Research Brief no.1 2006
Child abuse prevention: what works?
The effectiveness of parent education programs for preventing child maltreatment
National Child Protection Clearinghouse.
Published by the Australian Institute of Family Studies
ISSN 1833-7074 (Online)
The purpose of each Research Brief from the National Child Protection Clearinghouse's Child Abuse Prevention: What Works? project is to document research concerning the effectiveness of different types of child maltreatment prevention programs. Child Abuse Prevention: What Works? project is comprised of six individual papers, which are based on research undertaken for the Child Abuse Prevention Issues Paper no.24 (Holzer, Higgins, Bromfield, Richardson & Higgins, 2006). The types of programs detailed in the project are: parent education programs; home-visiting programs; personal safety programs; community-focused programs (for example, universal media campaigns); therapeutic programs for children; and family preservation programs.
The following paper concerns the effectiveness of parent education programs in preventing child maltreatment. The authors begin by providing a brief background to parent education, followed by a more detailed exploration of the components of an effective parent education program. The paper also includes specific parent education program evaluations conducted in local and international settings. For a detailed discussion of the different types of child abuse prevention programs (primary, secondary, and tertiary) and their evaluation, see Child Abuse Prevention Issues Paper no. 24, (Holzer, Higgins, Bromfield, Richardson & Higgins, 2006).
The term primary research refers to the original collection of data, whereas the term secondary research relates to the synthesis and analysis of data that have already been collected. In the case of secondary research, the data may have been collected by another source and possibly for another purpose (Esterberg, 2002). This publication is based on secondary research. Specifically, this paper represents a systematic review of existing research publications in which the effectiveness of child abuse prevention programs were evaluated. The use of systematic literature reviews (or meta-analyses) to determine the nature and extent of the research evidence base in specific areas are widely used in other Western nations (for example, the Cochran's and Campbell collaborations). For further information on conducting systematic literature reviews see Gough and Elbourne 2002).
Parent education programs are based on the premise that interventions that promote caring, consistent, and positive parenting are central to creating safe and supportive environments for children (Sanders & Cann, 2002). Research has documented that the risk of child maltreatment is heightened when parents lack necessary child rearing skills, social supports, and knowledge of child development (Tomison, 1998). Thus, parent education programs are designed to:
- increase parental knowledge of child development
- assist parents in developing parenting skills
- normalise the challenges and difficulty inherent in parenting (New South Wales Child Protection Council, 1995; Sanders, Markie-Dadds, Tully, & Bor, 2000).
Parent education programs operate on a number of levels. For example, some interventions operate at the community level (such as the Australian Childhood Foundation's 'Every child is important' campaign), whereas other interventions adopt a direct approach in working with individuals or groups (such as, the Triple P-Positive Parenting Program) (Australian Childhood Foundation, 2004; Sanders, Markie-Dadds, Tully, & Bor, 2000). Despite these differing approaches, all parent education programs are thought to assist families primarily by increasing parental knowledge and reducing parental stress. Parent education programs achieve these results by training parents in behavioural management techniques, problem solving, and personal coping skills (Tomison, 1998).
Policy makers and service providers began to embrace parent education programs in Australia in the late 1980s. At first, Australian service providers adopted existing parenting programs from other countries. Since that time, an increasing number of Australian programs have been developed and a growing number of overseas programs have been adapted to suit the Australian context (Tomison, 1998).
At present, parent education programs are an essential component of early intervention with at risk families (Tomison, 1998). However, until recently, few rigorous outcome evaluations had taken place. Tomison noted that in the absence of such research, the overall success of parent education programs in preventing child maltreatment was unclear. However, more recent audits of evaluative research indicate that progress has been made in these areas (Tomison & Poole, 2000).
Parent education programs emphasise the development of parenting skills and competence, and aim to achieve the application of these attributes to various care-giving contexts (Tomison, 1998). In order to determine the effectiveness of parent education programs in achieving these ends, a systematic literature search was conducted to retrieve parent education program evaluations.
As parent education programs are often a component of other types of prevention strategies (such as family support and home visiting programs), the parent education programs reviewed in the present study were primarily limited to programs that operate independently of other program types. However, evaluations concerning parent education programs, which feature as components of other program types (for example, as components of a composite home visiting program), were included when they evaluated the distinct contribution of the parent education intervention.
Parent education program evaluations were included in the present study if they met all of the following inclusion criteria:
- evaluated a program designed to prevent or treat some aspect of child maltreatment
- evaluated the impact or outcome of a particular prevention program or programs
- were methodologically rigorous (for example, included a control group, measured impact/outcome variables pre- and post-program); and
- were conducted from 1990 onwards.
The databases searched in order to retrieve published evaluations were: ERIC (Educational Resources Information Centre); AF&SA (Australian Family and Society Abstracts); PsychINFO; Australian Education Index; Child Abuse, Child Welfare, and Adoption; and Sociological Abstracts. The search terms used were: 'parent education program' and 'child abuse'. In total, 148 articles were retrieved. However, only 20 articles concerning parent education program evaluations met the inclusion criteria for the present study, 3 of which were meta-analyses.
Of the 20 articles sourced for this paper, 18 reported successful results following participation in a parent education program. Results included:
- fewer incidents of child maltreatment (however, only a small number of studies directly measured this outcome)
- a reduction in the prevalence of negative/unhelpful parenting attributions (for example, a parent attributing a child's behaviour to malicious intent)
- a greater ability to use positive/productive discipline strategies rather than punitive strategies
- increased parental competence and self-efficacy
- greater parental knowledge/awareness of child development, risk factors for maltreatment, and child outcomes following abuse and neglect (see Tables 1-20 in the Appendix).
The parent education programs reviewed in the articles sourced for the present paper are included in the tables in the Appendix:
- the Nurturing Program (offered by SAFEchild in the USA, see Table 2)
- the ESPACE Program (Canada, see Table 3)
- the Parent Education Program for Teen Mothers (USA, see Table 4)
- the Multilevel Selected Prevention Program (USA, see Table 5)
- the Child Parent Enrichment Project (USA, see Table 9)
- the Systematic Training for Effective Parenting Program (Canada, see Table 10)
- Project 12 Ways (USA, see Table 11)
- the Triple P-Positive Parenting Program (Australia, see Table 12)
- the Listen to Children Program (USA, see Table 14)
- the Signposts for Building Better Behaviour Program (Australia, see Table 16)
- the Parents Under Pressure Program (Australia, see Table 17)
- the DePelchin Children's Centre Parent Education Program (USA, see Table 18)
- the Parenting between Cultures Program (Australia, see Table 19)
- the Parent Effectiveness Training program (Australia, see Table 20)
Each program evaluation was analysed according to the location of the program; the aim of the program; the research design/methodology of the evaluation; the measures used to assess the effectiveness of the program; and the overall findings of the evaluation. The results of this systematic analysis are presented in tabular format for each program (see Tables 1-20).
Was the evidence base credible?
The majority of evaluations reviewed in this study documented favourable results following participation in parent education programs. However, these results were based on differing research designs. Some evaluations possessed rigorous research designs, whereas other evaluations were not conducted in such a rigorous fashion (for example, non-randomised allocation to treatment and control groups, the use of retrospective measures which relied on participant recall rather than a 'true' pre- and post-program design).
In addition, most studies did not include outcome measures that directly assessed whether there had been improvements in child wellbeing or a reduction in the incidence of child maltreatment. For example, most studies assessed whether program participation led to attitudinal change such as greater disapproval of punitive disciplinary strategies, rather than directly assessing a program's impact on child maltreatment through, for example, statutory child protection service data or child health data. Thus, although the majority of evaluations of parent education programs had favourable results, the direct influence of parent education programs in reducing the incidence of child maltreatment remains somewhat speculative, as this outcome was generally not measured directly.
What makes a good parent education program?
A successful parent education program:
The Triple P-Positive Parenting Program aims to 'prevent severe behavioural, emotional, and developmental problems in children by enhancing the knowledge, skills and confidence of parents' (Sanders, Markie-Dadds, & Turner, 2003). The Triple P Program has been subject to considerable empirical evaluation and as a consequence is considered to be an example of a successful parent education program (for a detailed description, see Table 12).
Although there are criticisms of each, the key features of successful programs included:
- targeted recruitment
- a structured program
- a combination of interventions/strategies
- a strengths-based approach.
Successful parent education programs specifically targeted families identified as 'at risk' for child maltreatment. In some studies, families were identified as 'at risk' for child maltreatment on the basis of self-report responses on scales measuring parent anger, parent attitude, family stress, and child abuse potential (for example, Bugental, Ellerson, Lin, Rainey, Kokotovic and O'Hara 2002). In other studies, a family's degree of risk was determined on the basis of income, level of parental education, parental age, parental unemployment and the absence of social support (for example, Peterson, Tremblay, Ewigman and Saldana 2003). Most programs identified and recruited families through agency and/or hospital referral or through family self-referral.
As Kelly (2000) explained, targeted recruitment is important to ensure that programs designed to treat 'at risk' families actually identify and service these families. In the absence of targeted recruitment practices, prevention programs may source participants who do not require the use of such interventions (for example, programs which recruit parents largely on the basis of self-referral may not be servicing the most 'at risk' parents). In short, for programs to demonstrate effectiveness in treating 'at risk' parents, they need to effectively target 'at risk' parents. For the most part, the parenting education programs reviewed in the present study, specifically recruited parents 'at risk' for child maltreatment.
The appropriate targeting of secondary prevention programs at populations identified as being at greater risk for maltreatment does not negate the need for universal or primary prevention programs (for a discussion, see Holzer et al. 2006).
Prevention programs are most likely to have a direct impact when targeted at those families assessed as having the greatest need for such programs. However, universal services may be more inclusive and less stigmatising.
Structured programs and length of participation
All of the parent education programs reviewed in this study possessed a clearly defined structure or sequence of intervention. However, there was some variety across programs in the nature and length of participant involvement. For example, some parent education programs encompassed educational workshops over the course of an afternoon, such as Hebert, Lavoie and Parent's (2002) evaluation of the ESPACE parent education workshop. In contrast, other programs consisted of tailored interventions involving ongoing parent participation over several weeks or months, such as Britner and Reppucci's (1997) evaluation of the Parent Education Program for Teen Mothers.
For the most part, the more intense and prolonged programs were more effective than short-term programs in reducing the prevalence of child maltreatment. Thus, Kelly's (2000) observation that the positive impacts of prevention programs are enhanced when treatment regimes are longer rather than shorter is applicable to the present findings. Operationally, 'longer' programs equate to programs with treatment periods in excess of 4-6 weeks, for example, the Multilevel Selected Prevention Program (Peterson, Tremblay, Ewigman, & Saldana, 2003).
All of the parent education programs that were evaluated in the present study possessed a clearly defined program structure, however, programs varied according to the length of parent involvement. Programs offering a more intense and prolonged service tended to be more effective than programs of a shorter duration.
A combination of interventions/strategies
The most successful programs were comprised of a combination of parent education strategies. Programs that included parent skills training, cognitive retraining, child development information, and concrete services, were generally more effective than programs that had a more narrow focus. Programs that focused exclusively on improving parental content knowledge were not as effective as programs that offered a combination of interventions.
Several authors of program evaluations have noted the benefits of combining parent education strategies (for example, education concerning prevalence rates, possible indicators of maltreatment, and child outcomes) with other complementary initiatives such as medical assistance, employment programs, behavioural/skills training, and therapeutic interventions. Although the evidence base was mixed concerning the added benefit of combining basic parent education strategies with complementary initiatives, the majority of papers reviewed in this study supported their inclusion (Britner & Reppucci, 1997; Kelly, 2000; Pecora, Fraser, & Haapala, 1992).
The most successful parent education programs offered a combination of interventions, for example, parent skills training, cognitive retraining, child development information, employment assistance and access to medical care.
For the most part programs that incorporated a strengths-based approach (meaning an approach that identifies parents' existing skills and strengths and builds on these) achieved more positive outcomes than programs that operated from a deficit perspective. MacLeod and Nelson's (2000) study was particularly illustrative of this point. Their meta-analysis revealed that programs incorporating client involvement and a strengths-based approach were significantly more effective than programs without these features (MacLeod & Nelson, 2000). Programs that adopt a strengths-based approach emphasise parental skill and proficiency, rather than focusing on shortfalls. In so doing, programs with this approach aim to further enhance parenting strengths and their application to all parenting/care-giving contexts (for example, the Triple P-Positive Parenting Program).
The adoption of a strengths-based approach in child protection reflects a broader trend in social welfare away from an exclusive focus on 'risks' and 'deficits' (DePanfilis & Wilson, 1996). DePanfilis and Wilson (1996) noted that a strengths-based perspective has become the preferred mode of practice in a number of diverse contexts. However, maltreating families who come into contact with child protection services tend to differ from families often referenced in the strengths-based practice literature. That is, maltreating families and families at greatest risk of child maltreatment tend to be faced with long term, chronic and multiple challenges. It may be more difficult for practitioners and families to identify strengths in these contexts. Similarly, parental risk factors for child maltreatment (such as mental health problems and drug/alcohol use) may exacerbate the difficulty of establishing a trusting and open dialogue with parents. Thus, although a strengths-based approach was favoured in the literature reviewed, the challenges of practicing in this framework with 'at risk' families must be acknowledged.
Parent education programs that adopted a strengths-based approach were more effective than programs that operated from a deficit perspective.
What other issues need to be considered when implementing parent education programs?
As a result of this synthesis of parent education programs, policy makers and service providers have reason to be optimistic about the benefits of these programs. However, it is important to note that the explicit goal of many parenting programs is to enhance competent parenting, rather than to reduce the prevalence of child maltreatment. It is highly likely that, in enhancing competent parenting, parent education programs will reduce the prevalence of child maltreatment. However, given that most programs do not specifically focus on the reduction of child maltreatment, evaluations have not generally employed direct measures of program impact on the prevalence of child maltreatment. Thus, caution should be exercised when attempting to extrapolate from the present findings to direct outcomes concerning the prevention of child maltreatment, as this outcome cannot be unequivocally assumed.
The parent education programs reviewed in the present study improved parenting competence, effectively addressed risk factors for child maltreatment, and in some instances where direct measurements were made (for example, through child protection service data), resulted in fewer incidents of child maltreatment. Thus, on the basis of the literature sourced, practitioners and policy makers have reason to be optimistic about the effectiveness of parenting education programs.
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Appendix: Summary of parent education programs
For a complete list and the full text of the papers see the Research Brief series.