Parenting Through Adversity

Why?

• Programmes are more effective if they are specific to a child’s developmental needs and tailored to parents’ abilities and capabilities.
• Effective programmes that support parents of children from conception to 2 years old are typically underpinned by the science of early child development and usually involve both parents and children together. These programmes often work with parents of babies and toddlers who are especially at risk of serious harm, including physical abuse.
• The developmental needs of children, and the role of parents’ change as babies become young children. At age 2 or 3, children have new ways of navigating their emotional world and new capabilities, such as walking and talking. Young children at this stage need distinct support from the adults caring for them.
• For a minority of children, behavioural issues may become chronic and entrenched and persist into adolescence and adulthood. This happens especially when parents are not supported to manage their child’s behaviour or when the family faces ongoing adversities.
• When unaddressed and unsupported, children’s behaviours that challenge are associated with increased economic and social pressures on families, relationship conflict, exclusion from childcare or school, limited daily activities and reduced opportunities for spending time with family and friends.

How?

• Local leaders and commissioners should be clear about the role and purpose of parenting interventions across the ages and stages of child development, including opportunities for engaging with children and families at key times and transition points.
• Local leaders, practice supervisors and practitioners should ensure opportunities for early identification of needs, for example, when families are in contact with maternity and antenatal services, through primary care (e.g. GPs, local health services), in education and childcare settings, and in Family Hubs or children’s centres.
• Practitioners can support parents’ understanding of their babies’ behaviour as communication. For example, babies being unsettled, difficult to soothe, having developmental delay, and feeding or sleeping problems can be signals of developmental or health issues. Practitioners can also support parents’ understanding of their toddler’s or young child’s behaviour as communication, for example, frequent and persistent behaviours that challenge such as aggressiveness; non-compliance with adult boundaries and rules; or frequent and persistent fearfulness, social withdrawal, sadness, upset, and worry.
• Practitioners should work relationally with parents by offering a safe space for them to reflect on their experiences and support for strengthening parent-child relationships. They should provide information and guidance to parents on child development and health.
• Practitioners should be aware that children’s behaviours that challenge can contribute to significant stress for parents and impact family functioning.

Why?

• Parents can be reluctant to seek help, disclose difficulties, or engage in interventions because of stigma, distrust in services and professionals, and/or concerns about safeguarding procedures and children’s social care involvement.
• Parents can benefit from parenting interventions across the end-to-end system, from settings including Family Hubs, Family Help and edge-of-care, and in ‘treatment’ settings such as therapeutic spaces for those with a family social worker.
• Parenting interventions work particularly well for parents most in need.
• Evidence shows that many fathers and male caregivers assume that parenting support is not for them, or that they are not welcome to participate. However, fathers and male caregivers welcome opportunities to reflect on their parenting role, on the perceived tensions between masculinity and warm and sensitive parenting, and on the co-parenting relationship.

How?

• Practitioners should build personalised, trusting and respectful relationships with parents.
• Practitioners should build upon parents’ strengths to help improve their relationship with their child.
• Practitioners should highlight what parents are getting right in their parenting, and the positive impacts of this on their child’s development.
• Practitioners should recognise parents’ challenging circumstances and help parents to help themselves. Where possible, support should also attend to parents’ various needs holistically or prioritise with the family the most pressing needs.
• Practitioners should give parents opportunities to reflect on their experiences of parenting, their own early childhoods and experiences of being parented, and their desires and motivations towards positive change.
• Practitioners should support parents to increase their understanding of their child’s inner world, and the rhythms of parent-child interactions.
• Local leaders and commissioners should offer interventions that meet parents’ needs at the time and in the way that will best support their readiness to engage. They should also design support so that it can reach higher need families who are most likely to benefit from parenting support.
• Local leaders must ensure parenting support actively includes fathers and male caregivers by addressing their specific needs and challenging assumptions that parenting interventions are for mothers and female caregivers only. This involves promoting father-focused initiatives where relevant to the family, offering programmes and emphasising whole-family approaches.
• Practice supervisors and practitioners should adopt whole-family approaches where relevant to the family being supported. Father-focused initiatives should be adopted to strengthen practitioners’ skills and confidence in working with fathers and male caregivers. Fathers should be provided with opportunities to reflect on their parenting roles, explore sensitive parenting, and strengthen co-parenting relationships. Leaders must also equip practitioners with the skills and confidence to engage fathers effectively to foster inclusive and meaningful participation.
• Evidence indicates that both shorter interventions (e.g. eight sessions, such as Level 4 Group Triple P) and longer ones (e.g. 12-16 sessions, such as Incredible Years School Age Basic) can be effective. Shorter programmes may be more appropriate for parents who experience challenges such as insecure housing, while others may benefit from longer-term support that enables relationship-building and change.

Why?

• For outcomes associated with parenting, impacts were stronger in interventions that included more than 50% of parents from minoritised ethnic groups.
• Lack of cultural sensitivity, conscious/ unconscious bias and racism can mean that some parenting practices are judged harshly by practitioners, and that parents’ own needs and experiences are not explored and met.
• Parents and practitioners identified accessibility barriers, including challenges for parents who struggle with literacy and written comprehension, and challenges when interventions are not matched to parents’ cultural experiences.

How?

• Local leaders and commissioners should consider the importance of family characteristics in relation to equality, diversity, inclusion, and equity in the design and planning of services, and work proactively to address barriers to access and inclusion.
• Local leaders and commissioners designing parenting support should analyse and carefully consider local population and community needs and preferences.
• Local leaders, practice supervisors and practitioners should work with local communities and parents to ensure that available support is equitable, accessible, culturally informed and responsive.
• Practitioners should be equipped and supported by practice supervisors to address racial inequalities.

Why?

• Parenting interventions play an important role in supporting parental mental health, by enabling parents to reflect on their experiences and build on parenting skills, and by strengthening parent-child relationships.
• Our evidence and wider research show that where parents have untreated mental health problems, parenting interventions work well to improve child and parenting outcomes.
• The management of mental health during pregnancy and in the postnatal period is necessarily different to management of these conditions at other times due to the nature of this life stage and potential impact of poor mental health on the mother, father/partner, and the baby.

How?

• Local leaders and commissioners should integrate parenting interventions into the wider system of specialist mental health services, taking a ‘think family’ approach.
• Local leaders, commissioners and practice supervisors should reassure practitioners that they do not need to wait until mental health treatment begins before offering parenting interventions; they can still improve child and parenting outcomes.
• Local leaders and commissioners should develop targeted strategies for managing mental health during and after pregnancy, incorporating parenting interventions as part of this support.
• Local leaders and commissioners should establish strong links with specialist clinical networks and have a good understanding of mental health referral and management routes that can support effective collaboration and continuity of care across agencies.
• Local leaders, commissioners, practice supervisors and practitioners should use multi-agency and multi-disciplinary coordination to ensure that all agencies and professionals engaging with parents have an awareness of the types of parenting interventions available locally.
• Those delivering parenting interventions should be aware of the wider mental health support that is available to parents.
• Collaboration between organisations and practitioners should strengthen information-sharing, build confidence in respective roles and responsibilities, and promote appropriate referrals to parenting interventions, as well as onward referral to specialist services.