1. Centre for Evidence Based Early Intervention
COPING Parent Programme: The Confident Parent Internet Guide: Strategies for all parents Evaluation of an online universal parenting programme: A pilot randomised controlled trial
Dawn Owen
3rd year PhD Student
Centre for Evidence Based Early Intervention

2. Background Parenting in the 21st century has become more demanding
Effects of divorce and relationship breakdown on children’s social competence (Amato, 2000)
Impact of work stress on parent-child interactions on child behaviour (Repetti & Wood, 1997)
Effects of maternal mental health on child behaviour (Elgar et al., 2004; Gao et al., 2007)
Negative impact of the growth in technology (e.g. smartphone and tablet use by children) on child behaviour and mental health (Palmer, 2006)
Could also briefly mention cyber bullying, effects of social media etc on child mental health
Exposure to more negativity i.e. news coverage

3. Importance of parenting
Good parenting is essential in the prevention of child mental health problems and the promotion of child health and well-being (Ulfsdotter et al., 2012).
Children learn new behaviours through direct experience or by observing the behaviour of others in their environment (Social Learning Theory: Bandura, 1977), and for young children, parents are their most important role models
Parenting plays a key role in the emergence and maintenance of problematic child behaviour (Furlong et al., 2012; Hutchings et al, 2007;
McMahon & Forehand, 2005)
Important to promote positive parenting even in the face of challenges!
Changing the behaviour of the parent is key in changing the behaviour of the child

4. Parenting programmes
Good evidence for parenting programmes that teach parents core social learning theory principles (Hutchings et al., 2007) and include relationship building, play, praise, reward and positive role modelling and non-violent discipline strategies (Furlong et al., 2012)
However, these programmes mostly target clinical levels of conduct problems (Hutchings et al., 2007), or target parents living in high risk areas (e.g. Flying Start areas)
Many parents not accessing support at all (Sanders, 2008)
Less evidence for universal parenting programmes (Ulfsdotter et al., 2014)
Many parents not accessing support, buy may need it for minor child problem behaviours.
As parents are now facing more challenges it is important to provide them with support and strategies on how to encourage positive child behaviour and strengthen relations.

5. Health visitors
Increased workload and difficulty in providing adequate support to all families (Wilson et al., 2008; Williams & Hutchings, 2017)
Services do not have the resources to provide universal programmes targeting health promotion and well-being to all parents (Lindberg et al., 2013).
An alternative mode of delivery is needed to ensure that all parents have access to evidence based advice. This could potentially reduce health service burden and avoid the low-level child behaviour problems that occur in many children from progressing to more challenging ones
Services overcome with demands, and so support not available to all.
If no support is provided, small problems may progress and end up being more of a burden on our services.

6. Role of technology Technology has the potential to reach more families
The internet allows access to evidence based advice for all parents without seeking referral from health care professionals
This could allow professionals more time and resources to target clinical (or identified at-risk) populations with individualised interventions
Potential to reduce cost burden
Opportunity to promote positive parenting strategies
Evidence for web-based interventions include weight loss, reducing alcohol consumption and some parenting ones too
Parents can access advice at home in their own time

7. COPING Parent universal programme
Trials conducted by Judy Hutchings and colleagues during the 1990s (Hutchings et al., 2002; Lane & Hutchings 2002; Hutchings, Lane & Kelly 2004) with parents and health visitors demonstrated good outcomes from parents being taught effective behavioural strategies
As part of these trials help sheets were provided and subsequently published as ‘The Little Parent Handbook’, (Hutchings, 2013)
This formed the basis of online universal programme

8. Outline of the programme
10 chapters
Parents complete one chapter each week
Each chapter focuses on different parenting skills
Log in and read through information
Watch video examples of positive parenting
Answer questions based on the videos and receive feedback
Complete multiple-choice quiz and receive feedback
Suggested activities and time given to practice the skills
8 content chapters and 2 revision chapters
Chapters include special time, praise, reward, instructions giving and language development
Video example short (30seconds – 1 minute)
Answer questions based on the video in an attempt to train parents to look out for the positive behaviour (observational skills)
Suggested activities include spend 10m playing with your child everyday and praise positive behaviour

9. Example page Optional audio button LifeGuide software used
All pages follow similar layout
Information presented in bullet point format and in small chunks
Key points highlighted in a different colour
Back and next buttons so that parents can go back to review previous points
Short videos to illustrate key parenting strategies
Instructions on how to make the videos full screen

10. Pilot randomised controlled trial
Recruitment methods: Word of mouth, health visitors, school nurses & recruitment posters distributed to local nurseries and primary schools
Inclusion criteria:
Parent/guardian of a child aged between 3-8 years
Good understanding of English
Access to internet on a PC, laptop, or tablet
HVs and school nurses approached parents on their caseloads
LifeGuide software does not yet support smartphones so parents unable to access the programme on their mobile

11. Procedure Recruited 56 parents of children aged 3-8 years
Randomised parents on a 2:1 ratio to either intervention (n=38) or 3-month wait-list control group (n=18)
Baseline visits conducted April – July 2016
3 month follow-up visits conducted July – December 2016
6 month follow-up visits for intervention group only conducted in December 2016, January & February 2017
Hvs/school nurses recruited 19 participants
Word of mouth also recruited 19 participants
Recruitment posters recruited 18 participants

12. Measures
Primary measure – researcher observed parent and child engaging in child-led play for 30 minutes. The play was coded using the DPICS coding system (Robinson & Eyberg, 1981). 20% of visits double coded.
Secondary measures – self-report questionnaires:
Eyberg Child Behaviour Inventory
Arnold O’Leary Parenting Scale
Parental Sense of Competence
General Health Questionnaire
Demographic information also collected
Direct observation was selected as the primary measures as direct observational methods provide a more precise account of behaviour defined by the researcher and not the parent
Discuss the DPICS coding categories

13. Results - Demographics
19 families (33.9%) were recruited by health visitors and school nurses, 21 (37.5%) by recruitment posters and 16 (28.6%) via other referral
The mean age of the children was 57.38months (SD=19.12) with over 70% boys
Over 80% of the sample were in employment and over 85% either married or in a relationship
Sixteen (28.6%) parents had previously attended a parenting course prior to completing baseline questionnaires
There were no significant differences between the intervention and control families in terms of demographic characteristics at baseline
Parenting course - (15 attended an ‘Incredible Years’ parenting group and 1 completed the ‘Enhancing Parenting Skills 2014 Programme’ with a health visitor).

14. Results – Behavioural Observation
Per-protocol analysis found a significant difference between intervention and control parents on the primary measure Parents in the intervention group demonstrated significantly less use of indirect commands and significantly more use of praise compared with control parents
Direct command: F (1,25) = 0.45, p=.507
Praise: F (1,25) = 5.56, p=.026 (*)
Indirect command: F (1,25) = 4,71, p=.040 (*)
Questions: F (1,25) = 2.10, p=.160
Negative Parenting: F (1,25) = 1.20, p= .282
Explain quickly why per-protocol
A lot of parents in the intervention condition not logging in at all
(*) significant

15. Results – Behavioural Observation
Pre and post scores for intervention and control conditions for praise and indirect command categories
Praise
Indirect Command
Discuss that the control group has improved also … but the main difference is the intervention group is praising more.
F (1,25) = 5.56, p=.026
F (1,25) = 4,71, p=.040

16. Results – Behavioural Observation
Intervention parents praising significantly more in comparison with control parents

17. Results – Secondary Measures
Over 40% of children scored above the cut-off on the ECBI intensity scale
Over 45% scored above the cut-off on the ECBI problem scale
Over 40% of parents scored above the clinical cut off on the General Health Questionnaire
Comparison of the scores for the Parenting Scale subscales with the mean clinical group scores from Arnold et al. (1993), showed that the sample was reporting problematic levels of parenting
No significant results found on any of the secondary measures
Mention that although this was a universal programme, children in the sample still scored highly on the ECBI and parents still displayed problematic levels of parenting.
Possible justification for the need of universal parenting programmes ?

18. Results – Secondary Measures
However, there was a reduction on both of the sub-scales of the Eyberg Child Behaviour Inventory for the intervention parents
Outcomes
Intervention
Control
Baseline
(n=38)
M (SD)
F-up
(n=25)
(n=18)
(n=11)
ECBI Intensity (131)
(30.20)
118.64
(31.01)
140.33
(29.70)
124.73
(33.39)
ECBI Problem (15)
13.11
(7.74)
9.20
(8.62)
13.06
(8.50)
13.36
(9.56)
Mention that although this was a universal programme, children in the sample still scored highly on the ECBI and parents still displayed problematic levels of parenting.
Possible justification for the need of universal parenting programmes ?

19. Results – Secondary Measures
Over 40% of children scored above the cut-off on the ECBI intensity scale
Over 45% scored above the cut-off on the ECBI problem scale
Over 40% of parents scored above the clinical cut off on the General Health Questionnaire
Comparison of the scores for the Parenting Scale subscales with the mean clinical group scores from Arnold et al. (1993), showed that the sample was reporting problematic levels of parenting
Interesting find that a relatively advantaged population reported significant levels of problems in terms of parenting, child behaviour and mental health …
Mention that although this was a universal programme, children in the sample still scored highly on the ECBI and parents still displayed problematic levels of parenting.
Possible justification for the need of universal parenting programmes ?

20. Strengths & Limitations
This was a randomised controlled trial with a wait-list control condition
The behavioural observations incorporated inter-rater reliability component
Data collectors remained blind to group allocation
Once randomised, intervention parents could start the online programme immediately thus reducing the amount of time spent waiting for the intervention
Programme was universal
Limitations:
Issues with the LifeGuide software
Parents not engaging with the programme weekly
Due to time and funding constraints only a small sample was recruited and was not based on a power calculation

21. Where to next?
School-based support staff project (Anwen Rhys Jones) The project is currently adapting this web-based programme in order to make it more relevant to school based support staff, particularly increasing the content associated with praise, teaching new behaviour and language development This project has the potential to contribute to improvements in the level of skills obtained by school based support staff by providing them with the positive behaviour change strategies, which could potentially improve child outcomes Please contact Anwen for more information on the school based programme
Introduce Anwen’s project and mention that she has a poster at the conference if anyone would like any more information to contact Anwen

22. Thank you very much
Any questions?