Effectiveness and cost-effectiveness of a parenting programme to improve family wellbeing in England (TOGETHER)

Source: Effectiveness and cost-effectiveness of a parenting programme to improve family wellbeing in England (TOGETHER): a multicentre, single-blind, randomised controlled trial

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Number of pages: 12 pages

1. Analytical summary

Context, target populations, and issues

The article starts from the observation of a deterioration in the mental health of children and young people in England, with 1 in 5 children likely to have a disorder in 2023, in a context of significant socio-economic and ethnic inequalities and over 4.5 million children living in poverty. Marginalised families (Bangladeshi, Pakistani, Black) are overexposed to poverty, structural racism, and discrimination, which sustainably undermines the health of parents and children. In light of this context, the team is evaluating the programmeStrengthening Families, Strengthening Communities(SFSC), developed by the Race Equality Foundation, originally designed for socially disadvantaged and ethnoculturally diverse families. The TOGETHER trial is a multicentre, single-blind randomised trial in disadvantaged urban areas (six territories, 34 sites) including 674 parents of children aged 3 to 18, predominantly mothers, on low incomes and often from ethnic minorities. The main issue is whether a universal, culturally inclusive parenting programme can improve parental mental well-being and family relationships without exacerbating inequalities.

Operational contributions for the field

The SFSC programme consists of 13 weekly group sessions of 3 hours (10–12 parents), structured around five components (cultural and spiritual identity, rites of passage, relationships, discipline, community involvement) and co-facilitated by two trained facilitators, sometimes peers with lived experience. The trial shows a significant improvement in the mental well-being of parents (WEMWBS) at the end of the programme and at 6 months, a decrease in the child's socio-emotional difficulties after the intervention, and a lasting reduction in the impact of these difficulties on the child's daily life. Positive parenting practices increase, negative practices decrease, parent-child conflicts reduce, relational closeness improves, and the quality of the couple's relationship progresses at 6 months. These effects are observed without major differences between ethnic groups or socio-economic levels, suggesting a potential for reducing or at least not exacerbating inequalities. Economically, the average cost per participant is £1,081, with no formal demonstration of short-term cost-effectiveness for QALYs, but with a cost increase deemed moderate in light of the clinical benefits.

2. Key points of the document 

1. Effectiveness on parental mental well-being

   The trial shows a significant improvement in the WEMWBS score among parents in the SFSC group, both post-intervention (mean difference 1.89) and at 6 months (1.66), while the control group deteriorates [file:1, p. e233–e234, e240–e241]. This gain, although small to moderate, is considered clinically relevant at the population level [file:1, p. e242].

2. Improvement in the child's socio-emotional difficulties

   Les scores « Total Difficulties » du SDQ sont significativement plus bas dans le groupe SFSC en post‑intervention (–1,12), même si l’effet ne se maintient pas pleinement à 6 mois, tandis que l’impact des difficultés sur la vie quotidienne de l’enfant (score impact) est significativement réduit à 6 mois (–0,37) [file:1, p. e239–e241]. Cela confirme un bénéfice sur le fonctionnement de l’enfant au‑delà des seuls symptômes [file:1, p. e242].

3. Effets positifs sur les pratiques parentales et les relations familiales

   Le programme augmente les pratiques parentales positives (MAPS) et réduit les pratiques négatives en post‑intervention et à 6 mois, diminue les conflits parent‑enfant et renforce la proximité relationnelle, avec des effets stables à 6 mois [file:1, p. e239–e241]. La qualité de la relation de couple s’améliore également à 6 mois (QMI), ce qui suggère un impact plus global sur le climat familial [file:1, p. e240–e242].

4. Inclusion de publics défavorisés et diversité linguistique/culturelle

   L’échantillon est notablement divers : 62% de parents issus de groupes ethniques minorisés, 50% dont la première langue n’est pas l’anglais, plus de la moitié avec un revenu annuel inférieur à 20 000 £, et un recours important à des versions du programme dans d’autres langues (turc, somali, bengali, arabe, etc.) [file:1, p. e234–e238]. Aucun gradient défavorable n’est observé selon l’ethnicité ou le statut socio‑économique sur les effets du programme [file:1, p. e241–e242].

5. Coût et absence de preuve forte de coût‑efficacité à court terme

   The average cost of the SFSC programme is estimated at £1,081 per participant, with an average incremental cost per family of £703 compared to the control and a gain of 0.0087 QALY for the index parent [file:1, p. e238–e241]. The cost-effectiveness probabilities remain low at the usual UK thresholds (£20,000–£30,000/QALY), but the authors highlight that the clinical benefits and the community nature of the programme may justify the investment from a broader public health perspective [file:1, p. e241–e243].

3. Action points for local stakeholders

1. Integrate SFSC-type parenting programmes into local health and prevention strategies

   Local authorities, ARS, PMI services, mental health teams, and social centres can schedule cycles of 13 group sessions, free for parents, prioritising disadvantaged neighbourhoods and marginalised families, similar to the six English urban areas involved [file:1, p. e235–e238]. It is essential to align these programmes with existing offers (mental health, social support, early childhood services) to maximise the effects on family well-being [file:1, p. e242–e243].

2. Plan for systematic linguistic and cultural adaptation

   The study shows that translating materials, using multilingual community facilitators, and considering the ethnocultural identity of parents promote engagement and adherence to the programme [file:1, p. e235–e237]. In practice, this involves co-constructing the sessions with local associations, intercultural mediators, and resource parents to ensure cultural relevance [file:1, p. e235–e236].

3. Use the five-component structure as a framework for other collective actions

   The dimensions addressed in SFSC (cultural/spiritual identity, rites of passage, relationship, discipline, community bond) can inspire the design of group workshops in other settings (schools, social centres, mobile teams) [file:1, p. e236–e237]. Professionals can use this structure to plan thematic sessions on parenting, incorporating the tools and techniques described in the appendix and protocol [file:1, p. e236–e238].

4. Establish a systematic follow-up of effects (WEMWBS, SDQ, family relationships)

   The article illustrates a range of validated tools that allow for tracking the impact on parental well-being, children's difficulties, and family relationships (WEMWBS, SDQ, MAPS, CPRS, QMI, EQ-5D-5L) [file:1, p. e236–e240]. Local structures can draw inspiration from this to set up realistic before/after evaluations (short questionnaires, limited time) in order to document the effects of their actions to funders and partners [file:1, p. e241–e243].

5. Anchor these programmes in a comprehensive policy for reducing inequalities

   The authors emphasise that parenting programmes, even if effective, are not sufficient on their own to correct health inequalities; they must be combined with measures addressing poverty, housing, discrimination, and access to services [file:1, p. e234–e235, e242–e243]. For local actors, this implies positioning parenting groups as one of the pillars of a broader strategy (economic support, combating racism, violence prevention, access to rights) [file:1, p. e242–e243].

4. Additional References

🔍➕ For more information, see the articles referenced by "Pratiques en Santé" on the topic of parenting ➡️🔗https://pratiquesensante.odoo.com/5-3-parentalite

1. Al Sager A et al., 2024 – Multi-component parenting interventions and mental health

   Al Sager A et al.Effects of multi-component parenting and parental mental health interventions on early childhood development and parent outcomes: a systematic review and meta-analysis (The Lancet Child & Adolescent Health, 2024). Recent review showing the overall effectiveness of multi-component parenting programmes on parental mental health and the development of young children.https://pubmed.ncbi.nlm.nih.gov/38779297/

2. NICE 2022 – Guidelines on social, emotional and mental wellbeing in schools

   NICE guideline NG223Social, emotional and mental wellbeing in primary and secondary education(2022). Recommendations on group interventions, family involvement, and the promotion of mental wellbeing, useful for aligning parenting programmes with schools.https://www.nice.org.uk/guidance/ng223/chapter/recommendations

3. Foundations, 2025 – Systematic review on parents with complex needs

   Foundations, 2025.Systematic review of interventions and practices for parents with complex and multiple needs(research report). Synthesis confirming the relevance of parenting programmes, particularly group-based, for parents with multiple vulnerabilities, with indications on good practices for cultural and structural adaptation.https://foundations.org.uk/wp-content/uploads/2025/02/systematic-review-interventions-practices-parents-complex-multiple-needs.pdf

5. Cross-sectional analysis — Values of Health Practices

• Literacy : Le document utilise des outils standardisés (WEMWBS, SDQ, etc.) mais dans le dispositif, des traductions, des chercheurs communautaires et des supports multilingues sont mobilisés pour s’adapter à des parents à faibles compétences linguistiques en anglais [file:1, p. e235–e237].

• Empowerment : Les parents sont positionnés comme acteurs de changement et non comme « bénéficiaires passifs », via un programme qui renforce compétences parentales, confiance, gestion des difficultés et liens communautaires [file:1, p. e235–e237, e242].

• Participation : La co‑construction est présente à travers des groupes conseil de parents, une co‑investigatrice communautaire, des chercheurs communautaires et un partenariat fort avec la Race Equality Foundation [file:1, p. e235–e236].

• Santé communautaire : La dimension collective est explicitement intégrée, SFSC étant conçu comme une intervention de groupe avec un volet « implication communautaire » et un fort ancrage dans des organisations locales [file:1, p. e235–e237, e242].

• Éthique : Les auteurs documentent les biais structurels (racisme, désavantage socio‑économique), détaillent la procédure d’éthique et le suivi d’événements indésirables, et reconnaissent les limites de représentativité (faible proportion de pères) [file:1, p. e233–e235, e242–e243].

• Droits humains : L’approche vise à ne pas creuser les inégalités, cible les zones défavorisées, favorise l’accès des familles minorisées et insiste sur l’équité et l’inclusion linguistique et culturelle [file:1, p. e234–e238, e242].

• Intersectorialité: The programme involves local authorities, health services, social services, schools, and community associations, although the detailed analysis of partnership governance remains limited [file:1, p. e235–e238].

• Partnership: The model is based on a structured partnership between the university, Race Equality Foundation, local authorities, and communities, with a sharing of roles between programme designers, researchers, and field actors [file:1, p. e233–e236].

• Combating discrimination: The document acknowledges the role of racism, xenophobia, and discrimination as major health determinants for the targeted families and values a programme explicitly focused on ethnocultural identity and the strength of communities [file:1, p. e233–e235, e242].

6. Assessment of the reliability of the resource

• Scientific relevance

  • Multicentre, single-blind randomised trial, with 674 participants and sufficient statistical power to detect a standardised effect of 0.3 on parental mental well-being [file:1, p. e235–e236, e239–e241].

  • Use of internationally validated scales (WEMWBS, SDQ, MAPS, CPRS, PMS, QMI, EQ-5D-5L) and intention-to-treat analyses, with adjusted mixed models and rigorous handling of missing data [file:1, p. e236–e240].

  • Review of the literature updated until 2025, reasoned discussion of the results and limitations (selection, low participation of fathers, follow-up duration limited to 6 months) [file:1, p. e234–e235, e242–e243].

• Operational relevance

  • Detailed description of the programme (duration, structure, components, recruitment methods, linguistic adaptation) allowing for concrete transposition in other contexts [file:1, p. e235–e237].

  • Results directly usable for planning: family profiles, attrition rates, costs, effects on relevant field indicators (parental well-being, child behaviours, family relationships) [file:1, p. e238–e243].

  • Limitations: lack of detailed description of the pedagogical tools used session by session in the main article (present in the appendix and programme resources), cost-effectiveness horizon limited to 9 months [file:1, p. e236–e237, e241].

7. MCQ — 5 questions

Part 1 — Questions (without the indicated answers)

Question 1 (p. e233–e235)

What was the main objective of the TOGETHER trial?

a) To reduce the number of hospitalisations for psychotic disorders in adolescents

b) To evaluate the effectiveness and cost-effectiveness of the SFSC programme on parental mental well-being

c) To compare SFSC with other parenting programmes based on intensive family therapy

d) To test an exclusively online parenting programme for parents of children under 3 years old

Question 2 (p. e235–e238)

What family profiles were predominantly included in the study?

a) High-income families living in rural areas

b) Families of young children hospitalised for chronic illnesses

c) Families living in disadvantaged urban areas with high ethnic and linguistic diversity

d) Families without children but with parenting plans

Question 3 (p. e236–e237)

Quelle est la structure principale du programme SFSC évalué ?

a) Cinq séances individuelles de 1 h avec un psychologue clinicien

b) Treize séances hebdomadaires de 3 h en groupe, co‑animées par deux facilitateurs formés

c) Dix séances hebdomadaires de 2 h, uniquement en ligne, animées par un psychiatre

d) Un atelier unique de 6 h combinant parents et enfants dans la même salle

Question 4 (p. e239–e241)

Quel résultat concernant le bien‑être mental parental (WEMWBS) a été observé ?

a) Aucune différence significative entre SFSC et groupe contrôle à tous les temps de mesure

b) Une amélioration significative du bien‑être parental dans SFSC uniquement en post‑intervention, mais pas à 6 mois

c) Une amélioration significative du bien‑être parental dans SFSC en post‑intervention et à 6 mois

d) Une détérioration significative du bien‑être parental dans SFSC par rapport au groupe contrôle

Question 5 (p. e238–e241)

Que montre l’analyse économique de l’intervention SFSC ?

a) Un coût nul grâce à un financement intégral par l’industrie pharmaceutique

b) Un coût moyen d’environ 1081 £ par participant, avec une probabilité de coût‑efficacité faible aux seuils habituels de QALY

c) Un programme systématiquement rentable avec une probabilité de coût‑efficacité supérieure à 90% quel que soit le seuil

d) Une absence totale de collecte de données économiques dans l’essai

Partie 2 — Correction commentée

Question 1 : Quel était l’objectif principal de l’essai TOGETHER ?

✅ Correct answer: b) Evaluate the effectiveness and cost-effectiveness of the SFSC programme on parental mental well-being

📝 Explanation: The TOGETHER trial is designed as a multicentre randomised trial to measure the effectiveness and cost-effectiveness of SFSC on parental mental well-being (primary outcome) and the socio-emotional well-being of children [file:1, p. e233–e235]. Source: p. e233–e235.

Question 2:What family profiles were predominantly included in the study?

✅ Correct answer: c) Families living in disadvantaged urban areas with high ethnic and linguistic diversity

📝 Explanation: Participants live in disadvantaged urban areas (London, Luton, Leeds, etc.), over 60% are from ethnic minorities, about half have a first language other than English, and more than half have an annual income of less than £20,000 [file:1, p. e234–e238]. Source: p. e234–e238.

Question 3:What is the main structure of the evaluated SFSC programme?

✅ Correct answer: b) Thirteen weekly 3-hour group sessions, co-facilitated by two trained facilitators

📝 Explanation: SFSC is described as a programme of 13 weekly 3-hour sessions, in a group of 10–12 parents, co-facilitated by two trained facilitators according to a standardised manual, sometimes peers [file:1, p. e236–e237]. Source: p. e236–e237.

Question 4:What outcome regarding parental mental well-being (WEMWBS) was observed?

✅ Correct answer: c) A significant improvement in parental well-being in SFSC post-intervention and at 6 months

📝 Explanation: The WEMWBS scores show an average difference of 1.89 post-intervention and 1.66 at 6 months in favour of the SFSC group compared to the control group, with deterioration in the control group [file:1, p. e239–e241]. Source: p. e239–e241.

Question 5:What does the economic analysis of the SFSC intervention show?

✅ Correct answer: b) An average cost of approximately £1081 per participant, with a low probability of cost-effectiveness at the usual QALY thresholds.

📝 Explanation: The average cost per participant is estimated at £1081; the incremental cost is £703 with a gain of 0.0087 QALY, and the probability of cost-effectiveness remains low at the standard thresholds of £20,000–30,000/QALY, despite some service cost shifts [file:1, p. e238–e241]. Source: p. e238–e241.

8. Frequently Asked Questions (FAQ)

1. Which audiences does the SFSC programme target in this study?

   The programme targets parents or caregivers aged 18 and over, responsible for children aged 3 to 18, living in disadvantaged urban areas and often from ethnic minorities, with a significant proportion of low-income families and newcomers [file:1, p. e235–e238].

2. What is the main objective of the SFSC programme as evaluated in the TOGETHER trial?

   The main objective is to improve the mental well-being of parents, seen as a lever to enhance parenting practices, the quality of family relationships, and the socio-emotional well-being of children [file:1, p. e233–e235].

3. How does a SFSC cycle actually take place?

   The cycle includes 13 weekly sessions of 3 hours, in groups of 10–12 parents, co-facilitated by two trained facilitators, following a manual structured into five components (cultural/spiritual identity, rites of passage, relationships, discipline, community involvement) [file:1, p. e236–e237].

4. What types of outcomes can a service reasonably expect in terms of mental health and children's behaviour?

   Services can expect a modest but significant improvement in parents' mental well-being, a reduction in children's socio-emotional difficulties immediately after the programme, and a lasting reduction in the impact of these difficulties on daily life, as well as an improvement in parenting practices and family relationships [file:1, p. e239–e242].

5. Does the programme work equally well for disadvantaged families and ethnic minorities?

   The analyses show no significant differences in effectiveness based on ethnicity or socio-economic status, suggesting comparable effectiveness for very diverse families, including the most disadvantaged [file:1, p. e241–e242].

6. What are the main limitations of the study to be aware of before transposing this programme?

   The authors note the low proportion of fathers (5%), an attrition rate of about 30% at 6 months, a limited follow-up duration, and the selection of parents able to commit for 13 weeks, which restricts generalisation to all families [file:1, p. e239–e243].

7. How should cost and cost-effectiveness aspects be interpreted for local decision-making?

   Although the analysis does not demonstrate strong cost-effectiveness in the short term in terms of QALY, the additional cost per family is moderate, and the authors advocate for the programme in light of its clinical benefits, population potential, and its pro-equity orientation in disadvantaged contexts [file:1, p. e238–e243].

9. Rewriting in Easy Read 

Easy Read Title

A programme to help parents and children in England

Context and issues (Easy Read)

• In England, many children have mental health problems.

• Poor families and those from minority backgrounds are more affected by these problems.

• The SFSC programme helps parents to live better with their children.

• Parents attend group sessions for thirteen weeks.

• Researchers want to know if this programme really helps families.

Operational contributions (Easy Read)

• Parents who attend SFSC feel a bit better mentally.

• Their children have slightly fewer behaviour problems after the programme.

• Family relationships become a bit calmer and closer.

• Parents shout less and use more positive parenting practices.

• The programme costs money but remains feasible for public services.

Key points in Easy Read

1. Well-being of parents

   • Parents' morale improves after the programme.

   • This effect continues for another six months after the sessions end.

2. Well-being of children

   • Children have fewer difficulties after the programme.

   • Problems interfere less with their daily lives.

3. Family relationships

   • Parents and children argue a little less.

   • They feel a little closer to each other.

4. Concerned families

   • Many families have little money.

   • Many parents do not speak English as their main language.

5. Cost of the programme

   • The programme has a cost for each participating parent.

   • The benefits are interesting but not huge in the short term.