The effectiveness of parenting support

CHILDREN & SOCIETY VOLUME 19 (2005) pp. 329–336Published online 12 May 2005 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/CHI.878

The Effectivenessof Parenting Support

This research review examines what is known about the effectiveness

of parenting support, and assesses the international evaluation

evidence focusing on primary and secondary prevention program-

mes. It outlines several factors affecting the success of parenting

support interventions in terms of service implementation and deli-

very, as well as outcomes for children and parents. The conclusions

highlight the need for more rigorous UK-based evaluations, and for

further investigation of the support services for specific parenting

groups such as very vulnerable families, fathers, and ethnically

diverse families. The review also underlines the need for further

national policies that address the broader social inequalities affecting

the impact of parenting programmes. Copyright # 2005 John Wiley

& Sons, Ltd.

Introduction

To judge by the attention given to parenting by UK policymakers in recent years, you could be forgiven for thinking thatthere were few headlining social problems—from anti-socialbehaviour on our streets to childhood obesity and fallingstandards in schools—for which ‘better parenting’ was not thesolution. The Government’s belief in the centrality of parentingfor the health and well-being of the nation has been much inevidence in recent years, as witnessed by a series of greenpapers highlighting the need for services to support parentsand thereby improve outcomes for children, includingSupporting Families (1998), Every Child Matters (2003), and itsfollow-up Every Child Matters: Next Steps (2004). In a discussionof the development of policy and practice in relation toparenting, Smith (1997) concludes that

parenting education and support will only become a major andwidely accepted plank of public policy when it has demon-strated much more explicitly its potential benefits, to parents, tochildren and to society as a whole

This raises the issue of just how much we now know about thekind of difference that parenting support and education canmake.

Copyright # 2005 John Wiley & Sons, Ltd.

Research

Review

Patricia Moran* andDeborah GhatePolicy Research Bureau

*Correspondence to: Dr Patricia

Moran Policy Research Bureau,

2a Tabernacle St., London EC2

4LU, UK.

E-mail: [email protected]

Contract/grant sponsor: Depart-

ment for Education and Skills.

A number of recent reviews of parenting support services and their efficacy go some wayto providing answers to this question in relation to specific aspects of parenting, such aschild and family mental health (Barnes and Freude-Lagevardi, 2002), child behaviourproblems (Richardson and Joughin, 2002), and educational achievement (Desforges andAbouchaar, 2003). However, the effectiveness of parenting support more generally acrossa broader range of outcomes for both children and parents has rarely been considered.This research review is a summary of a recent study commissioned by the Department forEducation and Skills, and intended to address this gap (Moran and others, 2004). Itconsiders evidence of effectiveness across multiple outcome domains including children’semotional, behavioural and educational development; parenting skills, attitudes, andknowledge; parental mental health and social support; and quality of parent-childrelationships. Specifically this review considers the following questions:

� How advanced is our knowledge of the effectiveness of parenting support services?� What characteristics of participants influence the effectiveness of services?� What characteristics of services help parents and children to benefit the most?� What characteristics of delivery affect the recruitment and retention of parents to

services?� What are the gaps in our knowledge about ‘what works’ in parenting support?

Methodological approach

‘Parenting support’ is a broad term meaning different things to policy makers, providersand recipients. For the purpose of the review, parenting support was taken to includeinterventions (that is services or programmes) provided by semi-formal support sources(such as community-based, voluntary sector organisations) or formal support sources(typically involving statutory sector provision, or statutory and voluntary sectorpartnerships.) Many previous reviews of parenting support take the form of systematicreviews and meta-analyses that draw together findings exclusively from randomisedcontrol trials. However, due to a scarcity of robust UK-based evaluations we chose toadditionally include less stringent quasi-experimental studies of merit, based on a systemof methodological grading (described more fully in the main report). We also includedsimilarly-graded qualitative evaluations of merit in order to provide a more fully roundedpicture of the process and implementation aspects of interventions that affect theirsuccess.

Searches of sociological, educational, and psychological citation databases covering thelast 20 years, as well as unpublished reports (or ‘grey’ literature), generated severalthousands of items for potential inclusion. These were narrowed down to just over ahundred studies, limited to those covering interventions that were: of ‘mainstream’ focus,dealing with relatively mild and/or frequent rather than rare or severe parenting needs ordifficulties; aimed at parents (or carers), or parents and children together, rather thanchildren alone; and aimed at reducing risks and/or promoting protective factors forchildren in relation to their social and emotional well-being (though children’s physicalwell-being was generally excluded as this encompassed a very large literature in its ownright). Further details of the methodological approach can be found in the full report(Moran and others, 2004) and details of the individual evaluation studies included can befound at an online database (DfES, 2004; Policy Research Bureau, 2004).

330 Patricia Moran and Deborah Ghate

Copyright # 2005 John Wiley & Sons, Ltd. CHILDREN & SOCIETY Vol. 19, 329–336 (2005)

The evidence base for knowing ‘what works’ in parenting support services

Application of the methodological approach described above highlighted the patchinessof knowledge about what works in this field. It was clear that some types of parentingsupport services have been far better evaluated than others. This partly reflects the policyagenda that drives the funding of evaluation research in this field: contrast, for example,the high priority given to interventions for preventing or reducing children’s ‘externalis-ing’ conduct problems and anti-social behaviour with the low priority given to preventionor reduction of ‘internalising’ disorders such as childhood depression or anxiety. Thespeed with which funders require answers to policy-based research questions also lendsitself more readily to the investigation of the immediate impacts of services at the cost ofknowledge about their lasting impact over the medium to long term. We also know far lessabout what works in the UK compared to the US, partly due to the relative recency ofparenting support programmes on a large or national scale in the UK (for example, SureStart) that lend themselves to the most rigorous types of evaluation research.

Researchers too have some responsibility for the patchiness in knowledge of what works,in that they tend to measure what is easily measurable rather than what we really want orneed to know. They choose qualitative methods because these are generally lesschallenging to implement than rigorous quantitative designs, rather than because theissues lend themselves best to qualitative methods. They sample parents, rather thanchildren, because children are harder to reach. They sample mothers because fathers areharder to reach, and they use either pre-existing tools that may not always fit the purposesfully, or untested new instruments rather than invest time and money in developingreliable and valid tools. The situation is further compounded by the bias againstpublishing results that are negative or inconclusive (Stoiber and Kratochwill, 2000),despite the valuable messages that can be learned from ‘failures’ as well as successes.

Despite these limitations in our knowledge, there are examples of effective interventionsto be found in relation to a number of areas of parenting support—effective, that is, mostlyin the short-term and in a predominantly US context. However, there are also a smallnumber of robust UK evaluations that show promising results. We are now in a position tobe able to draw some conclusions about the factors that influence effectiveness, and theimplications of these, as described below.

Participant characteristics that influence outcomes

While many studies indicate that, for the most part, parents welcome support and arewell-satisfied by services (for example, Barlow and Stewart-Brown, 2001; Ghate andRamella, 2002), there remains a significant proportion of parents who either drop out ofservices prematurely or whose difficulties remain entrenched despite receiving help.Generally, they tend to be parents with multiple, overlapping difficulties (for example,living in conditions of poverty, poor housing, social isolation, marital conflict, poorphysical or mental health), and whose children have behavioural and emotional problemsat the more severe end of the spectrum (Forehand and Kotchik, 2002; Kazdin and Wassell,1999). Where service providers are concerned, this means that thorough initialassessments of potential clients must be carried out, and that services need to be clearabout their ‘niche’ in terms of what kind of support they can offer and the type of parents

The Effectiveness of Parenting Support 331


(or children) they are best placed to help (Forehand and Kotchik, 2002). Overall, it isimportant to remember that it is a rare service that can cater to all needs and be all things toall people. There are a number of examples of intensive interventions that simultaneouslytackle adversities across multiple domains of families’ lives (for example, MultisystemicTreatment [Henggeler and others, 1998]; and the enhanced Triple P Programme [Sanders,1999]) but these require substantial resources to set up and maintain, and can only treat alimited number of families at any one time.

While carefully targeted, intensive, ‘wraparound’ services have been shown to be effectivefor working with higher risk families, there is also a place for early intervention withfamilies at the lower end of the risk spectrum. Often, these are the kinds of servicesdescribed as ‘universal’, providing help or support to all families regardless of need levels.However, there is a trade-off to be considered between the preventative benefits ofproviding a universal programme and the cost of providing a service for those that maynot need it. In the US, the Rand Organisation have analysed the differential cost-savings ofproviding interventions to high and low risk families in the Elmira Prenatal/Early InfancyProject (PEIP; Olds and others, 1997) and the Perry preschool project, (High/Scope;Schweinhart and others, 1993). In fact, although their analyses show that the cost-savingsin terms of government expenditure on welfare, health, education and criminal justicesystems are much greater for high risk families than low risk families, when broader‘benefits to society’ are also considered, intervention with low risk families is also cost-effective (Karoly and others, 1998). Comparable UK data are however lacking, and aremuch needed to provide understanding of the fiscal and broader benefits of early versuslate interventions in the UK context.

At the level of national policy, the difficulties of enhancing outcomes for higher riskfamilies highlight the importance of recognising the wider ecology or social context ofparenting, and the limited impact that any parent support intervention can have ifbroader social inequalities affecting families are not addressed. In recent years we haveseen the introduction of a number of national policies aimed at tackling inequalitiessuch as poverty (for example, the New Deal for Lone Parents, family and child taxcredits, etc), and social exclusion (for example, the Youth Justice Board’s YouthInclusion Programme). However, until there is further and perhaps more wide-rangingalignment of policy at national levels with provision of services locally, the ability ofparenting support programmes to impact on those most in need remains an uphillstruggle. For example, although engaging more fathers in child care has beenhighlighted as a highly desirable outcome of parenting support services, howachievable this is when British fathers continue to work the longest hours in Europeis questionable.

Service characteristics that maximise benefits to parents and children

Our review of the literature also highlighted the characteristics of services that caninfluence their effectiveness. What is delivered in a parenting support programme, howit is delivered, and who delivers it all matter in this respect. In terms of the nature ofwhat is delivered, services tend to be more successful across a range of outcomes whenthey have a clearly articulated set of aims and goals and a clearly mapped-out route forachieving them. This means paying attention not only to a ‘theory of change’ but also



delineating the precise mechanisms by which change for individual service users willbe achieved.

Parenting support services designed to have multiple components also tend to be moreeffective than uni-modal designs. Multi-component programmes typically address morethan one area of need while still retaining a core set of objectives; provide components forchildren as well as parents; use a variety of materials to support learning; and use a rangeof methods of delivery such as group work and home visitation sessions. In contrast, uni-modal programmes typically offer a single method of delivery, use limited materials, andaddress a single area of need. The reasons for the success of multi-componentprogrammes are hard to untangle but it may be due to their ability to tackle severalareas of risk simultaneously and to support a variety of learning styles.

Who delivers the service may be just as significant for impact as the theoretical orientationof the intervention or its content. Generally, programmes of proven efficacy tend to useprofessionally trained workers and paraprofessionals rather than volunteers (thoughthere are some exceptions). A critical factor is the ability of workers to build goodrelationships with parents, and to work in partnership with them. An example of a UKintervention that embodies this model of working is the Parent Advisor Service, in whichtrained Parent Advisors make home visits to families and establish a ‘respectful’partnership, bolstering parents’ own sense of control and competence (Davis and Spurr,1998). Relatedly, the extent to which the intervention can be presented in a non-stigmatising way also appears to matter, especially when working with high-need groups.An example of a UK programme that attributes some of its success to its non-stigmatisingapproach is SPOKES (Supporting parents on kids’ education) which wraps up a parentingskills programme for reducing disruptive behaviour within a parent-led literacyprogramme for primary school children (Scott and Sylva, 2003).

Other factors influencing successful implementation and delivery

Qualitative evaluation literature provides us with a rich source of information abouthow best to ‘get’, ‘keep’, and ‘engage’ parents with parenting support services—factorsthat are as essential to consider in relation to the success of any intervention as itsquantifiable impact on outcomes. There are many factors that appear to be important in thisrespect, which we describe in detail in the main study in terms of five dimensions: practical,relational, strategic, structural and cultural/contextual. Here we highlight some of thecultural/contextual factors of significance as these in particular warrant further research.

Sex of the parent is an important contextual factor influencing recruitment and retention ofparents to services (Ghate and others, 2000). Evidence examining the role of fathers withinSure Start projects by Lloyd and others (2003), for example, suggests that speciallydesigned activities are required to attract fathers, as well as provision of a staff memberdedicated to involving them. There is also some evidence to suggest that when fathersparticipate in services in parallel with their partners, the effects of parent training may beenhanced (Coplin and Houts, 1991). Further research is required to explore the ways inwhich a range of parenting support services can be tailored to attract fathers, and todetermine whether fathers and mothers are generally better served in separate but parallelservices or sessions, or by working together in joint sessions.



Another factor affecting willingness to engage with parenting services concerns cultureand ethnicity, as uptake of parenting support services is typically low among some groups(Ghate and Hazel, 2002). The perceived trustworthiness of the service provider has beenfound to be an important element in recruitment and retention of parents from someethnic groups (Gross and others, 2001). The use of same ethnic group service workers, andof individuals of social standing within the social networks of potential participants (suchas school and faith-group personnel) have been found to enhance recruitment. It has alsobeen suggested that as most parenting programmes have been developed with Caucasian,American groups of parents, the content and delivery methods of some programmes maybe less acceptable to some cultural groups (Catalano and others, 1993). Cheng Gorman(1996) suggests that the cultural adaptation of programmes needs to go beyond simpletranslation of language to the development of programmes that more fully embody thevalues and beliefs of the specific culture of the group. However, there may be as muchwithin-group variation in concepts of appropriate parenting as there is between groups,and while it is important to recognise cultural differences, it is also important to avoid alevel of preoccupation with culture that can lead to stereotyping groups (Forehand andKotchik, 2002). More robust evaluation work is needed in order to understand whatconstitutes a culturally sensitive parenting programme and its impact on recruitment,retention and ultimately on outcomes for parents and children.

Directions for future research

As we have noted, there are a number of shortcomings in our knowledge of theeffectiveness of parenting programmes. We have already highlighted the preponderanceof more rigorous studies in the US, whose findings may not be fully ‘transferable’ tothe UK context, as well as the lack of knowledge about outcomes from UK services overthe medium to longer term. This raises the need to invest in more longitudinal evaluationdesigns, although the need to fund rigorous evaluations of services must be balanced bythe need to fund research that investigates the causes of problems experienced by parentsand children. As O’Connor (2002) points out, we still lack a definitive, consensual andinclusive theory of parenting that describes what it is and how it shapes children’s psycho-social development. Until we have greater understanding of the mechanisms involved inthe onset and maintenance of family problems (and family well-being), we cannot developfully appropriate interventions to address them. Thus further research aimed at theorybuilding is also needed to pave the way for the development of services, in addition torobust evaluation.

In relation to specific characteristics of parenting groups and programmes, we requirefurther research to establish what aspects of parenting support are most effective whenworking with the most vulnerable families, with fathers, and with black and Asianparents. Lastly, we should not forget the importance of assessing children’s perceptions ofbeing parented in addition to assessing the impact of parenting programmes on theirdevelopmental trajectory.

Conclusions

Whatever the underlying motivation for providing parenting support programmes, theissue of their efficacy remains an important question if policy makers and serviceproviders are to justify the growth in interest and expenditure now seen in this field



(Smith, 1997). The answer to the question of whether we know if parenting supportservices can make a difference to the lives of families is both ‘yes’ and ‘no’. It is probablyfair to say that whilst we now have a reasonable idea of some of the approaches that ‘work’or at least look ‘promising’, we do not always know exactly why they work, or why someservices work for some parents but not others, or how long-lasting the effects are. This willrequire significant investment in well-designed evaluations (and, it goes without saying,long-term investment in the programmes being evaluated, rather than the more typicalshort-term approach to service funding). If policy makers want to know more about ‘whatworks’ in parenting support, they will need to dig deeper into their pockets to fund theanswer. They will also need to continue working on policies designed to tackle the broadersocial inequalities that provide the backdrop to parenting difficulties (such as poverty,unemployment, poor housing and health) if those most in need are to benefit fromservices. Individual parenting support programmes therefore need to be viewed as justone piece in the jigsaw of intervention required to produce positive changes in outcomesfor children and parents.

Acknowledgements

This research on which this review is based was funded by a grant from the FamiliesDivision of the Department of Education and Skills. We would like to thank Clare Roskilland colleagues at the Department for her support and advice, and the many peerreviewers who contributed comments on the full study report. We would also like to thankour colleagues at the Policy Research Bureau, in particular Ilan Katz and Amelia van derMerwe, for their invaluable contribution to this review.

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Contributors’ details

Dr Patricia Moran is a freelance Chartered Research Psychologist and Counsellor, specialising inresearch on families, mental health and parenting, and was formerly a Principal Research Associateat the Policy Research Bureau.

Dr Deborah Ghate is Director of the Policy Research Bureau, an independent not-for-profit centrefor applied social policy research into children, young people and their families.



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The effectiveness of parenting support