research in practice: Development Groups Wales

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research in practice Development Groups - Wales

• Family Support What do we know?
• Day 1 2005

Elizabeth Cooke
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Evidence v. Opinion

• In this study, boys at high risk of becoming
  delinquent were randomly allocated to
  no-intervention or a planned package of social
  and psychological support. Thirty years later the
  intervention was found to make a highly
  significant difference on measures of
  criminality, alcoholism, psychosis and early
  death. Those who took part in the social support
  programme did far worse that those who had not
  taken part in a treatment programme.
• The Cambridge-Somerville study (McCord - 1992)

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Does research tell it all?

• Evidence of effectiveness proceed with care
• No evidence of effectiveness not the same as
  evidence of lack of effectiveness
• Evidence of harm dont go there!

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Scoping Family Support

• A term that has come into prominence since the
  Children Act with its emphasis on supportive work
  with families (S.17)
• Ambiguous, complex and confusing term
• practice in search of a definition N.Frost,2003
• family and support
• complex relationship to child protection practice
• what gets included? what gets left out?

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The Policy Context

• Key principles
• Refocusing prevention and early intervention/
  improving outcomes
• Improved inter-agency working
• Improving the experience of service-users
• Listening to childrens views of needs and
  services
• The importance of a good assessment of needs and
• a good evidence base for planning care and
  developing services

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Family Support Definitions

• promotes the development and safety of
  children in their own family and promote
  conditions in the family, school and
  neighbourhood which are conducive to such safety
  and development
• Family Support Direction from diversity ed. John
  Canavan, Pat Dolan and John Pinkerton, 2002
• Any activity or facility provided either by
  statutory agencies or by community groups or
  individuals, aimed at providing advice and
  support to parents to help them in bringing up
  their children
• Audit Commission, 1994

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Family Support Definitions

• Resourcing and empowering families to resolve
  their own difficulties
• Promoting the welfare of the child within his/her
• own extended family network
• Reducing risks to, and promoting protective
  factors for social, physical , emotional and
  development well-being of the child
• Achieve better life outcomes
• Divert children from the public care system

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Different levels of intervention

• Base level universal services
• Services to vulnerable groups and communities
• Families suffering early stresses and temporary
  crises
• Families suffering severe stresses/vulnerable to
  family breakdown
• Services offered once children have been removed
  from home
• Hardiker, Exton and Barker, 1995

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Sources of Support

• Informal
• Semi-formal
• Formal
• D.Ghate and N.Hazel, 2002

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How is effectiveness assessed?

• Randomised controlled trial (RCT)
• Before-and-after studies with a control group
• Before-and-after studies with a control group
• Cohort studies
• Descriptive studies/user views/surveys/personal
  narratives/reports from focus groups/satisfaction
  questionnaires

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Issues in evaluating family support services

• Very few have been rigorously evaluated
• Some evaluations fail to record unanticipated
  outcomes
• Some outcomes are difficult to measure
• Few evaluations are longitudinal
• Information on processes can be as important as
  outcomes
• Evaluations need to take into account different
  perspectives and values
• J.Statham, 2000

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Practice interventions Early Years

• Pre- and post-natal home visiting
• Parenting Education
• Day care and early education
• Family centres
• Interventions to address childrens mental health
• Services for disabled children and their families

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Practice Interventions (cont)

• Teenage Pregnancy
• Befriending and social support
• Young carers support
• Short term fostering as family support
• Adolescent support/Parenting support and youth
  justice
• Family Group Conferences
• Post-adoption support/family and kin care/

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• Pre and Post Natal home visiting
• Evidence from review level literature
• Improvements in parenting/improvements in some
  child behavioural problems
• Improved cognitive development
• Improved management of post-natal
  depression/reduction in non accidental injury
• Improved rates of breastfeeding
• No evidence/inconclusive evidence
• Reduction in child abuse/immunisation
  uptake/reduced hospital admission
• Bull et al, Health Development Agency, 2004

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Parenting Education

• Covers a wide variety of activities, approaches
  and client groups
• Parent education does improve childrens
  behaviour and effects last (though 1/3 to 1/2
  continue to experience difficulty)
• Behaviourally orientated programmes have more
  impact (praise and reinforcement)
• Group based education programmes are more
  successful than one-to-one
• How the programmes run/are facilitated is
  important
• E. Lloyd (1999), J. Barlow (2002)

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But bear in mind .

• There is debate about whether programmes should
  be for parents with most difficulties, or whether
  they should be for all parents
• There are problems reaching parents with most
  difficulties, who are the group least likely to
  attend parent support programmes
• The programme run at the Maudsley Hospital and
  SPOKES run in South London helps to improve the
  relationship between parents and children, first
  through play and praise, and then looking at
  discipline and misbehaviour.
• The greatest improvement in parent child
  relationship occurred in the part of the
  programme dealing with praise and encouragement
• S. Scott SPOKES
  project, 2004

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Day Care and Pre-school Education

• Pre-school education enhances all-round
  development and the beneficial effects persist up
  to the age of 7
• Disadvantaged children benefit significantly
  (especially when there is a mix)
• Some settings were more effective than others
  those that are better are nursery schools and
  settings that integrate care and education
• Pre-school can help reduce disadvantage and
  social exclusion
• Sylva et al, 1997-2004, EPPE Project

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Pre-School Education

• The home learning environment is very important -
  what parents and carers do can make a real
  difference to a young childs development
• What parents do with their children is more
  important than who they are
• High levels of group care before 3 were
  associated with slightly higher levels of an
  anti-social behaviour
• Sylva et al, 1997-2004, EPPE Project

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Family Centres

• Little rigorous research, although there are
  many descriptive studies. Few studies have
  involved comparison, partly due to wide range of
  services a FC can offer/difficulties of defining
  the target population/open access v targeted
  services debate
• There is research evaluating specific services
  offered within Family Centres
• Many useful studies that describe characteristics
  of the centres
• J. Statham, 2000

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• Promoting Mental Health

• Many studies focussing on trials of specific
  therapies and
• treatments
• Few that look at the effectiveness of children
  and mental
• health services or other community initiatives
• Problem solving programmes, anti-bullying
  programmes,
• peer support, behaviour support some evidence
  for
• effectiveness found for all of these
• A. Buchanan et al, 1999

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• Services for Disabled Children and their
  Families
• Most evaluations are small-scale, focussed on
  parents needs, rather than outcomes specifically
• Families say they value family based respite
  care, parent groups, befriending schemes and
  early intervention schemes eg Portage
• P. Sloper, 1999
• The characteristics of services that work are
  an individual approach, respect for the views of
  family members, flexibility of provision, openess
  and honesty in information-sharing
• B. Beresford et al, 1996

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Parenting in Poor Environments

• Parenting in Poor Environments D Ghate and N
  Hazel, 2004
• A rigorous survey of children living in deprived
  areas
• (sample 1754)
• Identified what undermines coping with parenting
• Identified priority groups within poor
  environments

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What parents wanted

• Practical services that met parents self-defined
  needs
• Accessible services
• A range of users more of a mix
• Supporting written information
• Their skills as parents recognised
• There were substantial gaps in awareness of
  services amongst parents

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Messages for policy and practice

• Diversity of support
• Enhancing semi-formal services
• Services should help parents feel in control of
  what happens to them and their family
• The poor public image of family support services
  often acts as a barrier to seeking support
• Parents have multiple and overlapping needs and
  therefore require a holistic assessment of need
  and multi-agency solutions
• More comprehensive childcare support
• Build on strengths as well as tackling weaknesses

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What helps children do well in later life

• Higher birthweight (intervening before children
  are born
• Maternal health (critical factor for outcomes for
  children)
• Parental employment
• Parental interest in education and participation
  in school
• Pre-school education
• Staying in school (targeting children who look as
  if they are likely to withdraw)
• Reading by age of seven
• Parenting skills

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Conclusion

• The literature shows conclusively that families
  can be supported and parenting practices improved
  and that this leads to improved educational and
  behavioural adjustment in children
• It is an ongoing process that begins during
  pregnancy and continues throughout childhood and
  beyond
• Decisions about which programme to use and when
  depend on a range of factors, including available
  resources and the available time and commitment
  of professionals working with parents and
  families