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Parenting programmes: What works? Some UK evidence

Parenting programmes: What works? Some UK evidence. April 2003 Stephen Scott Reader in Child Health and Behaviour Institute of Psychiatry, King’s College London. Continuity of Antisocial Behaviour from age 5 to 17. ESCAPE. % of all children. 1/5. 1/5. 1/5. 1/5. 4/5. 4/5.

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Parenting programmes: What works? Some UK evidence

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  1. Parenting programmes: What works? Some UK evidence April 2003 Stephen Scott Reader in Child Health and Behaviour Institute of Psychiatry, King’s College London

  2. Continuity of Antisocial Behaviour from age 5 to 17 ESCAPE % of all children 1/5 1/5 1/5 1/5 4/5 4/5 Oppositional & Defiant Blamed by parents Disliked by siblings 4/5 Gets into fights Rejected by peers Low sel-esteem 4/5 Hard to control Poor school achievements Blems others Stealing & truanting Deviant peer group Antisocial attitude Career offender Unemployed Drug misuse

  3. NEGATIVE PARENTING SCHOOL FAILURE .3 .2 .6 .6 DISRUPTIVE BEHAVIOUR ANTISOCIAL BEHAVIOUR SOCIAL EXCLUSION ANTISOCIAL ‘FRIENDS’ .2 15 years 3 years 9 years PREDICTION OF SOCIAL EXCLUSION

  4. SWITCH - REPEAT RIGHT LEFT C > CD ACC IPC CD > C OFC/ IFC OFC PL TL PCu

  5. What is “Positive Parenting”? • Encouraging desirable behaviour & strengths (rather than just stopping undesirable behaviour) • Sensitively responding to child’s needs (rather than ignoring their signals) • Setting firm limits consistently and calmly (rather than exploding unpredictably and with venom)

  6. What are the consequences of negative parenting ?

  7. University centre vs Real-life clinic

  8. Successful Programmes • Collaborate with parents: involve vs tell • Provide practical assistance • Offer specific Skills AND Support • Last at least 20 hours • Catch children before adolescence • Supervise therapists, have a manual

  9. Principles of Trial for Conduct Problems • CAMHS clinic ordinary referrals • Reasonably broad entry criteria • Multiple sites in regular NHS clinics • Local clinicians trained as therapists

  10. Multicentre trial of positive parenting • 141 children age 3-7 referred to CAMHS • severe, persistent antisocial behaviour • ‘Incredible Years’ parenting programme: • videotapes shown in group, 3 wks each of • Play • praise & rewards • setting limits • handling misbehaviour

  11. Predictors of less child improvement • Child hyperactivity (.19 p.03) • Younger child (.17 p.04)

  12. No Barrier to Change

  13. Effect size by Centre

  14. Attend Parenting Group .53 .21 .43 Maternal depression change Parenting skill change Parental criticism change .25 .05 .44 .08 Child less antisocial

  15. DELIVERY IN EVERYDAY LIFE the SPOKES Programme in schools • Address a whole population • Get them young • Engage the most deprived • Address child behaviour AND learning • Use the most effective interventions • Make it normal and fun

  16. PROJECT PLAN Design • Screen whole school • Take +1SD (~16% national population/~ 30% Lambeth) • Screen positive : randomise to INTENSIVE PROGRAMME CONSULTATION HELPLINE OR 3

  17. Child Antisocial Behaviour - PACS Interview scores

  18. Child Hyperactivity - PACS Interview Scores

  19. Child Emotional problems - PACS Interview Scores

  20. LITERACY PROGRAMME SKILLS • Orientation • PAUSE • PROMPT: meaning – picture cues -own experience read on to end of sentence start sentence again • PRAISE • There should be less sounding out of letters

  21. Child Reading: BAS RA-CA

  22. Child Reading: BAS Percentile

  23. Conclusions • Parenting programs can improve antisocial behaviour in the family by a substantial amount • Parents can be taught to enhance reading skills • It would be worth finding out the extent to which parents could enhance peer relationships

  24. NEGATIVE PARENTING SCHOOL FAILURE .3 .2 .6 .6 DISRUPTIVE BEHAVIOUR ANTISOCIAL BEHAVIOUR SOCIAL EXCLUSION ANTISOCIAL ‘FRIENDS’ .2 15 years 3 years 9 years PREDICTION OF SOCIAL EXCLUSION

  25. Cognitions and beliefs Emotions and motivation Behaviour and skills

  26. Making your local parenting programme effective for a whole population: do you: Make it available, acceptable, accessible, affordable? Use programmes independently shown to work? Supervise workers regularly using a manual? Have strong management to coordinate elements? Define population, screen risk, pursue non-attenders?

  27. Systematic, population-based services • Level 1: universal, media-based “infotainment” • Level 2: primary care 20 min specific consult • Level 3: primary care 4 X 20 min wider skills • Level 4: group parenting, say 8 sessions • Level 5: more intensive – extra 10 sessions • Australian experience with Triple P (Sanders)

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