A comparison of the effectiveness of three parenting programmes in improving parenting skills, parent mental-well being and children's behaviour when implemented on a large scale in community settings in 18 English local authorities: the parenting early intervention pathfinder (PEIP).

BACKGROUND: There is growing evidence that parenting programmes can improve parenting skills and thereby the behaviour of children exhibiting or at risk of developing antisocial behaviour. Given the high prevalence of childhood behaviour problems the task is to develop large scale application of effective programmes. The aim of this study was to evaluate the UK government funded implementation of the Parenting Early Intervention Pathfinder (PEIP). This involved the large scale rolling out of three programmes to parents of children 8-13 years in 18 local authorities (LAs) over a 2 year period. METHODS: The UK government's Department for Education allocated each programme (Incredible Years, Triple P and Strengthening Families Strengthening Communities) to six LAs which then developed systems to intervene using parenting groups. Implementation fidelity was supported by the training of group facilitators by staff of the appropriate parenting programme supplemented by supervision. Parents completed measures of parenting style, efficacy, satisfaction, and mental well-being, and also child behaviour. RESULTS: A total of 1121 parents completed pre- and post-course measures. There were significant improvements on all measures for each programme; effect sizes (Cohen's d) ranged across the programmes from 0.57 to 0.93 for parenting style; 0.33 to 0.77 for parenting satisfaction and self-efficacy; and from 0.49 to 0.88 for parental mental well-being. Effectiveness varied between programmes: Strengthening Families Strengthening Communities was significantly less effective than both the other two programmes in improving parental efficacy, satisfaction and mental well-being. Improvements in child behaviour were found for all programmes: effect sizes for reduction in conduct problems ranged from -0.44 to -0.71 across programmes, with Strengthening Families Strengthening Communities again having significantly lower reductions than Incredible Years. CONCLUSIONS: Evidence-based parenting programmes can be implemented successfully on a large scale in community settings despite the lack of concentrated and sustained support available during a controlled trial.

Economic evaluation of an intensive home visiting programme for vulnerable families: a cost-effectiveness analysis of a public health intervention.

BACKGROUND: Recent reviews have shown that home visiting programmes that address parenting have the potential to improve long term health and social outcomes for children. However there are few studies exploring the cost-effectiveness of such interventions. The objective of this study was to evaluate the cost-effectiveness of an intensive home visiting programme directed at vulnerable families during the antenatal and postnatal periods. METHODS: The design was an economic evaluation alongside a multicentre randomized controlled trial, in which 131 eligible women were randomly allocated to receive 18 months of intensive home visiting (n=67) or standard services (n=64). Due to the public health nature of the intervention a cost-effectiveness analysis was undertaken from a societal perspective. RESULTS: The mean 'societal costs' in the control and intervention arms were 3874 pounds and 7120 pounds, respectively, a difference of 3246 pounds (p<0.000). The mean 'health service only' costs were 3324 pounds and 5685 pounds respectively, a difference of 2361 pounds (p<0.000). As well as significant improvements in maternal sensitivity and infant cooperativeness there was also a non-significant increase in the likelihood of the intervention group infants being removed from the home due to abuse and neglect. These incremental benefits were delivered at an incremental societal cost of 3246 pounds per woman. CONCLUSIONS: The results of the study provide evidence to suggest that, within the context of regular home visits, specially trained home visitors can increase maternal sensitivity and infant cooperativeness and are better able to identify infants in need of removal from the home for child protection. The extent to which these benefits are 'worth' the societal cost of 3246 pounds per woman however is a matter of judgment.

Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation.

OBJECTIVES: To evaluate the effectiveness and cost effectiveness of an intensive home visiting programme in improving outcomes for vulnerable families. DESIGN: Multicentre randomised controlled trial in which eligible women were allocated to receive home visiting (n = 67) or standard services (n = 64). Incremental cost analysis. SETTING: 40 general practitioner practices across 2 counties in the UK. PARTICIPANTS: 131 vulnerable pregnant women. INTERVENTION: Selected health visitors were trained in the Family Partnership Model to provide a weekly home visiting service from 6 months antenatally to 12 months postnatally. MAIN OUTCOME MEASURES: Mother-child interaction, maternal psychological health attitudes and behaviour, infant functioning and development, and risk of neglect or abuse. RESULTS: At 12 months, differences favouring the home-visited group were observed on an independent assessment of maternal sensitivity (p<0.04) and infant cooperativeness (p<0.02). No differences were identified on any other measures. A non-significant increase in the likelihood of intervention group infants being the subject of child protection proceedings, or being removed from the home, and one death in the control group were found. The mean incremental cost per infant of the home visiting intervention was 3246 pounds sterling (bootstrapped 95% CI for the difference 1645-4803 pounds sterling). CONCLUSION: This intervention may have the potential to improve parenting and increase the identification of infants at risk of abuse and neglect in vulnerable families. Further investigation is needed, along with long-term follow-up to assess possible sleeper effects.

The effectiveness and quality of routine child and adolescent mental health care outreach clinics.

OBJECTIVES: Little evidence has been available about the functioning and outcomes of child mental health services operating at the primary care interface. This study investigated the effectiveness and quality of one particular model of outreach clinic. DESIGN: The study used a quasi-experimental design comparing outcomes of children attending the outreach clinics with a waiting list comparison. The intervention group (n=88) was assessed at referral, four months and twelve months later. The comparison group (n=99) completed measures at referral and four months. METHOD: The main carers of participant children completed self-report measures of problem severity, impact, burden, parental stress and parent satisfaction. Clinicians provided clinical activity information. RESULTS: There were significant reductions in children's problem severity, distress and impairment, particularly for behavioural difficulties. In contrast, the results showed no effect upon the outcomes of children's emotional problems or parental stress. High ratings of satisfaction were obtained for many aspects of care. CONCLUSIONS: The children receiving care through this system of decentralised, outreach clinics derived clinical benefits that were maintained over time. The outreach clinics received strong consumer support suggesting the service offered a high level of acceptability to parents.

The psychosocial needs of young offenders and adolescents from an inner city area.

To date, assessments of the prevalence of mental health problems in young offenders have largely focused on incarcerated samples. This paper describes a quantitative study of a sample of 47 male young offenders under the supervision of an inner city Youth Offending Team. A semi-structured interview, modified from previous studies, was used to investigate the type and frequency of psychosocial and health problems they experienced. The results were compared with data from a random community sample of 38 male adolescents interviewed in a comparable way. Young offenders reported more psychosocial problems at a statistically significant level (including depression/misery, excessive worry and problematic substance use), as well as higher life-time rates of head injury, than adolescents in the community sample. Levels of problematic substance use and exposure to head injury continued to differentiate the groups when offenders in custody were removed from the analyses. The findings are discussed in relation to previous research and implications for service delivery.

The Role and Value of a Paediatric Specialist Neurodevelopmental Diagnostic Service: Parental Perceptions.

BACKGROUND: This study was undertaken to explore parental perceptions of the role and value of a specialist service for children and families. This service offers assessment and diagnosis of children with neurodevelopmental disorders of the kind that are not evident at birth. METHOD: Information was collected from 37 families on expectations and experience of clinic attendance, user satisfaction and outcome through interviews and questionnaires, once before and twice after clinic attendance. RESULTS: 87% of parents found clinic attendance worthwhile, with most expecting to be provided with a diagnosis and advice on education. Parents perceived that the clinic was best able to meet their diagnostic needs and they reported that they were more able to obtain a diagnosis and a specialist opinion at a regional centre than at local clinics. Parent satisfaction with the parent-child relationship improved following clinic attendance and parents' self-identified concerns about their child decreased.