Parent Training Lit Review

What makes parent training groups effective

Parent Training Research Review

By Andy Gill (1998)

Introduction

The term "parent training" is extensively used in the literature but it is unfortunate that it potentially
conjures up an image of a way of working which is one-way, mechanistic and prescriptive. A more
accurate picture is one that is concerned with collaboration, partnership, assessing individual need and
valuing therapeutically parental strengths and experiences. On the positive side, the term accurately
depicts the educational aspects of parenting. Being a parent does not come naturally or "out of thin air!",
it involves a complex set of skills and like any other new skills, they need to be learnt and practised.
Such a view challenges societal myths and stereotypes which emphasise parental independence and
privacy linked to an image whereby parents (particularly mothers) instinctively know, without outside
interference, how to deal with such behaviours as non-compliance and temper tantrums.

At the centre of behavioural parent training programmes is an emphasis on teaching parents skills
which will enable them to change the antecedent events and consequences which are eliciting and
maintaining problematic child behaviour (Skinner, 1953). Increasingly, with the development of Social
Learning and Systems Theories, such contingency management techniques are being supplemented with
methods which take into account parental cognition and placing the child within a systemic context
(family and wider community). Hence there is definite movement towards a more holistic approach
characterised by a convergence of traditions. Advocates of such a move, point to the research base and
the need to draw out the most effective aspects of the behavioural and social learning tradition whilst
critics argue that the impact of cognition on behaviour is very difficult to objectively quantify, hence
should be viewed with great caution (Hudson and Macdonald, 1986).

In tandem with the above, is the shift towards wider adjunctive methods which attempt to resolve
family problems that research indicates might get in the way of parents being able to get the most out of
parent training. For certain multi-problem families, parent training on its own might not be enough
(McAuley, 1982).

An analysis of the effectiveness of parent training programmes is extremely promising (Kazdin,

1986). Significant short-term improvements have been achieved in parental and child behaviour and in
parental perception of child adjustment (Serketich and Dumas, 1996; Gill, 1993; 1990; 1989; Lawes,
1992; Mullin et al., 1990; Webster-Stratton, Kolpacoff and Hollinsworth, 1989; McMahon and

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Forehand, 1984; Webster-Stratton, 1984; 1981a,b; Patterson, 1975). Some limited evidence of long-term
gain; 1-3 years (Webster-Stratton, 1996) and 1-14 years (Long et al. 1994). Long (1994) and his
colleagues finding that the outcomes for conduct disordered children who’s parents received parent
training was comparable with non-disordered children, though the sample was small (26). Change has
been particularly maintained over time when the child's problem is not complicated by parent related
difficulties or social adversity (Sanders, 1992; Forehand and Long, 1988; Sanders and James, 1983).
Home observations have shown a 20-60% reduction in children’s aggression (Webster-Stratton, 1984;
Patterson, 1982). The risk of further physical abuse and/or neglect has been significantly decreased
(Wolf, 1993; Wekerle and Wolf, 1993). Behavioural improvements have been successfully generalised
from the clinic to the home and across other settings (Sanders and Plant, 1989; Sanders and James, 1983;
Patterson, 1982; Peed, Roberts and Forehand, 1977) and positively there has been an impact on children
in the family who have not been targets for change (Webster-Stratton,1982a; 1990b; Webster-Stratton,
Kolpacoff and Hollinsworth, 1989; Forehand et al., 1986; Arnold, Levine and Patterson, 1975). Such
improvements though do not necessarily extend from home to school and there is some evidence to
suggest that conduct and peer relationships difficulties in the classroom are unaffected by parent training
(Breiner and Forehand, 1982; Forehand et al., 1979). Overall, parent training programmes receive high
ratings in consumer satisfaction and practical support (Gill, Lane and Webb, 1995 (unpublished); Gill,
1993; 1990; 1989; Webster-Stratton, 1989b; Cross, Calver and McMahon, 1987; McMahon and
Forehand, 1984).

A review of 148 parent training studies (1975-1990) cast doubt on the methodological design of
many of the studies. For instance, 50% of the groupwork research did not use control groups or follow-
up data (Rogers and Margaret, 1992). A more recent review (Serketich and Dumas, 1996) of 117 studies
found that only 26 met the criteria (controlled studies) for inclusion in a meta-analysis. Significant
evidence was found for short-term gains but it is less clear whether these changes are maintained over
time and how outcomes compare to other therapeutic interventions. Such issues were similarly raised in
Barlow’s review (1997) and Kazdin (1997) states that though the results from parent training are very
encouraging this enthusiasm needs to be tempered by the need for further longitudinal data. Hence there
are grounds not to become complacent.

Parent Training Methods

1. Triadic Model

The "triadic model" (Tharp and Wetzel, 1969; Tharp, Wetzel and Thorne, 1968) is characterised
by the therapist ("consultant") and the parent(s) or carer(s) ("mediators") working together to conduct an
assessment and intervention programme within the child’s natural home environment. More often than
not the therapist will be working through the parents to bring about a change in the way they handle and
respond to the "target" child (Ross, 1972). Parents then act as "change agents" who are equipped with
the necessary skills to improve their child’s behaviour (Herbert, 1988; Bunyan, 1986; Herbert and

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O’Driscoll, 1978; Herbert and Iwaniec, 1979). Houghton (1991) reported a 78% reduction in children’s
aggressive behaviour using the triadic model. A recent review of this way of working, found that it was
more effective when consideration was given to parental well being and self esteem, family dynamics
and the social context of children’s behaviour (Blair, 1991).

Working within the child’s home setting where the behaviour problems normally occur and are
maintained, avoids some of the possible problems associated with working in a "false" clinic setting
where the behaviour might present very differently (Herbert and Iwaniec, 1981).

2. Individual Programmes

The most influential parent training programme was developed by Patterson, Reid and colleagues
at the Oregon Social Learning Centre (Patterson, 1982; Patterson, Reid, Jones and Conger, 1975).
Spanning over two decades of work and involving more than 2,000 families, the Centre has produced
some of the most powerful outcome research on conduct disordered children. Originally their parent
training programme was designed for parents of pre-adolescent children (3-12 years) and comprised of
the following elements:

• Reading teaching text and being tested on material

• Taught step-by-step child management skills whereby each newly learned skill forms the
basis for the next. The five core components:

1. Pinpointing and recording problematic child behaviours at home.

2. Using positive reinforcement techniques such as praise and points systems.

3. Applying discipline methods such as removal of privileges and "time-out".

4. Supervising and monitoring child behaviour.

5. Negotiating and problem-solving strategies and designing individual programmes.

The above programme typically involved 20 hours of direct contact with individual families and
would include home visits to encourage generalisation. More recently the programme has been modified
to address delinquent adolescent problems which include: greater emphasis on teenager involvement,
selecting target behaviours which place the adolescent at risk of offending and using such punishment
techniques as chores and restriction of free time. Results have been extremely encouraging (Patterson
and Forgatch, 1995; Webster-Stratton, 1991).

Hanf and King (1973) developed a parent training programme to address non-compliance in
young children, aged 3-8 years. Forehand and McMahon (1981) subsequently modified and evaluated

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the programme, with highly significant results. The content consists of a first phase where parents are
taught to play with their children in a non-directive way (child centred) and then how to identify and
reward prosocial behaviour through praise and attention. Phase two then moves on to ways of giving
instructions geared to reduce the possibility of a defiant response and punishing non-compliance by time-
out. Treatment occurs in a clinic setting with individual families rather than a group. The playroom is
equipped with a one-way mirror and the parents are coached and supported in their play and interactions
with their child through the use of a "bug-in-the-ear". Additionally role play is employed as another
medium in which skills can be practised. Progression from one skill to another is dependent on
competence.

3. Groupwork Programmes

Webster-Stratton (1984; 1982a,b; 1981a,b) developed and thoroughly evaluated a further

programme for parents of younger children (3-8 year olds) that has been extensively used in a
groupwork context. The University of Washington Parenting Clinic’s BASIC parenting programme
included elements of the training model started by Hanf and King (1973), and the "child-directed" play
of Forehand and McMahon (1981). Additionally it contained:

• Differential attention and the effective use of commands.

• Patterson’s (1982) discipline components of time-out, Logical and Natural consequences and
Monitoring.

• Parental problem-solving and communicating with children (linked to the work of: D’Zurilla
and Nezu, 1982; Spivak, Platt and Shure, 1976).

One of the main thrusts of the work was to create a programme which was durable, universal, cost-
effective, and sustaining but most importantly offered practical help in reducing child conduct problems.
The Clinic’s aim being to normalise the need for acquiring and learning child management skills and to
make the programme as socially acceptable and accessible as possible.

Using Bandura’s (1977) modelling theory the sessions rely on demonstrating parent-child
interactions through video vignettes. To increase the possibility of empathy and rapport the models come
from different class and cultural backgrounds and are placed in everyday situations. There are 10
videoed parenting skill areas which involve 250 vignettes that each last 1-2 minutes. Each vignette is
shown by the therapist to a group of parents (8-12) for discussion of observed learning points which
enables problem-solving and the use of role-play and rehearsal. Deliberately "good" and "bad" examples
of parenting skills are used in order to accurately reflect parental experience, demonstrate the learning
process and not reinforce an image of the "perfect parent" which could create feelings of inadequacy
(Webster-Stratton, 1991). The same videoed programme has also been given to 80 parents to self
administer without therapist feedback or group support. Results indicate a significant impact on
parenting behaviour. Hence the possibilities of low cost mass dissemination and its preventative value

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are huge (Webster-Stratton, 1992a; 1984; 1982a,b; 1981b, Webster-Stratton and Hammond, 1988).

More recently the above programme has been developed to cover family issues as an adjunct to
child behaviour management skills. The ADVANCE initiative includes: anger management, coping with
depression, marital communication, problem-solving strategies and how to teach children to problem-
solve and manage their anger more effectively. In both the programmes the children do not attend the
group sessions but parents are given homework to practise with their children (Webster-Stratton, 1991).

The reason for a wider focus is that current research suggests some families do not respond to
parent training on its own and might require other problems to be addressed (Spaccarella, 1992).
Additionally this "hard to reach" group might be larger than previous results indicate, for if you change
the criteria for measuring parent training effectiveness to include parents and teachers reporting of
children’s adjustment, then the outcomes look less robust. Long-term follow-up studies suggest that 30-
50% of treated parents and 25-50% of teachers report that children continue to exhibit behaviour
problems in the deviant or clinical range (Webster-Stratton, 1990; Webster-Stratton, 1990a,b; Schmaling
and Jacobson, 1987; Forehand, Furey and McMahon, 1984).

Some of the personal factors which contribute to parents doing less well and treatment relapse
include depression, marital discord, unsupportive partner, poor problem-solving, lack of social support
and environmental stress (Forgatch, 1989; Dadds, Schwartz and Sanders, 1987; Wahler and Dumas,
1984; Dumas, 1984; Richard et al., 1981).

More recent work has been testing the hypothesis that broader based interventions can help to
mediate against the effects of the above factors and hence remove a significant barrier to more parents
fully benefiting from parent training. It is hoped that if effective, positive change will be generalised and
maintained for longer. Unfortunately there has not been enough work to confirm the hypothesis but what
has been done thus far is very encouraging (Webster-Statton, in press; Gill, 1993; 1990; Dadds and
McHugh, 1992). For instance a study at the University of Washington Parenting Clinic showed that
those parents who attended the BASIC and ADVANCE programme did significantly better than those
who just attended the BASIC programme (Webster-Stratton and Herbert, 1994). Dadds et al. (1987)
found that partner support training combined with advice on child management, positively impacted on
outcomes for those experiencing marital difficulties. Other methods aimed at improving maintenance
include overlearning, fading out intervention, "booster sessions" and utilising social support networks
(Gill, 1993).

Drawing from Patterson, Forehand and McMahon and Webster-Stratton, is the work of Dangel
and Polster (1988; 1984; Dangel et al., 1994) who developed the WINNING parent training programme.
It has evolved over the last 20 years in three countries and involved over 3,000 parents. It is of particular
interest here as the programme was replicated as part of the PhD research. Results from Dangel and
Polster (1984) indicate a significant improvement in parent and child behaviour across a wide
population: poor, wealthy, minority, non-minority, lone-parent, two-parent, referred, and voluntary.
Change was successfully generalised across times, activities and settings and in wider parent-child

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interactions. Also effects were maintained at short-term follow-up and parents reported a high level of
consumer satisfaction (Dangel and Polster, 1984). The videotaped groupwork programme is
underpinned by the following research based principles (Dangel and Polster, 1988):

• Success i.e. parents who have constantly experienced failure need to experience early success
to act as a springboard for continuation and developing new skills.

• Successive Approximations i.e. explaining and modelling of skills to enable parents over time
to gradually demonstrate acquisition.

• Sequencing i.e. child management skills are deliberately ordered and linked; each skill is
achieved as a prerequisite to the next; simpler skills are taught first and then built on with more
complex tasks, drawing upon previous learning and analysis.

• Multiple Examples i.e. provision of diverse and numerous practical examples to bring alive
what is intended and to make the content applicable to each parent.

• Practise i.e. emphasis on the need to practise skills both within the sessions but more
importantly in real life situations with their own children.

• Feedback i.e. clear and precise feedback which accentuates the positive.

• Mastery Criteria i.e. parents demonstrate a skill which is measured against a set criteria.

• Review i.e. reflection and review of main learning points to reinforce continuity and linkage
and to develop wider understanding/application.

The structure of each session reflects the above principles and methods and follows a common
learning process: reviewing practice records ("homework"), discussing previous weeks experience,
defining and explaining new skill, using examples and rationales, demonstrating new skill, role-playing
exercises with parents, providing feedback, completing mastery check, and assigning practice.

There are 8 sessions and each meeting covers one skill area:

1. Praise and Attention

2. Rewards and Privileges

3. Suggestive Praise

4. Extinction

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5. Removing Rewards and Privileges

6. Time-out

7. Physical Punishment

8. Special Problems and Maintaining Change

Within the UK, drawing from the American research, there has been a steady development in
parent training methods, accelerated recently by a renewed interest in prevention, family support and
preparation for parenthood (Dartington Social Research Unit, 1995; Utting, 1995; Audit Commission,
1994; Pugh, De’Ath and Smith, 1994). Of particular note is the work of Herbert (1987) at the Centre for
Behavioural Work with Families and the creation of the Centre for Fun and Families (Gill, 1991), both
in Leicester. The Maudsley Hospital in London have applied the work of Forehand McMahon (1981) in
the Parent/Child Game programme (Jenner and Gent, 1993; Jenner, 1992) with significant success and
most recently have made a UK version of the Webster-Stratton (1984) video.

Specifically in relation to groupwork, the Fun and Families programme for parents of 2-11 year
olds has been developed over the last 10 years and involved nationally around 1,000 parents with
encouraging results (Neville, King and Beak, 1995; Gill, 1989). Further discussion of this work and how
it pertains to the research will feature in future chapters. Scott’s (Scott and Stradling, 1987) work in
Liverpool with significantly deprived families influenced the content of the Fun and Families
programme, particularly in the emphasis on "play-acting" everyday coercive situations or scenarios.
Results from Scott’s 6 week programme indicated a significant reduction in the perceived number and
intensity of child behaviour problems, parental depression (inward and outward irritability) and the level
of perceived child conduct problems (impulsivity and anxiety). In addition child management skills were
significantly improved. On follow-up, positive changes in parental depression and irritability were
maintained at 3 months and child behaviour problems remained reduced at 3 and 6 months (Scott, 1989;
Scott and Stradling, 1987).

4. Family Intervention

As previously indicated, in certain multi-distressed families a wider analysis than parent training
might be justified if there is evidence to suggest that environmental influences outside of the parent-
child relationship are maintaining child behaviour problems (Sanders and Dadds, 1993). The emphasis
being on structural and interactional factors that are acting as barriers for parents acquiring and
implementing child management skills. This might include family organisational problems, the division
of labour between caregivers, the marital relationship, sibling rivalry or the quality of support from
friends, neighbours and relatives. Sanders and Dadds (1993) argue though that it is important not to be
too prescriptive and that intervention methods must reflect careful, individual assessment. Hence they
warn against set programmes which over time have become longer to accommodate more adjunctive
treatments (Dadds, Shwartz and Sanders, 1987). Dependent on need, intervention might be short term

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involving for instance, just parent training or more long term and require joint work with the child.

Assessment of setting events (time, persons, places and situations) and how they influence both
children’s and parents’ behaviour is important when making sense of environmental forces and
reciprocity within families (Herbert, 1987). In other words the environment within which parenting
occurs. For instance, children may be more difficult to manage when there are competing demands on
time and attention, perhaps first thing in the morning or at mealtimes. Over time such situations can
become frequent and intense and might be complicated by marital conflict leading to a greater
possibility of returning to a maladaptive or coercive style of interaction with the child following parent
training. However research is unclear about what combination of contextual, cognitive and affective
variables constitutes a high risk parenting environment. Sanders and Plant (1989) defined a high risk
setting as "a combination of contextual variables that serve to increase the probability that parents
experience difficulties in managing their child and fail to implement trained skills" (p. 285).

The "Behavioural Family Therapy" model (Falloon et al., 1993, 1984) focuses in on the whole
family as a dynamic and living social system, which has strengths and weaknesses which need to be
assessed in order to fully make sense of the function of child conduct problems. Rather than just utilising
parent training methods, the whole family is seen as resource for achieving change. Strengths can be
built upon and deficits worked with. The emphasis is on patterns of communication and interaction and
how these might be acting as barriers to problem-solving. It is hypothesised that until a family is
communicating effectively it will not be able to maintain the full effectiveness of parent training. Results
have indicated significant improvements in family functioning (Falloon et al., 1993) though further
research needs to be done in the arena of child conduct disorders. Work with families where a member
was suffering from schizophrenia, achieved a 75% drop in the relapse rate when behavioural family
therapy was combined with medication (Falloon et al., 1984).

Taking an overview of research into behavioural family interventions there is some evidence, in
relation to oppositional defiant and conduct disordered children, that a programme will be most effective
if it includes (Jackson and Sikora, 1992, Horne and Sayger, 1990; Sayger, Horne, Passmore and Walker,
1988; Fleischman and Horne, 1979):

1. An assessment that specifically defines problem areas and establishes goals for treatment
which are consistent with the families’ experiences.

2. Involvement from the relevant multiple systems (identified from the assessment), including
parents, siblings, teachers and others.

3. Effective therapeutic techniques which impact on environmental forces and create a positive
expectation for change.

4. Developing self-control skills for the entire family which enable parents and children to
reduce explosive and depressive behaviour.

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5. Agreeing a disciplinary approach which has a "pay-off" for individual members and the
family as a whole.

6. Social enhancement methods that increase children’s prosocial behaviour.

7. Programmes for intervening in wider systems such as the extended family, school and
community agencies.

8. Maintenance skills for continuing change once it has occurred.

Comparison Of Methods

Patterson’s parent training approach has been shown to be more effective than family based
psychotherapy, attention-placebo (discussion) and no treatment conditions (Patterson, Chamberlain and
Reid, 1982). Forehand and McMahon’s (1981) programme appeared to have more significant results
than a family systems therapy (Wells and Egan, 1988), and a group version of the programme was
superior to a parent discussion group based on the Systematic Training for Effective Parenting (STEP)
model (Baum, Reyna McGlone and Ollendick, 1986; Dinkmeyer and McKay, 1976). Webster-Stratton’s
work has been replicated with several different populations and found to produce better results than a
waiting list control group. More specifically, the group discussion videotape modelling method (GDVM-
therapist led) is demonstrably as good as, if not more effective, than a parent training method based on
the individualised "bug-in-the-ear" approach, a parent discussion group (without videotape modelling
methods) or a self-administered videotape modelling programme (without therapist feedback or group
discussion) (Webster-Stratton, Kolpacoff and Hollinsworth, 1989; Webster-Stratton et al., 1988). This
component analysis suggests that parent training methods built on videotape modelling plus parent
group discussion and support will produce more sustainable results than programmes that do not employ
either of these methods (Webster-Stratton, 1991).

Herbert (1997) in an extensive review of "Family Treatment" methods paid particular attention to
an exploration of the empirical base and effectiveness of what could be loosely referred to as the "family
therapies". What is presented is clear evidence of research rigour around Social Learning Theory and
behavioural family therapy/intervention as apposed to the other family therapies where the lack of an
empirically sound base and research of outcomes casts significant doubts on its efficacy and
effectiveness. Herbert (1997) presents the following evidence:

• Family therapy has not undergone the controlled trials to demonstrate whether, how or where
it is effective ( Kazdin, 1988; Gurman, Kniskern and Pinsof, 1986). Alternatively Spenkle, Piercy
et al (1986) state about behavioural family therapy that: "more methodologically sound research
has been conducted on behavioural marital and family therapies than on other family therapies,

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perhaps because of their emphasis on the operationalization of treatment components and

assessment of change" (p. 80).

• The majority of non-behavioural family therapies when looking at treatment methods, change
and what it looks like, tend to operate at an abstract, anecdotal and generalised level (Piercy,
Spenkle et al, 1986; see Speed, 1985); whereas in behavioural family work these elements are
made clear, specific and importantly measurable (see Herbert, 1991, 1987; Patterson &
Chamberlain, 1988; Reiss, 1988; Alexander and Parsons, 1982; Bandura, 1977). Hence in non-
behavioural family therapy the dependent (Bennun, 1986) and independent variables lack the
necessary clarity (de Kemp, 1995; Marmar, 1990; Hill, 1982).

• The emphasis on abstraction and anecdotal thought within family therapy is evidenced by the
use of such terms as "scapegoating", "doublebind", "sibling transfer" and the "go-between" (Lask,
1987) and such processes may be conscious or unconscious. For the experiential Family
Therapists goals are non-specific and are concerned with "self-worth", "self-responsibility" and
"personal growth". Empirical measurement is downgraded as it is not able to reflect the subtleties
of family relationships (Herbert 1997).

• Gurman, Kniskern and Pinsof (1986) compared 15 models of therapy addressing childhood
behaviour problems and found that only 2 models (the behavioural and psycho-educational)
produced convincing results. Of interest is the finding that directive methods were more effective.

• Using behavioural methods linked to a family systems model has shown significant positive
outcomes in family work where there are behavioural and relationship difficulties (Dare, 1985).

• Kazdin (1987) notes that no other intervention with children displaying conduct problems has
produced such effective results as behavioural parent training. A conclusion also reached by
Gurman, Kniskern and Pinsof (1985).

Therapeutic Process And Parent Training

Within the specific field of parent training there has been little work done on therapeutic process
and what helps and hinders in the relationship between therapist and parent(s). It has been generally
recognised within behavioural work that the quality of the relationship the therapist has with the client is
important (Dadds, 1989; Twardosz and Nordquist, 1988; Sweet, 1987; Chamberlain and Baldwin, 1987;
Patterson and Forgatch, 1985; Chamberlain, Patterson and Reid, Kavanagh and Forgatch, 1984) but not
a lot has been said about interactional style, communication and how therapeutically parents can get the
most out of the experience of parent training. In other words, are there essential therapeutic elements
required to achieve optimum results and what needs to go on process-wise between therapist and parent
(s) ?

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There is a need then to identify therapist variables linked to outcomes which go beyond purely
saying it is important to establish a relationship based on warmth, empathy, support, encouragement and
humour (Sanders and Dadds, 1993). For instance why is it when one therapist applies a set of learned
skills on giving constructive feedback, that the parent usefully questions his/her child management but
when another therapist applies the same skills the parent feels criticised, devalued and fails to return to
the next session? There are important process variables which impact on the acceptability (to parents) of
advice and support offered by clinicians.

Webster-Stratton’s (Webster-Stratton and Herbert, 1993) research looking at over 100 hours of
video which recorded parent group discussion and interaction, (therapist led, using the GDVM methods
previously discussed) concluded that a significant factor in the therapeutic process was collaboration and
partnership (similarities with Dangel and Polster, 1988; 1984). Importantly such general terms were
broken down into more meaningful elements. Within the collaboration model there were six roles
identified for the therapist: building a supportive relationship, empowering parents, teaching,
interpreting, leading and challenging, and prophesising. For the parent there were five recurring themes
linked to helping them cope more effectively: promoting parents’ problem-solving, helping parents
"come to terms" with their child, gaining empathy for their child, parents accepting their own
imperfections, and learning how to "refuel". Such results concurred with findings that emphasised the
importance of valuing parental skills due to the primary educational function and working together, non-
judgementally, to look at child behaviour problems. This helps parents feel better about themselves and
more confident in their own skills (Easen, Kendall and Shaw, 1992; Alessi, 1987).

Webster-Stratton (Webster-Stratton and Herbert, 1993) broke the six therapist roles down further
into sub-elements:

Building A Supportive Relationship

• Self-disclosure to create rapport and common understanding

• Using humour to reduce anxiety, anger, and cynicism ("break the ice")

• Being optimistic to model positive expectations for change

• Acting as an advocate for parents with other agencies

Empowering Parents

• Reinforcing and validating parental insights

• Challenging powerless thoughts

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• Encouraging self-empowerment to highlight parental strengths

• Promoting family and group support systems to reduce isolation and increase mutual sharing

Teaching

• Persuading by explaining clearly the connections between ideas and principles

• Adapting concepts and skills to the individual circumstances of each parent and the
temperamental attributes of the child

• Giving assignments and tasks which enable skills to be further practised and transferred to the
home setting

• Reviewing and summarising main learning points and agreed tasks to reduce confusion

• Teaching parents to apply skills and experience, not only to target behaviour, but wider
situations, settings and behaviour (encouraging generalisation)

• Using videotape examples and other "props" to get main ideas across (must be meaningful
and real to each parent)

• Using role-play and rehearsal to produce positive changes in interaction and child behaviour

• Evaluating each session to measure progress and satisfaction

Interpreting

• Using analogies and metaphors to practically explain theories and concepts (must be
culturally relevant and sensitive)

• Reframing parental stories and explanations in order to reshape beliefs about the nature of the
problems (cognitively restructuring)

Leading And Challenging

• Setting limits to provide a structure which facilitates group process

• Pacing the group in order that everyone understands each element prior to moving on

• Accepting, and working collaboratively with parents to understand reasons for resistance

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Prophesising

• Anticipating and predicting problems and setbacks to prevent disillusionment

• Predicting parental resistance to change or trying certain new strategies, to prevent feelings of
inadequacy (accepting that some techniques are not acceptable or relevant to everyone)

• Predicting positive change and success if tasks and programme are fully completed (builds an
agenda and set of expectations totally focused on change and moving forward)

Appendix 1 contains a checklist to evaluate the collaborative process (Webster-Stratton and

Herbert, 1993).

Prevention And Parent Training

Being a parent does not suddenly occur at the point of birth; it involves a complex set of skills that
have to be learned and practised over time. It significantly effects social arrangements, expectations,
level of free time, and the amount of disposable income - yet there is very little preparation for
parenthood and even less family support once the baby is born (Utting, 1995). For some this situation is
surprising, when parents are engaged in possibly the most difficult and responsible task they will ever
face in their lifetime i.e. the rearing of the next generation. To use a car analogy, people would be rightly
appalled if the Government was encouraging and advocating that first time drivers should go on to the
open road without supervisory support and teaching.

Some limited recent research has been conducted looking at the value of parent education and
preparation for parenthood. A school based programme with adolescent mothers significantly impacted
on the quality of parent-child interaction, created a more positive home environment which assisted the
child’s development (Causby, Nixon and Bright, 1991). Currently within the UK there are a number of
imaginative research projects looking at the value of preparation for parenthood classes and there is a
growing movement that the subject should become part of the National Curriculum.

Wekerle and Wolfe (1993) reviewed 34 studies where the main intervention was parent training
directed at reducing the risk of physical and emotional child abuse. The short term results were
extremely encouraging but the long term impact was unclear. Such findings are replicated elsewhere in
relation to prevention of child abuse and further longitudinal research is required (Sanders, 1992).

Pugh, De’Ath and Smith (1994) argue that being a parent should be viewed as a lifelong process
characterised by early preparation for parenthood, parenthood itself, and then extended to becoming a
grandparent. This "life cycle" model attempts to place the job of bringing up children in wider societal

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context whereby everyone has some collective role or responsibility. Statutory agencies working more
together and with local communities, should forge a clear partnership based on a common agenda and
shared interest. In addition the preventative value of such a community approach should be emphasised
in terms of improving the mental health of children and families and reducing the risk of abuse. It is
within this context that parent training should be firmly seated (Utting, 1995; Pugh, De’Ath and Smith,
1994).

Structural forces have been identified as working against a community perspective, for example,
an emphasis on individualism, privacy and mobility (Utting, 1995). Risley, Clark and Cataldo (1976)
state that the decline in extended family support networks in Western countries may be producing
parents who have had few role models for successful child rearing techniques and who receive minimal
support in raising children. A lack of support, interest and involvement, has meant communities do not
have "buffers" which are protective and nurturing of children and parents alike. In addition the
worsening of economic conditions, the modelling of violence on television, and the growth of suburban
overcrowding and isolation may all contribute to the growing salience of parenting problems (Sanders
and Dadds, 1993).

There is growing evidence to suggest that community based initiatives which emphasise and
facilitate parental mutual support, self-help groups, befriending or "buddy" systems, multi-agency
working and informal support between family, friends and neighbours, have a positive impact on
parenting behaviour (Rodgers, 1993; Gaudin, 1993; Barber, 1992; Gaudin et al., 1991; Jennings, Stagg
and Connors, 1991; Telleeen, Hertzog and Kilbane, 1989). Such networks ease or mediate stress and
pressure on families and create a safety net that helps with social cohesion and bonding.

An exciting development concerns parents being trained to run family support programmes and
structured parent training groups. Early results suggest a significant improvement in children’s
behaviour and parental confidence (Andersen, 1994; Gill, 1993). One study even found that parents
running parent study groups were just as effective as trained counsellors in improving child management
skills (Kottman and Wilborn, 1992). The potential for mass dissemination of such methods is huge and
would help in normalising the need and value of learning parenting skills. Within the UK, organisations
such as Home Start and Newpin are at the forefront of a movement to demonstrate the value of
recognising parental experience as a strength and community resource which could be used to support
families. Part III of the 1989 Children Act also offers a mandate for such an approach.

The prevention of child conduct disorders cannot be divorced from the above context of wider
social responsibility as it is indelibly interlinked. There have been a number of programmes specifically
designed to reduce the possibility of conduct disorders developing. One such programme was concerned
with early social bonding for the child, which encouraged commitment, attachment and adherence to the
values of the family, school and peers (Hawkins and Lam, 1987; Hawkins and Weis, 1985). There were
several components:

Classroom:-interactive teaching and co-operative (peer involved) learning methods.

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Family:-parent management training and conflict resolution for family members.

Peer social skills training.

Community focused career education and individual counselling.

It is hypothesised that the multiple context of family, school, and peers increases the bonding
required to reduce the possibility of anti-social behaviour starting (Kazdin, 1990). In looking at these
types of programmes there is evidence to suggest that early preventative intervention can reduce the
factors that may lead to child conduct disorders (Webster-Stratton and Herbert, 1994). Further research
is required to identify clear causal links.

Summary

The following summarises the key issues and findings in relation to the literature on parent
training:

• Identified the negative connotations of the term parent training.

• Demonstrated the convergence of behavioural and social learning theory and the move to joint
and wider adjunctive methods.

• Illustrated the effectiveness of parent training methods but warned against complacency,
particularly around maintenance of change over time.

• Detailed the historical growth and links of parent training, starting with the "triadic
model" (Tharp, Wetzel and Thorne, 1968).

• Detailed the pioneering work of Patterson et al. (1975), Hanf and King (1973) and Forehand
and McMahon (1981).

• Looked in detail at the BASIC and ADVANCE groupwork programmes developed by

Webster-Stratton (1991; 1981a,b) and the move towards a wider focus.

• Detailed the content and effectiveness of the WINNING programme (Dangel and Polster,
1984).

• Described the interest and growth of parent training methods in the UK and how it
corresponds with research into prevention and family support (Dartington Social Research Unit,

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1995; Audit Commission, 1994).

• Looked at the efficacy of Behavioural Family Therapy (Falloon et al., 1993; 1984) in
preventing relapse and fully utilising family strengths and resources (dependent on assessment,
parent training on its own can still be effective).

• Demonstrated that behavioural parent training has produced some very promising results
when compared with other methods.

• Highlighted the importance of therapeutic process and the lack of work identifying qualitative
factors. Drew heavily on research conducted by Webster-Stratton and Herbert (1993).

• Widened context of parent training to look at prevention, community involvement, mutual

support and social responsibility.

Extract from Gill, A. (1998). What Makes Parent Training Groups Effective. Promoting Positive
Parenting Through Collaboration. Unpublished PhD Thesis, University Of Leicester.

BACK TO TABLE OF CONTENTS

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