Evidence Based Parenting Intervention Programme - Dissertation Example

 Evidence Based Parenting Intervention Programme Introduction Every child born irrespective of its caste, creed or ethnicity has the right and also the potential to become a full fledged, physically and emotionally healthy adult capable of making positive contributions to the society. However, many children all over the world are born into poor and backward families which are unable to provide them with even the basic necessities. Findings of neuroscience and behavioural research indicate that most of the brain development happens during the age of 0 to 5 years and decreases sharply with age subsequently (Centre on the Developing Child). Lack of proper care during this critical phase can permanently extinguish the latent potential within the child. Even in developed countries, there is a need for parents to be given training to help them to identify and correct deficiencies in their children so that their full potential can be realised. As the early childhood marks a period of both ‘vulnerability and opportunity’, parents must stimulate and reinforce the developmental forces and curb the negative influences (WHO, Early child development). Hearing, vision, language and higher cognitive skills develop during the child’s interaction with others in the family, neighbourhood and care giver groups. Primarily, home is the starting place for positive learning experiences and behaviour formation through supportive relationships. However, this process can also be supplemented by utilising various outside services whose effectiveness has been established by evidence. The ultimate aim is the healthy development of the babies’ brain which requires stable, caring, interactive relationships with adults whenever and wherever it can be provided (Centre on the Developing Child). Money spent for early child development is not an expense but an investment which has the potential to realise 4 to 5 times the investment in terms of enhanced human potential (Unicef). Studies also indicate that individuals exposed to quality preschool programmes earned up to $ 2000 more per month and are more likely to own homes and more successful marriages (National Education Association, USA). Realising the need for early child development initiatives, many world organisations have come up with packages, especially aimed at developing and under developed countries. Care for Child Development (CCD) package, a joint initiative of UNICEF and WHO is an example (Unicef). Critical Evaluation It is a fact that many parents, even in developed countries are unable to provide proper parental care to their children due to many reasons. Poverty, long hours of work away from home, tensions and disappointments wear them out. Then there are specific problems of coping with disabilities and behavioural problems. In the modern context most parents do not have the knowledge and skills required for good parenting. Instances of violence at home and drug and alcohol abuse are also not uncommon. Taking into account the growing need for professional help in this matter, Governments in developed countries have formed exclusive departments in their health services to address the issues. Many professional organisations have also come up with evidence-based parenting programmes, which use well researched techniques proven to be effective. Tailor-made interventions for specific requirements are also available. United Nations Office on Drugs and Crime has published a compilation of Evidence-Based Family Skills Training Programmes. Triple P, The Incredible Years, Strengthening Families, Staying Connected with Your Teen, DARE to be You are some of the programmes discussed. “UNODC strongly recommends practitioners, clinicians and others working in the area to use of prevention to use evidence-based programmes rather than start developing their own from scratch”(UNODC, p. 3). Triple P-Positive Parenting Program is an evidence-based parenting program which has become very popular and has presence in more than 25 countries across the world (Triple P). According to Prinz ( Webinar, June5, 2013), evidence-based parenting interventions are intended to minimize emotional, mental and behavioural problems in early childhood and enable smooth school entry. It also aims at reducing incidents of child maltreatment, learning difficulties at school, teen substance abuse and teen parenthood. The following work is an attempt to critically evaluate the program and to establish the rationale for early intervention to promote child health and development. Triple P Model is based upon social learning theory proposed by Albert Bandura. According to him most of the learning happens through direct observation. Children observe and imitate behaviour. Model chosen may be a live model or a fictitious character (symbolic model) in a movie or TV programme. Modelling may also be based on oral description of desirable behaviour. There is also constant reciprocal interaction between the environment and the individual behaviour. Reinforcement in the form of reward or punishment encourages or discourages repetitive behavioural patterns (McLeod, 2011). Reinforcement can also be internal; a good feeling after performing an act. It is common for children to model upon characters that they identify with. Bandura (1971) also discusses the four stages in the modelling process; attention, retention, reproduction and motivation. The child’s full attention is required for properly learning the behaviour from the model. The newly learned behaviour has to be retained in memory and reproduced in the proper social context. Motivation in the form of internal or external reinforcement will ensure repeated exhibition of the desired behaviour. Self- regulation motivates a person to choose actions based on his own ideas of appropriateness. Confidence about one’s own capability to behave in a certain way can also be a motivation (Index of /oll/mobile/theory_workbook). The knowledge that the emotional and physical health of an individual and thereby his usefulness to the society are largely decided by the environment and the influences he is subjected to in his early childhood days, clearly informs the need for early parental interventions. Research studies also indicate that children who have received assistance in their early childhood are more successful at school, have less behavioural problems and later, as adults, have better employment, higher earnings, and show lesser dependence on support systems. The Triple P model draws largely from the model of social learning and builds upon the theory that it is possible to provide favourable learning environment consciously and to encourage positive behavioural patterns by proper reinforcements. The Triple P model specifically teaches parents positive child management skills as an alternative to coercive, inadequate or ineffective parenting practices. The model has broadly five levels of intervention ranging from low intensity media based parent information campaign at level 1 to high intensity behavioural family intervention at level 5 (Sanders et al, 2003). The modules are flexible and problem-specific. The degree of involvement by professional practitioners also depends on the intensity of the problem. Parents can choose the minimum level of interventions required for the specific problem and obtain cost-effective solutions. Another positive aspect of the programme is that its general principles are conveyed to nurses, doctors, health practitioners and such others with whom parents normally interact and seek guidance. This ensures that the benefits of the program are availed by a much wider population, without their having to enrol for the training sessions. The programme aims to equip the parents with proven parenting methods so that they can become self sufficient and do away with continued dependence on professional assistance. According to the parenting programme evaluation tool suggested by Children’s Workforce Development Council, UK, the following are the key elements of a good quality parenting programme. 1. The target population and the explicit processes to ensure recruitment and participation of the appropriate families are clearly specified. 2. The content of the programme and the methods of delivery are in accordance with sound theoretical base. 3. The procedures for training, supervision and implementation are easily adaptable to new settings. 4. Concrete evidence base is available to show that the programme results in substantial and long-lasting gains for the parents and their children (Source: Children’s Workforce Development Council). Examined in the light of this checklist, it can be seen Triple P has designed programmes for specific target groups and these are unambiguously declared in their prospectus. The identification and recruitment of the target population is also addressed satisfactorily. The content is based on social learning theory and various research data in behavioural patterns accumulated over many years. The flexible and tailor-made methods are amenable for implementation in any new setting. Triple P has designed its programme based on substantial evidence. It has also designed its own continuous evaluation methods and the evidence base is further strengthened by the findings. However, these programmes are designed for a population following western culture or variations of it. Majority of the evidence base is also built up in the western cultural setting. “Parent training, and the conceptual models upon which it is based, were developed with intact, middle-class families of European American descent” (Hoghughi M.S. et al, page 264).It is a fact that the other half of the world follows a culture and value system very much different. In the Eastern culture, the family structure and the economic and emotional interdependence among the members of the family leads to a much stronger bond and many of the social customs and traditions are obeyed implicitly. The interventions required are of a different kind in this setting. Therefore, Triple P has to rework its programmes to suit the requirements of Eastern countries like India, China and Japan. A comprehensive listing of Triple P’s evidence base can be found on the website of the University of Queensland wherein research data from 1977 onwards can be found (The University of Queensland). Some of these papers are case studies which prove the efficacy of specific Triple P programmes. Triple P claims that its evidence base “comprises more than 250 published papers including 8 meta-analyses, 68 randomised clinical trials, 51 effectiveness and service-based evaluations, and 13 single-case studies” (Triple P). A safe and engaging environment as envisaged in the Triple P program creates an atmosphere best suited for learning basic skills and performing well in all spheres of activity. Children also have opportunities for identifying and developing their unique skills. Parents’ role as first teachers requires them to equip themselves with sufficient knowledge base and in the process of acquiring it they enhance their own qualities and self-esteem. Knowledgeable parents command more respect and compliance from their children. Doing away with shouting, threatening and physical punishments promotes harmonious relationships and better conformance to rules. Stress levels of the parents are reduced considerably and the on the whole, the family becomes healthier. Realistic expectations and achievement targets which are consistent with the capabilities and aspirations of the children have much better chances of being realised. Disappointments and loss of self-esteem on account of failures are avoided. The emphasis on developing self-care, resourcefulness and wellbeing in the Triple P programme has positive implications for the parents as individual human beings and also improves their capacity to cope with anger, anxiety and depression in family and social settings. According to Davis (2011), conventional childcare sought to re-programme children and parents, recognizing their inappropriate behaviour, based on moralistic concepts. It failed to view behavioural formation in the context of family and society as whole units. Essentially it was a deficit-based approach. Triple P is essentially a strength-based parenting programme. It concentrates on early preventive mechanisms and equips the parents to do their parenting job professionally, so that deficiencies do not arise. Deficiencies, disabilities and behavioural problems that do exist are viewed in the proper family and social context and solutions are offered to eliminate the underlying causes. Deficit-based programmes label children as bad or defective and this aggravates the problem rather than solve it. The methods involve isolation of the wrong-doer and award of exemplary punishment, in the belief that others will be deterred by seeing the possibility of the undesirable consequences. Instilling fear of punishment is a primitive way of disciplining, which may lead to resentment and revolt. Zero-tolerance policy approach in schools towards bullying “may result in a high level of suspensions without full comprehension of how behaviour needs to and can be changed. It does not solve the problem of the bully, who typically spends more unsupervised time in the home or community if suspended or expelled” (Centre for Child Wellbeing, 2011). Deficit-based programmes tend to condemn the individual as well as the act and create a sense of hopelessness. In contrast, the essence of a strength-based programme is in highlighting the positive outcomes of good behaviour coupled with the prospect that the instance of bad behaviour will be forgiven and forgotten. Though there is a vast amount of research data and statistics extolling the virtues of the Triple P programme, one cannot accept it as a panacea for all behavioural problems. Triple P has enjoyed a privileged status right from the beginning, from the governmental and social agencies and much of the evidence base generated are through research sponsored by Triple P or its associates. Many of the principles it advocates are part of the knowledge base of health and medical services. It is primarily because of the absence of proactive interventions from the government agencies, that Triple P could assume the status of a mass intervention. A study group led by Prof Philip Wilson, Visiting Professor at the University of Glasgow has given a negative report on the effectiveness of the programme in Glasgow (University of Glasgow). Some of the points mentioned in the report were lack of improvement in the emotional well being of a study group of 5 year old children, 50% dropout of families enrolling for Triple P programme and selective benefit for more privileged families, who are more likely to complete the programme. In this context Prof Wilson made a very relevant observation that the parenting support structure of Glasgow had matured and it is worthwhile strengthening it further, rather than depend on an external agency. This could be seen as a general suggestion to all government health delivery systems. Government initiatives and community driven programmes best suited for the local needs have more chances of acceptance and coverage. The cost implications are also less, as parenting interventions can be integrated with normal health and social service delivery channels. Like immunisation programmes, the entire population can be covered. Expert advice and professional help can be obtained for cases where specialised interventions are warranted. Discussion and Reflection Effectiveness of any family intervention programme largely depends on the first line practitioner who actually interacts with the family regularly. They have to function within the legal and ethical framework stipulated by law and professional bodies. The family worker has multiple responsibilities. He has to follow the rules set by his employer and also has to obey the law of the land. The key concern areas in direct practice of family work are summarised below: The family worker must satisfy himself that he has the requisite knowledge and skill to undertake the work for the particular client. If not, he should make a referral to a person who is likely to have the same. He should explain to the client, the nature and extent of the service offered. To the extent possible the client should be involved in the design of the service plan with due consideration and respect to his capabilities. The appropriateness of the intervention in relation to the client’s requirements, its compliance to legal and ethical requirements and its orientation to agreed outcomes has to be assessed. The family worker should be aware of client’s relationship with his social environment and make adjustments in the interventions, to the extent possible. He must maintain proper records complying with ethical principles and relevant legislation, paying special attention to privacy and freedom of information provisions. He must also make an accurate and objective report of the client’s circumstances. As part of multi disciplinary teams, he should be guided by social work values and principles and should acknowledge the practice base of other disciplines. He must seek advice and expert supervision when needed. When a referral is required or the service has to be terminated, he has to arrange for it and in case of interruption he has to arrange interim service or other alternate arrangements. The worker should keep the client informed of his right to query any and every aspect of the service and also of the procedures to do so. Lastly, he has to obtain feedback from the client to improve future delivery of service (Australian Association of Social Workers, 2003). A professional family worker has to provide support to families coping with different types of challenges like physical disability, behavioural problems, autism etc. It is imperative that he keeps himself informed of the support services available in his area for the different types of interventions required for specific problems. There are specific forums for addressing the rights of women and children. The police also have functional groups for exclusively addressing women’s problems. There are many voluntary social service groups for addressing specific issues. For autism and behavioural challenges also specific infrastructure and resources are allocated. For example Autism Speaks Inc. has separate tool kits for siblings, parents, grandparents and friends of autism children (Family Support Tool Kits). The professional practitioner must take active interest in setting up and upgrading infrastructure by providing feedback to the authorities in the light of his field experience. For effective delivery of service, he must first gain the trust of the client and his family. He must study the problem thoroughly and also assess how and to what extent the family is currently coping with it. He must instil confidence in them about his capability to help. He has to make a general assessment of the type and intensity of professional intervention required. If there is any knowledge gap, he must immediately enlist help from experts, rather than manage with available data. He has to closely monitor the progress of the client and immediately take appropriate action if desired results are not forthcoming. Whether the positive parenting program is a part of the local government initiative or offered by agencies like Triple P, it is important that the practitioner at the client level has the required skills to do his job and is supported by supervision at higher levels. The implementing agency has to closely monitor progress and apply corrections to optimise the end results envisaged by the programme. Interventions for difficult problems like challenging behaviour is best done under close supervision by an expert as any wrong step will be a setback causing considerable loss of time and effort. Supervision not only improves the quality of the delivery, but also enriches the professionals associated with the project with new knowledge and insight. Summary & Conclusion In summary, the social learning theory and the evidence of its operation in the formation of the behaviour of the child, clearly establishes the need for early child development. This means that the physical and emotional well being of the adult population a few years from now largely depends upon how well we care for today’s children. Evidence based parenting interventions are preferred as they have been proven through case studies and are more likely to succeed. Money spent for early parenting initiatives is an investment which will bring in manifold returns in the form of increased health and productivity of the adults. Government sponsored, community driven initiatives have better chances of acceptance by the citizens and more likely to achieve desired results. The parenting methods used must conform to the ethical and legal requirements. The social workers deployed for implementing the programmes at the family level should have adequate knowledge and training which must be updated constantly. A proper structure for monitoring and supervision should be in place. The official system must have the infrastructure to deal with multiple problems of disability, autism, and behavioural challenges. External agencies like Triple P can play supportive roles, where an inadequacy of the official system is felt. The competitive systems in the field of education and employment are skewed very much in favour of the privileged. The fortunate ones who get a head start early in life in terms of wealth or upbringing remain on top. The poor, who have lesser opportunities for good education and childhood care, carry the disadvantages throughout their life. The Government has the responsibility to ensure that good quality education is available to every child irrespective of economic status. Also it should ensure that child support systems easily accessible to the poor at little or no cost. More courses on child care and parenting strategies should be included in the curriculum to encourage young people to take up career in social work. A minimum level of knowledge about child care and coping strategies should be imparted to all citizens as part of increasing community knowledge base. Child abuse and ill treatment within and outside the family should be curbed by enacting most stringent laws. Buildings, roads, transport, pathways etc have all been designed for the healthy adult individual. We should seriously contemplate on designs which will be user friendly for children, old people and the disabled also, because they have the right to a world of ease and comfort as much as anybody else. References Australian Association of Social Workers (2003) Practice standards for social workers: Achieving outcomes. Available at: Phttps://www.aasw.asn.au/document/item/16 Autism Speaks (2014) Family Support Tool Kits Available at: http://www.autismspeaks.org/family-services/tool-kits/family-support-tool-kits Bandura A (1971) Social learning theory. US: General Learning Corporation. Available at: http://www.jku.at/org/content/e54521/e54528/e54529/e178059/Bandura_Social LearningTheory_ger.pdf Center on the Developing Child. Available at: http://developingchild.harvard.edu/index.php/resources/briefs/inbrief_series/ inbrief_the_science_of_ecd/ Centre for Child Wellbeing (2011) Strengths-Based versus Deficit-BasedApproaches. Available at: http://www.mtroyal.ca/cs/groups/public/documents/pdf/strengthsvsdeficitrb.pdf Children’s Workforce Development Council (2010) Parenting Programme Evaluation Tool. Available at http://www.arnec.net/ntuc/slot/u2323/e- scussion/11017_SP700310_PPET[1].pdf Davis JM (2011) From Deficit Models to Strength Based Approaches In Children’s Services. Available at: http://www.sociology.leeds.ac.uk/assets/files/research/deeps/john%20davis.pdf Hoghughi MS & Long N (Eds) (2004) Handbook of Parenting: Theory and Research for Practice, London: Sage. Index of /oll/mobile/theory workbook. Available at: http://www.southalabama.edu/oll/mobile/theory_workbook/social_learning_theory.htm#theory National Education Association. Early Childhood Education Available at: http://www.nea.org/home/18163.htm Prinz, R (June5, 2013). Webinar The Triple P System as a Prevention Strategy with Parents. Available at http://www.nasmhpd.org/docs/Webinars%20ppts/TripleP-Prinz%20Webinar%20June5-2013_1.pdf Tripple P. Official site. http://www.triplep.net/glo-en/home/ McLeod SA (2011) Bandura - Social Learning Theory. Available at: http://www.simplypsychology.org/bandura.html Sanders MR, Markie‐Dadds C & Karen MT (2003) Theoretical, Scientific and Clinical Foundations of the Triple P‐Positive Parenting Program: A Population Approach to the Promotion of Parenting Competence. The Parenting and Family Support Centre, The University of Queensland. Available at: Turner http://www30.triplep.net/cicms/assets/pdfs/pg1as100gr5so184.pdf University of Glasgow. Researchers call for withdrawal of investment in Glasgow's flagship parenting programme. Available at: http://www.gla.ac.uk/news/headline_375758_en.html University of Queensland. Welcome to the Triple P evidence-base Available at http://www.pfsc.uq.edu.au/research/evidence/ Unicef. Why Early Childhood Development? Available at: http://www.unicef.org/earlychildhood/index_40748.html 26 July 2013 Unicef. Care for Child Development Package. Available at: http://www.unicef.org/earlychildhood/index_68195.html UNODC. Compilation of Evidence –Based Family Skills Training Programme. Available at: https://www.unodc.org/documents/prevention/family-compilation.pdf WHO. Early child development. Available at: http://www.who.int/maternal_child_adolescent/topics/child/development/en/ Read More