Empowering Parents, Empowering Communities The opportunity for A Better Start

Transcription

1 Empowering Parents, Empowering Communities The opportunity for A Better Start Dr Crispin Day South London and Maudsley NHS Foundation Trust, King s College, London, Institute of Psychiatry A Better Start Conference, Blackpool March 2nd, 2017

2 Centre for Parent and Child 1247 Support

3 Aims To briefly review peer-based approaches To describe the rationale for Empowering Parents, Empowering Communities (EPEC) To describe EPEC outcomes, parent experience and the central role of parent group leaders

4 Rationale for peer-to-peer support Peers with shared characteristics & common experiences may have greater credibility and influence Mutual identification & trust engendered by peers may boost engagement, improve support & accelerate change Peer support may be more cost effective & improve scope & scale of help available Peer supporters themselves may benefit from improved health & child development knowledge, confidence, community status, employment opprtunities Peer support may be underpinned by a positive moral purpose & be a vehicle for altruism & community connectedness (See Cupples et al, 2011, Solomon, 2004, Stolzenberg et al., 2011)

5 Peer-to-peer support: Evidence & impact Increasingly common feature across health, education & social care Big Lottery Fund outcomes Diet & Nutrition, more common, esp. breastfeeding support Fewer examples focussed on early communication & language and social & emotional development Methods range from Informal volunteer support Befriending Structured & intensive individual and group-based support Research evidence varies greatly in quality Can achieve high levels of family satisfaction Outcomes vary widely from little impact to at least the equivalent achieved by professional interventions (see Hoagwood et al., 2010, Jolly, 2012, Suppiah, 2008)

6 Peer support programmes: Working with local parents & communities Empowering Parents, Empowering Communities (EPEC): In UK and Australia, an early parenting intervention, a collaboration between King s College, London, South London & Maudsley NHS Foundation Trust Parents and Communities Together (PACT): in south London, a social support intervention and parent university, a collaboration between Citizen s UK and King s College, London emums: in South Australia, an online and social media platform for new mothers supported by child and family nurses, a collaboration between South Australia Child and Family Services and University of Adelaide

7 Empowering Parents Empowering Communities Innovative Evidence-based Effective Efficient Popular Low cost Award-winning International

8 1 in 10 children & young people

9 50% behavioural problems

10 Immediate harm to children s development, wellbeing, learning, achievement, family function and peer relationships Long term risk to adult mental health, employment, economic independence, family welfare & crime

11 10 times economic cost

12 The Good News.But Parenting programmes are an effective intervention (NICE, 2013) Families often do not get the help they need Families often don t get the help early enough to make a difference & reduce impact Scale of need far out weighs the service capacity available Complex referral pathways and stigma Innovation & transformation required to meet scale of family need, improve access to evidence based support and help families and children

13 Empowering parents, empowering communities: Aims To recruit, train and support local parents to lead parenting groups in their communities To improve parenting and child outcomes, family well-being, build social & community connectedness To use a universal, accessible approach to reduce barriers to participation from across communities and families. To improve the scale of effective parenting support, particularly for socially disadvantaged and excluded communities

14 Empowering parents, empowering communities: Three group programmes Being A Parent (2-11yrs) Living with Teenagers (11-16yrs) Our Baby & Us (0-1yr) Manualised programmes co-produced by parents & parenting practitioners Groups co-facilitated by two trained & accredited parents Eight 2hr sessions for between 8-12 parents Community location, children centres, schools, NGOs Universal access & on-site crèche Additional specialist programmes for higher need families in CAMHS and families living in homeless accommodation

15 Becoming an EPEC parent group leader Most parent group leaders have previously attended EPEC groups for their family s benefit EPEC peer facilitator training consists of 60hrs across 10 weekly workshops Parent group leaders learn to use one of the three manualised EPEC programme EPEC training they receive is accredited with UK Open College Network, equivalent to 18 NVQ credits Evaluation research shows that the EPEC facilitator training increases the parenting and group work skills, knowledge and confidence of our parent group leaders (Day et al, 2012a) After training, parent peer facilitators are paid for their group leader activity & continue to receive supervision and further training from EPEC

16 EPEC Group leader learning: Programme theory and methods Delivered using a structured manual based on attachment, social learning, relational, and cognitive behavioural theories and methods, Sessions involve sharing of information, group discussion, demonstration, role play, reflection, and planning/review of homework tasks.

17 EPEC Group leader tasks: Being a Parent programme Session 1: being a parent Good enough versus perfect parent Taking care of ourselves Session 2: feelings, communication, and culture Remembering what it was like to be a child Acknowledging, accepting, and expressing feelings Session 3: play and listening Non-directive play ( special time ) Practising listening Session 4: labels and praise Avoiding labels when describing behaviour Using descriptive praise to change behaviour Session 5: understanding children s behaviour Understanding children s behaviour in response to needs Discipline Session 6: setting boundaries Understanding boundaries Rewards Assertive versus aggressive behaviour Time out, challenging, and saying no Session 7: listening Session 8: review and coping with stress

18 So far we have Trained More than 250 peer facilitators in UK and Australia Wide range of ethnic and cultural backgrounds Peer facilitators have translated EPEC parenting programmes into African- French, Arabic, Chin Burmese & Vietnamese

19 So far EPEC has. Gone on to run over 250+ courses including more than parents with children in UK and Australia

20 EPEC access and acceptability: Who comes to the parenting groups? Two-thirds of parents attending groups come from the lowest 20% of the population based on disposable income, Only 10% are owner occupiers, 75% are unwaged, 40% are lone parents 75% of parents attending EPEC groups in London boroughs are from Black and Minority Ethnic backgrounds. 50% of participant parents have English as a second language. Very high levels of parent satisfaction

21 But does EPEC make a difference? Established programme, consistently effective (Early Intervention Foundation, 2016) Approved use as an evidence based programme (Australian Institute of Family Studies, 2015) Very efficient because of the high attendance and low dropout Very high level of attendance, 75-90% complete course Five outcome evaluations with excellent outcomes EPEC Randomised control trial (n=116, Day et al., 2012a) EPEC Quasi-experimental, uncontrolled trial (n=73, Day et al., 2012b) EPEC Feasibility pilot of Living with Teenagers (n=41, Michelson et al., 2014) EPEC BaP Pilot Homeless Families (n=15, Bradley, 2016) EPEC Quasi-experimental, uncontrolled trial, routine practice (n=109, Charalambides, 2015)

22 Results from EPEC RCT: Child Behavior Inventory (ECBI, Eyberg & Pincus, 1999) Children s behaviour problems improve Intervention Control 0 Before After Effect size=0.58 Day, Michelson, D., Thomson, S., et al. (2011). Child and Adolescent Mental Health Day, C., Michelson, D., Thomson, S., et al. (2012). British Medical Journal Michelson, D., Ben-Zion, et al. (2014).. Archives of Disease in Childhood.

23 Results from EPEC RCT: Parenting Scale (PS, Arnold et al., 1993) Parents parenting improves Intervention Control 2.5 Before After Effect size=0.85 Day, Michelson, D., Thomson, S., et al. (2011). Child and Adolescent Mental Health Day, C., Michelson, D., Thomson, S., et al. (2012). British Medical Journal Michelson, D., Ben-Zion, et al. (2014).. Archives of Disease in Childhood.

24 Results from EPEC RCT: Concerns About My Child (CAMC, Day et al., 2011) Parents achieve their parenting goals Intervention Control Before After Effect size=0.85 Day, Michelson, D., Thomson, S., et al. (2011). Child and Adolescent Mental Health Day, C., Michelson, D., Thomson, S., et al. (2012). British Medical Journal Michelson, D., Ben-Zion, et al. (2014).. Archives of Disease in Childhood.

25 Routine service evaluation Involving around 100 EPEC groups for approx parents delivered as part of routine services Maintain significant reductions in: child behaviour problems parenting parental concerns

26 Do not scream and shout at your kids. Do not label them. A lot of descriptive praise and understanding their feelings What do parents say about the Communicate better with my children; really listening; looking at them, no longer ignoring them; but really pay attention impact of EPEC... Giving rewards and stick to what you say when making clear boundaries Finding out that you re not the only parent experiencing difficulties and that there is solutions, support available.. This is a really great course, very practical and easy to use with your children.

27 Parent group leaders: At the heart of each EPEC group Group leaders bring personal qualities & skills, social class, cultural and ethnic identities Parent group leaders lead information sessions coffee mornings and 1-1 conversations Develop effective relationships with group participants Maintain fidelity to EPEC programme and personalise content for each group and each participant parent Parent facilitators' enthusiasm, openness and mutual identification with families seen by service users as critical to EPEC's impact and success. Thomson, S., Michelson, D. & Day, C. (2014)

28 EPEC course feedback: How effective are the parent group leaders? Parent rating of EPEC parent group leaders 70+ EPEC courses [n=793(%)] Not at all A Little Quite a lot A great deal Improves parent s understanding of positive parenting 5 (0.6) 57 (7.2) 285 (35.9) 446 (56.3) Helps to develop parent s positive parenting skills 10 (1.3) 59 (7.4) 317 (39.9) 408 (51.4) Improved parent s confidence in being an effective 8 (1.0) 67 (8.4) 338 (42.7) 379 (47.9) parent Parent will use learning from EPEC as a parent 5 (0.6) 50 (6.3) 291 (36.7) 448 (56.4) Competent EPEC parent group leaders 1 (0.1) 23 (2.9) 203 (25.7) 563 (71.3) Satisfaction with EPEC programme and group leaders 1 (0.1) 31 (3.9) 258 (32.5) 503 (63.5) Appropriate programme content covered by EPEC 0 (0.0) 49 (6.2) 244 (30.9) 497 (62.9) group leaders EPEC group leaders related effectively to parent 2 (0.2) 28 (3.6) 206 (26.2) 550 (70.0) participants EPEC group leaders motivated participant parents 1 (0.1) 23 (2.9) 190 (24.2) 572 (72.8)

29 D. and A.. are wonderful. They teach with care, understanding and support. They definitely know their stuff and have so much to offer other mums. K.. and S.. are great. Work great together and separate, learnt a lot from them. What do parents say about the parent group leaders.. Lovely trainers, very upbeat and used their experiences to illustrate strategies really well They really taught in an engaging way and made me enjoy the course more because of their way of delivery and their warm, patient personalities.. This is a really great course, very practical and easy to use with your children.

30 Parent peer facilitators: Research & practice "I enjoy seeing them bloom and change, I enjoy talking to the parents, learning from them" "It's given me confidence and a different way of life.. "I could rave about it all the time It should be more readily available. For me it's the best job ever.. it's money in my pocket and I love what I'm doing Strongly endorse value of EPEC programme manual, structured training and continuing supervision Wider personal gains such as social status/capital, new employment opportunities which reinforce parent facilitators' role commitment Emphasise the important value of a cohesive family identity among EPEC staff and service users. Thomson, S., Michelson, D. & Day, C. (2014)

31 EPEC sustainability, impact and success: A cold eye on a family that works Parent group leader recruitment & selection Previous EPEC course experience as a parent Standardised selection process, application form & interview Introductory group leader training Manualised, accredited, culture of support and succeeding Ongoing course quality & fidelity Manualised evidence-based content Facilitator matching, supervision & observation Research trials & routine outcome & quality evaluation Continuing EPEC group leader development Employment support & status Self-employed status, insurance, the forms!

32 Mutual Experience respect Admiration And a warm EPEC family heart Being valued Togetherness Shared belief Knowled Collective purpo Support Expertise

33 EPEC Success & Impact: Parents at the heart of effective support EPEC is a cost-effective, early intervention for parenting & early childhood difficulties Robust research base with strong evidence of effective outcomes Extensive experience of delivery & successful implementation