The New Forest Parenting Programme (NFPP)

The New Forest Parenting
Programme (NFPP)
Element 1: Who is the programme for?
PPET rating: **** A clearly specified and appropriate target population and
robust enrolment and referral processes
Who is the programme for?
The parents or carers of a child between the ages of three and eleven with a diagnosis of
ADHD. The programme content and practitioner qualifications are appropriate for families
with these characteristics.
How old must the children be?
Between the ages of two and nine.
Classification Targeted
Specialist
Level of need Moderate
Complex
High
Referral and recruitment
Families are referred to NFPP practitioners by primary care health professionals, educational
professionals and social workers.
Enrolment
All families undergo a ‘scaffold interview’ prior to the start of the programme. During the
interview, the practitioner collects detailed information about the family through a form
provided by the developer.
Are there any eligibility requirements?
The child must be diagnosed with ADHD or be in the process of being diagnosed with
ADHD. The parents must also not have any serious mental health or intellectual disabilities.
Parents should be able to speak and read English, although in some instances NFPP has been
successfully delivered with an interpreter.

How are the needs of parents assessed and monitored?
The family’s needs are initially assessed during the scaffold interview. The practitioner
may also use standardised measures to assess each family’s needs during the interview.
During the programme, the family’s needs are assessed through:
• Practitioner observations during each visit
• Parents completion of a weekly diary
• A progress check at the end of week four and week eight.
How are parents referred onto other services?
Practitioners are expected to be familiar with the systems available for referring families
onto other services within their local area. Each family’s need for additional services is also
assessed during practitioner supervision.

Element 2: What are the content and activities
of the intervention?
PPET rating: **** Strong theoretical framework and content
How is the programme delivered?
A single practitioner delivers the programme over eight weekly sessions. Each session lasts
two hours.
Where is the programme delivered?
In the family’s home.
NFPP
What do parents learn during the sessions?
Parents learn about the nature of ADHD and strategies for managing their child’s behaviour
and attention. In many of the sessions, the practitioner introduces games that help the
parent engage the child’s attention, increase his or her concentration, wait patiently and take
turns. The content for the eight sessions are as follows:
• Week 1: (parent only) The practitioner discusses the nature of ADHD with the parent
and introduces simple strategies, such as the use of praise and eye contact, to
manage the child’s behaviour and attention.
• Week 2: (parent only) The practitioner reviews the weekly diary with the parent and
discusses the child’s behaviour. Parents learn how to develop routines, communicate
clear messages, set limits and avoid confrontation.
• Week 3: (parent and child) Parents learn how to manage their child’s temper
tantrums and difficult behaviour through the use of firm limits and distraction
strategies.
• Week 4: (parent and child) Parents learn how to use time out and quiet time
effectively.
• Week 5: (parent only) The practitioner and parent assess the success of the new
strategies.
• Weeks 6&7: (parent and child) The practitioner observes the parent and child
interacting for 15 minutes. The practitioner then provides feedback about the
quality of the interaction.
• Week 8: (parent only) The practitioner reviews the key messages from the
previous weeks and discusses strategies for managing behaviours that may still be
challenging.
What is the scientific basis for the content?
NFPP is based on evidence from the neurosciences about the nature of ADHD, theories of
child development, social learning theory, behavioural theory and cognitive behavioural
theory.

How does programme work? (What is the theory of change?)
NFPP assumes that the ADHD child’s behaviour and attention problems can be ‘scaffolded’
by the parent through positive, reciprocal interactions with the child. NFPP therefore
teaches parents how to be supportive of their ADHD child’s needs, set appropriate limits
and select appropriate, yet challenging goals. Effective parent scaffolding will, in turn, help
the child better regulate his or her behaviour and increase his or her ability to concentrate.
Constructive
and positive
parent and child
interactions help
ADHD children
better manage
their attention and
impulses
Parents learn to:
• Reduce negative
responses to their
child
• Respond more
positively to their
child
• Enforce limits
• Scaffold their child’s
attention and selforganisation
skills
Short-term goals:
In the short term, it is expected that there will be improvements in:
• Parents’ knowledge about the nature of ADHD
• Parents’ use of strategies for managing ADHD
• Children’s behaviour and impulsivity
• The parent-child relationship.
Long-term goals:
In the long term, it is expected that:
• Children will have fewer symptoms of ADHD
• Parents will experience less stress.
Children are better
able to manage
their impulses and
attention
• Children’s behaviour
improves
• Children can
concentrate better
• Parents experience
less stress
• The parent-child
relationship improves
How do parents learn during the programme?
Parents learn from practitioner instruction and modelling, role-play, homework
assignments and discussion. Parents also learn from practitioner feedback provided during
games that aim to increase the child’s attention and reduce impulsive behaviour.
Parental engagement:
Home visiting ensures that parents can attend the sessions and that the activities are
relevant to the family’s needs. The practitioners also receive extensive training on how to
motivate parents and develop a supportive relationship with them.

Element 3: How are practitioners
trained and supported?
PPET rating: **** Prepared for implementation with fidelity
Practitioner qualifications:
The developers recommend that the practitioners have a minimum qualification of a QCF
Level 4/5. However, given the complexity of the programme content and the families’
levels of need, it is recommended that this programme be delivered by practitioners with
a QCF Level 6 or higher. This is especially important, since the developers have found that
the programme is less effective when delivered by non-specialist primary care health
professionals.
Practitioners suitable to deliver the programme include clinical psychologists, educational
psychologists, primary mental health workers, health visitors and school nurses.
Practitioners are also expected to have worked with parents and children for at least two
years.
Practitioner training:
Practitioners attend three days of training covering:
• The theoretical background of the programme
• The programme content
• Parent recruitment, retention and referral.
Practitioners also receive a detailed manual providing step-by-step guidance on the setup
and delivery of the programme.
Accreditation:
Accreditation is awarded to practitioners who can demonstrate they can deliver the
programme to a high standard and with fidelity to the programme model. This is done
by the practitioner providing videotapes of themselves implementing the programme
and then receiving weekly feedback from the programme developers. Practitioners must
provide videotapes from programmes completed with two families.
Systems for maintaining fidelity and quality assurance:
Fidelity is maintained through the following processes:
• The accreditation process
• Fidelity checklists
• Follow-up training.
NFPP

Supervision requirements:
• Supervision is provided by the programme developers during practitioner
accreditation. Once the practitioner is accredited, it is expected that supervision
will be provided by the host agency or by NFPP peers.
• NFPP supervisors are expected to have minimum of a QCF Level 6 qualification.
• NFPP would benefit from more detailed guidance about the supervision and
support for NFPP supervisors.
Wide-scale dissemination:
There is currently no system in place for training experts who can then independently
train trainers. This means that practitioners can only be trained by the programme
developer.
Implementation support:
The programme developers meet with the host agency for a scoping meeting prior to
the practitioner training. Practitioners are also expected to obtain a signed agreement
from their manager that they will have the time to deliver the programme once they have
completed training.

Element 4: The strength of the programme’s
evidence
PPET rating: **** Promising evidence of effectiveness
The New Forest Parenting Programme has promising evidence of reducing the
symptoms of ADHD in the short term from two randomised controlled trials. The findings
are described briefly below.
Population, study design and measures
Study 1. Sonuga-Barke et al. (2001)
The parents of 78 preschool children with
symptoms of ADHD were randomly assigned to 1)
NFPP, 2) parent counselling and support, 3) a waitlist
control group. Mothers completed standardised
measures of parent and child behaviour before
attending the course and 15 weeks afterwards.
Study 2. Thompson et al. (2009)
Forty-one preschool children were randomly
assigned to a revised version of NFPP and treatment
as usual. Mothers from both groups completed
standardised measures of parent and child
behaviour and participated in a coded videotape
session before the start of the programme and nine
weeks after its completion.
Significant outcomes
NFPP
Significant improvements in
mothers’ wellbeing and children’s
ADHD symptoms were observed
for families attending NFPP in
comparison to parents receiving
counselling or assigned to the
wait-list control group.
Significant improvements in
the children’s ADHD symptoms
were observed for families
participating in NFPP in
comparison to families receiving
treatment as usual. There were
also significant improvements
in the parents’ competency
during the videotaped sessions,
although there were no
improvements in the mothers’
self-reports of wellbeing in
comparison to the control group.
Additional research:
NFPP is continually being developed within a larger programme of research. Currently,
the programme is completing a randomised controlled trial in the USA that should be
complete in 2014. The feasibility of NFPP with hard-to-reach families is also currently being
investigated in the UK.

References:
Sonuga-Barke, E.J.S., Thompson, M., Daley, D., and Laver-Bradbury, C. (2004). Parent training for Attention Deficit/
Hyperactivity Disorder: Is it as effective when delivered as routine rather than as specialist care? British Journal of Clinical
Psychology, 43, 449 – 457.
Sonuga-Barke, E.J.S., Daley, D., Thompson, M., Laver-Bradbury, C., and Weeks, W. (2001). Parent-based therapies for
preschool Attention-Deficit/Hyperactivity Disorder: A randomized, controlled trial with a community sample. Journal of
the American Academy of Child and adolescent Psychiatry, 40, 402 – 408.
Thompson, M.J.J., Laver-Bardbury, C., Ayres, M., Le Poidevin, E., Mead, S., Dodds, C., Psychogiou, L., Bitsakou, P., Daley,
D., Weeks, A., Brotman, L.M., Abikoff, H., Thompson, P., Sonuga-Barke, E.J.S. (2009). A small-scale randomized controlled
trial of the revised New Forest parenting programme for preschoolers with Attention Deficit/Hyperactivity Disorder.
European Child and Adolescent Psychiatry, 18, 605 – 616.