Paper
Key elements of effective practice in supporting parents in vulnerable families: what the international evidence tells us
- issue: Issue 1 / 2009
- authors: Deborah Ghate
- keywords: parenting support, evidence reviews, United Kingdom
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abstract
Background. This paper is specifically concerned with the international evidence base on effective practice in supporting families of vulnerable children and youth. It will present selected key findings from three recent reviews of the international (English-medium) literature on 'what works' in parenting support, covering: (1) a review of the evidence in general, focusing mostly on prevention and 'broad spectrum' interventions to support parents (Moran, Ghate and van der Merwe, 2004); (2) a review of parenting support interventions for youth involved in antisocial behaviour and offending (Ghate, Hauari, Hollingworth and Lindfield, forthcoming 2008); and (3) a selective review of promising and effective programmes for supporting parents of high risk youth (Utting, Monteiro and Ghate, 2007).
The purpose of the paper is to present selected key messages for effective practice in parenting support based on these three rigorous reviews of the research literature, commissioned by policy makers in different departments of the UK government.
Methods overview. Literature reviews combining systematic searches of the English-language literature across multiple disciplines; extraction and tabulation of key information; and synthesis of messages for policy, practice and research. All reviews focused on higher-quality evaluation evidence, where studies met specified standards of rigour. These included, but were not limited to, experimental (randomised) and quasi-experimental designs. The reviews also drew on the practice literature and on expert appraisals of promising approaches to implementation in order to understand delivery issues in providing support as well as outcome data.
Data. Study (1) was a major review of the international English-medium parenting support evaluation literature using a 'Systematic Plus' approach. A systematic search process initially identified over 2,000 pieces of literature published between 1985 and 2003, of which 88 evaluation studies or meta-analyses and 50 reviews were retained in the evidence base after applying strict inclusion and exclusion criteria. All quantitative evaluation studies retained were assigned a score for methodological quality using the Maryland Scientific Methods Scale (SMS, Farrington, Gottfredson, Sherman and Welsh, 2002), and generally only studies reaching at least a score of 3 out of a possible 5 points were retained. In addition, qualitative studies and practice writing on delivery of services were reviewed to synthesise current thinking on elements of good practice in implementation. Study (2) used a similar 'systematic plus' approach, but was restricted to evaluation and practice literature on parenting support interventions specifically for parents of young offenders or youth at high risk of offending and antisocial behaviour. Initial searches identified several hundred potentially relevant documents, reduced to 130 documents of which 17 high grade evaluations and 13 reviews were retained in the data base for the study after applying strict inclusion/exclusion criteria including grading for methodological rigour. Study (3) was a more selective review, in which evidence on six specific interventions, each with a strong research base, was collated and synthesised to extract messages for best practice and to inform government thinking on commissioning of new interventions for the UK. 106 evaluations and meta-analyses and 36 reviews, mostly published in scholarly journals and books, were included in the data base for this study.
Key findings and implications. The selection of key findings presented below are based on the synthesis of messages from the three reviews, taking into account the extent to which the balance of evidence is strong and or/consistent, and based on methodologically robust studies.
For higher-risk youth and families where problems are chronic or long-standing, there are now a number of well-evidenced programmes that have been shown to be effective in improving outcomes for youth and parents. Aspects of programme delivery that are important include:
- theory-driven design, and manualised implementation,
- intensive, multi-dimensional approaches,
- responsive to specific and individual and family needs,
- work with both parents and young people,
- well-trained and professionally qualified staff,
- ongoing and post-care support,
- rigorous and ongoing monitoring and evaluation, over follow-up periods of length.
However, only some families are suitable for this kind of programme, and even the most successful programmes report a fair degree of treatment failure. The up-front investment is also costly.
For lower risk families and preventive approaches, there are fewer well-evidenced programmes, though a small number stand out. Here it may be a case of picking from a menu of promising approaches as much as implementing specific programmes. The evidence suggests the following:
- behavioural programmes teaching practical strategies for influencing child and youth behaviour can be effective in achieving change at the behavioural level,
- 'cognitive' approaches can influence thinking and attitudes to parenting,
- multi-modal service offer works best for accommodating differing needs and learning styles,
- lower-intensity interventions can achieve change in 'simple' behaviours and parenting knowledge, but more intensive duration and more complex services are needed to impact upon more complex behaviours,
- a 'tiered' approach, offering differing levels of support dependent on need, can be effective and cost-efficient,
- the 'social' element of community-based programmes, where stressed and isolated parents can meet others and gain informal support, is highly valued by participants,
- higher need groups often show the greatest benefits, even in relatively low-intensity programmes.
Recommendations. The general, overarching messages are that parenting support can be effective in improving outcomes for children and for helping parents cope with parenting challenges, though the latter is more easily achieved than the former. However, generally speaking the higher the programme quality, the easier to evaluate. This leads us to a situation where we have a growing evidence base on a relatively small number of exemplary programmes, but a continuing lack of clarity about the effectiveness of the large number of competing alternatives. Governments and key NGOs involved in providing services are increasingly (and rightly) attracted to investing in 'evidence-based' services, but it is probably important not to narrow down provision to a small number of programmes, since these may not meet all needs within the community. What we now need to do is learn the implementation lessons from the 'market leading' programmes and evaluations, and use these general principles to improve other programmes that are being developed to meet the needs of specific communities. Whether for therapeutic or preventive purposes, key elements of high quality implementation, and for spreading evidence-based practice more widely, are: theory-driven design; clear understanding of the expected 'mechanisms of change' for parents and children; evaluations that utilise randomisation to test outcomes where possible (and quasi-experimental methods if not); and careful attention to documenting how and what is delivered, and the extent to which parents engage with what is being offered. Finally, a core principle of effective delivery is partnership with parents, so that parents can identify their own needs and work collaboratively with service providers.
Key references
Farrington, D., Gottfredson, D., Sherman, L., & Welsh, B. (2002). The Maryland Scientific Methods Scale in Sherman, L., Farrington, D., Welsh, B. & Mackenzie D. (eds) Evidence-based crime prevention London: Routledge.
Ghate, D., Hauari, H., Hollingworth, K., & Lindfield, S. (forthcoming 2008). Key elements of effective practice in parenting support in the youth justice context: source document. London: Youth Justice Board.
Moran, P., Ghate, D. & Van der Merwe, A. (2004). What works in parenting support: a review of the international evidence. London: DfES RR574 and available to download at www.dfes.gov.uk/research/data/uploadfiles/RR574.pdf
Utting, D., Monteiro, H., & Ghate, D. (2007). Interventions for children at risk of developing antisocial personality disorder. London: PRB/Department of Health/Cabinet Office and available to download at http://www.prb.org.uk/ publications/P182%20 and%20P188%20Report.pdf
Contact: Deborah Ghate, Principal Research Officer, Thomas Coram Research Unit, Institute of Education, University of London, 27-28 Woburn Square, London WC1H 0AA England, E-mail:d.ghate@ioe.ac.uk, Phone 0207 612 6955, Fax 0207 612 6927.