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First evaluation of the
Parent and Child Empowerment program

Background

The Parent and Child Empowerment Program (PCEmP) was initiated and developed by staff at the Maden Centre in Bacup, Lancashire - a Sure Start / Children’s Centre project - in collaboration with staff at the Parent and Child Empowerment Organisation (PCEO)) in Bristol. The program is based on the concept of empowering and supporting parents, using strategies that have also been developed nationally in a number of other PCEO parent support programs during the past quarter century. In the PCEmP the program workers, known as Program Visitors, are trained in an in-service initiative to offer parents semi-structured support and encouragement, enabling them to resolve most of their own parenting problems.

Fuller details of the program are available from the PCEO or the Maden Centre.

Members of the first cohort of six visitors started their year’s training early in 2005. Organisational and other delays meant that the training was only completed by late 2006. One of those trained (one of the authors of this report) was selected to become coordinator and trainer, and underwent extended training in 2007. The second cohort was assembled late that year. Because of promotion and movement to other posts, only three of the original six program visitors are still involved. The new cohort of seven people, drawn from nursery nurses, family workers, outreach workers and other para-professional staff, is well on its way to completing training.

The original manager and co-creator of the new program (one of the authors of this report) has been promoted to other work, but retains an interest in and oversight of the program, in liaison with a new program manager. Both the original and the new managers are health visitors with a range of other responsibilities. Staff from the PCEO provided the training of the first cohort as well as that of the new program trainer. The latter has now taken over training responsibilities, with ongoing support from the PCEO.

Evaluation

An evaluation questionnaire was developed by the original program manager at the Maden Centre, in consultation with the PCEO. A shortened form of this questionnaire was used with the first 42 families to have completed their program visits. While the program is intended to be used for up to a year of monthly visits with any one family, some families receive longer support where this is indicated; other families stop before the end of the year because the mothers take up jobs or the families move elsewhere.

In general the responses provide evidence of a positive and successful program. The data were analysed using Excel. Because of the relatively limited number of families involved at this stage, the analyses were confined to quantitative summaries of the evidence. There is also a wealth of other qualitative evidence from the program visitors, including highly positive comments from the program parents. Most parents were initially dubious as to whether a visiting program which placed much of the responsibility for change in their own hands, could be of much interest or enjoyment to them. However the reality of the visiting brought an end to the doubts and it is expected that in future years the number of parents refusing the offer of program support will be reduced to a few isolated cases, as the program becomes more widely known in Bacup and surrounding residential areas and in other areas where the program is adopted.

Basic data on the families and visits

A total of 42 families who had completed the program were asked for their responses to the shortened questionnaire. Of this total, 41 forms were usable, though some data were missing. (One of the forms had so many non-responses that it was not considered worth including it in the analyses.)

Each family received a preliminary ante-natal or introductory visit to explain the purpose of the visiting and obtain the family’s agreement to the proposed visiting. The number of program visits is the total of those visits in which forms and cartoons are used. The 41 families received an average of just under 9 program visits, mostly at monthly intervals. The longest period of support continued for 21 visits, to a family in considerable difficulty. The shortest period of support was for 1 visit; normally that would not be included in an evaluation, as at least four to six visits are needed to help families bring about reasonable change, but in this case the mother was able to boast that as a result of that first visit she had at last started feeding herself properly, with breakfast and two other meals during the day.

Of the 41 families who completed the program and the evaluation, 5 left to return to employment outside the home. One parent left to look after a sick relative, while one other parent did not give any reason for stopping.

Regarding family composition, 23 of the 41 (56%) had fathers living with the families. Of the remainder, 11 fathers were absent (27%) and five fathers were only occasionally present. The mothers did not give any information on two of the fathers.

Positive changes in the families

There were an encouraging number of positive changes in the families, and no negative changes in the sample as a whole.

At the start of the visiting program only four mothers had any involvement in commuNity activities; by the end of the visiting a total of 21 mothers reported that they were now participating in some level of community activity. Only one mother reported that she was now less involved in the community.

There were few changes in work status as a result of the program, with five mothers employed outside the home and the remainder working mainly with looking after their children.

The library results were particularly satisfying. By the end of program visiting the number of mothers who were members of the library had risen from 17 to 26 (63%); persuading an additional quarter of the sample to join and use the library. Altogether 56% of the families had also enrolled their infant children in the library. These results were seen as really encouraging, indicating that the program had helped to widen the educational world of both mothers and children.

The finding of a much increased library membership was born out by the fact that whereas only 21 of the 41 homes (51%) had visible books at the time of the first evaluation, the total with visible books had risen to 38 (over 90%) by the end of the program. The number of mothers who sang nursery rhymes to their children had likewise risen, from the relatively small number of 14 at the initial evaluation to 33, a more than doubling, at the end of the program.

Mothers’ lifestyles and confidence

The lifestyles and confidence of the parents, particularly the mother, are major contributors to the quality and outcomes of their child-rearing. This study focused on the mother, as she is usually the key figure in that role.

Smoking figures showed only limited progress in reducing levels. The number of mothers smoking rose from 22 at the start to 23 at the end. However one of the smokers had stopped altogether and the number of heavy smokers had dropped from 8 to 5. It can be claimed, with some justification from the experiences of those involved in visiting families in areas of social stress, that for many mothers smoking brings some psychological relief.

The number of mothers receiving medication for depression or anxiety (20 at the start) hardly changed during the program, with 3 coming off medication and 2 being put on to it..

However, while 26 initially reported feeling tired most of the time, this had reduced by nearly half to 14 at the end of the program; those reporting the experiencing of frequent headaches had dropped from 14 to 9, while those saying that they did not want to go out and meet people showed the highest change, dropping from 12 to 4. These three questions are among the key items identified by Professor George Brown in his research on maternal depression, as indicating a state of depression. On the other hand, mothers who reported feelings that their lives were generally under their control had increased from 26 to 31 during the course of the program.

Nutrition and health

Parents’ nutritional habits have a long-lasting influence on the nutritional habits that their children develop; on the one hand it can be expected that parents are likely to feed their children in much the same way as they feed themselves, and on the other hand the children’s memories of how they were fed by their parents is likely to influence the children’s dietary habits into the adult years.

Mothers were asked whether they ate breakfast and two other meals each day. Whereas only 12 (just below 30% of the whole sample) said that they ate those three meals, by the end of the program the total was 23 - a rise to 56%. The number of mothers cooking food in the home had also risen, from 22 (54%) to 28 (68%) during the same period.

The evaluation also looked at how the infant child was fed. Only 9 mothers breast-fed (less than a quarter of the sample), but on average they breast-fed for nearly 12 weeks. Some three-quarters of mothers fed formula milk, while 4 (one-tenth) reported feeding dairy milk at an early age.

The evaluation looked at three aspects of child health - clinical check-ups, immunisation levels and accidents. A total of 23 (56%) had had been for all their clinical check-ups by the time the program had ended, 16 (39%) reported nearly all their check-ups having been done, and only 2 replied ‘some’.

The immunisation figures were even better. Here a total of 28 (68%) had all their immunisations by the end of the program, 11(27%) had most of their immunisations, and again only 2 reported ‘some’.

Only two parents reported their child having had an accident. This is a difficult question to ask, and even more difficult to know if the answer is correct, because of parental suspicions that even reporting a genuine accident can raise official doubts about the quality of their parenting care.

When mothers were asked how much they felt in control of their children, one-third stated that they felt in control all the time, over one-half said they were only ‘sometimes’ in control, while two reported ‘never’.

They were also asked how much time they found to play with their children. The proportions answering this question were much the same as for the previous question. One-third said they played a lot of the time with their child, over one half said they only played ‘some time’ and just two reported that they gave hardly any time to play with their child.

It was interesting to note that there appeared to be quite a close relationship between the answers given to the two questions. Three-quarters of the sample gave similar answers, in that parents finding a lot of time to play also felt in control of their child all the time, whereas those feeling in control only some of the time also played only ‘some time’ with the child. In only one quarter of the sample did the answers differ between the two questions. This suggests some relationship between playing with the child and feeling in control, although it would need further study to confirm that this was not just a response artefact.

Conclusion

The conclusion from this first evaluation of the Parent and Child Empowerment program (PCEmP) is that a considerable variety of positive changes in the parenting situation have been brought about by the program visits.

To summarise:

  1. At the start of the program only a handful of mothers had any involvement in community activities. By the end just on half the mothers had become involved.
  2. Library usage rose considerably during the program, with library membership rising from 41% to 63%, with 56% of the young children having been enrolled by their mothers; there was also a doubling in the number of mothers who sang nursery rhymes to their children (from 14 to 33).
  3. Smoking was the only area of disappointment, with the number of smokers rising from 22 to 23; a positive note was that the number of heavy smokers had dropped from 8 to 5 during the program period.
  4. Questions identified by a leading psychiatrist as strongly indicative of maternal depression showed a satisfying reduction over the program period; out of the sample of 41, mothers ‘tired most of the time’ dropped from 26 to 14, those reporting ‘frequent headaches’ dropped from 14 to 9, and those stating that they ‘did not want to go out and meet people’ had reduced from 12 to 4.
  5. Mothers with reasonable dietary intakes nearly doubled during the program, from 30% of the sample at the start, to 56% at the end; the number of mothers now cooking food in the home (rather than just warming it up or buying take-aways) rose from 54% to 68%./li>
  6. It was not possible to report before and after figures on child immunisation and clinical check-ups, but indications were that all but two of the target children had had all or nearly all their check-ups, and likewise all but two had had all or nearly all their immunisations.
  7. An interesting finding was the close agreement, in three-quarters of the sample, between the levels of mothers playing with their child and the levels of control that the mothers felt they had with their child.

These and possibly other improvements that were not recorded, have been brought about in families faced with considerable challenges and social stress, using a visiting program that is powerful in its ethos and yet low cost in terms of visitor time - with an average of only nine monthly visits and one preparatory visit to each family. Only 23 (56%) of those families had fathers living permanently in the home. The residential areas are characterised by disadvantage and high unemployment following the long-term decline of the area’s cotton mills and shoe-making factories.

It is reasonable to expect that in this program the reported changes in the parents would be likely to persist for the rest of their parenting years, given that it was the parents’ own decisions to make those changes. This contrasts with the situation in many other intervention programs where staff are trained to target the children and attempt to lead and guide the mothers’ actions; in such programs it is often found that changes in parent and child outcomes are relatively short-term.

The principle underlying the PCEmP and similar programs from the Parent and Child Empowerment Organisation (PCEO) is that the prime focus of support and intervention should be on the parents themselves, aiming to empower them and enable them to work out their own ways forward in dealing with the challenges of child-rearing.

Authors: Walter Barker, Director, Parent and Child Empowerment Organisation (PCEO), Bristol;    Judith Mace, Health Coordinator/Manager, East Lancs Teaching PCT;     Audrey Coulton, Coordinator, Parent and Child Empowerment program, Bacup.     program and data collection based on the Maden Centre, Bacup.     Analysis undertaken at the PCEO, Bristol.

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