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Thesis (M.A. (Social Work)) -- University of the North, 1996 / Refer to document

Background: Behaviour difficulties are one of the commonest problems for which parents seek professional advice. Behaviour difficulties in early childhood are associated with poorer educational and social outcomes in later life (Loeber & Dishion, 1983). The importance of early intervention and preventative work to support behaviour difficulties has been stressed in the literature and is a priority in the government’s strategy for promoting positive outcomes for children. It is now generally accepted that parenting programmes (PPs) are an effective mechanism for supporting children with behaviour difficulties. A review of the literature suggests that while there are numerous evaluations of PPs there is limited evidence of PPs that are successful outside of a clinic setting and even less evidence on particular aspects of PPs and how parents view them. Aims: The main aim of this research was to explore a community based PP (the Holding Hands Group Programme (HHGP)) in terms of both its outcomes and the perceptions of the parents involved. The aim of paper one was to investigate whether families who undergo the HHGP, notice any improvement in child behaviour, parental stress and parental confidence. A second aim was to compare the HHGP to the previously evaluated Holding Hands Individual Programme (HHIP). The aim of paper two was to examine the process elements of the Holding Hands Group Programme (HHGP), seeking new insights and a detailed descriptive portrayal of how parents experience the HHGP. Methods: The study utilised a pragmatic approach to evaluation, with mixed methods and differing methodologies. Paper 1 involved a fixed quasi-experimental design using a pre-test, post-test single group evaluation. Outcome data was gathered from 34 parental responses to a range of psychometric measures completed on each of three occasions. Paper 2 involved semi-structured interviews being carried out with 15 parents prior to, and on completion of, the HHGP. The interviews focused on parent’s experiences of the programme and what they liked/disliked. Results: Paper 1: At the start of the HHGP parents typically reported high levels of intensity of behaviour, behaviour that was a problem and stress levels. They also reported low levels of parental confidence. By the end of the HHGP parents reported significantly increased confidence and significantly reduced stress, intensity of behaviour and behaviour that was problem. These positive results were maintained beyond the end of the programme as indicated at follow-up meetings. The findings indicate that the HHGP was effective for all identified subgroups of the sample. These findings broadly mirror the findings of the evaluation of the HHIP, although results do show some significant differences between the HHIP and the HHGP. Paper 2: The interviews conducted with fifteen parents were analysed using a rigorous approach to thematic analysis to identify emerging themes. Six themes were identified from parental accounts: support, new knowledge, reconstructing, awareness, changes and interactions. Alongside these themes was a practical element about ‘what worked’. Prior to the HHGP parents gave detailed descriptions about the difficulties that they were experiencing with their child, were able to identify what they wanted to achieve through the group and seemed able to predict what might be useful to them. After the sessions parents discussed what they had gained from taking part and were able to give suggestions for what had caused any changes. Extensions and Implications: On methodological grounds it would be desirable to undertake further work with either a control group, or baseline wait list. A further extension would be to use a longer follow up period or to contact the current participants to see how this cohort is coping when they start school. This study relied on self report data, therefore future work could consider the use of videoing interactions. It would also be useful to extend the interview process to include the follow up period. The results of this study imply that PPs can be delivered effectively to groups in non-clinic settings, and this suggests a route to more cost-effective delivery of PPs. However, as the results indicate that the HHGP was not successful for all, it reminds us that practitioners need to be vigilant in attempting to identify those families that are not helped and flexible in trying to assist them in other ways - perhaps via booster sessions or through the use of self-guided written materials.

Background: Children living in low- and middle-income countries (LMICs) experience alarmingly high rates of maltreatment, frequently at the hands of caregivers. Group-based parenting programmes show promise for reducing and preventing child maltreatment, as well as for improving positive parenting, child behaviour problems, and caregiver mental health. However, parenting programmes can only benefit families if caregivers participate in them. Using secondary data, this study thus aimed to 1) identify factors that affect attendance and 2) investigate the impact of attendance on outcomes within two randomised controlled trials of Parenting for Lifelong Health (PLH) for Young Children for caregivers of children aged 2-9 years in Thailand (N = 120) and 2-6 years in the Philippines (N = 120). The interventions were delivered within existing service delivery systems in both countries, over eight weekly sessions (Thailand) or 12 sessions every second week (Philippines). Method: To address the first aim of this study, multivariable logistic regression models with robust sandwich estimators were used to examine family baseline characteristic as predictors of caregiver attendance in sessions. An exploratory approach was taken to test a range of factors that have previously been linked to attendance in parenting programmes, including economic and educational, social and health, parenting and child behaviour, and sociodemographic characteristics. To address the second aim, caregiver self-reports and observational assessments (Thailand only) from baseline, post-test, and follow-up were analysed using complier average causal effect (CACE) analyses to test the impact of attendance variability on the primary outcomes of child maltreatment, as well as secondary outcomes of positive parenting, dysfunctional parenting, child behaviour problems, and caregiver mental health. Results: Caregivers in Thailand attended 82.3% of sessions while those in the Philippines attended 61.8%. Overall, few baseline factors were significantly associated with attendance. In Thailand, caregivers who were less educated and those who were older were significantly more likely to attend sessions. In the Philippines, caregivers who were less healthy, those that who used more emotional abuse, and those who had boys rather than girls were significantly more likely to attend. Notably, caregivers who experienced higher rates of intimate partner violence significantly attended 8% fewer sessions in the Philippines. A comparison of CACE estimates to intention-to-treat estimates at post-test and at follow-up showed greater benefits of the intervention amongst caregivers who attended more sessions. Specifically, the strongest intervention effects were found for caregivers who attended at least 75% of the programme. Conclusion: This study showed no evidence that disadvantages related to lower socio-economic status were associated with attendance, suggesting that it is possible for vulnerable families in LMICs to attend parenting programmes. However, developing retention strategies that target subgroups who are at greater risk of missing sessions is especially important as higher attendance at sessions is positively related to greater improvements in caregiver and child outcomes.

Background: Conduct problems (CPs), a persistent pattern of challenging, oppositional, defiant or aggressive behaviour are a significant concern to educators, families and other professionals. CPs in preschool children are related to poorer educational and social outcomes in addition to a range of behavioural and emotional difficulties. Although there is evidence for hereditary and temperamental influences, parental factors are widely considered to be significant in the development of CPs. Parents experiencing psychological or social distress are considered to be at risk for challenging behaviour in their children. Psychologists and other theorists have suggested several possible reasons for this association. Firstly, it is possible that parents in distress have difficulty managing stress and as a result use harsh, inconsistent or coercive approaches to parenting. Secondly, parents with children who have CPs may be low in parental self efficacy, a consistent belief in their capacity to parent, which leads them to parent ineffectively and inconsistently. A third possibility is that parents in distress struggle to form stable attachments with their children which can lead to later behavioural difficulties. Finally, it is possible that parent’s distress is influenced by external contextual factors which also influence children such as family or social conflict. Studies suggest that training programmes for the parents of preschool children are effective in reducing child behaviour problems. Training approaches are influenced by a combination of psychological theories including behaviourist, social-cognitive, attachment and ecosystemic approaches. There have been many quantitative evaluations supporting the use of parent training programmes (PTPs). However, there has been limited inquiry into the process of PTPs from the perspective of those who attend them. Aims: The first part of this study was designed to evaluate vulnerability factors related to conduct problems; parental self efficacy, stress and child behaviour problems over the course of a community parent training programme designed to help participants to understand and manage the behaviour of young children. The overall research aim was to evaluate the outcomes and process, using different methodologies to address several questions. A realist methodology was applied to evaluating: 1. was there an association between parental stress, parental self efficacy and child behaviour problems at the start of the programme consistent with the established theory? 2. Did the parents attending the course experience higher than expected levels of stress and child behaviour problems? 3. Did quantitative and qualitative data indicate that these vulnerability factors changed over the duration of the course? Finally, an interpretivist methodology was used to explore how parents of young children evaluated as at risk of challenging behaviour described the experience of learning in the programme. Methods: The study utilised a pragmatic approach to evaluation with mixed methods and differing methodologies. At the start of the programme, a cohort of 38 parents agreed to participate in the study prior to the programme and completed self report measures related to parental stress and parental self efficacy. Parents with concerns about the behaviour of a child aged over three also completed a questionnaire relating to child behaviour problems. Of the original cohort, 27 completed self report measures at the end of the programme. 17 parents completed the same measures at a follow up meeting at the Children’s Centre, five to six weeks after the programme was completed. At this meeting 16 parents were interviewed to discuss their experience of the programme and any subsequent changes which had occurred. Results The results of the first part of the evaluation suggested a significant relationship between parental self-efficacy and stress and between stress and child behaviour problems. However, there was no statistical association between self-efficacy and child behaviour problems, as expected. This tentatively indicates that parental self-efficacy is less important in the development of child behaviour problems than has been previously suggested. The analysis of stress data at the start of the programme indicated that the frequency of parents reporting moderate to extremely severe stress was 4.42 times that which would be expected in a typical British cohort. At the start of the programme, frequency of child behaviour problems in the cohort were 5.9 times higher with conduct problems being 9 times what would be expected based on British norms. This suggests that the programme is being accessed by parents whose children are evidencing behaviour problems and, in particular, conduct problems. However, methodological issues are likely to have led to a slight overestimate of relative prevalence of child CPs in the cohort. Results indicated that parents reported significantly increased self efficacy, significantly reduced stress and child behaviour problems, including conduct problems, between the start and end of the programme. Thematic analysis and subsequent content analysis of outcome themes from interviews suggested that the majority of parents interviewed identified changes in parenting behaviour, knowledge, confidence, reduced stress and improved child behaviour as outcomes from the programme. However, changes in the quantitative data were not observed as frequently, reliably or to the same extent in the interview subgroup as they were in the main cohort, suggesting a sampling bias or a discrepancy in findings between methods. The self report data and interviews for all interviewees were then reviewed and interviews with six parents evaluated as having moderate to high stress, social or psychological difficulties and possible child behaviour problems were sampled. These were then re-analysed using a rigorous inductive approach to Thematic Analysis to identify emergent themes relating to the experience of participating and learning through the programme. Six themes emerged from analysis including; Understanding Difficulties, Identifying and Connecting, New Knowledge, Stopping and Thinking, Approach and Interaction and Reconstructing. The Understanding Difficulties theme described the different ways in which parents understood of their difficulties relating to themselves, their children and others which motivated them to attend the programme. The Identifying and Connecting theme described the importance to parents of personal identification with several aspects of the programme in terms of “being understood” in addition to identifying connections with established support, learning objectives and personal development goals. New Knowledge was categorised into three sub-themes of theoretical, practical and contextual. Contextual knowledge was constructed as understanding the experience of other parents, for example, identifying that other parents had similar difficulties. Theoretical knowledge about child behaviour and development encouraged parents to “stop and think” about the reasons for their children’s behaviour. Practical knowledge was constructed as parenting strategies which, when used, helped parents to feel more confident in themselves, more relaxed and more in control. The Stopping and Thinking theme described parents withholding action and considering the motivations for their children’s behaviour or the best approach to interacting with them. Approach and Interaction described changes to the way parents interacted with their children. The parents in question described changed or reconstructed understandings of their children, themselves and their difficulties as a result of participating in the programme. The theoretical implications of analysing the learning experience are that it highlights the importance of personal identification with the course objectives and experience.

Intensifying interventions to improve the quality of care that children receive from parents/ primary caregivers is mandated by several strategic objectives, such as the National Plan of Action for Children 2012-2017 (South Africa 2012), the White Paper on Families in South Africa (2013), and the Children’s Amendment Act 41 of 2007 (South Africa 2007). Parenting programmes remain popular parenting interventions (Daly, Bray, Bruckauf, Byrne, Margaria, Pecnik & Samms-Vaughan 2015:18; Richter & Naicker 2013:9) reporting outcomes of enhanced parent-child relationships, improved behaviour of children, and reduced parental stress. There is a concern that parenting programmes offered in South Africa lack evidence of their efficacy (Wessels 2012:9) and cultural and contextual relevance for the recipients (Begle, Lopez, Cappa, Dumas & de Arellano 2012:56; Richter & Naicker 2013:1). The study developed a locally specific parenting support intervention for parents/ primary caregivers living in the low-cost housing development of Welbedacht East using the Intervention Development Design model. Parents/ primary caregivers were involved throughout the study, contributing to the intervention’s applicability, as well as its contextual and cultural relevance. Bioecological and social inclusion theories framed the study. A qualitative research approach supported by an exploratory, descriptive and contextual design was used. Two purposive samples (parents/ primary caregivers and community champions) were recruited. Semi-structured interviews were conducted to collect the data. Thematic analysis (Braun & Clarke 2006) produced the findings that were presented at a consultation workshop attended by research participants and relevant stakeholders where the parameters of the intervention were determined. These were subsequently developed into the elements and intervention protocols by four indigenous community experts following the Delphi process. Lincoln and Guba’s (1985) approach to trustworthiness as presented by Porter (2007:85) and Thomas and Magilvy (2011:152) was used. Cultural competence was maintained throughout and ethical considerations were observed to circumvent harm to participants and uphold the integrity of the research process. The perceptions of the parents/ primary caregivers were consistent with scholarly indicators of ‘good enough’ parenting, but the contextual stressors they experienced challenges their ability to fulfil some of these indicators. An intervention was needed to increase parental capacity to improve parent-child relationships, cultivate life skills for improved psychological health, and advance the financial independence of parents. It was concluded that a parenting programme on its own would fail to address the most pressing needs of parents/ primary caregivers living in disadvantaged circumstances and custom-made parenting support interventions were needed to increase parental capacity to manage the structural challenges that compromised parenting, such as socioeconomic interventions of a social developmental nature. / Social Work / D. Phil. (Social Work)