills, parental mental well-being and child behaviour. In the present study this was achieved by central government funding of LAs within specified implementation parameters.
With respect to developing theory the finding that these three programmes, despite differences in length, style and content, were all effective raises the issue of mechanisms of change, suggesting that, in addition to a theoretically coherent content and implementation methods, relationships and style are also likely to be of importance [41
]. This implies that other, well designed programmes could also be effective provided they engage parents appropriately.
Regarding policy, our evidence suggests that further roll out of these three parenting programmes to support parents is justified as a component of a policy to reduce children's behaviour difficulties. Consistency and programme fidelity in an intervention on this scale require national planning, monitoring and support of local delivery in order to limit variations in implementation and thereby enhance effectiveness. However, national and local strategy to support parents and reduce behaviour difficulties in children must be multifaceted: parenting programmes are important, but only one of a number of possible strategies [24