Parenting and whole-family interventions for families with multiple & complex needs (11 to 19)

A mixed-methods systematic review

Supporting parenting
December 3, 2025

Parenting and whole-family interventions for families with multiple & complex needs with children & young people 11 to 19

Highlights

This review synthesises evidence from 57 effectiveness studies, 59 implementation studies, and nine qualitative studies examining parenting and whole-family interventions for families experiencing multiple and complex needs with adolescents aged 11–19 years old. The evidence spans the UK and comparable high-income countries, including across Europe, the United States, Australia and Singapore.
The review finds consistent, though modest, evidence of effectiveness across several intervention models, including systemic family therapies and behavioural parent-training approaches. Interventions showed positive impacts particularly on reducing behaviours that challenge, supporting parenting practices, and improving family functioning.
Qualitative findings show that no single intervention format suits all families. Engagement and acceptability depend on factors such as practitioner relationship, cultural relevance, flexibility, practical accessibility and sensitivity to families’ lived experiences. Interventions must be personalised and embedded within supportive, coordinated local systems to achieve the best outcomes.
This review underpins the Parenting Through Adversity (11–18) Practice Guide, commissioned by the Department for Education and developed by Foundations.

Main report

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Appendices

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Summary

Families facing multiple and complex needs, such as adolescent behavioural difficulties, parental mental ill health, or socio-economic adversity, often experience pressures that can significantly inhibit parenting capacity and strain family relationships. Yet evidence on which parenting and whole-family interventions best support adolescents aged 11–19 in these circumstances remains limited. This review synthesised both quantitative and qualitative evidence to identify interventions of promise, the factors that enable successful delivery, and how parents understand and experience these interventions.

Aims

To conduct a systematic review of quantitative, qualitative and mixed-methods studies to develop an understanding of the impacts of parenting and whole-family interventions for families with multiple and complex needs with adolescents aged 11–19
To undertake meta-analyses of eligible randomised and non-randomised trials to assess the effects of these interventions on parent, child and family outcomes across diverse interventions models
To identify intervention components and practice elements, such as delivery model, theoretical foundation, intensity and setting—associated with positive outcomes
To synthesise parent and carer perspectives to understand what supports or limits engagement, and the acceptability and effectiveness of these interventions.

Method

The review drew on rigorous evidence synthesis methods to identify, appraise and integrate quantitative, qualitative and mixed-method research on parenting and whole-family interventions for families experiencing multiple and complex needs with adolescents aged 11–19. We systematically searched both academic databases and grey literature. For effectiveness (RQ1–RQ3), we included randomised, quasi-experimental and non-randomised controlled studies assessing parent, child and family outcomes. For implementation (RQ4) and acceptability (RQ5), we included qualitative and mixed-method studies providing insight into delivery, engagement and user experience.

The review followed PRISMA and PRISMA-E guidance, and applied the PROGRESS-Plus framework to ensure attention to equity. Risk of bias was assessed using RoB2, ROBINS-I, MMAT and CASP tools, and certainty was evaluated through narrative GRADE-informed approaches and GRADE-CERQual. Meta-analysis and effect-direction plotting were used where appropriate. A protocol was developed and published on the Foundations website and the Open Science Framework.

Key Findings

This review identified 57 effectiveness studies, alongside 59 implementation studies and nine qualitative acceptability studies, providing a comprehensive picture of parenting and whole-family interventions for families with multiple and complex needs with adolescents aged 11–19. The evidence base covered systemic family therapy models, behavioural parent training programmes, attachment-based approaches and cognitive-behavioural family interventions, delivered across UK-relevant settings including early help, mental health, youth justice, and children’s social care.

Overall, the effectiveness evidence showed that parenting and family interventions typically led to modest but positive improvements in key outcomes, particularly in reducing behaviours that challenge in adolescents, supporting positive parenting practices and improving family functioning. Evidence for impacts on parental mental health and parenting stress were also modest, and evidence on maltreatment-related outcomes was more limited, reflecting both smaller numbers of studies and variability in measurement.

Interventions tended to be theoretically well-defined, with clear practice components such as therapeutic approaches, parenting skills training, or whole-family approaches. However, the review found high heterogeneity in programme aims, delivery formats, and intensity. Many studies targeted a single primary presenting problem, typically adolescent behavioural difficulties, rather than the full range of adversities seen in families with complex needs. This limited the ability to draw conclusions about interventions designed specifically for families experiencing multiple overlapping adversities.

Implementation findings highlighted that successful delivery depended on organisational capacity, skilled practitioners, and strong supervision and fidelity systems. Workforce expertise, particularly in systemic family therapy models, was important, as was the intervention’s compatibility with local service structures. Barriers included high caseloads, resource constraints, staff turnover, and challenges engaging families experiencing instability, crisis or statutory involvement.

The qualitative evidence demonstrated that parents valued programmes that were tailored to their circumstances, especially when facing multiple adversities that constrained parenting capacity. Parents emphasised the importance of practical support (e.g., scheduling flexibility, accessibility, transport), culturally attuned practice, and interventions that recognised the complexity of their lives. Experiences varied across delivery formats: while some parents appreciated group-based support for providing solidarity and shared experience, others found such settings uncomfortable or exposing.

Taken together, the evidence shows that parenting and family interventions hold promise for improving outcomes for adolescents and their families when delivered with fidelity, sensitivity and contextual awareness.

Implications for future research

Future research should prioritise the development and evaluation of interventions explicitly designed for families experiencing multiple and intersecting adversities, as most existing studies focus on single presenting problems. Understanding how combinations of challenges, such as parental mental ill-health, domestic abuse, poverty and adolescent behavioural difficulties, shape intervention needs and outcomes is essential for building a more relevant UK evidence base.

There is a need for more UK-based trials using robust experimental or quasi-experimental designs, given that much of the current evidence originates from the US or other international contexts. These studies should adopt consistent, validated outcome measures and include longer-term follow-up periods to assess durability of change, particularly for complex cases where progress may be non-linear.

Future research should also examine mechanisms of change, identifying which practice elements, such as delivery model, intensity, or delivery setting are most strongly linked to improvements in outcomes of interest.

To improve equity, studies must better report outcomes for demographic and socio-economic subgroups, including ethnicity, gender, disability, and level of adversity, using, for example, the PROGRESS-Plus framework. Research should actively include families from minoritised backgrounds, who are often underrepresented in evaluations despite being overrepresented in the children’s social care and youth justice systems.

Implementation research should be expanded to explore how organisational capacity, workforce skills, supervision structures, and multi-agency collaboration shape fidelity and effectiveness in real-world UK settings. Mixed-methods designs, realist approaches, and embedded implementation trials would help generate actionable learning for local authorities.

Finally, future studies should investigate accessibility and engagement barriers, testing flexible delivery formats. This includes outreach, in-home work, digital components, and blended approaches, to determine how interventions can best meet the needs of families facing multiple adversities.