Core Components

HNC is an individualised parenting programme that aims to help parents manage noncompliance, oppositional problems, and other conduct problems in children aged 3-8 years. The programmed is delivered in outpatient mental health clinics to families with children who had been clinically diagnosed, but can also be used in a preventative context for families in which the child’s behaviour is of concern, but has not yet reached the level of a clinical diagnosis.  

HNC programme recognises that inappropriate behaviours in children are reinforced by coercive parent-child interactions. This programme therefore aims to disrupt the cycle of coercive transactions by promoting effective parental strategies. HNC is delivered to parents and children by HNC trained practitioners in two phases;

• Phase 1 is the differential attention phase where parents are taught skills to disrupt the cycle of coercive interactions. Parents are taught skills to attend to child’s behaviour; reward positive behaviour; and ignore negative behaviour. The key focus of this phase is the establishment of a positive and mutually reinforcing parent-child relationship. 

• Phase 2 is the compliance training phase. Parents are taught skills to give direct, clear instructions; allow time for compliance; give positive attention for compliance; and time-out procedures for noncompliance. This phase also teaches the use of standing rules, and implementation of parenting skills outside the home environment. 

The number of sessions delivered to complete the programme range from 5-14, with a mean of 8-10 sessions, dependent on how quickly parents demonstrate competence in the taught skills, and the child’s response to the delivered intervention. This is evaluated by practitioners’ in-session use of observational data which determines if parent-child pair is competent to proceed to the next skill of the programme. Sessions are optimally delivered twice weekly to promote regular training and feedback. Each session lasts about 75-90 mins. However, sessions can be briefer, or on a once weekly basis if required. Sessions consist of homework review; practitioner observation of parent-child interaction; as well as teaching and practice of programme procedures/ skills. Parents are given handouts which describe the taught skills, and data recording forms for recording practice sessions carried out at home.

HNC programme is delivered in a clinic playroom, equipped with age appropriate toys, and large enough to sit the HNC practitioner, parent(s) and child. The programme is taught mainly through modelling and role play. Other methods used to teach this programme include; instructions and discussions; use of parent handbooks; and parent-child completion of homework assignments. One practitioner can deliver the programme per family. Families are referred via physicians, school personnel, or as self-referrals. 

Fidelity

Fidelity measures for each HNC session are to be adhered to ensure programme fidelity. This is comprised of a checklist of the key content and process issues for that session.  The checklists can be self-completed by the practitioner, by a supervisor, or other practitioners who observe the session.

Modifiable Components 

HNC programme is delivered to individual families, but has been adapted for use in group settings. An adaptation of HNC programme called “Parent/Child Game” has been delivered in the UK.

Implementation Support

HNC trainers/ core group of specialists deliver initial trainings and booster training sessions to practitioners interested in delivering HNC. They also provide regular consultation for problem solving, trouble shooting, technical support and other implementation issues.  

Licence Requirements

There are no licence requirements to deliver this programme

Start-up Costs

Start-up cost includes 2 days initial training by 2 trainers which cost US$6,000 (i.e., US$1,500/day/trainer) per 20 practitioners. Booster sessions are conducted by 1 trainer and cost US$2,500 per one day session. A minimum of 4 booster sessions are recommended. Training costs and booster sessions costs are not inclusive of travel, hotel and meals. Remote consultation with both trainers cost US$240/consultation, every 3 weeks for the first 4 months (i.e., until the first booster training), and US$120/consultation with one trainer, every 4-6 weeks thereafter. Other costs include practitioner manual which costs £29, copying costs for parent handouts, and sets of toys that are age-appropriate for 3-8 year olds.

If implementing agency/ organisation is not training up to 20 practitioners, then training can be a collaborative venture with other agencies to increase cost-effectiveness.   

Building Staff Competency

Qualifications Required

Psychologists, counsellors, and social workers, with a recommended qualification level of QFC 6 (or higher) are the most appropriate providers of HNC. Practitioners should be accustomed to applying the social learning principles to child behaviour. 

Training Requirements

Practitioners are required to read the HNC therapist manual titled “Helping the Noncompliant Child: Family-Based Treatment for Oppositional Behaviour”. This manual includes HNC programme theoretical assumptions; programme format, content and teaching methods; and assessment methods, assessment materials and parent handouts. Study of this manual before initial training is required.

Training prior to programme delivery is highly recommended. The 2 day in-person initial training (lasting 8 hours per day) is provided by two HNC trainers. This is followed by at least 4 one-day booster sessions, delivered in-person by one HNC trainer at 4, 10, 16-18 and 22-24 months after the initial training. HNC trainers also provide regular 90 mins remote consultation for the purpose of case review and troubleshooting. These consultations are held with both trainers, every 3 weeks for the first 4 months (i.e., until the first booster training), and with one trainer, every 4-6 weeks thereafter. While this is the recommended guideline, the number of booster sessions, booster sessions timelines, and frequency of consultation can be tailored to agencies/ organisations needs, and will vary based on circumstances.

Supervision Requirements

It is recommended that on-site supervisor(s) who are part of the implementing agency provide ongoing, on-the ground supervision.  These supervisors should have a qualification level of QFC 7/8. 

Theory of Change 

HNC programme is guided by social learning theory and behaviour modification principles. This is evident in the core method of programme delivery (modelling and role play), and core programme content.

Values

HNC is an individualised parent training programme aimed at helping parents manage noncompliance, oppositional problems, and other conduct problems in children aged 3-8 years. This out-patient clinic programme aims to disrupt the cycle of coercive parent-child transactions by promoting effective parental strategies. The programmed is delivered to families with children who had been clinically diagnosed, but can also be used in a preventative context for families in which the child’s behaviour is of concern, but has not yet reached the level of a clinical diagnosis.  

• Is your organisation looking to deliver a parenting programme that addresses noncompliance and conduct problems in children aged 3-8 years?

Priorities

• Is your organisation looking to deliver an out-patient clinic intervention?
• Is providing a targeted parenting programme to manage noncompliance and other conduct problems priority for your organisation?
• Would an individualised programme suit your organisation, or would a group parenting programme be a better fit?
• Would your organisation like to deliver a programme to children in early childhood, or would a programme that can also be delivered in middle childhood and adolescence suit better?
• Will the programme be delivered to children who have been clinically diagnosed or also be used in a preventive context?

Existing Initiatives 

• Does your agency have existing parenting programmes that promote positive parenting strategies? Do the existing programmes address noncompliance and other problem behaviours?
• Are the existing initiatives effective? Do the existing initiatives fit your current and anticipated future requirements?
• Are the existing programmes individualised or are they delivered in groups? Are existing initiatives delivered in the clinic, home or other settings?
• Do the existing initiatives address similar outcomes as HNC? Are there components within the HNC programme that are not met by existing programmes?

Workforce

One practitioner delivers the programme per family. HNC practitioners are typically psychologists, counsellors, and social workers, with a recommended qualification level of QFC 6 (or higher). To deliver the programme, practitioners are required to attend a 2 day training workshop (lasting 8 hours per day) and at least 4 one day booster trainings workshops. 

• Does your organisation have qualified practitioners in the relevant fields, who are interested in learning and delivering this programme?
• If not, can your organisation recruit practitioners for this programme?
• Is your organisation committed to supporting practitioner training?
• How many families will your organisation support in the first year? Based on this number, how many practitioners will require training in the HNC programme?

Technology Support

Practitioners receive regular remote consultation for problem solving, trouble shooting and other implementation support.

• Does your organisation have the technology to receive remote consultation from HNC trainers/ core specialists (e.g. telephone, computer/ tablet, internet access)

Administrative Support

HNC programme is delivered in an out-patient clinic playroom, equipped with age appropriate toys. The room should be large enough to sit the HNC practitioner, parent(s) and child. Sessions are optimally delivered twice weekly. Administrative support is needed to recruit families into the programme. 

• Does your organisation have the administrative capacity to support delivery of a twice weekly intervention?
• Does your organisation have access to a facility/playroom to deliver the programme?
• How will families be identified for inclusion into this programme?
• Can your organisation provide administrative support needed to recruit families into this programme?

Financial Support

Start-up cost includes 2 days initial training costing US$6,000 for 20 practitioners and one day booster sessions costing US$2,500. A minimum of 4 booster sessions are recommended. Remote consultation cost US$240/consultation, every 3 weeks for the first 4 months (i.e., until the first booster training), and US$120/consultation every 4-6 weeks thereafter. Other costs include a practitioner manual which costs £29, copying costs for parent handouts, and sets of toys that are age-appropriate for 3-8 year olds.

• How many practitioners would your organisation like to train? Can your organisation afford the training costs, booster sessions, and consultation fees for these practitioners?
• Based on the number of practitioners to be trained, will training be a collaborative venture between your organisation and another organisation in other to make it more cost effective?

Comparable Population 

HNC is a parenting programme that aims to help parents manage noncompliance, oppositional problems, and other conduct problems in children aged 3-8 years. 

• Is this comparable to the population your organisation would like to serve?
• Has your organisation identified families and who will benefit from this programme?
• Have your practitioners stated a need for a programme that addresses noncompliance and other conduct problems in children?

Desired Outcome

HNC programme delivery in children aged 3-4 years was associated with significantly reduced inattentiveness and hyperactivity in children with ADHD; significantly reduced defiance and aggressive behaviour; and significantly improved parenting behaviours.

• Are these priority outcomes for your organisation? Are there other outcomes that your organisation would like to achieve which are outside the premise of the HNC programme?
• Does your organisation have systems in place that address the above desired outcome? If yes, are there unmet needs that the HNC programme will address?