These systematic reviews informed the development of the Parenting Through Adversity Practice Guide (0–10). The Practice Guide sets out Key Principles and Recommendations on parenting support for parents who have babies and children aged between 0 and 10 years old, based on the best available evidence.
This project involved two systematic reviews. These reviews are designed to complement each other. While the first was informed by quantitative evidence, the second was informed by qualitative evidence. Both reviews underpin the Parenting Through Adversity Practice Guide (0–10), with the aim of understanding what works, how, and for whom, as well as the perspectives and experiences of practitioners and parents.
The findings show that parenting interventions can improve a range of parental and child outcomes including parental stress, parent/child relationships and child behaviour. A range of intervention features and demographic characteristics were also identified as impacting on intervention effectiveness. These include theoretical underpinnings, ethnicity, and delivery model.
Lastly, qualitative evidence suggests that parental engagement was enhanced when interventions were flexible to the needs of parents and when practitioners demonstrated positive interpersonal behaviours. The findings suggest policymakers should continue to support wider implementation of parenting support and continue to fund evaluations in this area.
The quantitative review sourced evidence on the effectiveness of parenting interventions for parents with multiple and complex needs. This review had the following research questions:
The qualitative review collected evidence on barriers and enablers of parental engagement in parenting interventions. The review also synthesised the views and perspectives of both practitioners and parents involved in parenting interventions. This review had the following research questions:
Both reviews followed established systematic review methods, with protocols registered and reporting following guidelines as set out by PRISMA. The quantitative review involved both meta-analysis and meta-regressions, while the qualitative review involved thematic analysis to identify key themes within the literature. Only randomised controlled trials were included in the quantitative review. Risk of bias was undertaken using the Cochrane Risk of Bias Tool versions 1 & 2. The qualitative review also used the GRADE CERQual tool as a measure of evidence certainty.
Quantitative review
The quantitative review screened 755 full text reports for eligibility, of which 131 were included in the review.
The findings of the quantitative review found that parenting interventions had a significant impact on outcomes of interest. Meta-analysis indicated that for parents with multiple and complex needs, parenting interventions lead to significant improvements in parenting behaviour, parental mental health, parenting stress, and parent-child relationships. They were also found to significantly improve child wellbeing and child attachment. Lastly, child behaviour was found to improve both in the short-term (0-6 months post-test) and long-term (6+ months post-test). Some parenting interventions and intervention features show promise in reducing child maltreatment.
Meta-regression analysis suggested that interventions were effective regardless of delivery model (fixed vs flexible scheduling), programme duration, or whether the intervention was delivered in groups or individually. Where mental health challenges exist, parenting interventions are likely to be ineffective in and of themselves in improving their mental health but can still improve parenting skills. Regardless of ethnic composition, parenting interventions were found to lead to significant improvements in both maltreatment behaviours and positive parenting.
Qualitative review
The qualitative review identified 666 records, of which 33 were included in the review. From these 33 studies, thematic analysis identified 10 statements which broadly related to three overarching categories.
The first centred on practitioner skillset and knowledge. Here, parents spoke of practitioner behaviours such as honesty and empathy which would lend themselves to long-term, trusting relationships.
Secondly, the importance of local-level multi-agency working was emphasised. This relates to parents receiving the ‘right support, at the right time’. Through extra support from relevant services (e.g. adult mental health services), practitioners can feel more supported and have clear referral pathways available to them when needed. There was a need for clear data-sharing procedures between services.
Lastly, there was a preference for whole-family, holistic approaches to working with families. There was an acknowledgement that in certain circumstances (e.g., domestic abuse), whole-family approaches are likely unsuitable. Nevertheless, where feasible, mothers spoke of the ability to share parenting responsibility, while fathers spoke of their desire to be a better parent.
Our reviews indicate that:
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