Core Components

NFPP is an individualised parenting programme designed to help parents manage ADHD in preschool children. This home based intervention educates parents about ADHD. It also teaches them behavioural strategies to promote self-regulation, and reduce inattentiveness, impulsiveness, and difficult behaviours in their children. In addition to taught behavioural strategies, parents are given ideas for play/ games to address the deficits associated with ADHD. NFPP is also applied to preschool children at risk of ADHD.  When used as a preventive intervention, NFPP intervenes early, preserves the parent-child relationship, and reduces the risk of association of child’s behaviour with anti-social tendency and school failure. 

NFPP is delivered weekly over eight weeks, each session lasting about 90 minutes. Parental scaffolding is applied when delivering the programme, as each weekly session teaches skills that build on the previous weeks. Each weekly session begins with the review and reinforcement of messages taught in the previous weeks. Four of the eight weekly sessions are delivered to parent(s) alone, while the remaining four sessions are delivered to parent(s) and children. The programme content taught over the eight weeks include; 1) Psychoeducation about ADHD, paying attention, child acceptance, effective interventions, using eye contact, and the importance of praise; 2) Giving clear instructions, having a routine, setting limits and boundaries, and avoiding conflict; 3) Parents feelings, temper tantrums, firmness and voice control, and power of distraction 4) Effective use of time out and quiet time; 5) Resolving identified problems, parents ability to use behavioural strategies, parents coping ability; 6&7) Observing parent-child interaction and giving feedback;  emphasising the importance of taught behavioural strategies; 8) Focus on areas of concern for individual families.

NFPP is delivered by trained practitioners, and one practitioner delivers the intervention per family. Practitioners use video sessions, role-play, modelling, homework assignments, instructions, discussions and feedback to teach this programme. 

Fidelity

NFPP manages fidelity through:

• A three day practitioner training prior to programme delivery

• Use of fidelity monitoring checklists for practitioner self-evaluation, and during supervision

• Practitioner accreditation process

Modifiable Components

NFPP is available in English, Danish, Japanese, Mandarin, Zulu, Turkish and Faroese. It has been delivered in UK, Denmark, Japan, China, South Africa, Hong Kong, Turkey and the Faroe Islands. A 6 week self-help version of NFPP is available. An adapted 12 week NFPP programme is also available. This adapted version is based on the original NFPP programme and is delivered over 12 weeks (instead of 8 weeks) to allow a slower delivery pace. It contains additional modules which address; 1) Children’s sleep, learning and language difficulties; and 2) Mental health problems, learning problems and ADHD in parents.  Mindfulness for parents, motivational techniques and use of social stories are also included in this version.  NFPP can be modified for group delivery (10-12 families/ group).

NFPP has been modified for group delivery (10-12 families/ group) and for delivery online both in the group or individual formats. 

Implementation Support

NFPP is owned by Solent NHS Trust. This NHS Trust provides community and mental health services to Southampton, Portsmouth and parts of Hampshire and the Isle of Wight.

There is an organisational model for programme implementation which allows NFPP specialists provide bespoke support to organisations looking to implement NFPP. Hence implementation support provided to organisations is designed to suit organisations’ needs. NFPP accredited supervisors or trainers provide a clear and structured step wise approach for practitioner training and accreditation. This includes training and supported supervision to become NFPP therapists, with additional accreditation processes to gain accredited NFPP therapist status. NFPP accredited therapists receive further support and supervision to gain NFPP supervisor or trainer status.

Licence Requirements

There is no licence requirement for practitioners delivering NFPP to families. However there is a licence requirement to run NFPP training courses.

Start-up Costs

Start-up costs include £1300 (per delegate) for 3 days practitioner training at Southampton. This cost includes training resources for the programme. Training delivered at implementing site costs £7455 for up to 20 practitioners. Programme resource for each practitioner trained at implementing site is purchased at £200. Practitioner supervision can be delivered remotely, but at least one face-to-face supervision session is recommended. Sixteen weekly remote supervision sessions can be delivered to up to 10 practitioners, and costs £1920. Face-to-face sessions can be delivered to up to 10 practitioners, and costs £600. These costs do not include travel. Other costs include £320 accreditation costs per practitioner, £80/hour for supervising supervisors,  £200 licence fee per year, and £100 paid by NFPP trainers or organisations per practitioner trained.

Building Staff Competency

Qualifications Required

There is flexibility in the educational background of individuals who are trained in NFPP. However it is encouraged that practitioners who receive training work in roles that will allow them to implement NFPP. All individuals who attend NFPP training need to have some basic clinical skills; some experience of working with children and families with mental health problems; and a level of competence that allows them to take on new ideas.

Training Requirements

Training prior to delivering NFPP to parents and children is required. Practitioners receive two volumes of the practitioner manual. One manual covers the background to understanding ADHD and the rational for the intervention. The second manual is a week by week, step by step guide to deliver the intervention, with guidance on how to tailor the intervention to family’s needs.

Practitioners attend three full days of training where they are taught NFPP methods and strategies. Practitioners also receive 16 supervision sessions which include observation of videotaped sessions delivered by the practitioners. All practitioners who receive NFPP training are given the opportunity to become accredited NFPP therapists.  For accreditation, practitioners are required to submit two videotaped sessions which are reviewed for fidelity and programme integrity. Further support and supervision is needed to gain accredited NFPP supervisor status, while additional support and co-delivery of training groups are required before practitioners can become certified NFPP trainers. Practitioner training as certified NFPP trainers will promote systemic understanding of NFPP, and sustainability of the programme within the organisation.

Training has been adapted for delivery of training online, availability can be provided by contacting the developer.

Supervision Requirements

Supervision is an essential part of the training process as it helps practitioners adapt the programme to fit the family. After training, practitioners receive sixteen remote supervision sessions (1-1.5 hours each), and one face-to-face supervision session (lasts at least 4 hours) from NFPP accredited supervisor or trainer. Supervision sessions include observation of videotaped sessions delivered by the practitioners. Practitioners become accredited NFPP therapists when reviewed videotaped recorded sessions delivered to two families are deemed satisfactory. Accredited NFPP therapists continue to receive monthly supervision sessions from NFPP accredited supervisor or trainer. Supervision is provided face-to-face and remotely (e.g. zoom or skype).

Theory of Change

NFPP is guided by theories of child development, behavioural theory, social learning theory, and the neuroscience of ADHD. This is evident in the core themes taught in this programme (including psycho-education, parent-child relationship, behavioural training), as well as the methods used to deliver the programme.

NFPP is a home based, individualised parenting programme designed to help parents manage ADHD in preschool children.  The programme educates parents about ADHD. It also teaches them behavioural strategies to promote self-regulation, and reduce inattentiveness, impulsiveness, and difficult behaviours in their children. The children are required to be present in some of the programme sessions. NFPP can be adapted for group delivery.

• Is your organisation looking to deliver a parenting programme specifically targeted at parents of preschool children with ADHD?
• Would your organisation like to deliver the intervention to children as well as parents?

Priorities

• Is your organisation looking to implement a home based intervention?
• Would an individually delivered programme be a good fit for your organisation, or would a group based programme suit better?
• Would an intervention that addresses a range of behavioural problems suit your organisation, or should the focus of the intervention be ADHD?

Existing Initiatives

• Does your agency have existing parenting programmes that educate parents about ADHD, and teach strategies to reduce ADHD symptoms?
• Do existing initiatives focus specifically on children with ADHD or do they address children with other types of behavioural problems?
• Are the existing initiatives effective? Do they fit your current and anticipated future requirements?
• Are the existing initiatives delivered as part of routine primary care, or are they provided outside routine care?
• Do the existing initiatives address similar outcomes as NFPP? Are there components within NFPP that are not met by existing programmes?

Workforce

There is flexibility in the educational background of individuals who are trained in NFPP. However it is encouraged that practitioners who receive training work in roles that will allow them to implement NFPP. To deliver the programme, practitioners are required to attend 3days of training. With additional support and supervision, practitioners can become accredited NFPP therapists, supervisors or trainers. One practitioner delivers the programme per family.

• Does your organisation have practitioners who are interested in learning and delivering this programme? Do they work in roles where they can deliver NFPP?
• Will your organisation support practitioner accreditation? Does your organisation want practitioners with accredited NFPP supervisor or trainer status?
• Can your organisation support practitioner(s) to achieve this?
• How many families will your organisation support in the first year? How many practitioners will be trained in the NFPP programme in the first year?

Technology Support

Practitioners need technology to deliver some of the NFPP programme content via video; videotape sessions for review; and receive remote supervision during programme delivery. 

• Does your organisation have the technology to support programme delivery (DVD/ USB, TV, computer, projector)?
• Will your practitioners have access to technology for video recording sessions for review?
• Does your organisation have the technology to receive remote supervision?

Administrative Support

NFPP is delivered over 8 weeks in the family home. Recorded sessions are reviewed for fidelity assessment, and practitioner accreditation.

• Does your organisation have administrative capacity and systems to meet the needs of a home based programme, including travel, documentation?
• Are there policies and procedures in place regarding the video recording and storing of these recordings?

Financial Support

Costs include £1300 (per delegate) for 3 days practitioner training at Southampton. This cost includes training resources for the programme. Training at implementing site costs £7455 for up to 20 practitioners. Programme resource for each practitioner trained at implementing site is purchased at £200. Sixteen weekly remote supervision sessions (for up to 10 practitioners) costs £1920, and face-to-face sessions (for up to 10 practitioners) costs £600. These costs do not include travel. Other costs include £320 accreditation costs per practitioner, £80/hour for supervising supervisors,  £200 licence fee per year (to run NFPP training courses), and £100 paid by NFPP trainers or organisations per practitioner trained.   

• How many practitioners would your organisation like to train? Will training be received in Southampton or at the implementing site?
• Can the training costs, programme resource costs and supervision costs be financially supported?
• Is your organisation looking to train accredited NFPP therapists, supervisors or trainers?
• Can these be financially supported bearing in mind the accreditation costs, supervision costs and license fees (where applicable)?

Comparable Population

NFPP is a parenting programme designed to help parents manage ADHD in preschool children. The programme educates parents about ADHD. It also teaches them skills needed to promote self-regulation, and reduce inattentiveness, impulsiveness, and difficult behaviours in their children.

• Is this comparable to the population your organisation would like to serve?
• Has your organisation identified families who could benefit from this programme?

Desired Outcome

NFPP delivery is associated with significantly reduced ADHD symptoms; significantly reduced conduct problems; as well as significantly improved parenting practices and sense of well-being. The evidence is from studies conducted in children aged 2-7 years with ADHD.

• Are the above outcomes priorities for your organisation? Are there other primary outcomes that your organisation would like to achieve, which are outside the premise of NFPP?
• Does your organisation have other initiatives in place that effectively and efficiency address the above outcomes? If implemented, will this programme link to other initiatives?