• By Dartington SRU
  • Posted on Monday 14th May, 2012

A small step toward EPEC success?

Most parents would probably agree that few things are more annoying than being told you need to improve your parenting skills. It is especially annoying when the person telling you is a complete stranger who knows nothing about you or your children. The advice is simply more palatable if the person giving it knows something about the circumstances under which you have to parent. At least that is the theory behind Empowering Parents, Empowering Communities (EPEC), a new, peer-led parenting support intervention. EPEC is a community-based program developed by clinician Crispin Day and his colleagues at the South London and Maudsley NHS Foundation Trust. The program aims to improve parenting and child behavior among families living in underserved areas by training local parents as “peer facilitators.” As Day and colleagues say, “Evidence-based parenting interventions are often under-utilised in mainstream mental health services by families from socially disadvantaged and black and minority ethnic communities.” Their newly-released results of a pilot evaluation suggest the EPEC model may be an effective and acceptable way to reach these otherwise hard-to-reach parents, although high drop-out rates are still a concern. The elements of EPECEPEC trains local parents to lead parenting groups in their own communities, aiming to provide cost effective and accessible help for families whose children are experiencing behavioral difficulties. The program includes two components: a Peer Facilitator Training course and the Being A Parent (BAP) intervention. The Peer Facilitator Training course lasts about 10 weeks. Participants learn the techniques they will need to support other parents in building their parenting skills, and they also work on how to manage group dynamics and how to identify if a child may be in danger. Support and supervision continues after the coursework ends, and parents who complete the training course receive an accredited qualification.The trained peer facilitators go on to lead Being a Parent (BAP) groups. The BAP program is designed for caregivers of children aged 2-11 years in poor communities. It aims to improve parent-child relationships, reduce child disruptive behavior, and increase parents’ confidence in their parenting abilities. BAP is delivered over eight weekly two-hour sessions to groups of between 6 and 14 parents. The contents are derived from attachment, social learning, structural, relational and cognitive-behavioral theories and methods, as recommended by clinical guidelines for the treatment of childhood disruptive behavior.Putting EPEC to the testBut would all this theory and program development work in practice? Would parents be willing and able to serve as peer facilitators? Would parent participants like the intervention? And would EPEC have the hoped-for impacts on kids’ behavior and parents’ stress? Day and colleagues are looking for these answers by putting EPEC to the test in a large study that includes both a randomized trial and qualitative feedback. In the meantime, they have published the results of a smaller pilot study that helped inform the larger one. The early results are promising, but concerns remain about drop-out rates. A third of enrolled parents dropped out before the program finished.First, Day and colleagues wanted to know if it would be possible to recruit and successfully train local parents to serve as facilitators – and it was. “Considerably more parents enquired about and applied for places on the program than could be trained,” say the authors. In the end, 31 parents were recruited and trained, 24 of whom went on to lead BAP groups. Both the facilitators’ knowledge of the BAP program content and their opinions of themselves as group leaders improved, and they reported high levels of satisfaction with their training. Next, Day and colleagues wanted to know if BAP would be acceptable to parents and, importantly, if it worked. The results were mixed for these questions. Although parenting groups were in strong demand within the local community and viewed positively by those parents who completed the BAP program, there was, nevertheless, a substantial proportion of parents who dropped out of the program prematurely. 78 parents were enrolled into BAP groups. Five of them dropped out before the groups began and 25 more dropped out before the groups ended. On the positive side, the overall satisfaction of the 48 parents who stayed was “very high.” Parents stated that they were more confident and had better relationships with their children. They also reported significant improvements in child behavior and a small number reported a reduction in their parenting stress. These results leave Day and colleagues hopeful. They note that subsequent stages of the EPEC evaluation, including a randomized controlled trial and qualitative study of peer facilitators’ experiences, will be published in due course.**********Reference: Day, C., Michelson, D., Thomson, S., Penney, C., & Draper, L. (2012). Innovations in practice: Empowering Parents, Empowering Communities: A pilot evaluation of a peer-led parenting programme. Child and Adolescent Mental Health, 17(1), 52-57.

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