Barriers and facilitators in the delivery of a proportionate universal parenting program model (E-SEE Steps) in community family services

Abstract

Background A proportionate universal (PU) approach to early years’ service provision has been advocated to improve children’s health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three “steps”—one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs). Methods An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions. Results The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents—particularly those with low mood—taking up the targeted programs. Service providers struggled to align the PU model with their commissioned service contracts and with their staff capacity to engage appropriate parents, including tackling common barriers to attendance. Conclusions Despite general enthusiasm and support for delivering high-quality parenting programs in community services in the England, several barriers exist to successfully delivering IY in a proportionate universal model within current services/systems.

Predictors of Mother and Infant Emergency Department Attendance and Admission: A Prospective Observational Study

“…This study was a planned and approved observational sub-study of the E-SEE Steps randomised controlled trial (Bywater et al, 2022a ) which included a trial (Bywater et al, 2022b ), process evaluation (Berry et al, 2022 ) and economic evaluation (Cox et al, 2022 ) where further information and detail about the measures, methods and findings can be found. The STROBE guidelines for reporting observational studies have been followed.…”

A quasi-experimental effectiveness evaluation of the ’Incredible Years Toddler’ parenting programme on children’s development aged 5: A study protocol

“…Prenatal attachment (Prenatal Attachment Inventory) Continuous [10,11,41] Prenatal Depression (PHQ-9) Continuous [10,11,41,42] Prenatal Anxiety (GAD-7) Continuous As above Ethnicity Categorical [10,11,30,41,43] Socioeconomic position (financial security) Continuous [30,42,[44][45][46] Speaks English Binary [30,46] Immigration status (proportion of life spent in UK) Continuous [30,47,48] Length…”

Is it feasible to nest a Trial within a Cohort Study (TwiCS) to evaluate an early years parenting programme? A Born in Bradford’s Better Start study protocol

“…Finally, previous RCTs of parenting programmes have suffered poor take up and attendance of the intervention, particularly for parents in disadvantaged areas, and parents with a higher level of need (e.g. due to low mood) (23,24). We therefore need to test the rates of participation and completion of the intervention to inform the feasibility of a larger evaluation, particularly in a disadvantaged setting.…”