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Randomized Controlled Trial
. 2022 Jun 13;17(6):e0265946.
doi: 10.1371/journal.pone.0265946. eCollection 2022.

Barriers and facilitators in the delivery of a proportionate universal parenting program model (E-SEE Steps) in community family services

Vashti Berry  1 , Siobhan B Mitchell  1 , Sarah Blower  2 , Karen Whittaker  3 , Kath Wilkinson  1 , Sinead McGilloway  4 , Amanda Mason-Jones  2 , Rachel Margaret Carr  2 , Tracey Bywater  2
Affiliations
Randomized Controlled Trial

Barriers and facilitators in the delivery of a proportionate universal parenting program model (E-SEE Steps) in community family services

Vashti Berry et al. PLoS One. .

Abstract

Background: A proportionate universal (PU) approach to early years' service provision has been advocated to improve children's health and development and to reduce health inequality, by ensuring that services provide timely and high-quality parenting support commensurate with need. Process-oriented research is critical to examine the factors that contribute to, or hinder, the effective delivery/implementation of such a model in community-based family services. This study aimed to assess the delivery, acceptability and feasibility of a new PU parenting intervention model (called E-SEE Steps), using the Incredible Years® (IY) parent program, when delivered by trained health/family service staff in three "steps"-one universal step (the IY Babies Book), and two targeted steps (group-based IY Infant and Toddler programs).

Methods: An embedded mixed-methods process evaluation within a pragmatic parallel two-arm, assessor blinded, randomized controlled trial was conducted in community services in four local authorities in England. The process evaluation used qualitative data gathered via interviews and focus groups with intervention arm parents who were offered the targeted steps (n = 29), practitioners (n = 50), service managers (n = 7) and IY program mentors (n = 3). This was supplemented by quantitative data collected using group leader pre-training (n = 50) and post-delivery (n = 39) questionnaires, and research notes of service design decisions.

Results: The E-SEE Steps model was acceptable to most parents, particularly when it was accompanied by engagement strategies that supported attendance, such as providing childcare. Practitioners also highlighted the positive development opportunities provided by the IY training and supervision. However, participant views did not support the provision of the IY Babies book as a standalone universal component, and there were barriers to eligible parents-particularly those with low mood-taking up the targeted programs. Service providers struggled to align the PU model with their commissioned service contracts and with their staff capacity to engage appropriate parents, including tackling common barriers to attendance.

Conclusions: Despite general enthusiasm and support for delivering high-quality parenting programs in community services in the England, several barriers exist to successfully delivering IY in a proportionate universal model within current services/systems.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: TB is a Trustee for Children’s Early Intervention Trust (CEIT). Early Intervention Wales Training (EIWT) is owned by CEIT and offers training courses, including Incredible Years® (IY). Trustees do not benefit financially from trainings or CEIT/EIWT activities. ESEE study trainings were arranged via the IY developer in the U.S. KWh is a Trustee at the Institute of Health Visiting, a charity that supports the professional development of health visitors/public health nurses through the provision of training, publications and conferences. Trustees do not benefit financially from trainings, publications or conferences. The remaining authors claim no competing interests. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flowchart of process evaluation participants.
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