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Selection of Studies
Several procedures were used to identify literature; published research, journals, literature reviews, programme description and policy documents. Studies were eligible for inclusion if they involved parents of 0-5 year old children irrespective of whether the children comprised clinical or population samples. Studies involving parents of a child older than 5 years of age were included. Studies of children with disability were included as from this I was able to assess their applicability to children with multiple needs and ethnic minorities.
- Reference lists of articles identified through database searches were examined to identify further relevant studies.
- Bibliographies of systematic and non-systematic review articles were also examined to identify relevant studies
- In addition to traditional methods of identifying literature I networked with colleagues, agencies and organisations to include local issues and concerns.
The following search terms were used: (parent training, parent program, social skills programmes, school based interventions, challenging behaviour, discipline, maladaptive behaviour.
Behavioural Intervention used in Schools
Research into Behavioural interventions and their Effectiveness
It has become apparent that before services in schools can be implemented and assessed in their effectiveness they should meet empirical standards (Kratochwill and Stoiber, 2002). Yet the call for evidence based interventions has not been reconciled with the realities of what actually takes place. One difficulty is that earlier insistence on random- assignment treatment and control studies has brought about the realization that these deigns in preventions programmes can be difficult to achieve and the outcomes for an intervention maybe spread across many years requiring large population samples. In addition to its implementation limitation careful examination of many studies around behavioural interventions has highlighted that research has been primarily conducted amongst white middle class and is not representative of minority groups.
Social Skills Training and School Based Interventions
Second Step is a quality based programme based on social and emotional learning (Frey, Hirshstein and Guzzo, 2000). The programme targets three areas; empathy, social problem solving and anger management, including a parent element. A randomised controlled trial showed that Second Step prompted a decrease in verbal and physical aggression, increases in their pro-social behaviour in classrooms and these changes were apparent after 6 months (Grossman et al., 1997). Results from studies with low income children demonstrated that Second Step maybe more effective at strengthening positive behaviour in relation to decreasing negative ones (Taub, 2001; McMahon and Washburn, 2003).
In comparison PATHS (Promoting alternative thinking strategies) is a universally applied competence building intervention that fosters self-determination and enhances self-regulatory skills (Kan, Greenber and Kusche, 2004). PATHS has also been used as a universal intervention within a multi-component prevention programme (Fast Track) that targeted children with early on-set of conduct problems (Conduct Problems Prevention Research Group, 1999, 2004). With this randomized trial children belonging to high risk families, decreased in aggressive behaviour and increased on task behaviour.
Another universal intervention that aimed to promote child competence is SDM-PSP (Social Decision Making and Problem Solving Program; Elias and Weissberg, 2000) aimed at effectively using emotions to problem solve. In a study of its effectiveness (Elias, Gara, Schoyler, Branden and Muller and Sayette, 1991), students in an experimental group received 2 years of the programme whereas a control group received no intervention. After the intervention the experiment group was able to better manage the stress and showed a higher level of social competence, self efficacy than the control group. It was the girls in the experimental group that benefited the most raising questions about the suitability of social and emotional interventions for boys?
Punishment and Behaviour Problems
In general schools adopt a reactive approachto behavioural issues, with aloss of privileges and formal discipline (Jackson and Panyan, 2002) and recurring problems become punished consistentl. This traditional method of punishment is a reactive approach, primarily designed to reduce the frequency of problem behaviour but research demonstrates that change is not long lasting and requires close monitoring (Crimmins et al., 2007; Netzel and Eber, 2003). The use of punishment has been closely associated with the increase in school drop-outs, truancy and other anti-social behaviours (March and Horner, 2002, Sulzer-Azaroff and Skiba and Peterson).
Persisting problems may lead the child to experience escalating punishments, the danger here can be that children may become familiar with this and may even find the attention reinforcing. Children may overcome the initial embarrassment of the punishment and then may use the punishment as a relief from other problems. A consequence that was intended to reduce the negative behaviour has now inadvertently reinforced it. Crimmins et al. (2007) work highlights this point whereby children become stuck in an escalating sequence of punishments without support for adaptive responses.
PBS (Positive Behaviour Strategies)
In stalk contrast positive interventions are not solely reliant on punishment and focus more upon sustainable alternative to problem behaviour. Sustainable change as promoted in the PBS programme, a deceleration of problem behaviour and acceleration of acceptable behaviours.
As an alternative PBS (Positive Behaviour Support) programmegives a dual focus to behaviour intervention, combining consequences with positive reinforcement strategies. PBS has emerged from a behaviour analytical tradition which offers individualised methods and strategies grounded with empirical research and designed to prevent problem behaviours. PBS gained empirical support with monographs synthesising over 100 published articles (Carr et al., 1999).
PBS takes a functional approach to behaviour where it is believed that problem behaviour exists in order to serve a function. Interventions do not suppress the behaviour but teach new skills that bring about positive outcomes. Crimmins And Farrell (2006) conducted a review of the research on IPBS (individual PBS) came to a general agreement about it effectiveness but no consensus of the procedures of IPBS. It has been suggested by many (Dunlap et. el., 2000, McCormick, 2006 and Heinmann and Dunlap, 2000).
Whilst the PBS model appears promising and is based on some key principle of behavioural reversal it appears to be a costly commitment for schools to engage in and the programme requires systematic organisational changes. PBS literature can be criticised for its lack of attention on family and child involvement. It appears to be an organisational approach focused highly on systematic change. It greatly relies on the training of school staff and theory expertise holding unrealistic expectation of implementation. Neverthless the existing research (Van Acker, Boreson, Gable, and Potterson, 2005) demonstrates that teachers participating in the PBS programme are better able to validate hypothesis about function, consider that in relation to replacement behaviours and examine outcomes.
It is apparent that there remains gaps in the research, it can be questioned for its validity as it does little more than provide a quick view of staff trained on PBS but does not evaluate if the training has increased competency levels and could that be linked to prevalence of behaviour problems. Field research needs to examine the amount of and type of training required for teachers of various backgrounds. Research studies need to be carried out at broader scale to examine effectiveness and differences. Another concern I would note is the training literature requires a balance between economic and practical feasibility and the need to maintain integral and procedural integrity. In the aim to improve the reliability and validity of school practices and for them to be fully articulated, more information is essential around current practices in schools. Information exits about individual case studies of schools or counties but in order to address a universal problem we would need to develop a universal approach.
Future initiatives like this can then examine the impact of these interventions on the child experiencing the behavioural problems and their counterparts that are affected by it. Also an examination of how the content and methods of such training models interact with participant, setting characteristics and other contextual variables. By using constituent-focused research it will address perceived social validity by educators, children and families. Current research indicates success, yet by undertaking rigorous, controlled (randomized) designs would be an endorsement of the model.
Applying Behaviour Modification in Schools
Behaviour modification states that all behaviour serves a purpose that is learnt, it is the environmental contingencies that maintain the behaviour. Behaviour becomes a function of consequences; the consequence that follows behaviour will predetermine the future of that behaviour. When the function of the maladaptive behaviour is identified and then a plan of action is initiated to unlearn the unwanted behaviour, with an alternative replacement (Myers 2008).
Positive reinforcement is one of the most powerful techniques and readily used when developing behavioural plans and would follow after a desired behaviour. It therefore needs to be an appropriate and appealing re-enforcer to the child in order for it to be effective. Negative reinforcement is used to decrease the frequency of behaviour, the aim here is to remove or prevent something from happening.
Stage et al. (1997) examined 99 studies that used interventions to decrease disruptive classroom behaviour in public education settings. This meta-analysis examined studies using various interventions, including behavioural interventions (group contingencies, differential reinforcement, overcorrection, time out), cognitive-behavioural interventions (anger control programs, affective imagery, social problem-solving, peer mediated), individual counselling, parent training and multi-modal interventions. The multi-modal interventions were those that employed two or more interventions into one treatment.
Results of this meta-analysis indicated that behavioural interventions were more effective than cognitive multi-component Intervention. On average, 78% of the treated students reduced their disruptive behaviour compared to the non-treated students. Further, students in self-contained classrooms were more likely to show a reduction in their disruptive behaviours. Additionally, studies using behavioural observation coding systems were found to be more sensitive to change compared with studies that used teacher ratings as the outcome measures. The least effective interventions of the meta-analysis involved functional assessment and cognitive-behavioural interventions.
The Role of Teachers in Behaviour Management in Classrooms/Social skills Training
What are the roles of teachers, other school based practitioners, and specialists or other professional.
Four studies of varying methodological quality support teacher involvement: Botvin et al (2006), Van Schoiack-Edstrom et al 2002, Farrell et al 2003 and Warren et al 2006). These studies were all conducted in the USA in populations which were majority African American. This may limit applicability to a typical English school.
Three further studies (including two good quality RCTs) were identified which involved teachers in interventions were not effective in preventing disruptive behaviours: Orpinas et al., 2000; Stevens et al., 2000 and Peterson and Rigby, 1999.
This evidence is unclear on the beneficial role of teacher involvement and training in universal interventions to prevent disruptive behaviour. It is important to acknowledge that it is likely that many other interventions did rely heavily on teacher involvement and training without explicitly stating so, therefore this evidence should be treated with caution.
Van Schoiack-Edstrom et al 2002 implemented the "Second Step" Curriculum in the USA (with two intervention and two control classes in each school). The curriculum focused on empathy, perspective taking, and problem solving and anger management. The results of this intervention varied (follow up was immediately after the intervention) with 6th and 7th graders showing decreased endorsement of social exclusion and 7th graders also showing less tolerance of physical and verbal aggression.
In the study by Farrell et al (2003) in the USA (mixed ethnicities, 4 intervention and 4 control middle schools. Over two years significant differences in frequency of aggression were seen.
The intervention administered by Warren et al (2006) to reduce aggression and violence in an inner city American middle school, over one year the school saw a significant reduction in disciplinary outcomes and subjective reports to indicate improvements in the school climate. However these gains were not sustained at 1 year follow up suggesting that the code of conduct needs to be continually reinforced to be effective.
Three studies showed interventions that involved /trained teachers were not effective. Orpinas et al (2000) conducted a violence prevention programme in the USA. The intervention curriculum was based on empathy, conflict resolution and anger management training. The intervention received yearly follow up over three years but no intervention affect was seen. The intervention experience considerable drop out over the three years (36%) and the authors attribute the poor results to this.
Stevens et al (2000) conducted a bullying/victimisation intervention involving primary and secondary schools in the Netherlands. The two intervention arms of this study involved input into the school policy and curriculum and included support for both bullies and victims. However, the intervention showed improvements in bullying, victimisation and positive interaction for primary school children only.
Peterson and Rigby (1999) develop a range of school behaviour policies in a large Australian school (which was compared with one control school), it showed no overall reduction in reported victimisation.
Multi-component Intervention as a Alternative
As part of the teacher training element of the research I propose to use a multi-component intervention. The multi-component intervention combines many behavioural management strategies with the goal of decreasing disruptive classroom behaviour. The various components typically include token economy and response cost, precision requests, mystery motivators, and antecedent strategies.
The rationale for using a multi-component intervention is based on the assumption that while all of the components may be effective when used in isolation, they may be even more effective in reducing disruptive behaviours if they are combined. According to Kehle et al. (2000), multi-component interventions consistently have been found to be teacher-friendly and cost-effective. They also can be employed in a variety of classroom settings.
Specific Strategies used in Multi-component Interventions
Token Economy and Response Cost
The basic premise of token economies is that students will be told that they will receive points for the amount of time that they can follow the classroom rules. According to Kehle et al. (2000), students should be awarded with points fairly frequently in order to establish a connection between the desired behaviour and rewards. Token economies have been one of the most effective ways to improve classroom behaviours (Higgens, William, & McLaughlin, 2001). They have been effective with school behaviours across school populations.
Additional research has shown that when implemented together, token reinforcement and response cost interventions are associated with less disruptive classroom behaviours (McGoey & DuPaul, 2000). Token economies, combined with other strategies can reduce disruptive classroom behaviour than a token economy system alone (Musser et al., 2001; Rosenberg, 1986).
Precision requests can be used to initiate student compliance, to stop disruptive behaviours and to prompt appropriate behaviours. As described in the DeMartini-Scully et al. al. (2000) investigation, teachers are trained to communicate instructions using a series of steps, if the student complies within five seconds, he/she is reinforced. If the student does not comply with the request, a reductive technique, such as a timeout, is administered. There exists little research examining the effects of precision requests used singularly. However, they have been shown to be effective in increasing compliance in home and neighbourhood environments (Mackay, McLauglin, Weber, & Derby, 2001).
Mystery motivators are another element of many multi-component intervention plans. A mystery motivator uses the principles of positive reinforcement to initiate compliance. Very simply, an envelope labelled with a question mark is placed in a visible spot in the classroom. Inside the envelope is a card stating what the student will win. Mystery motivators tend to increase the anticipation of the reward (DeMartini-Scully et al., 2000). Very little research has studied the effects and use of mystery motivators. However, two studies have found mystery motivators to be an effective tool in increasing compliance rates, and they have high acceptability ratings from teachers and students (Kehle, Maduas, Baratta, & Bray, 1998; Moore & Waguespack, 1994.
As with other behavioural intervention plans, antecedent strategies are often used to increase compliance. Antecedent strategies include teacher movement, which allows for increased opportunities for compliance, and the public posting of classroom rules. According to Kehle et al. (2000), when using antecedent strategies, classroom rules should be stated positively and definitively regarding expected behaviours. Research demonstrates that teacher movement and rule posting increases compliance rates of students (Rhode et al., 1993).
Research into the Effectiveness of Multi Component Interventions
Recent investigations have supported multi-component interventions in a variety of settings with different individuals. DeMartini-Scully et al. (2000) implemented the multi-component intervention within a general education setting. The disruptive behaviours were measured using time sampling procedures and a multiple baseline/reversal design. The researchers developed a multi-component intervention, which included precision requests, antecedent strategies, positive reinforcement, token economy, and response cost measures delivered through a contingency contract. During the baseline period, disruptive classroom behaviours of the students occurred 41% of the time. In contrast, during the intervention phase, disruptive behaviours were reduced to an average of 20% of the time. Also notable, teacher acceptability ratings from this study indicated that the implementation of this multi-component intervention is relatively trouble-free.
In another study, Musser et al. (2001) used a similar multi-component, multiple baseline design with three school-aged students with serious emotional disturbances. The intervention took place in a self-contained classroom in an alternative school setting. The researchers measured behaviours using 10-second partial-interval time sampling procedures. Musser and others employed a multi-component intervention that consisted of precision requests, mystery motivators, token economy with response cost, and antecedent strategies. The results indicated that disruptive behaviours occurred 37% of the time during the baseline period. They were reduced to 10% of the time during the intervention phase. Similar to the research by DeMartini-Scully et al. (2000), teacher acceptability scores were positive.
Another applicable study used a partial multi-component intervention (McGoey & DuPaul, 2000). In this study, the researchers found token reinforcement and response cost procedures to be effective in reducing the disruptive behaviour of four Caucasian preschool children with ADHD. This intervention included the use of buttons as token re-inforcers for good behaviour in a half-day preschool setting. Alternatively, students could lose buttons for breaking the classroom rules. Observers recorded how many times the children followed and disobeyed classroom rules, were off-task, threw temper tantrums and were engaged in positive and negative social interactions. The disruptive behaviours decreased significantly when the token reinforcement and response cost contingency intervention were implemented.
Limitations of Multi-component Interventions
There are several limitations of the research on multi-component interventions. While research exists regarding the specific effects of each component used in isolation, it is difficult to determine how the various components interplay to reduce disruptive classroom behaviours. Although preliminary studies indicate positive results regarding the implementation of multi-component intervention strategies, this is a relatively new area of applied research. Thus, multi-component interventions have not bee implemented over numerous situations. In addition, an interpretation of a synthesis of the literature in this area is problematic due to the small number of studies and the small sample of students. Therefore, the results of the existing empirical studies should be considered with caution.
Implications for Future Research & Practice
Further research is needed regarding the use of multi-component interventions to decrease disruptive classroom behaviours with a variety of children. More research is needed to determine the relative effectiveness of single components and which combinations can be most effective. Additionally, more research is needed to further validate the overall effectiveness and utility of multi-component interventions.
As multi-component intervention plans have received preliminary support as an effective way to decrease disruptive classroom behaviours and as educators are familiar with the several of specific components of multi-component interventions, this tool may have a wide scope for classroom implementation. Thus, teachers and school psychologists could employ specially designed multi-component plans in their classrooms and monitor the behaviours of their students to determine its effectiveness.
Additionally, educators need to be aware of the variety of strategies that exist to create an optimal learning environment for all students. Behavioural interventions exist to decrease their disruptive behaviours; it would appear that using several techniques in one approach might have greater utility than using a solitary behavioural intervention strategy.
The Role of Parents
Research and Practice Implications
Parenting Programme and their effectiveness in Behavioural change
What is the role of parents? Are parenting programmes effective in improving children"„¢s behaviour? Parenting programmes are short-term interventions aimed at helping parents preventing or treating a range of problems of behavioural and emotional adjustment. By applying behaviour modification techniques, parents could successfully decrease tantrums, self-destructive behaviours...oppositional behaviour and antisocial and immature behaviour (Johnson 1973; Rose 1974 in Barlow and Pearson, 2005). Parenting programmes are now being offered in a variety of settings, and a recent systematic review of randomised controlled trials showed that they are effective in improving behaviour problems in 3 - 10 year old children (Barlow 2001), and in improving maternal psychosocial health in the short term, including reducing anxiety and depression and improving self-esteem (Barlow 2000).
Although current evidence from controlled trials addresses the use of parenting programmes as part of secondary, high-risk approaches to prevention, it has been argued on theoretical grounds that they would be more effective if delivered as part of a population approach (Stewart-Brown 1998). Parenting programmes are also typically used in a secondary preventive.
In reference to research strong evidence was identified of good quality, which supports parent training/education in the implementation of interventions to reduce behaviour problems; (Evers et al., 2007; Flay et al., 2004 and Warren et al., 2006). Yet the proportion of African Americans included in the studies in the USA is high and may limit their applicability in English schools. One additional RCT study did not support parent training/education, in the implementation of interventions to reduce problem behaviours, Orpinas et al., (2000) and was also conducted in the USA.
Flay et al (2004) used a social development curriculum and delivered to African American children of low socio-economic status. The parent programme reinforced skills and promoted child-parent communication. The study which included the parental programme showed a greater effect on violence levels, but this effect was only seen for boys. It is suggested that target behaviours may be harder to reduce in girls as they are already occurring at a much lower level.
Evers et al (2007) delivered a computer based anti-bullying curriculum in the USA. In a self reported questionnaire completed immediately after the intervention, those who had completed the programme were 4 times less likely to state they would participate in bullying than those in the control group however, the impact of the parental involvement was not independently assessed.
Warren et al 2006 included two full days of parent training in their intervention to reduce aggression and violence in an inner city American middle school with a large proportion African Americans. Over one year the school saw a significant reduction in disciplinary outcomes and subjective reports to indicate improvements in the school climate (but these gains were not sustained at 1 year follow).
Although several studies were conducted in populations described as having low socio-economic status and/or within locations where the majority of children were from particular population subgroups, none of these studies made particular reference to these demographic variables in their results. In this context the studies focus on particular sub populations in areas where they are the majority, rather than mixed populations. This may reflect the make up of individual schools, particularly in the USA. From this evidence it is difficult to judge the effectiveness of parental involvement. However some positive outcomes for the children were seen.
Behavioural Interventions: Involving Parents
Interventions on parents"„¢ behaviour management skills and parent-child relationships. The two included studies which investigated the effectiveness of interventions on parents"„¢ behaviour management skills and parent-child relationship used different modes of delivery: individual and group. One of these interventions (McIntyre, 2008a) was a fixed duration (12 weekly sessions), the other (Bagner and Eyberg, 2007) continued until the desired outcomes had been achieved. It is not clear where these interventions were delivered.
Interventions on Behaviour Management and Teaching skills
Three studies have been evaluated for their effectiveness of interventions which sought to improve parents"„¢ behavioural problem behaviour management skills and teaching. These are as follows: Steps to Independence Programme (Brightman et al., 1982); Parents as Teachers (Prieto-Bayard and Baker, 1986) and Building Better Behaviour, (Hudson et al., 2003). All but one (Hudson et al., 2003) of the studies was a randomised controlled trial. All the RCTs were assessed as being of moderate research quality, and the quality of the controlled trial was assessed as weak. All of the interventions were delivered to parents with a wide age range of children. All the studies reported positive changes on at least one measure of child behaviour at post-treatment in the intervention group which were not found in the control group.
There is diversity in delivery of interventions which aim to improve parents"„¢ behaviour management skills and teaching skills. Two studies are compared with different delivery modes (group versus individual (Brightman et al., 1982); group versus individual versus self-directed (Hudson et al., 2003)).) These interventions were also delivered in a range of settings (community-based venues, clinics, home).
Brightman et al. (1982), using a behaviour problem checklist developed for the study, found statistically significant improvements in checklist scores from pre- to post-treatment for both intervention groups (individual sessions, parent group) which were not found in the waiting list control group.
Hudson et al. (2003) used the child behaviour subscale of the Parenting Hassles Scale (Gavidia-Payne et al., 1997) and found no significant changes in scores pre- and post-treatment for any of the study groups (group delivery, individual telephone support, self-directed or waiting list control).
Finally, Prieto-Bayard and Baker (1986) report a statistically significant improvement in intervention group scores at post-treatment on the child behaviour checklist developed for their study which was not found in the waiting list control sample. Neither the Brightman et al. (1982) study nor the Hudson et al. (2003) study report differences in effectiveness, in terms of improving child behaviour, between different delivery modes.
Roberts et al. (2006) also found statistically significant improvements in parenting skills in the intervention group but not the control group. Specifically, statistically and clinically significant improvements were found in mothers"„¢ over-reactivity (though this effect was not confirmed by intent to treat analysis), and fathers"„¢ laxness and verbosity (confirmed by intent to treat analysis). In all instances, these improvements were maintained at six month follow-up.
However, in terms of observational data on negative parent behaviour, neither study found significant intervention effects. In addition, Roberts et al. (2006) reports a statistically significant improvement in parental use of praise in target (but not generalisation) settings among the intervention group that was not found in the control group. This improvement was maintained at six month follow-up and confirmed by intent to treat analysis.
A key issue which needs to be considered when reviewing the findings of these studies is that most studies only used parents"„¢ reports of child behaviour or parenting as outcome measures. Parents undertaking these interventions, as well as learning about behavioural principles of managing difficult behaviour, are likely to improve their understanding of their child"„¢s behaviour, their child"„¢s condition and/or parenting per se. This change in understanding alone may affect how parents report their child"„¢s behaviour or their parenting.
Taken together and bearing in mind the various weaknesses of study design and research quality, these findings suggest that interventions to improve parents"„¢ skills in managing problem behaviours using principles of behaviour modification appear to be a promising intervention approach. The evidence reviewed shows they can have a positive impact on child behaviour and parent outcomes for at some parents of children with learning difficulties.
There are wide gaps in relation to children from ethnic minorities/diverse backgrounds as it is apparent most research is concentrated around behaviour management interventions have usually been investigated within the context of wider universal approaches. An important issue to draw from this synthesis of the research evidence concerns the effectiveness of these interventions for mothers and fathers. Just one study (Roberts et al., 2006) explores mothers"„¢ and fathers"„¢ outcomes separately. The main reason for this is because in most studies mothers were the sole recipients of the intervention. What is interesting in the Roberts et al. (2006) study is the findings suggest that the intervention affected parents"„¢ parenting skills differently and, in addition, at pre-intervention mothers"„¢ levels of parenting self-efficacy are poorer than fathers. This, in itself may impact on the effectiveness of a parent training intervention.The most effective parenting support programmes ensure that the content is personally meaningful for service users. The evidence suggests that services should focus on circumstances and needs at both individual and family levels (Santisteban et al, 2003; Liddle et al, 2004; Nee and Ellis, 2005; Henggeler, 2002; Chamberlain, 2002; Alexander and Sexton, 2002). Studies suggest that service staff should encourage user participation in identifying their own needs and collaborating with delivery staff in the development of a personalized menu of services (Henggeler, 2002; Dishion and Kavanagh, 2005; Ghate and Hazel, 2002). Parents with complex needs or who are in crisis are, however, more likely to benefit from one-to-one support in the first instance, which can then be followed by participation in a group programme (Ruffolo, Kuhn and Evans, 2005; see also Moran et al, 2004). Practice wisdom suggests that groups often do not work well for the most highly stressed or vulnerable families, in part because the hurdle of taking part in a Ã¢â‚¬Ëœpublic"„¢ event may be too exposing for these types of service users (Moran et al, 2004)
Most research on the effectiveness of parenting support services has tended to focus on White mothers, not least because these have traditionally been the constituencies served by parenting support initiatives (Moran et al, 2004). As a result there is a much smaller, though growing, and evidence base attesting to the outcomes of support work with fathers and with parents from Black and Minority Ethnic (BME) communities. number of studies reviewed for the Systematic element of this document have demonstrated positive outcomes across different cultural groups, including Brief Strategic Family Therapy (BSFT) (Santisteban et al, 2003), MST (Henggeler, 2002), MTFC (Chamberlain, Fisher and Moore, 2002), and Strong African American Families (SAAF) (Brody, Murrey, Spoth, Luo and Chen, 2006). The FSP shows good outcomes for African American families compared to other services such as probation (Quinn, 2004), and the Strengthening Families Program (SFP), working with parents addicted to alcohol, has shown good results (Ferrer-Wreder, Stattin, Lorente, Tubman and Adamson, 2004). However, it is important to note that the evidence base to date only tells us that it is possible to work effectively with parents from different ethnic backgrounds. It does not generally tell us whether outcomes are more or less positive across different ethnic groups.
An early intervention project, is Strengthening Families, Strengthening Communities(SFSC). SFSC is a parenting support programme developed from an American programme for use in the UK with Black and Asian parents (Steele, Marigna, Tello and Johnston, 2000). However, evaluation evidence of effectiveness in the UK is still being collected, though the programme is certainly considered promising.
Review of Research in Behaviour: Implications on Practice
The literature to support whole school interventions in general is not well developed, especially in terms of good quality effectiveness studies (and particularly those conducted in the UK). The literature has a substantial bias towards interventions conducted in the USA and the number of studies conducted in populations with high numbers of African Americans (and other ethic groups not frequently represented in the UK) will have further implications for applicability in English schools.
Although the evidence relating to pro-social behaviours and skills in particular was sparse, it does suggest that conflict resolution training is successful in promoting pro-social behaviours in the short term, and that the use of peer mediators may be effective for longer term outcomes. The evidence relating to preventing disruptive behaviour at the level of universal interventions is more varied with evidence of mixed effectiveness being identified for the roles of the community, teachers, young people, external agencies and parents. However this may reflect that fact that a greater volume of evidence relating to disruptive behaviour was identified.
In terms of the UK policy context it is interesting to note that the vast majority of the interventions we identified in the review are based in the classroom and takes a curriculum approach. The approach of primary SEAL however is not primarily curriculum based. This reflects its strong grounding in the theoretical literature and the paucity of empirical evidence to address the effectiveness of similar programmes. The current evaluation of SEAL should provide a more robust empirical evidence base for the future.
Gaps in the evidence and implications for future research
More UK research on the effectiveness of behavioural approaches to managing behaviour problems among ethnic minorities and disabled children is needed. In order to improve the evidence base a number of different issues need to be addressed. These concern both research design and research topic or research questions.
1. All studies should explore and report the clinical significance of the research findings. Including a measure of the extent to which parent-set targets for behavioural change have been achieved is also important.
2. Studies should seek to incorporate within their designs some means of triangulating evidence with regard to changes in child behaviour and, ideally, parenting skills. This would help to overcome the limitation noted above concerning possible confounding effects of the intervention on parents"„¢ perceptions and understanding of their child"„¢s behaviour and hence their reports of behaviour and parenting. The key difficulty with much of the research reviewed in this report is that the samples were self-selected. Future research should therefore look for ways by which the issue of selection bias can be addressed.
3. Mode of delivery is a key factor in costs of service delivery. Evidence to date on the impact on mode of delivery on effectiveness is unclear and studies are needed which will allow this issue to be investigated. More generally, where future research takes place in service settings, collecting data on costs should be part of the project.
4. An issue linked to mode of delivery and costs is that the interventions typically include a number of different ways both to train parents in behaviour modification principles and techniques, and to support them as they implement these skills. There is extremely limited evidence, however, on which elements of the interventions are necessary to achieving positive changes.
5. From the evidence reviewed, it would seem that generic parenting interventions can be effective in addressing behaviour problems for some families. Research which explores this, and which also identifies ways in which generic parenting programmes need to be adapted to make them effective when used with families with a child with learning difficulties or cultural or language barriers, is therefore required.
6. Most of the studies were not concerned with children with behavioural difficulties who had already been referred to a secondary or tertiary service for intervention. This may be an indication of a lack of services as opposed to severity of the behaviour problem. Alternatively, it may be that parents do not play an active role in modifying very severe behaviour problems, in which case such evaluations would have been excluded from this review. Thus this apparent gap in the evidence may be spurious. However, a clearer understanding of this issue would be helpful.
7. A number of studies highlight the difficulty of maintaining change in child behaviour and/or parenting strategies. Including a follow-up stage in research in this field is highly desirable. Research which, in addition, identifies the most effective ways to support or maintain improvements gained from an intervention would be extremely valuable.
8. Some of the studies have a number of methodological flaws compromising the generalisability of the findings.
Overall the findings provide some support for the use of parenting programmes to improve the behavioural adjustment of children. There is limited evidence available concerning the extent to which these results are maintained over time. More research is needed before questions of this nature can be answered. There is currently insufficient evidence to reach any firm conclusions regarding the role of parenting programmes in the prevention of behaviour problems, and further research is required which is UK based as research from abroad I not always transferable.
It has not been possible with the limited data available to provide conclusive evidence regarding the extent to which the positive effects identified, are maintained over time. Neither has it been possible to assess the role of parenting programmes. In relation to validity of research larger numbers of participants should be included, and the measurement of a wider range of outcomes should be undertaken, including an assessment of other factors impacting on the child/families life. Theses studies would provide the basis for further long-term follow-up through childhood and possibly even adolescence. Parenting programmes can improve the emotional and behavioural adjustment of infants and toddlers, and there is an urgent need for research to evaluate their effectiveness in preventing such problems.