Science stays doggedly on the side of parents

This week’s Dublin Archways conference brought together a handful of determined characters dead-set on putting scientific muscle into the slapdash approach to prevention taken by most governments. Carolyn Webster-Stratton in the United States, Judy Hutchings in Wales, Caroline White in England and Willy-Tore Mørch in Norway have all bucked the trend.

Another is Professor Stephen Scott, now Director of Research at the new UK National Academy for Parenting Practitioners [1]. His association with Carolyn Webster-Stratton's work began in the early 1990s when few in the UK were interested in prevention and the mere suggestion of a randomized controlled trial was enough to make otherwise strategically-minded politicians pale. The change of government in 1998 led to a resurgence in interest in prevention – but not in rigorous evaluation.

Stephen Scott was the leader of a team that introduced the Incredible Years basic parenting program into mental health services in South London and the city of Chichester. Between 1995 and 1999 141 children between the ages of three and eight, referred because of their anti-social behavior, were assigned to the Webster-Stratton program or to a waiting list for future intervention.

A few mechanical alterations were made to the US program to fit it to the UK context – for example, the tutorial videotapes shown to small groups of American parents had to be dubbed into English, but the basic logic of the program was untouched.

The results of the trial, published nearly seven years ago in the British Medical Journal, were very encouraging. Among the intervention group the ratio of praise to ineffectual commands increased three times over, and this change in fundamental behavior translated into significant reductions in anti-social lapses among the children.

All this was delivered for around $1,100 per child in the late 1990s. The figure was broadly similar to the cost of a standard mental health response for which there was no equivalent proof of impact on well-being.

In a commentary in the same edition of the British Medical Journal, Carolyn Webster-Stratton published a commentary. The Scott study, she said, helped narrow the gap between the science and practice of mental health for children.

Seven years on has the gap narrowed further still? Well perhaps.

Last year Stephen Scott became Director of Research at the National Academy of Parenting Practitioners whose brief includes undertaking more clinical trials to evaluate the effectiveness of promising approaches and using the evidence to advise Government. None of this could have been envisaged when The Incredible Years was trialled in South London 13 years ago.

In other respects the frustrations remain. Many parenting programs continue to be developed without reference to the evidence base or to proven models such as Incredible Years or Triple-P. There is acceptance of the need for rigorous evaluation but it is openly grudging in some quarters and it generally falls far short of full commitment.

We are still a disappointingly long way from embedding interventions in routine practice.

References
Scott S, Spender Q, Doolan M, Jacobs B and Aspland H, “Multcentre controlled trial of parenting groups for childhood anti-social behaviour in clinical practice”, British Medical Journal , 323, 28 July 2001

Webster-Stratton C, “Commentary: nipping conduct problems in the bud”, British Medical Journal , 323, 28 July 2001