Author: Neha Shah, Sarah Stewart-Brown
‘Every parent should go on this course’
‘It’s going to make a great generation ahead’
Hearing the feedback from parents attending a parenting programme I have been evaluating, it is clear that what they have learnt has had a profound impact on their wellbeing, their family life, and most importantly their child’s wellbeing and behaviour.
Findings from neuroscience and psychology indicate that a secure and loving relationship with caregivers is a key foundation for good mental health, which also impacts on educational attainment and later outcomes. Parenting interventions can work on improving emotional expression, understanding and communication between parents and children. By enabling change of unhelpful parenting behaviours such as harsh discipline, negative praise and inconsistent boundaries, they reduce problem behaviours in children. Many will have added effects of improving the social support and mental health of parents. Programmes delivered at key school transitional phases have indicated reduction in prevalence of substance misuse among adolescents, although effects on physical health outcomes seem otherwise more limited.
There are many parenting programmes available with good quality RCT evidence of effectiveness – some may have heard of the more widely promoted ones such as Triple P, Incredible years and Family Links. Difficulties are encountered in evaluating parenting programmes due to the complex nature of the intervention, complex social and organisational landscape in which parenting interventions are delivered and outcomes that are difficult to measure. Recruitment and retention is also difficult, due to stigma around being labelled as a bad parent.
The National Institute for Clinical and Care Excellence( NICE )has approved the use of parenting interventions for children with conduct disorders, which make up 5% of 5-10 year olds in the UK Economic analysis from the PSSRU indicates that, when parenting programmes are delivered to parents of children with conduct disorder, total gross savings over 25 years amount to £9,288 per child and thus exceed the average cost of the intervention by a factor of around 8 to 1. Savings to the public sector come to £3,368 per child, including £1,278 accruing to the NHS. The rest of the savings are primarily related to reduced crime rates. However, benefits that come are often delayed, with this analysis indicating it takes 8 years to achieve a positive return to the public sector, and 14 years for a positive return to the NHS.
A key dilemma with parenting programmes is whether to target interventions or keep them universal. As summed up by the parent above, every parent could benefit from going on a course. However, cost savings to the public purse are greater when parents of children with the worst behaviour are enrolled, leading to decisions to target services. Unfortunately, by doing this the stigmatisation of ‘failing’ parents is enhanced, and the very capability of courses to reach those who need it most is diminished.
As with many good public health prevention programmes, delayed impact leaves the intervention vulnerable to budget cuts. Provision of parenting support in the UK is patchy. Policy supporting parenting such as Sure Start have unfortunately not weathered political change and equivocal evaluations, although the Troubled Families Programme puts a welcome focus on families at need. Recent interest in Adverse Childhood Experiences (ACEs )and the release of the government’s green paper ‘Transforming children and young people’s mental health provision’ has put the spotlight on the mental health of children and young people. BACAPH have been laudably vocal about the impacts of rising child poverty. Parenting fits in with this agenda and should not be left out - good enough parenting can mitigate some of the adverse impacts of childhood inequality by maximising opportunities for healthy mental development.
So, what should we be doing?
Supporting parents to look after their children and themselves to the best of their abilities and not judging parents for their failures is key. Public discussion and openness around the difficulties of parenting will help reduce stigma.
Clinicians can highlight and praise positive parenting and refer to local programmes where appropriate.
Clinicians, public health practitioners and policymakers alike can advocate for provision of good parenting support and try to align approaches. Working with local support groups and delivery of parenting programmes through school or community groups can provide opportunities for linking parents in to services supporting both themselves and their children.
For more detailed discussion of the issues discussed in this blog please refer to the following article:
Parenting and health: a call for action, Shah, Neha and Stewart-Brown Sarah, Paediatrics and Child Health , Volume 28 , Issue 3 , 120 - 125