1. Key features of effective parenting programmes: what works and why Claire Halsey, Consultant Clinical Psychologist North Staffordshire Combined Healthcare NHS Trust First Steps Psychological Service

2. Overview The scale of the problem Why intervene early? Key features of effective parenting programmes Which programmes when Outcomes

4. The scale of the problem Child and Adolescent Difficulties 4 - 14% of children and young people show a clinical level of conduct disorder or oppositional defiant disorder, these make up 50% of referrals for psychological help 60% of children with untreated conduct disorder go on to later difficulties –Poor educational attainment, difficulties with friendships and relationships, anti-social behaviour and offending In Stoke-on-Trent, our service alone sees 425 children with conduct disorder annually. Age 2-12 our figures show 3622 children with conduct difficulty at a clinical level

5. Financial costs of of not intervening early Costs to age 28

6. Key features of effective parenting programmes National Institute for Health and Clinical Excellence and Social Care Institute for Excellence: technologies appraisal for the treatment of conduct disorder say programmes must be: Evidence based to random controlled trial level Based on social learning theory Have 8-12 sessions Include role play and homework Be provided by suitably trained staff Follow the programme manual (no cherry picking)

7. Which parenting programme? Three parenting programmes have been selected by government as meeting the criteria for best practice: Triple P – positive parenting program Webster-Stratton Incredible Years Strengthening Families, Strengthening Communities There is no evidence at present that these differ in efficacy for different populations or difficulties.

8. What is Triple P? Evidence based Multi level parenting program Strong theoretical basis It can be brief or intensive Can be delivered in group or 1:1 formats Reliable and valid assessment package Delivery is not profession specific Versions for ages 0–16 Cost effective

9. Core characteristics of Triple P Respectful - not prescriptive -An options model not an advisory model Principle of sufficiency Self regulatory Framework -Self-sufficiency: independence, support -Self-efficacy: parents can create change -Self-management: goals, self evaluation -Personal agency: changes are as a result of parents’ efforts rather than chance -Problem solving: skills generalisation

10. Do parenting programmes work?

11. Teen conduct and emotional outcomes Stoke on Trent n=55

12. Parenting Style pre-post Triple P Stoke on Trent n=56

13. Parent-adolescent conflict pre-post Triple P n=55 (parents) n=11 (teens)

14. Parental mental health outcome data Stoke on Trent – teen data n=54

15. RESPECT Parenting Practitioner outcomes n=25

16. Triple P Lessons from Stoke on Trent April 2008 “What a relief to know we’re not alone” Parents comments after first group session “I’m not shouting at the kids, I’m a lot calmer, everything has changed. You can see a completely different side to the kids.” Father after group session 2 “Having something to follow, I can refresh my memory by using the work book, I forget, so lots is there for you in black and white” Mother after group session 4 “Finding out about praise made the biggest difference to our family” Father after group session 4 “I think every parent should be able to do this course.” Mother in group

17. Resources Claire.Halsey@northstaffs.nhs.uk For more info about Triple P research contact www.pfsc.uq.edu.au www.pfsc.uq.edu.au For more information about Triple P training and resources contact www.triplep.netwww.triplep.net For more information about Triple P in Stoke on Trent contact www.firststepsstoke.co.ukwww.firststepsstoke.co.uk

18. Your response and questions