Parenting Through Adversity

There is promising evidence that parenting interventions can reduce the risk of harm to children for the group of parents in scope for this Practice Guide.

Why?

• Families who experience multiple adversities face challenges which can impact their parenting capacity. Nevertheless, consistently harsh and violent parenting has significant and long-term impacts on children’s development and health.
• There is promising evidence that single interventions can have short-term, small-scale effects on reducing the risk of more serious harm to children.
• However, it is important to recognise that there is insufficient evidence currently to suggest that a single intervention by itself can provide a sustained and long-term solution for serious problems, especially where families experience complex adversities. Parenting support should be part of a ‘jigsaw’ of services to prevent more serious risk of significant harm to children.

How?

• As part of their responsibility to prevent and address serious harm to children, local leaders and commissioners should ensure a coordinated and jointly owned network of support for parents.
• Local leaders and commissioners should focus on the specific intervention models and practices that evidence shows are the most effective in reducing the risk of more serious harm to children.
• Evidence identified that fixed and structured delivery models are more effective for reducing risks of more serious harm to children than more flexible models. Local leaders should reflect the need for more structured parenting support and wider multi-disciplinary services in the targeting of resources and prioritisation of support for families on the edge of care and/or receiving Family Help.

There is strong evidence for the benefits of providing parenting interventions to strengthen parent-child relationships.

Why?

• Typically, interventions that strengthen parent-child relationships are underpinned by Social Learning Theory and/or Attachment Theory, and the science of early child development.

How?

• Practice supervisors and practitioners working directly with families should be well trained (typically at degree-level) in these theories and their limitations, and in specific evidence-based interventions that are prioritised locally. They should also undertake regular refresher training to understand the latest developments in the field.
• Practice supervisors and practitioners focussed on improving parent-child relationships should deliver programmes that foreground the importance of strengthening sensitive and responsive caregiving. In some programmes, the focus is on improving parents’ actions. Others address intergenerational attachment experiences and parents’ own internal working models of attachment, which influence their parenting.
• Practitioners should deliver sessions which employ child-led play to promote curiosity, use careful observation to reflect on the meaning that parents give to their child’s cues, and explore how a parent’s own childhood experiences may have shaped their responses to their child.
• Interventions focussed on parent-child relationships are usually not in a fixed schedule, instead working around the individual needs of the primary caregiver (e.g., work commitments or medical appointments). Interventions such as Infant-Parent Psychotherapy and Promoting First Relationships are typically delivered in the home environment and provide practical, in-depth strategies, which promote secure and nurturing relationships between the child and primary caregiver. During an intervention, practitioners should observe interactions between parents and children and provide feedback on aspects such as communication and responsiveness to child eye-contact, sound and movement. Practitioners should model new techniques, encourage parental self-esteem, and provide practical parenting knowledge (e.g. soothing techniques).

There is strong evidence of impact from parenting interventions on child behaviours overall, and on behaviours that challenge, in both the short-term and long-term. There is also strong evidence that parenting interventions reduce negative parenting practices and improve positive parenting practices.

Why?

• Parenting interventions can work to empower parents to adopt more positive parenting practices, and in turn model these behaviours for their children. Improvements in child behaviour can lead to a range of positive outcomes in later life for the child.
• Evidence shows that parenting interventions benefit child behaviour in both the short-term (0-6 months post intervention) and long-term (+6 months post intervention).
• While many parents are aware of parenting strategies and know how to use them, others do not, may apply strategies incorrectly, or may not have the resources to deploy them when they are overwhelmed by experiences of adversity.
• Some parents have difficulty implementing effective strategies because they either misinterpret the reasons for their child’s behaviour, or they lack the confidence to follow through with effective boundary setting.
• Overly strict, harsh or unresponsive parenting can lead to and reinforce negative behaviours in children.

How?

• Practice supervisors and practitioners should use well-evidenced practices and interventions which improve child behaviour where this is a priority need for the parent and child.
• Practice supervisors and practitioners should include content which supports parents in setting clear expectations and boundaries for their child and supports child-led interactions.
• Interventions can also include practitioner-led content such as participation in group discussions, role-play activities and short videos to highlight key concepts and ways of achieving changes for parents and children.
• From when a child is aged 2, effective parenting strategies should be taught, role modelled and encouraged by practitioners to support parents to improve children’s behaviour and support children’s self-regulation.
• Practitioners should be skilled in coaching techniques, have experience of previously delivering parent coaching, and have the interpersonal skills needed to develop long-lasting, trusting relationships (e.g. empathy and compassion). Coaching can also provide opportunities and support for parents to practice and strengthen core parenting skills and receive individualised feedback from practitioners, such as through role-play, homework and group exercises.
• Practitioners should support parents to observe, recognise and scaffold communications or initiatives from the child, helping them ‘tune in’ to the child’s experiences and needs.
• Practitioners should support parents to hold boundaries during episodes of behaviours that challenge.
• Practitioners should support parents to use a point system and other incentives for rewarding behaviours that are optimal for children’s healthy interactions with family and peers.
• Practitioners should support parents to use verbal praise with their child (e.g. saying “thank you”, encouragement, and recognition in a warm and loving tone of voice with responsive body language) when children are behaving in a way that is healthy in terms of interactions with family and peers.
• Practitioners should support parents to develop strategies to avoid frequent arguments with children or long periods of verbal negotiation with them.
• Effective interventions, such as Incredible Years and Parent-Child Interaction Therapy, combine Social Learning Theory with approaches that recognise the importance of parents’ thoughts, feelings and beliefs about their child. These approaches focus on helping parents set age-appropriate expectations and boundaries for their child while encouraging positive behaviour through praise and rewards.

There is strong evidence that parenting interventions have a positive impact on reducing levels of parenting stress and support improved parental mental health.

Why?

• Persistent and severe parenting stress is known to increase adverse outcomes for parents, their children, and the wider family. These include increases in poor mental health, conflict in the couple’s relationship, impacts on the parent-child relationship, and on children’s behavioural, social and emotional outcomes.
• High levels of parenting stress can significantly interfere with parents’ ability to form a positive working relationship with practitioners and learn new skills.
• Evidence shows parenting interventions alone are not sufficient to see significant (clinical) change in parental mental health over time.
• Nevertheless, even for parents with clinical levels of mental health problems, evidence shows parenting interventions can improve parenting skills. Well-evidenced interventions include Infant-Parent Psychotherapy and Child First (see case studies in the full version of the Guide).

How?

• Practice supervisors should ensure that practitioners are given sufficient time to build relationships with parents, to enable them to help parents develop the confidence to learn new skills and make use of feedback. Practitioners should be skilled in understanding the impacts of stress on parents and how they can build trust and promote parental engagement.
• Parenting stress can be alleviated through interventions that enhance parent-child relationships, improve parenting practices, and positively influence children’s behaviour
• Practitioners should give support to parents’ capacity to think , and to manage their emotions.
• Where parents are experiencing more acute or severe mental health needs, a parenting intervention alone should not be considered sufficient. A more holistic service offer is recommended, including referral to specialist mental health support.