Children and Youth Services Review 130 (2021) 106223

Contents lists available at ScienceDirect

Children and Youth Services Review

journal homepage: www.elsevier.com/locate/childyouth

Breaking the cycle of intergenerational trauma: Evaluating the impact of

parental adverse childhood experiences on parenting group outcomes using
a mixed-methods approach
John Burke a, *, Mark Fitzhenry b, Sharon Houghton a, Donal G. Fortune a
a
Department of Psychology, University of Limerick, Ireland
b
Carlow Primary Care Child Psychology Services, Carlow, Ireland

A R T I C L E I N F O A B S T R A C T

Keywords: Many children experience some form of adversity in their childhood. These adverse childhood experiences
Understanding Your Child’s Behaviour (ACEs) can have long-term implications. Parenting group interventions were designed to support parents who
Solihull Approach struggle to act as the protective buffer against adversity, and provide skills and tools to be able to avoid
Adverse childhood experiences
maltreatment. Despite the wide-ranging impacts of ACEs, their influence on parenting intervention outcomes is
Parental self-regulation
Perceived stress
relatively unknown. This study used a mixed-methods, triangulation design incorporating repeated measures,
Child emotional and behavioural problems pre-post quantitative elements (n = 30) with qualitative aspects (n = 6) to evaluate the acceptability and
effectiveness of a 10-week integrative parenting group, Understanding your Child’s Behaviour (UYCB; Douglas &
Ginty, 2001) in an Irish-based sample. As the group also explores a parents’ own experiences of being parented,
the effects of cumulative parental ACE scores on outcomes were also assessed. This is the first study evaluating
the UYCBP in an Irish sample, and the first evaluating the effect of ACEs on UYCB outcomes. The group was
experienced as ‘acceptable’. Perceived stress and parental self-regulation showed significant improvements, but
no significant improvements on child-based measures were observed. There was no significant effect of ACEs at
baseline or on intervention outcomes. Qualitative data revealed salient themes of “Seeing” the child; Parental
self-regulation; and Experiences of being parented. The importance of adopting broader, more sensitive methods
of researching ACEs as well as tracking parent progression over longer periods are discussed.

1. Introduction dose–response effect of these ACEs, in that experiencing more ACEs

1.1. Adversity in childhood
Seventy-five percent of children experience some form of stressful
life event before the age of nine (Kelly, 2019). In some cases, the nature
and chronicity of these adverse childhood experiences (ACEs) can lead to
negative long-term outcomes (Bellis et al., 2016). The human physiology
is sensitive during childhood and has the unique ability to respond both
physically and psychologically to environmental changes during this
time (Shonkoff et al., 2012). ACEs exact their impact through toxic stress,
or “major unrelieved stress over prolonged periods of time” (Felitti &
Anda, 2014, p. 208). Research emphasises the cumulative or
results in more deleterious effects enduring throughout adulthood
(Hughes et al., 2018).
The specific pathways through which ACEs impact parenting are
multifaceted. ACEs are sometimes considered “ghosts in the nursery”,
where the “unremembered past” plays a significant role in how
parenting behaviours develop and are maintained through generations
(Fraiberg, Adelson, & Shapiro, 1975). Parents who have experienced
childhood adversity are at a greater risk of a broad range of adverse
parenting practices that range in severity from lack of sensitivity to
abusive behaviours (Pasalich et al., 2019). Parents who have experi­
enced more ACEs during their own childhood will be more susceptible to
maternal distress, including psychiatric disorders (Nanni, Uher, &

Abbreviations: ACEs, Adverse Childhood Experiences; EBD, Emotional and behavioural problems; UYCBP, Understanding Your Child’s Behaviour Programme; PC,
Primary Care; ITT, ‘Intention-to-treat’; PSS, Perceived Stress Scale; MaaP, ‘Me as a Parent’ Questionnaire; SDQ, Strengths and Difficulties Questionnaire; ESQ,
Experience of Service Questionnaire.
* Corresponding author at: Clinical Psychology Administrator, Department of Psychology, University of Limerick, Ireland.
E-mail address: jburke9@tcd.ie (J. Burke).

https://doi.org/10.1016/j.childyouth.2021.106223
Received 19 November 2020; Received in revised form 16 August 2021; Accepted 20 August 2021
Available online 23 August 2021
0190-7409/© 2021 Published by Elsevier Ltd.
J. Burke et al.
Danese, 2012). Some parents with psychiatric diagnoses can be more
critical, and less emotionally containing for their children (Johnson,
Cohen, Kasen, & Brook, 2006). Numerous studies have demonstrated
that parental affective distress mediates the relationship between
maternal childhood maltreatment and emotional and behavioural dif­
ficulties (EBD) in children (Plant, Pawlby, Pariante, & Jones, 2018).
Children of parents who experience these problems often display more
EBD (Clarkson Freeman, 2014). Much of the intergenerational trans­
mission of ACEs can be explained through poor parenting practices and
parental history of mental illness (Dixon, Hamilton-Giachritsis, &
Browne, 2005).
In the right circumstances, the parent–child relationship provides a
buffering effect against childhood adversity (Shonkoff et al., 2012).
Fostering a positive parent–child relationship can sometimes be a
difficult task, particularly for parents who have endured ACEs. Parents
who have experienced childhood adversity are at a greater risk of a
broad range of adverse parenting practices that range in severity from
lack of sensitivity to abusive behaviours (Pasalich et al., 2019). One
significant challenge that has emerged is tackling the intergenerational
transmission of ACEs. This phenomenon refers to the impact of parents’
ACEs on their offspring in two distinct pathways. Firstly, children of
parents’ who have endured ACEs are more likely to experience similar
adversity and be subjected to the associated negative outcomes (Lin
et al., 2019). Secondly, parents who have endured more ACEs are more
likely to engage in harsh parenting styles, experience higher levels of
perceived stress and have reduced capacity to self-regulate when man­
aging their own stress and the stresses of their child (Pereira et al.,
2018). Managing parental stress represents a key challenge when
improving child outcomes and is closely influenced by a parent’s ability
to regulate and tolerate negative emotional states (Verreault et al.,
2014). Difficulties with parental self-regulation often precede childhood
onset of emotional and behavioural difficulties (EBD; Dretzke et al., 2009).
Prevalence rates of EBD globally stand between 10 and 20% (Emerson &
Einfield, 2010). In robust parent–child attachment relationships, EBD
are less common because stressors are adaptively managed using posi­
tive coping strategies modelled by the parent and internalised by the
child (Steele & McKinney, 2019).
1.2. Parenting interventions
Parenting interventions support parents to build this adaptive
parent–child relationship. Meta-analyses have found that positive effects
may be maintained for up to 20 years following parenting interventions
(Sandler et al., 2011). The current study examines the integrative Un­
derstanding Your Child’s Behaviour Programme (UYCBP), which has been
developed based on the Solihull Approach and aims to instil the
importance of three core principles of containment, reciprocity and
behaviour management (Douglas & Ginty, 2001). Families that foster a
positive parent–child relationship in early childhood sow the seeds for
lasting benefits. The Solihull Approach uses this rationale in their
approach to behaviour management by focusing on parent-based re­
sponses to behaviour, rather than child-based behaviour reduction. This
focus equips parents with skills that help them to navigate the changing
behaviours as their child develops (Steele & McKinney, 2019). The
programme is implemented for two hours each week across a 10-week
period. Each session includes a break with refreshments. Course con­
tent includes presentations, role plays, group discussions and videos,
and each facilitator follows programme guidelines in a manual to ensure
fidelity to the programme. The group is facilitated by two practitioners
who are typically health visitors, school nurses or other mental health
clinicians such as psychotherapists or psychologists who have received
the 2-day SA foundation course, in addition to 1-day training in the
facilitation of the parenting group. Facilitators are required to have used
the SA in their practice for at least three months prior to facilitating the
group. While many parenting groups focus on building the parent–child
relationship, the UYCBP specifically acknowledges and explores how
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Children and Youth Services Review 130 (2021) 106223
parents’ own experiences of being parented influence how they parent
(Bateson et al., 2008).
Parenting group interventions that have evaluated the impact of
parental ACEs found that child of parents with higher ACE scores (≥4)
had higher levels of baseline impairments, particularly in child exter­
nalising behaviours (Blair et al., 2019). Parents with higher ACE scores
benefited most from parenting groups when both parent and child fac­
tors were measured (Blair et al., 2019; Rosenblum et al., 2017). Other
studies evaluating intervention moderators (Theise et al., 2014) have
not examined the cumulative effects of trauma specifically (Hurlburt
et al., 2013; Pearl et al., 2012; Shelleby & Shaw, 2014), highlighting the
specific need for the current study. Fig. 1.1 provides a visual depiction of
the conceptual framework underpinning this research study.
Of particular importance in parenting interventions is the concept of
acceptability, as this often dictates adherence to treatment which allows
for potential change (Sekhon et al., 2017). For the purpose of the current
study, acceptability is defined as a multi-faceted construct that reflect
participants’ experiential responses to an intervention and draws on the
theoretical framework of acceptability outlined by Sekhon and col­
leagues (2017). Specific components including affective attitude,
perceived effectiveness, burden, self-efficacy and intervention coher­
ence form the basis of investigation into acceptability of interventions.
Research has evaluated the UYCBP in several UK-based samples to date
and found it to be acceptable (Douglas & Johnson, 2019), but it has yet
to be evaluated with a Primary Care, Irish-based clinical sample.
1.3. Research objectives
Research indicates the cultural transferability of parenting pro­
grammes (Gardner et al., 2016), showing promise that the UYCBP may
be effective in an Irish-based sample. This study aims to evaluate the
acceptability and effectiveness of the UYCBP in an Irish sample. Effec­
tiveness will be measured by dependent variables of parental perceived
stress levels and parental self-regulation abilities, in addition to chil­
dren’s externalising and internalising behaviours. The prevalence and
effect of cumulative ACEs on parent and child outcomes following
intervention will also be investigated. Finally, acceptability of the pro­
gramme within an Irish setting will be measured using psychometric
measures, qualitative reports and attendance rates. Qualitative in­
vestigations will provide an in-depth exploration of particular elements
of effectiveness and acceptability of the UYCBP.
2. Materials and methods
2.1. Study design
A repeated measures, mixed-methods design was implemented.
Quantitative data was collected at pre- and post-intervention timepoints
using a quasi-experimental design, alongside post-intervention qualita­
tive data collection with no control group. A triangulation mixed-
methods design was adhered to, in which qualitative data was used to
corroborate and substantiate quantitative results by obtaining a more in-
depth exploration of parental experiences. Change between timepoints
was measured on dependent variables of parental perceived stress,
parental self-regulation and child internalising and externalising prob­
lems. The parental ACE score was the covariate. Using results outlined
by previous studies evaluating the UYCBP as a basis (Bateson et al.,
2008), a large effect size (d = 1) with p-value of 0.05 significance levels
were input to determine required sample sizes using G*Power software
(Faul et al., 2007). As this was the first study to evaluate the UYCBP in an
Irish setting, participant sampling was restricted to one community
health organisation to ensure controlled and consistent programme
implementation was maintained. The local Health Service Executive
Research Ethics Committee approved the study design (14/02/2019).
The research was conducted in accordance with the declaration of
Helsinki.
J. Burke et al. Children and Youth Services Review 130 (2021) 106223

Fig. 1.1. Conceptual Framework Employed. Note. UYCBP = Understanding Your Child’s Behaviour Programme; references for each element of the framework
outlined in Section 1.1 and 1.2.

2.2. Participants
Table 2.1
Descriptive Statistics For Parents Attending The UYCBP.
Participants were referred to Primary Care (PC) Child Psychology
Services in two locations within the same community health organisa­ N M ± SD Range
tion. To maintain a clinically representative sample, exclusion criteria Age of attendee 30 45.85 ± 26 – 54 (28)
were kept to a minimum with participants excluded if (1) The research 10.83
Youngest child 30 6.03 ± 2.78 1 – 11 (10)
was considered overburdensome, or (2) The research placed the
age
participant at increased risk of distress or harm. The group comprised a Oldest child age 30 11.73 ± 6.24 3 – 31 (28)
diverse group of parents, with 20% identifying as foster carers. Fig. 2.1 Age of referred 30 7.6 ± 2.72 3 – 14 (11)
details the number of participants at each time point from initial referral child
to the group, through to post-intervention research completion. Partic­ Children in 30 2.6 ± 1.10 1 – 5 (4)
family
ipant characteristics are displayed in Table 2.1. Aggression/Anger was
ACE score
the predominant reason for referral, with emotional well-being being Fully complete 26 1.96 ± 1.95
the second most common reason. Other less common reasons included Missing items = 30 1.77 ± 1.91
impulsivity/hyperactivity, social difficulties, sensory regulation and 0
Employment Employed Unemployed
reduced danger awareness. Four children had diagnoses of specific
Status
learning difficulties (e.g. dyslexia), two had diagnoses of either attach­ 10 20
ment disorder, sensory regulation disorder or emotional and behav­ Attender Gender Male Female
ioural disturbance, and one child had a diagnosis of ADHD. 2 28
Attender Irish Irish/British Polish
Nationality
28 1 1
Relationship Single Relationship LwP Married Sep/
Status* Div
7 1 1 16 4
Relationship to Mother Father Foster
child Carer
22 2 6

Note. n = number of participants in each group; M ± SD = mean ± standard

Fig. 2.1. Participant Attendance from Initial Referral to Post-Intervention.
Note. Pts = Participants; each number refers to number of participants within
specified group; ‘RC-Pre’ refers to Research Completers pre-intervention; ‘RC-
Post’ refers to Research Completers post-intervention timepoints. Group 1 and 2
attended Location A; Group 3 and 4 attended Location B.
deviation; ACE score Missing items = 0 = Items on questionnaires that were not
answered were given a score of 0 in total scores; Fully complete = 26 partici­
pants completed the questionnaire in full, without missing items; Relationship =
in a relationship; LwP = living with partner; Sep/Div = separated or divorced;
ACE score Fully complete = all items completed on questionnaire.
* One participant did not declare their relationship status.

3
J. Burke et al.
2.3. Procedure
Participants were informed about the research in an initial consul­
tation session facilitated by Clinical Psychologists as implemented in
standard clinical practice. Parent suitability for the UYCBP was assessed
in this session and assigned to the UYCBP group if appropriate. Infor­
mation about the research was reiterated before the first group session
prior to obtaining informed consent for research participation. Ques­
tionnaires were subsequently completed. Post-intervention data was
collected at the end of the final UYCBP session in week 10. The focus
group was held immediately after the final session of the first
programme.
2.4. Instruments
2.4.1. Aces questionnaires
The ACEs questionnaire (Felitti et al., 1998) is a well-established
questionnaire that has been used extensively in large-scale research. It
contains 10 items that require participants to answer binary “yes” or
“no” questions to retrospectively determine if they have had specific
experiences in childhood, such as neglect and physical, emotional or
sexual abuse. This measure was administered at pre-intervention. ACEs
scores of two or more were considered the cut-off for potential increased
risk of difficulty in the present study based on previous population data
indicating the increased risk associated with above average ACE scores
(ACE score > 1; Bellis et al., 2014). Missing items (N = 14) was coded as
‘no’ in the data, and total scores for each individual was summed
including these items. This allowed the ACE questionnaire be inter­
preted without inaccurately inflating their ACE score because of missing
items. It was not appropriate to pro-rate scores on this questionnaire
given the binary nature of the questions.
2.4.2. Perceived stress scale (PSS)
The PSS (Cohen et al., 1983) is a 10-item questionnaire measuring
the frequency of feelings and thoughts considering life uncontrollable,
unpredictable and overloading within the last month on a 5-point Likert
scale ranging from “never” to “very often”. Four positively-worded
questions were reverse-scored in the analyses. Higher scores on the
PSS are indicative of greater perceived stress. The PSS has been sub­
jected to extensive review and utilisation in the literature and satisfies
internal reliability requirements for perceived stress (α = 0.85) and
test–retest reliability up to twelve weeks (α = 0.85; Lee, 2012).
2.4.3. Strengths and difficulties questionnaire (SDQ)
The SDQ was used to measure child emotional and behavioural dif­
ficulties (Goodman, 1997). It is a 25-item scale with a 3-point Likert
scale completed by a parent or guardian about their child. Sum scores
range from 0 to 40, with higher scores indicative of higher levels of
difficulty. There are four problem subscales that combine to provide an
internalising problem score (emotional symptoms and peer relationship
difficulties) and externalising problem score (conduct problems and
hyperactivity). In addition to both of these problem scales, the total
difficulties score was utilised. This method of subscale combination was
conducted as outlined by the scale authors prior to statistical analyses.
Total difficulties scores are differentiated using predetermined cut-offs,
with 0–13 as ‘Close to Average’, 14–16 as ‘Slightly Raised’, 17–19 as
‘High’ and 20–40 as ‘Very High’ (Meltzer et al., 2003). The scale is
validated for use with children aged between three and 16 years and has
demonstrated adequate internal consistency (α ¼ 0.75) and adequate
test–retest reliability over 3-month periods (Goodman, 1997) in similar
samples (Goodman & Goodman, 2011).
2.4.4. ‘Me as a Parent’ (MaaP)
The MaaP scale contains 16 items scored on a 5-point Likert scale
that measures parental self-regulation. Sum scores range from 16 to 80,
with higher scores indicative of higher levels of parental self-regulation.
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Children and Youth Services Review 130 (2021) 106223
The MaaP includes questions relating to parental self-efficacy (“I have
confidence in myself as a parent”), personal agency (“How my child
turns out is mainly due to luck”), self-sufficiency (“I can find out what’s
needed to resolve any problems my child has”) and self-management (“I
meet my expectations for providing emotional support for my child”).
Each of these subscales are summed together to give an overall parental
self-regulation score. The initial development study for the MaaP
(Hamilton et al., 2015) identified adequate internal consistency (α ¼
0.85). The scale also demonstrated sufficient test–retest reliability across
a 3-month time period (r = 0.71).
2.4.5. Acceptability
Acceptability was defined as how well the intervention was received
by an Irish-based group of parents attending a Primary Care Psychology
service. Acceptability was measured using the 12-item Experience of
Service – Parent questionnaire (ESQ; Attride-Stirling, 2003). This is a
measure of satisfaction with and acceptability of treatment. It was
designed for use with parents or carers who have used a psychological
service for issues relating to their child. Two constructs are measured:
Satisfaction with care (9 items), and satisfaction with environment (3
items). Scores range from 0 to 18 with lower scores indicate higher
satisfaction. The measure demonstrates adequate construct validity
within a child mental health service similar to the current study (Brown
et al., 2014). In addition, attendance rates were used as a secondary
psychometric measure of acceptability, with higher attendance rates
indicating greater levels of acceptability within the population. Finally,
qualitative investigations were used to inform this research question
further.
2.4.6. Qualitative data
Written qualitative feedback was gathered from all participants and
a focus group was conducted after one intervention group to gain a more
in-depth understanding of participants’ experience and explore if par­
ents’ own experiences of being parented had impacted on their current
parenting behaviours. The questions were formulated in accordance
with guidance for qualitative research with focus groups (Massey, 2011)
and guidelines for thematic analysis in focus groups (Clarke et al., 2015;
Braun et al., 2019). Qualitative questions from the ESQ were used as a
basis for constructing further questions about the participants’ experi­
ences of the group, including “What was really good about your care?”,
and “Was there anything you didn’t like or needs improving?”, which
map onto the theoretical framework of acceptability adhered to in this
study. The focus group was facilitated by a researcher not affiliated with
the clinical service.
2.5. Data analysis overview
2.5.1. Quantitative analysis overview
Quantitative data was analysed using SPSS v26. Baseline descriptive
data was analysed to provide a profile of parents who attended the
UYCBP. Significance was set at p < 0.05 (Feise, 2002) and effect sizes
were calculated using Cohen’s d (Cohen, 1988). Baseline independent
sample t-tests for analysing differences between high and low parental
ACE scores on the dependent variables and Analysis of Covariance
(ANCOVA) procedures investigating the relationship of parental ACE
scores on outcomes required 34 and 33 participants respectively to
detect a large, two-tailed effect size. Repeated measures t-tests were
used to analyse pre to post-intervention differences, requiring 16 par­
ticipants for adequate power. Acceptability was measured using mean
and standard deviations on the ESQ care and environment scales, in
addition to attendance rates.
2.5.2. Data preparation and treatment
Incomplete questionnaires were handled as specified by authors of
the specific measures where possible. Two sets of analyses were
completed. “Research completers” completed both pre and post-
J. Burke et al.
intervention questionnaires as specified by the research protocol. The
“intention-to-treat” (ITT) sample included any participant who
completed the pre-intervention questionnaire but did not complete the
post-intervention questionnaire. Multiple imputation was carried out for
missing data at the second time point as outlined by best practice
guidelines for missing data (Lee & Carlin, 2010; Schafer, 1999). There
were no significant differences between the research completer and ITT
data on all dependent variables (all ps > 0.083). T-test and ANCOVA
assumptions were tested stringently prior to analysis.
2.6. Qualitative analysis
A reflexive thematic analysis (TA) was conducted on qualitative data
using guidelines provided by Braun and Clarke (2016, 2019), whilst
maintaining principles of good practice in qualitative analysis (Elliott
et al., 1999). Two main theoretical frameworks were drawn upon
throughout the analysis. The first was the triad of containment, reci­
procity and behaviour management, identified as core principles for
positive parenting approaches within the Solihull Approach. The second
was attachment theory and its explanation of how parental difficulties
are transmitted intergenerationally to offspring. In addition, the theo­
retical framework of acceptability and its associated core constructs
formed the basis of analysis related to the acceptability research ques­
tion. The Principal Investigator’s subjectivity was utilised as a resource
to create narratives from the data and provided a context for meaning-
making (Clarke & Braun, 2018). Reflective notes were maintained
throughout data collection and analysis to inform interpretation and
reduce the potential for bias (Smith, 2006).
The focus group was audio-recorded and transcribed. Raw data
included a written transcript of the focus group, qualitative responses
from the ESQ questionnaire and additional feedback forms gathered
after each session. These forms included open-ended questions about
specific elements of the programme participants found useful, which
elements they felt required more or less focus, and any suggestions to
improve the programme for future cohorts. The primary author initially
familiarised themselves with the raw data through multiple readings,
from which initial codes were generated. A framework of topics was
created from the initial codes and the distinct topics were categorised
into domains that were deemed representative of the data. Subthemes
were devised to reflect discrete aspects within each theme. The analysis
was continually reviewed across several iterations to ensure it accu­
rately represented the narratives interpreted from the data. The struc­
ture of the analysis was designed to fit within the guidelines for
conducting TA (Braun et al., 2016). The proposed themes and sub­
domains were modified to ensure they accurately described the amen­
ded categorisation of the data. Finally, relevant quotations were
presented in report format to depict the themes and subdomains.
3. Results
3.1. Quantitative results
3.1.1. Baseline association of parental ACE scores and outcome measures
Independent samples t-test analyses revealed no significant differ­
ences in the profile of difficulties in individuals with higher ACE scores
(N = 17) compared to those with lower ACE scores (N = 13; all ps >
0.52). Mean scores for both high and low ACE scores were within the
“moderate” range of perceived stress and “very high” on the SDQ. Mean
ACE scores were approximately one point higher than the average
population (1.97 ± 1.95 for complete responses; 1.77 ± 1.91 when
missing responses were scored as 0; Bellis et al., 2014).
3.1.2. Acceptability of the UYCBP
Mean score analyses revealed high satisfaction with care received (M
= 8.6 ± 1.08) and high satisfaction with the environment (M = 3.59 ±
1.26). These scores compare with previous research conducted in similar
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Children and Youth Services Review 130 (2021) 106223
services in which participants typically endorsed the most favourable
outcome rating for each item (Brown et al., 2014). Attendance data was
also considered within the research question relating to acceptability.
The mean number of sessions attended was 6.73 ± 2.60 when there were
10 sessions facilitated in total.
3.1.3. Intervention effects
Table 3.1 shows paired samples t-test results for both completer and
ITT analysis. In completer analysis, the PSS scale was the only variable
showing significant change. Three participants were observed to have
disimproved on the PSS scale, with the remaining 19 making improve­
ments from pre (Mdn = 23) to post (Mdn = 16) intervention, with a
median reduction of 3.0, p = .004. In ITT analysis, both MaaP (p = .005)
and PSS (p < .001) scores showed significant positive change with
moderate effect sizes across timepoints.
3.1.4. Parental ACEs association with group effectiveness
No significant differences were observed across time points between
low and high ACE scores in completer or ITT analysis (all ps > 0.20).
Mean scores on the SDQ remained within the ‘very high/very low’
category and within the ‘moderate’ PSS category for parents with both
low and high ACE scores. Table 3.2 displays non-significant mean dif­
ferences at pre- and post-measurement between low and high ACE
scores.
3.2. Qualitative results
The focus group was conducted with six participants for a duration of
50 min. Written qualitative data from the ESQ form was obtained from
20 participants, yielding a total of 120 responses. Data from individual
session feedback totalled 13 responses, and qualitative data obtained
from the overall feedback forms yielded 21 responses. When participant
information was available, participants were credited for their quota­
tions; quotations from anonymous feedback forms are quoted as
‘anonymous’ in the results below. Using reflexive TA, four themes were
interpreted across the dataset: Group acceptability; “Seeing” the child;
Parental self-regulation; and Experiences of being parented (Fig. 3.3).
3.2.1. Group acceptability
Establishing participants’ perspectives on their experience of the
group process and content was an important aspect of this research,
particularly as the UYCBP had not been previously evaluated in an Irish-
based sample. Overall, the content of the group process and delivery was
well-received, and the content of the group was relatable for
participants.
“It was well-delivered, always felt supported and not pressurised”.
Participant 20
“It kept all our attention; it was relaxed and fun at times”.
Participant 7
3.2.1.1. Facilitation expertise and flexibility. Participants valued the
expertise facilitators brought to the group. This expertise extended from
the relaying of important concepts clearly, to understanding participant
narratives and offering alternative ways of thinking at appropriate
moments:
“They gave great explanations, they explained it well, they let us talk
among ourselves, and in certain situations they gave us a different
outlook”.
Participant 3
“With me, I’ve the four kids and only one that’s not in school so it
was helpful for me to know well, Mam, are you going to be here this time
for the next ten weeks”.
Participant 5
The element of consistency aligns with the containment principle of
the Solihull Approach and data gathered suggests it is supportive of a
J. Burke et al. Children and Youth Services Review 130 (2021) 106223

Table 3.1
Paired Samples T-Tests Comparing Time Point One to Time Point Two Scores On Dependent Variables.
T1 M ± SD T2 M ± SD Mean diff. 95% CI t df p d

Completer N = 22
MaaP 55.15 ± 7.56 59.06 ± 9.11 3.91 (9.06) − 0.1 – 7.93 2.03 21 0.056 0.73
SDQ_Tot 23.01 ± 4.34 22.27 ± 6.30 − 0.74 (5.03) − 2.97 – 1.49 − 0.69 21 0.50 0.14
SDQ_Int 10.23 ± 3.38 9.32 ± 3.12 − 0.91 (2.71) − 2.11 – 0.29 − 1.58 21 0.13 0.28
SDQ_Ext 12.78 ± 2.38 12.95 ± 4.04 0.17 (3.52) − 1.4 – 1.73 0.23 21 0.82 0.05
PSS* 23 16 − 3.0 0.004**
ITT N = 30
MaaP 54.91 ± 7.39 59.57 ± 7.64 4.66 (8.46) 1.50 – 7.82 3.01 29 0.005** 0.62
SDQ_Tot 23.21 ± 5.27 22.57 ± 5.58 − 0.64 (5.76) − 2.79 – 1.51 − 0.61 29 0.55 0.12
SDQ_Int 10.37 ± 3.77 9.47 ± 2.86 − 0.90 (3.51) − 2.21 – 0.41 − 1.41 29 0.17 0.27
SDQ_Ext 12.84 ± 2.58 13.1 ± 3.57 0.26 (3.4) − 1.01 – 1.53 0.42 29 0.68 0.08
PSS 21.70 ± 6.34 17.33 ± 4.79 − 4.37 (5.38) − 6.38 – − 2.36 − 4.45 29 <0.000** 0.78

Note. T1 = Time point 1; T2 = Time point 2; M ± SD = Mean ± Standard deviation; Mean Diff. = Mean difference; 95% CI = 95% confidence interval; t = t value; df =
degrees of freedom; p = p-value; d = Cohen’s d effect size; ITT = ‘Intention to treat’; MaaP = Me as a Parent scale; SDQ_Tot = SDQ total score; SDQ_Int = SDQ
internalising score; SDQ_Ext = SDQ externalising score; PSS = Perceived Stress Scale; Exact Sign = Exact sign test alternative to paired samples t-test; Standard =
Standardised score; Sign = Sign test score.
* PSS scores are reported as median T1, median T2 and median difference instead of means, as required by the Exact sign test conducted.
** p < .005.

but that the opportunity was always there and it would be met without
Table 3.2
judgement. This non-judgemental space offered by the group appeared
Mean Difference Between Timepoints on Low and High ACE Scores.
to be of greater importance because of participants’ experiences outside
Mean Difference M ± SD of the group.
Completer ITT “It’s like a safe place, you can say anything, and you know no one is
Low (N = 14) High (N = 8) Low (N = 17) High (N = 13)
going say, ‘sure it’s your fault’ or, ‘sure why are you letting them do it’
and things like that”.
PSS − 4.36 ± 5.68 − 4.50 ± 5.37 − 4.59 ± 5.35 − 4.08 ± 5.62
Participant 1
MaaP 2.36 ± 9.98 6.64 ± 6.93 3.98 ± 9.60 5.54 ± 6.98
SDQ_Tot − 0.38 ± 5.66 − 1.38 ± 3.96 − 0.15 ± 5.91 − 1.46 ± 5.68 The experience of being judged outside of the group was a common
SDQ_Int − 0.71 ± 2.79 − 1.25 ± 2.71 − 0.18 ± 3.32 − 1.85 ± 3.65 theme for parents, particularly through ‘school-gate judgement’, which
SDQ_Ext 0.34 ± 3.85 − 0.13 ± 3.09 0.16 ± 3.67 0.38 ± 3.15 ranged from ‘looks’ to over questioning of their parenting decisions and
Note. Low = Low ACE score; High = High ACE score; M ± SD = Mean ± behaviours. These experiences were invalidating for parents who were
Standard deviation; MaaP = Me as a Parent scale; SDQ_Tot = Strengths and already finding it a challenge to manage their child’s behaviours
Difficulties questionnaire total score; SDQ_Int = Strengths and Difficulties appropriately and effectively.
questionnaire internalising score; SDQ_Ext = Strengths and Difficulties ques­
tionnaire externalising score; PSS = Perceived Stress Scale. 3.2.1.3. Support and validation through shared experiences. All partici­
pants made reference to the supportive group experience throughout the
positive group experience. 10-week journey. Participants valued hearing others’ experiences, as it
validated their own struggles with different aspects of parenting.
3.2.1.2. Non-Judgemental, safe space. The safe space gave participants “Having other people in the kind of same situation, that know what
an opportunity to share some of the trials and tribulations they experi­ you’re going through”.
enced as a parent, without repercussions or judgement from others. It Participant 1
was also notable that parents did not feel obliged to share experiences, “Shared experiences, and knowing that we all had problems with our

Fig. 3.3. Graphic Depiction Of Themes And Subdomains Extracted From Dataset.

6
J. Burke et al.
children – no supermums!”
Participant 8
“You’d feel like a weight was lifted off your shoulders coming out”.
Participant 5
Such statements are impactful because they highlight the distinct
pressure on participants to meet the expectations of being a ‘good
enough’ parent. The group offered a place where these expectations
could be explored and discussed, which ultimately reduced the burden
of them on attendees. By creating a contained atmosphere for parents,
the group allowed for more reflective thought and action for parents
when engaging with their child. The group created an opportunity to
model reciprocity between parents in their interactions with each other
within the group setting, another core principle of the Solihull
Approach.
“The group was split and then we had to come up [with suggestions].
It was nice to see that even though one half was there, one half was here,
that when [the facilitators] put up their charts, they were actually
similar, do you know, and that was really helpful to know”.
Participant 5
Giving participants the opportunity to problem-solve in their own
groups provided a sense of hope that each parent could draw upon their
experience to find appropriate solutions to scenarios each of them were
facing.
3.2.2. “Seeing” the child
3.2.2.1. Noticing and recognising. Parents are encouraged to observe
their child and try to notice small but significant changes that might be
indicative of certain behaviours. For some parents, this was a new skill
and may have required a change in their previously held beliefs about
certain behaviours or emotional states.
“Before I wouldn’t [have] really recognised that as anxiety to be
quite honest. Now I can see when she’s starting to [get] work[ed up].
There’s certain signs there that I would have missed the first time, and
I’m able to recognise now and I’m able to put a stop to it before it begins
and get her back to her happy place”.
Participant 3
This parent gives an insight into her own perception of how anxiety
looked in her daughter. Her participation in the group allowed her to
challenge this belief, notice different behaviours that were related to her
daughter’s anxiety, and intervene appropriately.
3.2.2.2. Taking the Child’s perspective. One significant change for par­
ents who attended the group was to better acknowledge their child’s
perspective. The arduous trial of parenting resulted in a ‘fire-fighting’
approach to managing their child’s behaviour that neglected their
child’s perspective.
“Learning that they [our children] have the same feelings as us. You
know, you wouldn’t like somebody to send us to our rooms… I wouldn’t
calm down if someone sent me to my room! So yeah, it’s just to learn that
you have to teach them the same, you have to treat them the same as an
adult”.
Participant 6
For this parent, the realisation that her child has emotions and
feelings just as she does was a powerful one. It allowed her to step into
her child’s shoes and wonder what it might feel like. The statement
reflects how the parent now realises the benefits of including their child
as an active participant in the behaviour management process; one that
has changeable moods, emotional states and perspectives, all of which
they can now explore together. Other parents had similar realisations
that resulted in practical changes to how they manage challenging sit­
uations with their child.
“Yes, I don’t just always give out, I will give him time to talk about
how he is feeling and time to cool down”.
Participant 14
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This parent has learned that taking their child’s perspective opens up
a new form of communication to explore. They are already acknowl­
edging their child’s emotional state by giving them time to ‘cool down’
so the child can better articulate how he is feeling. This mirrors the
principle of containment that the Solihull Approach posits as a central
component in successful parent–child relationships. Another parent
outlined each of the important aspects of developing reciprocity in the
parent–child relationship:
3.2.2.3. Facilitating reciprocity. Parents reported that they have learned
the importance of facilitating reciprocity in the parent–child relation­
ship, and also described ways in which they learned to do so. Closely
linked to taking the child’s perspective, one parent noticed that they
have to dedicate time and attention to their child to build a reciprocal
relationship where the child feels comfortable to interact with the
parent.
“It’s the attention like when they come to you with a problem, you
could be getting the dinner ready… it’s the stopping what you’re doing
and the turning and looking at them, and letting them see that you’re
interacting with them”.
Participant 5
Another parent has learned new ways of facilitating conversations
with her daughter, having learned the importance of opening the op­
portunity for conversation:
“I’d normally leave her down there. Now I just give her 5 min and I
go down and I talk to her and she’s beside me and she’ll talk to me”.
Participant 3
3.2.3. Parental Self-Regulation
3.2.3.1. Increasing capacity for managing stress. Many parents recog­
nised changes in how they manage stressful situations. One parent has
developed an increased ability to manage stressful situations and this
has contributed to an increased sense of competence in their ability to
resolve their child’s moments of emotional dysregulation.
“To be a lot calmer like instead of just snapping straight away at them
like it’s kind of like okay well I know what’s going on here to be able to
speak to them and bring them back down and whereas before I wouldn’t
have even tried to talk to them but it’s just like just go to your room
whereas now I was like I can talk to them and figure out what’s going
on”.
Participant 1
3.2.3.2. “Stepping Back”. Many of the parents found themselves over­
whelmed when trying to decide the best course of action to deescalate a
situation. However, the UYCBP helped participants to realise that
sometimes taking a step back was the best way to move forward.
Participant 1 describes this process:
“You’re stressed and they’re stressed and everyone’s stressed out…
it’s us learning when we are stressed as well and we have to take our
time to look after us, as hard as it is…in the last few weeks I’ve made that
time for me, and I’m more at ease with them, and the whole house seems
more at ease, because they pick up on your emotions too… so it’s
knowing and saying well look I need to be chilled, but it is it’s taking that
step back”.
Participant 1
3.2.3.3. Feeling more “At Home” as a parent. The UYCBP has helped
parents feel more comfortable in the parenting role. The combination of
skills that parents have built upon throughout the group has given them
a sense of competence in their abilities, perhaps helped by the group
members all sharing similar stories and normalising different challenges
faced as a parent.
“I feel more hopeful and positive as a mother, that I’m not alone in
what goes on day to day and that I’m more aware and equipped to deal
J. Burke et al.
with it”.
Anonymous
The group also highlighted the parenting abilities they already have,
extracting the many positives that they may not have given themselves
credit for previously.
“It just kind of helps you to realise you know what you can do, to
make it better you know at home”.
Participant 6
3.2.4. Experiences of being parented
“As bad as it sounds at all but like I realise that I don’t want to be the
same kind of mother as my mother… I want to be the opposite”.
Participant 1
As this participant poignantly expressed, the group brought about a
difficult realisation that her experiences of being parented have very
significantly shaped her own values as a parent, specifically providing
an antithesis to the parenting template she hoped to follow. There are
two important interpretations of this quote. Firstly, it demonstrates how
the participant has developed insight into how her own experiences of
being parented have shaped her own parenting style. Second, it portrays
the level of comfort this participant felt within the group format, high­
lighting that the group was successful in creating a safe space for sharing
vulnerability.
3.2.4.1. Behavioural intergenerational transmission. Participants identi­
fied several instances where their current behaviour as parents were
directly linked with their own childhood experiences of being parented.
“It’s only actually in the group that I realised that I was just giving
him everything that I didn’t have, like beforehand I wouldn’t be
thinking twice about that. He has about 10 pairs of runners and … he
really doesn’t [need them] but I know it’s only because I never had it
growing up”.
Participant 1
This parent identified how she tended to be more generous in her
parenting behaviours, as a method of ensuring her children would never
experience the same negative emotions she associated with not having
things she desired as a child. By developing an awareness of this transfer
across generations, she was able to acknowledge that she was over-
compensating for her own unfulfilled needs of childhood and adjust
her behaviour accordingly. Parents also talked about the differences
between generations and how this has challenged them as a parent.
3.2.4.2. Emotional intergenerational transmission. The changes of envi­
ronment between generations also implicates how emotions continue
across family generations. Parents described how they were allowed to
independently run free in fields, and adopted a different level of re­
sponsibility from a younger age, highlighted by one participant:
“when I was 12 I had my first part-time job”.
Participant 3
This excessive independence experienced in childhood has poten­
tially transmitted across generation to the opposite behaviour: a
perception that there is an increased need for vigilance of their child’s
safety.
“To be quite honest I was completely anxious all day that I text the
child all day… ‘Where are ya, what are you doing, how are ya, how’s the
movie’. Just to make sure”.
Participant 3
The phrase, “Just to make sure” highlights how this parent’s level of
vigilance is a measure of the significant level of anxiety some parents
experience when grappling with the balance between freedom, inde­
pendence, and safety. Other participants described how emotions
appear to transmit across three generations, particularly when there is
an increased level of contact in these relationships.
“That will never go away, like when I came in here I had to text [my
mother] to let her know that I arrived safe and I’ll have to ring her when
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Children and Youth Services Review 130 (2021) 106223
I’m leaving and then I’m heading to her straight away after anyway…
My mam is just a worrier… [My son] like my mum, very much, and my
mum’s around every day, he asks me now who’s driving when I’m going
somewhere, ‘oh don’t get Grandma to drive you drive mammy you’re a
better driver’. He’s picked up on my Mum’s worries and anxieties”.
Participant 5
This mother has developed an awareness of how patterns of navi­
gating the world and emotional responsivity do not develop in isolation,
rather they are in part a product of the child’s social influences and the
social environment they develop within. Acknowledging that these
patterns have developed is an essential part of breaking the cycle to
reduce negative emotional reactions such as excessive anxiety fostered
in this family across generations.
4. Discussion
4.1. Summary of key findings
This is the first study to evaluate parental adversity and its rela­
tionship with outcomes in the UYCBP. It is also the first study evaluating
the UYCB in an Irish-based sample, and it was experienced positively by
participants. Average attendance was seven sessions out of 10 (70%),
which is above average for a parenting group (Axford et al., 2012).
Participants valued the facilitator expertise and flexibility, the non-
judgemental and safe space provided by the group, along with the
support and validation received through sharing experiences. Pre to
post-intervention analyses revealed significant reductions in perceived
stress (completer and ITT analysis) and increases in parental self-
regulation (ITT analysis only). Findings indicate improvements in
proximal, parent-based factors but not distal, child-based factors
(Lindsay, 2019). This is consistent with other recent research evaluating
the UYCBP, which observed a similar pattern (Douglas & Johnson,
2019).
Reflexive TA produced three salient themes alongside the theme of
‘Group acceptability’ discussed above. The theme of ‘“Seeing” the child’
aligned with the reciprocity principle of the SA, with subthemes of
‘noticing and recognising’, ‘taking the child’s perspective’ and ‘facili­
tating reciprocity’ identified. Aligning with Solihull Approach’s
containment principle, the ‘Parental self-regulation’ theme included
subthemes of ‘increasing capacity for managing stress’, “Stepping back”,
and ‘feeling more “at home” as a parent’. The last theme named ‘Expe­
riences of being parented’ contained subthemes of ‘behavioural inter­
generational transmission’ and ‘emotional intergenerational
transmission’.
4.2. UYCBP acceptability and effectiveness
Quantitative and qualitative evaluation suggests the group is
acceptable in an Irish-based, PC sample of participants when considering
the core constructs of acceptability (Sekhon et al., 2017). The format of
the UYCBP was engaging for participants. Noticeably, some parents
enjoyed the group involvement as it gave them a sense of empowerment
beyond what was experienced through informational sessions previ­
ously attended primarily involving didactic teaching alone. Facilitating
an atmosphere in which parents can recognise their own abilities
allowing them to feel a sense of empowerment is an essential component
of effective parenting programmes (Walton, 2014) and relates to the
construct of self-efficacy within acceptability.
There is a wealth of research identifying the many barriers to
attending parenting groups (e.g. Lindsay, 2019). Qualitative analysis
conducted in the current study suggests that the UYCBP was able to
reduce these barriers to participation for parents by finding an appro­
priate balance between flexibility and containment. Parenting pro­
grammes that were more accessible for attendees have lower drop-out
rates (Axford et al., 2012), which is a core element of acceptability and
this research provided further support for these findings.
J. Burke et al.
The facilitators’ expertise was evident in how they maintained an
element of flexibility, but also harboured a containing atmosphere,
where participants felt safe to share their experiences in a non-
judgemental space. The value parents placed on this element of the
group highlighted the stark contrast it presented to their daily lives,
where they perceived they faced constant scrutiny and judgement from
unsupportive family members and through ‘school-gate judgement’.
This perceived judgement brought about a sense of shame for parents
and acted as a significant barrier to perceived parental competence and
subsequent positive parenting practices (Mintz et al., 2017). The safe
space allowed parents to feel a sense of togetherness, which contrasted
the isolation felt through perceived judgment outside of the group.
The UYCBP demonstrated significant positive effects for proximal
factors, including perceived stress and parental self-regulation. Results
suggested there was a change in parents’ own perceptions of their child
as a result of the group experience. This allowed for attuned caregiving
and sensitive responding, allowing parents to take a “step back”, rather
than emotive reactions that escalated the situation, which often occurs
when children display EBD (Leslie et al., 2016). The process of learning
self-regulation is more likely to be disrupted when ACEs occur and this
was a new skill for many parents (Ostlund et al., 2019).
The group itself modelled important aspects of parenting which
translated to parents’ own practices with their child. In a supportive
group environment, with appropriate structure and containment, par­
ents reduced their perceived stress and increased their self-regulation
abilities concurrently. These improvements are essential protective
factors against negative outcomes of EBD for themselves and their
children (Evans & Kim, 2013). One of the most important improvements
was in parents’ perceived parental competence. When parents were able
to draw on an internal sense of competence that assured them they are
handling a challenging situation appropriately, it reduced the impact of
external factors outside of their control, such as perceived judgements or
child temperament. Parents also began to realise their potential as a
parent through the successes and achievements they experienced during
the group which may have been forgotten through many instances of
perceived failure before the group. Repeated exposure to successful
experiences of managing their child’s behaviour allowed them to feel
more ‘at home’ as a parent. In line with previous qualitative research on
the UYCBP (Vella et al., 2015), the current study provides evidence
suggesting that the core principles of the Solihull Approach that focuses
on parent-based responses to behaviour were effectively communicated
within the group.
4.3. Parental ACE scores and intervention outcomes
No significant effects of ACE scores were observed in baseline com­
parisons, or in outcome analyses, which differs from existing research
(Blaire et al., 2019; Oxford et al., 2016). A series of conclusions can be
drawn from these findings. No information was gathered about partic­
ipants who did not attend, or dropped out of the group or the research.
Research has already identified the difficulties of engagement for in­
dividuals who are compromised by ACEs (Muzik et al., 2015). It is
possible that those with higher ACEs were less likely to attend in the first
place. There is also the possibility that the constructs evaluated, along
with the measures used to assess these constructs were less affected by
parental ACEs. More specific measures that assessed the parental impact
of trauma (Roy & Perry, 2004) may have more effectively evaluated the
impact of ACEs on group effectiveness. Mean ACE scores were two,
which is higher than the average population, but 50% of participants
still had an “average” ACE score. Evidence highlights how those with
lower ACE scores are more likely to report their child’s behaviours
within the non-clinical range before and after parenting interventions
(Hurlburt et al., 2013). The majority of parents reported their child’s
EBD within the most severe category at both timepoints, suggesting that
certain parents may have had more significant experiences of trauma
than the cumulative ACE score suggests.
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While ACE scores did not significantly impact group outcomes, the
exploration of the parents’ perceptions of their own experiences in
childhood produced some novel realisations for some of the participants.
This was evident through the qualitative piece, in which some partici­
pants highlighted discrete and individual experiences in their childhood
that they could specifically relate to their current parenting behaviours.
These adversities are often individual, discrete, and must be interpreted
through the person’s own perspective. The current findings supported
the notion that an ACE score does not fully capture a person’s experience
of childhood adversity. There are updated ACE questionnaires currently
in development that attempt to better capture the range of adversity
experienced in childhood which are more related to systemic and soci­
etal issues (Bethell et al., 2017). However, the types of ACEs captured in
the narratives of the current study’s participants required more in-depth
exploration, which focused on the meaning each individual inferred
from the experiences themselves. Identifying incidence alone represents
only a fraction of the bigger picture. The key piece of information that
researchers and clinicians need to extrapolate is each parent’s individual
perspective and felt impact of the ACEs.
4.4. Research implications
There are several implications specific to future research that were
highlighted by the present study’s findings. Follow-up measures
extending beyond the length of the programme may have provided more
conclusive data on the trajectory of parents following the intervention.
This would address an important gap in our understanding of how
parents progress over time after completing the UYCBP and determine if
this programme provides comparable long-term benefits on a child’s
behaviour to behavioural-focused programmes.
Finding more sensitive ways to gather information on childhood
adversity is important to improve accuracy of the information, and to
ensure participants feel safe when asked about such sensitive topics.
Accuracy and sensitivity could be increased by asking these questions
through a clinical interview, or by introducing an interrater reliability
component by asking therapists to score the questionnaire after con­
ducting a clinical interview as part of routine clinical practice, for
example.
Conducting cross-service evaluations of a parenting group would be
a more comprehensive approach to evaluate the influence of ACEs on
parenting group outcomes, as it would capture a range of parents across
the range of low and higher ACE scores in PC and more specialised
services respectively. Future research evaluating the impact of ACEs on
parenting should use methods to capturing discrete detail that cannot be
effectively gathered by a binary response questionnaire. This will likely
require a qualitative component given the complexity of each in­
dividual’s perception of an event, the timing and chronicity of such
events, the impact of protective factors and the differences in how
parents relate these events to their current parenting behaviours (Ford
et al., 2019).
4.5. Clinical implications
It is important to emphasise the contained and reciprocal atmosphere
fostered within the group. Parents shared experiences and allowed
themselves to be vulnerable in front of others. This experience has a
powerful healing effect for parents who may not have had supportive
relationships throughout their lives. An individual’s history of
connectedness is a better predictor of their resilience to adversity than
any history of trauma in childhood (Hambrick et al., 2019). The UYCBP
facilitates this connectedness by enabling the development of relation­
ships. The Solihull Approach considers the parent to be the primary
catalyst for change, and considers child behaviour primarily as a product
of the parent–child interaction, notwithstanding a child’s develop­
mental level and communication abilities.
Participants of the current group still represent a vulnerable
J. Burke et al.
population, as many still remain in the “moderate” or “high” range of
perceived stress and are supporting children who display “high” levels of
EBD. Without the on-going support of the group, these parents may find
it difficult to continue their progress, in spite of the improvements they
have experienced. These participants may require further support to
navigate through difficulties as their children grow older and parenting
demands change. This is especially the case for parents who have a
history of trauma (Pasalich et al., 2016). However, if a parent has greater
self-regulatory abilities, they are more likely to manage their behaviours
throughout a child’s emerging independence. It will be essential to
determine if improving proximal, parent-based factors is sufficient to
give parents the ability to alter patterns of challenging behaviours over
time, or if parents need more focused support to do so.
The current study evaluated a sample of parents that was clinically
representative and depicts a real world evaluation of clinical practice. In
keeping with this design, the programme was offered to a more diverse
group of parents, including foster carers, who made up 20% of the
overall sample. The ACE score gathered was that of the foster carer, as
the biological parents were not accessible for many ethical and practical
reasons. This meant that parental ACE scores for this group of partici­
pants did not capture the potentially intergenerational component of
ACEs. The recruited demographic also highlighted the difficulties that
arise in clinical practice of matching people to interventions within
services. That said, findings suggest that the group was acceptable even
with this more diverse group of parents. This is important for service
delivery as it provides evidence that the group can be offered to a diverse
group of parents without losing the core components of the Solihull
Approach. While the group was acceptable for a more inclusive popu­
lation, this diversity may have impacted on the overall effectiveness of
the group.
4.6. Limitations
The research did not utilise a control group, reducing the ability of
authors to attribute statistically significant changes to the programme
alone. Future studies should employ a control group for this reason. The
qualitative and quantitative mixed methodology is a specific strength of
the study. Future studies should employ sufficiently powered quantita­
tive analyses, and more widespread implementation of focus groups to
provide a more representative qualitative analyses and identify potential
nuance between cohort experience.
Introducing a follow-up element would also augment existing evi­
dence for the longer term impacts of the UYCBP. While three different
pairs of facilitators delivered the four UYCBP groups, treatment fidelity
was maintained as each facilitator received comprehensive training
specifically in UYCBP administration. While ACEs scores were relatively
low compared to previous studies evaluating the impact of parental
ACEs on outcomes, this study provided valuable evidence specifically for
this cohort. The current study evaluated a sample of parents that was
clinically representative and depicts a real world evaluation of clinical
practice. In keeping with this design, the programme was offered to a
more diverse group of parents, including foster carers, who made up
20% of the overall sample. The focus group data was gathered from one
intervention group only which contained 6 parents. While qualitative
data gathered in written format from the entire cohort showed compa­
rable findings across all intervention groups, exploring the experiences
of more participants through focus groups may have yielded more in­
sights from parents of other groups.
5. Conclusion
The UYCBP was acceptable for a diverse group of participants,
though an increase in diversity has the potential to reduce the overall
effectiveness for attendees. Group effects were observed mainly on
proximal as opposed to distal factors. This may be a result of the rela­
tional approach adopted by the UYCBP, or because of the characteristics
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Children and Youth Services Review 130 (2021) 106223
of the PC population. However, it must be acknowledged that this PC
sample still represents a disadvantaged group that face many obstacles
in their parenting practices. Finding more clinically relevant ways of
measuring change is also an important consideration for future research.
There were no significant impacts of ACEs observed, which may have
been related to the low mean ACE score of the group overall. More
importantly, the issue of how adversity is truly measured was high­
lighted. Findings suggest that qualitative exploration represents the
most sensitive way of measuring adversity and its individual impacts.
Bringing such adversities into parents’ awareness, specifically in how
they influenced their parenting practices was a significant realisation for
some participants, with positive impacts.
The UYCBP offered Irish parents an opportunity to connect and relate
with other parents experiencing similar difficulties. Parents experienced
a supportive, contained environment where judgement was left outside
the door, allowing space to explore difficult topics and experiences that
brought them to the group. The UYCBP enlightened parents to hold
broader perspectives of their own history of adversity, their child’s be­
haviours and on the importance of fostering a sensitive parent–child
relationship. Parents carried these contained, reciprocal group experi­
ences into interactions with their children. They used insights gained to
better manage behaviour that previously challenged their identity as a
parent. Adversity will visit every parent at some point in their life and
the UYCBP acted as a guiding light on these parents’ journey to feel more
“at home” in their parenting role.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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