Liverpool quick off the mark in FAST parenting trials

It's no mean feat for prevention science to be able to demonstrate in a controlled community trial that a parenting program works; but the recommendation won't mean very much if, ever after, the families it has been designed to help stay out of easy reach.

And that's all too often the case, even when incentives such as free transport and childcare are on offer. [See: When parent training doesn't work – try this [1]]

In the UK, the problem is serious enough to have provoked comment on the value-for-money of children's centers set up as part of the Government Sure Start initiative.

Pointing to the fact that they were failing to engage with the most disadvantaged families, despite their being funded specifically for that purpose, the National Audit Commission has commented anxiously on the "low level of outreach". [See: Sure Start children's centres - Memorandum for the Children, Schools and Families Committee [2]]

The better performance in the UK of one US program that takes a different approach to recruitment was discussed, last week, at a seminar in South-west England.

Developer Lynn McDonald [3] and UK project leader Elspeth Bromiley described the progress in Liverpool schools of Families and Schools Together (FAST), which Lynn McDonald devised in a non-profit community agency serving children and families, and later studied it as part of her work at the Wisconsin Center for Education Research, University of Wisconsin-Madison. She has since moved to the UK to be Professor in Social Work at Middlesex University in London.

At eight, weekly after-school FAST sessions groups of families share a meal and take part in structured games, responsive play and music. In facilitating this process, the program builds social capital in the local community. After the eight weekly sessions, FAST parent graduates lead monthly sessions of their own.

Experimental evaluation in the US suggests that FAST not only improves parental and child well-being but also succeeds in engaging and retaining the interest of the “hard-to-reach”.

FAST’s progress inside school neighborhoods is steered by a team of parents, key community members, school support staff and other practitioners (perhaps a counselor or therapist). It is down to the team to recruit parents, on the principle that local members are most likely to know the community and the parents who might be interested. As many as 40 families (four groups of ten) might be taking part at any one time.

Alongside the spread of its US cousin, Incredible Years, and the Australian program Triple P, the progress of FAST to the UK is being monitored by the National Academy for Parenting Practitioners. It is one of the few initiatives for which the Academy provides training.

Incredible Years recommends that program groups include parents of children whose behavior problems meet a severity threshold. For this reason it is referred to as a "targeted" program.

The rationale goes that because setting up and running a program group is expensive, it will not deliver value for money unless it reaches families who really need it.

So the targeted approach can sometimes be counterproductive: finding willing parents who meet the criteria and are also willing and able to attend group sessions can be too difficult.

FAST does not target to the extent of imposing eligibility criteria. Involvement tends to be offered in the most vulnerable communities and the program team sets out to contact families who might be disempowered or vulnerable. There is also an emphasis on cultural matching: if half of the children in school have a Muslim-Pakistani heritage, half of the team working in the school will have the same reassuring characteristics.

The Liverpool experiment McDonald and Bromiley described began a year ago. They made some small adjustments to the US template but the core components specified as sacrosanct by the developer have been faithfully implemented – and to good effect.

So much so, that Bromiley aims to have FAST rolled out to all Liverpool schools over the next three to five years.

She told the Peninsula Medical School seminar, “The implementation has been very carefully managed. I have worked hard to get support from the children and young people’s partnership as well as the school community. We aim to get this embedded into the system. People’s job descriptions are even being changed to make sure the program is delivered properly”.

On the debit side, for an non-targeted intervention FAST is labor intensive. Unit costs per family when salaries, training and supervision are taken into account per family are high.

There are anecdotal reports that Liverpool children who were at risk of being excluded are being maintained in school but, especially in the current economic climate, evidence that families have less need of high cost services as a result of the program will be required.

• See also: Proving the benefits of family life in the FAST lane [4].