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

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