Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial

Abstract

ObjectiveTo evaluate the effectiveness and cost utility of a universally provided early years parenting programme.DesignMulticentre randomised controlled trial with cost-effectiveness analysis.SettingEarly years centres in four deprived areas of South Wales.ParticipantsFamilies with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control.InterventionThe Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions.Main outcome measuresNegative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures.ResultsThere were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With ‘+’ indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI −1.90 to 3.69); in supportive parenting, +0.17 (95%CI −0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485–46 578) over 5 years and £18 954 (range 11 664–25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up.ConclusionsOur trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains.Trial registrationThe trial is registered with Current Controlled Trials ISRCTN13919732.

Randomised controlled trial evaluating the effectiveness and cost-effectiveness of ‘Families for Health’, a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years

“…27 A RCT of the Family Links Nurturing Programme was completed while the Families for Health trial was in progress. 102 The results have not found evidence of clinical or cost utility for the Family Links Nurturing Programme when run as a universal early-years parenting programme for the 2-4 years age group, although there were contamination issues with the trial. Thus, the parenting programme that the Families for Health programme has as its base is not itself of proven effectiveness under trial conditions.…”

Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective

“…However, it is important to stress that all parenting programmes are not the same, and that the IY is notable, first in terms of its content and processes, whereby there is an extensive training and certification process and ongoing supervision to maintain fidelity, and, second, that independent replications, on which this study is based, uphold the programme developer's findings, which is not always the case for other parenting interventions, for which either the original evaluation by the developers showed no effect (e.g. the Family Links Programme 199 ) or independent evaluations found much smaller effects (e.g. Triple P in Birmingham 119 ).…”

Incredible Years parenting programme: cost-effectiveness and implementation

“…There are a small but growing number of cost-effectiveness analyses of parenting interventions (O'Neill et al, 2013;Edwards et al, 2007;Charles et al, 2011;Simkiss et al, 2013) with some attempt to look at the longer-term effectiveness of these programmes (O'Neill et al, 2013;Bywater et al, 2009;Muntz et al, 2004). This trial would have benefited from a longer follow-up period, although ethically it is considered inappropriate to These reports highlight interventions that provide the best value for money in terms of benefit-cost ratios and return on investment and, as the Birmingham Brighter Futures…”