• By Dartington SRU
  • Posted on Friday 31st August, 2012

And now, a big step toward EPEC success

strong>A parenting program delivered by parents to parents in a deprived inner London borough delivers impressive improvements in child behavior, according to a newly published study. Just as impressive, 92% of these so-called “hard-to-reach” parents stuck with the program. Developed by a team of south London clinicians, Empowering Parents, Empowering Communities (EPEC) is an innovative peer-led parenting support intervention specifically designed to reach socially disadvantaged parents. The program aims to improve parenting and child behavior among families living in underserved areas by training local parents as “peer facilitators.” The challenge for EPEC is that the families it targets do not tend to turn to mainstream services for support. “This may be due in part to logistical barriers, such as competing demands and difficulties with transportation, which are especially salient for highly stressed and isolated families,” says the team of EPEC developers. “Negative parental expectancies about treatment, including concerns about the cultural acceptability of conventional parenting interventions, may also hinder initial and subsequent engagement.” It should be of little surprise, then, that around 40% of the parents who agreed to participate in a pilot study of EPEC dropped out before the program ended. (see: “A small step toward EPEC success?” ) But this did not stop the determined EPEC team. They learned from the pilot study and put the program through a more rigorous test. And this tougher test of the program delivered, producing more compelling results and a much higher retention rate. Upping the test of EPEC effectivenessBoth the earlier pilot and the newly released study took place in the Southwark area of London – one of the most deprived local authorities in England. Both studies recruited parents who were seeking help with their children’s problem behaviors. Both studies also used the key feature of the EPEC program: trained peer facilitators who were themselves parents from the local community. The studies differ in an important way: the newly released study was a randomized control trial (RCT), whereas the pilot only compared the “before and after” outcomes for a single group. RCTs are considered the most rigorous method to test a cause-and-effect relationship between a program and an outcome. Participants in an RCT are allocated at random to either receive the program or not. Since everything else is equal, any differences between the groups after one of them receives a particular program can be attributed to that program. Rising to the challengeThe results of the pilot indicated that the model could work, but only for the families who remained in the study. In the pilot, 78 parents were enrolled into EPEC. Five of them dropped out before the groups began and 25 more dropped out before it ended – for a total dropout rate of 40%. The overall satisfaction of the 48 parents who did stay in the pilot study 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.But without a control group, the program developers could not be sure that the improvements were related to the program. For example, it could be that the parents who remained in the study were more motivated to find ways to change their child’s behavior. The results of the RCT indicate, however, that the program itself did play a role in improving children’s behavior and parenting skills among participating families. The families of 116 children were recruited to the trial, and half were randomly assigned to participate in the program. A group of 12 peer facilitators – themselves parents from the local community – were responsible for leading parenting groups to discuss and demonstrate parenting skills aimed at reducing the children’s disruptive behavior. Compared to the parents in the control group, parents in the EPEC group reported significantly less child behavior problems and significantly greater improvements in their competency as parents. Parental stress levels did not differ between the program group and the control group.More than 70% of the families who participated were from black and ethnic minority groups – double the proportion in Southwark as a whole – and participants were more economically disadvantaged than the average Southwark resident.All in all, these findings suggest that a peer-led parenting intervention can reduce behavior problems in children and improve parenting in families characterized by a high degree of socioeconomic disadvantage. Moreover, only 8% of the families assigned to receive EPEC dropped out before the program ended. While the authors do not explain the great improvement in retention compared to the pilot study, the low rate of dropout in this trial suggests that the peer-led approach used in EPEC has the potential to be an effective way to get support to otherwise hard-to-reach families. **********Reference: Day, C., Michelson, D., Thomson, S., Penney, C., & Draper, L. (2012). Evaluation of a peer led parenting intervention for disruptive behaviour problems in children: Community based randomized controlled trial. BMJ, 344. doi: 10.1136/bmj.e1107.

Back to Archives