Session 2 Parenting, evidence and outcomes

1. Session 2Parenting, evidence and outcomes DataPrev Training Module - Session 2 - Parenting

2. Session 2 structure • Parenting programmes: what works? • Why look at the evidence? • Whatoutcomes are of interest? DataPrev Training Module - Session 2 - Parenting

3. The importance of parenting • Basic needs (food, shelter) and care (also when sick) • Education • Basic skills + language • Relationships • Socialisation + discipline • Mental capital • Mental health in adulthood DataPrev Training Module - Session 2 - Parenting

4. What works? • Universal practices in the perinatal period • Very low cost • antenatal abdominalmassage • skin to skin care • kangaroo care • media based parenting programmes • Slightly higher cost practices for all parents • Guidance on developmental milestones • anticipatory guidance • regular infant massage DataPrev Training Module - Session 2 - Parenting

5. What works? • Prevent and treat postnatal depression • Prevention for high risk groups (selective) • delivered on one to one basis to high risk mothers • psychosocial approachescombining practicaland emotional support • Treatment of post-natal depression as MHP (effective psychosocial approaches ) • cognitive behavioural approaches • interpersonal psychotherapy • non-directive counselling DataPrev Training Module - Session 2 - Parenting

6. What works? • Parenting support in infancy and early years • Promote sensitive parent-infant communication • Short courses (6 sessions) • Start at or after 6 months • Target high risk infants(not high risk parents) • Longer-term home support for high risk groups • Longerprogrammes • Multi-componentprogrammes • Startafterbirth • Positive focus and empowering approach DataPrev Training Module - Session 2 - Parenting

7. What works? 4. Parenting to prevent behaviour problems. • Cognitive behavioural and relational approaches • Media-based parenting courses General principles of effectiveness: • Guided with curriculum or manual, • Include: positive parent child interaction, emotional, socialisation and communication skills • parents to practice new skills • Strengths-based non-judgemental support • accepted by other parents in the social group DataPrev Training Module - Session 2 - Parenting

8. What works? 5. Parenting support in very high risk groups (e.g. history of abuse) – lack of evidence • intensive family support, multi-component,multi-systemic approaches and CB-based courses show some promise. • Group-basedbehavioural parent training + anger management techniques • CBT for non-abusingparentand children • Problemdrugusers – a) multi-component, b) attachment-basedpsychoeducation. DataPrev Training Module - Session 2 - Parenting

9. Whyevidence? Evidence Based Medicine(EBM) EBM emphasises the need to generate knowledge through controlled empirical research that can provide the most unbiased results, and considers the Randomised Controlled Trial (RCT), as the gold standard evaluation method to generate reliable evidence. • Studies on a specific topic are critically appraised (trustworthy or free of bias) • Multiple study results are synthesized (usually by systematic reviews and meta-analyses) • The findings are cast into evidence-based practice guidelines DataPrev Training Module - Session 2 - Parenting

10. Whyevidence? Typical questions asked of evidence in MHP/MDP: “What types of interventions can be implemented?” “Do they generally work and what effects could we expect?” “Can one of these interventions potentially also work in my country or given setting?” “What would be the implications if we would use the same resources on some other intervention?” DataPrev Training Module - Session 2 - Parenting

11. Whyevidence? Facts 1. Mental health promotion and mental disorder prevention • Mental health promotion (MHP) implies the creation of individual, social and environmental conditions that are empowering and enable optimal health and development. • Mental disorder prevention (MDP) aims at reducing occurrence, frequency, and re-occurrence of mental disorders, the time spent with symptoms, or the risk for a mental illness, preventing or delaying their occurrence and also decreasing their impact in the affected person, their families and society. DataPrev Training Module - Session 2 - Parenting

12. Whyevidence? Scenario 1. A school-based intervention to promote mental health The aim of the programme is to enhance social competence and self-esteem of the children, positive peer relations and increased understanding of cultural differences, social networks, and empowerment the children. The teachers in the school are trained to teach social, emotional and cognitive skills to the children, in an interactive and supportive environment. The overall school context is also changed. DataPrev Training Module - Session 2 - Parenting

13. Whyevidence? Scenario 2. A school-based intervention to prevent mental disorders Only children with a number of sub-clinical depressive symptoms would be involved, for instance, in a cognitive behavioural and problem-solving-skills intervention to increase their understanding and recognition of emotions and improve self-esteem, while creating a peer support group. This specific intervention, could be a component of the more comprehensive intervention in Scenario 1, or a stand alone intervention in a school with no universal mental health promotion programme. DataPrev Training Module - Session 2 - Parenting

14. Whyevidence? Facts 2. Efficacy, effectiveness and cost-effectiveness • Efficacy studies answer the question “Will it work at all?” – evaluating the impact of an intervention under ideal conditions. Results of efficacy studies cannot be globally generalised to real world settings. • Effectiveness studies answer the question “Does it work in the real world?” – Important as they consider whether the findings of efficacy studies (in ideal conditions) can indeed be replicated in a variety of contexts and settings. • Cost-effectiveness studies answer the question “Do the benefits of the intervention represent good value for money?” Resources are limited and the collection of information not only on effectiveness, but also on both the costs and resource consequences of interventions, plays a key role in decision making in health promotion and public health. DataPrev Training Module - Session 2 - Parenting

15. Whyevidence? There is no such thing as “value free evidence”; decisions will always be informed by various values and perspectives. DataPrev Training Module - Session 2 - Parenting

16. Whatoutcomes? • Examples include changes in : quality of life use of services behaviour life expectancy attitudessocio-economic impact political views • Outcomes can be measuredat: • Population level • Group level (e.g., prisons, schools or ethnic groups) • Individual level. DataPrev Training Module - Session 2 - Parenting

17. Whatoutcomes? Scenario 3. Measuring the effects of a school-based intervention In assessing the impact of the school-based mental health intervention, one has to choose between measures focusing on the well-being of individual pupils (e.g., their mental well-being, experience of bullying, drug use or symptoms of distress) and/or social level outcomes (such as school level of pupils’ absence, the school’s level of educational achievement, or school climate). Long term follow-up outcomes could include employment, crime or even death rates. DataPrev Training Module - Session 2 - Parenting

18. Whatoutcomes? Scenario 4. Stakeholder views on important effects of school-based intervention Different stakeholders may have different expectations on a school-based intervention. Teachers may focus on educational achievement, pupils may expect improvements in school climate, and administrators may focus on enhanced productivity. Improvements in mental well-being (and therefore a reduction in the need for curative services) may be of key importance to service providers. Another factor may be cost, while this should not be seen as an outcome, ideally, it can be examined alongside any chosen outcomes in an economic evaluation DataPrev Training Module - Session 2 - Parenting

19. Whatoutcomes? Scenario 5. Final and intermediate outcomes of school-based intervention For example, in a suicide-prevention school-based intervention, ideally the key outcome is likely to be the (decreased) rate of completed suicides. As the actual number of suicides is often very small, attempted suicide, suicidal ideation, treatment referrals, etc., might be used as intermediate outcome measures. DataPrev Training Module - Session 2 - Parenting

20. Whatoutcomes? Scenario 6. Impact of choice of scale and outcome measurement in a school-based intervention Pupils’ depressive symptoms may be measured by a sensitive rating scale. Each pupil provides a self-rating, and it may for example turn out that the average rating is statistically significantly better in schools or classes that received the intervention than in comparison schools or classes. If a sensitive scale is used even a small difference between targeted and non-targeted schools or classes can be statistically significant (especially if many schools participate in the study). Whether the finding is relevant in real life cannot be judged from the statistical significance alone, but one needs to consider also the size of the difference between targeted and non-targeted groups. DataPrev Training Module - Session 2 - Parenting

21. Whatoutcomes? Facts 3. Crucial issues in a study’s choice of outcomes • Definition of outcomes before start of evaluation • Stakeholders’ involvement in outcome selection • Use of outcomes relevant to people • Final outcomes offer more certainty than intermediate outcomes • Possibilities to detect harm • Choice of measurement method: hard facts preferable to scales • Fit of outcome measurement’s responsiveness to change • Independent measurement of outcomes • Provisions for long-term follow-up DataPrev Training Module - Session 2 - Parenting