Validated local practice details

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C4EO theme: Adoption and Fostering

Parenting skills training programme adapted for adoptive families, Coram

Themes this local practice example relates to:

  • Families, Parents and Carers
  • General resources
  • Adoption and Fostering

Priorities this local practice example relates to:

    Basic details

    Organisation submitting example

    Coram

    Local authority/local area:

    London and surrounding areas

     

    The context and rationale

    Background details to your example

    Summary
    A parenting skills training programme for adoptive families developed by Coram and based on the Webster-Stratton Incredible Years programme. It takes account of adoptive families’ particular needs and circumstances.

    Background
    A widespread lack of support for adoptive parents was highlighted by Lowe and Murch (1999) and (post) adoption support was subsequently identified in the Prime Minister’s Review of Adoption (Performance and Innovation Unit, 2000) as a way to prevent adoption breakdown and help families adjust positively. The Adoption and Children Act (2002) and Adoption Support Services Regulations 2005 now place a duty on local authorities to maintain a core set of adoption support services. These should include ‘services to support the relationship between the adopted child and their adoptive parents (e.g. training for the adoptive parents to meet the child’s special needs)’.

    Older children being placed for adoption have often experienced abuse and neglect in their family of origin, frequently followed by changes of carer during a period of foster care (Quinton, D., Rushton, A., Dance, C. and Mayes, D., (1998). Joining New Families: A study of adoption and fostering in middle childhood. Chichester: John Wiley & Sons). They bring emotional and behavioural difficulties into their new families that seem to differ in important ways from the types of difficulty seen in intact birth families and that may require different parenting approaches. This is acknowledged in the Practice Guidance on Assessing the Support Needs of Adoptive Families (Department for Education and Skills, 2005) which states that:

    The particular issues associated with parenting children with the emotional and behavioural difficulties associated with maltreatment, separation and loss need to be addressed through more specialised approaches to developing parenting
    skills.


    Coram has a long history of placing children with adoptive families. Over the last ten years, Coram has worked with the Anna Freud Centre to run a research programme aimed at understanding the complexities of how adopted children’s attachment to their adoptive parents develop, and how to support their new parents in developing their attachments. One particular outcome of this programme has been the Parenting Skills for Adopters training programme which was conceived in order to build upon one of the most widely-used programmes – the Incredible Years programme developed by Professor Carolyn Webster-Stratton – with particular additions and amendments tailored to meet the specific challenges faced by many adoptive families. It was felt that the proven behavioural management strategies of the Incredible Years package would help parents to feel more confident and in control and allow a ‘breathing space’ in which to think about the specific issues related to adoptive parenting.

    Evidence for the model
    Parenting skills training programmes have been shown to be effective for a range of difficulties when used with biological families (see list below for reviews) and offer a framework for the development of adoption support (for example; Gilkes, L. and Klimes, I. (2003). ‘Parenting skills for adoptive parents’, Adoption & Fostering, 27: 1, pp 19–25).

    Barlow, J. (1997). Systematic Review of the Effectiveness of Parent Training Programmes in Improving Behaviour Problems in Children Aged 3–10 Years, Oxford: Department of Public Health, Oxford University;
    Scott, S. (2002). ‘Parent training programmes’, in Rutter, M. and Taylor, E. (eds), Child and Adolescent Psychiatry (fourth edition), Oxford: Blackwell;
    Barrett, H. (2003). Parenting Programmes for Families at Risk: A source book, London: National Family and Parenting Institute;
    Moran, P., Ghate, D. and van der Merwe, A. (2004). What Works in Parenting Support? A review of the International Evidence, London: Policy Research Bureau.

    The Incredible Years parenting programme has substantial evidence of effectiveness in reducing conduct disorder in children and improving parenting competencies. These research studies and evaluations can be found at http://www.incredibleyears.com/library/show_reviews.asp

    Aims
    The Incredible Years parenting programme aims to:
    • strengthen parenting competencies (monitoring, positive discipline, confidence);
    • improve the parent-child relationship;
    • increase parents' involvement in children's school experiences in order to promote children's academic, social and emotional competencies and reduce conduct problems.

    The Parenting Skills for Adopters training programme aims specifically to:
    • improve adoptive parents’ ability to deal with parenting issues;
    • enable adopted children and adults to feel more positive about their background
    • provide adopters with a ‘toolkit’ of strategies to use to encourage positive engagement;
    • provide a forum for peer support.

    The service model
    Parents attended the training at Coram on Saturday mornings for 12 weeks and a crèche with a high staff ratio was provided for their children. This was considered a vital element as it enabled both parents to attend the course and jointly apply the material to their parenting. Each weekly session began with a round-up of how things had been in the previous week for each family and discussion on how the ‘homework tasks’ had gone. The material from the Webster-Stratton course was then covered, with discussion and feedback from parents.

    Evaluation of the courses was undertaken by completion of widely used, validated questionnaires by all parents, before and after participation on the parenting course.

     

    The practice

    Further details about the practice

    How we set up and developed the programme
    The parenting groups for adoptive parents were first run at Coram in 2005 by an experienced adoption support worker trained in Webster-Stratton techniques, assisted by another member of Coram’s adoption staff. A researcher from the Anna Freud Centre sat in during the group sessions, taking notes of the discussions and highlighting issues raised by the parents that were not specifically addressed by the Incredible Years material, but which seemed pertinent to adoptive parenting. Parents were also interviewed individually around the mid-point of each course, and again at the end, to ascertain their thoughts about the relevance of the material to their particular circumstances and to gather ideas about possible additions to the course material. Potential additional material was then discussed among the research group and developed by the group leaders. This material was included in the programme presented to the next group, and so on, in an iterative process over the course of the development phase.

    Four parenting groups were run in this way from 2001 to 2004. Participants (46 parents from 26 families) were drawn mainly from Coram’s Adoption Service but were also referred from the Catholic Children’s Society (Arundel & Brighton, Portsmouth and Southwark) and the London boroughs of Haringey and Hackney, via Great Ormond Street Hospital and the Tavistock Clinic.

    Main adaptations of the Incredible Years programme

    Play
    • Within the standard Webster-Stratton training programme, the issue of play is a central component; the first three sessions of the course are focused on play and helping parents to play in ‘child-led’ ways. The play of children who have experienced maltreatment in their early lives is very different from that portrayed in the Webster-Stratton programme. Parents tended to raise concerns about the levels of aggression, violence, death and catastrophe in their children’s play. They questioned whether this play reflected actual early experiences and were concerned that it was often repetitive and distressing to watch. As a result, the first major adaptation to the material was to explain play and its ‘function’ for maltreated children. The course material was amended to help them understand why their children may be playing in these ways and to assist their thinking about ways to help their children work through some issues in play.
    • The second adaptation also related to the ‘play’ theme. Adoptive parents are acutely aware of how much their children had ‘missed out on’ in early life and this can lead to difficulties. Adopters need help to resist the temptation to use play as a teaching vehicle to help their child ‘catch up’. As a result, greater emphasis was placed on the importance of just ‘being there’ and paying attention to the child’s play, following rather than leading, and limiting the parents’ interference by taking the play over, or using it to show the child ‘how to do it’.
    • Furthermore, because the age range of the children in the Coram groups was somewhat wider than those featured in the Webster-Stratton programme, consideration was given to how to ‘play’ with older children.

    Increasing parents’ awareness of the impact of the child’s early experiences
    • The course was adapted to increase parents’ awareness of their children’s ability to ‘re-create’ experiences from their family of origin within their new family setting, through discussion.

    Regression
    • A specific amendment was made to reflect the needs of adoptive parents whose children had had early experiences of neglect and abuse. As a result, the course was modified to include discussion on why children experience or re-experience infantile behaviours and the benefits of allowing this type of behaviour, and also to enable parents to explore their feelings about this issue.
    • It also gave parents practical tips about what to buy/use as ‘props’ and how to ‘contain’ the behaviours in appropriate settings.

    Praise
    • Children who have felt ‘worthless’ in their family of origin may have particular difficulties accepting praise and may behave in ways that will deliberately disrupt a positive interaction. The focus of this adaption to the programme involved helping parents to develop strategies that allow the child to be praised without this leading to disruptive behaviour.

    Emotional regulation
    The majority of children in the adoption parenting groups have experienced abuse and/or neglect in their original birth families. They have been exposed not only to frightening situations but also have failed to be exposed to the normal ‘regulatory’ soothing and calming interactions with parents which help children gradually learn the skills to self soothe and regulate their emotions when distressed.

    The course has therefore been amended to include discussions around:
    • Parents’ own feelings of anger at being the subject of attacks by their children.
    • How these children have not had experiences in infancy which have helped them develop a system for regulating their emotions, or for any types of self soothing. Parents are encouraged to actively name feelings and sensations e.g. ‘This is your warm, cosy bed’, ‘you must be feeling sleepy’ etc.
    • How the Webster-Stratton technique of using ‘time out’ needs to be instigated when interactions are calm and before situations get to ‘boiling point’ with both children and parents feeling overwhelmed by anger. This needs to be explained to the child at a time when the child is calm, and presented not as a punishment but as the parent’s way of helping the child calm down so that he can manage his behaviour.

    Telling about the adoption
    Some parents are unsure who should know their children are adopted, when people should be told and how much the child should know about their previous life. Discussions have been introduced to address this, including:
    • parents talking about their experiences and an open discussion about how issues of telling about, or contact with birth relatives can be handled;
    • acknowledgement of the fact that these children might have many people called ‘mummy’ and ‘daddy’ in their lives and how this makes parents feel;
    • practical suggestions for celebrating adoption;
    • suggestions from parents about how to make children realise they are constantly in their parents’ thoughts, even if physically separate.

    Other general amendments
    • At the first session, families introduce themselves and talk about their motivations for attending the course. At the same time, they are encouraged to exchange ideas about where they have accessed help for their children.
    • Information is provided to parents about how to claim disability benefits in cases where their children need relevant extra support.
    • Parents are given a reading list of each weekly topic so that they can explore issues in more depth if they wish.
    • Parents are also given a reading list of children’s books on topics which can help parents open discussions with their children about behaviours, families etc.

    The programmes Coram has run
    Since September 2001, Coram has run 14 parenting groups for adoptive parents (two programmes per year). The groups are open to all parents that have had an adoption order granted and a child placed with them (this does not necessarily have to be through Coram).

    The research study which focussed on the four pilot groups presented in-depth information on the parents who attended these groups. It revealed that:
    • Parents came from a range of backgrounds with the majority having no previous parenting experience.
    • Their children ranged in age at the time of placement from approximately six months to eight years old, and had been with their adoptive parents for up to ten years.
    • Almost two-thirds of the children had been placed along with a biological sibling, presenting their parents with the additional and unique challenge of having to parent two newly-placed children of different ages (and sometimes gender) and cope with their different developmental needs.

     

    Evidence and evaluation - making a difference to children, young people and families

    Evidencing your practice has made a difference to children, young people and families

    The programme has been found, both through the original evaluation study undertaken when it was piloted, and through recent routine, embedded, evaluation processes, to enhance adoptive parents’ confidence. A high level of satisfaction has been expressed by parents undertaking the programme. Key features identified as valuable are:
    • Based on a validated programme for conduct disordered children, but drawing upon attachment theory to adapt to the adoption situation.
    • The value of building up positive interactions is the focus of the first four sessions – three on play, one on praise.
    • Parents have the opportunity to practice a range of strategies between sessions.
    • Parents benefit from sharing these strategies with peers in the group.

    Performance measures
    The effectiveness of the parenting courses delivered during the research study was monitored by using a number of validated questionnaires. Parents were asked to complete the Parenting Stress Index (PSI; Abidin, 1983) which is divided into domains, relating to child characteristics and parent characteristics. The scores in each domain are totalled to give a Child Total, a Parent Total and a Total for the whole questionnaire that gives an overall evaluation of Parenting Stress.

    The second questionnaire completed by parents was the ‘Strengths and Difficulties Questionnaire’ (Goodman, 1994) that assesses aspects of child behaviour.

    Outcomes data
    Analysis of evaluation questionnaires completed by parents attending the pilot parenting groups revealed that there were considerable positive benefits for the families who attended:
    • Parenting stress levels overall fell (although this failed to reach statistical significance).
    • Statistically significant improvement was found on the levels of stress reported as being associated with child characteristics generally.
    • Parents reported feeling significantly more competent after the course, found their children significantly more positively reinforcing, and reported significantly fewer difficult life events after the course.
    • They found their children’s characteristics less stressful and found interactions with their child(ren) more positively rewarding and enjoyable.
    • There were also reductions in parental reports of conduct disorder and a reduction in the general level of behavioural difficulties reported by parents amongst their children.

    In addition, during interviews and group sessions, parents reported feeling supported and understood by the group and that they valued the experience of being with highly trained adoption social workers and other adoptive parents. They commented spontaneously on the specific techniques that they had taken from the programme, and on how these were improving the quality of their family life. Their comments included:

    “I was so stunned that other families were also feeling like that. I just thought we were the only people. The course gave me a lot of support just by realising that we were not the only ones.”

    “I feel that I’m their mum, you know, I just feel more able to cope. I think the course probably had a lot to do with it, because I didn’t know anything about parenting.”

    “For me, it’s a revelation. I knew the play was important but again to have it actually explained and try it, and see such a dramatic improvement in the boys, was a revelation.”


    Feedback from the groups indicates that the groups were remarkably successful in giving adoptive parents the kind of help they needed and that they could make use of. For example:
    • the strategies designed to promote positive interactions between parents and their children gave parents a repertoire of behaviours to use with their children which enhanced their sense of competence as parents;
    • this enabled parents to feel better about themselves as parents and to be reinforced in that role.

    In addition to the strategies, however, was the beneficial experience of being able to share experiences and feelings safely in a group where others had had similar experiences and could empathize. Parents found it liberating to learn that others had shared similar feelings of despair and rage, feelings that it would normally be too risky to expose to others.

    Impact
    The research also demonstrated that over a period of a year, the adopters continued to report that they felt their competence as parents had been enhanced, and that they were, overall, managing their children more effectively.

    More recently, an Ofsted inspection of Coram’s London team’s work listed the Parenting Skills for adoptive parents training programmes as one of the interventions which were ‘effective in sustaining children in placements despite some significant issues, and the disruption rate of 1.8% is well below the national average of 6% as a result.’ (Ofsted, March 2012).

    Recent evaluation of the Webster Stratton Parenting Programmes
    Coram ran two parenting programmes based on the Webster Stratton Incredible Years programme during 2012. An evaluation form was distributed at the end of the programme. Nineteen parents responded in total (see Chart 1 below).
    Chart 1
    Respondents commented on the usefulness of the facilitation format. The formats that all nineteen respondents found useful were ‘practicing strategies’ (of which 17 said ‘extremely/very useful’), the ‘group discussion’ (of which 16 said ‘extremely/very useful’), ‘the information presented’ (of which 13 said ‘extremely/very useful’), and ‘reading chapters’ as useful (of which 12 found it ‘extremely/very useful’). Two of the respondents felt the DVD vignettes were ‘not very useful/useless’.
    Chart 2
    Respondents said the parenting strategies they found most useful (see Chart 2 above) were ‘child led play’ (17 of the 19 said ‘extremely/very useful’), ‘group of strategies’ (referring to the whole curriculum) (17 of the 19 said ‘extremely/very useful’) and ‘praise and encouragement’ (16 of the 19 said ‘extremely/very useful’).

    Recent survey of Coram’s adopters
    In 2011, in addition to feedback collected at the end of the programmes, Coram’s Policy and Research team carried out a broad-based survey across all Coram’s adopters over the last ten years or so. The survey asked for adopters’ views on the whole adoption process and allowed them to reflect on their experiences. As part of Coram’s quality assurance processes the adopters’ responses are fed back to the service and used to improve Coram’s service delivery. Levels of satisfaction overall were particularly high amongst parents who had adopted through the London Adoption Team – the team that provides the Webster-Stratton programme.

    Of the 160 who responded to the survey, 34 out of 108 (31%) London adoptive parents, five out of 31(16%) East Midlands and five out of 21(24%) for Adopt Anglia parents had attended a parenting skills course. Some travelled from outside London to attend the programme.
    Chart 3
    Of those who rated the parenting course, 96% (45 out of 47) said it was fairly good or excellent, with 68% rating it excellent. Parents said:
    “The parenting skills programme itself was excellent and the leaders of the programme excellent.”

    “Our experience of the support during placement and our learning from the parenting skills programmes makes us the envy of all adopters we speak to and many other families.”

     

    Sustaining and replicating your practice

    Helping others to replicate your practice

    Sustainability
    From 2005 – 2009, Coram and the Anna Freud Centre ran ‘train the trainer’ courses twice a year for professionals who were already familiar with the Incredible Years programme. Sixty six people attended six ‘train the trainer’ courses, the aim being for them to take it back and disseminate it to their wider teams. Those who attended were in various roles including local authority and voluntary agency adoption managers, CAMHS workers, adoptive parents, psychologists, social workers, support workers, family therapists, and directors. Local authorities represented included: Barnet, Redbridge, Kent, Kensington and Chelsea, Hackney, Blackburn, Orkney Islands Council, Gloucester, Wandsworth, Stockport, Birmingham, Colchester, and Medway council. Organizations included: Reading Family Makers CCS, Parents for Children, Our Place, Childlink, BAAF, Catholic Children’s Society, and Parents as First Teachers.

    Costs and benefits
    In terms of its cost-effectiveness, Incredible Years improves children’s behaviour at an average cost of £1344 per child (Edward, R.T., Ce´illeachair, A., Bywater, T., Hughes, T.A. and Hutchings, J. (2007). ‘Parenting programmes for parents at risk of developing conduct disorder: cost effectiveness analysis’, BMJ, Vol 334, pp 682–685). It is estimated that by the age of 28, an individual with conduct disorder has cost an additional £60,000 to public services, compared to an individual without (Scott, S., Knapp, P., Henderson, J. and Maughan, P. (2001). ‘Financial cost of social exclusion: follow up study of antisocial children into adulthood’, BMJ, Vol 323, pp 191–194).

    The cost benefits delivered by the Parenting Skills for Adopters training programme are therefore far greater, as the potential for conduct disorder amongst adopted children is far higher. Children who are adopted are at elevated risk for mental health disorders, such as attention-deficit/hyperactivity, oppositional defiance, major depression and separation anxiety disorders, according to a wide body of research.

    Learning
    The research project demonstrated how supportive parenting skills training groups can be for adoptive parents when they are specifically run for adopters, staffed by workers who understand adoption issues, and use material which takes the adoption dimension into account. The researchers concluded that this programme has an important contribution to make in supporting adoptive parents to develop their skills and also their understanding of their children.

    Experience indicates that families benefit most if the parents attend within six months – two years of the child joining their family – i.e. before the negative interactions have become too entrenched. This does not mean that families who attend later do not find the programme helpful, but it can be more difficult to make an impact. Some families have elected to repeat the programme after a few years as a ‘refresher’.

    A full description of how the intervention programme was adapted for adoptive families can be found in:
    Henderson, K and Sargent, N. (2005). Developing the Incredible Years Webster-Stratton parenting skills training programme for use with adoptive families. Adoption and Fostering, Vol 29, Number 4, pp 34-44.

    Challenges
    Some of the children whose parents attended the groups were also in individual psychotherapy, and some of the others were subsequently referred for such help. The programme cannot be a panacea for all the emotional, behavioural and psychological difficulties which older adopted children may have. However, if they and their parents are able to enjoy a more harmonious family life together, that will make an important contribution to the healing process.

    Replicability
    Coram has produced a manual for facilitators delivering the Parenting Skills for Adopters training programme. This manual is available to those attending the ‘train the trainers’ course described above.

    Core leadership behaviours
    Eight core behaviours have been identified as part of successful elements of leadership (see National College for Leadership of Schools and Children’s Services/C4EO (2011). Resourceful leadership: how directors of children’s services improve outcomes for children. Full report. Nottingham: NCSL. Those shown below apply to this example.

    Openness to possibilities
    We needed the openness and flexibility to perceive the possibility that a programme designed for use with one population (conduct disordered children) could be effectively adapted for use with a very different group.

    Ability to collaborate
    Developing the programme required collaboration between Coram as an adoption agency responsible for practice, and the Anna Freud Centre which is a research and clinical institution. We also needed to engage the cooperation of adopters during the pilot phase.

    Demonstrating a belief in team and people
    We needed to have the confidence that adopters have the potential to care for the very troubled children who are placed with them in a positive and enabling way, and that this intervention would enable them to do so more effectively

    Ability to simplify
    Designing and delivering this programme has required a sophisticated ability to reframe complex psychological constructs such as regression or insecure attachments in terms which are straightforward and readily accessible to a lay audience.

    C4EO Golden Threads
    The following Golden Threads apply to this example.

    You can do it – promoting resilience
    By providing adoptive parents with a range of positive behaviour strategies, they gain confidence in being able to manage their children, and have enhanced opportunities for enjoyable interactions. This enhances the development of trust and secure attachments, which is considered to be the foundation of resilience.

    Together with children, parents and families – involve service users
    Parenting skills training offers adopters the opportunity to share their experiences with a peer group and to benefit from peer support. The group programme offers a wide range of strategies to use and parents are able to explore what works for them and their child. Children attend a crèche with other adopted children which reduces their sense of difference and isolation.

    Unite to succeed – the right support at the right time
    Attending parenting skills groups gives parents the opportunity to share the learning experience with their partner (if they are part of a couple), and also to share with other new adopters. Attending these groups within the first eighteen months of their child joining the family gives support whilst new relationships are forming and enables parents to develop confidence in a supported setting.


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