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Taking part in ‘Understanding Your Child’s Behaviour’ and positive changes for parents

02 February 2016

Rebecca Appleton, Hazel Douglas and Mary Rheeston evaluated what parents thought of child behaviour group programmes and any positive changes reported.

Volunteers

Rebecca Appleton BA Hons
Research intern, Solihull Approach, Heart of England NHS Foundation Trust

Hazel Douglas M.Psychol., D.Psych. Psych
Director of Solihull Approach, Heart of England NHS Foundation Trust

Mary Rheeston RCN, RSCN, RHV (BSc Hons), DTLLS
Manager of Solihull Approach, Heart of England NHS Foundation Trust

Correspondence: rebecca.appleton@heartofengland.nhs.uk


Key points

  • The majority of parents evaluated ‘Understanding Your Child’s Behaviour’ positively
  • Parents feel they can apply strategies learned in this group to help them make changes in how they interact with their children
  • Parent’s understanding of how to use this model increases over the 10 sessions, suggesting that all 10 sessions are needed for the group to result in successful outcomes
  • As a result of this group, parents feel calmer and more confident in their parenting skills.

Key words: Solihull Approach, Understanding Your Child’s Behaviour (UYCB), Parenting Group, Parent-Child Relationship, Confidence.


Abstract

The Solihull Approach’s Understanding Your Child’s Behaviour (UYCB) is a 10-session group for parents run by facilitators in their local area. Previous studies have shown that parents enjoy taking part in the group, and that UYCB can reduce problematic behaviours in children. Building on this research, the present study evaluated whether UYCB programmes run more recently in the UK were rated as positively by parents, and what positive changes were reported by parents. Both quantitative and qualitative data was analysed from 105 parents who took part in 18 different UYCB groups between 2012 and 2015. The results of this analysis showed that 90 per cent of parents found the group a great place to relax and share experiences, 93 per cent rated the group as ‘great’ for helping them understand their child, and 92 per cent gave a ‘great’ rating for helping them identify changes. In addition to this, content analysis showed that 47 per cent of parents reported having a better relationship with their child after taking part, 42 per cent said they were more confident, and importantly six per cent reported a significant positive change in their lives generally as a direct result of UYCB.


Introduction

Parenting classes are recommended as a type of early intervention for children presenting with behavioural problems (NICE, 2013). There is evidence for their positive outcomes: following early intervention for conduct disorder, one randomised controlled trial showed taking part in Sure Start parenting courses reduced problematic behaviour significantly more than parents in a control group (Hutchings et al, 2007). Larger-scale studies have also shown the positive impact of attending parenting courses, for example Lindsay and Strand (2013) investigated the effectiveness of several parenting programmes which took place over the whole UK and found that children showed reduction in behaviour, emotional and conduct problems, whilst parents had increase in wellbeing and parenting skills. These results show that parents whose children are at risk of developing conduct disorder would benefit from attending parenting courses. If parents did attend these courses, there would also be an overall financial benefit to society as shown in a modelling study (Bonin et al, 2011) which found that parenting programmes for parents whose child is at risk of developing conduct disorder could save the public sector more than £16,000 over the following 25 years, with some studies estimating as high as £260,000 over 20 years (Parsonage et al, 2014). Other research also indicated a net saving: Scott et al (2001) found that attending parenting courses results in a 10-fold saving to society. In relation to these figures, it has been estimated to cost up to £1,500 to run the Solihull Approach Understanding Your Child’s Behaviour (UYCB) course (Douglas, 2015), which shows how
large the economic benefits can be if they prevent just one child per session from developing conduct disorder.

There is an increasing body of evidence showing that the relationship between a parent and child is crucial for the development of the child (Britto et al, 2013; Zeanah, 2009). Therefore, the present study investigated the outcomes from the Solihull UYCB parenting group in relation to the impact it has had on parents and their relationships with their children.


Background

UYCB is a 10-week parenting group based on the Solihull Approach model which aims to promote more effective and sensitive parenting. It is based on the three main principles of the Solihull Approach (Douglas, 2012): emotional containment and reciprocity which lead to effective behaviour management. This programme aims to help parents identify their own goals and solutions to problems and prioritises the relationship between the parent and the child. Community practitioners are often involved in running groups or encouraging parents to attend. Parents self-refer to the group, and by improving their understanding become less anxious, and they are able to use containment to problem solve. This in turn can have positive benefits on their child’s behaviour (Bateson et al, 2008) due to more successful behaviour management. The UYCB course has also been shown to improve parent’s confidence and self-esteem, while reducing behaviour difficulties in children (Cabral, 2013; Vella et al, 2015).

Previous study and hypotheses Johnson and Wilson (2012) carried out the first service evaluation investigating parents’ responses to the UYCB programme. They found that the majority of parents (95 per cent) rated the group as ‘great’ in helping them to relax and share experiences, with 88 per cent rating the group as ‘great’ for helping them understand their child and 89 per cent ‘great’ scores for helping them to make changes. They also carried out qualitative analysis on data from a written questionnaire presented at the end of the course, and found the most common theme was ‘making changes’, followed by ‘increased knowledge’. This implies that the UYCB group for parents is effective in helping parents understand their child’s behaviour, and learn new skills to enable them to manage their behaviour more effectively.

The present paper aims to follow up on this previous service evaluation to investigate whether UYCB groups run between 2012 and 2015 are evaluated as positively by parents. Our hypothesis was that this would be the case, with the majority of parents giving positive feedback. In addition, the main objective was to find out what impact these programmes have on parents’ lives and their attitudes to parenting.


Method

Intervention

Parents took part in the UYCB group for parents in two hour sessions over a 10 week period, and the content for each session is shown in Table 1. These were facilitated by a variety of practitioners, such as school nurses, social workers, health visitors or health professionals, with two present for each group. The facilitators had been trained in the Solihull Approach at a two-day foundation course, as well as an additional day of UYCB facilitation training.

Participants

Data was collected from parents who took part in 97 different UYCB groups between September 2012 and October 2015 across the UK. Of these 97 data sets, 18 were complete with all parents completing evaluations after each session, and within these 18 groups there were 105 parents in total who completed the group to session 10. All forms were completed anonymously. Parents had self-referred to the programme and were required to commit to attending all 10 sessions. Ethical approval was not needed for this study as it was a service evaluation.

Evaluation forms

Data was collected from parents at the end of each session by the group facilitators using a simple written evaluation form containing a visual
Likert scale (Bateson, 2008). This scale is shown in Figure 1. In session 10 three more questions were added to this, requiring parents to write a longer and more detailed response. These questions were: ‘What do you feel has changed as a result of you being in this group?’, ‘What do you feel you have learned in this group?’ and ‘Any other comments?’

Data was only included in this analysis if it was complete for all 10 sessions. In total, 1,165 responses from parents were analysed, although due to the simple nature of the outcome measures it was not possible to identify parents’ responses over time. Figure 2 shows the total responses to each question for each session. From session two to session 10, there was a 79 per cent completion rate showing most parents completed the course.


Analysis

The scores for the amount of parents who rated each session as ‘great’, ‘okay’, and ‘poor’ were converted into numerical scores, which were then analysed for each session using descriptive statistical analysis and turned into percentages using Microsoft Excel. These were then plotted on individual graphs for each question in order to track ratings over time and to allow comparisons between sessions.

Qualitative analysis was carried out by the researcher on the parents’ responses to the longer questions in session 10 using Inductive Content Analysis (Elo and Kyngäs, 2008) as themes were identified directly from the data. Descriptive statistics were then used to analyse what percentage of parents mentioned comments which related to each theme. This was done using Microsoft Excel.


Results

Quantitative frequency analysis was carried out for each question on the Likert scale. From the first session, 78 per cent of respondents reported that the group was successful in allowing them to relax and share experiences. Figure 3 shows that this rose over the course of the programme, with 93 per cent scoring the group as ‘great’ by session 10. The number of ‘poor’ responses was consistently low, with only two per cent of respondents giving a ‘poor’ rating in session two.

Our analysis showed that the extent to which the course helped them understand their child improved over the 10 sessions, with the percentage of parents giving a rating of ‘great’ increasing from 51 per cent in session one to 90 per cent in session 10. There was a sharp increase in parents giving a ‘great’ score between sessions one and two, as shown in Figure 4. Once again, the percentage of parents giving a ‘poor’ rating was consistently low across the 10 sessions, at either 0 or one per cent of total responses.

Analysis of parents’ scores for the final question on the Likert scale also showed an increase in the number of ‘great’ responses as the course went on. In session one, 62 per cent of parents scored the session as being ‘great’ in helping them identify changes, which rose to 92 per cent by session 10. The number of ‘poor’ responses was one per cent in session one, and 0 per cent for the rest of the course.

In total, there are 3,482 responses (the sum of responses for each question), of which only six gave a poor rating. As this is so small, it gives a percentage of 0 per cent, with 80 per cent rated as ‘great’, and 20 per cent as ‘okay’ overall.

Content analysis of the parents’ responses to the questions after session 10 revealed five consistent themes about how the UYCB group had changed them as a person, which have been labelled as follows: ‘more calm/ patient’; ‘better relationship with child’; ‘more confident’; ‘paradigm shift’, and ‘better parent/enjoy parenting more’. These are presented in Table 2 with a description and examples of each theme.

These themes were analysed using descriptive statistics to investigate what percentage of parents reported comments which fit into each different theme. This is shown in Figure 6.


Discussion

The results from our analysis of the Likert scales has shown that the UYCB group for parents is successful in helping parents to relax and share experiences, understand their child, and identify any changes. Our analysis replicated the results of an earlier evaluation study by Johnson and Wilson (2012) which found this programme is well regarded by parents. By the end of the group, 93 per cent of parents reported the group as being ‘great’ for allowing them to relax and share experiences, 90 per cent rated it as ‘great’ for improving their understanding of their child, and 92 per cent found it ‘great’ at helping them to identify changes. Our results in fact show a slightly higher percentage of parents gave ‘great’ scores by the end of the group, and strikingly for the second session in ‘understanding their child’s behaviour’ which could be explained by the fact that group facilitators are now more experienced at facilitating groups and more skilled at applying concepts of containment and reciprocity in both the content and process of the group.

Like Johnson & Wilson (2012), our results also showed a slight decrease in the number of ‘great’ scores for understanding your child and identifying changes in session five. This can be explained by the fact that session five focuses on different parenting styles and how they were parented, so is designed to have a different emphasis.

Our content analysis of the qualitative data found five main themes: ‘more calm/patient’; ‘better relationship with child’; ‘more confident’; ‘paradigm shift’, and ‘better parent/enjoy parenting more’. Of these, ‘more calm/patient’ and ‘better relationship with child’ were the most common (42 per cent and 47 per cent respectively). This supports the hypothesis of the Solihull Approach that teaching parents emotional containment will help them to stay calm and process emotions more effectively, without becoming overwhelmed. As the course aims to help them understand their child’s behaviour, the fact that 47 per cent commented about this shows it has been successful in teaching parents about their child’s development, and how their feelings and behaviour are linked. This knowledge was then able to make parents feel more confident (12 per cent) and feel like they were a better parent and enjoying parenting more (24 per cent). Six per cent of parents made remarks which showed a significant paradigm shift, and that the UYCB course has had a remarkable difference on their lives. Parents described the group as being “the best thing that’s ever happened to me” and that “it has changed… so many aspects of my life”. These responses show how important the effects of attending UYCB courses can be.

It is also worth noting that several parents remarked that the group had made them feel as though they were not alone, which could relate to the high percentage of ‘great’ responses by the end of the course for being a supportive environment for them to relax and share experiences with others.

Limitations and recommendations

One of the limitations of our data is that due to its simple nature, individual parents could not be identified, meaning their data could not be tracked over time. We also had a relatively small sample compared to the number of groups who returned data (n=97) as the majority of data sets were incomplete, which was probably due to time constraints for facilitators. While it would be difficult to ask facilitators to track data over time as it would require a more complicated design for evaluation, we can encourage them to send back completed data sets, which would give future studies a larger sample size. This would enable more detailed thematic analysis and may also make the sample more representative. A further recommendation is that as over 90 per cent of parents reported positive outcomes after attending the group, more parents should be encouraged to take part in parenting groups as it is likely to have significant benefits for them and their families. If parents of children at risk of developing conduct disorder had incentives to attend, it would likely have large economic as well as social benefits to society.


Conclusion

Overall, the results from our analysis show that parents who attend UYCB groups for parents rate them positively. Outcomes from attending include feeling calmer and more confident, having a better relationship with their child, and enjoying parenting more. A proportion of parents also experienced a significant positive change as a result of attending. Through these positive outcomes, these results show the value of attending parenting classes, which could hopefully increase future participation. They also illustrate the success of the Solihull Approach UYCB group in engaging parents and increasing effective behaviour management. Taking into account the economic cost of parenting courses compared to the cost of an individual with conduct disorder to society (e.g. Parsonage et al, 2014), it makes economic sense to make more evidence-based parenting courses available to parents.


References

Bateson, K., Delaney, J. and Pybus, R. (2008) Meeting expectations: the pilot evaluation of the Solihull Approach Parenting Group. Community Practitioner, 81(5), pp. 28-31.

Bonin, E-M., Stevens, M., Beecham, J., Byford, S. and Parsonage, M. (2011). Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study. BMC Public Health, 11(803), pp. 1-9.

Britto, P.R., Engle, P.L., and Super, C.M. (2013). Handbook of Early Childhood Development Research and its Impact on Global Policy. Oxford: Oxford University Press.

Cabral, J. (2013) The value of evaluating parenting groups: a new researcher’s perspective on methods and results. Community Practitioner, 86(6), pp. 30-33.

Douglas, H. (2012). Solihull Approach resource pack: The first five years (5th edn). Cambridge: Jill Rogers Associates.

Douglas, H. (2015). Solihull Approach Parenting. See: www.solihullapproachparenting.com/product/parenting-groupfacilitators-manual/ [Accessed: 8th January 2016].

Elo, S. and Kyngäs, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), pp.107-115.

Johnson, R. and Wilson, H. (2012). Parents’ evaluation of ‘Understanding Your Child’s Behaviour’, a parenting group based on the Solihull Approach. Community Practitioner, 85(5), pp. 29-33.

Lindsay, G. and Strand, S. (2013). Evaluation of the national roll-out of parenting programmes across England: the parenting early intervention programme (PEIP). BMC Public Health, 13(972), pp. 1-17.

NICE. (2013). Antisocial behaviour and conduct disorders in children and young people: recognition and management. London: NICE.

Parsonage, M., Khan, L. and Saunders, A. (2014). Building a better future: The lifetime costs of childhood behavioural problems and the benefits of early intervention. London: Centre for Mental Health.

Scott, S., Spender, Q., Doolan, M., Jacobs, B. and Aspland, H. (2001). Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice. British Medical Journal, 323(7306), pp. 194.

Vella, L.R., Butterworth, R.E., Johnson, R. and Urquhart Law, G. (2015). Parents’ experiences of being in the Solihull Approach parenting group, ‘Understanding Your Child’s Behaviour’: an interpretative phenomenological analysis. Child: care, health and development, 41(6), pp. 882-894.

Zeanah, C.H. (2009). Handbook of Infant Mental Health (3rd Ed). New York: The Guilford Press.

 

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