• By Dartington SRU
  • Posted on Thursday 11th June, 2015

When 800,000 families can’t wait for clinical trials

More than three quarters of a million parents receive parent training through child welfare services in the US each year. The good news is that there are a handful of well-tested programmes for parents of young children. The bad news is that, given low budgets and a tradition of home-grown programmes, it’s not always practical for child welfare agencies to use them.

A new review suggests a way forward. Successful parent training programmes, the authors find, share several common components. Agencies that want to base their programmes on scientific evidence can incorporate these characteristics, even if they don’t have the funding or the infrastructure to adopt a manualised intervention.

Parenting programmes for child welfare aim to reduce child abuse and neglect, and decrease children’s disruptive behaviour, by changing parenting practices.

Well-tested parent training programmes have several components in common. These include a high level of professional qualification in the provider, live or video-based feedback to parents, homework between sessions, home-based or group options, and a duration of roughly 14 to 20 weeks.

The programmes also share a social learning approach. Therapists encourage parents to focus on positive reinforcement rather than punishment, and to anticipate and address triggers for problem behaviour. The training involves modeling and role-play of effective parenting techniques.

Generic parent-training programmes based on these characteristics would, the authors argue, be a practical way for agencies to “increase the proportion of their clients who receive evidence-informed parent training programmes.”

The researchers used the California Evidence-based Clearinghouse for Child Welfare (CEBC4CW) to identify well-tested parent training programmes for children from birth to eight years old.

The review was limited to the programmes rated well-supported or supported by CEBC4CW. A well-supported intervention must have undergone two randomised control trials that found positive effects after one year. A supported programme was subject to at least one randomised control trial where positive effects were found at least six months afterward.

Seven parenting programmes were identified: SelfCare, Child Parent Psychotherapy, Triple P Positive Parenting- Level 4, 1-2-3 Magic, Parent Child Interaction Therapy, The Incredible Years and the Parent Management Training Oregon Model.

The evidence base was weaker for younger children than for older ones. For children aged 0 to 3, there were no parent training models that had a rating of well-supported, although Triple P was rated as well-supported for children between birth and 12 years. SelfCare and Child-Parent Psychotherapy were identified as being supported by research evidence.

By contrast, there has been more research on parenting programmes for children aged 4 to 8. The Incredible Years, Parent-child Interaction Therapy, and Parent Management Training Oregon Model (PMT-O) were rated well-supported. 1-2-3 Magic was rated as supported.

Two raters coded each programme. They examined the components considered essential by each programme developer. A “common component” was one that occurred in at least two-thirds of the programmes.

All seven programmes required a bachelor’s degree or higher, generally with specific training in a relevant subject area. Most of the programmes incorporated feedback for parents on their progress, either live or by video. All but one required homework. Several had home-based, center-based, and group options. The large majority were 5 to 20 weeks long; about half were 14 to 20 weeks long, and met weekly.

Finally, they were almost all based on social learning theory, so shared similarities in their curricula.

Urged on by scientists and advocates, policy makers are increasingly using lists of evidence-based practices in their funding decisions. Should programmes that draw on well-proven scientific principles be included on these lists – even if the programmes themselves have not been tested in randomised trials?

Yes, the authors argue. While randomised trials continue to be valuable, practitioners can’t wait for each new test. “Waiting for additional clinical trials [for] generic parent training programmes… is the scientifically conservative course but not, in our view, the best for children and families.”

Rather, including generic, home-grown social learning-based parent training programmes among science-based practices is, they say, “well warranted.”

Barth, P.R., & Liggett-Creel, K. (2014). Common components of parenting programmemes for children birth to eight years of age involved with child welfare services. Children and Youth Services Review, 40, 6-12.

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