title: Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness and cost utility of a universally provided early years parenting programme.
  
  
  METHODS
  Multicentre randomised controlled trial with cost-effectiveness analysis.
  
  
  METHODS
  Early years centres in four deprived areas of South Wales.
  
  
  METHODS
  Families with children aged between 2 and 4 years. 286 families were recruited and randomly allocated to the intervention or waiting list control.
  
  
  METHODS
  The Family Links Nurturing Programme (FLNP), a 10-week course with weekly 2 h facilitated group sessions.
  
  
  METHODS
  Negative and supportive parenting, child and parental well-being and costs assessed before the intervention, following the course (3 months) and at 9 months using standardised measures.
  
  
  RESULTS
  There were no significant differences in primary or secondary outcomes between trial arms at 3 or 9 months. With '+' indicating improvement, difference in change in negative parenting score at 9 months was +0.90 (95%CI -1.90 to 3.69); in supportive parenting, +0.17 (95%CI -0.61 to 0.94); and 12 of the 17 secondary outcomes showed a non-significant positive effect in the FLNP arm. Based on changes in parental well-being (SF-12), the cost per quality-adjusted life year (QALY) gained was estimated to be £34 913 (range 21 485-46 578) over 5 years and £18 954 (range 11 664-25 287) over 10 years. Probability of cost per QALY gained below £30 000 was 47% at 5 years and 57% at 10 years. Attendance was low: 34% of intervention families attended no sessions (n=48); only 47% completed the course (n=68). Also, 19% of control families attended a parenting programme before 9-month follow-up.
  
  
  CONCLUSIONS
  Our trial has not found evidence of clinical or cost utility for the FLNP in a universal setting. However, low levels of exposure and contamination mean that uncertainty remains.
  
  
  BACKGROUND
  The trial is registered with Current Controlled Trials ISRCTN13919732.
authors.affiliation: Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: D E
authors.initials: DE
authors.lastname: Simkiss
authors.forename: H A
authors.initials: HA
authors.lastname: Snooks
authors.forename: N
authors.initials: N
authors.lastname: Stallard
authors.forename: P K
authors.initials: PK
authors.lastname: Kimani
authors.forename: B
authors.initials: B
authors.lastname: Sewell
authors.forename: D
authors.initials: D
authors.lastname: Fitzsimmons
authors.forename: R
authors.initials: R
authors.lastname: Anthony
authors.forename: S
authors.initials: S
authors.lastname: Winstanley
authors.forename: L
authors.initials: L
authors.lastname: Wilson
authors.forename: C J
authors.initials: CJ
authors.lastname: Phillips
authors.forename: S
authors.initials: S
authors.lastname: Stewart-Brown
keywords: Public Health
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