A family approach to protecting children whose

parents misuse drug/alcohol: Evaluation findings

and messages from practice

Sue Proudlove, Linda Crosskill, Rachel Margolis and Prakash Fernandes

What is the FED UP programme?

3

FED UP

Family Environment Drug Using Parents• Adopts a whole family approach

• Combines group work with children and individual work with their parents or carers

• Includes joint working sessions for the parent and child to address key issues together.

• Delivered over 12 weeks, with families going through a four week assessment process

before commencing on the programme.

The key outcomes of the programme are:

Children Parents Increased self-esteem Greater insight into impact of

drug/alcohol on children

Reduced emotional and behavioural problems

Increased protective parenting

Better process thoughts and feelings

• The NSPCC have been running the FED UP service since September 2011.

• FED UP is run in the following NSPCC service centres: Blackpool, Cardiff, Coventry,

Crewe, Grimsby, Hull, Liverpool, Southampton, Stoke, Warrington and West London.

Up until October 2013, it was also run in Foyle, Glasgow, Lincoln, Manchester and

Sheffield.

• 232 parents and 310 children completed the FED UP programme, until the end of

2014

4

FED UP

Where is FED UP run and how many people have used the service?

What we have learnt from the evaluation so far

Evaluation tools and timeframes

6

Outcome Tool Number at T1 & T2

Children’s emotional wellbeing (child/ parent perspective)

Practitioner perspective

SDQ

HoNOSCA

127

129Children’s self esteem (child’s perspective)

Self Esteem Scale (based on Rosenberg)

157

Children better able to process their thoughts and feelings (child’s perspective)

Children’s Evaluation Wheel

192

Protective parenting (parent’s perspective)

CAPI

Parent Evaluation Wheel

50

71

Key points about the data

• No comparison group data currently analysed*: cannot attribute changes

• Some of the quantitative measures ( especially for parents) have low completions

• Statistical significance indicates a pattern, not random chance. Clinical significance

is the practical importance of the change- does it have a real noticeable effect on

daily life

• Interviews were completed with 13children and 12 parents/carers. The qualitative

work is to understand aspects of the programme that helped or not.

* Comparison group data will be included in the final report

7

Aim 1: To reduce children and young people’s emotional & behavioral problems

8

127 SDQs have been completed at both T1 and T2 (40 parent completed and 87 self-completed).

• The proportion of children moving from a ‘clinical’ level of difficulty to a ‘normal’ level is clinically significant (p = 0.003). The normal band includes all data that does not fall into the ‘abnormal’ score band for the SDQ.

• HoNOSCA data shows the same trend from practitioners’ perspective (n = 129). The mean score at T1 is 6.3 and the mean at T2 is 5.7. The change is not statistically significant (p = 0.06 )

T1 T20%

20%

40%

60%

80%

100%

ClinicalNormal

Aim 2: To enable children and young people to feel better about themselves

9

157 Adapted Rosenberg Self-esteem questionnaires have been completed at T1 and T2

There has been an increase from a mean of 19.5 at T1 to 21 at T2. The change is

statistically significant (p= 0.001)

T1 T202468

10121416182022

T1T2

Children’s Evaluation Wheels at T1 and T2 (n=192)

Aim 3: To enable children and young people to process their thoughts and feelings

10

The changes between T1 and T2 are statistically significant for three criteria: talking to someone if worried about parent’s health, being able to talk to parent about affects of drug/ alcohol use and if being bullied. But not for easily making friends, having fun or feeling supported.

I can talk to someone if I am worried about my parent's health (p=0.0001)

I can talk to my parent about how their drug/ alcohol use affects me (p=0.004)

I can easily make friends (p=0.16)

I can talk to someone if I was being bullied (p=0.002)

I am able to have a fun time when I want to (p=0.33)

I feel supported by others around me (p=0.69)

012345

T1T2

Aim 4: To enhance Protective Parenting

11

Overall reduction in behaviours that contributes to risk in children as shown by the CAPI. 50 CAPIs suitable for evaluation at T1 and T2

Subscale Mean T1 Mean T2 Statistically significant (p<=0.05)

Distress (cut off = 152) 158.56 138.48 Yes (p=0.002)

Rigidity (cut off = 30) 10.96 10.9 No

Unhappiness (cut off = 23) 30.22 25.66 Yes (p=0.049)

Problems with child and self (cut off = 11) 6.5 4.64 Yes (p = 0.009)

Problems with family (cut of = 18) 14 15.36 No

Problems with others (cut off = 20) 15.92 15.5 No

Total score (cut off 215) 240.46 210.54 Yes (p=0.001)

Ego strength scale 14.86 17.66 Yes (p=0.005)

Loneliness scale 9.8 8.92 Yes (p=0.04)

Aim 5: Increase parent’s insight into impact of drug/alcohol on children

12

Parent Evaluation Wheels at T1 and T2 (n=71)

The changes between T1 and T2 are statistically significant for all criteria on the wheel.

How much I think that my child is affected by my behaviour (p=0.002)

How confident I feel that I am doing the best for my child (p<0.001)

How supported I feel in taking care of my child (p=0.001)How confident I feel in asking for help when I need it (p<0.001)

How much knowledge I have about children's needs at different stages of their development (p<0.001)

0

1

2

3

4

5

T1 T2

Mechanisms of change

Mechanisms of change: children feeling less alone

“I always felt like I was the only one who had problems but since I met other people I don’t think that anymore. Since I went to FEDUP group it feels nice not being the only person………. thinking you are the only person with problems” (Child)

“They helped us with stuff, helped us express ourselves, helped us with our feelings, didn’t make it too hard for us” (Child)

What children & parents told us

Addressing emotional and conduct problems

“Now I’m like more responsible and

like I don’t want to like mess around

my sisters to annoy them, so they don’t annoy

me that much anymore.”

“Well before I went to the FEDUP group I was

like really stressed out all the time. Really

like angry at everyone all the time, but now

I’ve done that group I’m not as angry.”

Value of the group work with children

“she was able to talk about her feelings

and everything that maybe she didn’t want

to tell me because she didn’t want to upset

me. So it gave her that, just a little bit

away… you know sometimes mums are a

bit too close”

“I think it was meeting other people that

parents have the same problem and

realising he's not on his own and there's

lots of children out there with their parents

that do the same.”

15

Mechanisms of change: parents insights into the rollercoaster effect

 “I learnt from FEDUP to just stop and think before I act. I am not chaotic anymore but realising that when I do make a decision to do something it can have a rollercoaster effect. You don’t want to think that one little blip is really going to affect your kids, but if they did find out they might get worried again.” (Parent)

“It was upsetting at times coz obviously you have got to think about what you have gone through and past experiences and how my decisions along the way have affected the kids, so yeah hindsight is a wonderful but you cant change what’s happened just learn from it.” (Parent)

Mechanisms of change: families communicating more

“I think they probably feel that they can talk to me now instead of talking to each other and you just get a calmer vibe. I can make time out more than I did” (Parent)

“I just thought that I couldn’t talk to her about a lot of things, but now I know I can talk to her about loads”( Child)

Barriers and

challenges in

delivering the

programme

Barriers and Challenges

Barriers• Wide age range of

children in some groups• Being the only boy or girl

in a group• Offering the service at

the right time for the child• Unstable family

environment• Parents motivation to

take part in the programme

19

Challenges• Transporting children• Working at the parents’

pace• Children’s differing levels

of understanding• Differences in the type of

addiction-alcohol/street drugs-when delivering group work

Deciding the strategic implications for the NSPCC

Identify adaptions to the FEDUP service. ( eg: work with grandparents, siblings; work

with children to address co-morbidity of other risk factors in their family)

Identify innovative ways in which we can expand the impact/exposure of the service

( eg. Closer partnership working with adult treatment programmes; Offering

FEDUP as a module / part of the pathway within adult treatment programmes)

Consider more carefully how we can use national data on parental drug and alcohol

use to influence outcomes for children

Explore potential policy and legislative changes that might reduce the number of

children that are exposed to parental substance misuse to begin with.

20

Next Steps

2121

Summaries of all our evaluation plansEach summary includes:• Details of the evaluation methods we are using for the service• Details of any challenges faced and how we overcame them• A list of the measurement tools we are using • Contact information of the staff member involved in the evaluation

Tools for measuring outcomes for children and Families We've outlined our experiences of using each tool, along

with details of what it measures and how easy it is to use.Each measure includes:

• An explanation of the measure• Details of who to use it with• The time it takes to administer • Any training or expertise required • It’s validity and reliability • Cost• Our experience of using it

And much, much more….

Our Impact and Evidence Hub can be found at www.nspcc.org.uk/evidencehub 

Join the debate at:@nspccpro

Search #evidencehub

Our hub features…

  The NSPCC Impact and Evidence Hub