WHAT WORKS? A LITERATURE REVIEW OF THE EVIDENCE FOR THE EFFECTIVENESS OF PARENTING STRATEGIES

Prepared for Child and Youth Health

by Pam Linke in June 2001

Updated October 2004

CONTENTS

Introduction

Executive summary

Background

·  current context for parenting

·  risk and protective factors

·  cost of risk factors

Rationale for parenting programs

·  introduction

·  research

·  reports

Evaluated parenting programs

·  introduction

·  interventions that address risk and protective factors

·  elements of programs that work

·  cost effectiveness

Recommendations from the literature

Conclusion

References

Appendices

·  program examples

INTRODUCTION

This literature review has been undertaken to provide a basis for decision making about Child and Youth Health services to parents. Apart from a few exceptions, which have been noted in the text, it focuses on parenting interventions which have been rigorously evaluated and have shown benefits in positive outcomes for children. There are many other parenting programs which may also be effective, but have not met the standards of evaluation so have been omitted. Because this study was undertaken for Child and Youth Health purposes, it looks mainly at the health/socio-emotional aspects of parenting. This means that to a large extent early literacy programs per se are excluded, although it is acknowledged that there is evidence that these can have a positive impact on children's development and this offers opportunities for Child and Youth Health to link with the Department of Education, Training and Employment in partnerships to assist children’s development. Many of the programs for parents covered in the report do have a specific literacy component and all programs could be expected to have an impact on literacy through focus on communication.

Wider areas where support for parents and parenting could be important have not been considered in this paper because of the scope of the literature review. These could include, for example, areas such as family friendly work practices, family friendly communities, housing, child and family impact considerations on government and community policies and practices.

In spite of the clear evidence of the disadvantages of children in this group I was unable to find evaluations of successful programs for Aboriginal children.

EXECUTIVE SUMMARY

This report highlights the fact that there are cost effective programs which can bring about more positive outcomes for children who are at risk of social or emotional or mental problems which inhibit their living skills, contribution to the community and enjoyment of life both in childhood and ongoing into adulthood.

·  Risk factors have been well documented by considerable international and cross cultural research as have the factors which help to protect children against adverse outcomes. Most protective factors for children can be addressed through parenting.

·  The cost to the community of not addressing risk factors, particularly in the early years, is very large in relation to the cost of intervention, however expenditure is in the present and savings are in the future.

·  Parenting programs tend to have more cost benefits for the community when used with parents who have more risk factors than for the general community.

·  Current research into the development of the brain as well as current and past research into social, educational and mental outcomes for children highlights the importance of a positive and supportive early environment - the environment provided, usually, by parents.

·  Numerous national and international government reports support the importance of programs for parents, especially in the early years but also at transition or crisis points.

·  Programs that have been shown by rigorous evaluation to have potential to lead to positive outcomes for children include: home visiting by professionals, parent education groups, antenatal support and early childhood and parenting centres.

·  Other programs such as community development/social capital building have not been rigorously evaluated in the same way but may have contextual benefits in providing positive and supportive environments for families and children.

·  Social marketing can play a major role in community education and the raising of community literacy about parenting and outcomes for children.

·  Elements that contribute to programs that work include careful design and program planning and staff with both appropriate qualifications and personal skills.

·  Programs such as home visiting, alone, are not as likely to be successful as interventions which involve a raft of different options and resources for families, eg selected services for particular needs within universal services.

·  A number of recommendations from this literature review have been highlighted in the recommendations section of the report and offer considerable possibilities for effective support for parents and children in South Australia.

BACKGROUND

Glad to have you aboard……

For the next 18 years you will

be personally responsible for the

care and well-being of another

human being. You're on your own

Good Luck!

Popkin, 1986.

Current context for parenting

We live in an era and a culture where we know more about parenting and what works for children than ever before, so there are huge windows of opportunity to make a real difference. While it is clear that conditions for children have improved in many ways over the past century there are still too many children who are not getting the start they need to make the most of their lives.

There is probably more pressure on parenting than ever before. While the evidence presented daily in the media about the importance of parents to outcomes for children can be helpful, it also can be seen by parents as an added responsibility and pressure and even, sometimes, blame. In spite of rhetoric about the importance of "the village" to raise children, child rearing is largely seen in our community as a private responsibility of parents unless it goes seriously wrong.

In all other parts of home management, technology has reduced the workload. In parenting the opposite effect has been observed especially where both parents work outside the home, so the time for the complex roles of parenting has been eroded. At the same time many of the traditional structures to support parenting are also being eroded - structures like clear marriage expectations and parenting roles, and support networks such as families, extended families, communities and villages. While many of these changes offer new opportunities to parents - employment all over the world, opportunities to leave dysfunctional relationships and much more choice for women, adequate new supports for the parenting function of adults have often not been put into place.

In South Australia in 1998 18% of children lived in a family with neither parent employed, and more than 25% in families where no male was employed. The number of sole parent families in South Australia is growing, including sole parent families where the head of the family is unemployed. In the 1996 census 45.6% of all children in Adelaide were living in families receiving income support. The South Australian Child Health Council (1999) noted that "increasing numbers of children in South Australia face socioeconomic and other forms of disadvantage, resulting in significant adverse effects on their health and well-being…particularly in the case of many indigenous children."

As a society we give lip service to the value of children, but services and resources have not followed the rhetoric, especially for young children. There is an assumption that flies in the face of consistent evidence that young children are "resilient" so that what they require for optimum development can be easily overlooked. [The concept of resilience is discussed later].

Programs for parents are still largely focused on treatment. In Western societies, where parenting is considered a private rather than community responsibility, this can lead to difficulties in parents asking for and accepting help. This is exacerbated by increasing knowledge about child development and higher expectations of parents, both personal and from the community.

Some of the current issues for parents and parenting as identified by parents include:

·  poverty

·  family break-up; including residence and access issues after separation

·  isolation

·  living and working away from family supports

·  step family parenting

·  isolation of parents from their cultures of child rearing

·  community values and confusion about the importance of childrearing

·  quality of out of home care for young children.(Hogg et al, 2000)

Note: in parts of this report the term early intervention is used. In the context of the paper this implies early intervention with parenting. The term mental health as used in this report indicates the literal meaning of mental and emotional well-being, not as is often inferred, mental illness.

Risk and protective factors

Resilience

In discussing programs for parents and children it is important to view them in relation to the risk factors they are intended to address, and the protective factors they are working to develop. Often these factors are seen in the context of the development of resilience in children. Resilience may be defined as the ability to cope with the challenges of growing up and living in the adult world without major disruptions such as criminal convictions or mental illness. Resilience is always defined in relation to risk factors - usually risk for mental illness, criminality or drug dependence. [Resilience is never absolute, and studies of adults who have coped in the presence of risk factors have shown that there are still some damaging effects from the risk factors, albeit not major life-disruptive ones (Werner, 1992)]. There is always an imperative to try to remove the risk factors where possible as well as to develop protective factors.

Risk and protective factors have been the subject of much research over many years and results are remarkably consistent over time and culture (Linke, 1998). Protective factors can be classified into three main areas, factors in the child eg temperament, factors in the family eg positive attachment in the first year and factors in the environment eg a supportive relationship with a school.

Exactly how the protective factors work is not clear from the research but accumulated risks lessens the possibility of children developing resilience (or coping skills) while accumulated protective factors enhance this.

Risk factors

Some of the risk factors that are associated with juvenile delinquency and antisocial behaviour in adolescence and adulthood include harsh or abusive discipline, parent offending, being a victim of child abuse, need for special education, a family death or family break-up and anti-social behaviour at a young age (Walker et al, 1998). Factors that relate to the family and are therefore potentially amenable to parenting interventions include harsh discipline, weak parental supervision, lack of positive discipline, lack of parent involvement with the child, poor problem solving and negative family communication (Patterson et al., 1992).

A recent report from the Australian Institute of Criminology (Bor, 2001) highlights the "predictable developmental trajectory of behaviour problems beginning in childhood" for antisocial behaviour in adolescence. They note that there is evidence of continuity between aggressive, non-compliant behaviours measure between one and three years of age and externalising behaviour problems at five years of age and a significant proportion of the children (up to 50%) will experience similar problems into adolescence.

Webster-Stratton (1997) notes that risk factors that lead to continuation of problems into adolescence include: beginning in the preschool years, problems in different settings eg home and school, frequency and intensity of antisocial behaviour, having many different antisocial behaviours and the presence of ADHD.

Risk factors for mental health problems and delinquency (Commonwealth of Aust. 2000) and delinquency include:

·  Prenatal brain damage

·  Low birthweight (6.8% of children in South Australia*)

·  Perinatal stress

·  Physical and Intellectual disability (7.8% of children in South Australia*)

·  Low intelligence

·  Difficult temperament

·  Having a teenage mother

·  Having a single parent (70% of children in one parent families were in the lowest 40% of income distribution in 1996/7*)

·  Absence of the father in childhood

·  Large family size

·  Long parental unemployment

·  Mental illness in a parent

·  Parental alcoholism

·  Parental criminality

·  Poor quality care in the first year of life, if both parents are working outside the home

·  Major separations in the early years

·  Family break-up especially where there is parental conflict. (21% of Australian children with one natural parent living away from their home*)

*Children Australia: a social report (1999)

Risk factors are not necessarily causal and may be associations with other causal problems rather than causal in themselves. It is important to note that risk is not destiny and these factors are related to populations, not individuals.

Cost of risk factors

The cost to the community of the risk factors that parenting programs seek to address is considerable.

·  Over $2 billion is spent each year in Australia for mental health services (O'Hanlon, 2000). About 20% of people have some kind of mental health problem.

·  The economic cost of child abuse to South Australia in 1995/6 was estimated at $303.33 million.(McGurk, 1998)

·  The cost of the criminal justice system to the South Australian community per annum is approximately $300 per person ($450 million, pa.)

Appropriate early parenting interventions are associated with better outcomes for children and less demand on services for all of the above areas.

From “Crime in Australia – Law enforcement resources”. http://www.ncavac.gov.au/ncp/publications/crime/law_enforcement_resources.htm

Protective factors

Protective Factors (Linke, 1998) which mitigate against damaging outcomes from risk include

·  secure attachment

·  positive discipline

·  parental supervision (knowing where children are)

·  family support eg grandparent

·  a sense of achievement

·  being needed (required helpfulness)

·  external supports such as school

·  belonging to a supportive community group such as a church group

·  internal locus of control ( a sense of being able to impact on what happens to a person).

It should be noted that most of the protective factors are related to parenting and potentially can be impacted on by supporting parents.

RATIONALE FOR PARENTING PROGRAMS

If we do not attend to the needs of children "we risk paying a terrible price in our children's later behavior - drugs and anti social and violent acts…..our grandchildren will live together in a society with the offspring of neglected families. So will yours." (Brazelton, 2000)