Evidence Based Parenting, Measuring Outcomes, Commissioning and challenges

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• Evidence Based Parenting, Measuring Outcomes,
  Commissioning and challenges

Jo Hook Senior Commissioning Officer
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Good enough Parents build social and emotional
capabilities of children.

• The Allan Review refers to the social and
  emotional capabilities of a child as critical
  building blocks.
• A child or young person who has these skills in
  place is more likely to do well at school, form
  satisfying relationships, develop a capacity for
  compassion and have inherent resilience in the
  face of the ups and downs of living.
• Children / young people who experience poor
  relationships in their early years with adults
  who care for them, have a greater likelihood of
  developing significant mental health / well-being
  problems, conduct disorder and educational
  difficulties.

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Parenting Skills Outcomes- Good enough Parents .

• have good relationships with their children and
  family
• promote their childs learning and involvement in
  education
• promote resilience in their children and young
  people
• empathise with their child and communicate
  respectfully and effectively
• feel in control and remain calm when facing
  difficulties and find ways to avoid conflict
• establish clear boundaries and successfully
  manage behaviour issues.
• effectively manage the pressures of parenting
• have the information they need to make choices
  and decisions to support positive outcomes for
  their child
• have a good understanding of child development
  and how to ensure their child has a healthy
  lifestyle

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Structured Parenting Programmes in Kent- our
core offer and what this means

• A set number of sessions.
• A clear curriculum or framework.
• Universal, Targeted, or Specialist.
• Clear target population / issues.
• Clear expected outcomes.
• Evidence based.
• Programmes involve factual learning (theory),
  reflection, feedback (peer and
• facilitator), socialisation (group processes),
  and varying degrees of support.

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Universal- Solihull Approach parenting group

• This programme is for parents of children aged
  1-7and runs for 2 hours a week over 10 weeks. The
  group format explores parenting styles,
  developmental needs, temper tantrums,
  communication, sleep, having fun together and
  general behaviour issues. It builds on the
  Solihull Approach themes of Containment,
  Reciprocity and Behaviour Management.
• This group is not be suitable for parents with
  mental health problems, domestic violence, drug
  and alcohol related issues, or where children
  have certain special needs or more significant
  behavioural difficulties.
• Evaluations through Solihull demonstrated
• reduction in parental anxiety
•  Reduction in child behaviour problems

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Targeted/Specialist Strengthening Families,
Strengthening Communities ( SFSC)

• This is a programme designed for parents of
  children aged 3-18 years and runs over 12 weeks.
  It focuses on how parents can improve their
  self-esteem and achieve positive change in their
  parenting and, consequently, their family
  relationships. It asks parents to reflect on
  their values and how values are passed on to
  younger generations. Because of this it can be
  particularly effective in addressing social
  cohesion, and appropriate where there is cultural
  and ethnic diversity. The programme also aims to
  increase parents involvement in local
  communities and services.
• Aims to reduce anti-social behaviour and increase
  parents involvement in local communities and
  services. Culturally and ethnically diverse
• In Kent this programme is sometimes referred to
  as Your Family Matters

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Examples of impact

• 85.3 improvement in parental mental health
• 30 improvement in parental self esteem
• 70.6 improvement in parental responsiveness
• 65 reduction in childrens conduct disorder
• 30 reduction in use of physical discipline
• 40 reduction in parental anger to genuine
  mistakes
• 35 reduction in shouting at children
• 40 increase in optimism for the future
• 40 increase in parents feeling loved
• 30 increase in trying new things
• 30 increase in parental affection to children
• 40 increased in praising of positive behaviour
• 35 increase in listening to childrens opinions

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Specialist- Webster Stratton The Incredible Years

• Incredible Years is a parenting intervention for
  parents of children with moderate- severe
  behavioural difficulties including those with a
  diagnoses of oppositional-defiant disorder (ODD),
  conduct disorder (CD), Autistic Spectrum Disorder
  (ASD) or Attention Deficit Hyperactivity Disorder
  (ADHD).
• For parents of children with moderate-severe
  behavioural difficulties including those with a
  diagnoses of ASD and ADHD. Promotes strategies to
  increase play and reduce need for sanctions, thus
  improving parent-child relationship, child
  development and attachment.
• We use IY babies (0) and Toddler (1-3)
• IY Early years ( 3-8)
• We do have some running for children with special
  and severe needs

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Example of impact

• One of two parenting interventions identified by
  NICE as cost-effective in reducing conduct
  disorder. The large lifetime costs associated
  with conduct disorder, estimated to average
  75,000 in milder cases to 225,000 in extreme
  ones, suggest that even a low success rate would
  constitute good value for money.
• Evaluation outcomes include
• significantly reduced antisocial and hyperactive
  behaviour in children
• reduction in parenting stress and improvement in
  parenting competences and
• positive effects on child behaviour and
  parenting.

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Purpose of Outcomes Framework

• Common set of outcomes for commissioning of
  parenting skills programmes
• Common measurement tool to be used
• One database that holds information for
• pre and post analysis of progress
• Demonstrate distance travelled per parent, per
  programme, per facilitator and more.
• Compare programmes and can address cost
  effectiveness
• Compares progress overall
• Compare progress against individual issues,
  areas, facilitators
• Ability to measure direct impact on parent
• Ability to look at how well we offer our service
• Inform wider commissioning support for families,
  parents and carers

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What do we as service providers need to do to
make sure that parents can make the most of our
services? ( performance
outcomes)

• Appropriate and needs led evidence based
  programmes are readily available in each district
  and easy to access
• Sufficiently trained, accredited and supported
  staff are available to deliver evidence based
  programmes to ensure equal coverage in each
  district across Kent
• Evidence based programmes are perceived
  positively by mothers, fathers, carers and
  practitioners
• Evidence based programmes are easily accessible
  for a range of diversity groups and family members

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The Parent Child Relationship Inventory (PCRI

• Parental Support
• Satisfaction with Parenting
• Involvement
• Communication
• Limit Setting
• Autonomy
• Role Orientation.
• The PCRI is designed to identify specific
  aspects of the parent- child relationship that
  may cause problems and to give an overall picture
  of the quality of the relationship. Because many
  fathers now take an active role in parenting,
  PCRI items are appropriate for either parent and
  separate norms are provided for mothers and other
  carer couples. In order to establish a baseline,
  this will be used before the programme. To
  measure distance travelled, the PCRI will then be
  used after the programme is delivered.

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Bespoke forms, online capture

• 2 additional forms
• 1 participant- covers demographic info,
  perception of course and facilitator and
  additional questions. Pre and post
• 2 tutor- end of course. Covers barriers, issues,
  confidence, demographics
• Tutors will need to generate parent codes
• All paperwork will need to be entered online

• PCRI http//www.kenttrustweb.org.uk?pcri
• Parent/Carer questionnaire - http//www.kenttrust
  web.org.uk?parentcarerquestionnaire
• Parenting course tutor questionnaire -
  http//www.kenttrustweb.org.uk?parentingcoursetuto
  rquestionnaire 

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Outcome Framework-Messages that need to be shared

• Rigorous research informed this choice.
• There will never be one best option, but this is
  the closest fit for a range of outcomes
• Has to be embedded in practice and managerial
  support is required
• Use of forms mandatory for all KCC funded
  programmes.
• CAMHS providers will also use. ( new CAMHS model)
• Input onto central database ( mandatory)
• From march 2012 PCRI forms will need to be
  purchased locally. Other forms can be downloaded.
• Available from US so planning will need to
  incorporate order of forms.
• Support available from Supporting Parents team (
  of course)

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Commissioning of programmes

• Core offer now embedded and recognised- CAMHS,
  Community Budgets, Early Intervention and
  Prevention
• All other parenting programmes must have
  sufficient evidence base/cost effective
• Think Family Grant EIG includes, staff,
  training, delivery grant to districts.
• Only LA in South East to continue with core offer
  due to the virtual model but flimsy due to staff
  losses, and reduction in funding
• Market development started last year through the
  VCS and KCC staff- build capacity so it can be
  integrated through commissioning of family
  support.
• Train the trainers being funded through CAMHS for
  IY. ( long process)
• Internal assessors trained for SFSC to reduce
  cost of agreement
• Solihull trainers already in Kent.
• Costs can be reduced as long as virtual team can
  be sustained and delivery of core offer
  programmes is integral to commissioning of other
  services.

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Challenges and issues currently being addressed

• Maintain delivery with loss of capacity and
  funding.
• Practitioner fora key to co-ordination/managers
  agreement crucial
• Investigating therapeutic evidence based models
  for tier adolescent support- FFT/ NVR
• Investigating workbank options to maintain skills
  base /market development
• Supervision and workforce training still crucial
  issues
• Commissioning evidence based parenting as part of
  other services, a systemic approach