Sue Proudlove, Linda Crosskill, Rachel Margolis and Prakash Fernandes

1. A family approach to protecting children whose
parents misuse drug/alcohol: Evaluation findings
and messages from practice
Sue Proudlove, Linda Crosskill, Rachel Margolis and Prakash Fernandes

2. What is the
FED UP
programme?

3. 3
FED UP
Family Environment Drug Using Parents
• Adopts a whole family approach
• Combines group work with children and individual work with their parents or carers
• Includes joint working sessions for the parent and child to address key issues together.
• Delivered over 12 weeks, with families going through a four week assessment process
before commencing on the programme.
The key outcomes of the programme are:
Children Parents
Increased self-esteem Greater insight into impact of
drug/alcohol on children
Reduced emotional and behavioural
problems
Increased protective parenting
Better process thoughts and feelings

4. • The NSPCC have been running the FED UP service since September 2011.
• FED UP is run in the following NSPCC service centres: Blackpool, Cardiff, Coventry,
Crewe, Grimsby, Hull, Liverpool, Southampton, Stoke, Warrington and West London.
Up until October 2013, it was also run in Foyle, Glasgow, Lincoln, Manchester and
Sheffield.
• 232 parents and 310 children completed the FED UP programme, until the end of
2014
4
FED UP
Where is FED UP run and how many people have used the service?

5. What we
have learnt
from the
evaluation
so far

6. Evaluation tools and timeframes
6
Outcome Tool Number at T1 & T2
Children’s emotional wellbeing (child/
parent perspective)
Practitioner perspective
SDQ
HoNOSCA
127
129
Children’s self esteem (child’s
perspective)
Self Esteem Scale (based
on Rosenberg)
157
Children better able to process their
thoughts and feelings (child’s
perspective)
Children’s Evaluation
Wheel
192
Protective parenting (parent’s
perspective)
CAPI
Parent Evaluation Wheel
50
71

7. Key points about the data
• No comparison group data currently analysed*: cannot attribute changes
• Some of the quantitative measures ( especially for parents) have low completions
• Statistical significance indicates a pattern, not random chance. Clinical significance
is the practical importance of the change- does it have a real noticeable effect on
daily life
• Interviews were completed with 13children and 12 parents/carers. The qualitative
work is to understand aspects of the programme that helped or not.
* Comparison group data will be included in the final report
7

8. Aim 1: To reduce children and young people’s emotional
& behavioral problems
8
127 SDQs have been completed at both T1 and T2 (40 parent completed and 87 self-
completed).
• The proportion of children moving from a ‘clinical’ level of difficulty to a ‘normal’ level is
clinically significant (p = 0.003). The normal band includes all data that does not fall into
the ‘abnormal’ score band for the SDQ.
• HoNOSCA data shows the same trend from practitioners’ perspective (n = 129). The
mean score at T1 is 6.3 and the mean at T2 is 5.7. The change is not statistically
significant (p = 0.06 )
0%
20%
40%
60%
80%
100%
T1 T2
Clinical
Normal

9. Aim 2: To enable children and young people to
feel better about themselves
9
157 Adapted Rosenberg Self-esteem questionnaires have been completed at T1 and T2
There has been an increase from a mean of 19.5 at T1 to 21 at T2. The change is
statistically significant (p= 0.001)
0
2
4
6
8
10
12
14
16
18
20
22
T1 T2
T1
T2

10. Children’s Evaluation Wheels at T1 and T2 (n=192)
Aim 3: To enable children and young people to
process their thoughts and feelings
10
The changes between T1 and T2 are statistically significant for three criteria: talking to someone
if worried about parent’s health, being able to talk to parent about affects of drug/ alcohol use
and if being bullied. But not for easily making friends, having fun or feeling supported.
0
1
2
3
4
5
I can talk to someone
if I am worried about
my parent's health
(p=0.0001)
I can talk to my parent
about how their drug/
alcohol use affects me
(p=0.004)
I can easily make
friends (p=0.16)
I can talk to someone
if I was being bullied
(p=0.002)
I am able to have a fun
time when I want to
(p=0.33)
I feel supported by
others around me
(p=0.69)
T1
T2

11. Aim 4: To enhance Protective Parenting
11
Overall reduction in behaviours that contributes to risk in children as shown by the
CAPI. 50 CAPIs suitable for evaluation at T1 and T2
Subscale Mean T1 Mean T2 Statistically
significant (p<=0.05)
Distress (cut off = 152) 158.56 138.48 Yes (p=0.002)
Rigidity (cut off = 30) 10.96 10.9 No
Unhappiness (cut off = 23) 30.22 25.66 Yes (p=0.049)
Problems with child and self (cut off = 11) 6.5 4.64 Yes (p = 0.009)
Problems with family (cut of = 18) 14 15.36 No
Problems with others (cut off = 20) 15.92 15.5 No
Total score (cut off 215) 240.46 210.54 Yes (p=0.001)
Ego strength scale 14.86 17.66 Yes (p=0.005)
Loneliness scale 9.8 8.92 Yes (p=0.04)

12. Aim 5: Increase parent’s insight into impact of
drug/alcohol on children
12
Parent Evaluation Wheels at T1 and T2 (n=71)
The changes between T1 and T2 are statistically significant for all criteria on the wheel.
0
1
2
3
4
5
How much I think that my
child is affected by my
behaviour (p=0.002)
How confident I feel that I
am doing the best for my
child (p<0.001)
How supported I feel in
taking care of my child
(p=0.001)
How confident I feel in
asking for help when I
need it (p<0.001)
How much knowledge I
have about children's
needs at different stages
of their development
(p<0.001) T1
T2

13. Mechanisms
of change

14. Mechanisms of change: children feeling
less alone
“I always felt like I was the only one who
had problems but since I met other people
I don’t think that anymore. Since I went to
FEDUP group it feels nice not being the
only person………. thinking you are the
only person with problems” (Child)
“They helped us with stuff, helped us
express ourselves, helped us with our
feelings, didn’t make it too hard for us” (Child)

15. What children & parents told us
Addressing emotional and conduct
problems
“Now I’m like more responsible and
like I don’t want to like mess around
my sisters to annoy them, so they don’t annoy
me that much anymore.”
“Well before I went to the FEDUP group I was
like really stressed out all the time. Really
like angry at everyone all the time, but now
I’ve done that group I’m not as angry.”
Value of the group work with
children
“she was able to talk about her feelings
and everything that maybe she didn’t want
to tell me because she didn’t want to upset
me. So it gave her that, just a little bit
away… you know sometimes mums are a
bit too close”
“I think it was meeting other people that
parents have the same problem and
realising he's not on his own and there's
lots of children out there with their parents
that do the same.”
15

16. Mechanisms of change: parents
insights into the rollercoaster
effect
“I learnt from FEDUP to just stop and think
before I act. I am not chaotic anymore but
realising that when I do make a decision to
do something it can have a rollercoaster
effect. You don’t want to think that one
little blip is really going to affect your kids,
but if they did find out they might get
worried again.” (Parent)
“It was upsetting at times coz obviously
you have got to think about what you have
gone through and past experiences and
how my decisions along the way have
affected the kids, so yeah hindsight is a
wonderful but you cant change what’s
happened just learn from it.” (Parent)

17. Mechanisms of change:
families communicating more
“I think they probably feel that
they can talk to me now instead
of talking to each other and you
just get a calmer vibe. I can
make time out more than I did”
(Parent)
“I just thought that I couldn’t talk to her
about a lot of things, but now I know I
can talk to her about loads”
( Child)

18. Barriers and
challenges in
delivering the
programme

19. Barriers and Challenges
Barriers
• Wide age range of
children in some groups
• Being the only boy or girl
in a group
• Offering the service at
the right time for the child
• Unstable family
environment
• Parents motivation to
take part in the
programme
19
Challenges
• Transporting children
• Working at the parents’
pace
• Children’s differing levels
of understanding
• Differences in the type of
addiction-alcohol/street
drugs-when delivering
group work

20. Deciding the strategic implications for the NSPCC
 Identify adaptions to the FEDUP service. ( eg: work with grandparents, siblings; work
with children to address co-morbidity of other risk factors in their family)
 Identify innovative ways in which we can expand the impact/exposure of the service
( eg. Closer partnership working with adult treatment programmes; Offering FEDUP as
a module / part of the pathway within adult treatment programmes)
 Consider more carefully how we can use national data on parental drug and alcohol
use to influence outcomes for children
 Explore potential policy and legislative changes that might reduce the number of
children that are exposed to parental substance misuse to begin with.
20
Next Steps

21. 2121
Summaries of all our evaluation plans
Each summary includes:
• Details of the evaluation methods we are using for the service
• Details of any challenges faced and how we overcame them
• A list of the measurement tools we are using
• Contact information of the staff member involved in the evaluation
Tools for measuring outcomes for children and Families
We've outlined our experiences of using each tool, along
with details of what it measures and how easy it is to
use.
Each measure includes:
• An explanation of the measure
• Details of who to use it with
• The time it takes to administer
• Any training or expertise required
• It’s validity and reliability
• Cost
• Our experience of using it
And much, much more….
Our Impact and Evidence Hub can be found at
www.nspcc.org.uk/evidencehub
Join the debate at:
@nspccpro
Search #evidencehub
Our hub features…
The NSPCC Impact and Evidence Hub