The New Forest Parenting Programme (NFPP)
The New Forest Parenting Programme (NFPP)
The New Forest Parenting Programme (NFPP)
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<strong>The</strong> <strong>New</strong> <strong>Forest</strong> <strong>Parenting</strong><br />
<strong>Programme</strong> (<strong>NFPP</strong>)<br />
Element 1: Who is the programme for?<br />
PPET rating: **** A clearly specified and appropriate target population and<br />
robust enrolment and referral processes<br />
Who is the programme for?<br />
<strong>The</strong> parents or carers of a child between the ages of three and eleven with a diagnosis of<br />
ADHD. <strong>The</strong> programme content and practitioner qualifications are appropriate for families<br />
with these characteristics.<br />
How old must the children be?<br />
Between the ages of two and nine.<br />
Classification Targeted<br />
Specialist<br />
Level of need Moderate<br />
Complex<br />
High<br />
Referral and recruitment<br />
Families are referred to <strong>NFPP</strong> practitioners by primary care health professionals, educational<br />
professionals and social workers.<br />
Enrolment<br />
All families undergo a ‘scaffold interview’ prior to the start of the programme. During the<br />
interview, the practitioner collects detailed information about the family through a form<br />
provided by the developer.<br />
Are there any eligibility requirements?<br />
<strong>The</strong> child must be diagnosed with ADHD or be in the process of being diagnosed with<br />
ADHD. <strong>The</strong> parents must also not have any serious mental health or intellectual disabilities.<br />
Parents should be able to speak and read English, although in some instances <strong>NFPP</strong> has been<br />
successfully delivered with an interpreter.
How are the needs of parents assessed and monitored?<br />
<strong>The</strong> family’s needs are initially assessed during the scaffold interview. <strong>The</strong> practitioner<br />
may also use standardised measures to assess each family’s needs during the interview.<br />
During the programme, the family’s needs are assessed through:<br />
• Practitioner observations during each visit<br />
• Parents completion of a weekly diary<br />
• A progress check at the end of week four and week eight.<br />
How are parents referred onto other services?<br />
Practitioners are expected to be familiar with the systems available for referring families<br />
onto other services within their local area. Each family’s need for additional services is also<br />
assessed during practitioner supervision.
Element 2: What are the content and activities<br />
of the intervention?<br />
PPET rating: **** Strong theoretical framework and content<br />
How is the programme delivered?<br />
A single practitioner delivers the programme over eight weekly sessions. Each session lasts<br />
two hours.<br />
Where is the programme delivered?<br />
In the family’s home.<br />
<strong>NFPP</strong><br />
What do parents learn during the sessions?<br />
Parents learn about the nature of ADHD and strategies for managing their child’s behaviour<br />
and attention. In many of the sessions, the practitioner introduces games that help the<br />
parent engage the child’s attention, increase his or her concentration, wait patiently and take<br />
turns. <strong>The</strong> content for the eight sessions are as follows:<br />
• Week 1: (parent only) <strong>The</strong> practitioner discusses the nature of ADHD with the parent<br />
and introduces simple strategies, such as the use of praise and eye contact, to<br />
manage the child’s behaviour and attention.<br />
• Week 2: (parent only) <strong>The</strong> practitioner reviews the weekly diary with the parent and<br />
discusses the child’s behaviour. Parents learn how to develop routines, communicate<br />
clear messages, set limits and avoid confrontation.<br />
• Week 3: (parent and child) Parents learn how to manage their child’s temper<br />
tantrums and difficult behaviour through the use of firm limits and distraction<br />
strategies.<br />
• Week 4: (parent and child) Parents learn how to use time out and quiet time<br />
effectively.<br />
• Week 5: (parent only) <strong>The</strong> practitioner and parent assess the success of the new<br />
strategies.<br />
• Weeks 6&7: (parent and child) <strong>The</strong> practitioner observes the parent and child<br />
interacting for 15 minutes. <strong>The</strong> practitioner then provides feedback about the<br />
quality of the interaction.<br />
• Week 8: (parent only) <strong>The</strong> practitioner reviews the key messages from the<br />
previous weeks and discusses strategies for managing behaviours that may still be<br />
challenging.<br />
What is the scientific basis for the content?<br />
<strong>NFPP</strong> is based on evidence from the neurosciences about the nature of ADHD, theories of<br />
child development, social learning theory, behavioural theory and cognitive behavioural<br />
theory.
How does programme work? (What is the theory of change?)<br />
<strong>NFPP</strong> assumes that the ADHD child’s behaviour and attention problems can be ‘scaffolded’<br />
by the parent through positive, reciprocal interactions with the child. <strong>NFPP</strong> therefore<br />
teaches parents how to be supportive of their ADHD child’s needs, set appropriate limits<br />
and select appropriate, yet challenging goals. Effective parent scaffolding will, in turn, help<br />
the child better regulate his or her behaviour and increase his or her ability to concentrate.<br />
Constructive<br />
and positive<br />
parent and child<br />
interactions help<br />
ADHD children<br />
better manage<br />
their attention and<br />
impulses<br />
Parents learn to:<br />
• Reduce negative<br />
responses to their<br />
child<br />
• Respond more<br />
positively to their<br />
child<br />
• Enforce limits<br />
• Scaffold their child’s<br />
attention and selforganisation<br />
skills<br />
Short-term goals:<br />
In the short term, it is expected that there will be improvements in:<br />
• Parents’ knowledge about the nature of ADHD<br />
• Parents’ use of strategies for managing ADHD<br />
• Children’s behaviour and impulsivity<br />
• <strong>The</strong> parent-child relationship.<br />
Long-term goals:<br />
In the long term, it is expected that:<br />
• Children will have fewer symptoms of ADHD<br />
• Parents will experience less stress.<br />
Children are better<br />
able to manage<br />
their impulses and<br />
attention<br />
• Children’s behaviour<br />
improves<br />
• Children can<br />
concentrate better<br />
• Parents experience<br />
less stress<br />
• <strong>The</strong> parent-child<br />
relationship improves<br />
How do parents learn during the programme?<br />
Parents learn from practitioner instruction and modelling, role-play, homework<br />
assignments and discussion. Parents also learn from practitioner feedback provided during<br />
games that aim to increase the child’s attention and reduce impulsive behaviour.<br />
Parental engagement:<br />
Home visiting ensures that parents can attend the sessions and that the activities are<br />
relevant to the family’s needs. <strong>The</strong> practitioners also receive extensive training on how to<br />
motivate parents and develop a supportive relationship with them.
Element 3: How are practitioners<br />
trained and supported?<br />
PPET rating: **** Prepared for implementation with fidelity<br />
Practitioner qualifications:<br />
<strong>The</strong> developers recommend that the practitioners have a minimum qualification of a QCF<br />
Level 4/5. However, given the complexity of the programme content and the families’<br />
levels of need, it is recommended that this programme be delivered by practitioners with<br />
a QCF Level 6 or higher. This is especially important, since the developers have found that<br />
the programme is less effective when delivered by non-specialist primary care health<br />
professionals.<br />
Practitioners suitable to deliver the programme include clinical psychologists, educational<br />
psychologists, primary mental health workers, health visitors and school nurses.<br />
Practitioners are also expected to have worked with parents and children for at least two<br />
years.<br />
Practitioner training:<br />
Practitioners attend three days of training covering:<br />
• <strong>The</strong> theoretical background of the programme<br />
• <strong>The</strong> programme content<br />
• Parent recruitment, retention and referral.<br />
Practitioners also receive a detailed manual providing step-by-step guidance on the setup<br />
and delivery of the programme.<br />
Accreditation:<br />
Accreditation is awarded to practitioners who can demonstrate they can deliver the<br />
programme to a high standard and with fidelity to the programme model. This is done<br />
by the practitioner providing videotapes of themselves implementing the programme<br />
and then receiving weekly feedback from the programme developers. Practitioners must<br />
provide videotapes from programmes completed with two families.<br />
Systems for maintaining fidelity and quality assurance:<br />
Fidelity is maintained through the following processes:<br />
• <strong>The</strong> accreditation process<br />
• Fidelity checklists<br />
• Follow-up training.<br />
<strong>NFPP</strong>
Supervision requirements:<br />
• Supervision is provided by the programme developers during practitioner<br />
accreditation. Once the practitioner is accredited, it is expected that supervision<br />
will be provided by the host agency or by <strong>NFPP</strong> peers.<br />
• <strong>NFPP</strong> supervisors are expected to have minimum of a QCF Level 6 qualification.<br />
• <strong>NFPP</strong> would benefit from more detailed guidance about the supervision and<br />
support for <strong>NFPP</strong> supervisors.<br />
Wide-scale dissemination:<br />
<strong>The</strong>re is currently no system in place for training experts who can then independently<br />
train trainers. This means that practitioners can only be trained by the programme<br />
developer.<br />
Implementation support:<br />
<strong>The</strong> programme developers meet with the host agency for a scoping meeting prior to<br />
the practitioner training. Practitioners are also expected to obtain a signed agreement<br />
from their manager that they will have the time to deliver the programme once they have<br />
completed training.
Element 4: <strong>The</strong> strength of the programme’s<br />
evidence<br />
PPET rating: **** Promising evidence of effectiveness<br />
<strong>The</strong> <strong>New</strong> <strong>Forest</strong> <strong>Parenting</strong> <strong>Programme</strong> has promising evidence of reducing the<br />
symptoms of ADHD in the short term from two randomised controlled trials. <strong>The</strong> findings<br />
are described briefly below.<br />
Population, study design and measures<br />
Study 1. Sonuga-Barke et al. (2001)<br />
<strong>The</strong> parents of 78 preschool children with<br />
symptoms of ADHD were randomly assigned to 1)<br />
<strong>NFPP</strong>, 2) parent counselling and support, 3) a waitlist<br />
control group. Mothers completed standardised<br />
measures of parent and child behaviour before<br />
attending the course and 15 weeks afterwards.<br />
Study 2. Thompson et al. (2009)<br />
Forty-one preschool children were randomly<br />
assigned to a revised version of <strong>NFPP</strong> and treatment<br />
as usual. Mothers from both groups completed<br />
standardised measures of parent and child<br />
behaviour and participated in a coded videotape<br />
session before the start of the programme and nine<br />
weeks after its completion.<br />
Significant outcomes<br />
<strong>NFPP</strong><br />
Significant improvements in<br />
mothers’ wellbeing and children’s<br />
ADHD symptoms were observed<br />
for families attending <strong>NFPP</strong> in<br />
comparison to parents receiving<br />
counselling or assigned to the<br />
wait-list control group.<br />
Significant improvements in<br />
the children’s ADHD symptoms<br />
were observed for families<br />
participating in <strong>NFPP</strong> in<br />
comparison to families receiving<br />
treatment as usual. <strong>The</strong>re were<br />
also significant improvements<br />
in the parents’ competency<br />
during the videotaped sessions,<br />
although there were no<br />
improvements in the mothers’<br />
self-reports of wellbeing in<br />
comparison to the control group.<br />
Additional research:<br />
<strong>NFPP</strong> is continually being developed within a larger programme of research. Currently,<br />
the programme is completing a randomised controlled trial in the USA that should be<br />
complete in 2014. <strong>The</strong> feasibility of <strong>NFPP</strong> with hard-to-reach families is also currently being<br />
investigated in the UK.
References:<br />
Sonuga-Barke, E.J.S., Thompson, M., Daley, D., and Laver-Bradbury, C. (2004). Parent training for Attention Deficit/<br />
Hyperactivity Disorder: Is it as effective when delivered as routine rather than as specialist care? British Journal of Clinical<br />
Psychology, 43, 449 – 457.<br />
Sonuga-Barke, E.J.S., Daley, D., Thompson, M., Laver-Bradbury, C., and Weeks, W. (2001). Parent-based therapies for<br />
preschool Attention-Deficit/Hyperactivity Disorder: A randomized, controlled trial with a community sample. Journal of<br />
the American Academy of Child and adolescent Psychiatry, 40, 402 – 408.<br />
Thompson, M.J.J., Laver-Bardbury, C., Ayres, M., Le Poidevin, E., Mead, S., Dodds, C., Psychogiou, L., Bitsakou, P., Daley,<br />
D., Weeks, A., Brotman, L.M., Abikoff, H., Thompson, P., Sonuga-Barke, E.J.S. (2009). A small-scale randomized controlled<br />
trial of the revised <strong>New</strong> <strong>Forest</strong> parenting programme for preschoolers with Attention Deficit/Hyperactivity Disorder.<br />
European Child and Adolescent Psychiatry, 18, 605 – 616.