Evaluation Report RISE Mutual CIC: Child to Parent Violence Programme: Feasibility and pilot study report

Executive Summary
The project
The Child to Parent Violence (CPV) programme aims to improve the behaviour of violent 10–14-year-olds by showing their parents and carers techniques to de-escalate and avoid violence. Young people who have been violent towards their parents/carers may be referred to the programme by social workers, schools, Child and Adolescent Mental Health Services, family intervention workers and early help teams. Delivered by RISE Mutual CIC, the intervention provides sessions to parents/carers. If judged appropriate, separate sessions are then delivered to children, with up to 20 home-based sessions implemented with families. Work with parents teaches non-violent resistance (NVR) techniques, including reconciliation methods. Sessions with children use cognitive behavioural therapy (CBT) techniques that aim to change negative behaviours. The content of the programme is tailored to the specific needs presented by each young person.
YEF funded a feasibility and pilot evaluation of the CPV programme. The feasibility phase of the evaluation aimed to ascertain what factors supported or interfered with the successful delivery of the programme; whether the intervention’s recruitment, retention and reach were feasible; and service users’ views and experiences of the intervention. The pilot study then aimed to describe the referral and screening process, assess family retention, ascertain the readiness for a larger-scale evaluation, evaluate the implementation process, and assess the direction and magnitude of changes in child behaviour and family-functioning outcomes over time. By the end of the feasibility phase, 90 families had been enrolled to the CPV programme, and over both phases, 104 families (107 children) were enrolled. Eleven participants (including six RISE practitioners, three referrers and two parents/carers) took part in interviews for the feasibility study. For the pilot study, 15 participants (including five participants with parental responsibility, three referrers and seven RISE members of staff) were interviewed, and quantitative data for the 104 families involved were analysed. Data initially collected related to the delivery of the programme, demographic data and some core measures (including the Strengths and Difficulties Questionnaire [SDQ], a measure of behaviour, and the SCORE 15 Index of Family Functioning and Change). The SCORE 15 was dropped during the feasibility phase. The evaluation was undertaken from February 2020–June 2022. Both evaluation phases took place during the COVID-19 pandemic, requiring both the delivery and evaluation teams to adapt to challenging circumstances.
Key conclusions
In the feasibility study, delivery of the CPV programme was supported by the regular exchange of information between referrers and RISE practitioners. Referrers were positive about the planning and communication from RISE staff and appreciated being updated on the progress of families. RISE project staff reported that non-judgemental, supportive approaches were important for facilitating delivery. They also observed that many families had very complex needs beyond those initially anticipated.
In the feasibility study, most of the referrals met the eligibility criteria. Demand for the intervention was high, while initial enrolment and retention rates were promising. The two parent/carers interviewed gave very positive comments about the attentive and flexible support provided. Staff, referrers and parents also noted that the blended model of phone calls and face-to-face meetings imposed as a result of COVID-19 restrictions worked well.
In the pilot study, retention in the intervention was high, with 76% of enrolled families completing the programme. However, core measure completion was a serious challenge. Less than half of families provided SDQ data after 12 months. COVID-19 contributed to challenges with data collection. However, even in this context, data collection was low.
The pilot study found that the referral and screening processes worked well, and the programme was largely delivered as intended for parents. Children’s perceptions of the CPV programme, and the implementation of the child-focused components, could not be assessed due to their limited engagement in the intervention and non-engagement with the evaluation.
The evaluator judges that the CPV programme has the potential to be evaluated in a large-scale randomised controlled trial. However, several issues require resolving before proceeding, including improving measure completion rates.
InterpretationIn the feasibility study, delivery of the CPV programme was supported by the regular exchange of information between referrers and RISE practitioners. The three referrers interviewed were positive about the planning and communication from RISE staff and appreciated being updated on the progress of families. Referrers also mentioned that they had seen positive changes in families they had worked with and were very satisfied with what had happened for families in the intervention. RISE project staff reflected that non-judgemental, supportive approaches were also seen to be important for facilitating delivery. RISE project staff reflected that many families had very complex needs, which required additional inter-agency collaboration. Indeed, many of these needs (such as involvement in county lines criminal exploitation, drug misuse, staying out overnight, autism spectrum disorder, attention deficit hyperactivity disorder or oppositional defiance disorder) were greater than had been anticipated.In the feasibility phase, most of the referrals met the eligibility criteria. Demand for the intervention was high, while initial enrolment and retention rates were promising. The two parents interviewed gave very positive comments about the attentive and flexible support provided. They felt respected by the RISE staff and would recommend the programme to other parents. Staff, referrers and parents also noted how the blended model (combining phone and video calls with face-to-face meetings when possible) imposed as a result of COVID-19 restrictions worked well.In the pilot study, retention in the intervention was high, with 81 of 107 (76%) enrolled young people and their families completing the programme. However, data collection was a serious challenge. Only two children competed the child outcome measures, and the maximum number of families providing data at follow-up was 17 (16%) at six months and 47 (44% of those enrolled) at 12 months. Where data were collected from parent-reported measures, there were improvements in behaviour and family functioning. However, without a counterfactual group that did not receive the CPV programme, we are unable to be sure that all positive effects are attributable to the programme.The pilot study found that the referral and screening processes worked well. One hundred and seven young people were initially enrolled following the referral of 170 families. For most, time from referral to enrolment was rapid (ranging from two to 14 days), and there appears to be very little risk of bias in the process. The programme was also largely delivered as intended for parents. An average of 15 sessions were received by those families who completed the programme (in line with the ‘up to 20’ offered), and sessions appeared to support parents and carers to consider practical NVR, de-escalation techniques and different affirmation strategies to improve children’s behaviour. In addition, across interviews with parent/carers and professionals, it was commonly reported that the programme of support was flexible and responsive to the needs of families.Differences from the originally intended model include the age of children enrolled; this ranged from 9–17 (rather than 10-14 as commissioned). This appeared to be because the RISE team accepted referrals of older and younger children due to their high needs and current distress. Children’s perceptions of, and engagement in, the CPV programme could not be assessed due to their limited engagement in the intervention and non-engagement with the evaluation. It is therefore not possible to comment on the implementation of the child-focused elements (such as the teaching of CBT techniques).The evaluators judge that the CPV programme has the potential to be evaluated in a large-scale randomised controlled trial. However, several issues require resolving before proceeding. Most notably, the primary risk to a trial is the lack of measure completion. The impact of the COVID-19 pandemic needs to be considered, but even under these circumstances, the level of data completion in this evaluation is very low. YEF is currently exploring further evaluation of the programme.