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Empowering Parents, Empowering Communities The opportunity for A Better Start
Dr Crispin Day South London and Maudsley NHS Foundation Trust, King’s College, London, Institute of Psychiatry A Better Start Conference, Blackpool October 26th, 2017
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Centre for Parent and Child Support
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Aims To briefly review peer-based approaches
To describe the rationale for Empowering Parents, Empowering Communities (EPEC) To describe EPEC outcomes, parent experience and the central role of parent group leaders To describe EPEC in Blackpool
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Rationale for peer-to-peer support
Peers with shared characteristics & common experiences may have greater credibility and influence Mutual identification & trust engendered by peers may boost engagement, improve support & accelerate change Peer support may be more cost effective & improve scope & scale of help available Peer supporters themselves may benefit from improved health & child development knowledge, confidence , community status, employment opprtunities Peer support may be underpinned by a positive moral purpose & be a vehicle for altruism & community connectedness (See Cupples et al, 2011, Solomon, 2004, Stolzenberg et al., 2011)
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Peer-to-peer support: Evidence & impact
Increasingly common feature across health, education & social care Big Lottery Fund outcomes Diet & Nutrition , more common, esp. breastfeeding support Fewer examples focussed on early communication & language and social & emotional development Methods range from Informal volunteer support Befriending Structured & intensive individual and group-based support Research evidence varies greatly in quality Can achieve high levels of family satisfaction Outcomes vary widely from little impact to at least the equivalent achieved by professional interventions (see Hoagwood et al., 2010, Jolly, 2012, Suppiah, 2008)
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Peer support programmes: Working with local parents & communities
Empowering Parents, Empowering Communities (EPEC): In UK and Australia, an early parenting intervention, a collaboration between King’s College, London, South London & Maudsley NHS Foundation Trust Parents and Communities Together (PACT): in south London, a social support intervention and ‘parent university’, a collaboration between Citizen’s UK and King’s College, London eMums: in South Australia, an online and social media platform for new mothers supported by child and family nurses, a collaboration between South Australia Child and Family Services and University of Adelaide
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Empowering Parents Empowering Communities
Innovative Evidence-based Effective Efficient Popular Low cost Award-winning International
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children & young people
1 in 10 children & young people
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50% behavioural problems
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Immediate harm to children’s development, wellbeing, learning, achievement, family function and peer relationships Long term risk to adult mental health, employment, economic independence, family welfare & crime
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10 times economic cost
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The Good News …….But Parenting programmes are an effective intervention (NICE, 2013) Families often do not get the help they need Families often don’t get the help early enough to make a difference & reduce impact Scale of need far out weighs the service capacity available Complex referral pathways and stigma
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Innovation & transformation is essential
Meet scale of family need Improve access to evidence based support Help families and children get the very best start
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Empowering parents, empowering communities: Innovation & transformation
Uses a universal, accessible approach to reduce barriers to participation from across communities & families Uses effective, tested methods to improve parenting & child outcomes, family well-being, build social & community connectedness Uses a cost effective approach to improve the scale & availability of effective parenting support, particularly for socially disadvantaged & excluded communities Recruits, trains & supports local parents to lead parenting groups in their communities
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Empowering parents, empowering communities: Three group programmes
Being A Parent (2-11yrs) Living with Teenagers (11-16yrs) Our Baby & Us (0-1yr) Manualised programmes co-produced by parents & parenting practitioners Groups co-facilitated by two trained & accredited parents Eight 2hr sessions for between 8-12 parents Community location, children centres, schools, NGOs Universal access & on-site crèche Additional specialist programmes for higher need families in CAMHS and families living in homeless accommodation
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Becoming an EPEC parent group leader
Most parent group leaders have been EPEC group participants EPEC peer facilitator training 10 weekly 6hr workshops Accredited with UK Open College Network, equivalent to 18 NVQ credits Research (Day et al, 2012a) shows EPEC facilitator training increases Parenting knowledge and confidence Group work skills, After training, parent peer facilitators are Receive supervision, session observation & further training Routine outcome evaluation Reimbursed for time and expenses
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Samira’s Story …
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EPEC Group leader learning: Programme theory and methods
Delivered using a structured manual based on attachment, social learning, relational, and cognitive behavioural theories and methods, Sessions involve sharing of information, group discussion, demonstration, role play, reflection, and planning/review of homework tasks.
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EPEC Group leader tasks: Being a Parent programme
Session 1: being a parent “Good enough” versus “perfect” parent Taking care of ourselves Session 2: feelings Remembering what it was like to be a child Acknowledging, accepting, and expressing feelings Session 3: play Non-directive play (“special time”) Session 4: valuing my child Avoiding “labels” when describing behaviour Using descriptive praise to change behaviour Session 5: understanding children’s behaviour Understanding children’s behaviour in response to needs Discipline Commands, consequences, rewards and star charts Session 6: discipline strategies Understanding boundaries Time Out and saying ‘no’ Household Rules Session 7: listening Communication styles Open and closed questions Reflective listening Session 8: review and coping with stress Coping with stress Reviewing the course and knowing where to get support Ending and celebration
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So far EPEC has…. Gone on to run over 300+ courses including more than parents with children in UK and Australia New expansion programme to set up 16 new EPEC sites in England
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Blackpool ABS: EPEC the plan
By August 2018: 130 parents will have undertaken the Being a Parent course Up to 18 parent facilitators will be trained Up to 9 supervisors will have been identified to undertake supervision training Work towards establishing local EPEC Hub
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Blackpool ABS: EPEC Progress so far
Delivered Being a Parent courses in 8 different Children’s Centres 90 parents registered Parent Facilitator training January 2018 Children’s Centre Managers’ Training January 2018
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Blackpool ABS: Learning so far
Fidelity Course material Evaluation measures Facilitators On site supervision Local outreach Key local workers and ‘champions’ Accreditation Application and selection Flex Outreach strategy Facilitator experience Earlier local support Engagement Parent information Practicalities Peer community links Food!
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But does EPEC work?
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EPEC access and acceptability: Who comes to the parenting groups?
Two-thirds of parents attending groups come from the lowest 20% of the population based on disposable income, Only 10% are owner occupiers, 75% are unwaged, 40% are lone parents 75% of parents attending EPEC groups in London boroughs are from Black and Minority Ethnic backgrounds. 50% of participant parents have English as a second language.
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But does EPEC make a difference?
Seven outcome evaluations with excellent outcomes EPEC Randomised control trial (n=116, Day et al., 2012a) EPEC Quasi-experimental, uncontrolled trial (n=73, Day et al., 2012b) EPEC Feasibility pilot of Living with Teenagers (n=41, Michelson et al., 2014) EPEC BaP Pilot Homeless Families (n=15, Bradley, 2016) EPEC Quasi-experimental, uncontrolled trial, routine practice (n=109, Charalambides, 2015) EPEC Quasi-experimental, uncontrolled trial, Reflective Function (n=69, Harwood, 2017) EPEC Pilot trials of Baby & Us (n=78, Fernandez Cubillas, 2017) ‘Established programme, consistently effective’ (Early Intervention Foundation, 2016) ‘Approved use as an evidence based programme’ (Australian Institute of Family Studies, 2015) Very efficient because of the high attendance and low drop-out Very high level of attendance, 75-90% complete course
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Results from EPEC RCT: Child Behavior Inventory (ECBI, Eyberg & Pincus, 1999)
Children’s behaviour problems improve Effect size=0.58 Day, Michelson, D., Thomson, S., et al. (2011). Child and Adolescent Mental Health Day, C., Michelson, D., Thomson, S., et al. (2012). British Medical Journal Michelson, D., Ben-Zion, et al. (2014).. Archives of Disease in Childhood.
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Results from EPEC RCT: Parenting Scale (PS, Arnold et al., 1993)
Parents’ parenting improves Effect size=0.85 Day, Michelson, D., Thomson, S., et al. (2011). Child and Adolescent Mental Health Day, C., Michelson, D., Thomson, S., et al. (2012). British Medical Journal Michelson, D., Ben-Zion, et al. (2014).. Archives of Disease in Childhood.
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Results from EPEC RCT: Concerns About My Child (CAMC, Day et al
Parents’ achieve their parenting goals Effect size=0.85 Day, Michelson, D., Thomson, S., et al. (2011). Child and Adolescent Mental Health Day, C., Michelson, D., Thomson, S., et al. (2012). British Medical Journal Michelson, D., Ben-Zion, et al. (2014).. Archives of Disease in Childhood. Effect size=0.85
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Routine service evaluation
Involving around 100 EPEC groups for approx parents delivered as part of routine services Maintain significant reductions in: child behaviour problems parenting parental concerns
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Impact on Parenting: Parent feedback
Parent rating of EPEC Course Impact 70+ EPEC courses [n=793(%)] Not at all A Little Quite a lot A great deal Improves parent’s understanding of positive parenting 5 (0.6) 57 (7.2) 285 (35.9) 446 (56.3) Helps to develop parent’s positive parenting skills 10 (1.3) 59 (7.4) 317 (39.9) 408 (51.4) Improved parent’s confidence in being an effective parent 8 (1.0) 67 (8.4) 338 (42.7) 379 (47.9) Parent will use learning from EPEC as a parent 50 (6.3) 291 (36.7) 448 (56.4)
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What do parents say about the impact of EPEC……..………….
“Do not scream and shout at your kids. Do not label them. A lot of descriptive praise and understanding their feelings” What do parents say about the impact of EPEC……..…………. “Communicate better with my children; really listening; looking at them, no longer ignoring them; but really pay attention” “Giving rewards and stick to what you say when making clear” boundaries” “Finding out that you’re not the only parent experiencing difficulties and that there is solutions, support available.” “I have tried to improve on listening more and not dismissing the feelings of my child” . “This is a really great course, very practical and easy to use with your children” .
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Parent group leaders: At the heart of each EPEC group
Group leaders bring personal qualities & skills, social class, cultural and ethnic identities Parent group leaders lead information sessions coffee mornings and 1-1 conversations Develop effective relationships with group participants Maintain fidelity to EPEC programme and personalise content for each group and each participant parent Parent facilitators' enthusiasm, openness and mutual identification with families seen by service users as critical to EPEC's impact and success. Thomson, S., Michelson, D. & Day, C. (2014)
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Parent group leaders: Parents’ experience
Parent satisfaction with EPEC parent group leaders 70+ EPEC courses [n=793(%)] Not at all A Little Quite a lot A great deal Competent EPEC parent group leaders 1 (0.1) 23 (2.9) 203 (25.7) 563 (71.3) Satisfaction with EPEC programme and group leaders 31 (3.9) 258 (32.5) 503 (63.5) Appropriate programme content covered by EPEC group leaders 0 (0.0) 49 (6.2) 244 (30.9) 497 (62.9) EPEC group leaders related effectively to parent participants 2 (0.2) 28 (3.6) 206 (26.2) 550 (70.0) EPEC group leaders motivated participant parents 190 (24.2) 572 (72.8)
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What do parents say about the parent group leaders……..…
“D…. and A….. are wonderful. They teach with care, understanding and support.” “K….. and S…….. are great. Work great together and separate, learnt a lot from them.” What do parents say about the parent group leaders……..… “They definitely know their stuff and have so much to offer other mums.” “They really taught in an engaging way and made me enjoy the course more because of their way of delivery and their warm, patient personalities.” “Lovely trainers, very upbeat and used their experiences to illustrate strategies really well” “M…… and P……. have been absolutely fantastic at delivering the course, empathising with our situations and making us feel really comfortable with sharing our experiences and comments. ” . “This is a really great course, very practical and easy to use with your children” .
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Parent peer facilitators: Research & practice
"I enjoy seeing them bloom and change, I enjoy talking to the parents, learning from them" "It's given me confidence and a different way of life..“ "I could rave about it all the time…It should be more readily available.“ “For me it's the best job ever.. it's money in my pocket and I love what I'm doing“ Strongly endorse value of EPEC programme manual, structured training and continuing supervision Wider personal gains such as social status/capital, new employment opportunities which reinforce parent facilitators' role commitment Emphasise the important value of a cohesive ‘family’ identity among EPEC staff and service users. Thomson, S., Michelson, D. & Day, C. (2014)
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EPEC sustainability, impact and success: A cold eye on a ‘family’ that works
System & operational support Strong relationships & shared understanding Shared commitment to empowerment Parent group leader recruitment & selection Previous EPEC course experience as a parent Standardised selection process, application form & interview Introductory group leader training Manualised, accredited, culture of support and succeeding Ongoing course quality & fidelity Manualised evidence-based content Facilitator matching, supervision & observation Research trials & routine outcome & quality evaluation Continuing EPEC group leader development
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And a warm EPEC family heart
Experience Mutual respect Admiration And a warm EPEC family heart Being valued Togetherness Knowledge Shared belief Collective purpose Support Expertise
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EPEC Scaling Programme
NESTA/Dept for Digital, Media, Culture & Sport 2-yr funding to set up and 16 new EPEC sites in England Focussed on families with children aged 0-4yrs Contact /
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EPEC Success & Impact: Parents at the heart of effective support
Fundamental early experiences last a life time EPEC is a cost-effective, early intervention for parenting & early childhood difficulties Robust research base with strong evidence of effective outcomes Extensive experience of delivery & successful implementation
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