What Works Reviewed

8/12/2019 What Works Reviewed

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WHAT WORKS? A LITERATURE REVIEW OF THE EVIDENCE FOR THE

EFFECTIVENESS OF PARENTING STRATEGIES


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CONTENTS

Introduction

Executive summary

Background current context for parenting risk and protective factors cost of risk factors

Rationalefor parenting programs introduction research reports

Evaluated parenting programs introduction interventions that address risk and protective factors elements of programs that work cost effectiveness

Recommendations from the literature

Conclusion


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INTRODUCTION

his literature review has !een undertaken to provide a !asis for decision making a!outChild and "outh #ealth services to parents$ Apart from a few exceptions% which have!een noted in the text% it focuses on parenting interventions which have !een rigorouslyevaluated and have shown !enefits in positive outcomes for children$ here are manyother parenting programs which may also !e effective% !ut have not met the standards of

evaluation so have !een omitted$ Because this study was undertaken for Child and "outh#ealth purposes% it looks mainly at the health&socio'emotional aspects of parenting$ hismeans that to a large extent early literacy programs per se are excluded% although it isacknowledged that there is evidence that these can have a positive impact on children(sdevelopment and this offers opportunities for Child and "outh #ealth to link with the)epartment of Education% raining and Employment in partnerships to assist children*sdevelopment$ +any of the programs for parents covered in the report do have a specificliteracy component and all programs could !e expected to have an impact on literacythrough focus on communication$

,ider areas where support for parents and parenting could !e important have not !eenconsidered in this paper !ecause of the scope of the literature review$ hese couldinclude% for example% areas such as family friendly work practices% family friendlycommunities% housing% child and family impact considerations on government andcommunity policies and practices$

In spite of the clear evidence of the disadvantages of children in this group I was una!leto find evaluations of successful programs for A!original children$


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E.ECUTIVE SU//AR!

his report highlights the fact that there are cost effective programs which can !ringa!out more positive outcomes for children who are at risk of social or emotional ormental pro!lems which inhi!it their living skills% contri!ution to the community anden.oyment of life !oth in childhood and ongoing into adulthood$

Risk factors have !een well documented !y considera!le international and crosscultural research as have the factors which help to protect children against adverseoutcomes$ +ost protective factors for children can !e addressed throughparenting$

he cost to the community of not addressing risk factors% particularly in the earlyyears% is very large in relation to the cost of intervention% however expenditure isin the present and savings are in the future$

/arenting programs tend to have more cost !enefits for the community when usedwith parents who have more risk factors than for the general community$

Current research into the development of the !rain as well as current and pastresearch into social% educational and mental outcomes for children highlights theimportance of a positive and supportive early environment ' the environmentprovided% usually% !y parents$

0umerous national and international government reports support the importance ofprograms for parents% especially in the early years !ut also at transition or crisispoints$

/rograms that have !een shown !y rigorous evaluation to have potential to lead topositive outcomes for children include home visiting !y professionals% parenteducation groups% antenatal support and early childhood and parenting centres$

ther programs such as community development&social capital !uilding have not


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0ACKGROUND

Glad to have you aboard

For the next 18 years you willbe personally responsible for the

care and well-being of another

human being. Youre on your own

Good !uc"#/opkin% 1678$

C"rre# ,o#e1# for pare#i2

,e live in an era and a culture where we know more a!out parenting and what works forchildren than ever !efore% so there are huge windows of opportunity to make a realdifference$ ,hile it is clear that conditions for children have improved in many ways

over the past century there are still too many children who are not getting the start theyneed to make the most of their lives$

here is pro!a!ly more pressure on parenting than ever !efore$ ,hile the evidencepresented daily in the media a!out the importance of parents to outcomes for children can!e helpful% it also can !e seen !y parents as an added responsi!ility and pressure andeven% sometimes% !lame$ In spite of rhetoric a!out the importance of 9the village9 to raisechildren% child rearing is largely seen in our community as a private responsi!ility ofparents unless it goes seriously wrong$

In all other parts of home management% technology has reduced the workload$ In


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As a society we give lip service to the value of children% !ut services and resources havenot followed the rhetoric% especially for young children$ here is an assumption that flies

in the face of consistent evidence that young children are 9resilient9 so that what theyre4uire for optimum development can !e easily overlooked$ ?he concept of resilience isdiscussed later@$

/rograms for parents are still largely focused on treatment$ In ,estern societies% whereparenting is considered a private rather than community responsi!ility% this can lead todifficulties in parents asking for and accepting help$ his is exacer!ated !y increasingknowledge a!out child development and higher expectations of parents% !oth personal

and from the community$

3ome of the current issues for parents and parenting as identified !y parents include poverty family !reak'up including residence and access issues after separation isolation living and working away from family supports

step family parenting isolation of parents from their cultures of child rearing community values and confusion a!out the importance of childrearing 4uality of out of home care for young children$


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family eg positive attachment in the first year and factors in the environment eg asupportive relationship with a school$

Exactly how the protective factors work is not clear from the research !ut accumulatedrisks lessens the possi!ility of children developing resilience


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/arental criminality /oor 4uality care in the first year of life% if !oth parents are working outside the

home +a.or separations in the early years Damily !reak'up especially where there is parental conflict$


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/rotective factors

/rotective Dactors


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RATIONALE FOR PARENTING PROGRA/S

$f we do not attend to the needs of children %we ris" paying a terrible price in our

childrens later behavior - drugs and anti social and violent acts..our grandchildren

will live together in a society with the offspring of neglected families. &o will yours.%


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parenting as a key factor in early child development for families at all socioeconomiclevels$

Repor#3

InternationalIn response to the evidence of the importance of supporting parents governments indeveloped countries are investing large amounts in programs for parents of infants andyoung children$ In response to the Acheson report into ine4ualities in health% the British

overnment is investing more than Q;5 million into the 3ure 3tart program for

supporting families$ A 0ational Commission on the Damily Report in Ireland


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programs>% develop and evaluate demonstration high 4uality child care programs%implement and coordinate screening programs for infant health and parent mental

health pro!lems$ he Australian 0ational +ental #ealth 3trategy

the central role of early relationships


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EVALUATED PARENTING PROGRA/S

I#rod",#io

his section looks at programs which have !een evaluated and show positive outcomesfor children$ Except incidentally it does not cover outcomes for parents% although in manyprograms these have !een positive even where they are not the ma.or program goals$

9#igh risk intervention%


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I#er4e#io3 #ha# addre33 ri3' ad pro#e,#i4e fa,#or3

he following interventions have !een identified as successful in addressing some riskgeneral and some particular factors$

#ome Sisiting/rograms that enhance attachment !etween parent and child in the first year of life have!een shown to have sustained positive outcomes for social and cognitive development$Early positive attachment is an important component of resilience$ Donagy


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A recent review of group !ased parent education programs for children with!ehaviour pro!lems


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programs for parents of adolescents with conduct pro!lems do not seem to !e effective interms of !ehaviour change for the adolescents and the evidence for 9early determinants of

adolescent !ehaviour9 is strong


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provides educational and family support services to children aged - to 6 years$ hey arelocated in the poorest neigh!ourhoods in Chicago$ It includes special learning activities

for children% and parenting and personal resources for parents including home visits%resource mo!ilisation% educational workshops% health and nutrition services% healthscreening% speech therapy% nursing and meal services$ At age 2 years there were lessschool dropouts than the control group% and significantly lower .uvenile arrests$

niversal /rogramsniversal programs are few and usually limited to the provision of information% parenthelplines and child health checks and preparatory development information$ Reviews of

the efficacy of these are limited$ hey are generally are part of a raft of programs thatparents seek$

3ocial marketing&health promotion$,hile it is harder to find evidence !ased assessment of the impact of social marketing ondevelopmental outcomes for children there is evidence of successful pu!lic educationcampaigns regarding health% eg immunisation media campaigns$ he media influencessocial attitudes and can play a ma.or role in community education


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for A!original and orres 3trait Islander parents% however the Resourceful Adolescent/rogram for /arents


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rained leaders for parenting groups$ /rograms which provide training to !oth children and parents% !ut not !oth together

have !een shown to !e effective$$


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6,hile the health system might argua!ly !e the !est (home( for nurse home visitingthe savings are across government welfare% criminal .ustice% tax increase fromfuture earned income% thus a whole of government perspective is needed to .ustifycosts9


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RECO//ENDATIONS FRO/ THE LITERATURE

1$ +ost programs are aimed at treatment and more attention should !e given toprevention% although accessi!le early treatment options are important$

2$ he )avid and ucile /ackard Doundation(s review of home visiting programs


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$ Being a!le to standardise 4uality of programs across service delivery centres isimportant to success$

7$ /rograms should !e sustaina!le and not end a!ruptly !ut with planned transitions toappropriate community resources$6$ Although 4ualifications are important the personal 4ualities and life experience of

service providers should also !e considered$


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1$ ,hile there are enough properly run evaluations of parenting interventions to support

the efficacy and value of the some programs% many programs which could !e valua!lehave not !een ade4uately evaluated$ he need to evaluate in order to find out whatworks and for whom cannot !e overstressed and should !e part of any new parentingprograms$ Research and evaluation of programs is fundamental especially aspects on which

there is not yet enough information such as the optimal intensity and duration ofprograms% which families !enefit and which aspects of which models are mosteffective$ In the !est programs% some parents drop out% some families do not seem

to !enefit and research is needed into these areas$ /rograms need to !e evaluated against clear goals$ he Australian 0ational

+ental #ealth 3trategy


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CONCLUSION

It is clear from all the evidence that intervening in the early years where there are risks ofchild a!use% antisocial !ehaviour and mental illness is the most cost effective andsuccessful way to prevent ma.or costs to !oth the individual and the community$ Riskfactors are readily identifia!le


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efforts to eliminate risk factors should not !e forgotten$ Eliminating the risk% wherepossi!le% should !e the first step$

RESEARCH UPDATE )**-

he following section comprises an update from selected research papers notavaila!le when the original ,hat ,orks was written


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In an evaluation of #awaii*s Early 3tart /rogram% )uggan


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Adding a cognitive therapy component showed dramatic effect in the #ealthy3tart home visiting program% suggesting that this is a worthwhile component

of program content$


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he program is not a separate unit !ut rather its policies% procedures andresponsi!ilities are integrated into the organisation

3omeone in authority% other than the program director% is a champion of theprogram at high levels$

he program has few Jrival providersL who would !enefit from the programdiscontinuing

he host organisation has a history of innovation he value and mission of the program fit in well with the !roader community he program has community champions who would decry its discontinuing$

ther organisations are copying the innovations of the program$

JIn our formal evaluation of ,ashington*s effort at implementing research'provenprograms for .uvenile offenders% one important lesson was learned$ he programs workand they produce more !enefits than costs K !ut only when implemented rigorously withclose attention to 4uality control and adherence to the original design of the program$,ithout 4uality control% the programs do not workL$


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REFERENCES

1$ Acheson% ) et al


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17$ Commission on the Damily


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-$ Oaroly% ynn et al


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;8$ 0ational Crime /revention


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8$ he 3cottish ffice A 3afer 3cotland tackling crime and its causeswww$scotland$gov$uk&li!rary&documents'w8&cp'5$htm

$ 3hore% R$


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APPENDI.

E1a&ple3 of 3o&e pro2ra& o"#,o&e3

Na&e Ti&e Co#rol T%pe of Pro2ra& Re3"l#3 Co&&e#

Bristol childdevelopment/rogram

+onthly for 1st

yr% ongoingwhere needed

"es #ome visits for 1st!a!y$Including handouts$

-: found home visits v$useful5: found written material v$useful

+ostly used indeprived areas% ifnot universal parentscan feel singled out$

AdelaideChildren(s#ospital

ngoing "es S health promotionprograms for parents inwaiting room

Experimental group hadsustained increase inknowledge


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Na&e Ti&e Co#rol T%pe of pro2ra& Re3"l#3 Co&&e#3

#ealthy DamiliesAmerica

/rograms vary Improved parent childinteraction$ +ixed success

with a!use% health status$

Recommend 3tateor 0ationwide

context in whichsupport for all newparents is the norm$

Tueensland#ome visitingprogram

,eekly for8wks% monthlyto - months%up to 8 monthspost partum

"es Child health nurse homevisiting program for Englishspeaking families with a new!a!y$ Relationship !uilding%anticipatory guidance%supported !y 3, and/aediatrician

ess a!use% less smoking%more parental confidence%!etter attachment

Elmira /rogram


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Na&e Ti&e Co#rol T%pe of Pro2ra& Re3"l#3 Co&&e#3

A!ecedarian/ro.ect

'; yrs"ear round allday

educationalchildcare&preschool prgram

"es /rogram emphasises thedevelopment of cognitive%language and adaptive

!ehaviour skills$ [ nutritionalsupplements and socialservices as needed

#igher academic achievement$Reduced need for special ed%less dropout% less .uvenile and

adult crime$

onger involvementassociated with!etter outcomes$

/erry /reschool/ro.ect

2 yrintervention x2 \ hrs perday ; days aweek% months of yr

"es Includes weekly home visits!y teachers% small classes%specially trained teachers%support and supervision forstaff

By age 2 !etter .o!s% fewerarrests% lower likely hood ofreceiving pu!lic assistance

Chicago Child/arent Centres

Docuses on child(s totalenvironment and for somegroups continues for 8 years$

0eigh!ourhood centresproviding health% education%parent involvement$

ains in school achievementdepending on num!er of yearsin program

Because there are nooverall specificstandards !etween

centres% some showsu!stantialachievements% someshow none$

"ale Child,elfare /ro.ect

/regnancy '2 \ yrs

yes #ome visits focused oncurrent concerns% assistance inachieving long term goals andliaison to support services$/aediatric care andanticipatory guidance$ #igh4uality day care$

+others achieved highereducation% smaller families%almost all !ecameeconomically independent%male children !etter ad.usted


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Na&e Ti&e Co#rol T%pe of pro2ra& Re3"l#3 Co&&e#3

DA3 track rades 1'8%most intensiveat transitionseg 3tarting3chool]

"es earning programs includingtutoring and anger control andsocial skills training at school$Bi'weekly home visits% parenttraining$

Early evaluations showimproved !ehaviour% parentingskills% less aggression$

3eattle 3ocialdevelopmentprogram

rades 1'primary school

"es /arent ed groups% proactiveclassroom management% socialskills training% home visits$+ultilevel intervention

ess alcohol and delin4uency%!etter family attachment andcommunication% morecommitment to school

+ontreal/revention/ro.ect

2 yrs% earlyprimary age

"es /arent ed$ Child training$Docused on disruptive !oys inearly primary school$

ower delin4uency and antisocial !ehaviour at age 12

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