Award Title: A randomised controlled trial evaluating the effectiveness and cost effectiveness of 'Strengthening Families, Strengthening Communities': a community led parenting programme (TOGETHER)
Funder: Department of Health and Social Care

Abstract: Aim _x000D_
We aim to assess whether parents who are offered a 13-week group-based parenting programme will feel better in themselves, feel less stressed and generally more able to cope with looking after their families. We will also assess if the programme has any effect on children’s behaviour. _x000D_
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Background_x000D_
Childhood is an important stage of life which has long lasting effects into adulthood. Unfortunately many children in modern society experience emotional and behavioural problems which can lead to problems within their family, school and local communities. If these are not dealt with early on, they can get much worse and cause major difficulties for all those involved. Several parenting programmes have been developed and been shown to be helpful to parents and children. However most of these have focused on families with pre-school children, and children with very severe behaviour problems, and have not included many families from Black and ethnic minority groups, and those living in poverty. For over 10 years the Race Equality Foundation, a charity working to promote race equality in the UK, has been organising group-based parenting programmes for families with older children, particularly from minority ethnic communities and those living in poverty. This programme called Strengthening Families, Strengthening Communities has had major success in engaging with these communities across many parts of the country. Although very popular with the families involved, the programme has not yet been fully assessed to show if it is effective in achieving its key goals. This study aims to answer this gap in knowledge. _x000D_
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Design _x000D_
Across 7 urban areas of England where ethnically and socially mixed communities live, the parenting programme will be offered to families who either decide themselves that they need help or families referred by professionals for help. 676 parents agreeing to take part in the study will be randomly allocated (like flipping a coin) to either immediately starting the programme or having to wait for a 10-month period before starting it. All the parents agreeing to take part in the study will be interviewed at the start, after the programme has been completed and then 6 months later. A smaller number of parents and staff involved in delivering the programme will also be interviewed about their views and experiences of it._x000D_
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Public involvement_x000D_
Parenting is a potentially sensitive and stressful issue. It is therefore vitally important that the public are fully involved in a study which aims to assess the potential value of a parenting programme. A parent and former participant in the programme has agreed to be a co-applicant to assist the team in planning and conducting the study, to ensure parents’ concerns and needs are considered. In addition, 3 parent forums comprising 8-12 parents will be established to provide additional input into all aspects of the study. Two young people's forums will also be set up to provide an opportunity for discussion and interaction with teenagers to assess their views and opinions of the study. _x000D_
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Dissemination_x000D_
Given the current high level of research, policy and media interest into the best ways of providing parenting support to families in need, the findings of this study are likely to get a high level of attention. The team will therefore take great care in ensuring that all interested parties including the families involved in the study and their local communities are given information about the results. The PPI co-applicant, parent forums and young people's forums will assist with the dissemination of the study results.

Lay Abstract: Background_x000D_
Between 10-20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children’s well-being exist. Giving every child the best start in life is a key strategy to reduce inequalities. Supporting parents to develop effective parenting skills is an important preventive strategy. A range of group-based parenting programmes have been delivered in the UK and evidence from recent reviews showed these can be effective. However most parenting interventions have focused on early childhood (0-5 years) and have failed to engage with families from ethnic minority groups and those living in poverty. A parenting programme for families with children aged up to 18 years (Strengthening Families, Strengthening Communities - SFSC) has been designed by the Race Equality Foundation, a charitable community organisation focused on promoting race equality, and has been delivered across the UK for over 10 years. Small pre-post studies have produced encouraging results but no randomised controlled trials have been undertaken so far. This study aims to address this knowledge gap._x000D_
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Aim_x000D_
To assess the effectiveness and cost-effectiveness of the SFSC parenting programme in enhancing parental mental well-being and children’s social and emotional well-being at 6-months follow-up._x000D_
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Design_x000D_
This multi-centre waiting list control randomised controlled trial will evaluate the SFSC programme. The study will be conducted in 2 phases. Participants will be randomly allocated to intervention or control arms. Phase 1 will comprise of a 6-month internal pilot to determine the feasibility of the trial. Should progression criteria be met, phase 2 will comprise the main trial. A nested process evaluation will also assess the fidelity and acceptability of the intervention. _x000D_
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Setting  participants_x000D_
The study will be conducted across 7 urban English areas with ethnically and socially diverse populations where the programme is currently being delivered. Participants (n=676) will be parents of children aged 3-18 years who either self-refer or are referred by health/social care professionals to attend the programme._x000D_
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Intervention and comparator_x000D_
Based on social learning theory, the 13-week programme aims to develop parents’ confidence, competence and skills through interactive group based activities. Local authorities in the 7 areas will supply staff, community venues, resources and other costs associated with delivering the intervention through existing contracts. Participants randomised to the control arm will be offered the intervention after approximately a 10-month wait._x000D_
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Outcomes_x000D_
The primary outcome will be parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes will include child socio-emotional well-being, parenting practices, family relationships, parenting stress, quality of life, and community engagement. Outcomes will be assessed at baseline, post intervention and 6 months follow-up._x000D_
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Potential impact_x000D_
If this trial demonstrates beneficial effects on both parental and child outcomes, then the potential impact, both immediate and longer term, is potentially significant. As the intervention focuses in particular on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities.

Research Activity Codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health Categories: MENTAL HEALTH