Parenting: The Challenging Task of Modern WorldA Critical Review of COPE (Community Parent Education Program)Strengths and Weaknesses of COPE from the Point of View of Parents and Educators

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Department of Social Work

International Master of Science in Social Work

Parenting: The Challenging Task of Modern World

A Critical Review of COPE (Community Parent Education Program)

Strengths and Weaknesses of COPE from the Point of View of Parents and Educators

Degree report 15 higher education credits Spring 2008

Author: Sahar Kaleibari Notash Supervisor: Anita Kihlström

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Abstract

COPE is one of the state-based public parent education programs carried on in Sweden with an aim to prevent the behavioral problems of young children. This study is a qualitative research to examine the strengths and weaknesses of COPE from the point of view of parents and educators.

The study has an intercultural perspective and intends to assess if the cognitive-behavioral education can lead to the empowerment of parents. Semi-structured interviews are used to gather information. Empowerment and Cognitive-behavioral theories are used to analyze the findings of this study.

According to the findings, meeting other parents with the same problems and learning the behavioral means to create the desired behavior and extinguish the undesired ones are the first strong points of the program according to parents and educators. They also mentioned that gaining self confidence, self control and anger control, as well as learning to behave rationally and according to the correct models are the results of this education.

The most important barrier for the application of COPE is a cultural aspect. The Swedish society is not comfortable with the usage of material means of encouragement and punishment according to my informants. Low participation of parents both in the sessions and discussions is another problem.

Individual empowerment both for parents and educators are achieved in COPE according to the interviews. Parents reported being more secure and in control in relation to children after taking part in COPE. Despite my earlier experiences of family education programs in Iran, reports about social empowerment is lacking in the Swedish context. Meanwhile, parents and educators had some suggestions to improve the program most importantly about social empowerment of parents.

Key words: parent education, empowerment, parent views, educator views, cognitive-behavioral education, COPE.

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Acknowledgment

I would like to thank the Department of Social Work in Göteborg University which prepared a rich ground for my study, and my supervisor Anita Kihlström who helped me in this degree report. Also, I am grateful to the kind cooperation of Astrid Tunås who helped me in gathering information for this report. I would like to thank my dear friends Reyhaneh and Arezou for their kind support and help. Finally, I thank all the informants who participated in my interviews and expressed their views.

Sahar Kaleibari Notash

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1. Introduction

1.1. The research subject: COPE

Social Work with children and families is a specialized area of work in Sweden. The state began to have a stronger role in the family life by introducing new laws about children and women, providing public childcare facilities and emphasizing on dual earner model during the last century. Nuclear family is still the predominant form of family in Sweden, but there are many indicators which show that the situation of the nuclear families is moving towards instability.

Facts like high divorce rate and reduction of fertility as well as introduction of other family patterns are changing the family system in Sweden (Therborn, 2004).

There are several different reasons for the importance of family education in Sweden which makes parent education one of the important areas of social work with families. One reason is that for most people, parenting can be a challenging task of adulthood. They may face a difficult situation in fulfilling this responsibility while this task is an opportunity for learning, growth, and development of them (Marienau C. and Segal J., 2006). Secondly, providing secure and favorable conditions during childhood and adolescence is one of the national public health policies of Sweden. Lastly, mental ill-health is one of the three most important public health issues in Sweden (Bremberg, S. 2003). General family education programs can prevent mental ill health in children. A study done in Canada shows that a significant number of children with behavior disorders do not get support. Ironically, children at greatest risk are more deprived from professional support. This is because they come from the poor socioeconomic strata, and their parents recognize their behavior problems late, and feel stigmatized if they seek assistance (Cunningham, Bremner and, Boyle, 1995). A general family education can cover all social strata including the neediest.

For children of families with disabilities, single parents, or those otherwise receiving long-term social assistance there is a higher risk of unfavourable development in many aspects including mental health. These parents might be at greater risk of early retirement for medical reasons or hospital care for mental problems. According to the Swedish medical authorities single parents with seriously impaired children are especially vulnerable when it comes to financial resources and health (The National Board of Health and Welfare, 2006).

One of the prevalent mental health problems is BMP (Behavior Management Problems).

According to Axberg et al (2007), in Sweden BMP is common among children (4-12%). This problem is increasing and in long-term will result in poor psychosocial adjustment. Barlow and Stewart-Brown (2000) believes that behavior problems in children are an important social, educational, and health issue. They mention that the prevalence of these problems, their stability over time, their poor prognosis, and their costs to both individuals and the society, all point to the need for primary prevention and early effective interventions.

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As a result of mentioned reasons, the Swedish government decided to use the parental support programs for prevention of mental illnesses based on the findings of one hundred different high quality studies which proved the effectiveness of parent education. The parliament and government provide facilities for family education to help with the prevention of mental ill- health by appropriate regulations (Bremberg, S., 2003).

Researching about the implemented programs and their effectiveness is one essential part of the program in order to correct the directions, content and methods of education. A lot of studies are done to assess the effect of the program on the behavior of the children and parents. It is also important to study and research the views of the partners who are participating in the programs and hear their voices and their assessments about their experience of participating in the program. Since COPE is a new program in Sweden, there is no research about its implementation. The only available sources are some reports of educators. So there is a need to study the program in the Swedish society. Also there is little information about the views of parents and educators about the program, and most of the researchers studied the effectiveness of the program on child behavior and parent-child relation according to the positivist ideas of reality. According to Gilbert(2003) individuals and groups construct their own version of reality.

Therefore I want to examine the experiences of parents and educators who are participating in the program.

I have been engaged in family education in Iran for some years. Due to my previous studies in early childhood education, and my working experience in this field, I was interested to observe a similar program in Sweden. As an educator, back home, I observed that all kind of family education has a great influence on parents, mostly mothers. They came to our center to know about their children and how to treat them. As soon as they get education about the family systems, child rights and other related subject, they start to seek their own rights. It seems parent education is a little sparkle which helps them to go ahead. They initiate their own study groups and try to help and support each other in a very patriarchal society. The knowledge and the skills they learn give them power in the family. The social network they participate in, on the other hand make the basis of their individual and social empowerment.

Also, my field placement period in the international master program gave me this opportunity to be in contact with the families and the educators of COPE (Community Parent Education Program). Social department office of Frölunda renders family education program since 2004. I participated in the program and obtained the educational material during my field placement. I decided to perform a study about COPE after being in contact with the families and the educators. I was more convinced about the importance of this study because all the previous studies were concentrated on the effectiveness of the program and views of the participants were generally ignored. There was a need to study the program from the point of view of parents and educators.

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1.2 Problem Area and aim of the study

As mentioned the family education is a tool to enhance mental health. Many researchers studied the effectiveness of these programs, and most of them concluded that these programs are highly effective. There are a few researches about the point of view of parents and educators about the content, method and aims of these programs. The subjective role of the participants is ignored in the most of the studies. This research is going to achieve a deeper understanding about the implementation of these cognitive- behavioral programs. In other words, this study wants to look at the effectiveness of the program from the point of view of the practitioners and service users.

Every educational program has some weaknesses and strengths, whose recognition is a way to enrich them and bring in new possibilities to educate target group better. In this research the weaknesses and strengths of the program will be considered from the point of view of educators and parents to achieve a thorough understanding of the program characteristics. Empowerment theory will be used alongside the cognitive-behavioral theory to interpret the subjects’ ideas about the program and to find a new definition of effectiveness of the program.

1.3. Research Questions.

 What are the strengths of the COPE program from the point of view of the parents and the educators?

 What are the weaknesses of the COPE program from the point of view of the parents and educators?

 Can the behavioral education of COPE result in parents’ empowerment?

1.4 Definitions

The phrase "parent education program" is used here to refer to group-based programs with a standardized format aimed at enhancing parenting skills (Barlow and Stewart-Brown, 2000).

Attention-deficit/hyperactivity disorder (ADHD) is the most recent diagnostic label for children presenting with significant problems with attention, impulsiveness and over activity which is one of the most prevalent childhood psychiatric disorders (Barkley, 1998).

2. COPE

2.1 Background

In Sweden, family education programs implemented by the government are known as

“Interaction programs”. They are the instruments of the government to support parents in two main areas: providing emotional development and creating boundaries for their children. These programs emphasize on collected experience of all the parents in the group. The programs are divided according to different age groups. In the age group of 2-9 years, the goal of programs is to reduce the risk of developing behavior problems. There are three main programs for this age

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group (2-9): De otroliga åren [The Incredible Years], Community Parent Education Program (COPE) and KOMET [COMET] (Bremberg, S., 2003). The programs include watching of movies, discussing problems, providing solutions for them and practicing the solutions.

COPE (Community Parent Education Program) is a family education program which is designed by Professor Charles E. Cunningham in McMaster University Faculty of Health Sciences in Canada. It is a large group version of individual family programs for families of children with ADHA which later have been implemented in mental health clinics (Barkley, 1998, p. 396). The program was introduced to Sweden as of year 2004 (Swedish COPE site).

In Sweden, COPE is implemented by National Institute of Public Health free of charge for all parents of children between 3-12 years old. It has facilities for free child care during the sessions of program. This program is implemented with some changes in content, order of the subjects and movies, and is used as a general family education program in different cities and different centers (National Institute of Public Health website). Most of the educators or leaders are social workers, preschool or school teachers and are educated directly by Charles E. Cunningham, the author of the program, or the private center of ‘Svenska COPE- Foreningen’ under the supervision of Agneta Hellstrom.

2.2 The purpose of COPE

According to Barkley (1998), parents of children with ADHD suffer from low self-esteem, a sense of lack of control over the child’s difficulties, and higher depression. Low regulated behavior of their children causes more controlling and less positive approach to child management. There are some groups pf parents for whom the rate of participation in intervention programs is lower. Younger, economically disadvantaged, socially isolated, depressed, immigrant parents, parents whom the official language of the country is their second language and are culturally different are least likely to enroll in and complete intervention programs. The same is true for parents of children with the most severe problems. On the other hand, studies shows that these groups come to community-based parenting courses more regularly.

Barkley (1998) showed that parent training improves child management skills, enhances parental confidence, reduces stress and improves family relationships. He believes that “Improving parenting skills is accompanied with less behavioral difficulties of children” (p. 394). COPE family education can be a good response to the needs of families who are in trouble or are at risk to be in trouble because of ADHD of the children. Also, COPE teaches self-control strategies, and the group provides a sense of universal parenting experiences with common problems. The group encourages supportive contacts and exchange of knowledge between the parents (Barkley, 1998). These are achieved with a low cost, single-leader program which uses community utilizations to help families.

When the parents find solutions by themselves in the groups, they show more commitment to the findings. They feel they own the solutions and alternative suggestions. This fact reduces their

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resistant for change, and helps them to implement the findings. Finding solutions is a life skill.

This practice helps them to find individual solutions for their own special situations in the future.

They also build skills for cooperative problem solving process (Barkley, 1998).

Providing group education for parents which are facing less severe problems gives more opportunity to help children with more severe problems. The fact that their families use clinical and professional help more frequently is a practical evidence for effectiveness of the program.

COPE is an educational program which is based on social learning-based parenting programs, social-cognitive psychology, family systems theory, small-group interventions and larger- support-group models (Barkley, 1998). This is followed with a coping-modeling problem- solving approach.

According to Barkley(1998), leaders use modeling, role playing, goal setting, and self-monitored homework strategies to introduce new skills. ‘Social-Cognitive psychology’ tries to use attitude change models and it is assumed that optimal shifts in attitudes and behavior will be obtained when parents devise their own solutions and rationales.

2.3 How COPE is implemented

In order to increase the chances of parents’ participation in COPE, the program has predicted the possible causes for parents’ evasion from educational programs. According to Cunningham (1998), some barriers which may stop parents to go to parent education programs are difficulties for day-time attendance, extracurricular activities, travel time or transportation costs, and child care problems. These problems are solved in COPE by different hours for course, using neighborhood schools and facilities, free education and free child care facilities. The whole average 25 member of the group will be divided to five to seven sub-groups who can work together. Each group has a leader who is responsible for keeping members concentrated on tasks and writes the discussion of group and shares them with the large group. Each member must take the responsibilities of the leader in the subgroup.

To have a COPE education in an area these steps is followed:

 Advertising in different places including schools, pre-schools and mental health clinics

 Informing parents about the program and its goals; its format, benefits and advantages for parents in an informative session

 Parent training in a course which is included of 8-16 two hours weekly sessions

 Follow up in monthly discussion for the parents educated in COPE

According to Cunningham (1998) and the leaders which I interviewed, the structure of each session is as follows: The session starts with informal social activities including taking sandwiches and coffee and talking to each other. Then leader outlines session plan by describing what will be done during the session. Subgroups review homework to build self-efficacy and focus on small gains which the results of revision will be presented in large-group. Then the new

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subject will be presented to parents by watching the videotapes which simplifies complex problems by a vignettes depicting, exaggerated version of common child management errors.

Parents in participant subgroups identify errors, discuss their consequences, develop alternative strategies, and formulate supporting rationales instead of the problematic behavior. In the large group proposed solutions are discussed by subgroups and leaders demonstrate the solutions by modeling. Subgroups brainstorm about applications and make a list of the situations which the strategies are applicable. Pairs of parents rehear strategies to strengthen skills, build confidence and prepare for applying the strategies. Leaders plan homework and close the session.

The most important aims of the program are encouraging positive behavior and improving child- parent relationship. Parents learn how to pay attention to the child in a positive way and to identify and encourage or reinforce the child’s good behavior which can improve child’s behavior and make the relationship of parent-child friendly and help to development of language, conversational skills and social competence. Balancing family relationships is another aim which is achieved by education of time management, allocation and attention between siblings, spouse and self. Parents should learn to avoid conflicts by disengaging from escalating conflicts and controlling thoughts which intensify anger.

Another aim is to help parents facilitate managing transitions. That is transition from non- obeying child to cooperative child by using when-then strategies which encourage compliance via the application of the rewarding principles. In this line Point system is introduced in which parents learn how to give points for god behavior and delete points for bad behavior. Collecting of a certain number of points results in a reward. This can help to form a new behavior. Self- regulation strategies are improved by using planning ahead strategies in which parents identify problematic situation and try to help child to develop a plan for that situation and negotiate incentives. Parents should ignore minor errors, reward follow through and review the plans as necessary. Parents are educated to deal with more serious problems by showing some effective responses to aggressive behavior. This can be time-out from positive reinforcement. This includes firm emotionally neutral commands, a quick neutral warning and application of an effective consequence.

Finally, problem-solving is educated using PASTE strategy which implies picking one soluble problem, analyzing the advantages and disadvantages of alternative solutions, selecting the most promising alternative, trying it out and evaluating outcomes.

This is a summary of the COPE program which is outlined by Cunningham and is copied, translated and adjusted to the Swedish needs and was implemented during my observation period.

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3. Earlier researches about behavioral parent educational programs

With the help of librarians in the Gothenburg University’s library and Research Methods course I started my research by searching the recourses in the university library. I started by searching library catalogues like Gunda and Libris and search the following databases: Illumina; Science Direct and Eric. I tried to find books and essays in journals according the following keywords:

Family education, parent education, behavioral education, empowerment, Cope, family social work, Swedish social work, family in Sweden, cognitive-behavioral theory, ADHD, Family Empowerment. Also I used Google advanced search to find some information about Dr Cunningham’s works and researches. I found some research according to the keywords but none of them had both aspects of BPT and empowerment of families. Therefore I selected some of the more relevant works from each aspect.

Most of the researches which are related to the subject of parent education use quantitative methods to study the effectiveness of program on the behavior of parents or children. I did not find qualitative research, studying behavioral parent education (BPT). But there are some works about the empowerment of families and the mental health of their children. I mentioned first the BPT researches and then empowerment researches according to the date from recent to later researches.

3.1. Researches about the Behavioral Parent Education

One of the aims of the study of Axberg, U. (2007) is to evaluate the effectiveness of the parent training program “Incredible Years Series” (IYS) in diverse clinical settings in Sweden. The parents answered various questionnaires before and after participating in the parent-training groups. The results show significant reduction of BMP in the children on all relevant measures.

A significant increase in the self-rated well-being of the mothers was also found.

Hoofdakker, B.J. et al (2007) investigated the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC). They compared a group of 5 months RCC with other group which had 5 months RCC plus 12 educational sessions in group format. Results show that adjunctive BPT enhances the effectiveness of routine treatment of children with ADHD, particularly in decreasing behavioral and internalizing problems, but not in reducing ADHD symptoms or parenting stress.

Reyno, S. M. and McGrath, P. J. examined the parent training literature to distinguish the child, parent, and family factors which can predict the effectiveness of parent education in child behavioral problems. This literature review included from 1980 to 2004 the studies which were about the prevention and treatment of child behavioral problems. Socioeconomic status and maternal mental health are particularly important factors.

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Corkum, Penny V. et al (2005) evaluated a 10-week behavior training program for parents of children with ADHD and also examined whether the inclusion of an intervention provided to children's classroom teachers would result in additional behavioral benefits. Two groups are compared: parent training and parent plus teacher training groups. Results indicate that the program is effective in improving of home behavior of children. Also, greater reduction in children's ADHD symptoms was observed in the second group which shows the importance of teacher education alongside of parent training programs.

Rooke et al (2004) mentioned that many parents of children with conduct problems do not seek professional help. In this research, they studied the relevance of the beliefs of parents about the problem behavior and their attendance in parent education programs. The parents who showed a stronger believe in potential change, and the effect of child’s behavior on parents’ behavior, attended more often. These findings shows the importance of routine open access group parent training offered at schools so that parents feel less stigmatized, and the turnouts would increase.

Bunting (2004) studied a number of systematic reviews of parenting programs effectiveness that summaries the impact of these programs on a range of parental and child outcomes. The findings show that parenting programs can have a positive impact on a range of outcomes, including improved child behavior, increased maternal self-esteem and relationship adjustment, improved mother- child interaction and knowledge and decreased maternal depression and stress. These positive results are maintained over time, with group-based, behaviorally orientated programs.

But high drop-out rates may show the limited effectiveness for a minority of parents.

Andrea M. Chronis et al (2004) reviewed the parameters of BPT including, parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD.

Different longitudinal studies show that BPT has improved both child ADHD behavior and maladaptive parenting behavior. Also there are other improvements like reducing parenting stress and child classroom behavior. Group-based interventions which are more cost-effective, efficient, may be less stigmatizing for some families. Also, researchers emphasis on importance of videotaped modeling and coping modeling problem solving techniques in BPT skills education. Community based programs which are more accessible for low-SES families and those from diverse backgrounds are recommended. Also, parents of children with ADHD may need parent focused interventions like parental psychopathology, marital problems, father involvement, and issues relevant for single parents and parents from disadvantaged backgrounds.

The study of Hartman et al (2003) showed that all of the families don’t benefit from PBT programs and one third of children need clinical help after the intervention. Mothers of boys, exhibiting conduct problems attended a parent training program (The Incredible Years).

Treatment effectiveness was assessed. Results indicated significant decreases in mothers' negative parenting interactions with their children and in children’s conduct problems. Boys with elevated ratings of attention problems showed similar benefits from the parent training program.

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A systematic review by Barlow and Stewart-Brown (2000) examined the effectiveness of group parent education programs that aimed to improve behavior problems in children. Critical appraisal of these studies revealed considerable heterogeneity in the interventions, the populations studied, and the outcome measures used. Nevertheless, these studies suggest that structured parent education programs can be effective in producing positive change in both parental perceptions and objective measures of children's behavior and that these changes are maintained over time.

Cunningham et al (1995) compared a large group community-based parent training program to a clinic-based individual parent training (FT) program. All families of junior kindergartners with above the 90th percentile reported behavioral problems randomly assigned to: (1) a 12–week clinic-based individual parent training (Clinic/Individual), (2) a 12–week community-based large group parent training (Community/Group), or (3) a waiting list control condition. Immigrant families, those using English as a second language and parents of children with severe behavior problems were significantly more likely to enroll in Community/Groups than Clinic/Individual FT. Parents in Community/Groups reported greater improvements in behavior problems at home and better maintenance of these gains at 6-month follow-up. A cost analysis showed that, with groups of 18 families, Community/Groups are more than six times as cost effective as Clinic/Individual programs.

With a look to these researches, I conclude that the BPT is effective for the improvement of the behavioral problems in children and behavior of their parents. Also, it is helpful for improvement of mental situation of parents and children. Group based interventions have better results than individual methods generally and are most cost effective. They attract disadvantaged and marginalized families.

3.2. Earlier Researches about empowerment of families

In their article Parents as developing adult learner, Marienau and Segal (2006) presented that parents as continuous learners whose critical reflections on their experiences with parenting can be a rich fodder for their growth and development. Theories and models are highlighted that may suggest a wider repertoire of approaches for helping professionals who are facilitating parents in their learning and growth.

Johnson et al (2003) explored the extent to which a national random sample of National Assoc of Social Workers members holds beliefs and attitudes congruent with the parent empowerment perspective. Two profiles emerged from the data. Respondents who disagree with statements attributing blame to parents agree with sharing information openly with parents; believe that parents are doing their best, are credible reporters, and are experts about their own children;

agree that workers need research knowledge; and disagree that the child is usually the identified patient in a dysfunctional family. In contrast, respondents who believe parents cause their children's emotional and behavioral problems disagree with open information sharing; disagree

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that parents are doing their best or are experts about their own children; agree that the child is an identified patient in a dysfunctional family; and agree that parents' ideas are important mostly to give the worker clues about family dynamics.

Taub, Tighe, and Burchard (2001) examined the relations between family empowerment, children's mental health, and longitudinal changes in family empowerment. Family empowerment increased significantly over time while a child was receiving mental health services. There was also a trend for an increase in parent-reported community empowerment.

Parents' reports of children's adjustment were found to correlate significantly with both family and service system empowerment at follow-up. Change in family empowerment over time was found to be a significant predictor of change in children's externalizing problems while in services.

Canning and Fantuzzo (2000) mentioned that a brief empowered parent education strategy was developed and evaluated on African American parents who participated in Head Start (a family support program implemented in US). This was compared with a conventional parent education approach. Parents who participated in this unique approach to parent education critisized the content and process of a conventional parent education strategy and collaborated with professionals to design and conduct their own culturally relevant parent workshop. Engagement for parents who participated in the empowered strategy was significantly greater than parents who participated in the conventional one. Content was judged as more relevant and presenter behavior was judged as more respectful than in the conventional approach. Ninety percent of participants queried preferred empowered parent education when asked which workshop they would attend if given the choice.

Bickman et al (1998), in Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy.

Scheel and Rieckmann (1998) mentioned that parents of clinic-referred preschool children are particularly vulnerable to less self-efficacious judgments of their ability to effectively parent their child. It is vital that these parents demonstrate empowerment through proactive involvement in treatment. Parent internal perceptions of stress, family functioning, stress due to child condition, and extra familial influences were considered in separate predictive models of parent self-efficacy and parent empowerment. Stepwise regression revealed parent stress and family functioning as significant predictors of parent self-efficacy, while a broader range of variables that also included parent employment and education constituted the parent empowerment model. These findings support a multiple-level perspective of empowerment that includes self-efficacy.

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Vincent (1996) examined contrasting perspectives to the 'empowerment' of parents, which have informed developments at a national and local level. The first approach is exemplified by social democratic initiatives which define 'empowerment' as a strengthening of the role of parent-as- citizen, through mechanisms designed to encourage the closer involvement of parents in the planning and delivery of local education services. The second definition of empowerment is contained within the Conservative Party's emphasis on promoting the role of the parent-as- consumer, especially through policies claiming to enhance parental choice of school. A third approach, supported by the 'new centrists', emphasizes the responsibility of the individual to empower him/herself, by taking advantage of opportunities to participate. Discourses around 'empowerment' are understood by differently situated groups and individuals.

4. Theoretical framework

To analyze my results I used two different theories: Empowerment and Cognitive- behavioral theory. The empowerment theory is applied for two different reasons which will be explained bellow. The cognitive-behavioral theory is used because COPE program is based on it.

As mentioned in the earlier research part parents of children with behavioral problems are not only isolated and marginalized but also feel guilty and blame themselves continually because of the problems of their children. This situation makes them feel powerless. I used empowerment theory to assess effectiveness of the PBT programs to empower parents.

On the other COPE is based on Cognitive-behavioral theory. The aim of behavioral education is to change from undesired behavior to desired behavior. Empowerment also seeks change of the views about the problems and their roots. By ‘conscious-raising’, empowerment tries to change the understanding of social context of the problems and developing ways of addressing them. It helps people to avoid self-blaming and accept personal responsibilities to achieve change and work on their effectiveness to make change (Payne, 2005). In particular, I would like to examine if the behavioral programs can lead to empowerment of the parents. That is if the behavior change can lead into changing of views and feeling empowered in child-raising.

4.1. Empowerment

Although empowerment came late to social work literature but has achieved prominence in social work. Some social workers think empowerment is the keystone of social work and is the fundamental part of it. The empowerment can be used in several ranges of activities from consulting to involvement in service planning. The purpose of empowerment is to help people resist in front of labeling process which wants to put them down, marginalize and dismiss them (Adams, 2003). It helps people gain collective control to manage their lives to achieve the power of decision and action to get their own goals, influence policies, get a subjective role instead of being object of intervention of society (Payne,2005).

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Empowerment is based on self-directed group-work in an educational process (Adams, 2003).Empowerment help people feel self-worthier by reducing their isolation and connecting them to social relations. It tries to improve self-concept and self-confidence. By sharing experience of stigmatization in collective networks, people can move from dependence to interdependence (Payne, 2005). COPE program tries to improve self confidence in parents by encouraging them to share their problems and find solutions in a peer group.

Empowerment seeks different things for different people. It is searching social justice by bringing equality through equal social right for allocating of resources (Adams, 2003). COPE also, tries to share the resources of society among all people and give them equal opportunities to gain their different needs during a collective action.

There are different interrelated domains of empowerment which can cover different areas of life.

Empowerment includes self, individual, group, organization and community domains. Self, individual and group empowerment which are related to this research will be explained.

The empowered person is more motivated and able to empower other people. So, before empowering other people, social workers need to consider their thoughts, feelings and situation and empower themselves. They need to develop a democratic way of working towards the goal of self-empowerment and empowerment of service-users. For service users, empowerment is to overcome their disempowerment and gain more control over their lives (Adams, 2003).

Empowering individuals is an essential prerequisite for group empowerment. Individual empowerment makes clients more self-directive and assertive, creates positive attitudes toward working with others. Dialogue is center of work and is linked to education and criticality.

Without dialogue there is no communication, and without communication there can be no true education. Again, true dialogue cannot exist unless it involves critical thinking.

(Adams, 2003, p. 66) Similarly, COPE uses dialogue as a central part of its work. Subgroups discuss subjects and present it in the main group. Dialogue takes place among individuals, in small groups, in the big group, among leaders, and between leaders and the group members.

Most of the empowerment is done in group work because of its democratic, participative and humanistic values (Payne, 2005). Adams (2003) believes groups can provide support, reduce the risk of isolation, offer a context in which personal skills can be developed and practiced.

Characteristics of group empowerment are: equality of members, independent decision-making, common problems, confidentiality, free participation, voluntary activity, mutual help and support, sharing the roles of helper and helped, and sharing common experiences (Adams, 2003).

The same regulations of group work govern COPE program.

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As a result of all of the similarities in content and process of COPE and empowerment, I will analyze my findings in the light of empowerment theory in order to assess how much COPE can contribute in empowering parents.

4.2. Cognitive-behavioral social work

Cognitive-behavioral theories are two separate but related groups of ideas. Their origins are psychological learning and psychological theories of perception and information-processing.

Behaviorists think that the only thing that we can study is the behavior. Therefore, the only thing we can change is behavior, if it makes trouble for person. Behavioral work by using a linear model of explanation of behavior (one thing leads to another thing) focuses on specific behaviors. It relies on behavioral principles and learning theory and its intervention is based on research evidenced of effectiveness. Workers help clients to use changed behaviors in many situations and generalize the desired behavior (Payne, 2005).

As Payne (2005) stated the main aim of behavioral social work is increasing desired behaviors and reducing undesired behavior. Some social workers work with the parents of children who have behavior problems. They teach them being consistent and use social skills approach to educate parents. What they learn can be practiced at home. Rewarding is taught alongside time out, fines and penalties. There are practice and homework which will be reviewed in next sessions. Both the process of education and what is educated use cognitive- behavioral rules.

COPE is designed to change undesired behavior of children to the desired behavior by changing behavior of parents. It is an educational program to teach parents how they can change their children’s behavior by using encouragement and punishment. Base of work is cognitive- behavioral theory.

Cognitive-behavioral methods are therapeutic procedures which focus on changing thoughts and feelings alongside, instead of or as a precursor to, changing behaviors.

(Payne, 2005, p.122) This kind of social work uses psychological change of individuals instead of social changes and emphasis on scientific methods .This branch of social work has a limited use and is specially used in some special psychological problems like school phobia, childhood problems and in psychiatric settings, particularly, in the case of cognitive methods, with mild anxiety and depression. These approaches can be used successfully in group work where people have common problems or backgrounds (Payne, 2005).

Some of the important ideas underlying behavioral work which are applicable in COPE are explained below:

Operant conditioning is one of the concepts used in this program. Social workers try to control the contingencies which influence behavior and consequence by positive or negative

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reinforcement and punishment. Encouraging (positive reinforcement) of useful behavior makes the process easier.

Another concept is assertiveness training. It is one of the treating techniques used for lack of confidence. People can practice desired behavior in a safe and supportive situation, so they can use it in the real life.

Cognitive factors such as disorders of perception or attribution (the meaning attached to events and experiences) are the focus of attention in behavioral work. Since the behavior is under the influence of perception or interpretation of the events, undesired behavior is related to misunderstanding. Therefore cognitive work tries to correct the perceptions and interpretation.

The other concept is social learning and modeling. In social learning, social worker focuses on the social situation which can help to learn desired behavior. Modeling is the main idea which people learn especially from the successful behaviors of other people.

Most people do not learn by reading books or being told what to do; getting a demonstration of what to do, experimenting while in a supportive environment and getting feedback and encouragement are important.

(Payne, 2005, p.125).

According to Payne (2005), the following steps are taken in social skills training programs:

 Specify problems where there are gaps in existent behavior and the desired one

 Divide the problems into small stages

 Cognitive work to identify the misunderstandings

 Demonstration of the desired behavior and practicing it

 Connecting changed behaviors together to make more complex ones

 Teaching the application of the learned behavior

As mentioned during the description of COPE program in second part, the same procedure is applied in COPE.

5. Method

5.1 Design

According to Gilbert (2003) classification this research is a policy-oriented applied research. It is an evaluation research which is focused on collecting data to study the effects of some form of planned change. The primary aim of evaluation research is to determine if a particular policy or intervention is working and the purpose of this kind of research is enlightenment.

This research is directed in a qualitative method to grasp the views of the participants of program and approach to their point of view and interpretation of the reality of the program.

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According to Adams (2003), service users’ views and experiences are dismally under- represented in research, theorizing and practice-based material. Thus, their views beside the educators' views are used to evaluate the program. Therefore, I decided to use interviews as the main method of data collection in order to access to service users views.

As May (2001) stated interviews yield rich insights into people’s biographies, experiences, opinions, values, aspirations, attitudes and feelings. Kvale (1996) defines interview as a conversation which has a structure and a purpose, which is to obtain descriptions of the life world of the interviewee with respect to interpreting the meaning of the described phenomena.

Therefore interview is used as a method of data collection in order to include attitudes of educators and parents.

I decided to use semi-structured interview because this method uses techniques from both focused and structured of interview. The interviewer asks specified questions but also is free to probe beyond the answers. The interviewer can record qualitative information about the topic and this enables the interviewer to inter into dialogue with interviewee (May, 2001).

A semi-structured interview was used to collect data. Besides the questions of interview guide, follow up questions used to clarify especially the influence of empowerment theory on the weaknesses and strengths of the program. Three kind of questions (what, why and how) are answered by the interviewees about the program.

5.1.1 Preparing for Interviews

In performing the interviews I was interested about the following questions:

 What are the aims of the program?

 Who can participate in the program?

 What are the content and the method of the work?

 What evaluation systems are used?

 Number, gender and nationality of clients

 Duration and the process of each session

These questions were formed in my mind after I observed the reporting process made by the Health Manger of Frölunda district to political members of the district council about the implementation of COPE. To have more background about the program, I studied further information about the program in the study plans made by educators. The questions of interview guide were prepared according to the views of parents and educators which I collected from the evaluation papers which are regularly filled by participants after each period, observations and the views of educators. The interview guide is available in appendix. The questions are based three main parts: advantages, weaknesses and the ways to improve COPE.

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Later I participated in four educational sessions in order to get familiar with the context of the program. This helped me to get to know the participants. I could contact some of them later and ask them to participate in research.

To get a deep understanding of the advantages and difficulties of the program I needed to be familiar with the views of both parents and educators about the program. Along with the informal meetings with the educators, four set of evaluation papers of the previous COPE programs were gathered and translated by two educators.

5.2 Data collection

I performed semi-structured interviews with four people (two parents and two educators) in English.

The sample is a non-probable sample with volunteer interviewees. In most of the cases researchers redefine their qualitative study population to conform to the available lists. When the goal of a research is to understand the social processes, the researcher uses purposive or non- probability sampling. In this method the chance of selection for each element in a population is unknown and for some elements is zero (May, 2001).

I invited all the participants in different groups to take part in the interviews for this study. Five people volunteered to participate in this study. Three female educators in two different center of Frölunda district and two mothers from two different groups in one center were volunteered to participate in the research. I had met them during the observation phase. Five interviews were planned, according to the number of volunteers. One interview was canceled by one of the educators because of the difficulties of language and no more people were found to replace. One of the mothers had a non-Swedish background but has been grown up in Sweden. The rest of the interviewees were native Swedes.

The interviews were conducted in English because I did not speak Swedish. This proved to be a constraint to the study because many parents were not comfortable to participate in the study due to the language limitations. Only the people who were able to speak in English volunteered to participate in the interviews. Nevertheless, some of them had problems in expressing themselves in English. In one case the interviewee used Swedish language to answer to two questions which are translated by someone else for the researcher with the permission of the interviewee.

Therefore, I believe the language barrier did not affect the research in general.

The interviews were conducted and recorded in a calm place. One of the educators was interviewed in her office in preschool and the other in the group study room in the social work department in the Göteborg University. The parents preferred their houses for the interviews because they have young children.

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In interview sessions, I first thanked the interviewees for their participation. Then I informed them about their rights, and I told them they could ask me about the research after the interview.

The interviews were done according to the interview guide and took at least 40 minutes and maximum around 75 minutes.

Two interviews were stopped several times because of the needs of the children who were present at the interview place. The children made sound and wanted their parents’ attention.

Therefore the parents were not fully concentrated.

5.3 Data processing

All interviews were recorded. Transcriptions were prepared according to the recorded speech.

They included the whole conversations. I sent them later to the interviewees and asked them to read the text and inform me if they found some mistakes or wanted to withdraw their interviews.

But they did not ask me to cut any part of the interview.

The categorization method was used to analyze the interviews. The transcriptions were categorized according to different themes in the interviews in order to facilitate the analysis of the interviews. The categorization method is used to analyze the experience that is shared by a group of people and compare all references to the selected phenomenon in one interview or across several interviews (Gilbert, 2008).

The categorization is done according to the themes of the interview guide. The followings themes are discussed: Why parents need this program, Aims and benefits of program, the weakness and strengths of it, proposals to improve the program, effects of COPE, problems of leaders, problems of application, integrability of the program to the Swedish culture

The interviews were analyzed according to the empowerment theory, cognitive-behavioral theory and research questions.

5.4. Validity, Reliability and Generalizability

Social sciences use reliability, validity and generalizability for verifying of knowledge. Against positivist view which tries to generalize the laws of behavior, a contrasting humanistic view assumes that situations are unique and each phenomenon has its own intrinsic structure and logic (Kvale, 1996). Therefore, the emphasis in this view is on the heterogeneity and conceptuality of knowledge, with a shift from generalization to contextualization.

Analytical generalization is a logical conclusion in which the researcher indicates why (according to similarities and differences and using theory based logical statements) one finding can be used in another situation. In other word, it must be cleared in the process of generalization what is, what may be and what could be in a situation (Kvale, 1996). The interviews and observations were used to answer the question what is, and I used empowerment theory and the

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results to get a logical statement to predict what may be and what could be in next parent education programs.

My sample was somehow biased especially about parents because they were volunteered from people who were interested and were able to speak English. Therefore, they might be more educated and self-confident. It is the same about educators. Also, they accept to have an interview with a non-Swedish student which may show some especial political or social interests.

Therefore they might not be a representative sample of the population in question.

Reliability means the consistency of the research findings. Validity, which is the degree that a method investigates what it is intended to investigate, is changed from a product investigation to the quality control process during the knowledge construction. By emphasizing on pragmatic truth, validity determination in this view seeks for abstractions from a unity, where a comprehensive verification of qualitative research findings will involve observation, conversation and interaction (Kvale, 1996).

As a result of my professional background as a family educator in Iran, I was much dedicated to empowerment theory as a meaningful and necessary tool for family education. I was much interested to assess if the collective family education programs lead to empowerment of parents in Sweden. Therefore, during my interviews, I focused on questions directed to feeling more powerful and getting support from the group. Thus, some of my follow up questions might be somehow leading in this context. In the same way, the transcription of the tape records might be influenced by my personal interests and attitudes when the voice was not clear.

The program is new. Therefore, according to educators, they are not so skillful and practiced about the program to see the weaknesses and the strengths of it. They think they need more time to understand the weaknesses and strengths of the program. It can limit the validity of the research. Also, the language is an important issue. Since it is not the language which researcher and interviewees speak conveniently some meanings might be missed by both partners.

Since I tried to make rapport with the interviewees to encourage them to participate, it is possible that they answered the questions according to what they assumed about my interests and hide some parts of their beliefs.

5.5. Ethical consideration.

According to Kvale (1996) the ethical issues should be considered in seven stages of the research which will be discussed below.

I ensured that the aim of research is not against the society or some groups of it. Since the results can help the improvement of the program, the purpose of the research is in the behalf of the service users and educators.

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The voluntariness of participation in the research was ensued. All of the interviewees were volunteers. They were informed about the purpose of the research and they could ask about the research in the end of interview. Moreover, they were informed that they can refuse to answer a question if they didn’t want, and they could withdraw their statements in the later stage if they choose to. They were advised that if there is a part or some special points in the interview that they don’t want be mentioned they can inform the researcher. The transcriptions of the interviews were sent to the interviewees later.

The confidentiality of the information was also guaranteed by the researcher. Nobody would have access to their personal information. Only the researcher and supervisor and examiner will have access to the tape records and transcriptions. The personal information that may result in their recognition will be eliminated.

To prevent a stressful situation it was mentioned that language problems are common between the interviewee and interviewer. Therefore, they could feel comfortable for thinking about the wording and structuring of the sentences during the interview. The statements of the interviewees were clarified by follow up questions during the interviews to avoid the wrong interpretations.

The interviews were conducted without any stranger. The researcher did not enter in the subjects which interviewees avoided them obviously. Nevertheless, the interviewees seemed stressed because they were not accustomed to speaking English. Also, those whose young children were present during the interview were more uncomfortable.

The analysis is done according to the interviews and theoretical framework. Since the results are not against the interests of special group or person, they can be published. After the completion of grade report, the thesis will be sent to all participants.

6. Results and Analysis

In this part, first the results of interviews will be presented using categorization approach as a qualitative method. Then the results will be discussed according to the theoretical frameworks.

The categorization is according to the themes of the interview guide. The followings themes are discussed: Why parents need this program, Aims and benefits of program, the weakness and strengths of it, proposals to improve the program, effects of COPE, problems of leaders, problems of application, integrability of the program to the Swedish culture. I will describe the results for each theme in the following.

6.1.Why parents need this program

Parents participated in the program because of the following reasons. They heard about the parent education programs from friends. Besides they felt that they have not enough parenting experiences and skills. They felt a need for getting advice and meeting other parents. One of them felt more need for communication with other parents because she is a single mother.

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Educators mentioned another set of the reasons which is categorized in four sections. The first category is behavioral problems of children. They think parents participate in programs because children disobey them and always argue. They think parents don’t have good relationship with their children.

That the child doesn’t listen to them and the parents feel that they are just screaming and arguing don’t have a nice relationship with the child. (Educator 1)

The second category is socio-economical situation of the parents. They stated that most of the time both parents work excessive and are in a stressful economical situation. As a result, they feel guilty that they don’t have enough time for their children and want to be nice with them.

They think if they don’t put limitation for children they will compensate for their absence .In this category also we see single parents which are alone and are not able to do their parental responsibilities.

Because I am a single parent and I don’t have anybody to ask for advice I have only rely on myself when there is tow parents you can communicate and come up with the solutions and see the problems easier so for me that is the most being single makes it hard. So that is why I choose to go to COPE. (Parent 1) There is a cultural aspect for this issue in Sweden as mentioned by the educators. Parents think if they put limitation or are strict with their children other people will think they are not good parent so they feel uncomfortable to do their parental responsibilities. They participate in educational program to overcome this problem.

The last point as mentioned by educators is the lack of parenting skills. They don’t know the best way for putting limitations and giving consequences for bad behavior of their children. The educators stated that the parents are unable to spend a meaningful time with their children in a structured way. It means that even if they find a time to spend with their children, they don’t know how to plan it so that they can construct a good relationship with their children. One educator mentioned that parents give extra importance for domestic works like cleaning and tidying up and can’t dedicate enough time to their children. Besides, the parents don’t know what is the definition and responsibilities of a good parent.

As we can see there are different reasons which attract parents to the program. Some of them can be answered by a behavioral program. They gain skills and tolls to overcome in a difficult situation. On the other hand they empower themselves by meeting the peers and sharing the problem. Problems can be social, economical, cultural, or problems relating to their parenting skills.

6.2. Benefits and aims of the program:

Parents mentioned several benefits which they gained during the implementation of COPE.

These benefits can be categorized into three parts. The first category includes the advantages

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which are usually aimed by the most of the parent educational programs. In this category parents stated that COPE reminded them the essential rules of parenting and taught them to be patient. It helped them to see the situations with different eyes and don’t get confused by different parenting theories. They mentioned that the teachers gave them useful advices.

The second group is the benefits which is obviously related to the cognitive behavioral theory and shows how they learned from a behavioral program. In this category, they mentioned that COPE gave them an organized way of thinking about parenting and improved their strategies for reinforcement and problem solving strategies. It helped them to learn to react in the problematic situation rationally instead of emotionally.

You don’t react with your brain you react with your feelings. You need to be reminded all the time about all the things. (Parent 2)

They think they found a path to follow in parenting and learned how to teach children the rules of prioritizing most important tasks. They learned how to apply different disciplinary methods in different situations. As a last point, they stated that they gained more confidence to be more firm and apply rules.

The third category is the benefits which can be related to self and individual empowerment.

Parents stated that COPE helped them to gain strengths in parental role and feel more secure. It helped them to hear the views and experiences of the other parents. This resulted in a shared experience for them, not to feel alone and feel in the same boat with other parents.

‘I got to meet the parents and I got to be a part of their stories’. (parent 1)

It seems that they improved self confidence and self control and improved parenting styles in the different type of dialogues.

Educators gave similar answers to the question of what are the aims of the COPE. Their answers also are categorized in three main parts. As a usual result of parent education they stated that COPE can help parents to be happy. They can enjoy shared time with children without conflicts and anger. They can meet other parents and give good tips for parenting to each other.

They mentioned that parents can learn the parenting skills together which is obviously related to social learning theory. Also, they stated that parents can find new ways to distinguish and solve problems.

Some of the aims of COPE related to empowerment theory according o the educators are the following. COPE helps parents not to feel alone and teach them to support each other. It makes them stronger parents and improves their self confidence and self control. They can feel more powerful through making their own community and controlling the undesirable situation.

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In short, we can see that parents and educators share the understanding about the purposes of the program. It shows that the program is well-implemented according to the predefined aims. The statements of the parents implicate that they feel more individually empowered. As a result of the education of behavioral tools they gained more control on themselves and their situations. They feel that they are not alone and their situation is not a unique one.

6.3.Strengths of the program

The most important strength point of the program as mentioned by parents is what they learn in the first session. They learn how to pay attention to their children and encourage them. The other important part of the program is planning ahead which helps them learn how to plan their activities and how to help children understand and cooperate with them. Parents mentioned that it is easy for them to learn and apply the planning. The other point which parents think is a new idea and helps them a lot is ignoring bad behavior.

Also educators believe that the most important part of the program is to learn how to pay attention to children and encourage them. The strategies for ignoring bad behavior come later.

They think if parents learn the when-and-then strategies, which help them to plan a prioritized plan for children, they will have fewer conflicts with their children. Also, they will be able to use their time in a useful way. Educators mentioned that improving self control of children can help parents be calmer and teach their children to be independent. Educators think that the program tries to encourage parents in several ways: positive feedback of the educators or peers, as well as the reinforcing results they gain after changing their own behavior with children. This improves the self images of the parents that is parents gain better images of their own parenting skills which encourages them into acting even better. They have a feeling of mutual gain and give.

During the group interactions since they think they bring something into the group, it is easier for them to accept the conclusions in the group.

The other advantage of the program as put forth by educators is giving rational thinking abilities in the parenting issues. They learn to think about their own behavior and its consequences. Also, parents can adjust the program according to their needs.

It can be concluded that parents mentioned cognitive-behavioral aspects of the program as strengthens of it. They have mentioned several points about the behavior control strategies.

Educators also put the cognitive benefits of the program in first place. They mentioned that the behavioral education and behavioral methods improve the behavior of parents beside the behavior of the children. Also they have mentioned some points which can be related to empowerment theory. The benefits of group work and mutual aid of parents can lead to individual empowerment.

Parenting: The Challenging Task of Modern WorldA Critical Review of COPE (Community Parent Education Program)Strengths and Weaknesses of COPE from the Point of View of Parents and Educators

Department of Social Work

International Master of Science in Social Work