How do Facilitators Explain Paternal Absence from Parenting Groups?

By

Simone Irvine

Submitted in partial fulfilment of the degree of Doctor of Psychology (Clinical Psychology)

School of Psychology

Faculty of Health and Medical Sciences

University of Surrey

November 2018

© Simone Irvine 2018

Abstract

Background: Parent programmes are a NICE (2017) recommended intervention for parents

of children who have a conduct disorder and evidence suggests a number of benefits to

paternal involvement in such interventions. However, on the whole fathers are often

unrepresented at parenting groups. The present study aimed to understand the issues to which

facilitators attributed paternal absence from parenting groups.

Method: Thematic analysis was chosen to highlight salient ideas in facilitators’ explanations.

The participants were a volunteer sample of nine parenting group facilitators, from various

child services in South East England. Semi-structured interviews were conducted in person

and over the phone, and were up to 60 minutes long. Interviews were transcribed and

analysed using an inductive approach.

Results: The data revealed five main themes: “An uncomfortable topic”, “Responsibility”,

“Our hands are tied”, “Fathers are peripheral parents” and “What makes fathers more

comfortable?”. Facilitators appeared uncomfortable discussing this topic and tried to avoid

generalisations or the appearance of sexism. They had differing ideas of who was responsible

for paternal attendance and many felt they had done all they could. An important aspect of

facilitators explanations of paternal absence was of parents adherence to traditional gender

roles in relation to childcare. They also considered that greater familiarity with services and

the presence of other men in groups might make fathers more comfortable attending

parenting groups.

Conclusion: Facilitators found this an uncomfortable topic but mainly explained absence in

terms of parents adopting traditional gender roles and service constraints. Clinical

implications and research recommendations based on this are discussed.

Acknowledgements

I would like to express appreciation and acknowledge all those who have contributed to my

clinical training experience. This includes the entire course team at the University of Surrey,

but I would like to give special thanks to Dr. Mary John (Personal Tutor), Dr. Linda Morison

(Research Supervisor), and Dr. Kate Gleeson who generously offered ad hoc support.

Beyond the classroom I have had the pleasure to experience different fields of psychology

through excellent placements. The experience I gained on each placement was invaluable was

greatly enhanced by each placement supervisor. Therefore, I would like to thank all my

placement supervisors for their expert knowledge and guidance, which contributed to my

personal and professional development over the three years of training.

Finally, I would like to thank my husband Matthew, my mother Janet, family and friends for

their unwavering support, encouragement and patience over the past four years that it has

taken me to complete the doctorate. It has been a long journey, but to my colleagues in

Cohort 43, thank you for your friendship. I could not have taken this journey with a better

group of people.

Contents

Acknowledgements 3

Introductory section 4

Major Research Project Empirical Paper

How do facilitators explain paternal absence from parenting groups? 65

References 101

Appendices 107

Literature Review

What do parents value about facilitators of group-based parenting 5

programmes: a review of the qualitative evidence

References 45

Appendix 53

Introductory Section

This thesis includes an empirical paper and systematic literature review on the topic of

parenting group interventions.

The present study aimed to explore how facilitators explained paternal absence from

parenting groups. This study aimed to extend the UK literature available on this subject

matter and lay the groundwork for future studies that may want to consider whether staff

perspectives, specifically, influence the effort made to engage fathers and ultimately, whether

this influences paternal involvement in family interventions. Differential perceptions of

mothers and fathers are likely to be relevant to future facilitator training programmes and

service efforts to target both parents for support.

Then a systematic literature review focused on what parents valued about facilitators of

group-based parenting programmes. This included 10 studies. There was evidence to support

commonalities in what parents value about group facilitators such as the facilitator’s use of

personal disclosure, and their ability to build a good therapeutic relationship. However, as the

number of relevant papers was limited it suggested that more research that focuses on

facilitators of parenting groups is needed. Suggestions for future research were to explore

whether valued facilitator factors influence parental engagement with parenting groups and

should also seek for greater equity in the number of paternal participants and perspectives

which represent a diverse range of backgrounds.

How do facilitators explain paternal absence from parenting groups?

Word count: 9,631

Statement of Journal Choice:

The target peer-reviewed journal for this qualitative paper is Journal of Children’s Services.

The journal encourages the international development of research-based, outcome-focused

services to promote the well-being of children and their families. The journal covers

discussion of the conceptual frameworks that inform service provision and promotion of

initiatives to forge stronger links between research, service policy and practice.

Abstract

Background: Parent programmes are a NICE (2017) recommended intervention for parents

of children who have a conduct disorder and evidence suggests a number of benefits to

paternal involvement in such interventions. However, on the whole fathers are often

unrepresented at parenting groups. The present study aimed to understand the issues to which

facilitators attributed paternal absence from parenting groups.

Method: Thematic analysis was chosen to highlight salient ideas in facilitators’ explanations.

The participants were a volunteer sample of nine parenting group facilitators, from various

child services in South East England. Semi-structured interviews were conducted in person

and over the phone, and were up to 60 minutes long. Interviews were transcribed and

analysed using an inductive approach.

Results: The data revealed five main themes: “An uncomfortable topic”, “Responsibility”,

“Our hands are tied”, “Fathers are peripheral parents” and “What makes fathers more

comfortable?”. Facilitators appeared uncomfortable discussing this topic and tried to avoid

generalisations or the appearance of sexism. They had differing ideas of who was responsible

for paternal attendance and many felt they had done all they could. An important aspect of

facilitators explanations of paternal absence was of parents adherence to traditional gender

roles in relation to childcare. They also considered that greater familiarity with services and

the presence of other men in groups might make fathers more comfortable attending

parenting groups.

Conclusion: Facilitators found this an uncomfortable topic but mainly explained absence in

terms of parents adopting traditional gender roles and service constraints. Clinical

implications and research recommendations based on this are discussed.

Introduction

Background and Rationale

In 1999 and 2004 the Office of National Statistics (ONS) reported that ten percent of children

and young adults under the age of 16 were diagnosed with a mental health problem, of which,

conduct disorders were most prevalent (ONS, 1999; Green, McGinnity, Meltzer, Ford, and

Goodman, 2005). Children with a conduct disorder are more likely to be involved with the

criminal justice system, have poor social skills, poor academic performance, to abuse

substances, and have a co-morbid mental health problem. Accordingly, the ONS reported that

conduct disorders were the leading cause of referral to child and adolescent mental health

services (CAMHS).

The National Institute for Health and Care Excellence (NICE, 2017) recommends that parent

training groups be offered to parents of children who have, or are at risk of developing, a

conduct disorder. Parenting groups are an important intervention option because there is

evidence to support their efficacy (Bodenmann, et al., 2008; Jones, et al., 2008; Sanders,

2008) and other benefits such as cost effectiveness (Scott et al., 2001; Edwards et al., 2007).

As well as recommending that parenting groups are offered, NICE (2017) also states that

both parents should attend where possible, due to the number of benefits to paternal

involvement in parenting groups. Parenting interventions that include fathers are more likely

to lead to an improved parent-child relationship, parent-parent relationship, and to produce

positive outcomes for children with behavioural problems that are maintained over time

(Bagner, 2013; Levant & Doyle, 1983; Webster-Stratton, 1985; Wiggins et al., 2009). Thus,

the non-attendance of fathers has been identified as a disadvantageous.

Despite the importance of paternal involvement, a systematic review of the global evidence

for parenting interventions stated that across the world, thousands of programmes were

delivered to largely maternal groups every year (Panter-Brick et al., 2014). Unfortunately, on

the whole, researchers agree that successful paternal engagement with child and family

services is the exception, rather than the rule. According to the Fatherhood Institute’s

Fairness in Families Index (2016), in comparison with the rest of the developed world, British

fathers were the worst at sharing parenting responsibilities with their partners. In Panter-

Brick et al.’s, (2014) study of global evidence only 34 parenting programmes were identified

as exemplary in their engagement of fathers, and of these, only three were based in the UK.

Consequently, various researchers and family organisations believe that there is a need for

services to adapt and innovate new ways to engage fathers. Further, that this should address

the attitudes of professionals as well (Barnardos, 2006; Berlyn, Wise and Soriano, 2008).

NICE (2007) guidance on changing practice confirms the importance of the second priority

and explains that an individual practitioner’s personal beliefs, their attitude, and perception of

the views of others, greatly impact their own behaviour towards implementing change.

In line with the first of these recommended objectives, some research has focused on existing

innovations that are specifically designed to increase paternal involvement. For example,

three national evaluations of services resulting from government initiatives in the UK,

America, and Australia reported successful rates of paternal engagement. In these cases,

specialist dad workers who facilitated groups as part of their multi-faceted roles, were

specifically appointed to target fathers and to cater to their unique needs (Lloyd, O’Brien, &

Lewis, 2003; Raikes, Summers & Roggman 2005; Berlyn, Wise & Soriano, 2008).

In terms of the second objective, to address professional attitudes, various writers have

identified that fathers are more likely to engage with child and family services where

professionals subscribe to the belief and communicate the importance of the paternal role

(Lloyd, O’Brien, & Lewis, 2003; Berlyn, Wise & Soriano, 2008). So then, holding group

interventions in mind, this finding suggests that professionals who act as facilitators are

influential and strategically positioned gatekeepers in regard to paternal involvement with

parenting groups. In support of this understanding and in order to effect change, NICE (2007)

advises talking to key individuals that have the knowledge, skills, authority, and specific

understanding of the situation in question, to enable exploration of the topic and new ideas.

In the realm of family intervention and professional attitudes research, there are studies that

demonstrate the important influence of attitudes, opinions, and beliefs on professional

practice and family involvement in family interventions. It has been found that the attitude of

the professional determines the likelihood of family being involved in treatment (Brent &

Giuliano, 2007). For example, professionals in several studies held the belief that involving

family members in their client’s treatment or implementing innovative family interventions

required more time and was an optional extra to their role’s main responsibilities (Goudreau,

Duhamel, & Ricard, 2006; Bailey, Burbach & Lea, 2003). Additional barriers to involving

family members in innovative interventions were professional attitudes that conflicted with

existing family service concepts and practices (Bailey, Burbach & Lea, 2003). In some

studies professional participant consensus was that innovation implementation was dependent

on one or more practitioners in the team to openly state their belief in it and champion it’s

importance. Furthermore, to believe in the importance of involving family members and

perceive that their colleagues would be willing to support their work (Bailey, Burbach & Lea,

2003; Murphy & Withnell, 2013). On the other hand, families reported that the most helpful

aspect of the family intervention was the attitude of respect from the facilitating professional

(Goudreau, Duhamel, & Ricard, 2006).

In summary, the current research basis suggests that professional attitudes and beliefs can

create either a barrier to, or facilitate involvement in family interventions. To the knowledge

of the author of the present study, however, there is no research that focuses exclusively on

the attitudes and beliefs of facilitators on the issue of paternal involvement in parenting

groups. Hypothetically, if men are largely absent from parenting groups and experience the

professionals who facilitate them as intervention gatekeepers, then it stands to reason that it

would be important to explore said facilitator perspectives around this issue.

Research Question

The motivation for the present study was to provide an opportunity for facilitators, who work

closely with parents, to openly share and reflect on their own beliefs and assumptions around

paternal absence from parenting groups. The importance of this study is that facilitators’

perceptions of fathers’ involvement in parenting interventions are likely to be relevant to

future facilitator training programmes and family services’ efforts to effectively target both

parents for support. In addition, to understand the issues to which facilitators, in their

expertise and experience, attribute paternal absence from parenting groups and to extend the

UK literature available on this subject matter. The research question therefore was “How do

facilitators explain paternal absence from parenting groups?”

Method

Design

An inductive approach to thematic analysis (TA) was chosen to highlight key opinions,

beliefs and assumptions in facilitators explanations of paternal absence. According to Braun

and Clarke (2006) TA is a method of describing the patterns or ‘themes’ that reoccur and

appear to be central to the phenomenon under study. An inductive approach to TA is

concerned with the themes that ‘emerge’ from the data collected, namely a bottom up

approach. This is alternate to a deductive approach where the data is compared against

existing themes from the literature or used to test theory-driven hypotheses formed by the

researcher (Hayes, 2000).

Thematic analysis was chosen for several reasons that include but are not limited to the

following; (1) it provides a useful way of summarising a large body of data (2) it is a flexible

approach that does not require allegiance to any particular theoretical perspective but can be

successfully employed by researchers of various epistemological approaches (3) TA allows

the most salient ideas in the data to be highlighted (4) TA is a systematic method that is able

to capture both manifest (content that is explicitly mentioned) and latent (implicit content) (5)

TA is an approach conducive to treating participants as collaborators in the area under study

(6) the results of thematic analysis are generally easy to understand and accessible to the

general public

An inductive approach was chosen as, to the principal researcher’s knowledge, there are no

psychological theories specifically aimed at explaining paternal absence from parenting

groups.

Braun and Clarke’s (2006) guidance for using TA in psychology was the main guidance

considered in constructing the method of this study, as it provided an accessible and clear

description of the processes involved and recommendations for quality monitoring (Appendix

B).

Participants

Therefore, the present study will provide qualitative data, through a thematic analysis of the

opinions, beliefs and assumptions present in explanations of paternal absence. Rather than

exploring paternal perspectives however, group facilitators were selected for interview. The

rationale for choosing facilitators was greater accessibility to these individuals, and the fact

they that are key personnel who often hold dual roles as family key workers and programme

facilitators. A purposive sample of nine group facilitators of parenting programmes were

recruited from a County Council in the South of England (Table 1). Facilitators who were

eligible to participate in this study, were those for whom English had been their first language

and who had facilitated at least one manualised or locally developed parenting programme.

They had experience running programmes for children and adolescents under the age of 18

years old. They needed to be available during the period of data collection and willing to take

part in a semi-structured interview enquiring about their own opinions, beliefs and

assumptions around fathers’ absence from parenting groups. This criteria was checked at the

recruitment stage. Facilitators were informed of the study topic and given an information

sheet and consent form to read, prior to their agreement to participate in the study (Appendix

C and Appendix D).

Table 1: Participant Characteristics, length of time as a facilitator, and groups facilitated

Participant Gender Length of time as a facilitator

Groups facilitated

Facilitator 1 Female 10 years Incredible Years (5 – 9 years old)Stop (10 – 13 years old)

Facilitator 2 Female 4 years Stop (11+ years old)

Facilitator 3 Female 2.5 years Incredible Years (5 – 9 years old)

Facilitator 4 Male 4 years Stop (11+ years old)

Facilitator 5 Female 2.5 years Triple P (2 – 12 years old)

Facilitator 6 Female 4 years Triple P (2 – 12 years old)

Facilitator 7 Female 13 years Incredible Years (5 – 9 years old)

Facilitator 8 Female 3 months Triple P (2 – 12 years old)

Facilitator 9 Female 3 months Triple P (2 – 12 years old)

Data Collection

Semi-structured interviews were carried out with participants using the interview schedule

outlined in Appendix E. Each interview began by re-introducing the main research question

and sharing the interview schedule. However, following the warm up questions the

participants were encouraged to respond, and talk around the main research question. The

aim of the interview was then to explore the points raised, in a conversational style. The

interview schedule was used flexibly and prompts were used as appropriate, when the

conversation waned, to support the participants to continue to talk around the area of interest.

Interviews lasted up to 60 minutes in duration and were conducted at the participants’ place

of work wherever possible, in County Council buildings, in an interview room free from

distractions. In two cases the interviews were conducted over the phone due to the

availability of the participants.

Interview Schedule

The interview schedule was comprised of two warm up questions, seven open-ended

questions and prompts to keep the conversation flowing at a natural pace (Appendix E).

Following the warm up questions, each facilitator was asked the main research question first;

‘How do you explain paternal absence from parenting groups?’. The primary aim was to

allow the interviewee to talk freely around the main topic and secondly, to use the interview

schedule flexibly to encourage depth of information relating to their opinions, beliefs and

assumptions.

Procedure

1. Participants were recruited with the support of the lead practitioner responsible for the

co-ordination of parenting programmes run by various child and family services,

within the Council. The lead practitioner emailed each team of facilitators, to request

permission to give their contact details to the principal researcher. Initially, ten

facilitators gave permission to be contacted by the principal researcher by email and

nine of these individuals were eventually interviewed (Appendix F). One facilitator

was no longer working for the Council at the time a contact attempt was made and

therefore, could not to be reached.

2. Once individual facilitators had given their permission to be contacted, the principal

researcher emailed them the information sheet and consent form which outlined the

nature of the study and requirements for participation (Appendix C and Appendix D).

At this stage the facilitators were also given the option of a phone call follow up to the

email, to enable the principal researcher to answer any questions they might have.

3. All nine facilitators participated in one-to-one, semi-structured interviews with the

principal researcher that were audio recorded. All audio files were transferred to an

encrypted memory stick within 24 hours of recording (see section on Ethical

Considerations for further information on data storage).

4. Data analysis was completed in line with Braun and Clarke’s (2006) guidelines,

which outlined a six phase process (Appendix L). Once completed, all the interviews

were transcribed by the principal researcher, in preparation for analysis (Appendix G).

Data was initially reviewed by the principal researcher, who did line by line coding

and started to note reoccurring areas of interest to begin to identify initial themes and

subthemes (1st order).

5. Each new potential theme was compared to the data corpus (a term meaning all the

data collected). As part of the narrowing down process, the principal researcher

created thematic maps, a visual representation of how the potential themes and

subthemes related to one another (Appendix H). These were also discussed in

consultation with both research supervisors to arrive at the final set of themes and

subthemes (2nd order; Appendix I).

6. Throughout the research process the principal researcher endeavoured to maximise

the quality of the research being conducted, by considering the quality framework

proposed by Braun and Clarke (2006) depicted in Appendix B.

Ethical Considerations

Participants were asked about their personal views and experiences linked to their role as a

group facilitator, and so care was taken to avoid inadvertently implying they were

incompetent or were acting improperly towards programme attendees. The principal

researcher allowed participants to talk about their experiences using their own language. Prior

to interviewing, each participant was informed that they could decline to talk about any topics

that they were uncomfortable discussing, and were able to stop and withdraw from the

interview at any time. During the interview, if the facilitator appeared to be uncomfortable,

the principal researcher paused to check whether they were happy to continue. None of the

facilitators chose to exercise this right.

Due to the potentially sensitive nature of the information being gathered, a signed informed

consent form was a requirement of participation. Consent was sought for both, the process of

collecting and reporting the data. Quotes presented in the results section are assigned a

pseudonym and are presented in such a way as to avoid identification of any particular

participant.

The interviews were recorded using a digital audio recording device and the principal

researcher personally transcribed all the interviews to preserve confidentiality. Audio

recordings were removed from the device immediately after recording and stored on an

encrypted memory stick. Data relating to the present study was only transported between sites

via encrypted memory stick. Any names or identifying details of people and places were

anonymised on paper transcripts and notes kept.

Research and Development Considerations

The present study was reviewed and received a favourable opinion from relevant County

Council research governance panel, and the Faculty of Health and Medical Sciences Ethics

Committee at the University of Surrey (Appendix J and Appendix K). The study was planned

in conjunction with, and supervised by an internal university supervisor and an external

supervisor from the same locality of the participants.

Epistemological Assumptions

It was important to acknowledge my epistemological assumptions and personal background,

as the principal researcher, which was likely to have some impact on the data analysis

process. My assumptions were aligned with a weak social constructionist perspective;

“weak constructionism assumes that how people engage with a particular issue is socially

constructed although the issues themselves have a material basis” (Joffe, 2012, p. 211).

This epistemological stance sits in between a realist and social constructionist perspective

without the need to fully subscribe to either. I come from the perspective of a Black British

female of Caribbean dissent, with experience of being raised by a single mother, and having

been exposed to wider societal discourses about paternal absence in general, which are

common in the Black British Caribbean community. From the outset, I held the belief that

facilitator explanations would consist mainly of ‘material’ or practical barriers to paternal

attendance (eg. work) and would reflect a shared passive, and ‘socially constructed’,

acceptance of paternal absence. Supervision and multiple reviews of the analysis throughout

the process, helped to ensure that interpretations were more closely reflective of the data and

not themes that pre-existed to me.

Figure 1. Emergent themes and subthemes following analysis of facilitator interview transcripts.

Results

Analysis of the transcripts revealed five main themes with sub-themes, shown in Figure 1.

Each theme is self-contained, however the first theme; “An Uncomfortable Topic”, provides

an overall context in which to consider all other themes and subthemes described. The

principal researcher noticed that paternal absence from parenting groups was an

uncomfortable topic for professionals, who may have been more inclined to share socially

desirable opinions, beliefs and assumptions. The researchers held this in mind during analysis

of the facilitators’ transcripts and contemplation of emerging themes and sub-themes.

The main themes and sub-themes identified are outlined below and quotes are used to

illustrate findings.

An Uncomfortable Topic

During conversations with facilitators it became clear that exploring paternal absence was an

uncomfortable topic. Facilitators often exercised caution when expressing their opinions; they

seemed to be avoiding sexism, they pointed out potential assumptions or generalisations

before commenting, and emphasised the equality of mothers and fathers. Accordingly, it

provided the first main theme and an over-arching context in which to consider all the

findings.

Dads contribute challenge. I think they contribute challenge to us as facilitators cause again sweeping

generalisation, but… (facilitator 4)

Now we could go down the sexist route there but I'll try to steer clear well, well, no, no, I mean

obviously, if I wanted to I could do in laymen’s terms and it's slightly sexist… the men look upon it

as - what's a couple of women trying to tell me - this is all assumptions. (facilitator 2)

Everyone is different. Facilitators were careful not to be too prescriptive and

explained that absence from parenting groups was dependant on the father’s unique

circumstances and family dynamics.

I think that depends on their home situation or relationship at home, whether they work together as a

team with their children. Some you know, have where they might live together but they do this caring

separately… so every situation has been completely different, that it's hard to comment... (facilitator 5)

I would hate to tar anybody with the same brush. I really wouldn't want to do that. (facilitator 2)

Everyone is equal. Facilitators also explained that the nature of their efforts to recruit

fathers to parenting groups, and their handling of both parents within the group, reflected a

desire to treat mothers and fathers equally.

If a male says they don't want to come, I don't do a lot of pushing but then I wouldn't do that for a

female. You know I would like to think that I do treat them the same (facilitator 7)

I mean we talk about, not as a male, female issue but, you know, the support that people need

around them to bring up children... but we don't talk about the gender issue as such (facilitator 1)

Responsibility

In facilitator attempts to account for paternal absence, the question of responsibility arose.

Some facilitators felt that fathers bore responsibility for their own attendance, while others

felt that their service and referring services should be more proactive in their approach to

paternal engagement. A few facilitators also posited that fathers might see behavioural

change as the child’s responsibility and thus, not recognise the need to attend a parenting

course.

They should do more. Facilitators held differing ideas around responsibility and

some explanations involved shifting responsibility to another party. They asserted that

referring services held responsibility for the individuals they referred to the group and

attributed paternal absence to the lack of paternal information they received.

We're the facilitators, that's their responsibility to get the right people there. (Facilitator 4)

Facilitators also hypothesised that some fathers place the responsibility for change on their

child believing the child needed to do more to amend their own behaviour. In this case,

fathers might deny any need to improve their own parenting strategies and thus, not recognise

the need to attend a parenting course.

…whereas a man, from my experience, will have been parented a certain way and to them that is just

the way you do it …it’s not a topic that’s up for discussion, it’s just a case of my kids aren’t behaving

themselves, there must be something wrong with the kids because I’m doing what my dad did to me

and I turned out all right. (Facilitator 8)

…others (fathers) are more closed down and say…I don't need this… he just needs to behave himself.

(Facilitator 4)

We tried but it did not work. Facilitators indicated that fathers themselves were

largely responsible for the lack of paternal involvement in parenting groups. They stated that

services had made attempts to be flexible in the timing of programmes; offering evening and

Saturday groups to increase father attendance.

We run 3 each year, one is always run in the evening to try and get dads in as well. (Facilitator 1)

…it's essential groups run with dads, that's why we do an evening one to try and encourage them to

attend. (Facilitator 4)

A few facilitators however, reported that attempts to be flexible had proved unsuccessful.

We try and offer evenings, we've even offered a Saturday before, we didn't get a lot of take up. Didn't

get any take up on the Saturday so we've tried to be flexible. (Facilitator 6)

We have tried to put out evening courses and tried to do Saturday courses but we haven't had an uptake

on that so we've tried to put it out there. (Facilitator 5)

Our approach is too passive. Some facilitators however, felt it was the

responsibility of their services to encourage paternal attendance. They suggested the service

was somewhat passive in its approach, waiting for fathers to come forward with expressed

interest.

We will run a group when we have enough interest from fathers. (Facilitator 5)

…for a service, we might not even contact that father, I don't think, which is a bit wrong

really cause they may well be chomping at the bit to get in (Facilitator 4)

Facilitators acknowledged that more could be done. For example, creating promotional

materials that appealed to men or directing recruitment efforts towards existing community

groups of fathers.

I think we could probably think about how we would make them (leaflets and posters) more dad-

friendly...that's something that we're beginning to start thinking about in a way. (Facilitator 6)

…perhaps we need to target the father group that runs and speak to them probably a bit more and apart

from that just keeping an eye on our expressions of interest for dads (Facilitator 5)

Our Hands are Tied

In their interviews, many facilitators’ explanations revealed that they believed they lacked the

freedom to tackle paternal absence for three reasons. Firstly, because they did not directly

manage referrals received, secondly, due to the limitations of the parenting programmes on

offer and thirdly, due to work related pressure.

We do not deal with referrals. A few facilitators explained that their approach to

paternal engagement was determined by service protocols and conventions around

recruitment. For example, in some services the main source of recruitment was self-referrals

and so facilitators only contacted parents who had directly expressed interest and referred

themselves to a parenting group. In this way, those facilitators expressed a limited ability to

influence paternal attendance.

…well for our system here, I think we're doing what we can (Facilitator 5).

…they call in our admin team and they book them onto the course so a few weeks before the

course the facilitators will look at that list… because mum would be the only one on the

attendance list, so it's whoever’s on the attendance list and booked on to the course, we would

then contact those people (Facilitator 5)

Consequently, there was a sense for these facilitators that paternal attendance was determined

at the point of referral and so, if the father’s details were not included on the referral form,

efforts to engage him were viewed as unnecessary.

We don't tend to ask about whether dad's around or not, simply because at that point of contact (home

visit), it's not relevant, we're just there to meet the mum. The one who's going to be doing the course.

(Facilitator 3)

The programme has its limits. Almost all programmes discussed were standardised

and employed established protocols, as opposed to being created by and for local services.

Accordingly, some facilitators cited course requirements to practice new strategies at home,

as a barrier to paternal attendance. The facilitators reported that fathers might be court

ordered to attend a parenting course, and/ or might have limited contact with their children.

While some facilitators took the position that, inappropriate course content tied their hands

and so discouraged these fathers from group attendance, others still allowed them to attend.

…they need to put the things into practice and if they haven't got contact with their children,

they can't do that… that is one of the reasons why we quite often don't encourage them to

come on the Incredible Years (course) because it would be very difficult for them to put it in

to practice… (Facilitator 7)

Occasionally there has been a call for some work with dads that haven't got their children living with

them that could be court requested, so that's another way we get dads occasionally. (Facilitator 1)

We are under pressure. Facilitators spoke about the impact of work-related

pressures on their ability to make additional efforts to recruit fathers to parenting groups and

to sustain team conversations around this topic. In this context, some facilitators reported that

mothers were viewed as more willing to engage, easier to contact, and so represented the path

of least resistance.

We have really busy periods…I think it's a culture within our organisation…and actually it’s the way

of least resistance, you know mum's there and mum will answer the questions - great, tick, I've talked

to parents but I don't think we do enough to engage dads and it's a challenge to engage dads and I think

again, some staff may not feel a need, you know, able to do that sort of work… but it’s how

comfortable staff feel with doing that work when we feel quite restricted (Facilitator 4)

…to be honest I don't think it's a conversation (paternal engagement) we have enough. We've gone

through fits and starts, so when we've been able to, we've discussed it but that's sort of going back quite

a while now. I must admit and then it tends to get dropped and we just, cause I think with the caseload

we've got you just get single minded and you're just running things you normally do, so no we're not

spending enough time looking at father's needs with all of this....(Facilitator 1)

Fathers are Peripheral Parents

Facilitators suggested that fathers perceive themselves as peripheral to mothers, who were

viewed as the main caregivers. Facilitators speculated that traditional and cultural ideas

about men’s roles and beliefs around help-seeking as emasculating, placed fathers on the

periphery of parenting activities and caused them to be absent from parenting groups.

…it's still that stigma of this is mum's job and I'm (father) on the outside, if mum is the main carer.

(Facilitator 5)

I think there's still some historic stuff around parents are carers, you know mothers are parents, the

carers, so fathers are less involved in some way (Facilitator 1)

Traditional roles create reluctant fathers. Most facilitators tentatively interpreted

paternal absence as the father’s alignment with traditional and cultural beliefs of what

constituted the male domain. Generally, an assumption was made that fathers went out to

work and so their main parenting role was the provision of discipline. Facilitators suggested

that these ideas made fathers reluctant to participate in parenting groups, as many of the

associated activities would involve stepping outside of their domain.

…that's difficult for them as far as from a male, you know alpha male or…the head of the household…

maybe makes them slightly more resistant (Facilitator 5)

…I think more of the traditional families who are still there and culturally where, perhaps it's been

generational, would expect mum still to have more of, of the input in the bringing up of the children

and it may be that father would only intervene when things are going wrong or as a punishment which

is a shame...those that are quite traditionalist that see the parent role as mum, mum's job so to speak so

mum would be the one coming along. (Facilitator 2)

I think a lot of it is the stigma, that parenting is seen as something that a woman deals with. So even,

I’ve had a couple of men come along to sessions but they tend to give all the paperwork to the woman,

they won’t generally answer any questions, they’ll pass it over to their partner. (Facilitator 8)

According to most facilitators, fathers demonstrated their reluctance by making excuses, and

were more likely than mothers, attend a parenting group because they had been ordered to do

so.

It is more difficult to get dads to come, they will try and make excuses. (Facilitator 4)

Some come with their arm up their back…fathers, in particular, will come along because either social

workers or the court. In my personal experience, men have mainly come because of that. (Facilitator 7)

Sometimes they’re (fathers) court ordered to do the courses (Facilitator 9)

Seeking help is emasculating. Finally, facilitators postulated that traditional and

cultural concepts of masculinity as strong and in control, caused men stay away from

parenting groups because they find help-seeking emasculating. They felt that fathers might

struggle with a perceived lack of control over their child’s behaviour, particularly if discipline

was viewed as part of the male domain.

Traditionally, I think also it could be that, fathers, men will feel more emasculated if they don't feel like

they've got control over this challenging behaviour and that's difficult for them as far as from a male,

you know alpha male… (Facilitator 2)

Some facilitators presumed that fathers felt uncomfortable admitting they needed help to

change their parenting strategies, particularly in a group setting, if parenting or nurturing was

viewed as part of the female domain.

Getting men to talk about their feelings is a whole other thing, because the stereotype is that men don’t

talk about their feelings and that’s not something they should be doing, going along to a discussion

group…I think it’s something that is still very much seen as a women’s domain (Facilitator 8)

… I don't know whether it's a sign of weakness. It takes a bit of humility to ask for help doesn't it, and I

think, in my opinion, again it's easier for a woman to ask for help more than it is for a man… It might

just not be cool for a man to attend a group, to sort of attend a group and I guess they sort of probably

see it as 'it's all a load of women’ (Facilitator 7)

I do think they (fathers) struggle more than mums do with the changes that are expected and because of

the traditional views. For example, it's very rare we'll get a woman come through the door, but it's not

so rare to have a man come through the door, and say ‘well, when I was growing up my dad gave me a

good hiding, it never did me any harm’… I do think the fathers struggle with the idea that they should

have to change more so than the mothers. (Facilitator 2)

What Makes Fathers More Comfortable?

Most facilitators supposed that feelings of discomfort played a role in fathers’ non-attendance

of parenting programmes. In their explanations, they expressed three key issues that they

believed might increase paternal comfort levels: familiarity with service staff, male attendees

and facilitators, and the opportunity to identify similar experiences to others in the group

including group facilitators. Simply put, facilitators felt that fathers needed to feel; I know

you, I am not alone, and you understand me.

I know you. Most facilitators felt that fathers who had an existing relationship with

them or the wider service, through key work and engagement strategies such as home visits,

were more likely to attend a parenting course. Thus, facilitators explained that fathers were

more likely to be absent from parenting groups if they did not know the other attendees,

group facilitators, or the service beforehand.

I think off the top of my head we've had 1, 2, 3 - 3 fathers who came from families who were already

being worked with by our service. (Facilitator 3)

When key workers refer someone in, they tend to attend better. In a community venue, it takes a lot of

guts to walk in you don’t know if there is going to be two people or 500 people (Facilitator 8)

As a Key Worker, we work with families, we work with the whole family, so with the dad even if they

work we’ll see them in the evening (at home visits)… so we would have that relationship with those

parents and we would have those parents on board and you are more likely to get engagement from

them, or participation from them because you have that relationship and they trust you. (Facilitator 9)

I am not alone. On the basis of their experience in groups, some facilitators described

how fathers would be more comfortable in groups where there were other male attendees or a

male facilitator, so they did not feel alone.

...and they see other dads there, it's a different thing all together and they relax a bit. (Facilitator 4)

I’m trying really hard to get at least two men in the group that I’m running soon, because if there’s two

of them they’ll feel a bit better and they’re more likely to stay attending, whereas if it’s just the one

bloke every week and he thinks, ‘oh I’m going to spend two hours with a load of women’…it’s a bit

difficult (Facilitator 8)

I used to run a group with myself (female facilitator) and another female professional and we had the

odd dad that came in and couple, but they disappeared quite quickly, since I've been doing it with (male

facilitator), we keep the males. (Facilitators 2)

Similarly, these facilitators postulated that men might feel isolated in groups that were

dominated by women, and were likely to be absent from parenting under these circumstances.

If there’s a room full of women and they’re the only male it’s very off-putting and then men, typically

might not be so comfortable discussing things that they think are personal…so, often men might come

along to one session and then never come back (Facilitator 8)

I think more male workers would be beneficial to make fathers, feel that it’s not just a female

environment, because if its female facilitators and a group of 10 women, you know, that's quite

daunting for one man to come in on his own… (Facilitator 5)

You understand me. The facilitators believed that fathers would be more

comfortable in a group where fellow attendees or the facilitators had experienced similar

parenting challenges, and so felt understood.

…they will find a common denominator with someone in that group, so inevitably he (father) will find

someone who’s on his side (Facilitator 9)

…if you got that experience of being a parent and that experience of knowing about those challenges,

people can identify with you…. I think for dads perhaps more, because I think they actually want to

know that you know what you're talking about and we do at the beginning of the course. We do tell

them a little bit about ourselves and our families and things. and I think that the dads that we've had in

these groups and it's almost that I think that they feel a little bit reassured… so I think for a dad it

validates it more, yeah. (Facilitator 6)

Discussion

The aim of this research was to examine how facilitators explain paternal absence from

parenting groups. Analysis of the interviews with nine facilitators from a county in the South

of England resulted in five main themes which are discussed below.

An uncomfortable topic

Some facilitators were cautious when sharing their beliefs and opinions regarding reasons for

paternal absence. In some cases they made explicit attempts to avoid the appearance of

sexism and emphasised the equality of mothers and fathers. This provided an over-arching

context in which to consider all the explanations offered. Largely facilitators employed two

strategies to avoid the appearance of sexism; (1) everyone is different - they attributed

paternal absence to each father’s unique circumstances and family dynamics (2) everyone is

equal - they concluded that paternal absence was difficult to explain as fathers were treated

the same as mothers, who did attend parenting groups.

It may be helpful to examine this discomfort in the context of Social Desirability Bias

(Edwards, 1953) where individuals who are aware of being observed tend to behave in ways

and express ideas that are socially acceptable. Furthermore, in the wider social context

society has steadily strived for equality amongst its members and in the UK the Equality Act

(2010), intended to help achieve this goal, outlines several protected characteristics including

gender. Considering the potential social discourses around gender equality (Edley &

Wetherell, 2008), it may be that discomfort was created by the semantic framing of the

research question and asking facilitators to talk about a topic, highlighting differences

between mothers and fathers. Subsequently, the main thrust of this study might have been

incongruent with facilitators’ wishes to prioritise more popular discourses of equality, rather

than difference.

Considering Social Desirability Bias, it might be also useful to acknowledge the duality of

my role, as the principal researcher and a trainee psychologist with experience of working in

child services. Although I cannot assume, I must acknowledge that it might have been

difficult for facilitators to share their honest opinions and beliefs with someone who was not

only a researcher but also a fellow professional.

Responsibility

In facilitator attempts to account for paternal absence, the question of responsibility arose.

Some facilitators reported unsuccessfully offering groups outside of working hours,

specifically to accommodate fathers and implied that it was the father’s responsibility then

that they did not attend. This finding is contrary to expectation, as in their quest for greater

paternal involvement in early childhood programmes, Fagan and Palm (2004) interviewed

fathers directly. In their study fathers were reportedly ‘adamant’ that groups offered in the

evening and at weekends would facilitate paternal involvement (p. 127). In the present study

some facilitators did not give fathers this option, while those that did reported that it had been

unsuccessful. As this strategy has been advocated by more than one author (Anderson, Aller,

Piercy & Roggman, 2015; Bagner, 2013; Berlyn, Wise, & Soriano, 2008; Lloyd, O’Brien, &

Lewis, 2003), the conditions under which this would result in the greatest paternal

engagement, would benefit from further investigation.

Some facilitators felt that their service and referring services should be more proactive in

their approach to paternal engagement. For example, by tailoring promotional materials to a

male audience or by reaching out to known father support groups in the community. A few

facilitators also suggested that fathers’ absence in some cases was due to the fathers seeing

behavioural change as the child’s responsibility and thus, not recognising the need to attend a

parenting course. Overall it appeared that responsibility was an important aspect of

facilitators’ explanations of paternal absence but facilitators had differing views as to whose

responsibility it is. The finding of disparate views of responsibility identified as a potential

contributor to low paternal involvement in parenting programmes in the present study add

support to the observations of McAllister, Wilson and Burton (2014). In their close

observation of staff experiences, they reported that similar barriers to fathers’ participation in

an Early Head Start parenting programme were due to a lack of clarity amongst staff as to

who was responsible for paternal engagement. They suggested that there should be a staff

member who is specifically responsible for paternal engagement but that all staff should view

this as a key aspect of their work with families.

According to the literature, services that were successful in recruiting fathers to parenting

groups had a clear strategy, such as assigning this responsibility to a specialist dad worker

(Lloyd, O’Brien, & Lewis, 2003; Raikes, Summers & Roggman 2005; Berlyn, Wise &

Soriano, 2008). Although the facilitators interviewed came from a variety of family services,

they had similar experiences in the lack of paternal engagement but differing ideas of who

should be responsible for doing more. The facilitators’ shared acknowledgment of paternal

absence as a problem, but their services’ lack of a clear strategy for recruiting fathers or an

individual assigned to take on this responsibility demonstrates that responsibility is a key

issue that needs to be addressed in the arena of paternal engagement.

Our hands are tied

Many facilitators’ explanations revealed that they felt their hands were tied in relation

to paternal engagement. Firstly, their approach to paternal engagement was determined by

service protocols and conventions around recruitment. Thus, they explained that paternal

attendance was determined at the point of referral. Secondly, that by using pre-established

programmes, such as Incredible Years, certain fathers were automatically excluded by virtue

of limited contact with their children and lack of opportunity to practice strategies taught.

Thirdly, facilitators reported experiencing work-related pressures, such as a high caseload,

which diminished their ability to make additional efforts to recruit fathers, or for their team to

sustain motivation and conversations around this topic. In this context, some facilitators

reported that mothers were viewed as more willing to engage, easier to contact, and so

represented the path of least resistance.

It may be helpful to examine these perceived service-related barriers in the context of Aim

Inhibition. Aim Inhibition describes a compensatory strategy where, when it is perceived that

a goal is unachievable, the goal is reduced or put aside in favour of something that is believed

to be more easily achieved or realistic. In the context of Aim Inhibition these findings would

suggest that facilitators do not feel they have the freedom or resources (eg., time paternal

contact details, flexible programme material) to be able to prioritise fathers, which could

explain why maternal engagement is thought to represents a more achievable goal.

Furthermore, these findings are consistent with other research findings that efforts and

initiatives intended to engage fathers have a tendency to become side-lined in favour of other

service priorities (McAllister, Wilson & Burton, 2004). Therefore, the current study’s

findings would add support to Fletcher, Silberberg and Baxter’s (2001) argument that efforts

to tackle paternal absence need to become a planned priority, fully integrated into services’

operational procedures.

Fathers are peripheral parents

Facilitators suggested that fathers perceive themselves as peripheral to mothers, who were

viewed as the main caregivers. This perspective could be considered corroborated by finding

that British fathers tend to take on a much smaller share of parenting responsibilities than

mothers (Fatherhood Institute, FIFI, 2016). Facilitators speculated that traditional and cultural

ideas about what constituted male and female domains or roles led fathers to be reluctant to

attend parenting groups. Their hypothesis is in line with evidence from other studies which

found that fathers were more likely to participate in groups, within services where they were

directly supported, encouraged, and the importance of the paternal role in parenting was

communicated (Lloyd, O’Brien, & Lewis, 2003; Henley & Pasley, 2005; Berlyn, Wise &

Soriano, 2008). In line with these findings, the present study suggests that fathers need know

that they are not peripheral in the eyes of family service professionals.

In this study, facilitators also explained paternal absence by positing that traditional and

cultural perspectives, caused fathers to view help seeking as emasculating which again,

placed fathers on the periphery of family services. An explanation matching their hypothesis

has already been offered by Gender Role Theory (GRT). According to GRT, gender is

conditioned by an individual’s upbringing and cultural environment therefore, as a result of

masculine gender role socialisation, fathers’ could view attendance of parenting groups and

help seeking as incongruent with the masculine norms to which they subscribe (Addis &

Mahalik, 2003).

Alternatively, from a weak social constructionist perspective, the expression of masculine

gender norms would be seen to have a fixed root in the individual’s socialisation, but is

something that may manifest in some situations and not in others. Hence, a father might find

it acceptable to seek help on behalf of his child if the focus is kept on changing the child’s

behaviour, but may not find it acceptable to seek help to change his own parenting practices.

Especially if these practices are widely accepted in his community or were passed down by

his own father.

What makes fathers more comfortable?

Most facilitators supposed that feelings of discomfort played a role in fathers’ non-attendance

of parenting programmes. In their explanations, they expressed key issues that they believed

might affect paternal comfort levels. This included the idea that fathers without an existing

relationship with them or the wider service, would feel more uncomfortable about attending

and therefore were more likely to be absent from parenting courses. Further, facilitators

described how fathers were more comfortable in groups where there was a male facilitator or

other male attendees. These facilitators explained paternal absence as resulting from fathers

feeling isolated and uncomfortable in groups consisting only of women. Finally, some

facilitators explained that fathers would be more comfortable in a group where fellow

attendees or the facilitators had experienced similar parenting challenges, as this enabled the

father to feel understood.

These conclusions are supported by some and contested by others. The finding that

facilitators believe that fathers are more comfortable in groups lead and attended by other

men who share their experiences, are in line with Berlyn, Wise & Soriano’s (2008) findings

that fathers and facilitators believed that paternal engagement was most likely in situations

where the facilitator was male, a father himself, and willing to share their personal parenting

experiences.

Similarly, other research studies found that fathers prefer groups with a male-orientated

atmosphere or approach such as father-only groups and groups that overtly aimed to be male

inclusive or gender-differentiated in their teaching (Potter & Carpenter, 2008; Frank, Keown,

Dittman, & Sanders, 2015). However, while in Frank et al.’s (2015) study, fathers in a focus

group stated a preference for father only groups, fathers responding to a survey reported

contrary preference for both parents to attend. Both survey and focus group fathers did not

view a male facilitator as necessary to secure their attendance but agreed it would be

preferable, particularly for father-only groups. Frank et al.’s (2015) findings corroborated that

fathers appreciate like the opportunity to share personal experiences with other fathers

experiencing similar issues as a means to normalise their own experiences.

In summary, the findings of this study suggest that facilitators felt that fathers lack of

familiarity with them, their service, and/ or the lack of a male presence in the form of a male

group facilitator or other male attendees would cause fathers to feel uncomfortable and avoid

parenting groups.

Strengths and Limitations of the Research

Thematic analysis was chosen to highlight the most salient ideas in facilitators explanations,

it provided a comprehensive summary of the data, and allowed facilitators to be treated as

collaborators in the quest to understand paternal absence from parenting groups. However, it

did not afford the opportunity to state which themes were viewed as the most important. This

might be helpful for services who would like to prioritise the implementation of changes

viewed as most essential to paternal engagement.

Braun and Clarke (2013) suggested that a minimum of six participants was adequate for

thematic analysis and so nine participants meets this threshold. The interviews conducted

were of sufficient length to provide an acceptable level of detail and depth of knowledge. In

quantitative studies generalisability is often a case of representative sample size, whereas in

qualitative studies the emphasis is on the depth of knowledge gleaned, therefore it may be

helpful to consider the results in light of the present study’s stated epistemological stance.

The underrepresentation of fathers in parenting groups is a problem that services have clearly

identified which is in line with a weak stance of social constructionism as it is a real difficulty

services are experiencing and want to understand in order to solve. Although it’s a real

problem it should be considered that facilitators social reality and perception of fathers’

absence from parenting groups may be different from father’s experience and perception of

the same phenomena. According to social constructionism, it may be that apparent

commonalities in themes arising in facilitators’ explanations were influenced and shaped by

prior conversations and interactions that I was not privy to. A focus group might have been a

good way to witness some of these processes in action. Finally, it is possible that the

socioeconomic characteristics of the services’ catchment area eg. a high population of single

mothers, affect the perception of fathers and the conversations that are had about their

involvement in parenting groups amongst mothers and facilitators. These unique

characteristics must be taken into account and so, might affect the generalisability of the

present study’s results when considering paternal absence from groups in services in other

geographical areas. Further, the small sample size limits the extent to which these

experiences would generalise to others in a similar position. Similarly, the fact that all the

participants were from the same County Council area might limit generalisation as different

geographical and socio-economic conditions in other Council areas might affect facilitators’

explanations.

A strength of this research was that efforts were made and time was taken to meet Braun and

Clarke’s (2006) quality checklist, outlined in Appendix B. This included but was not limited

to: checking transcripts against the audio recordings, a comprehensive coding process that

endeavoured to pay attention to all the available data, and themes were checked against each

other and against the wider data set. As described in the method section, supervision and

multiple reviews of the coding process and developing themes, throughout the data analysis

process, were provided by two research supervisors. This helped to ensure that interpretations

were more closely reflective of the data, than themes that pre-existed to me. However, despite

best efforts to mitigate this, it may be that my stance of weak social constructionism

influenced the questions I asked during the data collection phase and the information that

appeared salient during the data analysis phase.

It could be viewed as a limitation of the present study that I did not explicitly discuss striving

for saturation of the data. I followed the process of TA described by Braun and Clarke’s

(2006) who also do not mention ‘saturation’ as part of their guidance. However typically,

reaching ‘saturation’ is used by qualitative researchers to indicate adequate sampling, rich

data, and higher quality research (Guest, Bunce, & Johnson, 2006; Bowen, 2008). Bowen

(2008) argued that saturation cannot always be achieved due to practical constraints such as

time and resources, as was the case in this study, which affect how many participants can be

interviewed. Some authors explain that this does not invalidate findings, instead they argue

that new information can always be uncovered and therefore, data can never be truly

saturated (Wray, Markovic & Manderson, 2007). O’Reilly and Parker (2012) suggest that

saturation can be achieved where researchers have imposed clear categories, referenced from

existing themes in the literature, on the data analysis process. On the other hand, using an

inductive approach to TA, as in the present study, saturation could be viewed as an unrealistic

target and thus hold less relevance.

Child and family service staff are often female and therefore the group facilitators

interviewed were also mostly female, which reflects the gender imbalance that exists. The

male facilitator that was interviewed seemed to put forward broadly similar explanations to

the women interviewed, but other male facilitators may have provided a different perspective.

Similarly, as a volunteer sample, they might have differed in their experiences, beliefs and

opinions, from those who chose not to participate.

Implications

The discomfort apparent in discussing this topic suggests that it may be beneficial to facilitate

making professionals more comfortable in discussing the potential unique needs of fathers, as

acknowledging differences would be beneficial to services users so that their unique needs

can be met. This could take the form of inclusion of gender differentiated practice, as topic in

facilitator training as well as additional workshops or courses as part of continuous

professional development. This forum could also serve update professionals on strategies that

have already been used to engage fathers, with success. In their national curriculum, the

nationwide Children and Young People Improving Access to Psychological Therapies

programme (CYP IAPT) states the need for parent programme facilitators to develop a

critical knowledge of the research literature on parent training for children with conduct

problems (IAPT, 2014). Broadly, they highlight the need to learn how to successfully engage

parents but do not specifically mention issues of gender differentiated practice. On the other

hand, the Fatherhood Institute (2009) champions gender differentiated approaches, explaining

that men are more likely to live separately from their children, and to have circumstances and

experiences that differ substantially to mothers. Furthermore, they state that fathers usually

experience greater cultural pressure to be financially successful and are more likely to discuss

parenting with other men, but family services have a largely female workforce. While the

present study demonstrates that gender differentiation can be an uncomfortable topic, it

suggests that it would be useful to include such discussions in facilitator training

programmes.

The differing views around responsibility and the service factors which hindered efforts to

engage fathers, suggest that it would be helpful for services to generate a clear strategy

agreed upon and supported by the team. The most obvious intervention would be for a

specialist dad worker or champion to be assigned the responsibility for the implementation of

this strategy (Lloyd, O’Brien, & Lewis, 2003). Services allow such specialist workers time,

protected time and a lighter caseload to allow and incentivise professionals to do this work.

The resource implications of this need to be considered in the light of the likely benefits to

the effectiveness of parenting groups. There are more economical strategies that could be

trialled, such as parent buddy schemes and foot-in-the-door strategies, where only a

commitment to attend the first session is required (Beatty & King, 2008; McDonald, FitzRoy,

Fuchs, Fooken & Klasen, 2012).

The results suggest that father’s recruitment and engagement with parenting groups would be

enhanced by previous contact with and thus familiarity with services. It would therefore be

beneficial for facilitators to reach out to community groups on a more consistent basis,

preferably with face to face contact to create a point of contact with the service and

familiarity for potential service users. In addition, services should continue to do home visits

and other such activities to build relationships with service users. However, the workload and

resource constraints of doing additional outreach work would need to be taken into account as

workload pressure was commonly mentioned by facilitators.

As the referral process seems to be a barrier to paternal engagement, a consultation could be

held with referring services to explore whether further avenues can be opened to make it

easier for fathers to access services and for facilitators to have a means to contact fathers.

One practical intervention that could be implemented relatively easily would be for

professionals to be prompted to be more proactive in asking mums for dads contact details at

the point of referral.

Future Research

It is recommended that future research seeks to explore father’s views of the themes found in

this research using focus groups of fathers and in addition exploring which strategies they

might find helpful.

This research included only the perspectives of parenting facilitators in a specific County in

the South of England so facilitator’s explanations in different parts of the country could be

examined qualitatively. Other studies have touched more on the perspectives of parents who

have attended or dropped out of parenting groups but more research is needed from the

perspective of fathers themselves. In addition, given that referral was an important part of

facilitators explanations it would be useful to conduct research to gain the perspectives of

those involved in referral.

There has been a very limited number of strategies aimed at meeting fathers’ needs that have

been evaluated in America, Australia and the UK. More evaluation of specific interventions,

such as specialist dad workers in the UK, is needed. Qualitative studies could be used to

explore fathers’ experiences of these strategies, and the explanations and attitudes towards

fathers in the wider service team. Alternatively, measures of father’s attendance and/or

dropout could be compared with these using mixed method, randomised control trials.

Conclusion

The findings of this research increase our understanding of what parenting group facilitators

believe to be key issues in explaining paternal absence. Facilitators found this an

uncomfortable topic to discuss, but mainly explained absence in terms of parents adopting

traditional gender roles and service constraints. They suggested that fathers’ traditional

perceptions of caregiving, help seeking and involvement with child services, as female

activities were pivotal to their absence from parenting groups. The main service constraints

mentioned were: the referral process, parenting programme content, and work-related

pressure.

Further research is now needed to evaluate the success of specific strategies, aimed at

increasing paternal engagement in UK based parenting interventions and services. In

particular, for such research to include paternal participants.

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data to increase father engagement in evidence-based parenting programs. Journal of

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Appendices

Appendix A – Author guidelines for the Journal of Child Services

Author Guidelines

Submit to the journal

Submissions to Journal of Children's Services are made using ScholarOne Manuscripts, the online submission and peer review system. Registration and access is available at http://mc.manuscriptcentral.com/jnlcs. 

If you are unable to find the information you need in the author guidelines or our author resources (http://emeraldgrouppublishing.com/authors/index.htm) section, please email manuscriptcentral@emeraldinsight.com  for assistance. Please quote the journal name, your contact details and the infromation you require.

Registering on ScholarOne Manuscripts

If you have not yet registered on ScholarOne Manuscripts, please follow the instructions below:

Please log on to: http://mc.manuscriptcentral.com/jnlcs Click on Create Account Follow the on-screen instructions, filling in the requested details before

proceeding Your username will be your email address and you have to input a password

of at least 8 characters in length and containing two or more numbers Click Finish and your account has been created.

Submitting an article to Journal of Children's Services on ScholarOne Manuscripts

Please log on to Journal of Children's Services at http://mc.manuscriptcentral.com/jnlcs with your username and password. This will take you through to the Welcome page (To consult the Author Guidelines for this journal, click on the Home Page link in the Resources column)

Click on the Author Centre button

Click on the submit a manuscript link which will take you through to the Manuscript Submission page

Complete all fields and browse to upload your article When all required sections are completed, preview your .pdf proof Submit your manuscript

 Review process

Each paper is reviewed by the editor and, if it is judged suitable for this publication, it is then sent to at least two independent referees for double blind peer review.

Copyright

Articles submitted to the journal should not have been published before in their current or substantially similar form, or be under consideration for publication with another journal. Please see Emerald's originality guidelines for details. Use this in conjunction with the points below about references, before submission i.e. always attribute clearly using either indented text or quote marks as well as making use of the preferred Harvard style of formatting. Authors submitting articles for publication warrant that the work is not an infringement of any existing copyright and will indemnify the publisher against any breach of such warranty. For ease of dissemination and to ensure proper policing of use, papers and contributions become the legal copyright of the publisher unless otherwise agreed.

The editor may make use of iThenticate software for checking the originality of submissions received. Please see our press release for further details.

Third party copyright permissions

Prior to article submission, authors should clear permission to use any content that has not been created by them. Failure to do so may lead to lengthy delays in publication. Emerald is unable to publish any article which has permissions pending.  The rights Emerald requires are:

1. Non-exclusive rights to reproduce the material in the article or book chapter.2. Print and electronic rights.3. Worldwide English language rights.4. To use the material for the life of the work (i.e. there should be no time

restrictions on the re-use of material e.g. a one-year licence).

When reproducing tables, figures or excerpts (of more than 250 words) from another source, it is expected that:

1. Authors obtain the necessary written permission in advance from any third party owners of copyright for the use in print and electronic formats of any of their text, illustrations, graphics, or other material, in their manuscript.  Permission must also be cleared for any minor adaptations of any work not created by them.

2. If an author adapts significantly any material, the author must inform the copyright holder of the original work.

3. Authors obtain any proof of consent statements4. Authors must always acknowledge the source in figure captions and refer to

the source in the reference list.

5. Authors should not assume that any content which is freely available on the web is free to use.  Authors should check the website for details of the copyright holder to seek permission for re-use.

Emerald is a member of the STM Association and participates in the reciprocal free exchange of material with other STM members.  This may mean that in some cases, authors do not need to clear permission for re-use of content. If so, please highlight this upon submission. For more information and additional help, please follow the Permissions for your Manuscript guide.

Committee on Publication Ethics (COPE)

Emerald supports the development of, and practical application of consistent ethical standards throughout the scholarly publishing community. All Emerald’s journals and editors are members of the Committee on Publication Ethics (COPE) which provides advice on all aspects of publication ethics. Emerald follows the Committee’s flowcharts in cases of research and publication misconduct, enabling journals to adhere to the highest ethical standards in publishing. For more information on Emerald’s publication ethics policy, please click here.

Copyright forms

Where possible, Emerald seeks to obtain copyright for the material it publishes, without authors giving up their scholarly rights to reuse the work.

Assigning copyright to Emerald allows us to:

Act on your behalf in instances such as copyright infringement or unauthorised copying

Protect your moral rights in cases of plagiarism or unauthorised derivative works

Offer a premium service for permission requests Invest in new platforms and services for the journals or book series you have

published in Disseminate your work as widely as possible, ensuring your work receives the

citations it deserves Recoup copyright fees from reproduction rights organisations to reinvest in

new initiatives and author/user services, such as the Research Fund Awards and the Outstanding Doctoral Research Awards.

If an article is accepted for publication in an Emerald journal authors will be asked to submit a copyright form through ScholarOne. All authors are sent an email with links to their copyright forms which they must check for accuracy and submit electronically.

If authors can not assign copyright to Emerald, they should discuss this with the journal Content Editor. Each journal has an Editorial Team page which will list the Content Editor for that journal.

Editorial Services

Emerald is pleased to partner with Peerwith to provide editorial support for authors wishing to submit papers to Emerald journals. Peerwith is a platform for author services, connecting academics seeking support for their work with the relevant

expert who can help out with language editing and translation, visuals, consulting, or anything else academics need to get their research submission-ready.

Final submission

The author must ensure that the manuscript is complete, grammatically correct and without spelling or typographical errors. Before submitting, authors should check their submission completeness using the available Article Submission Checklist. Proofs will be emailed prior to publication.

Open access submissions and information

Emerald currently offers two routes for Open Access in all journal publications, Green Open Access (Green OA) and Gold Open Access (Gold OA). Authors who are mandated to make the branded Publisher PDF (also known as the "Version of Record") freely available immediately upon publication can select the Gold OA route during the submission process. More information on all Open Access options can be found here.

For more information on HEFCE, visit our author rights page.

Manuscript requirements

Please prepare your manuscript before submission, using the following guidelines:

Format Article files should be provided in Microsoft Word format. LaTex files can be used if an accompanying PDF document is provided. PDF as a sole file type is not accepted, a PDF must

be accompanied by the source file. Acceptable figure file types are listed further below.

Article Length Articles should be between 5000 and 8000 words in length. This includes all text including references and appendices.

Please allow 350 words for each figure or table.

Article Title A title of not more than eight words should be provided.

Author details All contributing authors’ names should be added to the ScholarOne submission, and their names arranged in the

correct order for publication.

Correct email addresses should be supplied for each author in their separate author accounts

The full name of each author must be present in their author account in the exact format they should appear

for publication, including or excluding any middle names or initials as required

The affiliation of each contributing author should be correct in their individual author account. The affiliation listed should be where they were based at the time that

the research for the paper was conducted

Biographies and Authors who wish to include these items should save them

acknowledgements

together in an MS Word file to be uploaded with the submission. If they are to be included, a brief professional

biography of not more than 100 words should be supplied for each named author.

Research funding Authors must declare all sources of external research funding in their article and a statement to this effect should appear in the Acknowledgements section. Authors should describe the role of the funder or financial sponsor in the entire research

process, from study design to submission.

Structured Abstract

Authors must supply a structured abstract in their submission, set out under 4-7 sub-headings (see our "How to... write an

abstract" guide for practical help and guidance):

Purpose (mandatory) Design/methodology/approach (mandatory)

Findings (mandatory) Research limitations/implications (if applicable)

Practical implications (if applicable) Social implications (if applicable)

Originality/value (mandatory)

Maximum is 250 words in total (including keywords and article classification, see below).

Authors should avoid the use of personal pronouns within the structured abstract and body of the paper (e.g. "this paper

investigates..." is correct, "I investigate..." is incorrect).Keywords Authors should provide appropriate and short keywords in the

ScholarOne submission that encapsulate the principal topics of the paper (see the How to... ensure your article is highly

downloaded guide for practical help and guidance on choosing search-engine friendly keywords). The maximum number of

keywords is 12.

Whilst Emerald will endeavour to use submitted keywords in the published version, all keywords are subject to approval by Emerald’s in house editorial team and may be replaced by a

matching term to ensure consistency.

Article Classification

Authors must categorize their paper as part of the ScholarOne submission process. The category which most closely

describes their paper should be selected from the list below.

Research paper. This category covers papers which report on any type of research undertaken by the author(s). The

research may involve the construction or testing of a model or framework, action research, testing of data, market research

or surveys, empirical, scientific or clinical research.

Viewpoint. Any paper, where content is dependent on the author's opinion and interpretation, should be included in this

category; this also includes journalistic pieces.

Technical paper. Describes and evaluates technical products, processes or services.

Conceptual paper. These papers will not be based on research but will develop hypotheses. The papers are likely to

be discursive and will cover philosophical discussions and comparative studies of others' work and thinking.

Case study. Case studies describe actual interventions or experiences within organizations. They may well be subjective

and will not generally report on research. A description of a legal case or a hypothetical case study used as a teaching

exercise would also fit into this category.

Literature review. It is expected that all types of paper cite any relevant literature so this category should only be used if the main purpose of the paper is to annotate and/or critique

the literature in a particular subject area. It may be a selective bibliography providing advice on information sources or it may be comprehensive in that the paper's aim is to cover the main contributors to the development of a topic and explore their

different views.

General review. This category covers those papers which provide an overview or historical examination of some

concept, technique or phenomenon. The papers are likely to be more descriptive or instructional ("how to" papers) than

discursive.

Headings Headings must be concise, with a clear indication of the distinction between the hierarchy of headings.

The preferred format is for first level headings to be presented in bold format and subsequent sub-headings to be presented

in medium italics.

Notes/Endnotes Notes or Endnotes should be used only if absolutely necessary and must be identified in the text by consecutive numbers,

enclosed in square brackets and listed at the end of the article.

Figures All Figures (charts, diagrams, line drawings, web pages/screenshots, and photographic images) should be

submitted in electronic form.

All Figures should be of high quality, legible and numbered consecutively with arabic numerals. Graphics may be supplied in colour to facilitate their appearance on the online database.

Figures created in MS Word, MS PowerPoint, MS Excel, Illustrator should be supplied in their native formats.

Electronic figures created in other applications should be copied from the origination software and pasted into a blank MS Word document or saved and imported into an MS Word document or alternatively create a .pdf file

from the origination software. Figures which cannot be supplied as above are

acceptable in the standard image formats which are: .pdf, .ai, and .eps. If you are unable to supply graphics in these formats then please ensure they

are .tif, .jpeg, or .bmp at a resolution of at least 300dpi and at least 10cm wide.

To prepare web pages/screenshots simultaneously press the "Alt" and "Print screen" keys on the keyboard,

open a blank Microsoft Word document and simultaneously press "Ctrl" and "V" to paste the image.

(Capture all the contents/windows on the computer screen to paste into MS Word, by simultaneously

pressing "Ctrl" and "Print screen".) Photographic images should be submitted electronically

and of high quality. They should be saved as .tif or .jpeg files at a resolution of at least 300dpi and at least 10cm

wide. Digital camera settings should be set at the highest resolution/quality possible.

Tables Tables should be typed and included in a separate file to the main body of the article. The position of each table should be clearly labelled in the body text of article with corresponding

labels being clearly shown in the separate file.

Ensure that any superscripts or asterisks are shown next to the relevant items and have corresponding explanations

displayed as footnotes to the table, figure or plate.

References References to other publications must be in Harvard style and carefully checked for completeness, accuracy and consistency. This is very important in an electronic environment because it enables your readers to exploit the Reference Linking facility on the database and link back to the works you have cited

through CrossRef.

You should cite publications in the text: (Adams, 2006) using the first named author's name or (Adams and Brown, 2006)

citing both names of two, or (Adams et al., 2006), when there are three or more authors. At the end of the paper a reference

list in alphabetical order should be supplied:

For books Surname, Initials (year), Title of Book, Publisher, Place of publication.

e.g. Harrow, R. (2005), No Place to Hide, Simon & Schuster, New York, NY.

For book chapters Surname, Initials (year), "Chapter title", Editor's Surname,

Initials, Title of Book, Publisher, Place of publication, pages.

e.g. Calabrese, F.A. (2005), "The early pathways: theory to practice – a continuum", in Stankosky, M. (Ed.), Creating the

Discipline of Knowledge Management, Elsevier, New York, NY, pp. 15-20.

For journals Surname, Initials (year), "Title of article", Journal Name, volume issue, pages.

e.g. Capizzi, M.T. and Ferguson, R. (2005), "Loyalty trends for the twenty-first century", Journal of Consumer Marketing, Vol.

22 No. 2, pp. 72-80.

For published conference proceedings

Surname, Initials (year of publication), "Title of paper", in Surname, Initials (Ed.), Title of published proceeding which

may include place and date(s) held, Publisher, Place of publication, Page numbers.

e.g. Jakkilinki, R., Georgievski, M. and Sharda, N. (2007), "Connecting destinations with an ontology-based e-tourism planner", in Information and communication technologies in tourism 2007 proceedings of the international conference in Ljubljana, Slovenia, 2007, Springer-Verlag, Vienna, pp. 12-32.

For unpublished conference proceedings

Surname, Initials (year), "Title of paper", paper presented at Name of Conference, date of conference, place of conference, available at: URL if freely available on the internet (accessed

date).

e.g. Aumueller, D. (2005), "Semantic authoring and retrieval within a wiki", paper presented at the European Semantic Web Conference (ESWC), 29 May-1 June, Heraklion, Crete, available

at: http://dbs.uni-leipzig.de/file/aumueller05wiksar.pdf (accessed 20 February 2007).

For working papers Surname, Initials (year), "Title of article", working paper [number if available], Institution or organization, Place of

organization, date.

e.g. Moizer, P. (2003), "How published academic research can inform policy decisions: the case of mandatory rotation of

audit appointments", working paper, Leeds University Business School, University of Leeds, Leeds, 28 March.

For encyclopedia entries

(with no author or editor)

Title of Encyclopedia (year) "Title of entry", volume, edition, Title of Encyclopedia, Publisher, Place of publication, pages.

e.g. Encyclopaedia Britannica (1926) "Psychology of culture contact", Vol. 1, 13th ed., Encyclopaedia Britannica, London

and New York, NY, pp. 765-71.

(For authored entries please refer to book chapter guidelines

above)

For newspaper articles (authored)

Surname, Initials (year), "Article title", Newspaper, date, pages.

e.g. Smith, A. (2008), "Money for old rope", Daily News, 21 January, pp. 1, 3-4.

For newspaper articles (non-

authored)

Newspaper (year), "Article title", date, pages.

e.g. Daily News (2008), "Small change", 2 February, p. 7.

For archival or other unpublished sources

Surname, Initials, (year), "Title of document", Unpublished Manuscript, collection name, inventory record, name of

archive, location of archive.

e.g. Litman, S. (1902), "Mechanism & Technique of Commerce", Unpublished Manuscript, Simon Litman Papers,

Record series 9/5/29 Box 3, University of Illinois Archives, Urbana-Champaign, IL.

For electronic sources

If available online, the full URL should be supplied at the end of the reference, as well as a date that the resource was

accessed.

e.g. Castle, B. (2005), "Introduction to web services for remote portlets", available at:

http://www-128.ibm.com/developerworks/library/ws-wsrp/ (accessed 12 November 2007).

Standalone URLs, i.e. without an author or date, should be included either within parentheses within the main text, or

preferably set as a note (roman numeral within square brackets within text followed by the full URL address at the

end of the paper).

Appendix B – Braun and Clarke’s (2006) 15 point checklist of criteria for good thematic

analysis

Appendix CParticipant Information Sheet

Introduction I am a Trainee Clinical Psychologist from the University of Surrey. I am being supervised by Linda Morison and an external supervisor, Warren Matofsky.

What is the purpose of the study? Parenting programmes are an important front line treatment for families of children with conduct disorders and similar difficulties. Although proven effective, parenting programmes continue to face challenges encouraging parents to attend and remain engaged. This study seeks to explore the experiences of parenting group facilitators, in particular their experience of gender differences in group attendance. The study hopes to identify barriers to attendance, particularly amongst fathers.

How will the study be conducted? The research will be conducted in form of a face to face interview. If needed, it can be conducted over the phone or by skype. If you agree to take part in this project, I will contact you to arrange a time to meet and will send you a list of topics that will be discussed. The interview will be conducted at the agreed venue. For the your convenience, this is likely to be a quiet interview room at your place of work. Interviews will take approximately 60 minutes to complete and will be audio-recorded. This is a time limited project, but if time permits the researcher will also check the findings of the initial interviews in a focus group, to confirm that our understanding of your collective responses and the resulting themes are correct and representative.

What are the possible disadvantages or risks of taking part? We are only interviewing a small number of participants, approximately 10-15 individuals. Due to this number and the fact that interviews are likely to take place at participants’ places of work it is possible that colleagues will be aware that you are taking part in the study. However, we will prioritise participants’ confidentiality and any quotes from participant interviews will be anonymised in the final research report. Aside from this, there are no other known risks or disadvantages of taking part.

What are the possible benefits of taking part? In taking part, you will be able to reflect on barriers parents encounter to accessing parenting programmes, which may provide useful insights into daily practice and service delivery. By taking part in an interview with us, we hope to be able to provide you and your colleagues with a training workshop informed by the research results.

What happens when the research study stops? The study will be written up for the University of Surrey in the form of an academic Major Research Project Report. The research will also aim to publish the results in academic papers. Primarily however, we aim to engage both facilitators and the services in which they work in improving access and engagement in parenting programmes, particularly for those who are hard to engage.

Do I have to take part in this research? You are under no obligation to take part in this research. You can withdraw at any time without giving a reason and there will be no adverse consequences if you do so.

Will my taking part in the study be kept confidential? Yes. All of the information you give will be anonymised so that those reading the final report from the research will not know who has contributed to it. No-one other than the principal researcher,

research supervisors, and peer raters of the data will have access to the data, which will be saved securely on encrypted USB sticks, password-protected computers and stored securely for 10 years in accordance with the Data Protection Act 1998. This applies to all conversations between myself and the researcher, including face-to-face, telephone and skype interviews.

If Skype is used will they protect my privacy?Conversations conducted over Skype are also subject to Data Protection Act 1998. Further information can be found at the following web link: https://privacy.microsoft.com/en-gb/privacystatement

What if there is a problem?If you have any complaints or concerns about any aspect of the way you have been dealt with during the study then you can contact my university supervisor, Linda Morison – contact details are listed below.

Contact details of the Principal Researcher:

Principal ResearcherSimone Chester-HandySchool of Psychology University of Surrey Guildford Surrey GU2 7XH

Email: s.chester-handy@surrey.ac.uk

Contact details of the researcher supervisors:

University Research Supervisor External Supervisor

Linda Morison

School of Psychology University of Surrey Guildford Surrey GU2 7XH

Email: l.morison@surrey.ac.uk Phone: 01483 68 6875

Warren Matofsky

Email: warren.matofsky@xxxxxxxxx.uk

Who has reviewed the project? The study has been reviewed and received a favourable opinion from XXXX County Council Research Governance Panel, and the Faculty of Health and Medical Sciences Ethics Committee.

Thank you for taking the time to read this Information Sheet.

Appendix DConsent Form

Title : ‘How do facilitators explain paternal absence from parenting groups?’

Study Ref Number: 1188-PSY-16

I am interested in the experiences of parenting group facilitators. The project will involve facilitators being interviewed about their understanding, beliefs about, and experiences of paternal absence from parenting programmes. This form is to request your consent to participant in this project – through participating in the aforementioned interview. It also requests your permission for this to be written up in the form of an anonymised report that will be submitted to the University of Surrey. At the end of the project, the university will also interview me regarding the research process and findings.

Please initial each box

I have read and understood the Information Sheet provided (version 1, 25/04/16). I have been given a full explanation by the investigators of the nature, purpose, location and likely duration of the study, and of what I will be expected to do.

I have been advised about any disadvantages/risks which may result. I have been given the opportunity to ask questions on all aspects of the study and have understood the advice and information given as a result.

I understand that in accordance with the English law, insurance is in place which covers harm that is likely to result from my participation in this study as detailed in the participant information sheet.

I agree for my anonymised data to be used for this study / future research that will have received all relevant legal, professional and ethical approvals*.

I give consent for my interview with the researcher to be audio recorded.

I give consent to anonymous verbatim quotation being used in reports.

I understand that all project data will be held for at least 6 years and all research data for at least 10 years in accordance with University policy that my personal data is held and processed in the strictest confidence, and in accordance with the UK Data Protection Act (1998).

I understand that I am free to withdraw from the study at any time without needing to justify my decision, without prejudice and without my legal rights being affected.

I understand that I can request for my data to be withdrawn until publication of the data* and that following my request all data already collected from me will be destroyed but I allow the researchers to use anonymous data already collected.

If I withdraw I also allow the researchers to use my personal data, in addition to anonymous data, already collected as outlined in the participant information sheet and this consent form.

I confirm that I have read and understood the above and freely consent to participating in this study. I have been given adequate time to consider my participation.

Name of participant (BLOCK CAPITALS) ......................................................

Signed ......................................................

Date ......................................................

Appendix EInterview Schedule

The interviews will be natural conversations which aim to include the topics mentioned in the questions below. The questions are provided to give examples of how the topic might be approached. Possible prompts are also provided to help the participant expand on their answers if elaboration doesn’t occur naturally.

Warm up questions (around 5 minutes):

1. How long have you been a facilitator?

2. Can you tell me a little about your experience facilitating parenting programmes?

Main Interview Questions

1. What in your experience is the gender balance of participants in the parenting groups?

2. To what extent do you think the gender imbalance matters?

3. How do you explain the gender balance in attendance?For example, what about practical aspects? referral and recruitment? attitudes or beliefs of mothers and fathers? experiences of fathers attending these groups?

4. Do you think that as a facilitator you influence paternal attendance or engagement with the groups?For example, what about your own gender? challenges of managing gender composition in groups? For example, if only one

father present? managing how comfortable those of different gender might feel about participating

in a group?

5. Does the issue of paternal attendance or engagement ever come up in supervision/ team discussions/ with other facilitators? In what way?

If not already mentioned

6. What are your views on how the referral and recruitment process influence paternal attendance?

7. What are your views on how the group content and materials influence paternal attendance or engagement?

For the interviewer to bear in mind:

o social context or cultural norms o acceptability of non-attendance? o Emphasis? o Meaning?o Changes in explanation? o External constraint – what do you make of that?

Prompts for the interviewer:

Could you tell me more/ say more about that? Why do you think that is? Or how does that work? Why might that be? What has your experience been of that? What do you mean by that?

Appendix F – Initial recruitment email to facilitators who gave permission to becontacted

Dear

You do a very important job and I would like to speak to you about it. I am particularly interested in interviewing you about your experience as a parenting group facilitator.

Parenting groups are an important frontline intervention, in which your role is essential. Due to your unique perspective, I would appreciate the chance to ask you about your understanding of the underrepresentation of fathers in parenting programmes. I hope that your contribution will help broaden our understanding of this area and support the development of training for yourself and your colleagues.

Your input is invaluable. Therefore, please email me if you are interested in participating. For your information, I have attached a participant information sheet and a consent form above. However, if you would like to know more about this study first, we can arrange a time for a telephone appointment for me to give you further information.

Thank you in advance!

………………………….

Trainee Clinical Psychologist

Appendix G – Extraction of the transcript of Facilitator 8

Appendix H – Examples of the thematic maps used to develop the themes andSubthemes

Appendix I - Extract of Facilitator 5’s transcript with 1st and 2nd order coding

Avoidance of considering this issue?

Few male staff membersMore male staff helpfulDad group has male facilitator

Dad group has male facilitatorFacilitator is a parentMore male workers beneficialMainly female environmentFemale group off putting?Father would be alone

Fathers feel outnumberedStigma – parenting is mum’s job/ father on the outsideMum is the main carer/ every family unique

Every family uniqueFamily roles – who is earning most?Every situation different

Do you think the gender of the facilitator makes a difference to whether dads

attend or not?

I don't know.

Any thoughts on it?

I think it would be nice to have more male workers in any kind of environment like this

we don't have as many male workers, I think that would help. The dads group that is

running is a male facilitator.

Is that the specialist dads group?

The specialist dads group is a male worker who runs the group that they go with, so that

might make them feel more comfortable and also it's a dad that's experienced himself,

having a child with a disability, so I think more male workers would be beneficial to

make fathers, you know, feel that its not just a female environment, because if its

female facilitators and a group of 10 women, you know, that's quite daunting for one

man to come in on his own.

Why do you think that would put men off, having female facilitators and a mostly

female environment?

I think that's just the way they feel, I think they just think that they're outnumbered or

it's not their job. It's still that stigma of this is mum's job and I'm on the outside, if mum

is the main carer. Every family situation is different obviously.

An uncomfortable topic

What makes fathers more comfortable?- I am not alone

What makes fathers more comfortable?- I am not alone- You understand me

- I am not alone

What makes fathers more comfortable?- I am not aloneFathers are peripheral parents- Traditional roles create reluctant fathersAn uncomfortable topic- Everyone is different

Dads have attended groupsFather attendees had relationship the service.

Prior work with fathers at home encourages attendance?Attendee dads have existing relationship with service.

Where do you think that idea of, it's ‘mum's job’ to look after children and maybe

even to attend the parenting group - where do you think that comes from?

I think that's like I say everyone's family situation is different, I suppose it goes on

earnings, who's going to earn the most at work, whose going to provide, it's probably a

number of different reasons. I mean there is obviously, we obviously do work with

families where its dads caring for children, there is every different situation, so it's a

tricky one.

And does there seem to be anything different between the odd dad that you do get

attending to the dads that don't attend?

No I think that the dads that have attended, we've worked with them and built that

relationship beforehand, so that's why they've....the dads that I can think of, we've all

worked with them before, so they've attended knowing, either a, either they've had a

social worker involvement or an early intervention worker involvement and then

they've all come on the course, so the work we've done with them in the home and then

they've attended the course, so I think that's a real beneficial side to it, cause all the dads

I can think of, have all been known to us before.

An uncomfortable topic- Everyone is differentFathers are peripheral parents- Traditional roles create reluctant fathersAn uncomfortable topic- Everyone is different

What makes fathers more comfortable?- I know you

Appendix J – Email of ethical approval from the County Council research governance panel

From: xxxxxxSent: Thu xxxxxxTo: Chester-Handy SA Miss (PG/R - Psychology);Cc: xxxx; Research Governance <Research.Governancexxxxxxxx >; xxxxx <xxxxx>;

Dear Simone

Apologies for the minor delay - we aim to respond within 20 working days, and unfortunately I have been on compassionate leave during this time.

I can confirm that your application has been reviewed and approved by the xxxxxxxxx County Council Research Governance Panel.  I wish you all the best with your research.

Best wishes xxxxxx

xxxxxxxxxxxxxxxxx Manager (xxxxx)xxxxxxxxxxxxxxxxxx

Appendix K – Ethical approval from Faculty of Health and Medical Sciences Ethics Committee at the University of Surrey

Appendix L – Braun and Clarke’s (2006) six phases of thematic analysis

What do parents value about facilitators of group-based parenting programmes: a

review of the qualitative evidence

Word count: 7,999

Statement of Journal Choice:

The target peer-reviewed journal for this review is Journal of Children’s Services. The

journal encourages the international development of research-based, outcome-focused

services to promote the well-being of children and their families. The journal covers

discussion of the conceptual frameworks that inform service provision and promotion of

initiatives to forge stronger links between research, service policy and practice.

Abstract

Introduction

Recently, family intervention research has focused on working with parents in group settings,

such as parenting programmes. Parenting groups have been shown to be an effective

intervention, however, low treatment engagement can mitigate the benefits and there are

various challenges to implementation, including parental engagement. Thus, some

researchers have suggested that there are specific practitioner behaviours that optimize

treatment engagement. Accordingly, this review was interested in understanding the various

behaviours and other facilitator factors that are valued by parents.

Method

A systematic review of the literature on what parents value about parenting group facilitators

was conducted. Papers were included if they met the following criteria: 1) parents had

attended a parenting group 2) the group was led by a professional facilitators 3) groups

focused on parenting skills for children with emotional and/or behavioural difficulties and 4)

there is qualitative data relevant to the review question. The search resulted in 10 journal

articles.

Results

An analysis of the identified papers revealed four themes: the facilitator’s use of personal

disclosure, the facilitator’s approach to managing the group, the ability to build a good

therapeutic relationship, and the facilitator’s knowledge and ability to apply it.

Discussion

It is difficult to draw firm conclusions about what parents value about facilitators due to the

limited amount of the evidence available. However, across the literature there were

identifiable commonalities of what parents value about group facilitators. Recommendations

for future research are discussed.

Introduction

Children and adolescents with developmental and/or disruptive behaviour disorders (DBDs),

mental health issues and emotional difficulties, often demonstrate behavioural problems and

may experience impairment across various domains (Barkley & Murphy, 1998). These issues

increase the risk of educational difficulties, peer rejection, substance misuse, criminal activity

and poor mental health (Wasik, 1987; Loeber & Keenan, 1994; MacDonald, Achenbach &

Green, 1999; Kazdin, 2000; Scott, Knapp, Henderson, & Maughan, 2001).

A young person’s behavioural problems are likely to affect, and to some extent be maintained

by, their family (Johnston, 1996, Vitanza & Guarnaccia, 1999). The need to help children at

risk of the aforementioned difficulties, by directly supporting their parents has long been

recognised at various levels, including sectors of the UK government (e.g. ‘Supporting

Families’, Home Office, 1998). This is outlined in documentation such as ‘Every Child

Matters’ (HM Treasury, 2003) and ‘Supporting Families in the Foundation Years’

(Department for Education, 2011). Both advocate improving parenting practices as a means

to support families, and to prevent or address the difficulties in question.

Parenting groups have become important and cost-effective option when compared with

individual treatment (Brookman-Frazee et al., 2006; Gross & Grady, 2002). A group format

allows one or two professionals to deliver an intervention to multiple parents at the same

time. This may include educating parents about different diagnoses, providing them with

tools and strategies, and increasing their confidence in their ability to manage challenging

behaviour. Parents also have the opportunity to meet other parents who face similar

challenges, and who have had parallel experiences. In the case of parenting groups, parents

are not only supported by professionals but also by their peers (Bromley et al., 2004; Gross &

Grady, 2002).

There is a growing body of evidence which demonstrates that parenting groups are

effective and can have a wide-ranging impact, reducing behaviour problems, negative parent–

child interactions, parental stress, and feelings of isolation (Barlow et al., 2012; Hames &

Rollings, 2009; Hutchings et al., 2007; McIntyre, 2008; McGilloway et al., 2012).

Importantly, Barlow and Stewart-Brown (2001) found that the gains achieved by attending a

parenting group were maintained in the short term and also at the long-term follow-up data

collection point.

Previous research on child behavioural and psychological interventions found that

parental engagement was essential to produce positive parent and child outcomes (Gross and

Grady 2002; McIntyre, 2008; Prinz and Miller 1996). The evidence available across multiple

areas of interest suggests that low treatment engagement is predictive of unfavourable

outcomes, whilst a higher level of participation increases the benefits experienced by

engaging in treatment (Boggs et al. 2004; Karver et al. 2005; O’Brien et al. 2009).

Despite the clear benefits of parenting groups, there are various challenges to

implementation. Practical barriers such as childcare and group location are relatively well

documented (Dumas, Nissley-Tsiopinis, & Moreland, 2007; Mytton, Ingram, Manns, &

Thomas, 2014). While more nuanced aspects of parental engagement such as what parents

value about various aspects of group treatment, such as the facilitating professionals, have

received more limited attention. Therefore, some researchers have proposed that those

interested in engagement should study these elements (Yatchmenoff, 2005; Staudt, 2007;

King et al. 2014).

In areas of psychology beyond parenting it is possible to outline some of what is

already known about the influence of group facilitators on participant engagement in other

types of groups. Examples include feminist support groups (Butler & Wintram, 1991), CBT

groups for troubled youth (Rose, 1998),general adolescent groups (Malekoff, 1997), group

psychotherapy (Orlinsky et al. 1994), social work groups (Tropp, 1976), group counselling

(Gladding, 1998), and general training and educational groups (Doel & Sawdon, 1999).

Several authors state that it is important for group leaders to be mindful of their

facilitating behaviours as they need to be proactive in maintaining the focus and flow of the

group while on the other hand being careful to leave enough space and freedom for group

members to step forward as active participants (Kelly et al., 2001; Rose, 1998; Mullender &

Ward, 1991).

Orlinsky et al. (1994) reinforce the key role of group leaders and reported that a

positive perception of the group leader leads to positive therapy outcomes. Other writers state

the benefits of facilitator behaviours that ensure the consistency of group structure (Tropp,

1976; Gladding, 1998; Napier, 1998), and make participants feel safe in the a group setting

(Doel & Sawdon, 1999; Butler & Wintram, 1991) and thus increase intervention engagement.

Furthermore, appropriate self-disclosure used by group leaders further promotes a safe group

atmosphere and models good level of participation to group members (Doel & Sawdon, 1999;

Malekoff, 1997).

King et al. (2014) in particular, suggested that there were specific practitioner behaviours that

optimized parental engagement in child-focused treatment. Accordingly, this review was

interested in understanding the various behaviours and other facilitator factors valued by

parents.

Qualitative research into parents’ general views about parenting groups have identified

various programme elements that are important to parents (Webster-Stratton & Spitzer, 1996;

Grimshaw & McGuire, 1998; Barlow & Stewart-Brown, 2001). This research has started to

equip providers with information that has the potential to help them improve engagement and

ensure that group interventions meet parents’ needs. However, to the best of the author’s

knowledge there is no work of professional consensus that focuses directly and exclusively

on what parents find important and value about facilitators of group interventions.

Traditionally, systematic reviews have concentrated on quantitative research and have

predominantly been used to synthesize evidence from Randomised Controlled Trials (RCTs).

There is growing recognition, however, that evidence-based practice should not be confined

to RCTs, and that reviews of qualitative studies are also valuable (Dixon-Wood &

Fitzpatrick, 2001). Systematic reviews of qualitative findings increase the likelihood that

service user concerns, such as the key factors that parents value about group facilitators are

acknowledged and addressed, (Dixon-Woods et al. ,2004).

Aims and main question. The aim of this paper was to summarize the findings of a

systematic review, quality assessment and synthesis of the existing qualitative literature on

what parents value about parenting group facilitators. The rationale for examining what

parents value about group leaders was that their opinions of these individuals may influence

their engagement with such interventions. The intention is that such a review will extend the

current knowledge base on the facilitator factors that parents value and therefore, on group

engagement. Furthermore, that it will sensitize facilitators, facilitator trainers, and other key

stakeholders to the qualities, skills and behaviours that parents perceive to be of value in

group leaders. Therefore, the question for the present literature review was ‘What do parents

value about facilitators of group-based parenting programmes? This will be explored using

qualitative findings.

aim of this paper was to examineparents’ experience and perceptions of parenting programmes using the

meta-ethnographicmethod, in order to sensitize policymakers and practitioners to the key factors

that parents perceiveto be of value.The aim of this paper was to examineparents’ experience and perceptions of parenting

programmes using the meta-ethnographicmethod, in order to sensitize policymakers and practitioners to

the key factors that parents perceiveto be of value.Method

A systematic review of the literature on parenting group facilitator factors valued by parents

was conducted. Five database collections (PsycARTICLES, PsychINFO, Psychology and

Behavioural Sciences Collection, MEDLINE and PubMed) were searched using the terms

“group* OR program* (title/abstract) AND parent* OR mother* OR father* OR mum* OR

dad* (title/abstract) AND facilitator* OR leader* OR therapist* OR practitioner* (all text)”.

A search with no date limitations was initially conducted; however, other limitations were

imposed including the exclusion of articles on research involving non-human subjects and

papers not available to read in English. Database searches alone may not yield all the

available results; therefore, hand searches of the reference lists of relevant articles, including

reviews, were also conducted. The titles and abstracts of all potentially relevant papers were

then examined in greater detail.

Inclusion and Exclusion Criteria. Papers were included if they met the following criteria: 1)

parent participants had attended a group or programme delivered in a group format 2) groups

had clearly identified professional facilitators (eg. not rotating or peer leadership) and 3)

groups focused on parenting skills for children with emotional and/or behavioural difficulties.

Accordingly, the following exclusion criteria were applied: parenting groups that had a

different focus, for example psychotherapy, medical treatment or health promotion, and

reviews and Meta-analyses, in favour of including any relevant original research mentioned

in them.

The present review was specifically interested in qualitative data, in order to focus on what

parents explicitly report that they value about group facilitators (see Figure. 1). Therefore,

qualitative research and mixed method research papers that collected qualitative data directly

from parents on the subject matter in question, were included. Quantitative data within mixed

method papers was purposefully not attended to and quantitative only papers were excluded.

Identified eligible records through database searches:

PsychoInfoPsycARTICLES

Psychology and Behavioural Sciences Collection (N= 79)

PubmedMedline (N= 232)

Abstracts and titles screened.

Potentially eligible records:

N= 49

Full articles read to assess for eligibility.

Manual searches yielded

duplicates only. Excluded (N= 262): Duplicates: N= 53Medical or physical health focus: N= 91Reviews and Meta analysis: N= 4A programme not group based: N= 26Group focus other than parent skills: N= 83No parent data collected: N= 5

Scre

enin

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nd a

bstr

acts

Iden

tific

atio

n

Figure. 1 – Prisma diagram of the journal article selection process

Content Extraction and Synthesis. The content extraction and synthesis process

involved reading the identified papers several times to provide the author of the present

review with a full understanding of their core features and main findings. Information

relevant to the review question was then extracted from each paper and synthesized manually

in two ways: firstly, the characteristics of the studies were summarised in table 1 and

secondly, after reading the papers, their findings were grouped into themes (Mays, Roberts &

Popay, 2001). Findings not relevant to the review question were not included in this process.

The tabulative synthesis involved summarizing key features of the studies in a table,

including the qualitative evidence sources available and those used to address the review

question. The thematic synthesis considered the findings of the studies collectively to identify

the key themes expressed within those findings. It was conducted in four stages: (i) the

Full articles read to assess for eligibility.

findings from each paper relating to the review question (parents’ comments about

facilitators) were extracted and compared across the 10 papers included to identify common

themes. (ii) Reoccurring patterns in what parents reported that they valued about facilitators

in each paper (e.g. the importance of the therapeutic relationship with the facilitator) were

grouped together to form 11 potential themes. (iii) To check that these potential themes were

an appropriate way to organise the findings, a table was created to compare the contributions

from each paper to the theme(s) they appeared to support. (iiii) In this part of the process,

potential themes that appeared to emphasize different aspects of the same topic were re-

organised to form 11 sub-groups within 4 over-arching or main themes. For example findings

relating to the facilitator’s ability to create a comfortable group atmosphere and the

facilitator’s use of different teaching methods, which were initially potential themes, were

then both deemed to be sub-themes relating to the facilitator’s general approach to managing

the parenting group. This then became a main overarching theme. A demonstration of how

findings from each study fit within the themes, is provided in Table 6a and 6b.

Defining terms in the review. For the purpose of this review it is helpful to define

and/or highlight key terms; the words ‘group’ and ‘programme’ are used interchangeably,

‘facilitator’, and ‘leader’ are also used interchangeably to refer to the professional responsible

for facilitating the parenting groups in question. Where mothers and fathers are not referred

to directly, ‘parent’ may denote the views of mothers or fathers, or a mix of both. In the

review ‘value’ is used to discuss facilitator qualities, skills, behaviours, techniques and

related experiences which parents explicitly appreciated, and described as important, helpful

or supportive.

Quality Assessment. To assess their quality, each paper was analysed using the

‘standard quality assessment criteria for evaluating primary research papers from a variety of

fields’ (QualSyst; Kmet, Lee & Cook, 2004). These criteria were chosen as they provided a

systematic and replicable means to produce a quantitative score which could be used to assess

and compare the quality of qualitative research papers. To analyse quality, each paper was

scored on the degree to which they met each item on a 10-item checklist (Yes = 2, Partial = 1,

No = 0; see Table 2 in Appendix B). A quality summary score was then calculated for each

paper by dividing the total score achieved across all 10 items by the maximum score possible

(e.g. x ÷ 20). Overall, the quality rating of papers in this review, ranged from 0.60 to 0.90

(see Table 3 in Appendix C). The QualSyst assessment method does not offer cut-off scores

for quality and so, for the purpose of the present review, quality scores were divided into

descriptive categories; very poor (0.00-0.20), poor (0.21-0.40), fair (0.41-0.60), good (0.61-

0.80), excellent (0.81-1.00). Based on this scale, the quality of nine articles considered in this

review were good or excellent. One article was considered to be fair in quality (Table 4 in

Appendix D).

Inter-rater Reliability. To ensure reliability of ratings the principal researcher and a

peer rater used the QualSyst tool to independently assess 50% of the papers (N = 5). The

papers selected were the first five papers that appeared alphabetically in the list of 10. Inter-

rater agreement initially ranged from 50 - 80%. These ratings were then discussed in order to

identify and resolve any disagreements where possible. Following this process, the inter-rater

agreement ranged from 90 – 100% on 4 of the 5 papers assessed and both raters assigned the

same overall score to the fifth paper (Table 5. See Appendix E).

Table 1 – Alphabetical list of papers included in the literature review, the evidence used and associated themes

Name of Paper Location Design Participants Evidence Used Summary of Relevant Findings

Bell, M. (2007). Community-based parenting programmes: an exploration of the interplay between environmental and organizational factors in a Webster Stratton project. British Journal of Social Work, 37(1), 55-72.

England Mixed method- Individual interviews- Interviews- Focus group- Questionnaires

29 Families in programme

(23 mothers, 6 Families, 27 children)8 Facilitators 4 Managers

- Questionnaires- 2 Focus groups

(All parents participated)

- Differences in the facilitators’ styles of group management were noted by the parents, particularly in relation to pace.

- Parents noted that the facilitators’ service influenced the way in which the they ran the groups.

- It was important to parents was that groups were not associated with Social Services.

- Personal contact with facilitators in the community was key.

- Establishing a relationship and trust with the facilitators and within the group was important to maintaining attendance.

Estefan, L., Coulter, M. & VandeWeerd, C. (2013). Relationships between stressors and parenting attitudes in a child welfare parenting program. Journal of Child and Family Studies, 22(2), 199-208.

USA Mixed method- Abstraction of

parenting programmefiles

- Individual interviews

124 Parents in programme

Interviewed:12 Mothers7 Fathers

- Individual interviews(19 arents participated)

- Parents highlighted that the group facilitators were supportive, helpful, and concerned about them.

Friars, P., & Mellor, D. (2009). Drop-out from parenting programmes: A retrospective study. Journal of Child & Adolescent Mental Health, 21, 29-38.

Australia Qualitative- Individual interviews

33 Parentsdropped out of programme

Interviewed:8 Mothers1 Father

- Individual interviews (9 parents participated)

- Parents reported faith in the therapist’s competence.

- Parents reported the importance of the facilitators’ experience of being a parent over the facilitators’ level of education.

Heinz, L. & Grant, P. (2003). A process evaluation of a parenting

Canada Qualitative- Observation

34 Parentsin programme

- 1 Small group interview(3 parents participated)

- Parents reported appreciating the supportive and comfortable

group for parents with intellectual disabilities. Evaluation and Program Planning, 26(3), 263-274.

- Small group interview- Written comments

28 Mothers6 Fathers

environment created by the facilitators.

- Parents reported satisfaction with how facilitators taught them how to manage their own problems.

Hock, R., Yingling, M. E., & Kinsman, A. (2015). A Parent-Informed Framework of Treatment Engagement in Group-Based Interventions. Journal of Child and Family Studies, 24(11), 3372-3382.

USA Qualitative- Individual phone

interviews

26 Parentsin programme

Interviewed:13 Parents (3 fathers joined part of the intervention)

- Individual phone interviews

(All parents participated)

- Parents reported that the effective presentation techniques used by the facilitators positively influenced their group attendance.

- Parents reported that the facilitators availability before and after session was important.

- A strong therapeutic alliance with the facilitator was also important to parents.

- A facilitator disclosing that they also had a child with ASD was viewed favourably by parents.

- Lack of facilitator follow-up negatively influenced parental engagement.

- Parents identified that facilitators were knowledgeable which was helpful.

Levac, A. M., McCay, E., Merka, P., & Reddon‐D’Arcy, M. L. (2008). Exploring parent participation in a parent training program for children's aggression: Understanding and illuminating mechanisms of change. Journal of child and adolescent psychiatric nursing, 21(2), 78-88.

Canada Qualitative - Interviews- Demographic

questionnaires

41 parents in programme

Interviewed:25 Mothers12 Fathers

- Interviews(29 individual interviews8 interviewed as a couple)

- Parents appreciated that facilitators checked in with them individually between sessions.

- Parents valued facilitators’ flexible group management skills.

Owens, J., Richerson, L., Murphy, C., Jageleweski, A., & Rossi, L. (2007). The parent perspective: Informing the cultural sensitivity of parenting programs in rural

USA Mixed Method- Focus group- Stress questionnaires- Hollingshead

(1975) index of

44 parents in programme

Focus group:67% female

- Focus group (15 parents participated)

- Parents appreciated group leaders’ efforts to create a “non-judgmental” atmosphere.

- Parents valued the leaders’ knowledge.

communities. Child Youth Care Forum, 36, 179-194.

family socioeconomic status

33% male (4 of 5 attended with spouses)

- Parents appreciated that new strategies were offered as alternatives rather than mandates.

- Parents in one group expressed disappointment that the group leaders were not parents themselves.

Parra‐Cardona, J. R., López‐Zerón, G., Domenech Rodríguez, M. M., Escobar‐Chew, A. R., Whitehead, M. R., Sullivan, C. M., & Bernal, G. (2015). A Balancing Act: Integrating Evidence‐Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants. Family process.

USA Qualitative- ‘Focus group

interviews’

130 parents in programme

(59 in control group)

71 Mothers 59 Fathers

- ‘Focus group interviews’(112 parents participated)

- Parents noticed how group leaders helped to motivate them to improve their parenting skills.

- According to the parents, the most important facilitator qualities consisted of their ability to engage parents in genuine ways, their expertise of the intervention, having a good sense of humor, and their ability to frame the parenting skills within relevant cultural experiences and values.

Patterson J, Mockford C, Stewart-Brown S (2005) Parents’ perceptions of the value of the Webster-Stratton Parenting Programme: a qualitative study of a general practice based initiative. Child Care Health Development, 31, 53–64

England Qualitative - Individual Interviews- Open-ended

questionnaire

31 parents

(Number of parents who attended the original programme was unclear.)

- Individual Interviews- Open-ended

questionnaire

(18 parents participated in both 8 in interview only 5 in questionnaire only)

- Parents valued the facilitators’ non-judgemental support and being invited to try new approaches to parenting, as opposed to being told how to parent.

- Parents also found being guided by the leaders in a confidential atmosphere supportive.

Scourfield, J., Allely, C., Coffey, A. & Yates, P. (2016) Working with fathers of at-risk children: Insights from a qualitative process evaluation of an intensive group-based intervention. Children and Youth Services Review, 69, 259-267

Scotland Qualitative - Individual interviews- Group interviews- Observations- Study of programme

manuals

6 fathers

5 staff members

(Number of parents who attended the original two programmes not stated.)

- Individual interviews- Group interviews

(All fathers participated in both)

- Parents reported that the facilitators’ creating a ‘relaxed’ atmosphere which was helpful.

- Parents valued the facilitators sharing their own experiences of parenting.

- Facilitators’ use and allowance of humour was appreciated.

Results

The search resulted in 10 journal articles. A summary of the study characteristics for each

paper is provided in Table 1. The papers were dated from 2005 to 2016 and of the 10 papers

identified 6 were qualitative and 4 applied mixed methods. The parenting populations

represented in these papers were from England (2), Scotland (1), America (4), Canada (2) and

Australia (1). None of the papers had as their main focus facilitator factors valued by parents;

however, 2 of the papers mentioned this as a subordinate line of enquiry. In the remaining 8

papers, parents mentioned facilitator factors they valued as a result of being questioned about

important and valued aspects of the programme they attended.

Overall Quality Summary. Based on the QualSyst assessment criteria six main

strengths and weaknesses of the studies included were identified: (1) Eight of ten papers

clearly outlined the study’s context, aim(s), any relevant theoretical framework(s) and

selected an appropriate design. For two papers, one or more of these elements were partially

unclear or assessed as somewhat inadequate. (2) Eight of ten papers appropriately selected

and clearly described systematic methods of data collection and analysis, and supported their

conclusions with relevant findings. For two papers, one or more of these elements were

partially unclear, unsystematic or assessed as somewhat inappropriate. (3) Three of ten papers

did not describe the use verification procedures to establish the credibility of their results. (4)

Three of ten papers described but did not provide justification for the sampling strategy used.

(5) None of the papers talked reflexively about how the researchers’ own characteristics and

epistemological stance may have influenced their analysis of the results and subsequent

findings.

Table 6a - Main themes and key aspects of these themes

Main themes:

The facilitator’s use of personal disclosure

The facilitator’s approach to managing the group

The ability to build a good therapeutic relationship

The facilitator’s knowledge and ability to apply it

Key aspects of this theme

Experience of being a parent

Use of general disclosures

Creating the right atmosphere

Non-expert and non-autoritative style which encourages autonomy

Teaching methods that encourage learning

Strategies that encourage participation and involvement(follow up/ flow of group)

Qualities and characteristics that help parents connect with facilitators

Establishing trust, reducing stigma

Facilitators make themselves available and listen

General knowledge and competence

Specialist knowledge which makes the programme relevant

Table 6b – Examples of contribution to themes identified from the papers selected

The facilitator’s use of personal disclosure

The facilitator’s approach to managing the group

The ability to build a good therapeutic relationship

The facilitator’s knowledge and ability to apply it

Bell (2007)

Estefan, Coulter, VandeWeerd, Armstrong & Gorski (2013)

Strategies that encourage participation and involvement

The researcher found that differences in the practitioners’ styles of group management were commented on by the parents, especially in relation to pace of content delivery and allowing parents to talk.

Establishing trust, reducing stigma

The researcher found that parents were encouraged to attend because the programme was not run by Social Services. Personal contact with the facilitating community-based workers was key and all of this contributed to a programme identity which was not associated with being a problem parent and having a naughty child.

Facilitators make themselves available and listenThe researchers found that one-third of parents reported that the facilitators of the parenting program were supportive, helpful, and concerned. Parents reported that the parenting program was the first place where they felt professionals were interested in their perceptions and concerns. Researchers concluded that the supportiveness of the group facilitators contributed positively to parents’ perceptions, and suggested that it made them feel less stigmatized, thus better meeting their needs.

The facilitator’s use of personal disclosure

The facilitator’s approach to managing the group

The ability to build a good therapeutic relationship

The facilitator’s knowledge and ability to apply it

Friars & Mellor (2009)

The researchers found that parents felt that a therapist would have to have a child or children with a disruptive behaviour disorder to fully understand what the parents were going through.

The researchers found that dropout parents developed the impression that the therapist judged them harshly for not implementing the strategies put forward in the group.

The researchers found that the dropout parents developed the impression that the therapist was unsympathetic to their plight.

The researchers found that some parents felt that the therapist was good in terms of their level of education and their knowledge of relevant reading material.

Heinz & Grant (2003)

Non-expert and non-autoritative style which encourages autonomyThe researchers found that all the parents were satisfied with how the facilitators treated them and helped them through their problem. They explained that facilitators asked them how they would deal with problems rather than immediately offering solutions.

Facilitators make themselves available and listen

The researchers found that parents experienced group facilitators as available to help any time and to listen to all problems.

The facilitator’s use of personal disclosure

The facilitator’s approach to managing the group

The ability to build a good therapeutic relationship

The facilitator’s knowledge and ability to apply it

Hock, Yingling, & Kinsman (2015)

Experience of being a parent

The researchers found that many parents reacted favorably to the group leader’s disclosure of having a child with autism.

Teaching methods that encourage learningThe researchers found that parents referenced the behaviors of practitioners that eitherfacilitated their engagement or detracted from it. In general, parents discussed the effective techniques practitioners utilized to present material. Many parents cited the use of visual aids as conducive to engaging with the treatment materials.

Facilitators make themselves available The researchers found that parents appreciated that practitioners consistently made themselves available before and after the group.

Specialist knowledge which makes the programme relevant The researchers found that parents noted that the leaders were knowledgeable. Parents reported that practitioners were able to establish multiple issues common for children with autism and provided the parents with methods to manage stressful situations and techniques to communicate with their children.

Levac, McCay, Merka & Reddon‐D’Arcy (2008)

Strategies that encourage learning and involvement

The researchers found that parents valued the facilitators’ skills in keeping the group focused and flexible, while gently balancing the level of participation of all the parents in group discussion.

Qualities and characteristics that help parents connect with facilitatorsThe researchers found that parents experienced the facilitators as caring.

The facilitator’s use of personal disclosure

The facilitator’s approach to managing the group

The ability to build a good therapeutic relationship

The facilitator’s knowledge and ability to apply it

Owens, J., Richerson, L., Murphy, C., Jageleweski, A., & Rossi, L. (2007)

Experience of being a parent

The researchers found that participants in one group expressed disappointment that the group leaders were not parents themselves.

Non-expert and non-autoritative style which encourages autonomyThe researchers found that participants viewed the leaders as knowledgeable, yet noted that new strategies were offered as alternatives rather than mandates.

Establishing trust, reducing stigma

The researchers found that participants highlighted the importance of developing trust between parents and group leaders.

General knowledge and competence

The researchers found that participants viewed the leaders as knowledgeable.

Patterson, Mockford & Stewart-Brown(2005)

Non-expert and non-autoritative style which encourages autonomyThe researchers found that parents appreciated being invited to try new approaches to parenting, as opposed to being told how to parent.

Qualities and characteristics that help parents connect with facilitatorsThe researchers found that parents experienced group leaders as easy to get on with which made them feel comfortable.

The facilitator’s use of personal disclosure

The facilitator’s approach to managing the group

The ability to build a good therapeutic relationship

The facilitator’s knowledge and ability to apply it

Parra‐Cardona, López‐Zerón, Domenech Rodríguez, Escobar‐Chew, Whitehead, Sullivan & Bernal(2015)

Use of general disclosure

The researchers found that parents reported the value of interventionists sharing their own personal experiences.

Non-expert and non-autoritative style which encourages autonomyThe researchers found that parents reflected on how the interventionists motivated them to refine their monitoring practices in external settings.

Facilitators make themselves available

The researchers found that parents viewed interventionalists to be dedicated, attentive and invariably accessible to all group members.

Specialist knowledge which makes the programme relevant

The researchers found that parents viewed the interventionists’ expertise as important. Parents felt that the interventionists knew the program well and knew how to respond to each scenario presented to them.

Scourfield, Allely, Coffey & Yates(2016)

Use of general disclosure

The researchers found that the fathers valued the facilitators sharing their own experiences.

Creating the right atmosphere

The researchers found that parents highlighted that facilitators succeeded in creating a ‘relaxed’ atmosphere.

Qualities and characteristics that help parents connect with facilitatorsThe researchers found that parents viewed the facilitators as one of the group, ‘down to earth’, and easy to talk to.

Main Results. The analysis of the identified papers revealed four main themes with

subgroups of key features which provided a useful way of organising the material (Table 6a).

The main themes were: the facilitator’s use of personal disclosure, the facilitator’s approach

to managing the group, the ability to build a good therapeutic relationship, and the

facilitator’s knowledge and ability to apply it. Table 6b shows which theme each paper

contributed to. An expansion of these themes follows.

The facilitator’s use of personal disclosure. In the literature parents reported the

value of group facilitators’ use of both general personal disclosure and more specific

disclosures related to their own experience as a parent.

Use of general disclosures. In Scourfield, Allely, Coffey and Yates’ (2016) intensive

group study of fathers of at-risk children, fathers reported the value of facilitators sharing

their experiences.

Facilitators manage to get away from an ‘us and them’ feel to the group - quite jokey, telling funny

stories from their own family experiences, generally quite light-hearted. (Scourfield et. al., 2016,

p. 263)

Likewise, parent participants in Parra‐Cardona et. al’s (2015) qualitative study of

Latino families reported that facilitators who talked about their own experiences encouraged

parents who were struggling and were seen as helpful. It gave parents a sense that facilitators

had lived what they had lived.

The facilitator’s experience of being a parent. Various studies presented evidence

that suggested a course facilitator’s direct experience of being a parent is important to

parenting group attendees and in many cases, influences their engagement with programmes.

In a mixed methods study of excellent quality, Owens, Richerson, Murphy, Jagelewski, and

Rossi (2008) explored the cultural sensitivities of parenting programmes in rural

communities. In their study of the Ohio Appalachian community, parent participants stated

their disappointment that neither of the group facilitators was a parent. In themes that arose

from focus groups in the study, parents highlighted the value of facilitators understanding of

their experiences with their children as an important concept to their engagement. Similarly,

in Parra-Cardona et al’s. (2015) large qualitative study of Latino families settled in America,

emerging themes showed that parents appreciated the parenthood of facilitators. Furthermore,

they valued the self-disclosures of those facilitators who shared their own parenting

experiences within the group.

What I love about them [facilitators] was that they talked about their own experiences. That helped a

lot because sometimes, I felt like things were not going well and then you heard about how they also

struggled. So, for me, it was very important to hear their own experiences, because they had lived what

we were living in the program. (Parra-Cardona et al., 2015, p. 13)

However, a possible limitation to the above study was that financial compensation

was offered to participants at every level of data collection (baseline, intervention completion

and follow-up). Various incentives have also been used in other studies around parenting

programmes; therefore, in these cases caution should be taken when attempting to understand

what parents value about facilitators, who may play a gate-keeping role in providing these

incentives (Heinz & Grant, 2003; Estefan et al., 2013).

In the literature, there are various examples of the value to parents and impact of

facilitators who have children with the same difficulties as those of programme attendees.

Examples include children with behavioural issues (Friar & Mellor, 2009; Parra-Cardona et

al., 2015) and children with Autism Spectrum Disorder (ASD) (Hock, Yingling & Kinsman,

2015). Helpfully, Friar and Mellor (2009) are one of a limited number of studies who have

looked specifically at reasons for drop out or non-attendance, including facilitator factors. In

Friar and Mellor’s (2009) qualitative study of drop out from parenting programmes, parents

who dropped out felt facilitators did not understand the extent of their children’s behaviour

issues and thus, were unsympathetic. It should be noted however, that of a potential 33 drop

outs, only 9 were interviewed. This was because 16 individuals could not be contacted and 7

people declined to participate. It is possible that this created a non-response bias and that

those who did not engage in the programme may have valued something different about

group facilitators or added further support to those points previously outlined. Parra-Cardona

et al. (2015) in their good quality qualitative study, found that the high retention rate of their

parenting programme was due in part to the value Latino parents placed on facilitators

sharing their own experiences of parenting children with conduct problems. In Hock,

Yingling and Kinsman’s (2015) small mixed method engagement study of parents of children

with Autism, many parents reacted favourably to one practitioner’s disclosure of having a

child with ASD. Although the number was not specified, parents in this study of excellent

quality reported that this encouraged their participation in the parenting group.

The facilitator’s approach to managing the group. In Bell’s (2007) examination of

community-based parenting programmes, he reported that parents noted differences in

facilitators’ styles and methods of group management. This was also a common theme in

other studies, where parents provided feedback in relation to aspects of those facilitators’

approaches they valued most. This theme had several key components which included: the

way in which group facilitators managed the atmosphere and flow of the group, the

leadership style which influenced their delivery, and the methods used to facilitate learning.

Creating the right atmosphere. Parents self-reports in the literature suggest that they

value facilitators who are able to create an atmosphere in which they feel safe, comfortable,

able to learn, and able to share their struggles with other parents free from judgement.

In Owen’s et. al’s (2007) study parents lauded facilitators’ efforts to create a safe and non-

judgemental atmosphere. This was particularly important to parents who worried that group

leaders would criticize their parenting methods and judge them based on the severity of their

child’s behaviour. Likewise, parents in other studies of both fair and excellent quality

credited facilitators with creating a group atmosphere that was confidential (Patterson,

Mockford, & Stewart-Brown, 2005), relaxed (Levac, McCay, Merka, & Reddon‐D’Arcy,

2008), non-threatening (Patterson, et al., 2005), and where humour was allowed (Scourfield

et al., 2016).

Group leaders were easy to get on with and made me feel comfortable. It had a non-threatening feel

about it. (Patterson et al., 2005, p. 60)

These authors reported that fears of an intense environment and public scrutiny did not

materialise and in reality, parents valued the facilitators ability to create the aforementioned

atmospheres, all of which enabled them to feel comfortable participating and facilitated their

learning.

Non-expert and non-authoritative style which encourages autonomy. According to

the literature it appears that parents value facilitators who encourage autonomy through a

non-expert and non-authoritative approach that recognises group attendees’ parenthood

which comes with its own expertise. Parents appreciated when this approach permeated the

facilitators’ management of the group and delivery of course content.

In Owens et al’s. (2007) focus groups, many parents expressed initial concerns that

course facilitators would believe themselves experts despite not knowing their children and

would provide inappropriate generic advice. In actuality Owens et al. (2007) found that

parents valued the fact that facilitators offered strategies as alternatives rather than

commands, which made the learning environment feel supportive. These findings are

supported by Patterson et al. (2005), who interviewed parents following a parenting group

and found that many valued the non-prescriptive approach of the facilitators, where they were

invited to try strategies rather than directed to do so.

I didn’t disagree with any of the comments or advice that was given because the facilitators didn’t

make it ‘you don’t do this or that’, it was ‘it might work, it might not work.’ There was no right or

wrong. (Patterson et al., 2005, p. 58)

In Scourfield et al’s. (2016) study of intensive group-based parenting interventions, parents

directly expressed appreciation for the fact that facilitators did not come across as

authoritative. In another study, Latino families, parents valued how facilitators motivated

them to take individual responsibility for practicing learnt strategies outside of the group

setting (Parra-Cardona et al., 2015).

In one qualitative study parents who had approached facilitators about specific problems

explained that they valued how the facilitators dealt with this (Heinz & Grant, 2003). Parents

reported that the facilitators encouraged their autonomy by first asking how they would

manage it and then offering to support them along the way.

They [facilitators] ask you how you would deal with it and they say they will stand by you. (Heinz &

Grant, 2003, p. 271)

This study was assessed to be excellent in quality but was subject to a small sample size of

three parents who participated in the group interview that yielded this finding (see Table 1

and Table 4). Although, this is often the case in qualitative research, it should be recognised

that the strength and quality of qualitative research is often rooted in the richness of data,

rather than large and representative sample sizes (Mays & Pope, 2000).

Teaching methods that encourage learning. In the literature parents valued the

facilitators who used a good mix of teaching methods (Patterson et al., 2005). More

specifically, in some studies parents valued facilitators who utilised effective presentation

techniques and visual aids which helped parents to better engage with the material (Hock et

al., 2015).

Having the big boards up…they would write everything down on easels…so it’s easier to… just kind

of watch the flow of it. I’m a more visual person and our children are more visual as well so that

always was, you know, real helpful, too, that they try to do things in that way, and it was very helpful

for, for us to be able to show our children. (Hock et al., 2015, p. 3376)

They valued where the facilitator had used a teaching style that was relevant to how parents

wanted to receive information and learn. For example, some parents appreciated the use of

visual aids and commented that it was then easier to understand the group content and

material, and to share this information with their children following the group.

Strategies that encourage participation and involvement. The facilitators’ role

includes managing the flow of the group, meaning the pacing and participation of group

members but also other activities such as contact with parents before and after the group. On

one hand, they valued the facilitator’s skill in keeping the group focused and flexible, while

encouraging the participation from all attendees and balancing the involvement of all parents

(Levac et al., 2008). Furthermore, parents also appreciated facilitators who checked in with

them individually between sessions. On the other hand, parents also talked about facilitators

behaviours which they did not value and detracted from their involvement in parenting

groups. For example, in Bell’s study (2007) parents commented on their disapproval of

facilitators who they felt rushed the group, watched the clock, and prioritised time keeping

over all else.

B would kind of rush things—she would try to keep us on schedule and was clock watching…whereas

Y would let you talk and let you have time to explain what you mean and she would listen more.

(Bell, 2007, p.64)

Equally, parents indicated that a lack of follow-up was not valued, for example, the lack of

follow-up by facilitators of parents who signed up to participate in parenting group but did

not attend. Hock et al. (2015) detailed an example of a participant who was unable to attend

session 1 of a group she had previously agreed to attend. Although she and her partner had

made it clear they wanted to be involved in the group, they were not informed that they could

have attended subsequent sessions or future programmes. The resulting misunderstanding and

lack of facilitator follow-up prevented her from engaging further in groups. When

interviewed about her reasons for dropping out the parent emphasised the value of facilitator

follow-up to manage such misunderstanding and ensure attendance.

The ability to build a good therapeutic relationship. Across the literature there

were various examples where parents expressed the value of the facilitator’s ability to build a

good therapeutic relationship with them. Parents identified the facilitator’s personal qualities,

ability to build trust, and availability to listen as key elements which helped parents connect

with facilitators.

Qualities and characteristics that help parents connect with facilitators. In the

literature there appears to be a link between the personal qualities of the facilitator and the

perceived existence of a therapeutic relationship. Much of this has focused on the qualities

that make parents feel comfortable and supported. The most frequently stated valued

characteristic was the facilitator’s relatability. For example, In Hock et al’s. (2015)

engagement study, parents explained that their relationship with the group facilitator was

promoted by the facilitator’s relatability. Similarly, in Patterson et al.’s (2005) study of

excellent quality parents reportedly welcomed the fact that facilitators were easy to get on

with which made them feel comfortable. Scourfield et al.’s (2016) study of fair quality

corroborated this finding with parents who stated that facilitators were easy to get on with

and felt they could talk to them as if they were friends. Patterson et al. (2005) reported that

parents valued group leaders who were easy to get on with.

They were down to earth, they felt like one of us sort of thing….We still talk to them like we'd talk to a

pal in the street...( Scourfield et al., 2016, p. 263)

Other researchers also reported that parents in their studies found it most important that group

leaders’ characteristics ensured that were able to engage parents in genuine ways (Parra-

Cardona et al., 2015). Accordingly, other facilitator qualities valued by parents were a sense

of humour, patience, a caring attitude (Levac et al., 2008; Hock et al., 2015; Parra-Cardona et

al., 2015) warmth (Patterson et al., 2005), concern (Heinz & Grant, 2003; Estefan et al.,

2013), and a relaxed and happy demeanour (Scourfield et al., 2016), all of which caused

parents to experience facilitators as helpful and supportive. In contrast, parents sense that the

facilitator was unsympathetic to their plight was damaging to the therapeutic relationship, and

parents felt blamed rather than understood or supported (Friars & Mellor, 2009).

Establishing trust, reducing stigma. In Heinz and Grant’s (2003) study, parents

stated that group facilitators were good people to approach with their problems, as parents

felt they could be trusted. This points to another quality valued by parents: the facilitator’s

ability to establish trust with them and amongst the group which serves to reduce the stigma

they might feel in attending a parenting group or may associate with particular services or

professionals.

Owens et al. (2007) found that the primary barrier to programme recruitment was the

parents’ distrust of group facilitators. Furthermore, In Bell’s (2007) study of good quality

parents stated that it was important to them that the programme they attended was not run by

Social Services and the involvement of community practitioners as facilitators contributed to

a programme identity which was not associated with being a problem parent and having a

naughty child. Trust was also a key issue identified by participants in Owens et al’s (2007)

study. Participants highlighted the importance of developing trust between parents and group

leaders, while distrust of outsiders to the community, such as university-affiliated group

leaders, was a barrier to parental participation.

Facilitators make themselves available and listen. Finally, parents valued when

facilitators made themselves available and listened to parents, which also contributed to

building a good therapeutic relationship. In several studies of good and excellent quality

parents stated the value of facilitators who listened to them in comparison to facilitators who

were unavailable (Heinz & Grant, 2003; Bell, 2007; Estefan et al., 2013). In these cases,

parents praised facilitators for their attitude towards listening as a priority (Heinz & Grant,

2003). For example, in one study parents commended the parenting programme facilitators as

the first professionals who were interested in them and listened to their perceptions and

concerns (Estefan et al., 2013)

Well the caseworker didn’t [ask about our concerns], but when they referred us to those people [group

facilitators],…they were really interested in the family life, and our concerns with the kids, what goes

on with them and stuff like that. (Estefan et al., 2013, p. 206)

Parents praised facilitators who they felt were dedicated to them, did not ignore them

and were always accessible to them (Parra-Cardona et al., 2015). Likewise, parents

interviewed in Hock et al’s. (2015) study highlighted the value of facilitators who made

themselves available before, during and after class so that parents had the option to ask them

questions.

The facilitator’s knowledge and ability to apply it. The literature indicated that

parents appreciated facilitators who were generally knowledgeable, as well as facilitators who

had specialist knowledge and were able to apply their knowledge to tailor programme content

to meet parents’ needs.

General knowledge and competence. Both Parra-Cardona et al. (2015) and Hock et

al. (2015) reported that parent participants viewed the facilitator’s general knowledge and

expertise in the given intervention programme as important. Hock et al. (2015) in particular,

noted that parents valued facilitators who were easy to understand and therefore, competent

in content delivery. However, parents in Friars and Mellor’s (2009) study of good quality

pointed out, as addressed in early themes that general knowledge was not always sufficient.

They indicated that specific knowledge and experience would be required to fully understand

what the parents had dealt with. Parra Cardona et al. (2015) reported that parents noted the

importance of interventionists’ general knowledge, they also spoke of their ability to frame

information according to the participants’ most relevant cultural experiences and values.

Specialist knowledge which makes the programme relevant. According to parents a

knowledgeable facilitator is important. However, a more frequently mentioned aspect of

knowledge that is mentioned in the literature as valued is how the facilitator applies their

specialist knowledge to make the group content more relevant for the parents. In Hock et al.’s

(2015) study parents were asked directly about whether the parenting programme they

attended was relevant to their needs. All parent participants in their study reportedly, affirmed

the value of the facilitators who were able to establish many areas that were common issues

for parents of children with autism. Furthermore, the facilitators then used this knowledge as

a basis to provide group attendees with tools and tactics for parents to manage stressful

situations and improve communicate with their children. Similarly, as alluded to previously

Parra Cardona et al. (2015) reported that parents valued the fact that all the facilitators were

fully bilingual and Latino/a and thus were able to frame parenting skills being taught within

culturally relevant examples and with Latino values in mind.

The topics are very relevant but without these interventionists, they would not have been as relevant as

they were. They knew how to present it to us as Latinos. Even with a good program, without good

facilitators, the program will not work. Thanks to them, the program was excellent. (Parra-Cardona

et al., 2015, p. 12)

Parents noted, that they were also able to deal adeptly with any situational examples

presented to them and tailor course content. On a final note, parents appreciated when

facilitators went beyond the course content, possibly to cover or get them material that was

not covered by the programme (Patterson et al., 2005).

Discussion

The efficacy of parenting programmes is well established in the literature, but there are many

factors which may influence their outcome, such as the level of parental engagement. Given

the central role that a facilitator has in the set up and management of parenting groups, it

follows that they might influence parental engagement and thus it would be helpful to know

what parents value about facilitators. Therefore, the aim of this review was to explore themes

in the qualitative findings from the existing literature in relation to what parents’ value about

facilitators in order to synthesise and evaluate what is already known. In this process four

main areas emerged: the facilitator’s use of personal disclosure, the facilitator’s approach to

managing the group, the ability to build a good therapeutic relationship, and the facilitator’s

knowledge and ability to apply it.

The evidence available and outlined in this literature review suggests that parents value

facilitators who are able to make them feel understood and supported. These findings in

relation to parenting groups are consistent with the findings of broader intervention adherence

literature. such as those of Cormier & Nurius (2003). They found that practitioner behaviours

such as providing support and demonstrating respect helped clients achieve their treatment

goals. Likewise, Calhoun and Rider (2008) reported the clients were more engaged by

therapists who were deemed effective due to their empathy, and listening and interpersonal

skills.

The review evidence also suggests that parents feel that understanding and support is best

achieved by facilitators who share their personal experiences of parenthood. These findings

are similar to other findings which support self-disclosure, stating that it serves to create a

safe and non-judgemental atmosphere which increases individuals’ engagement. They did

however, caution against the overuse of self-disclosure which could shift focus to the

facilitator and detract from group interaction (Doel & Sawdon, 1999; Malekoff, 1997; Butler

& Wintram, 1991).

According to the present review parents value facilitators who make efforts to nurture a

genuine relationship with them. The importance of this is emphasised in the existing broader

literature available. For example, Garcia and Weisz (2002) reported that problems in the

therapeutic relationship are a distinguishing factor between those who complete and those

who drop out of treatment. Equally, Karver et al. (2005) described the process by which

greater treatment engagement is achieved in their therapeutic process model. They reported

that a therapist’s characteristics and behaviours influenced client reaction to and participation

in treatment.

The present review indicated that parents value facilitators who manage the activities and

structure of the group appropriately, and help them learn using a variety of teaching methods.

Various authors from broader areas of psychology agree that facilitators need to be proactive

in maintaining the focus and flow of group interventions while allowing space for

spontaneous group member interaction (Kelly et al., 2001; Rose, 1998; Mullender & Ward,

1991). Finally, the current review found that parents valued facilitators who used their

specialist knowledge to ensure that group content was tailored to their needs and was

sensitive to their unique circumstances (e.g. cultural context).

Based on these findings, a number of suggestions can be made to facilitators, their

services and facilitator training programmes, where resources permit. (i) Facilitator training

programmes should equip facilitators to utilise a variety of teaching methods aimed at

supporting parents to engage with the course material and learning process. (ii) Facilitators

should also be aware of the local community to which the group has been offered and have

knowledge of the parents’ cultural context so that they can tailor group content to make it

more relevant to group attendees. (iii) Ideally, a group facilitator would be a parent or, where

there are two facilitators, at least one facilitator has experience as a parent. Whether or not

this is feasible, facilitators should work in partnership with parents, emphasising and drawing

upon parents’ own expertise. (iiii) Attending a parenting group can feel like a stigmatising

and anxiety provoking experience, therefore it is helpful for facilitators to create an

environment that parents feel is comfortable, safe and non-judgemental. (iiiii) Building trust

and a therapeutic relationship with parents is also important. Accordingly, it would be helpful

for facilitators meet with parents prior to the group, to check in with parents during the group

and where possible, provide some form of follow-up after the group. The benefits and

efficacy of working in close partnership with parents have been highlighted in various studies

(Davis & Rushton, 1991; Davis & Spurr, 1998; Puura et al., 2005)

It should be noted however, that there were some limitations to the literature review process

and the studies included. The first point to consider was that 10 papers were reviewed after a

possible 39 papers, that met the initial inclusion criteria, were eliminated on the basis of

containing no relevant qualitative information. Subsequently, this review has highlighted the

paucity of qualitative findings on the topic in question. Two of four themes were heavily

supported by 90-100% of the papers included, whereas the remaining two the themes were

supported by 40-50% of the papers. It is possible that more papers would have increased

support for the identified themes, provided additional themes or disconfirming information,

therefore there is a need for more qualitative studies on this topic.

The majority of the studies outlined in the present review were conducted in populations such

as America (Estefan et al., 2013), Canada (Heinz & Grant, 2003) and Australia (Friars &

Mellor, 2009). The values of parents in these countries are more likely to be similar than

those raising their children in a different socio-cultural context. For example, the

aforementioned parent populations are more likely to value autonomy and assertiveness,

whereas Asian cultures, are more likely to value social courtesy and self-control (Bornstein,

2012). Likewise, it should also be acknowledged that in many of the reviewed studies, the

majority of participants were Caucasian (Patterson et al., 2005; Bell, 2007; levac et al., 2008).

Although positively, some more recent studies of parenting research have focused on families

of varied socioeconomic status, ethnicity and cultural background (Parra Cardona et al.,

2015). This means that there may be a slight limitation in ability to apply the present review’s

findings to populations with dissimilar parenting cultures or from dissimilar ethnic

backgrounds, as they may value different behaviours, skills and qualities in parenting group

leaders to those outlined in this review.

Although it was not the focus of this review, it should be noted that the body of research

available on parenting programmes suffers from the same issue as the groups it seeks to

understand which is the underrepresentation of fathers as research participants. In the 10

studies reviewed, fathers were often in the minority and in many cases, fathers accounted for

less than a third of the participants or there was no differentiation between fathers and

mothers. There is a paucity of fathers’ perspectives, a greater number of which might have

revealed different facilitator preferences to those discussed here.

Many of the studies had relatively small participant numbers which is not uncommon in

qualitative literature and none of the papers focused exclusively on what parents valued about

facilitators. In fact, many of the studies utilised mixed methods to explore multiple issues and

thus, not all parent participants who attended the parenting groups participated in the

qualitative portion of these studies where additional data was gathered by individual

interview, focus group and/or open-ended questionnaires. For example, in Heinz and Grant’s

(2003) study only 3 of 34 participants attended the small group interview where parental

perspectives were gathered. Mays and Pope (2000) argued that qualitative research is a

distinct paradigm and so a conventional [quantitative] measure such as ‘generalisability’ is

not appropriate to assess the quality of qualitative research. Therefore, in light of the general

size and nature of the samples of the studies considered in the present review which has

collated rich information and brought ideas about valued group facilitator factors to the fore,

it would be beneficial for these ideas to be tested in larger scale studies.

The developers of the quality assessment tool used in this review defined ‘quality’ in terms of

the internal validity, and the appropriateness of the design, methods and analysis. They also

identified the need for standard criteria to critically evaluate these points of quality in a

replicable manner (Kmet, Cook, & Lee, 2004).

Using numerical assessment has both advantages and disadvantages. Firstly, when assigning

each paper a number that represents their level of quality, amongst the advantages is that it

gives criteria which makes it easier to establish interrater reliability for qualitative papers as

they are using the same standardised criteria.

Secondly, using a numerical assessment tool such as this one is means to condense, manage

and help understand the key quality points from the large volume of data that is typical of

qualitative papers. Furthermore, it is suitable for the evaluation of both quantitative and

qualitative research. Therefore it provides a means to compare qualitative and quantitative

research if needed. Using numbers to represent quality ratings means that quality information

is quickly accessible to readers of this review.

Thirdly, a potential disadvantage of using numerical assessment tools to evaluate quality is

that the chosen tool will determine the view of the quality and eligibility of studies for

inclusion in the review in question. Accordingly, if another assessment tool had been used the

view of quality might have been different, meaning that subjectivity is still a factor. It could

also be said that using scores to represent research quality, is at the expense of a more

nuanced qualitative account of a paper’s quality.

Positively, the use of the QualSyst assessment tool the level of acceptability of the quality of

each paper can be set for purposes of individual literature review, however lack of a defined

quality threshold and cut off criteria could create a problem when attempting to define which

papers are high and low quality. Arguably, this could pose a methodological limitation to

using the quality assessment tool and so it would be useful for there to be more

developmental research in to this aspect of the assessment tool. In order to assist in the

establishment of evidence based thresholds.

According to Mays and Pope (2000) there is some debate about how to assess the quality of

qualitative studies and suggest that an evaluation of reflexivity in the account should be

included in this assessment. Therefore, the assessment criteria chosen included reflexivity as

one of the 10 items to be assessed in all the papers. While almost all of the papers included in

this review were deemed to be good or excellent quality, most of the papers lacked reflexivity

and there was little or no discussion of how the researchers or research process may have

affected the findings. For example, there were studies that provided financial and other types

of incentives for parent participants who attended parenting groups. As facilitators may have

acted as gate-keepers in dispensing incentives to parents and it is possible that this may have

influenced the parent-facilitator relationship in a way that was not directly apparent in the

data.

To fully understand the applicability of this review, the limitations of the method of synthesis

should be considered. One limitation that cannot be ignored is the level of subjectivity in

choosing what is considered relevant data and then judging what information is ‘common’

across the included articles. Although efforts were taken to pay attention to what was

explicitly expressed by parent participants in those articles.

It could also be argued that certain pieces of data were put together under overarching themes

during the synthesis process that represent separate constructs in their own right (eg.

‘Creating the right atmosphere’ and ‘Teaching methods that encourage learning’). This is

acknowledged as a limitation of the synthesizing process, however, it should be said that

decisions regarding themes were partially made with accessibility for the review reader in

mind, facilitated by having fewer themes.

In terms of the themes, if a piece of data did not appear to reoccur across more than one paper

it is possible that it was left out as not pertaining to a common theme. Frequency was,

therefore, a key determining feature in the synthesis but it is possible that relevant data might

have been overlooked by the author of this review if it was not highlighted by researchers in

the original paper. Researchers, who themselves may have attended more to certain parent

comments which they then gave more emphasis in their results.

In summary, it is difficult to draw firm conclusions about what parents value about

facilitators due to the limited amount of the evidence available. Despite this, across the

literature considered in the present review there were identifiable commonalities of what

parents in those studies, viewed as important. Thus far, what parents value about facilitators

has not been the focus of parenting group research and therefore this information needs to be

carefully sought and specifically looked for where it does exist in the literature. In particular,

diverse in terms of parent participant gender and ethnicity, as frequently these perspectives

are underrepresented in the current body of literature.

Recommendations for new research. The body of research considered suggests that

the facilitator factors valued by parents are skills, personal qualities and approaches which

make them feel understood and supported.

The relative paucity of studies that focus specifically on valued facilitator factors suggests

that qualitative research which focuses on parent perspectives of facilitators of parenting

groups is needed. Future research could explore whether valued facilitator factors influence

parental attendance and engagement with parenting groups. It should also seek for greater

equity in the number of paternal participants and also perspectives which represent a diverse

range of backgrounds.

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Appendices

Appendix A

Author guidelines for the Journal of Child Services

Author Guidelines

Submit to the journal

Submissions to Journal of Children's Services are made using ScholarOne Manuscripts, the online submission and peer review system. Registration and access is available at http://mc.manuscriptcentral.com/jnlcs. 

If you are unable to find the information you need in the author guidelines or our author resources (http://emeraldgrouppublishing.com/authors/index.htm) section, please email manuscriptcentral@emeraldinsight.com  for assistance. Please quote the journal name, your contact details and the infromation you require.

Registering on ScholarOne Manuscripts

If you have not yet registered on ScholarOne Manuscripts, please follow the instructions below:

Please log on to: http://mc.manuscriptcentral.com/jnlcs Click on Create Account Follow the on-screen instructions, filling in the requested details before

proceeding Your username will be your email address and you have to input a password

of at least 8 characters in length and containing two or more numbers Click Finish and your account has been created.

Submitting an article to Journal of Children's Services on ScholarOne Manuscripts

Please log on to Journal of Children's Services at http://mc.manuscriptcentral.com/jnlcs with your username and password. This will take you through to the Welcome page (To consult the Author Guidelines for this journal, click on the Home Page link in the Resources column)

Click on the Author Centre button Click on the submit a manuscript link which will take you through to the

Manuscript Submission page Complete all fields and browse to upload your article When all required sections are completed, preview your .pdf proof Submit your manuscript

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Each paper is reviewed by the editor and, if it is judged suitable for this publication, it is then sent to at least two independent referees for double blind peer review.

Copyright

Articles submitted to the journal should not have been published before in their current or substantially similar form, or be under consideration for publication with another journal. Please see Emerald's originality guidelines for details. Use this in conjunction with the points below about references, before submission i.e. always attribute clearly using either indented text or quote marks as well as making use of the preferred Harvard style of formatting. Authors submitting articles for publication warrant that the work is not an infringement of any existing copyright and will indemnify the publisher against any breach of such warranty. For ease of dissemination and to ensure proper policing of use, papers and contributions become the legal copyright of the publisher unless otherwise agreed.

The editor may make use of iThenticate software for checking the originality of submissions received. Please see our press release for further details.

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If an article is accepted for publication in an Emerald journal authors will be asked to submit a copyright form through ScholarOne. All authors are sent an email with links to their copyright forms which they must check for accuracy and submit electronically.

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Manuscript requirements

Please prepare your manuscript before submission, using the following guidelines:

Format Article files should be provided in Microsoft Word format. LaTex files can be used if an accompanying PDF document is provided. PDF as a sole file type is not accepted, a PDF must

be accompanied by the source file. Acceptable figure file types are listed further below.

Article Length Articles should be between 5000 and 8000 words in length. This includes all text including references and appendices.

Please allow 350 words for each figure or table.

Article Title A title of not more than eight words should be provided.

Author details All contributing authors’ names should be added to the ScholarOne submission, and their names arranged in the

correct order for publication.

Correct email addresses should be supplied for each author in their separate author accounts

The full name of each author must be present in their author account in the exact format they should appear

for publication, including or excluding any middle names or initials as required

The affiliation of each contributing author should be correct in their individual author account. The affiliation listed should be where they were based at the time that

the research for the paper was conducted

Biographies and acknowledgement

s

Authors who wish to include these items should save them together in an MS Word file to be uploaded with the

submission. If they are to be included, a brief professional biography of not more than 100 words should be supplied for

each named author.

Research funding Authors must declare all sources of external research funding in their article and a statement to this effect should appear in the Acknowledgements section. Authors should describe the role of the funder or financial sponsor in the entire research

process, from study design to submission.

Structured Abstract

Authors must supply a structured abstract in their submission, set out under 4-7 sub-headings (see our "How to... write an

abstract" guide for practical help and guidance):

Purpose (mandatory) Design/methodology/approach (mandatory)

Findings (mandatory) Research limitations/implications (if applicable)

Practical implications (if applicable) Social implications (if applicable)

Originality/value (mandatory)

Maximum is 250 words in total (including keywords and article classification, see below).

Authors should avoid the use of personal pronouns within the structured abstract and body of the paper (e.g. "this paper

investigates..." is correct, "I investigate..." is incorrect).Keywords Authors should provide appropriate and short keywords in the

ScholarOne submission that encapsulate the principal topics of the paper (see the How to... ensure your article is highly

downloaded guide for practical help and guidance on choosing search-engine friendly keywords). The maximum number of

keywords is 12.

Whilst Emerald will endeavour to use submitted keywords in the published version, all keywords are subject to approval by Emerald’s in house editorial team and may be replaced by a

matching term to ensure consistency.

Article Classification

Authors must categorize their paper as part of the ScholarOne submission process. The category which most closely

describes their paper should be selected from the list below.

Research paper. This category covers papers which report on any type of research undertaken by the author(s). The

research may involve the construction or testing of a model or framework, action research, testing of data, market research

or surveys, empirical, scientific or clinical research.

Viewpoint. Any paper, where content is dependent on the author's opinion and interpretation, should be included in this

category; this also includes journalistic pieces.

Technical paper. Describes and evaluates technical products, processes or services.

Conceptual paper. These papers will not be based on research but will develop hypotheses. The papers are likely to

be discursive and will cover philosophical discussions and comparative studies of others' work and thinking.

Case study. Case studies describe actual interventions or experiences within organizations. They may well be subjective

and will not generally report on research. A description of a legal case or a hypothetical case study used as a teaching

exercise would also fit into this category.

Literature review. It is expected that all types of paper cite any relevant literature so this category should only be used if the main purpose of the paper is to annotate and/or critique

the literature in a particular subject area. It may be a selective bibliography providing advice on information sources or it may be comprehensive in that the paper's aim is to cover the main contributors to the development of a topic and explore their

different views.

General review. This category covers those papers which provide an overview or historical examination of some

concept, technique or phenomenon. The papers are likely to be more descriptive or instructional ("how to" papers) than

discursive.

Headings Headings must be concise, with a clear indication of the distinction between the hierarchy of headings.

The preferred format is for first level headings to be presented in bold format and subsequent sub-headings to be presented

in medium italics.

Notes/Endnotes Notes or Endnotes should be used only if absolutely necessary and must be identified in the text by consecutive numbers,

enclosed in square brackets and listed at the end of the article.

Figures All Figures (charts, diagrams, line drawings, web pages/screenshots, and photographic images) should be

submitted in electronic form.

All Figures should be of high quality, legible and numbered consecutively with arabic numerals. Graphics may be supplied in colour to facilitate their appearance on the online database.

Figures created in MS Word, MS PowerPoint, MS Excel, Illustrator should be supplied in their native formats.

Electronic figures created in other applications should be copied from the origination software and pasted into a blank MS Word document or saved and imported into an MS Word document or alternatively create a .pdf file

from the origination software. Figures which cannot be supplied as above are

acceptable in the standard image formats which are: .pdf, .ai, and .eps. If you are unable to supply graphics in these formats then please ensure they

are .tif, .jpeg, or .bmp at a resolution of at least 300dpi

and at least 10cm wide. To prepare web pages/screenshots simultaneously press the "Alt" and "Print screen" keys on the keyboard,

open a blank Microsoft Word document and simultaneously press "Ctrl" and "V" to paste the image.

(Capture all the contents/windows on the computer screen to paste into MS Word, by simultaneously

pressing "Ctrl" and "Print screen".) Photographic images should be submitted electronically

and of high quality. They should be saved as .tif or .jpeg files at a resolution of at least 300dpi and at least 10cm

wide. Digital camera settings should be set at the highest resolution/quality possible.

Tables Tables should be typed and included in a separate file to the main body of the article. The position of each table should be clearly labelled in the body text of article with corresponding

labels being clearly shown in the separate file.

Ensure that any superscripts or asterisks are shown next to the relevant items and have corresponding explanations

displayed as footnotes to the table, figure or plate.

References References to other publications must be in Harvard style and carefully checked for completeness, accuracy and consistency. This is very important in an electronic environment because it enables your readers to exploit the Reference Linking facility on the database and link back to the works you have cited

through CrossRef.

You should cite publications in the text: (Adams, 2006) using the first named author's name or (Adams and Brown, 2006)

citing both names of two, or (Adams et al., 2006), when there are three or more authors. At the end of the paper a reference

list in alphabetical order should be supplied:

For books Surname, Initials (year), Title of Book, Publisher, Place of publication.

e.g. Harrow, R. (2005), No Place to Hide, Simon & Schuster, New York, NY.

For book chapters Surname, Initials (year), "Chapter title", Editor's Surname, Initials, Title of Book, Publisher, Place of publication, pages.

e.g. Calabrese, F.A. (2005), "The early pathways: theory to practice – a continuum", in Stankosky, M. (Ed.), Creating the

Discipline of Knowledge Management, Elsevier, New York, NY, pp. 15-20.

For journals Surname, Initials (year), "Title of article", Journal Name, volume issue, pages.

e.g. Capizzi, M.T. and Ferguson, R. (2005), "Loyalty trends for

the twenty-first century", Journal of Consumer Marketing, Vol. 22 No. 2, pp. 72-80.

For published conference proceedings

Surname, Initials (year of publication), "Title of paper", in Surname, Initials (Ed.), Title of published proceeding which

may include place and date(s) held, Publisher, Place of publication, Page numbers.

e.g. Jakkilinki, R., Georgievski, M. and Sharda, N. (2007), "Connecting destinations with an ontology-based e-tourism planner", in Information and communication technologies in tourism 2007 proceedings of the international conference in Ljubljana, Slovenia, 2007, Springer-Verlag, Vienna, pp. 12-32.

For unpublished conference proceedings

Surname, Initials (year), "Title of paper", paper presented at Name of Conference, date of conference, place of conference, available at: URL if freely available on the internet (accessed

date).

e.g. Aumueller, D. (2005), "Semantic authoring and retrieval within a wiki", paper presented at the European Semantic Web Conference (ESWC), 29 May-1 June, Heraklion, Crete, available

at: http://dbs.uni-leipzig.de/file/aumueller05wiksar.pdf (accessed 20 February 2007).

For working papers Surname, Initials (year), "Title of article", working paper [number if available], Institution or organization, Place of

organization, date.

e.g. Moizer, P. (2003), "How published academic research can inform policy decisions: the case of mandatory rotation of

audit appointments", working paper, Leeds University Business School, University of Leeds, Leeds, 28 March.

For encyclopedia entries

(with no author or editor)

Title of Encyclopedia (year) "Title of entry", volume, edition, Title of Encyclopedia, Publisher, Place of publication, pages.

e.g. Encyclopaedia Britannica (1926) "Psychology of culture contact", Vol. 1, 13th ed., Encyclopaedia Britannica, London

and New York, NY, pp. 765-71.

(For authored entries please refer to book chapter guidelines above)

For newspaper articles (authored)

Surname, Initials (year), "Article title", Newspaper, date, pages.

e.g. Smith, A. (2008), "Money for old rope", Daily News, 21 January, pp. 1, 3-4.

For newspaper articles (non-

authored)

Newspaper (year), "Article title", date, pages.

e.g. Daily News (2008), "Small change", 2 February, p. 7.

For archival or other unpublished sources

Surname, Initials, (year), "Title of document", Unpublished Manuscript, collection name, inventory record, name of

archive, location of archive.

e.g. Litman, S. (1902), "Mechanism & Technique of Commerce", Unpublished Manuscript, Simon Litman Papers,

Record series 9/5/29 Box 3, University of Illinois Archives, Urbana-Champaign, IL.

For electronic sources

If available online, the full URL should be supplied at the end of the reference, as well as a date that the resource was

accessed.

e.g. Castle, B. (2005), "Introduction to web services for remote portlets", available at:

http://www-128.ibm.com/developerworks/library/ws-wsrp/ (accessed 12 November 2007).

Standalone URLs, i.e. without an author or date, should be included either within parentheses within the main text, or

preferably set as a note (roman numeral within square brackets within text followed by the full URL address at the

end of the paper).

Appendix B

Table 2 – Checklist for assessing the quality of papers included in the literature review

Yes (2) Partial (1) No (0)

1. Question / objective sufficiently described?

2. Study design evident and appropriate?

3. Context for the study clear?

4. Connection to a theoretical framework / wider body of knowledge?

5. Sampling strategy described, relevant and justified?

6. Data collection methods clearly described and systematic?

7. Data analysis clearly described and systematic?

8. Use of verification procedure(s) to establish credibility?

9. Conclusions supported by the results?

10. Reflexivity of the account?

Appendix C

Table 3 – Quality summary score calculated for each paper.

Research Paper Overall Score

Rater 1 Rater 21. 0.75 0.752. 0.85 0.853. 0.75 0.704. 0.90 0.905. 0.90 0.856. 0.90 -7. 0.90 -8. 0.75 -9. 0.90 -10. 0.60 -

Appendix D

Table 4 – Descriptive quality rating for the papers included in the literature review.

Paper Quality score

Descriptive quality rating

Paper 1 - Bell (2007) 0.75 GoodPaper 2 - Estefan, Coulter & VandeWeerd (2013) 0.85 ExcellentPaper 3 - Friars & Mellor (2009) 0.75 GoodPaper 4 - Heinz & Grant (2003) 0.90 ExcellentPaper 5 - Hock, Yingling & Kinsman (2015) 0.90 ExcellentPaper 6 - Levac, McCay, Merka & Reddon‐D’Arcy (2008) 0.90 ExcellentPaper 7 - Owens, Richerson, Murphy, Jageleweski & Rossi (2007) 0.90 ExcellentPaper 8 - Parra‐Cardona, López‐Zerón, Domenech Rodríguez, Escobar‐Chew, Whitehead, Sullivan & Bernal (2015) 0.75 GoodPaper 9 - Patterson, Mockford, Stewart-Brown (2005) 0.90 ExcellentPaper 10 - Scourfield, Allely, Coffey, & Yates, (2016) 0.60 Fair

Appendix E

Table 5 – Inter-rater agreement for the quality of 50% of the papers included in the literature review.

Paper Observed Agreement (%)(N = 5)

Paper 1 80%Paper 2 100%

Paper 3 90%

Paper 4 100%

Paper 5 90%

SUMMARY OF CLINICAL EXPERIENCE

2014-2017

Speciality: Working age adult Dates: Nov 2014 – Sept 2015

Service: Assessment and Treatment Team / Assertive Outreach

Experience Gained:

I with clients ranging from 18 to 65 years old. Patients were male and female, mostly White British, but I also saw two patients who were Black British and of Asian dissent.

I saw clients in their own homes, in the community (different locations) and at the team base.

I did 5 stand-alone assessments and 10 clients who were assessed were taken onto my caseload for treatment. I completed two neuropsychological assessments; the WAIS-IV and the WMS-IV.

During this placement I worked with clients presenting with various difficulties including a history of abuse, long standing depression, Post-Traumatic Stress Disorder (PTSD), Schizophrenia, general anxiety (GAD), Body Dysmorphic Disorder (BDD), Obsessive Compulsive Disorder (OCD), social anxiety, panic disorder, agoraphobia, Borderline Personality Disorder (BPD) and Emetaphobia. I also worked with a client who had a learning disability co-morbid with mental health difficulties.

The main model used was Cognitive Behavioural Therapy (CBT) but Narrative Emotive Therapy (NET) was also used for one client. Interventions offered included psychoeducation, activity scheduling, reliving (with grounding techniques), mindfulness, relaxation techniques, cognitive restructuring, behaviour experiments, assertiveness training, problem solving techniques, motivational interviewing, and exposure and response prevention.

Many clients presented with risk issues such as suicidal ideation and self-harm, past and/or present. I experienced assessing and managing risk, and agreeing risk management plans collaboratively with patients.

Speciality: Learning disability Dates: Oct 2015 – March 2016

Service: Mental Health and Learning Disabilities Team

Experience Gained:

I worked with clients ranging from 18 to 52 years old, presenting with mild, moderate and severe learning disability. Patients were male and female, and were all White British. I saw clients in the community (different locations), at home, and at the team base.

In many cases patients had co-morbid issues including, general anxiety, ASD and sensory issues such as hyperacusis, challenging behaviour (including inappropriate sexual behaviour), long-term physical health conditions, anger management problems, Bipolar Disorder,

Emotionally Unstable Personality Disorder (EUPD), Schizophrenia or a single episode of psychosis.

I completed assessments and undertook interventions. This included psycho education, adapted CBT and DBT, and systemic approaches.

Learning experiences included, but were not limited to, undertaking a formal observation of a patient with a severe learning disability in a supported living home, gathering information from the patient’s support network, providing consultation to other professionals involved in the care of patients on my caseload, and creation and supporting others to implement a positive behavioural support plan.

Speciality: Older adult Dates: April 2016 – Sept 2016

Service: Older Adults Community Mental Health Team

Experience Gained:

I worked with older adults with a variety of presentations including depression (including grief related), anxiety and different types of dementia.

I facilitated an Acceptance and Commitment Therapy (ACT) Group and a dementia information group. I also worked in the memory clinic completing dementia diagnostic assessments using psychometric testing (eg. WAIS-IV, WMS – IV, BADS, DKEFS, VOSP, TOPF, Graded Naming Task, Haling and Brixton Test).

As will all other placements risk assessment was a standard and regular part of my duties.

I completed formal observations in a nursing home environment. I worked with and gathered information from various professionals such as client family members, nurses, carers and nursing home staff. I also provided consultation to nursing home staff regarding how to manage challenging behaviour resulting from dementia.

Interventions undertaken included, behavioural interventions for challenging behaviour, neuropsychological assessments and an integrated approach (CBT and psychodynamic counselling) to adjustment disorder resulting from bereavement.

Speciality: Child and Adolescent Dates: Oct 2016 – April 2017

Service: Child and Adolescent Mental Health Service

Experience Gained:

I worked with clients ranging from 7 to 16 years old and from a range of ethnic backgrounds. I also worked with a variety of presentations including depression, general anxiety, panic disorder, social anxiety, specific phobias and Obsessive Compulsive Disorder (OCD). I also worked with a client would had Down’s Syndrome.

The main therapeutic approaches used were Cognitive Behavioural Therapy and Systemic approaches. Some treatment was offered to patients on their own and with their parent(s) in attendance.

As part of the placement I also completed cognitive assessments to diagnosis learning disability. I also completed a formal observation of patients in a special needs school environment. I identified the need for, and referred to, specialist services to complete an assessment for Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

I gathered information from family members and professionals (eg. teachers, social workers, psychiatrists, SENCOs, etc) in the child’s network and I focused on feedback informed treatment.

Speciality: Specialist placement Dates: April 2017 – Sept 2017

Service: Deaf Adult Community Mental Health Team

Experience Gained:

I worked directly, and indirectly through consultation, with deaf clients ranging from 12 to 51 years old, from a range of ethnic backgrounds, in a variety of settings including the community, the team base, adult and child/ adolescent inpatient wards.

Within specialist deaf services I worked with a variety of presentations including depression, general anxiety, panic disorder, agoraphobia, emotional dysregulation, psychosis, and relationship issues in the client’s support network. I also worked with client’s with co-morbid learning disabilities, Autistic Spectrum Disorder, long-term physical health issues, Fragile X Syndrome, Ushers Syndrome, and poor mobility.

I also adapted and carried out intellectual assessments and administered psychometric questions for deaf clients. I co-facilitated an inpatient hearing voices support group.

.

PSYCHD CLINICAL PROGAMME

TABLE OF ASSESSMENTS COMPLETED DURING TRAINING

Year I Assessments

ASSESSMENT TITLE

WAIS WAIS Interpretation (online assessment)

Practice Report of Clinical Activity

Practice report of clinical activity with John: a male client in his 30s presenting with anxiety.

Audio Recording of Clinical Activity with Critical Appraisal

Critical appraisal of an audio recording of clinical activity with Ann: a female client in her 60s presenting with depression and trauma.

Report of Clinical Activity N=1

Report of clinical activity with Ann: a female client in her 60s presenting with depression and trauma.

Major Research Project Literature Survey

‘What are the constraints on paternal involvement in parenting programmes?’

Major Research Project Proposal

‘How do facilitators explain paternal absence from parenting groups?’

Service-Related Project ‘The Development and Evaluation of Bite-Size Learning Sessions to Trust Staff Working with Psychosis’

Year II Assessments

ASSESSMENT TITLE

Report of Clinical Activity/Report of Clinical Activity – Formal Assessment

Assessment and Treatment of a Young Woman in her Late Teens, with a Moderate Learning Disability and Autism, Presenting with Anxiety and Intrusive Thoughts.

PPLD Process Account Personal and Professional Learning and Development Group Process Account

Year III Assessments

ASSESSMENT TITLE

Presentation of Clinical Activity

Assessment and Treatment of a Gentleman in his Late 80s, Presenting with a Depression, Following Bereavement.

Major Research Project Literature Review

What do parents value about facilitators of group-based parenting programmes: a review of the qualitative evidence

Major Research Project Empirical Paper

How do facilitators explain paternal absence from parenting groups?

Report of Clinical Activity/Report of Clinical Activity – Formal Assessment

Extended Assessment of a Gentleman in his Eighties, Presenting with a Memory Problems and Physical Health Issues.

Final Reflective Account

On becoming a clinical psychologist: A retrospective, developmental, reflective account of the experience of training