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Empowerment -
the key to parenting success



Parenting deficits have serious effects on children and society. Some infants suffer needless ill health or even death. Many others experience inadequate feeding and poor stimulation of language and social skills, and learn the meaning of failure at an early age. When such children reach school they are often unable to cope and experience further failure. In adult life they may be unable to find or hold down jobs, they may not have the resources or skills to contribute through taxes and in other ways to society. Ultimately they may fail in their efforts to rear their own children effectively.

Most parents cannot be blamed for these problems. Many are faced with limited income and live in areas of social stress. Few have the help and close support of an extended family, a system which throughout history has helped the young parent to learn the art of parenting, with relatives at hand to take over in times of difficulty. The parenting task is complicated by the fact that society shows little appreciation of the work and sacrifices of parents, while readily criticising their failures. Some parents’ self-esteem is so low that they end up abusing their children.

The failure of professional remediation

In this and many other technically advanced societies, conventional methods of dealing with the mounting level of parenting failure have not succeeded. The health, social and educational professions have been unable to reverse what is a growing human disaster. Almost every indicator points to increasing rather than decreasing social disintegration, despite tremendous and expensive efforts to reverse the trend. Much of this disintegration has its roots in the early years of parenting.

What parents need most of all is support and encouragement in a situation in which they are enabled to take control over their own lives and their children's development. Such empowerment is essential. Support without empowering the parents simply leads to ever greater dependence and reliance on the professional and other helping services. Most of that help is focused on averting family crisis or overcoming developmental delay and damage to the children, rather than assisting the parents to build their parenting capacity.

Parent empowerment as a more effective option

Families with young children tend to make heavy demands on all the services, health, education, fiscal and social. Many of these demands are to be expected in a society aware of its social responsibilities. But there is also a significant and costly part of the service burden that arises because of parenting problems, such as parental unawareness of how to feed their families adequately, how to stimulate the language, mind and behaviour of the developing infants, how to keep the children safe, how to be sensitive to their health and other needs, and how to avoid the gross failure of child neglect or abuse.

In response to this situation a unique programme of parent support and empowerment has been developed during the past quarter century by the Early Childhood Development Centre (ECDC), a small UK voluntary organisation with charitable status. Under the title of the Child Development Programme, the ECDC provides a variety of home visiting initiatives aimed at empowering parents and fostering their child-rearing skills. The programmes exist in various parts of the UK, in the Republic of Ireland and elsewhere. They operate mainly in less advantaged residential areas.

In these initiatives, home visitors - professional, semi-professional or lay - are trained in the programme`s philosophy and strategies. Thus, in addition to their existing skills as professionals, the visitors learn how to empower parents and encourage them to find their own answers to their problems, instead of being handed solutions and advice. The trained home visitors also have access to the programme`s large variety of illustrated informational material, which deals light-heartedly with everyday issues of child-rearing and child care.

Programme options

Over the past quarter century the ECDC`s parent support programmes have helped to empower and inform an estimated 100,000 families, while more than a thousand people - professional and community - have been trained to use these initiatives. Some of the major programmes included in this group are:

Integrated Urban Model     This was developed to take into account the latest structural changes in the National Health Service (NHS) across the UK. It offers to all health visitors within an area the opportunity of training in programme visiting. It is not an easy option from which visitors can pick and choose whether or not to offer empowering visits. Visitors given this training are asked to agree that all the first-time parents on th eir caseload will receive programme visiting during part or all of the first year of life; and that any other families whom they visit, for whatever reason, will be offered programme visits (rather than visits to advise and guide), for up to six months or longer. Programme visits encourage such families to learn how to resolve their own crises.

The Community Mothers Programme (also known as Community Parents Programme)    In this community-based programme, experienced mothers from housing estates are carefully selected and trained to offer support visits to younger families in the same communities. The community parents use the same illustrated resources as professional home visitors, but their visiting strategies differ in that they do not deal in the same depth with health issues. The initial community programme was pioneered in Dublin, where major research studies on its effectiveness were carried out. A number of these programmes exist in the Republic of Ireland, in Northern Ireland and in Australia.

The Parent and Child Empowerment Programme     This model is a new development. The latest NHS changes in primary health care services require health visitors to lead teams of primary health care workers and undertake a variety of group and other public health work, thus reducing sharply their home visiting work. The Parent and Child Empowerment Programme (PCEmP) has been introduced to utilise the many and varied skills of associated primary health care staff such as health care assistants, family support workers, nursery nurses, practice and staff nurses, Sure Start or Children`s Centre team members, and others who work with parents. The associated programme visitors have the same intensive training as the health visitors, and have access to the same illustrated resources. There is provision for health visitors to be trained as programme visitors within the same initiative.

Unique features of the Child Development Programmes

These programmes are all based on home visiting, and are usually targeted on areas of greater need. There is a simple visiting protocol in which parents and home visitors explore issues such as health, development, diet (both the children`s and parents`), and self-esteem. The parents are encouraged to set themselves developmental, dietary, health or other tasks to carry out with their children in the coming month. This approach contrasts sharply with conventional home visits in which there are no mutually shared agendas, where the visitor is clearly in control, and where parents` targets are suggested by the visitor in the hope that the parent will comply.

In addition to the friendly forms used during a visit, the programme visitors select from a wide range of cartoon like material. They choose several cartoons in advance of each visit, to give to the families as information on topics of health, nutrition, language, social or cognitive development. Once a programme has been set up and the training completed within an area, the authority`s own trainer helps to maintain the momentum of the work.

The programmes are as much of a challenge to the parents as they are to the home visitors. The conventional dependency relationship is replaced by one of independence so that parents learn to seek the services they need rather than rely on expensive service personnel to map out their lives for them. The long term consequences of these programmes could mean not only a diminution in parent and child demands for crisis services but also a strengthening of communities.

Results show significant effects

Evaluation has always been an important feature of the programme. In the first four years of the programme a randomised controlled intervention study was undertaken on a sample of over 1,000 families, comparing intervention and control parents and children. Using a team of researchers, nutritionists and statisticians, comprehensive statistical analyses of the changes in the parenting environment and child outcomes were undertaken. These showed a considerable degree of achievement as a result of this programme. Its success was attributed by those taking part to several factors:

Among the positive findings of the various evaluation studies are the following:

Health changes    Rather than concentrating on a few health goals such as immunisation, an approach which can at times be counter-productive, the programme aims to persuade parents to take responsibility for all areas of their children`s health care. An evaluation of immunisation levels in a number of health authorities, prior to the introduction of incentive schemes, showed that immunisation rates in key disadvantaged areas were increased from as low as 50 to well over 95 per cent. A study on 10,000 children in Belfast pointed to many positive changes in child hospitalisa¬tion and other factors, comparing intervention and control families.

Nutrition changes    In-depth studies of the nutritional status of infants and young children in disadvantaged samples in West Glamorgan and Dublin (two of the six areas where the initial study was undertaken) showed that after weaning, the quality of most children`s diets normally became seriously deficient, especially in micro-nutrients. By offering nutritional information at a practical level, parents were helped to realise that preparing simple dishes was not complicated or expensive. The programme`s original research studies in those areas and later in Belfast showed consistent improvements in the quality of children`s diets as result of the visiting, compared with controls.

Language, social and early educational changes    Many of the results from the intervention phase showed that there were meaningful changes in the level of stimulation in the home as well as in the children themselves. Intervention children up to three years showed greater concentration and better social behaviours than comparable control children. In many homes where no books or newspapers were normally present it was found that by the end of the programme, young children`s story books were being brought into the home and used; it was also found that many young pre-schoolers had been taught by their parents to read simple environmental words.

Child Abuse    A detailed study of 31,000 families who had been involved in the Child Development Programme showed that, several years later, levels of physical abuse had been reduced by 50 per cent and placement on the Child Protection Register by 40 per cent, compared with families in surrounding areas. This is believed to be one of the highest reductions in abuse rates achieved in any major programme targeting families in disadvantaged areas.

The results of the ongoing field programmes are being evaluated in some areas with the aid of a specially designed Early Health and Development Monitor. This monitor, a relatively simple document, has been created to enable home visitors to evaluate the effectiveness of all forms of home visiting on children`s health and development (programme or non-programme). It records a wide variety of indicators of health, nutrition, language, social and early educational development. The latest version of the Monitor automatically provides colour charts to illustrate the analyses, together with extensive tables for those wishing to write more detailed reports on what has been achieved.

Several major reports have been produced in association with the health authorities or boards where the Monitor has been used for a number of years. These as well as the evaluation reports from the original research are available from the Early Childhood Development Centre.

Training for the CDP

A special in-service training programme has been developed for preparing visitors to do programme visiting. This requires only three hours each month for a year; much of the training is concentrated on reviewing the effectiveness of the programme visits made by each visitor. The programme trainers also go on accompanied visits with the visitors to observe and help them improve their visiting strategies.

Highly experienced health visitors who have themselves had a long involvement as programme visitors have been employed as regional trainers in the Centre`s programme team.

Administrative adaptation

Unlike many changes in health and social service strategies, the Child Development Programme does not require the use of additional staff. Health visitors are helped to reprioritise their work so that empowering and structured support is offered to all first time parents and other selected parents who find difficulty in coping. It is based on the principle that support before problems arise or as soon as they are identified is far more effective and less costly than trying to deal with crisis situations. Prevention and development during critical periods of early parenting are more likely to result in adequately coping parents, than intensive therapy once matters have gone seriously wrong./p>

Apart from the initial training costs, mainly in the first year, with reduced costs in the next two years, the ongoing costs of the programme are minimal, relating mainly to monitoring the field training of staff and the procurement of cartoons, forms and other resources. The total training costs over the three year period are about half the overall costs of employing one professional for one year. As the training is essentially in-service, programme visiting of families starts within a few months of the first training session.

Long-term effectiveness

It is hoped to establish, in the long-term, that this method of encouraging parents to take full responsibility for the health, nutrition and development of their young children, will result in significant reductions in the level of costly intervention. Attempts to minimise ill health, poor socialisation and educational failure in older children and teenagers are expensive and often unsuccessful. The Child Development Programme is a workable alternative because it is much cheaper than crisis intervention and is based firmly on using the parents` own skills and resources in the earliest years of child-rearing.

Conclusion

The overall conclusion from this brief review of the Child Development Programme is that the various programmes offer a powerful method of supporting parents at the most vulnera¬ble stage of their lives. The methods used have been refined in the light of a quarter century of experience with thousands of families, and aim to place as much responsibility as possible in the hands of the parents, with service personnel (or locally recruited parents) in a support and monitoring role. It is hoped that the programme will encourage commu¬nity health, social and other services to give more recognition to people`s self-help potential, enabling those services to make more sensitive and more economic use of the skills of their own professionals, para-professionals and community parents, by empowering families and their communities.

Dr. Walter Barker, BSc, MA, PhD

Director, Early Childhood Development Centre

82a Gloucester Road, Bristol BS7 8BN, U.K.

ecdc@ecdc.org.uk    www.ecdc.org.uk

References (more detailed lists of the Centre`s publications are available on request)

  1. Barker, W E and Anderson, R. (1988) The Child Development Programme: an evaluation of process and outcomes.  ECDC, University of Bristol
  2. Barker, W E (1991) Empowering parents - the evolution, expansion and evaluation of a program.   Zero to Three, National Center for Clinical Infant Programs, Arlington
  3. Johnson, Z., Howell, F. and Molloy, B. (1993) Community mothers` programme: randomised controlled trial of non-professional intervention in parenting.  British Medical Journal 306 29 May 1449-1452
  4. Barker, W E, Anderson, R A and Chalmers, C. (1994) EHSSB: health trends over time and major outcomes of the Child Development Programme.  ECDC, University of Bristol, and Eastern Health and Social Services Board, Belfast
  5. Barker, W E, Anderson, R A and Chalmers, C. (1992) Child Protection: the impact of the Child Development Programme.  ECDC, University of Bristol
  6. Johnson, Z, Molloy, B et al (2000) Community Mothers Programme – seven-year follow-up of a randomised controlled trial of non-professional intervention in parenting.   Journal of Public Health Medicine, 22, 3 337-342


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