There is strong evidence that parenting support services improve outcomes for children and adults in families experiencing adversity, councils have been told.

The latest government-commissioned practice guide to what works in children’s social care said interventions for parents of children aged 0-10 could improve parenting practices and child behaviour, lessen levels of stress and support adults mental health.

It also highlighted the vital importance of practitioners’ skills in building trusting relationships with, and in empowering, parents, and also the value placed by staff and parents alike on interventions that recognised the interconnections between parents’ and children’s needs.

Case for prioritising parenting support ‘has never been stronger’

Sector what works body Foundations, which published the guide today, said it was based on the first major review of UK and international evidence on parenting support for families experiencing adversity, including adult mental health problems, substance misuse or domestic abuse.

On the back of the guide, Foundations’ deputy chief executive, Donna Molloy said: “As councils struggle to cope with the costs of children’s social care, our evidence shows that proven models of parenting support can help to keep children safe with their families, improve their outcomes and alleviate pressure on an already overstretched system.

“The case for prioritising proven parenting interventions has never been stronger.”

Evidence to meet government social care outcomes

The practice guide is the second of a series of Department for Education-commissioned resources from Foundations designed to provide senior leaders in councils and partner agencies with the strongest available evidence to deliver on the outcomes in the children’s social care national framework.

The DfE-issued statutory guidance, published in 2023 under the previous government’s children’s social care reforms, sets four overarching objectives for the sector and three key enablers for achieving them:

• Outcome 1: children, young people and families stay together and get the help they need.
• Outcome 2: children and young people are supported by their family network.
• Outcome 3: children and young people are safe in and outside of their homes.
• Outcome 4: children in care and care leavers have stable, loving homes.
• Enabler 1: multi-agency working is prioritised and effective.
• Enabler 2: leaders drive conditions for effective practice.
• Enabler 3: the workforce is equipped and effective.

The first guide, on kinship care, was published in October last year, and the one on parenting through adversity for parents of babies and children aged 0-10 is the first of four on parenting support. The others will cover support for families in adversity with children aged 11-19, parents or carers of children with disabilities or severe mental illness and adoptive and foster parents.

Rising parental mental health needs ahead of family help reforms

The parenting through adversity guide comes amid a growth in the numbers of children in need assessments identifying parental mental health or substance misuse problems, which directors of children’s services have warned is increasing risks to the youngest children.

At the same time, councils are set to implement significant reforms to the way they support families, through the rollout of the family help model in 2025-26.

This involves the merger of targeted early help and child in need services into multidisciplinary teams, designed to provide families experiencing adversity with early, non-stigmatising help, =to resolve issues and prevent them escalating into child protection concerns.

Though the government is providing a £270m grant to implement the changes, the reforms come with councils under significant financial strain.

Guide ‘will help councils focus resources on what works’

Foundations’ head of practice guides, social worker Nimal Jude, said the latest guide would enable authorities to determine where to invest their resources.

“We are acutely aware of some of the workforce pressures and the wider financial situations that local areas are in,” she said. 

“It feels like this guide has come at such a crucial time during this transformation to family help, because you can really make some decisions about what things that you might want to scale back and what things that you might want to focus attention on, not least because you can now focus your attention with the full confidence that this is actually the best available evidence.”

The evidence base

The guide is based on two systematic reviews of the evidence around parenting support for families with multiple and complex needs.

The first, carried out by the Centre for Evidence and Implementation (CEI), in partnership with the universities of Oxford, Amsterdam and Monash, examined which interventions relevant to the UK, had the strongest evidence for reducing child maltreatment or improving child outcomes, along with what practice and delivery approaches contributed to success.

It examined 95 randomised controlled trials – where participants are randomly allocated into a group that receives the intervention and a control group – of 50 parenting interventions, finding:

• Small to moderate statistically significant effects on children’s emotional and behavioural problems, child wellbeing and parent-child relationships.
• Small to moderate statistically significant effects on promoting positive parenting (for example, appropriate disciplining, praise, warmth, and nurturing behaviours) and reducing negative parenting (for example, hostile parenting or laxness).
• Small statistically significant effects on parental mental health and reducing parental stress.
• Small but non-significant effects on reducing parental maltreatment and child abuse risk.

Strengthening parent-child relationships 

Based on the CEI’s systematic review, Foundations said there was “strong evidence” for the benefits of providing parenting interventions to strengthen parent-child relationships, and that councils should make these available to families with children aged 0-3.

It said these should be based on, and delivered by practitioners well-trained in, attachment and/or social learning theory (which posits that children learn through observation, including parental modelling). These staff should be able to observe and reflect on how parents respond to children’s cues and explore parents’ own attachment experiences.

The guide also said there was “strong evidence” for councils commissioning interventions to improve child behaviours, reduce negative parenting practices and improve positive practices.

Improving child behaviour and parenting practices

In relation to behaviour, key features shared by effective interventions were supporting parents in setting clear expectations and boundaries and promoting child-led interactions.

Promoting positive parenting can include practitioners taking on a coaching role, which requires them being skilled in coaching techniques and being able to build long-lasting, trusting relationships with parents.

The guide also said there was “strong evidence” that parenting interventions can reduce parental stress and improve mental health for those with mild-to-moderate problems.

Improving mental health

It said practitioners should be skilled in understanding the impacts of stress on parents experiencing adversity and should be given time to develop relationships with them, to enable parents to learn new skills and make use of feedback.

While the guide stressed that that parenting interventions were not sufficient to achieve significant changes to mental health, it said there was evidence they could improve parenting skills, even in adults with clinical levels of illness.

It said these programmes should involve practitioners offering guidance on child development and supporting parents’ abilities to manage their emotions.

Evidence ‘promising’ in relation to reducing harm

On reducing the risk of harm to children, Foundations said the level of evidence for parenting interventions was “promising”.

It said programmes that involved a fixed and structured series of sessions tended to be more effective in this area than those that were flexible.

The guide added that local leaders should examine the need to invest in these services for families with children on the edge of care and in the rollout of family help.

Vital importance of practitioners’ interpersonal skills

Alongside the CEI review, Foundations carried out its own systematic review of studies on the barriers and enablers to successful implementation of parenting interventions for families in adversity and on parents’ views, experiences and preferences in relation to these. This drew upon 33 studies.

Among two findings that had “high” certainty, based on the strength of the evidence, was that practitioner interpersonal behaviours were “essential to building trusting relationships and empowering parents”.

The review said parents valued practitioner characteristics such as openness, non-judgmentalism and encouragement, which facilitated the development of the trust that was “essential” in promoting change.

Building trust was supported by an initial home visit, communication outside of scheduled sessions, regular attendance from the parent and a consistent workforce, with parents highlighting the challenges of doing so when workers changed.

Recognising that parents’ and children’s needs are ‘intertwined’

The other finding that was deemed to be of high certainty was that both parents and practitioners value interventions that recognise “the intertwined relationship between parents’ practical and psychological needs and the needs of their children”.

Practitioners appreciated that supporting the parent, by focusing on their practical, social and emotional needs, was often the best way to help the child, with this approach welcomed by parents, the review said.

Based on its review, Foundations identified 12 principles for working with families in delivering parenting interventions:

1. Tailoring parenting support to ages and stages of child development.
2. Using strengths-based approaches to engage parents and offering parenting support across the system.
3. Ensuring that parents from minoritised ethnic backgrounds have equitable access to effective parenting interventions and that these are delivered in a way that fully meets
   their needs.
4. Understanding that parenting interventions work well for families where the parent has poor mental health, and, when delivered successfully, support parents to improve parent and child outcomes.
5. Prioritising face-to-face delivery of support.
6. Implementing both fixed and flexible delivery models to support a mixed local offer and prioritising more structured interventions to effectively reduce the risk of serious harm to children, directing resources where they are most needed.
7. Tailoring local programmes to meet the specific needs of families, offering both group and individual options to support engagement and provide parents with choice.
8. Focusing on careful implementation, effective delivery, and ongoing quality assurance to ensure the success of interventions.
9. That a strong local offer should start with a robust population needs analysis and involve place-based system leadership to develop a multi-agency offer.
10. That local areas should have effective referral routes into parenting interventions from a range of local services.
11. That effective parenting support requires a skilled and integrated workforce to deliver effective interventions.
12. Parenting support should form part of a wider system of support that strengthens the resources available to parents.

The youngest children are at increased risk of harm due to growth in the numbers of parents with mental health and substance misuse issues, research has found.

Directors linked the trends in parental needs to poverty, inadequate housing and the legacy of pandemic, and said they were leaving infants at risk of neglect and physical injury.

The findings were reported in the latest phase of the Association of Directors of Children’s Services’ (ADCS) Safeguarding Pressures research series, through which it has analysed demand for, and provision of, children’s social care since 2010.

Phase 9 of the series covered 2022-24 and was based on data from 124 local authorities, extrapolated to cover all 153 councils, survey responses from 86 authorities and interviews with 34 directors of children’s services.

Growth in parental mental ill-health and substance misuse

Department for Education (DfE) data has revealed growth in the numbers of children in need assessments which identified parental mental health or substance misuse problems between 2022 and 2024. According to the DfE’s children in need census:

• Parental mental health concerns were identified 165,480 times in 2023-24, up from 158,330 in 2021-22, a rise of 4.5%. This made it the most common factor identified following an assessment, replacing domestic abuse where a parent is the victim, for which there were 160,600 cases in 2023-24, a similar number to 2021-22.
• Parental alcohol misuse concerns were identified 72,410 times in 2023-24, up 3% on 2021-22 (70,310).
• Parental drug misuse concerns were identified 70,940 times in 2023-24, up 5.8% on 2021-22 (67,010).

Three-quarters of respondents to the ADCS survey said issues arising from a deterioration in parental mental health had increased pressures on their services over the past two years, while two-thirds said the same about parental substance misuse.

Increased numbers of infants at risk

Directors said this was leading to increasing numbers of infants being at risk of, or experiencing, serious harm, particularly neglect or physical injury, and they linked the rising levels of parental need to family levels, poverty and inadequate housing.

Most directors reported increasing demand for children’s services from poor quality housing, homelessness and families experiencing poverty as a result of welfare reforms.

They also linked increasing parental mental health issues to the legacy of the pandemic, new parents lacking experiences of “good enough parenting” from their own childhoods and cuts to other services, such as health visiting provision.

In response to the findings, sector what works body Foundations said they underlined “the need to provide effective mental health support for parents”, including through parenting support. Its deputy chief executive, Donna Molloy, said it would shortly produce guidance for councils on “proven interventions” in relation to parenting support for families in contact with children’s social care.

Rising numbers of initial contacts but referral numbers fall

Councils reported a rise in initial contacts regarding safeguarding concerns, continuing a trend dating back to 2007-8, with the number received in 2023-24 (3,001,339) 8% up on the 2021-22 total. Two-thirds of the 2023-24 contacts came from the police, health or education.

However, the DfE’s census has shown a decrease in the number of referrals to children’s social care, which fell from 650,270 in 2021-22 to 621,880 in 2023-24, as well as in the number of children in need plans and child protection plans from 2022-24.

The ADCS found that councils accepted 22% of contacts in 2023-24 as a children’s social care referral (compared with 24% in 2021-22). Fourteen per cent were passed to early help (down from 16% in 2021-22), 30% signposted to other services or resulting in the provision of information and advice (33% in 2021-22) and 23% resulted in no further action, up from 16% in 2021-22.

“This suggests that much of this demand is being managed through an increased early help offer and by local authorities acting as a central point for offering information, advice and signposting to other services on behalf of the local partnership,” the ADCS said.

Increased use of early help

Despite the drop in the proportion of contacts referred to early help from 2022-24, the ADCS said the number of such referrals had grown by 93% from 2015-16 to 2023-24, from about 224,000 to 431,000.

Two-thirds of survey respondents said they had increased their provision of early help and targeted family support services from 2022-24. This included the establishment of family hubs, which provide a range of support services to families in a single place and for which half of local authority areas have received funding since 2022.

The ADCS said family hubs were “viewed very positively” by directors, with three-quarters of survey respondents saying they had set up such services, including some who had not received government funding.

The association added that councils had also relied heavily on funding from the Supporting Families programme, under which families with multiple needs are provided with multi-agency support, co-ordinated by a lead practitioner, and for which councils have been provided with £695m from 2022-25.

Last November, in a move strongly welcomed by ADCS, the government scrapped the payment by results element of the scheme, under which most councils received some money up front with the rest delivered based on the outcomes achieved for families.

Rollout of family help

Looking ahead, the government has allocated £250m in 2025-26 to roll out the family help model, under which councils provide multidisciplinary support to families in need by merging existing targeted early help and child in need services and bringing in staff with expertise in areas such as domestic abuse.

The model is being tested in the 10 families first for children pathfinder areas, though ADCS found that some other councils were adopting a similar approach.

In relation to looked-after children, the ADCS report charted the significant rise in the number of unaccompanied children, which grew by 30% from 2022-24, from 5,680 to 7,380, according to DfE figures.

The ADCS also highlighted the changing composition of the group, with the proportion of boys rising from 90% to 96%, and the proportion of those aged 16 or 17 increasing from 86% to 89%, from 2020-24.

Concerns over care of unaccompanied children and care leavers

Despite the government’s National Transfer Scheme – which aims to ensure unaccompanied children are more evenly spread throughout the country – the ADCS found numbers were far higher in the South East, where the vast majority of young people arrive, than in other regions.

Directors said that the “absence of national planning and support to enable an effective and sustainable asylum system was a source of real concern”. They also reported struggling to provide young people with the trauma-informed care and support they needed.

The ADCS also highlighted the number of care leavers who were former unaccompanied children, which grew by 25%, from 11,640 to 14,560, from 2022-24, and warned that councils were being under-funded to support them.

‘Shortfall in care leaver funding leaving young people at risk’

It cited a report last year by East Midlands Councils, which said that Home Office funding covered just 59% of the costs of supporting former unaccompanied care leavers, with the region’s annual shortfall in cash rising from £5.2m to £7.5m from 2020-24.

“Respondents to both the survey and interviews described how a lack of access to education, employment and appropriate therapeutic support leaves young people in limbo, exacerbating
mental health difficulties, risk of exploitation and involvement in unlawful activity, such as modern slavery,” the ADCS said.

A growing workforce but concerns over experience and agency use

The Safeguarding Pressures report also referenced the fact that the number of social workers in post in local authority children’s services reached a record high – 33,119 full-time equivalents – in September 2023, up by 4.7% on the year before.

The ADCS said that the increased numbers were largely newly qualified staff, “which can create pressures on more experienced colleagues”.

The report also noted that the number of agency staff in post also reached a record high (7,174 full-time equivalents) in September 2023, representing 17.8% of the workforce.

The association said that, while the 10 authorities with the lowest rates of agency use were all rated outstanding or good by Ofsted, seven of the 10 with the highest rates were rated inadequate with another two graded as requires improvement.

“[Directors] report that a negative judgement following inspection by Ofsted generates increased staff churn and reliance on agency social workers,” the report said.

Agency social work rules

In October 2024, the government began implementing rules on councils’ use of agency social work, which will be fully in force by October 2025. These include:

• A bar on staff with less than three years’ experience in a permanent role in local authority children’s services from taking up an agency post.
• A three-month ban on councils engaging social workers as locums within three months of them leaving a permanent role in the same region.
• Regionally agreed caps on maximum hourly pay rates for agency staff.
• Ensuring councils have direct management of staff supplied through agency project teams.

The ADCS is very supportive of the rules, but have called on the government to go further, by banning project teams outright for case-holding social work.

While the government has not committed to this, it has pledged to strengthen the agency rules by putting them into legislation and to extend them to non-social work roles in children’s services.

Stigma

‘Stigma’ can be understood as a form of social devaluation and rejection of an individual or group because they have an attribute that is seen as socially undesirable (Goffman, 1963). What is considered ‘undesirable’ varies across different societies, but mental illness is one of the most commonly stigmatised attributes.

People with mental illnesses are at risk of being stigmatised as dangerous, unpredictable, incompetent, lacking in responsibility, mentally and emotionally weak (Corrigan & Kosyluk, 2014), and as less capable of being a good parent.

Despite more public conversations about mental health, stigma is still a major problem, and can increase distress, discourage social interaction and help-seeking, and hinder recovery.

Types of stigma

It can be helpful to break down stigma in relation to parental mental health into public stigma, self-stigma, and courtesy stigma.

• Public stigma: the attitudes and beliefs held by other people that lead them to avoid, socially reject and discriminate against the stigmatised person. The consequences of this for a parent can include, for example: workplace discrimination or loss of jobs, friendships or wider family relationships.
• Self-stigma: the internalisation of negative attitudes and beliefs, so that the person comes to believe that the negative stereotypes of mental illness apply to them. This can lower a parent’s self-esteem and sense of self-efficacy (belief in their own ability to positively affect their circumstances). It can also lead to them internalising an idea of themselves as a poor parent and blaming themselves for negative outcomes in the family.
• Courtesy stigma: stigma experienced by people close to those with stigmatised characteristics – ‘stigma-by-association’. Family members can experience prejudice and discrimination through association with their mentally unwell relatives (Larson & Corrigan, 2008). Children of parents with a mental illness can often experience this, notably through bullying or being ostracised by peers.

Consequences of stigma

Without intending to, family members can direct stigmatising ideas and labels towards one another as they try to understand and negotiate the illness, family experiences, relationships and responsibilities (Yates & Gatsou, 2021).

For example, a child might change their behaviour towards their parent – ignoring their authority or being rude. The parent may then feel the child is being disrespectful and hurtful but the behaviour is likely due to societal attitudes, lack of understanding and confusion, rather than malice.

Professionals should also be aware that one of the most common strategies for managing the impacts of stigma is concealment. Parents may try to conceal the existence of their illness, both from other members of their family and from the outside world.

Children can be drawn into strategies to conceal the illness from others, which can add to their distress and confusion. Whole families can then become isolated from contact with peers, friends and potential sources of support. Parents and children may fear that if services learn of the illness, the family will be broken up.

Unwell parents are often highly sensitive to perceived criticisms of their parenting and may have had negative experiences of feeling they were judged or criticised by services in the past.

The full guide to parental mental illness includes more information about key principles for supporting families, as well as how to address the complex needs and adversities experienced by parents with mental illness. If you have a Community Care Inform Children licence, log on to see the full guide and read more detailed information.

You might also be interested in:

• Working with domestic abuse, substance use and mental ill health
• Attachment-based trauma and parenting
• Domestic abuse and mental health problems: quick guide