The Evidence-based Parenting Practitioner's Handbook

Kirsten Asmussen

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136717154
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The Evidence-based Parenting Practitioner's Handbook provides a comprehensive overview of the knowledge necessary to effectively deliver evidence-based parenting interventions within community and health settings. Using clear examples of how this knowledge can inform frontline work with parents, this practical handbook includes:

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• an overview of the policy context underpinning evidence-based parenting work in the US, UK, Australia and Norway

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• a discussion of how a robust evidence base is established and the ways in which practitioners can access information about good-quality research

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• an overview of how research in the field of child development has contributed to the development of evidence-based parenting interventions

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• an overview of how theories and research in the field of therapeutic practice have contributed to the development of evidence-based parenting interventions

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• what research evidence suggests about the role of the practitioner in the delivery of evidence-based support

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• outcome-focused methods for establishing the evidence base of new parenting interventions

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• outcome-focused methods for commissioning evidence-based parenting services.

Emphasizing the ways in which practitioners can evaluate and translate messages from research into applied work with parents and families, The Evidence-based Parenting Practitioner's Handbook is suitable for all those involved in the delivery of evidence-based parenting support, including frontline practitioners, service managers, parenting commissioners, heads of children's services and policy makers.

1 Introduction

Why Evidence-Based Parenting Interventions?

Societies benefit when children thrive. Evidence suggests, however, that a significant number of children and young people living in industrial, English-speaking countries are not thriving. In the United Kingdom, one out of every ten children is assessed as having a mental health disorder annually (Green et al. 2005). In Australia, Canada, and the United States, this figure is higher, suggesting that between 12 and 14 per cent of all children have a diagnosable mental health problem in any given year (Costello et al. 2003, Green et al. 2005, McGorry et al. 2007, Waddell et al. 2005). Child mental health disorders include emotional problems, such as depression and anxiety, and behavioral problems, such as conduct disorders and hyperactivity (Kazdin 2003).

Between 35 and 40 per cent of all children will have been diagnosed with one, if not more, mental health problems by the age of 18 (Costello et al. 2003, Jaffee et al. 2005). When left untreated, mental health problems impair functioning well into adulthood, significantly interfering with the chances of finding a rewarding job or developing a positive romantic relationship (Patel et al. 2007). Between one-fourth and one-third of all adults suffer from a psychological disorder at any given point in time and slightly less than one-half will be diagnosed with a mental health problem during their lifetime (Kessler, Berglund et al. 2005, Kessler, Chiu et al. 2005). Approximately 50 per cent of all adult mental health problems are identified during childhood or adolescence (Belfer 2008, Costello et al. 2003).

Research suggests that child and adolescent mental health disorders are unfortunately on the rise. A British study comparing parental reports of children’s behavior in the 1970s, 80s and 90s observed a 50 per cent increase in adolescent behavioral problems for each successive decade (Collishaw et al. 2004). Comparisons of young people’s self-reports of their own well being also suggest increases in child mental health problems, with twice as many adolescents reporting feelings of depression or anxiety today as young people reporting in the 1980s (Collishaw et al. 2010). Collectively, these findings suggest that childhood mental health problems may have more than doubled over the past forty years.

This trend is disturbing for a number of reasons. First, childhood mental health problems create multiple costs and hardships – including the personal costs incurred by those suffering from them and the financial costs involved in treating them. For example, a child with a diagnosed conduct disorder at age 10 can cost a community up to ten times as much as a child with no mental health problems, especially when crime- and school-related costs are taken into account (Cohen 2005, Scott 2001). Second, most childhood mental health problems are treatable and preventable (Fonagy et al. 2002, Kazdin 2003). Over the past 50 years, numerous effective interventions have been identified for preventing and/or treating childhood mental health disorders, as well as preventing the onset of further problems in adulthood (O’Connell et al. 2009, Patel et al. 2007, Scott 2010a).

Interestingly, many of the most effective treatments for childhood mental health problems are delivered to parents rather than children. This is because research evidence consistently suggests that parenting behaviors are highly associated with children’s well being. In particular, key parenting strategies, especially those that encourage and reward positive child behavior, reliably predict the development of pro-social skills and reduce the likelihood of child and adolescent conduct problems (Forgatch et al. 2009, Kazdin 2003, Martinez and Forgatch 2002). A positive parent–child relationship is also associated with children’s ability to self-regulate and maintain a positive sense of self-worth (Baumrind 1991, Grolnick and Farkas 2002, Sroufe et al. 2005). These abilities, in turn, protect children from the negative emotions and thoughts typically associated with psychological difficulties in adulthood (Mrazek and Haggerty 1994).

Numerous parenting programs now exist to help parents learn appropriate strategies for supporting their children’s development and managing their behavior (Sanders and Morawska 2006). Those with a particularly strong track record in improving parent and child outcomes are now referred to as evidence-based parenting interventions (Weisz and Kazdin 2010). Research suggests that programs which teach parents how to interact positively with their children and discourage negative child behaviors are particularly effective in reducing the likelihood of behavioral problems in adolescence and adulthood (Prinz and Jones 2003). Research also suggests that when these programs are available to entire communities, population-wide benefits can be achieved. These benefits typically include reductions in youth offending, reduced rates of substance misuse, reduced rates of child maltreatment and increased rates of school achievement (Aos et al. 2004, Brody et al. 2008, Bumbarger 2010, CPPRG 2007, Prinz et al. 2009). For these reasons, governments in a number of countries are now investing in policies and initiatives to improve the quality and availability of evidence-based parenting support, as well as expand the evidence base (O’Connell et al. 2009). The following sections provide an overview of how evidence-based initiatives and policies have improved the quality of parenting interventions in the United States, United Kingdom, Norway and Australia over the past twenty years.

Evidence-Based Parenting Policy in the United States

Since the early 1990s, US policies aimed at children and parents have become increasingly informed by research evidence. This is due to a steady increase in scientific knowledge regarding the importance of the parent–child relationship and an improved understanding of the genetic and environmental factors that place this relationship at risk. US policies have also benefited from an increased consensus on what constitutes good evidence, informed by improved methodologies for testing hypotheses and analyzing research findings (O’Connell et al. 2009). The increased use of clinical trials to test the efficacy of family-based interventions has been particularly influential in informing US policy through the identification of programs that do and do not work (O’Connell et al. 2009). Information regarding the most effective interventions is now shared on numerous web directories which are increasingly used to inform federal- and state-wide funding decisions. The activity of consulting research evidence to inform government decision making is now referred to as ‘evidence-based policy’ and is considered by many to be a hallmark of modern democratic governments (Head 2008, Sanderson 2002).

Expanding the Science: Three Influential Reports

US policy makers have historically believed that unless parents abuse or neglect their children, parenting practices are personal matters that should not be subject to government policy or intervention (O’Connell et al. 2009). This perspective began to change, however, as findings from a number of government-funded research reports converged to suggest a strong link between parenting practices and child and adolescent mental health outcomes. Three reports were particularly influential in changing the US perspective in this respect: Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research (Mrazek and Haggerty 1994), From Neurons to Neighborhoods (Shonkoff and Phillips 2000) and Youth Violence: A Report of the Surgeon General (US Surgeon General 2001).

Reducing Risks for Mental Disorders (Mzarek and Haggerty) was published by the Institute of Medicine in 1994 in response to a congressional request for a review on the status of research on the prevention of mental illness and problem behaviors. The report identified key risks known to be associated with the onset of mental health problems, with the aim of developing interventions that could reduce these risks. Maladaptive parenting behavior was identified as a primary risk for a variety of mental health problems, with child maltreatment, inappropriate disciplinary practices, problematic spousal relations and parental psychological dysfunction recognized as particular threats to children’s well being.

Reducing Risks also identified the need for mental health interventions to provide strong evidence of their effectiveness. In doing so, the report recommended that randomized controlled trials¹ (RCTs) be used whenever possible, since they provided the highest level of confidence of an intervention’s efficacy. Since the report’s publication in 1994, there has been a dramatic rise in the use of RCTs to test the impact of mental health treatments, with many government agencies now funding only programs underpinned by strong RCT evidence (O’Connell et al. 2009).

From Neurons to Neighborhoods (Shonkoff and Phillips) was published by the Institute of Medicine in 2000 to provide policy makers with an understanding of how scientific evidence could be used to support children’s development through policy and practice. The report synthesized neurological evidence involving early brain development with findings from the behavioral sciences regarding emotional and cognitive development. A primary conclusion of the report was that nature and nurture are inextricably linked and that the quality of the parent–child relationship exerts a tremendous influence on children’s emotional and intellectual development. A key recommendation of the report was to develop more interventions to support the parent–child relationship. In particular, From Neurons to Neighborhoods highlighted the need for programs that had clearly defined objectives and were underpinned by strong evaluation evidence:

Model early childhood programs that deliver carefully designed interventions with well-defined objectives and that include well-designed evaluations have been shown to influence the developmental trajectories of children whose life course is threatened by socioeconomic disadvantage, family disruption, and diagnosed disabilities. Programs that combine child-focused educational activities with explicit attention to parent-child interaction patterns and relationship building appear to have the greatest impacts. In contrast, services that are based on generic family support, often without a clear delineation of intervention strategies matched directly to measurable objectives, and that are funded by more modest budgets, appear to be less effective.

(Shonkoff and Phillips: 398)

Youth Violence: A Report of the Surgeon General (US Surgeon General 2001) was commissioned by President Clinton in 1999 in response to the Columbine shootings, with the aim of identifying evidence-based methods for keeping an event like Columbine from occurring again. In response to this request, the report developed a hierarchical model (informed, in part, on the Maryland Scale of Scientific Methods – see Box 2.4) to identify programs with evidence of effectiveness in reducing youth violence and delinquent behavior.

The report identified 27 programs, categorizing them as ‘model’ or ‘promising’ depending upon the quality of their evaluation evidence. ‘Model’ programs were interventions with rigorous evaluation evidence demonstrating 1) strong evidence of a deterrent effect against youth violence that was 2) sustainable over time and 3) replicated in multiple evaluations conducted in multiple, independent settings. A ‘promising’ program also had to demonstrate a strong deterrent effect through rigorous evaluation, although evidence of its sustainability or replicability might not yet have been established. Five of the seven model programs and ten out of the twenty promising programs included parents in their delivery models.

Youth Violence was also noteworthy through its introduction of the ‘does not work’ category that identified programs and practices with no evidence of reducing youth violence. Although none of the programs identified as not working included parents in their delivery model, many practices categorized as ineffective were popular and widespread. In fact, a number of common interventions such as peer counseling, boot camp and diversionary programs (e.g. Midnight Basketball) were identified as harmful, with some evaluation evidence suggesting that they actually increased the likelihood of youth offending. These findings led the Surgeon General to conclude that research and policy needed to ‘build the science’ so that more effective prevention and intervention programs could be made available to reduce the prevalence of youth violence.

Evidence of Long-Term Benefits

As reports such as Reducing Risks, From Neurons to Neighborhoods and Youth Violence repeatedly stressed the need for evidence-based interventions, funding agencies increasingly began to favor programs that had undergone a randomized controlled trial and/or demonstrated sustainable, long-term effects. Numerous web-based directories were subsequently established to help local and national funding agencies identify programs with strong evaluation evidence. These directories included Blueprints for Violence Prevention, the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Effective Prevention Programs (NREPP) and the What Works Clearinghouse (sponsored by the US Department of Education). These directories were informed by a growing consensus of what constituted evidence of effectiveness,² as a well as promising long-term findings from several parenting programs developed in the 1960s and 70s.

Central to these findings we...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Dedication
• Contents
• List of boxes
• List of figures
• List of tables
• Acknowledgments
• Preface
• Foreword
• 1. Introduction
• 2. Understanding the Evidence Base
• 3. Evidence-Based Theories of Parenting
• 4. Evidence-Based Therapies used in Parenting Interventions
• 5. Practitioner Expertise: Understanding how to Deliver Evidence-Based Parenting Support
• 6. Developing and Monitoring Evidence-Based Parenting Services
• 7. Evidence-Based Commissioning and Implemention of Parenting Support for Community Change
• 8. Moving the Agenda Forward
• Acronyms
• Glossary
• References
• Author index
• Subject index