Challenges recruiting families with children at risk of anti‐social behaviour into intervention trials: lessons from the Helping Children Achieve (HCA) study

Pages285-302
Date30 November 2012
Published date30 November 2012
DOIhttps://doi.org/10.1108/17466661211286508
AuthorMilena Stateva,Jacqueline Minton,Celia Beckett,Moira Doolan,Tamsin Ford,Angeliki Kallitsoglou,Stephen Scott
Subject MatterEducation,Health & social care,Sociology
Challenges recruiting families with children
at risk of anti-social behaviour into
intervention trials: lessons from the Helping
Children Achieve (HCA) study
Milena Stateva, Jacqueline Minton, Celia Beckett, Moira Doolan, Tamsin Ford,
Angeliki Kallitsoglou and Stephen Scott
Abstract
Purpose – The Helping Children Achieve study is a randomised controlled trial designed to test the
effectiveness of parenting interventions for children at risk of anti-social behaviour. The paper aims to
examine the challenges in recruitment to the HCA trial.
Design/methodology/approach – The study is on-going and is being conducted at two sites: an inner
city London borough and a city in the South West of England. In total, 395 participants consented to
participate in the trial; 325 were assessed at baseline and 215 met the criteria and agreed to take part.
Recruitment used population screens and referrals.
Findings – The screening procedure was more labour intensive but attracted greater numbers,
including many parents who might not otherwise have sought help and included many families from
disadvantaged backgrounds. The referrals included those with more serious problems and a higher
proportion engaged with the service. Recruitment rates were lower in the London site due to ineligibility
and greater difficulty in accessing schools. Retention in the two areas was similar.
Originality/value – The study provides data on recruitment challenges and lessons learned that could
help formulate future policy regarding service delivery. Also of value is the finding that it is possible to
conduct population screens in very deprived, multi-ethnic areas and to get high rates of return.
Keywords Parenting interventions, Anti-social behaviour, Randomised controlledtrial,
Disadvantaged groups, Social problems, United Kingdom, Social services
Paper type Research paper
Introduction
Early interventions for behavioural difficulties can be a cost-effective way to prevent
adverse outcomes (Scott et al., 2010). Randomised controlled trials (RCTs) are considered
the ‘‘gold standard’’ in developing and enhancing interventions, but they face a challenge in
achieving the recruitment and retention levels ne cessary to ensure that they are
representative of real life practice and to produce generalisable findings.
Recruitment from a population of eligible parents to parenting programmes (either to
universal programmes or specifically to a research trial) can be challenging. Recruitment
rates vary from 17 to 70 per cent depending on the intervention and for socially
disadvantaged populations the challenge can be even greater (August et al., 2003;
Heinrichs et al., 2005). Understanding the complexities of trials of this nature is vital to help
inform future policy and implementation. As Brown et al. (2001, p. 156) point out, with no
models for successful recruitment, many innovative and promising projects ‘‘face the
formidable task of creating diverse subject populations within very limited time and
budgetary restraints’’.
DOI 10.1108/17466661211286508 VOL. 7 NO. 4 2012, pp. 285-302, QEmerald Group Publishing Limited, ISSN 1746-6660
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JOURNAL OF CHILDREN’S SERVICES
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PAGE 285
Milena Stateva is based at
King’s College London,
London, UK.
Jacqueline Minton is based
at University of Exeter,
Exeter, UK.
Celia Beckett and
Moira Doolan are based at
King’s College London,
London, UK.
Tamsin Ford is based at
University of Exeter,
Exeter, UK.
Angeliki Kallitsoglou and
Stephen Scott are based at
King’s College London,
London, UK.
There may be particular challenges in recruitment for evaluations of services aimed at
helping socially disadvantaged groups (Cooney et al., 2007; Williams and Corbie-Smith,
2006). Investigators may lack information about effective strategies to recruit in diverse
contexts, for example through using members from the target community to aid in
recruitment. Groups that are harder to reach may include recently arrived migrants who are
at a greater risk of isolation (Scott et al., 2010) and those from lower socioeconomic groups
where the additional stressor of poverty makes these families less willing or able to invest
time in research and/or interventions (Baydar et al., 2003). RCTs may have additional
constraints arising from the design in that participants may lack awareness or understanding
of research, in particular regarding the random allocation of groups.
Experience with intervention trials suggests that the approach of professionals working
directly with the target population is crucial. Where recruitment relies on trusted pre-existing
links with the families, there is a greater acceptance by parents; one study successfully
recruited 69 per cent of the at-risk population using health visitors (Hutchings et al., 2007).
Similarly recruitment can be made more successful where the researchers enter the
recruitment process after a first contact by interventionists (Gardner et al., 2006); or where
recruitment is aimed at children already referred to mental health services (Scott et al.,
2001). Consequently, the ease of the referral process and the ways in which referrals are
handled can have a significant influence on engagement (Chew-Graham et al., 2007).
In order to identify children at risk in the general population, school screens may be a
successful route. The Supporting Parents on Kids’ Education in Schools (SPOKES) trial
recruited two-thirds of those who were eligible by working solely with the schools (Scott et al.,
2010) and a similar rate was achieved in a US trial (August et al., 2003). Thus, the choice of
strategy can have a significant bearing on recruitment in terms of the range of participants,
the level of engagement and retention.
The Helping Children Achieve (HCA) study is a two-site, four-arm trial comparing a
well-established parenting intervention focusing on behaviour management called the
Incredible Years(IY) programme (Reid et al., 2007; Webster-Stratton, 1989); a more recently
developed literacy support programme called SPOKES (Sylva et al., 2008); a combination of
both these programmes; and a control group whereparents are signposted to usual services.
Parents were recruited to the trial via referral or screening (whereby a whole population
is assessed to identify those at risk). Children in the last term of the foundation year, year one
or year two of primary school were screened or referred for conduct problems by parents
and teachers, who completed a brief questionnaire, described later. Parents of children with
scores indicating that they were at risk of conduct problems were approached by the
research team and if they were interested and consented they were further assessed using
the Parent Account of Child Symptoms (PACS) disruptive scale, an in-depth interview to
confirm eligibility. Families who met the eligibility criteria were randomly assigned to one of
the four groups described above. This article aims to describe the challenges of recruitment
and initial retention to this complex intervention trial, while looking at factors that may have
had an influence on families’ decisions to engage or not.
Rationale for the design
The trial had several goals:
BTo test early years interventions that address child conduct problems and reading.
BTo target children at risk of poor outcomes due to anti-social behaviour (ASB) and
intervene early in their school career.
BTo recruit using a whole school population approach to ensure a wide reach.
BTo evaluate interventions’ cost effectiveness.
To address child behaviour, the basic IY programme was chosen (Webster-Stratton, 1989).
It has a strong evidence base for improving child outcomes and parenting, and has been
shown to create strong, positive relationships within families, paying particular attention to
parents’ emotional needs (Scott et al., 2001).
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