‘Wanting the best for my children.’

1. ‘Wanting the best for my children.’ Parenting programmes: improving outcomes for children with early behavioural problems Lorraine Khan, Lead for Children and Young People

2. The Centre’s research • Study of evidence-based parenting programmes • Parents access to programmes • Multi sector awareness of significance of early behavioural difficulties • Implementation effectiveness • National Survey • Detailed analysis of pathways/experiences in four areas • 159 interviews with practitioners stakeholders • 44 interviews with parents (attenders and non attenders). • Literature review

3. Why early starting behavioural problems matter • Behaviour is how children communicate distress, developmental difficulties or frustration • 5% of children (<11 years) have severe and persistent behavioural problems meeting threshold for mental health diagnosis • 15% have less severe (but still life-chance damaging) behavioural problems

4. These children face very poor outcomes • More likely to end up on child protection caseloads and in care • lower life expectancy • higher risk of school exclusion • Higher risk of suicide • Higher risk of teenage parenthood • Higher risk of drug dependency and smoking… • 20 times more likely to end up in prison Well implemented parenting programmes can help; BUT a minority of children get early help they need.

5. What parents told us • Most common criticism – poor knowledge of what helps and how to find support I’m a bit disappointed that it’s not more widely known about. (Mother, attender of parenting group). There was no information at all about courses. Nothing at my school or nothing on […] the borough website. It was very difficult to find information about courses like this. (Mother, attender of parenting group). It’s good, it’s just not widely known. […] When you go to baby groups and things I don’t think people really know about it, that’s my take. (Mother, attender of parenting group).

6. What parents told us about seeking help • Parents underestimated significance of early behavioural problems as gauge of child’s healthy development • Confusion: ‘naughty’ or in need of support? I actually thought he was just a generally naughty boy. • Stigma: parents felt they were ‘failing’ You think your kids a right terror and you think it’s because of you - the way you’re doing stuff • Confusion and stigma delayed help-seeking and increased family stress - crisis

7. What parents told us • Knowledgeable & motivational referrers using the right language were critical to supporting attendance • Schools – important gateways to support • GPs • Also Health Visitors, nursery staff, school nurses and social workers = important routes into programmes • Importance of word of mouth recommendation by other parents

8. What’s helps parents engage • Practical incentives are critical - crèches, transport, venue • Motivation • Additional outreach support for cautious/sceptical parents • Motivational interviewing approaches • Understanding what the programme feels like • Interactive, supportive, non patronising/judgemental • Problem solving • Skills-building important for fathers • Understanding parenting within community and cultural context important for BME – dedicated groups? • Success stories

9. What parents interviews revealed… • Parents with most complex needs waited longest for help…often over many years e.g. case example • Some evidence of: • Lack of join up between health, social and educational behavioural provision • Limited stepped system linking severity of need with appropriate care

10. Implications… • Programmes (and healthy child development) need better promotion • during pregnancy • 30 month checks and nursery contact • in GP/dentist surgeries • in schools – most popular source of info for parents • among those in contact with children in crisis or those working with higher risk parents • Word of mouth recommendation most powerful

11. Language and marketing - involve parents in campaigns • ‘Behaviour should fall within healthy developmental ranges to help children make progress in life’ • ‘Some children are more challenging to parent; simple techniques can make a real difference to your child’s behaviour, to their well being…and to your confidence.’ • Focus on strengths and benefits: ‘Get it right now and you improve your child’s chances in life - and your family’s quality of life’.

12. One system to improve mental health • Routine and systematic tracking of who needs additional support: • multi sector use of Strengths and Difficulties Questionnaire • Glasgow example • Market programmes to multi sector referrers • Sell bespoke benefits for partners’ outcomes • Skill up referrers • Coach in motivational language and brief intervention approaches

13. Engagement and fidelity • Track enrolment and drop-out rates – analyse and problem solve dips in performance • Don’t cut corners on practical incentives –it’s a false economy • Poorly skilled and supervised staff make children’s outcomes worse • Quality control is important – to guarantee results

14. Strategically • Develop simple referral process - single well-publicised gateway • Develop all-age integrated health, education, social care & justice pathway supporting children with behavioural problems • Needs Assessment: • Using SDQ data - compare existing provision with need • Close gap through local commissioning • Involve parents in strategic planning, campaigns and delivery

15. The costs • Children with early starting behavioural difficulties: • cost public purse ten times more by age 28 • savings disperse across range of budgets affecting schools, Looked After Children costs, child hospital admissions, other health and mostly ‘anti social behaviour’/crime. • Beneficiaries from early intervention don’t fund parenting programmes • Need pooled funding mechanisms involving multi sector key beneficiaries from early intervention

16. Thank you lorraine.khan@centreformentalhealth.org.uk