1. 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

2. Centre for Parent and Child Support
1247

3. 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

4. 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)

5. 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)

6. 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

7. Empowering Parents Empowering Communities
Innovative
Evidence-based
Effective
Efficient
Popular
Low cost
Award-winning
International

8. children & young people
1 in 10
children & young people

9. 50%
behavioural
problems

10. 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

11. 10 times
economic cost

12. 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

13. Innovation & transformation is essential
Meet scale of family need
Improve access to evidence based support
Help families and children get the very best start

14. 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

15. 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

16. 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

17. Samira’s Story …

18. 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.

19. 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

20. 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

21. 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

22. 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

23. 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!

24. But does EPEC work?

25. 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.

26. 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

27. 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.

28. 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.

29. 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

30. 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

31. 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)

32. 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” .

33. 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)

34. 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)

35. 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” .

36. 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)

37. 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

38. 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

39. 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 /

40. 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