Children’s well-being is a serious and growing concern in the UK, as elsewhere. According to Professor Richard Watt and colleagues (2026), writing in The Lancet Public Health, “The National Health Service reported in 2023 that one in five children and young people in England had a probable mental disorder, a sharp increase since 2017 when the prevalence was estimated to be 13%.” This problem is exacerbated for children growing up in poverty or racialised communities.
Can a simple intervention like a parenting support group help struggling children and families thrive? And can it be implemented cost-effectively across culturally and economically diverse settings? Aiming to address socioeconomic health inequalities in the UK and to improve parental and societal well-being, the researchers assessed the effectiveness and cost-effectiveness of a group-based intervention called Strengthening Families, Strengthening Communities (SFSC).
Unlike most other parenting programmes, SFSC was developed by the Race Equality Foundation to engage and support ethnically diverse families. It emphasises the importance of ethnocultural identity and works to strengthen parents’ connections within their communities, based on the premise that these connections encourage parents’ well-being, thereby leading to more positive parenting practices that enhance their children’s development.
Children’s well-being is declining, with the incidence of mental disorders now approaching 20% in the UK, with problems particularly exacerbated in ethnically diverse families and those experiencing poverty.
Methods
This randomised intervention study was conducted in 34 socially and ethnically diverse urban areas across England. Adult caregivers of children aged 3-18 participated in 13 weeks of 3-hour group sessions. Data were collected for both intervention and control groups at the beginning of the study, immediately following it, 3 months after completion, and 6 months post-intervention.
A wide range of outcomes were assessed. Measures included the Warwick-Edinburgh Mental Well-Being Scale, the Total Difficulties score on the Strengths and Difficulties Questionnaire to assess children’s socioemotional well-being, the Multidimensional Assessment of Parenting Scale, the Pearlin Mastery Scale to assess self-efficacy, the Child–Parent Relationship Scale, the Quality of Marriage Index, an adapted Buckner scale assessing neighbourhood belonging and social cohesion, and the 5-level EQ-5D, assessing health-related quality of life.
Cost-effectiveness was analysed with a complex comparison of SFSC costs and gains in participants’ health-related quality of life.
Results
674 participants in 34 urban sites with high proportions of deprivation were randomly assigned either to the control group (n=314) and put on the waiting list, or to the intervention group (n=360) and invited to participate in the Strengthening Families, Strengthening Communities (SFSC) programme. Participants were recruited across England. The majority of participants (65%, n=435) were from London, and the remaining participants (35%, n=239) were from other urban areas, including Luton, Leeds, Calderdale, Hull, and Kirklees.
Participants were mostly female (95%, n=641). Just over half (52%) had household incomes lower than £20,000 per year, and about a quarter had incomes under £10,000 per year. The majority (62%) came from ethnic minority groups; more than half (56%) were born abroad, and half did not speak English as their first language. The biggest religious group was Muslim (46%), with 26% of the study participants describing themselves as having no religion and 23% as Christian. The vast majority of participants (93%) were the birth mother of the index child, and most (57%) lived in 2-parent families.
Family characteristics and outcome measures showed no substantial between-group differences at baseline.
Results showed many important benefits of SFSC participation, with no differences across ethnic and socioeconomic groups. At the 6-month follow-up, participants in the SFSC programme reported higher parental well-being (the primary outcome measure) (adjusted mean difference 1·66 [95% CI 0·30 to 3·02]) as compared with those in the control group.
Seven of the ten secondary outcome measures also showed improvements for the programme participants relative to the control group. Benefits sustained at the 6-month follow-up included a reduction in the extent to which problems interfered with the child’s daily life (–0·37 [–0·72 to –0·03]), more positive parenting practices (0·07 [0·01 to 0·14]), fewer negative parenting practices (–0·11 [–0·26 to –0·05]), fewer child-parent conflicts (–2·08 [–3·16 to –1·01]) and improved closeness in child–parent relationships (0·83 [0·26 to 1·39]). There were no between-group differences in community engagement, social cohesion, or parental self-efficacy.
In order to assess cost-effectiveness, the researchers calculated mean cost per participant, including SFSC intervention costs, costs for the index parent and child, and quality-adjusted life-years (QALYs) for the parent. They found that the incremental cost per family in the intervention group versus control group was £703 (95% CI £26 to £,1380) and the QALYs gained were 0·0087 (95% CI –0·0055 to 0·0229).
Parenting support groups that strengthen parents’ connections to their ethnocultural communities are cost-effective and reduce the health gap.
Conclusions
The Strengthening Families, Strengthening Communities parenting programme was beneficial for its participants at a relatively small cost. The authors concluded:
The findings from this trial, when combined with previous evidence, indicate that parenting programmes such as SFSC can effectively improve parental and child outcomes in diverse and disadvantaged communities. The SFSC programme offers a scalable, culturally inclusive approach to supporting families, particularly those from ethnic minority groups who are often under-represented in research. Policy makers and commissioners can consider implementing SFSC as part of a wider set of measures to promote child and family wellbeing and address social determinants of health.
The Strengthening Families, Strengthening Communities parenting programme improved parents’, children’s, and families’ wellbeing in a culturally diverse sample of participants living in disadvantaged areas across England.
Strengths and limitations
This was a solidly designed and implemented study, with compelling results that support providing SFSC-type programmes more widely across the population.
The Strengthening Families, Strengthening Communities programme was carefully designed to address concerns about children’s mental health. It involved many site-specific pilots and a great deal of consultation with a wide range of professionals and others across socially, culturally, linguistically, and economically diverse communities.
The implementation of SFSC appears to have been thoughtful and methodical. From start to finish, the researchers respected and incorporated a wide diversity of communities’ perspectives and needs. In areas with a preponderance of speakers of languages other than English, the programme material was translated and delivered by someone who shared that first language, including Turkish, Bengali, Somali, and Arabic.
While it’s striking that so many of the outcome measures showed statistically significant improvements for the programme’s participants, the between-group differences were relatively small. This raises the question, how much of a difference did the programme actually make for participants? The authors address this in the report, observing that parenting support programmes typically yield small effect sizes, and that although communities have to do a lot more in order to provide the range of supports required by those living in disadvantaged circumstances, the small difference that parenting support groups provide can make a large difference over time and across the population.
I’d like to have seen the within-group ranges for outcome measures. There may have been individuals who benefited enormously from participating in SFSC, while most of the participants showed marginal or no benefits. This kind of analysis might help future researchers and practitioners better understand who might benefit most from this kind of programme.
I would also like to have seen a sampling of comments from SFSC participants and providers, both positive and negative. Even a few comments would have brought a human dimension to a well-written, but rather dry report, about a very human set of problems.
Another question I have concerns the importance of the cultural inclusion and social cohesion focus of SFSC. While there is considerable evidence for the importance of respect for cultural differences, SFSC may have overemphasised this at the expense of other parenting support goals. Two of the three outcome measures that showed no between-group differences assessed community engagement and social cohesion. Perhaps these factors weren’t as important to the participants as they were to the programme designers?
The SFSC was a solidly designed parenting programme that was carefully implemented and provided compelling support across urban areas, especially culturally, linguistically, and economically diverse communities.
Implications for practice
It is a worrisome time for those of us who work with troubled families. More and more children are showing signs of mental health challenges, and very few parents know how to respond to these problems. This is especially true for parents who are coping with challenges of their own, whether physical, emotional, financial, or social.
As the authors of this study point out, a parenting support group like Strengthening Families, Strengthening Communities can’t be expected to address all the problems posed by financial distress, racism, and mental and physical health challenges. If, however, such a programme goes a little way toward improving parents’ and children’s well-being, behaviour, and relationships, and does so in a way that respects cultural diversity, that’s valuable.
One of the biggest differences between SFSC and other parenting programmes is the fact that it was developed in consultation with the Race Equality Foundation, with the intention of engaging and supporting ethnically diverse families. By emphasising the importance of ethnocultural identity and working to strengthen parents’ connections within their communities, it has a better chance of supporting parents’ well-being in ways that lead to more positive parenting practices, thereby supporting their children’s well-being.
While the results of the study did not show an increase in participants’ sense of social cohesion, I have to think that respecting cultural diversity helps them engage with the parenting group sessions. And perhaps, as the authors point out, it takes longer than six months before changes can be seen in parents’ sense of connection to their community.
Based on the results of this study, I agree with the authors’ conclusion that the implementation at scale of evidence-based parenting interventions like SFSC would go some way to promoting family and child health, and would thereby support communities in thriving.
I also agree with the authors’ conclusion that…
Further research is […] required to assess whether the SFSC programme could be implemented as part of a wider range of complementary pro-equity policy measures to support families and address health inequalities in the long term.
At a time when children’s well-being is a serious and growing concern, especially in diversely challenged neighbourhoods, parenting programmes can be of immense value.
Statement of interests
Dona Matthews has no conflict of interest.
Edited by
Dr Dafni Katsampa.
Links
Primary paper
Richard Watt, Annemarie Lodder, Leandra Box, Andrew Brand, Jabeer Butt, Mike Crawford, Anja Heilmann, Zoe Hoare, Saffron Karlsen, Yvonne Kelly, Karlet Manning, Efthalia Massou, Stephen Morris, Hana Pavlickova, Paul Ramchandani, Grzegorz Suldecki, Timothy Weaver, Anita Mehay (2026). Effectiveness and cost-effectiveness of a parenting programme to improve family wellbeing in England. The Lancet Public Health Volume 11, April 2026 e233-44 DOI: 10.1016/S2468-2667(26)00046-0
