The research of the Consortium Integration Knowledge Promotion Effectiveness of Parenting Interventions (CIKEO) has provided more insight into the concerns of parents about parenting and the effective elements of parenting programmes. This knowledge makes it possible to provide more demand-driven support for parents and better advice to municipalities.
‘Thanks to our research, we now have a much better understanding of which questions parents have about the parenting of their children’, says Professor of Youth Healthcare Hein Raat, who leads the consortium. For one sub-study, parents completed a questionnaire about parenting at the start and at the end of a one-year period. A total of 1150 parents participated in the so-called naturalistic effect evaluation. Of them, 70% have questions or concerns about the parenting of their children, and 14% wanted advice or expert help.
The vast majority of questionnaires were sent to parents who visited a child health clinic or school physician during the usual contact moments, explains Raat. About 10% were completed by parents who had followed a parenting intervention. Many parents were found to seek information themselves or received advice from the youth healthcare service (Dutch acronym: JGZ). Relatively few parents participated in a special parenting intervention. ‘This random sample of the population of parents gives a good impression of what their concerns are and where they find parenting information: in books, on the Internet or from friends and family.’
A comparison of parents who had or had not received a parenting programme gave an unexpected result. Raat: ‘We could not demonstrate that parents from that first group were doing better than parents who had not followed the parenting programme, and neither could we demonstrate that their children had fewer problems. However, the parents who had followed a programme were highly satisfied and stated that it had helped.’ The fact that parents seek help, does underline the severity of the problem, thinks Raat. That is possibly why the researchers could not demonstrate a difference between both groups.
Marlinda Stam participated in the naturalistic effect evaluation as a youth care doctor at Jong JGZ (previously Rivas-Careyn). She was struck by how many parents had a need for advice or had questions. ‘Setting boundaries was by far the biggest problem among parents who had questions but did not really need support. Among parents who needed support, the problems had more to do with tantrums and aggression. This ties in with what we see during consultations.’
The JGZ professionals also completed questionnaires. This revealed that they most often gave advice about nutrition. Stam: ‘That gives me the feeling that we need to connect even more with the concerns of parents and be more cautious about offering the advice that we think parents need. Meanwhile, we are now working in a more demand-driven manner throughout the country. The results of our research support the need for this.’
Marlinda Stam: 'We need to connect more with the concerns of parents and be more cautious about offering the advice that we think parents need.'
The JGZ advises municipalities about the parenting programmes that they can purchase and therefore wants to know which programmes are most suitable and when. Researchers from CIKEO have therefore now produced two decision trees. Professionals can use these in their advice to parents and municipalities. ‘In these decision trees, we analyse the problems in a demand-driven manner and therefore based on what the parents or the family need. We link that to an appropriate provision or programme’, explains Raat. Two variants of the decision trees have now been submitted to JGZ professionals. Their feedback will be used to further develop these instruments.
The consortium is also investigating whether it is possible to consolidate the number of effective parenting programmes or interventions in the Databank Effective Youth Interventions (Dutch acronym DEI) from the Netherlands Youth Institute. However, that proved not to be feasible. Most parents receive their parenting advice from the JGZ, explains Raat. The JGZ therefore provides important support, but their advice is not a parenting intervention like the ones included in the DEI. However, the same effective elements are found in many of these interventions. That was clear when the researchers analysed the effects of parenting programmes in the Dutch and international literature. For example, group interventions were found to be effective, as equally effective elements like setting targets and planning, practising and repeating behaviour.
In the overview of effective elements and group interventions, explanations about the consequences of parents’ parenting behaviour and feedback on dealing with their child also score high, notes Stam. ‘We also see that in our targeted parenting consultations and in an intervention like video home training. I think we should emphasise such strong points of interventions and make use of these.’
With insight into which elements are more or less effective, you can select existing interventions, refine these and make these more flexible by working with small modules, says Raat. ‘That is possible due to the thinking in terms of effective key elements that ZonMw has stimulated. This is a departure from the traditional approach of realising programmes with a completely proven effectiveness. As a result of this, we can combine key elements from interventions, strengthen existing programmes or, where necessary, develop a new programme more easily. That is a considerable gain.’
Hein Raat: 'Thanks to the analysis of effective elements, we can now combine elements, strengthen existing programmes or develop a new programme more easily.'
This spring, thanks to a contact established by ZonMw, Raat could present the research results to the Ministry of Health, Welfare and Sport programme Promising Start, which includes parenting support. Soon everybody will be able to get to know the extensive research findings of CIKEO via a concise brochure. Municipalities, professionals and researchers can make good use of this information. ‘The results from CIKEO stimulate demand-driven working based on effective elements. That is a major step forwards’, concludes Stam.
In the consortia Effectiveness of Psychosocial Interventions Youth, researchers and youth care organisations are exploring new possibilities for seven larger substantive themes related to growing up and parenting. The research provides knowledge about which (aspects of) interventions can best be used when, for who and by which persons. The key elements of interventions with proven effectiveness are the starting point for these interventions. Through innovative impact studies, the consortia provide answers to questions such as: What actually makes an intervention effective? Are there effective factors that can be found in all interventions? How can the care provider exert an influence on the impact? And: which interventions or aspects of these are cost-effective? Realising impact studies in an appropriate form is a challenge. Each consortium takes a different approach, but they work together to ensure that their approaches are well aligned with each other. The research from the consortia must improve the interventions and enable professionals and municipalities to choose an effective approach. The outcomes will make it possible to improve the effectiveness of professional practice and provide better help to children and families.
The consortia Effectiveness of Psychosocial Interventions Youth are working on these seven themes:
In the consortia, key elements of interventions will be investigated. But what exactly are those key elements? Key elements are the things that a care provider can do to teach desired behaviour to young people or their parents, guardians or carers. Or to diminish undesirable behaviour. This is given various names in the literature (e.g. components, elements, ingredients, kernels and techniques). We have chosen the term “key element” because this is used by most of the consortia and ties in well with the literature. As it is often not yet clear whether the element actually works, we ought to use the term “potentially effective key elements”. However, that is quite a mouthful. A collection of these key elements defines an intervention. Structural elements also play a role in defining an intervention. For example, the sequence, frequency and intensity of the key elements involved.
CIKEO has done research into the supply of preventative parenting support and into the possibility of consolidating the number of interventions from the Databank Effective Youth Interventions (DEI) of the Netherlands Youth Institute. One sub-study consisted of a cohort study among 1100 parents into the need for and use of parenting support and the effects of this on parents and children. The researchers also used protocols from interventions to analyse the effective elements of these. Using a meta-analysis of the research literature, the impact of these elements in interventions with a demonstrated effectiveness was described and portrayed in a taxonomy. Thanks to a literature study and focus groups in four cities, it has become clearer how parenting interventions can best be implemented and what the impact of these is at population level. Two decision trees were developed to help professionals and parents choose an intervention. The decision trees are being modified based on feedback from professionals.
The studies from CIKEO provided more insight into what works, for who and why with respect to preventive parenting support, the needs for and use of parenting support, and the implementation and impact of such support at the population level. This knowledge can be used to make parenting support as specific as possible. Providers of parenting support and municipalities that purchase interventions can base their approach and policy on this knowledge. Furthermore, the knowledge acquired can be used to combine the most effective elements in a flexible provision. As a result of this, the existing care can be better adjusted to the possibilities of organisations and professionals and to the needs of parents. Gaps or interventions without a clear evidence base can be filled or improved due to the enhanced insight into effective elements. Accordingly, this strengthens the provision of preventative parenting support. Finally, the new knowledge has been used to improve both the initial professional training and the continued professional development.
Text Veronique Huijbregts. Translation Dave Thomas. Photography header Studio Oostrum. Portraits Sannaz Moghaddam.