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Journal of Child and Family Studies

, Volume 27, Issue 8, pp 2367–2383 | Cite as

Facilitated Parent-child Groups as Family Support: A Systematic Literature Review of Supported Playgroup Studies

  • Kate E. Williams
  • Donna Berthelsen
  • Maria Viviani
  • Jan M. Nicholson
Review Paper

Abstract

Supported playgroups are community-based services that provide low intensity family support, through regular group sessions for parents and their young children. Led by a playgroup facilitator, the program aims to enrich children’s early learning, enhance positive parenting behaviors, provide social connections for parents, and enable access to other community services. Despite high community acceptance and government investment, little is known about the extent to which such services are effective. This paper reports findings from a systematic review of research on supported playgroups and their effectiveness to improve child, parent, and community outcomes. Thirty-four studies were included, of which 28 were conducted in Australia. Programs targeted a diverse range of families who were considered socially disadvantaged. Seven studies employed experimental or quasi-experimental designs from which reliable evidence for effectiveness could be established. A high proportion of studies were qualitative and included action research, case studies, or ethnographies. A range of qualitative and quantitative measures were used to assess child, parent, and community outcomes. While findings suggested that supported playgroup programs were highly valued by parents and other stakeholders, rigorous evidence of effectiveness for achieving desired improvements in child outcomes or parenting behavior was rare and limited by low quality study designs. More explicit theories of change about how different types of supported playgroup programs can meet diverse family needs are required. Such theories of change would provide directions for specific content and delivery approaches that could address and improve different child and parent outcomes targeted to specific populations of attending families.

Keywords

Supported playgroups Literature review Family support 

Introduction

Socio-economic disadvantage reduces parental capacities to engage in positive parenting and early home learning activities that support children’s development both in the short and long term (Walker et al. 2011). Provision of family support programs during early childhood are a key policy strategy to enhance children’s early development internationally. However, evidence about the effectiveness of many early parenting interventions for achieving better outcomes for young children and parents is mixed (Kalil 2014; Wade et al. 2012). Supported playgroups are a form of family support intervention that has not to-date received a great deal of international recognition. They are a localized, low-cost, light-touch model of intervention designed for families with young children who are at risk of poor early development. The supported playgroup model seeks to provide a non-stigmatizing program that engages families in enjoyable parent-child activities and creates opportunities to build social support through connections with other parents.

For this review, the definition of supported playgroups used is: a group program in which parents and their young children (birth to 5 years) participate together in the program in play and other activities and in which an employed facilitator is available to guide the activities of the group (ARTD Consultants 2008a). In Australia, the free provision of supported playgroups to vulnerable families has been a widely-adopted policy initiative across the federal and all state governments since the early 2000s. It is not known how common this model of family support is internationally. The broad aims of supported playgroups are to enhance children’s early learning, support positive parenting behaviors, and improve social connectedness within communities. The underlying premise is that children’s development will be enhanced through increased parental responsiveness and engagement of the child in early learning through play and other home activities (Fraley et al. 2013). Supported playgroups also seek to build parents’ social capital through interactions with other parents, the playgroup facilitator, and other service providers, with a positive impact on parental wellbeing and parenting capacity. Finally, supported playgroups are conceptualized as providing a ‘soft-entry’ point for families to engage with other more targeted or specialized child and family services, as required. By addressing these proximal family processes, the long-term goal is to provide the developmental foundations for successful transitions into school for children, and support long term adjustment and achievement.

Because the funding of supported playgroups is a key family policy strategy across Australia, a number of Australian research studies have been conducted. However, there has not been a systematic review of the international literature to assess the evidence about the effectiveness of supported playgroups in achieving the desired outcomes. This systematic literature review maps the nature and quality of the research evidence about supported playgroups to set the stage for future research in the area.

The primary aim of this review is to address the following question: What is the evidence for the effectiveness of supported playgroups in improving child, parent, and community outcomes? Specific research objectives are to: identify studies involving supported playgroup or similar family support programs internationally; assess the quality of the study methodologies employed; review the nature of the measures used to assess outcomes for children, parents, and communities; and evaluate the level of research evidence provided for improved outcomes for children, parents, and communities. The review will also identify gaps in the evidence base to make recommendations for future research directions.

Method

Search Strategies

Three strategies were used to identify primary studies. The academic databases of PsychInfo, Medline, Australian theses via Trove and ProQuest were searched using the search terms: (child* OR infan* OR preschool* OR toddler* OR kindergarten* OR baby) in abstract; AND (playgroup* OR program* OR intervention OR support OR group*) in title; AND (mother* OR parent* OR maternal OR father* OR paternal) in title; and (efficacy OR effective* OR evaluat* OR outcome* OR result* OR impact) in abstract; AND (group) in abstract. The search was conducted in September, 2014 and limited to primary research published between 2004 and 2014. Non-peer reviewed reports and publications were also sought from Internet websites (grey literature). A search of the non-academic database (Google) was also conducted using keywords including “supported playgroup” and “supported playgroup evaluation” in order to identify relevant public organizational and government reports that were available in Portable Document Format (PDF) only. In this process, one key report from 2003 was identified in the initial search and a decision was made to retain it. Finally, through a network strategy, other studies (and authors) that were known to the research team and which had not been identified from the academic database search were checked; as well as the reference lists from included studies to identify any other relevant studies.

The initial search across all search strategies yielded a total of 1801 studies (Fig. 1). The first stage of screening involved a review of titles, abstracts, and keywords to identify studies of a program that fitted the primary definition for a supported playgroup. The full-text of 141 studies was then reviewed against the following full inclusion and exclusion criteria.
Fig. 1

Flow diagram of the process for study selection

Inclusion and Exclusion Criteria

Inclusion criteria were: a) program delivery directed to both parents and children, in which parent-child dyads were present at the same time (i.e., not delivered to parents/ and children in separate spaces or at different times); b) program delivery was in a group (i.e., not to individual families on a one-on-one basis); c) age of participating children was birth to 5-years-old; d) program had a focus on supporting children’s early development and learning and may have included a specific focus on successful transition to school; and, e) the parenting component focused on overall parental wellbeing and social support for parenting (i.e., not a therapeutic or case management approach). This process was completed by three members of the research team, yielding a final sample of 34 relevant studies. In some cases, a single intervention or program may have resulted in multiple publications (e.g., a pre-post study and a follow-up study two years later). In these cases, each study was included and summarized separately.

Quality Assessment

Study quality was assessed independently by two reviewers (KW, DB) using standardized criteria for quantitative, qualitative and mixed method studies. The reviewers rated quality on the criteria described below, with the overall global rating for the study designated as either high (no low ratings across criteria), moderate (one low rating), or low (two or more low ratings). Discrepancies were resolved through reviewer discussion.

For quantitative studies, a version of the Effective Public Health Practice Project (EPHPP) checklist (EPHPP 2009) was used to assess research quality in relation to six criteria: selection bias (e.g., likely to be representative of target population); study design (e.g., likelihood of bias in experimental designs; an equivalent control group included); confounders (e.g., confounding variables identified and included in analyses; baseline equivalence reported); blinding (e.g., assessors are blinded to research group membership; participants unaware of research questions); measures (e.g., psychometric information on outcome measures provided; ‘face’ or ‘content’ validity demonstrated); and, withdrawal and dropout (e.g., numbers and reasons for withdrawal or drop-out reported as below specific criteria).

For qualitative studies, an adapted version of the Critical Appraisal Skill Programme (CASP) guide (CASP, n.d) was used to assess research quality on nine criteria: aims (e.g., clear statement of aims); methodology (e.g., research seeks to interpret or illuminate actions or subjective experiences of research participants); research design (e.g., appropriate to achieve research aims); recruitment strategy (e.g., explanation on how participants were selected); data collection (e.g., researcher has justified method(s) selected and detail on method is explicit); relationship between researcher and participants (e.g., researcher’s own role and potential bias identified including participant recruitment); ethics (e.g., identification on how ethical issues considered and ethical approvals obtained); data analysis (e.g., in-depth description of analysis process); and, findings (e.g., findings are explicit and discussed in relation to original research aims).

For mixed methods studies, assessment was conducted for each of the quantitative and qualitative components of the studies using the EPHPP and CASP respectively. In addition, the Mixed Methods Appraisal Tool (MMAT; Pluye et al. 2011) was used to assess three additional criteria: relevance of the mixed method design to the research questions; integration of qualitative and quantitative data; and, consideration of limitations to the integration of quantitative and qualitative components noted.

Results

The primary research aim was to assess the evidence for the effectiveness of supported playgroups to improve child, parent, and community outcomes. While effectiveness has a specific meaning in intervention research implying a causal association between intervention participation and outcomes demonstrated through a study design that allows for these causal inferences (Murnane and Willett 2010), studies in this review were not excluded on the basis of research design. Rather this review aims to describe and synthesize the existing evidence base using a broad definition of ‘evidence’ to provide the basis upon which future research agendas can be developed.

Categories of Supported Playgroups

The 34 research studies reviewed were grouped by three different program delivery models and details on each study are provided in: Table 1 (Standard Supported Playgroups), Table 2 (Mobile Playgroups), and Table 3 (Supported Playgroups with Specific Interventions). These tables provide information on the national context in which the study was conducted, primary focus of the research, research design, participant description, key findings, and the rating of research quality. These descriptions are very informative; for example, the key findings may include practice recommendations identified from the research, as well as identifying the benefits of playgroups as perceived by parents.
Table 1

Narrative synthesis of research studies: Standard Supported Playgroups (Category 1: 15 studies)

First author

Country

Research focus

Research design

Participants

Key findings

Quality

ARTD (2008a)

Australia

Explored playgroup benefits for parents and children; and important process factors.

Mixed methods: Case studies (5 sites): document analyses, focus groups, interviews. Survey: broader population of parents and facilitators.

Disadvantaged families: Included CALDa and ATSIb families. Survey: (n = 1348 parents from 158 playgroups).

Benefits for children: learning and socialization; exposure to preschool activities. Benefits for parents: support network; learn new parenting skills; links to services. Success factors: adapt to local needs; regular event for parents; consistent structure; play focus.

Low

ARTD (2008b)

Australia

Evaluated National Playgroup Program (implementation, participation, practice factors, human / material resources).

Mixed methods: Case studies (12 sites, including 6 supported playgroups). Quantitative data: administrative data; surveys and interviews (parents and facilitators).

Disadvantaged families: Included CALD, ATSI, teenage and young parents, and refugee families.

Benefits for parents: social interaction, learn parenting skills, focus on child development; link to local services. Barriers: limited access to playgroups in rural areas; low supply of skilled staff.

Low

Berthelsen (2012)

Australia

Evaluated parent and facilitator experiences of playgroups; explored parent attendance patterns.

Quantitative: Pre-post design - no comparison group: parent survey (2 phone interviews at 6 month interval); facilitator questionnaires; family attendance.

Disadvantaged families: Included CALD, ATSI, young parents; families with children with disabilities. 100 parents

Outcomes for parents: Parents with higher attendance over 6 months compared to parents with lower attendance rated benefits of playgroup attendance more positively; high attenders were more engaged. Barriers: loss of facilitator after a set period a concern

Low

DEECD, Victoria (2012)

Australia

Explored playgroup benefits for parents and perspectives of facilitators.

Mixed Methods: Parent survey (pre and post) and parent and facilitator interviews: Parent survey (6–8 month interval); in-depth interviews parents and 12 facilitators.

Disadvantaged families: 61 parents (first round interviews); 42 parents (second round interviews).

Benefits for parents: increased social networks and support systems; built parental confidence and skills, improved parent-child relationships; Challenges: Facilitators reported difficulties in recruitment and retention of families.

Low

Dockett (2007)

Australia

Explored how playgroup experiences for Aboriginal families can support children’s successful transition to school.

Qualitative: Case studies (15 sites - 10 study sites; 5 trial sites across NSW): discussions with staff, Aboriginal communities, parents and children; program observations; document analysis.

Aboriginal families: Parents, Aboriginal community members, community workers.

Success factors: Importance of outreach activities by Aboriginal staff members to support family engagement in playgroups that support school transitions (e.g., activities to improve connections with schools; mobile playgroups for outreach to isolated families).

Mod.

Jackson (2006)

Australia

Investigated benefits of a supported playgroup for refugee families.

Qualitative: Case study (1 school-based site): observations; individual & group interviews with parents & children, facilitator interview.

Refugee families: 12 families attended (5 adults interviewed; 9 children engaged in group interview).

Benefits Value of playgroup to reduce child separation anxiety and support transition to school; build parent-child relationships and increase social connections.

Low

Jackson (2011)

Australia

Analyzed parental experiences of supported playgroups.

Qualitative: Multi-case study (3 sites): observations and field notes, focus groups, semi-structured interviews with parents and facilitators.

Disadvantaged families: Included low SES families, young parents.

Categories of parent support: provide friendship & social networks; relational, peer & emotional supports; support for parenting role; information & resources, ‘circle of care’ & multidisciplinary services.

Low

Jackson (2013)

Australia

Analyzed the multi-dimensional role of facilitators in supported playgroups.

Qualitative: Multi-case study (3 sites): observations and field notes, focus groups, and semi-structured interviews with parents and facilitators.

Disadvantaged families: Low SES, young parents; and general disadvantage.

Categories of facilitator role: family-centred practice; care factor; creating a ‘space’ for parents; provide knowledge of local services & resources. Challenges: training needs of facilitators.

Low

Morgan (2013)

Australia

Explored ways of responding to linguistic and cultural diversity for families in supported playgroups.

Qualitative: Ethnographic study (3 sites – drop-in services): observations with audio and video of children’s play and group times; parent and facilitator interviews and informal discussions.

Immigrant and CALD families: 46 mothers, 88 children, 4 grandmothers.

Responding to linguistic and cultural diversity: employ bilingual staff; provide opportunities to use both home and English language; make available selected bilingual texts and cultural resources.

Mod.

New (2012)

Australia

Explored playgroup experiences of refugee mothers for children’s school readiness.

Qualitative: Case study: focus group with parents plus individual interviews; 2 staff member interviews.

Refugee families: parents from East Africa (8 mothers).

Parent outcomes: Relational & emotional support within the group was highly important because of past traumatic experiences.

Low

Oke (2007)

Australia

Investigated practices for inclusion and barriers to attendance for parents.

Qualitative: Interviews and focus groups: parents and playgroup facilitators, across one local government area.

Immigrant and CALD families: 22 parents (some playgroup attendees and some not).

Barriers to participation: lack of familiarity with playgroup concept; English language in playgroup; transport problems. Recommendation: Employment of a paid & skilled playgroup leader is important.

Low

Peters (2013)

UK

Explored parental relational and social experiences in a playgroup.

Qualitative: Ethnographic study (1 site): observations and field notes, interviews and focus groups for parents & children.

Universal access: Although universal access, participants were referred by health workers. 7 mothers with complex needs.

Factors affecting engagement in the playgroup: past history of relationships; maintaining identity in ‘being a mother’ (i.e., control and role competence). Parents unclear on playgroup purpose (i.e., parent-child play versus social connections).

High

Playgroup Australia (2010)

Australia

Explored playgroup experiences of families who had a child with Autistic Spectrum Disorder (ASD).

Quantitative: Cross-sectional survey: Online survey for parents of children (0 to 6 years) with ASD, including attendees of PlayConnect programs.

Families with children with ASD: 246 parents of children with ASD (26% of parents had specific PlayConnect experience).

Benefits for parent: connected with others parenting a child with ASD; more confidence in caring for child with ASD; PlayConnect parents felt better informed about ASD-specific support services.

Low

Shulver (2011)

Australia

Explored mothers’ experiences of supported playgroups and parental outcomes.

Mixed methods: Interviews study (2 sites): Aboriginal and non-Aboriginal supported playgroups. Secondary data analysis (LSAC) of playgroup participation and parental outcomes (maternal wellbeing).

Disadvantaged families: Aboriginal and non-Aboriginal families (2 playgroups and 1 parenting group). 16 parents

Benefits: Facilitators provide social support (i.e., offer guidance & information); make connections to other services; Recommendation: potential to have maximum benefit by combining playgroup with a specific parenting group in a single model.

High

Warr (2013)

Australia

Explored ways of responding to linguistic and cultural diversity in supported playgroups.

Qualitative: Interview study involved facilitators.

Multi-cultural and immigrant families: Facilitators/coordinators of playgroup programs. 14 participants.

Challenges: Playgroups are a low priority for immigrant families; families have other concerns. Barriers: language barriers, cultural sensitivities, lack of familiarity with service provisions. Recommendations: migration background of facilitator important to family engagement; facilitators viewed as trustworthy figures.

Low

aCALD Culturally and linguistically diverse

bATSI Aboriginal and Torres Strait Islander

Table 2

Narrative synthesis of research studies: Mobile Playgroups (Category 2: 4 research studies)

First author

Country

Research focus

Research design and data

Participants

Key findings

Quality

Cumming (2008)

Australia

Evaluated how PlayLinks staff build and sustain relationships with parents.

Qualitative: Observation and interviews: Playgroups observed across consecutive weeks; observations of reflective practice staff meetings; staff interviews.

Marginalized families: Playgroups catered for marginalized families.

Successful practice factors: family-centered practice approach; relationship-building practices with families; need for cultural sensitivity, engagement in reflective practice; practices validated parents as experts.

Mod.

Eddy (2003)

Australia

To develop an operational model for best practice when working with families in crisis who live in caravan parks.

Qualitative: Action research and case studies (8 caravan parks sites): research conducted over 2 years; involved community services participants; site visits with field notes, program records, and stakeholder survey.

Marginalized families: Data from family participants, key stakeholders & facilitators across sites.

Parent-reported benefits: parent-child group activities; receipt of community information; support in crises; links to local services. Challenges reported by key stakeholder and facilitators: Intensive staff support required for families; need for high levels of organizational skills; child-oriented activities are crucial mechanism to engage parents.

Low

Gahan (2010)

Australia

Explored successful program factors that optimize child and family outcomes across community contexts.

Qualitative: Case studies: (11 sites) observations; informal conversations with parents; staff interviews; stakeholder focus groups).

Marginalized families: Staff and parents from mobile playgroup sites.

Successful practice factors: supporting social contact for families; enable links to mainstream health, education, and community programs; staff teamwork important; ongoing staff professional development.

High

Johnson (2004)

Australia

Evaluated mobile playgroup programs to assess effectiveness and impact on target groups.

Qualitative: Case studies: 9 sites (telephone and ace to face interviews, site observations and focus groups; document analysis and analysis of administrative data).

Disadvantaged families: Included Aboriginal families. Conversations with parents at site visits; interviews with facilitators and community service providers.

Benefits for parents and children: parent socialization and learning of new parenting skills; child socialization and play in a safe environment with opportunities to use a wide range of educative toys and equipment. Barriers: transport and operational costs.

Low

Table 3

Narrative synthesis of research studies: supported playgroups with specific interventions (Category 3: 15 studies)

First author

Country

Research focus

Research design

Participants

Key findings

Quality

Bohr (2010)

Australia

Evaluated impact on parenting and child outcomes of 8-week attachment-focused, parent-child play intervention (based on Right from the Start).

Quantitative: Pre-post design - no comparison group: Measured parenting sensitivity (using video analysis); and self-reported parenting stress and parenting confidence.

CALD families: referred from a home-visiting program for high-risk families and child welfare agencies.22 parent-child dyads.

Parenting outcomes: parenting stress decreased, parenting confidence improved; no improvement in maternal sensitivity.

Mod.

Deutscher (2006)

USA

Evaluated impact of a relationship-focused parenting program delivered in school settings with adolescent mothers (24 sessions).

Quantitative: Quasi-experimental design - comparison group – drawn from similar population: Measured parenting behaviors during videoed play sessions with children; coded at pre and post intervention; and child outcomes.

Young parents: 94 teen-mother-child dyads (48 in the intervention group) participating in school academic programs designed to facilitate return to regular school.

Child and parent outcomes: Mothers in intervention group had higher responsiveness, lower directiveness, and higher language facilitation skills in play interactions with their children: children in intervention group had higher development scores.

Mod.

Evangelou (2003)

UK

Investigated impact of PEEP intervention (using ORIM skills framework) delivered in weekly facilitated group sessions across school year.

Quantitative: Quasi-experimental design - matched case control study: children tracked from 3 to 5 years; standardized assessments of child development (cognition, language and social-emotional skills).

Universal access: 156 children and families: 70 in intervention group matched with 86 children attending other playgroups.

Child outcomes: After 1 year, children in PEEP group had made significant gains in language and literacy, numeracy, and elf-esteem; after 2 years, children in PEEP group were ahead of matched peers on same measures.

Mod.

Evangelou (2007)

UK

Evaluated community and parent effects of PEEP intervention program.

Quantitative: Quasi-experimental design - intervention group in PEEP birth cohort community). Measured parental stress, home activities; standardized measured of child development.

Universal access: PEEP group (n = 301) matched to comparison families in similar community on poverty indices (n = 303);

Parent and child outcomes: Stronger outcomes for parent-child interaction for PEEP parents (after 1 year) and quality of home environment (after 2 years); Intervention group had stronger child outcomes on measures of cognition (2 to 5 years); small effects for children in PEEP community who didn’t attend sessions (suggested community-wide benefits).

High

Evangelou (2013)

UK

Evaluated program, Room to Play, based on PEEP intervention but provided at drop-in center in a shopping mall.

Mixed methods: Snapshots of users of the center developed from parent surveys, unstructured observations, staff interviews, field notes, attendance records.

Universal access: Overall, diverse participants (e.g., 33% had left school at age 16 years and were in receipt of welfare benefits).

Family engagement: Program reach was successful - diverse families attending on regular basis. Challenges: High level skills required by staff to put families at ease and manage difficult conversations about parenting & parent wellbeing.

Mod.

Freiberg (2005)

Australia

Evaluated preschool-aged children’s communication and social skills who participated in Pathways to Participation (PIP) and Family Independence Program (FIP) providing parent support including supported playgroups.

Quantitative: Quasi-experimental design: PIP: 7 preschools (4 intervention groups; 3 comparison groups) with measures of child behavior reported by teachers. FIP: descriptive data gathered on characteristics of FIP participants.

Disadvantaged and multi-cultural families: PIP evaluation: 597 preschool children with pre and post, teacher data. FIP evaluation: 161 families.

PIP: Improvements in boys’ but not girls’ behaviors across preschool year. FIP: Program reach successful in engaging hard-to-reach families experiencing high levels of adversity.

Low

Hackworth (2013)

Australia

Examined efficacy of a parenting intervention, Early Home Learning Study – smalltalk (6 to 10 weeks program) delivered in supported playgroups and parenting groups.

Quantitative: Experimental design: Two parallel cluster-randomized controlled trials (RCTs) across 20 geographic localities in Victoria areas (pre, post, and follow-up at 5 months). Measured parent and child outcomes.

Disadvantaged families: 2238 parents participated across 2 years; including (1226 parents in facilitated playgroups and parenting groups with toddlers).

Parenting and child outcomes: Greater positive effects for intervention groups in supported playgroups for parent well-being, quality of the home environment, and child’s language outcomes; also positive effects for observed parent-child interactions.

High

Nicholson (2010)

Australia

Examined effectiveness of the Sing & Grow early parenting intervention (10-week group music therapy parenting program).

Quantitative: Pre-post design with no comparison group: parent and child outcome measured by parent questionnaires; clinician’s observations; attendance data.

Disadvantaged families: 850 parent-child dyads who attended 161 group programs across four Australian states.

Parenting outcomes: Significant improvements from pre to post in parent-reported parenting and child outcomes; similar across all sites; limited evidence of differential outcomes by implementation site.

Low

Pelletier (2005)

Canada

Evaluated a kindergarten readiness program for parent-child dyads participating in 12-week sessional program facilitated by a teacher.

Quantitative: Pre-post design with no comparison groupa: Short-term longitudinal study involving 14 Readiness Centers across 2 year of implementation. Outcomes assessed on teacher report on child development, teacher interviews and field notes.

Disadvantaged and CALD families: Most families were recent immigrants (CALD). 313 families with 4 year old children.

Child & parent outcomes: Directly assessed outcomes related to quality of interactions between teachers, parents, & children. Positive effects for children and for families reported.

Mod.

Robinson (2009)

Australia

Evaluated Let’s Start Project for Indigenous (and non-Indigenous parents); delivered in schools and early childhood programs (weekly sessions - 1 h for parent-child play; 1 h for parent group).

Quantitative: Pre-post design with no comparison group: Measures taken at pre, post, and follow-up: child behavioral adjustment & academic ratings; parental wellbeing.

Aboriginal families: 110 children aged 4 to 6 years with parent/caregiver.

Child and parent outcomes: Reductions in problem and risk behavior among children with substantial effect sizes 6 months after program completion, both at home and school.

Mod.

Scharfe (2011)

Canada

Evaluated Parent-Child Mother Goose Program (PCMGP) to support parenting skills and to facilitate parent-attachment in a 10 week program (circle time - rhyme and music program).

Quantitative: Quasi-experimental design: intervention group and waitlist, comparison group; parent questionnaires (pre, post, and follow-up); measured parenting and child outcomes (e.g., child attachment security; and parenting competence).

Universal access: Mothers and children (0 to 50 months). At pre, 178 intervention participants and 144 at post.

Benefits to parents: Mothers in the PCMGP group reported positive change in parenting efficacy over time and children were more likely to be classified as secure over time compared to waitlist control group parents, at post and follow-up.

Low

Stock (2012)

Australia

Evaluated an adaptation of Let’s Start Project, described in Robinson (2009) - used narrative approaches (parents’ stories; expressive arts) to build relationships.

Qualitative: Case study: Narrative approach used drawings and descriptive reports; parents interviewed before start of program by group leaders to discuss concerns for their children, collect family data.

Aboriginal families: 10 referrals of children and parents received from school and health clinic; 6 mothers participated.

Benefits of narrative approaches with Aboriginal families: Adaptation enabled parents to tell stories about own parenting from a personal perspective; facilitators learned about cultural considerations in working with Aboriginal families.

Low

Terrett (2012)

Australia

Evaluated impact of PCMGP (described in Scharfe 2011) on children’s expressive and receptive language; and parenting skills.

Quantitative: Quasi-experimental design: 10 intervention groups recruited through Maternal Child Health Centers; comparison group drawn from community playgroups in same communities as for intervention groups.

Universal access: Intervention group: 29 parents and 30 children; comparison group (22 parents with 25 children.

Child and parent outcomes: Intervention group made greater gains in language skills, and specifically expressive language; parents in intervention group had more positive perceptions of child’s demands.

Mod.

Weber (2013)

Australia

Examined feasibility for supported playgroups to promote physical activity for young children through training playgroup facilitators to deliver a 10-week active play intervention.

Quantitative: Pre and post design - no comparison group: Outcomes measured through parent survey (level of children’s active play and screen time; and parental knowledge of National Physical Activity Recommendations for young children.

Disadvantaged families: 13 supported playgroups (including 4 multi-cultural groups and 3 Aboriginal groups); 64 parents completed pre & post surveys.

Child and parent outcomes: Children spent more time in active outdoor play during the week; parents increased time in active play time engagement with children on weekdays and weekends; improved parental knowledge about physical activity recommendations.

Low

Williams (2012)

Australia

Evaluated effectiveness of short-term group music therapy parenting intervention (10 weeks) for parents of children with disabilities.

Quantitative: Pre post design - no comparison group: Utilized parent questionnaires and clinician observations to assess parent wellbeing, parenting behaviours, and child development measures; quality of parent-child interactions and program engagement.

Families with a child with a disability: 201 mother-child dyads in which child had a disability.

Child and parent outcomes: Improvements from pre to post for parent mental health; children’s communication and social skills, parenting sensitivity and engagement with child; child responsiveness to parent, and child interest in program activities; and improved social connections for families.

Low

aWhile there was no comparison group by design there were some comparisons made with a naturally occurring comparison group of children who were in kindergarten at the schools with Readiness Centres, but who had not participated in the program

Category 1: Standard supported playgroups

Fifteen studies were identified that examined the standard program delivery format widely used across Australia. This entails a two-hour, weekly meeting in the same location, and with the same playgroup facilitator each week (Table 1). There was limited specific information about program content and delivery provided across the studies, but overall program structure appeared to be flexible with no specified curriculum content or routine. Common elements included parents engaging in play with their children, conversations between parents, and sharing a snack-time (Berthelsen et al. 2012). Some groups had a combination of outdoor and indoor play, while others were conducted indoors only. Indoor activities included music, singing, a group story, and free play. Outdoor activities included water and sand play, and gross-motor development activities using various play equipment. Provision of high quality toys and resources was described in a number of studies as being an important factor that encouraged parent participation (Evangelou et al. 2013; Morgan et al. 2013) and, in general, children at playgroups were fond of ‘unusual’ resources and activities which children may have not have had access to at home (Evangelou et al. 2013). Fourteen studies in this category were conducted in Australia, with one study from the United Kingdom (Evangelou et al. 2013). See S4 Table for a more detailed narrative synthesis of the aims and features of these programs.

Category 2: Mobile playgroups

Four studies examined outreach programs in which playgroup facilitators drove a van equipped with resources to deliver the playgroup at different locations on a regular schedule and offered to various targeted populations (Table 2). These mobile playgroup programs also had a flexible approach to the routine of the program and the session content. They tended to mirror the structure of mainstream early childhood education programs, delivered in half-day or full-day sessions, following a routine that might include a welcome group, outside play, inside play, morning tea, group activity, and farewells (Cumming and Wong 2008; Gahan and Broughton 2010). This playgroup model targeted families who lived in isolated areas or in temporary accommodation, such as caravan parks. All studies were conducted in Australia, suggesting that this approach is unique to Australia. See S5 Table for a more detailed narrative synthesis of the aims and features of these programs.

Category 3: Supported playgroups with specific interventions

Fifteen studies examined playgroups that involved a specific intervention or curriculum delivered to parents and their children through play-based activities under the leadership of a facilitator (Table 3). Some programs were conducted within the ‘standard supported playgroup’ model and the research focus was an evaluation of an additional focused intervention component or a specific curriculum that was delivered within the playgroup. Many of these programs were delivered weekly for a time-limited period. Programs were delivered as either: highly specific curricula described as modules (or self-contained units of work) with clearly defined objectives and a structured sequence of activities (Deutscher et al. 2006; Evangelou et al. 2007; Evangelou and Sylva 2003; Hackworth et al. 2013); adapted versions of previously documented curricula to meet local needs, including targeted populations (Bohr et al. 2010; Pelletier and Corter 2005); or, specific content delivered through manualized activities in which presentation or structure was flexible or unclear (Freiberg et al. 2005; Nicholson et al. 2010; Robinson et al. 2009; Scharfe 2011; Stock et al. 2012; Terrett et al. 2012; Weber et al. 2013; Williams et al. 2012). Common to these programs were specific intervention or curricula goals, initial and specific training of playgroup facilitators on the intervention components, and ongoing and regular support. Studies in this category included playgroup programs in Australia, the United Kingdom, United States, and Canada. See S6 Table for a more detailed narrative synthesis of the aims and features of these programs.

Research Methodologies

Design and purpose

Studies were identified as taking one of five methodological approaches with the assumption of a hierarchy of methodologies in which experimental studies provided the strongest quality of evidence regarding program effectiveness and possible generalizability of findings to other settings (Murnane and Willett 2010). In descending order, the five methods were: experimental designs (random assignment to intervention and control groups); quasi-experimental designs (non-random assignment to intervention and control groups); pre-post designs with no comparison group; other quantitative or mixed method designs (e.g., cross-sectional design and analyses); and qualitative studies. The designs addressed different aims and purposes. Experimental and quasi-experimental studies assessed impact on child, parent, and community outcomes with quantitative measurement. Qualitative studies analyzed descriptive data on playgroup participants and their experiences and the role and experiences of the facilitator in supporting parents and children. See S1, S2, and S3 Tables for a more detailed narrative synthesis of the research design features of each study.

Twenty studies used quantitative or mixed methods designs with most of these examining supported playgroups with specific interventions. Only one study employed an experimental design (Hackworth et al. 2013). The Early Home Learning Study (EHLS) examined the effectiveness of a brief early childhood parenting intervention delivered within a supported playgroup, to improve outcomes for children and parents in vulnerable circumstances. It employed a cluster-randomized controlled trial (RCT) methodology conducted across 10 local government areas in the state of Victoria. Six studies used quasi-experimental designs, including two studies from the United Kingdom that evaluated a family-focused intervention that aimed to improve children’s early literacy and numeracy outcomes, and self-esteem in ‘at risk’ communities (Evangelou et al. 2007; Evangelou and Sylva 2003). Eight studies employed pre-post designs without comparison groups. Two of these examined standard supported playgroups, of which one study investigated benefits to parents and children (DEECD 2012), and the other focused on family participation and engagement in the program (Berthelsen et al. 2012). Five studies employed other quantitative and mixed method designs. Three used cross-sectional surveys with additional qualitative data collected through case studies, focus groups, observations, and field notes (ARTD Consultants 2008a, 2008b; Evangelou et al. 2013). One study used a one-off quantitative survey with parents in standard supported playgroups (Playgroup Australia 2010). One study used secondary analyses of data from Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) along with qualitative interview data from two groups of parents to compare the playgroup experiences of Indigenous mothers and non-Indigenous mothers and to investigate the role of supported playgroups in providing parenting support and enhancing parental wellbeing (Shulver 2011).

Fourteen studies employed qualitative designs. Almost all of the evaluations of standard supported playgroups (Table 1) and mobile playgroups (Table 2) were qualitative studies with methodologies that included action research, case studies, and ethnographies. One study focused on the identification of best practice examples in supporting the transition to school of Indigenous children (Dockett et al. 2008). These qualitative research designs were well suited to describing the playgroup experiences of families, capturing the demographic diversity of the parent participants and their different experiences of playgroups (e.g., refugee families), providing detailed descriptions of program elements, and exploring social and organizational features that are important in implementation processes. However, they do not provide a rigorous evaluation of the effectiveness of a supported playgroup intervention that would support future policy decisions on funding.

Participants

Almost all of the 34 studies reported that programs were targeted to families facing general social disadvantage and/or specific populations regarded as vulnerable for poor child development. Participants in standard supported playgroups (Category 1) were primarily socially disadvantaged families variously described as at-risk, vulnerable, or marginalized. Populations specifically targeted for particular playgroups included refugee, multi-lingual, or culturally diverse families (New 2012; Warr et al. 2013), Aboriginal and Torres Strait Islander families (Dockett et al. 2008; Shulver 2011), and families who had a child with a diagnosis or likely diagnosis of Autistic Spectrum Disorder (PlayConnect Program; Playgroup Australia 2010). Other types of families targeted in this program category were described as young parents, social isolated families, families in which parents had substance abuse problems or mental health problems, as well as families with low socio-economic status (DEECD 2012).

Participants in mobile playgroups (Category 2) were families with young children living in geographically or socially isolated areas, in mobile home parks, or at risk of being homeless (Cumming and Wong 2008; Eddy 2003).

Supported playgroups with specific interventions (Category 3) targeted disadvantaged families or targeted populations including: young parents (Deutscher et al. 2006); children with or at risk of behavior problems (Bohr et al. 2010); culturally and linguistically diverse families (Pelletier and Corter 2005); and, Aboriginal and Torres Strait Islander families (Robinson et al. 2009; Stock et al. 2012).

While all studies documented a specific target population for the supported playgroup program, rather than universal access, the extent to which any of the playgroup programs reached and retained those families most in need of additional support was unclear in many of the studies. With the exception of those with experimental and quasi-experimental designs, the research reports did not provide sufficient information about recruitment or retention within supported playgroups. In the studies with case study designs, the number of research participants was usually quite small, typically between 6 to 12 families. The largest sample sizes were found in the studies of supported playgroups with specific interventions (Category 3). These studies included the Victorian Early Home Learning Study (N = 1200; Hackworth et al. 2013) and the evaluation of the Sing & Grow intervention (N = 850 l Nicholson et al. 2010). Evaluations of Mobile playgroups (Category 2) had particularly small numbers of participants possibly due to difficulties in engaging these families in research. Most studies of standard supported playgroups (Category 1) had fewer than 20 research participants, with the exception of: a cross-sectional survey of: 1348 parents reported by ARTD Consultants (2008a); a cross-sectional survey with PlayConnect participants (N = 246; Playgroup Australia 2010); a Queensland study that used a repeated measures design with 100 parent participants (Berthelsen et al. 2012); and, a qualitative interview study of 34 parents in Victoria (Oke et al. 2007).

Measures

Measures used across both quantitative and qualitative studies assessed a wide range of parent, child, and community characteristics, as well as process variables and participation data. Sixteen of the 34 studies collected qualitative data only. The remaining 18 studies collected primarily quantitative data, although in some cases this was supplemented by qualitative data to add explanatory depth. Surveys of participants and playgroup facilitators usually included established measurement scales. Other measurement approaches included participant and facilitator interviews or focus groups. Observational data were also collected through live and video-recorded data and other data included document analyses, field notes and reflective journals.

Quantitative measures used across studies are listed in Table 4. Citations for the studies in which the listed measures were used are provided in the final column. Standardized measures of child development were commonly used in the quantitative studies to measure language and cognitive competence, social and motor skills, and behavioral adjustment. Other common variables measured included family attendance and engagement, parenting skills, knowledge and self-efficacy, parental wellbeing, qualities of the home learning environments and parent-child play activities, and parent satisfaction with their playgroup experiences, social connections, and awareness of other services.
Table 4

Selection of established measures used across studies

Measure and source citation

Method

Research study citation

Child development

Strengths and Difficulties Questionnaire (Goodman 2001)

Teacher and parent report

(Hackworth et al. 2013; Robinson et al. 2009)

Ngari-P measure of children’s behavior (Robinson and Tyler 2008)

Teacher and parent report

(Robinson et al. 2009)

NEILS Scales of Developmental Competency (SRI International 2003)

Parent report

(Nicholson et al. 2010; Williams et al. 2012)

Social-emotional Outcomes Adaptive social Behaviour Inventory (Hogan et al. 1992)

Teacher report

(Evangelou and Sylva 2003)

Pictorial Scale of Perceived Competence and Acceptance for Young Children in Reception grades (Harter and Pike 1984)

Child report

(Evangelou and Sylva 2003)

Peabody Picture Vocabulary Test – Third Edition (Dunn and Dunn 1997)

Direct test with children

(Bohr et al. 2010)

Bayley Scales of Infant Development II (Bayley 1993)

Direct test with children

(Evangelou et al. 2007)

MacArthur Communicative Development Inventory (Fenson et al. 1993)

Direct test with children

(Evangelou et al. 2007)

British Ability Scales II (Elliott et al. 1996)

Direct test with children

(Evangelou et al. 2007)

Parenting skills and knowledge

Maternal Behavior Rating Scale–Revised (Mahoney 1992)

Video analysis

(Deutscher et al. 2006)

Language Facilitator Rating Scale (Deutscher and Fewell 1998)

Observed during mother-child play

(Deutscher et al. 2006)

Parenting wellbeing, confidence, and efficacy

Toddler Care Questionnaire (Gross and Rocissano 1988)

Parent self-report

(Bohr et al. 2010)

Parenting Stress Index (PSI) (Abidin 1995)

Parent self-report

(Bohr et al. 2010; Evangelou et al. 2007; Terrett et al. 2012)

Edinburg Postnatal Depression Scale (EPDS) (Cox et al. 1987)

Parent self-report

(Bohr et al. 2010)

Kessler K6 (Furukawa et al. 2003)

Parent self-report

(Hackworth et al. 2013; Nicholson et al. 2010; Robinson et al. 2009; Williams et al. 2012)

Relationship Scales Questionnaire (RSQ) (Bartholomew and Horowitz 1991)

Parent self-report

(Scharfe 2011)

Parenting Sense of Competence (Johnston and Mash 1989)

Parent self-report

(Scharfe 2011)

Pleasure in Parenting Scale (Fagot 1995)

Parent self-report

(Evangelou et al. 2007)

Parent-child / family relationships and home learning environments

Parent-Child Joint Activity Scale (Chandani et al. 1999)

Parent self-report

(Evangelou et al. 2007)

Observational Record of the Care-giving Environment (National Institute of Child Health and Human Development 1996)

Parent-report

(Evangelou et al. 2007)

Qualitative data were collected through interviews, focus groups, and observations. The content focus included parental reports about their own experiences and children’s experiences in a supported playgroup including their satisfaction with the program. Data collected through observations and field note records focused on the nature of the group dynamics and parental engagement with the program and the role of the program in linking families. Data collected from facilitators included their perceptions of the parents’ program experiences, enablers and barriers to program participation, quality of parent-child interactions, and examples and stories of best practice.

The majority of studies used measures devised by researchers, with less than one third using established and standardized measures. The studies that most commonly used established measures were those in the category of supported playgroups with specific interventions reflecting the greater use of experimental designs.

Evidence for Effectiveness

In this section the evidence presented across the studies for each of parenting outcomes, child outcomes, and community outcomes is summarized. The study findings are summarized in order of strength of evidence, with the strongest evidence of possible program effects provided by quantitative data from studies that employed experimental designs, quasi-experimental designs, and pre-post designs with no comparison.

Child outcomes

Each of the seven experimental and quasi-experimental studies (all Category 3 studies - Supported playgroups with specific interventions) provided evidence for the effect of these programs in improving outcomes for child participants. Impacts documented included improved child language (Deutscher et al. 2006; Evangelou and Sylva 2003; Hackworth et al. 2013; Terrett et al. 2012), cognition (Deutscher et al. 2006; Evangelou et al. 2007), and behavior skills (Deutscher et al. 2006; Evangelou and Sylva 2003; Evangelou et al. 2007; Freiberg et al. 2005; Hackworth et al. 2013; Terrett et al. 2012) and improved attachment status (Scharfe 2011). Studies with repeated measures (pre-post) but no control group reinforced these findings and also documented significant changes over time in social development (Nicholson et al. 2010; Williams et al. 2012), time in outdoor play (Weber et al. 2013), and decreased behavioral problems maintained to 6-month follow-up (Robinson et al. 2009). Bilingual support within the supported playgroup platform was associated with increased language gains in children with English as a second language (Pelletier and Corter 2005). Cross-sectional, mixed method and qualitative research supported these findings and identified an important role for playgroups in: supporting children in the transition to school or kindergarten (Dockett et al. 2008; Jackson 2013; Oke et al. 2007); improving children’s social skills and general development (ARTD Consultants 2008a, 2008b; DEECD 2012; Jackson 2013; Oke et al. 2007); and, exposing children to learning opportunities and resources (ARTD Consultants 2008a, 2008b).

Parenting outcomes

Four of the seven experimental and quasi-experimental studies (all Category 3 studies - supported playgroups with specific interventions) provided the strongest evidence for parenting effects. Impacts on parenting behavior included: increased facilitation of children’s learning (Hackworth et al. 2013); higher responsiveness, lower directiveness, and higher language facilitation (Deutscher et al. 2006); enhancement of the quality of parent-child interactions and higher quality in care-giving environments (Evangelou et al. 2007); and, more positive parental perceptions of children (Terrett et al. 2012). Studies also reported no significant effects for some targeted parenting constructs including maternal sensitivity (Bohr et al. 2010) and parenting self-efficacy (Nicholson et al. 2010; Scharfe 2011; Terrett et al. 2012; Williams et al. 2012).

Studies with repeated measures (pre and post) but no control group provide some additional evidence that program participation was associated with positive parenting changes. Most of these studies were also of supported playgroups with specific interventions (Category 3). Findings for parent participants included: improved parent mental health and positive parenting behaviors (Nicholson et al. 2010; Williams et al. 2012), growth in parental self-efficacy (Scharfe 2011); increased parenting confidence and decreased stress (Bohr et al. 2010); and, increased time in physical play with children (Weber et al. 2013). The only repeated-measures study of a standard supported playgroup that measured parenting outcomes, found that participation was associated with increased parent confidence and skills, resilience, social support, and improved parent-child relationships (DEECD 2012) though this study did not use established measures.

Findings from the other research design categories (i.e., other quantitative and mixed methods studies and qualitative studies) reflect the findings from the studies with more robust methodologies. These descriptive accounts suggested an important role for playgroups in decreasing social isolation for parents (Jackson 2013) and providing peer support (ARTD Consultants 2008a, 2008b; Jackson 2006; Playgroup Australia 2010; Shulver 2011), thus building social capital for the family (Shulver 2011). Supported playgroups also have a documented role in supporting newly arrived refugees and immigrants in overcoming social and cultural barriers (New 2012) and providing important developmental information to parent participants (Jackson 2006; Shulver 2011). These studies also describe the ways in which supported playgroups have supported the development of parenting competence and confidence (ARTD Consultants 2008a, 2008b; Oke et al. 2007; Playgroup Australia 2010) and improved parent-child relationships (Eddy 2003). Many studies also reported data suggesting that playgroups were a highly valued service by parents (ARTD Consultants 2008a, 2008b; Berthelsen et al. 2012; Eddy 2003; Jackson 2006, 2011; Playgroup Australia 2010; Shulver 2011).

Community outcomes

Although playgroups have been described as effective soft entry points to other family support services for at-risk families (Jackson 2013), only a few of the studies of standard supported playgroup programs included measures related to service linkage (ARTD Consultants 2008a, 2008b; Berthelsen et al. 2012; Oke et al. 2007; Playgroup Australia 2010; Warr et al. 2013). These studies documented that parents increased their knowledge about the availability of other services or viewed playgroups as a gateway to other services. Importantly, one paper which included qualitative measures implemented in 15 case study sites of Australian supported playgroups, noted the important role that the playgroups had in supporting the successful transition to school for Aboriginal and Torres Strait Islander children (Dockett et al. 2008). Specifically, playgroups were held at the schools, allowing families to become known at the school and for families to become more comfortable with the school environment and processes. Relationships made through playgroup attendance appeared to be maintained into the school years (Dockett et al. 2008). A number of studies reported data suggesting that stakeholders including playgroup facilitators and community workers placed high value on the role of supported playgroups within the community in terms of connecting parents with services and supporting important family transitions (Evangelou et al. 2007; Dockett et al. 2008; Jackson 2013; Eddy 2003). In sum, although there is qualitative and descriptive data indicating the role of supported playgroups in achieving important outcomes related to connections with community for families and in building community capacities, there was little focus on measuring community outcomes and minimal evidence for the efficacy of supported playgroups to do this.

Discussion

This systematic review evaluated the nature of the research conducted with supported playgroups and the evidence that participation in supported playgroups may positively impact on parent, child, and community outcomes. The 34 research studies included examined three categories of program models: standard supported playgroups; mobile playgroups; and, supported playgroups with specific interventions. Standard supported playgroups (Category 1) and mobile playgroups (Category 2) were most often evaluated through the collection of qualitative data that provided examples of best practice and descriptions of program features through case studies that identified the ‘how’ and ‘why’ possible changes occurred for children and parents. However, these designs do not provide the same strength of evidence as quantitative designs that control for sources of research bias (factors related to internal and external validity of the research). While there were limited experimental designs from which to draw strong conclusions of effectiveness, this literature review presents an important first step in understanding the contexts of the work, and in identifying the gaps that should be addressed in future research.

The quantitative designs used to examine supported playgroups with specific interventions (Category 3) provide the greatest confidence that identified associations are likely to reflect impacts of the intervention. Seven studies in this category used experimental or quasi-experimental designs and these more rigorous studies were characterized by larger sample sizes, inclusion of comparison (or non-intervention) groups, and repeated measures across time points using established measures with known psychometric properties to assess outcomes. Together these studies suggest that the supported playgroups with specific intervention delivery model holds some promise as an early parenting intervention. The findings indicated the interventions were effective in improving parental behavior in ways that are known to support children’s early learning and development, and in improving child developmental outcomes. In addition, the alignment of discretely measured outcomes to the strong content focus characteristic of these interventions contributed to a greater capacity for evaluating program effectiveness.

While the strongest overall evidence for the effectiveness was found for the category of supported playgroups with specific interventions, this is a less common approach than the standard supported playgroup form (Category 1) and so substantial gaps in the evidence base remain. It is unknown to what extent the more flexible standard and mobile supported playgroup model yields positive benefits in terms of positive parenting and improved child development outcomes. Many of the studies of standard and mobile supported playgroups were qualitative with small numbers of research participants and while these are informative about key processes, and have implications for practice in delivering supported playgroups, they do not provide strong evidence for effects on parental behaviors, attitudes, or knowledge. As well as the research designs employed, there are other fundamental differences between the approaches that preclude comparisons across studies. For example, higher levels of resourcing were apparent in the supported playgroup studies that delivered specific interventions and staff were more likely to have higher professional qualifications than facilitators in standard or mobile supported playgroups.

Overall, the studies reviewed in this paper suggest that supported playgroups are a largely Australian approach to support early parenting that holds promise for improving a range of child and parent outcomes for a diverse range of disadvantaged and vulnerable families. The review identified at least three areas where the evidence base could be improved in future research. First, a greater use of randomized controlled trials which are generally regarded as the gold standard methodology, would be desirable. However, such designs are difficult to implement in the context of a program that is already in widespread use. Rather, future research should aim to incrementally and sequentially build an evidence base in a planned way through studies that use comparison groups to compare outcomes for example, between supported playgroup participants and matched families who do not use or have access to, a supported playgroup. Second, there is a need for more planned comparisons of variations in playgroup practice, structure, and participant characteristics. Pragmatic research designs that explore controlled variations of these aspects will help to address the questions of what works best, for whom and under what conditions. Third, our review highlighted a number of measurement challenges. More consistent use of reliable and valid measures of various child and parent outcomes with repeated measurement over time is needed. This will assist in building a coherent evidence base, enable comparisons across studies and program types, and establish whether program effects are maintained in the longer term.

A substantial challenge for the field is that evaluation studies of supported playgroups are inherently complex because of the diverse ways that these programs are delivered. In addition to the three main delivery models identified, the review also found considerable variations in: targeted parents and children; qualifications of staff and the training provided; the duration of facilitator support to the group (ongoing versus a set duration); and session content. This suggests that the supported playgroup model has evolved in different ways in different places, potentially driven by the knowledge, interests and concerns of local service providers and the opportunities that arise when government funding becomes available for targeted services. It is likely this ad hoc development process partly accounts for the corresponding proliferation of smaller case study designs in lieu of a more systematic approach to evaluating programs and practices.

Advancing the evidence base in the field will require the development of a more explicit theory of change for the program. Across the studies reviewed, the specifics of what happens in the program to facilitate change was usually poorly or not explained. By explaining how the program is expected to work, a theory of change helps to build capacity and program sustainability by ensuring that program activities are: meaningful in the context of the program; plausible in that they have face validity and are aligned with the intentions of the program; doable in the program settings with the level of resources available; and, ultimately testable to establish effectiveness (Funnell and Rogers 2011). A theory of change would also articulate program goals in measurable units of change for example in parental attitudes, behaviors, and knowledge, as well as for child behaviors, supporting future evaluation endeavors.

A theory of change developed with reference to existing evidence in the family support field would also help to define ‘quality’ within supported playgroups for which there is currently no consensus, and would help develop a shared professional language for practitioners. It is recommended that a more explicit content focus also be designed with built-in flexibility to meet the needs of families. This could be in the form of a ‘key messages’ curricula or through formal links to existing early childhood or parenting support curricula. It is possible that developing a framework for the delivery of playgroup sessions which includes key messages and activities could: build opportunities for high quality effectiveness research designs; inform the work and training of the diverse group of playgroup facilitators employed in supported playgroup programs; and, ultimately, improve the quality of support services provided to families. The Early Home Learning Study (Hackworth et al. 2013) and Sing & Grow (Nicholson et al. 2010; Williams et al. 2012) are examples of Australian programs that have managed this process. Finally, it is recommended that evaluative capacities of the organizations delivering supported playgroups be built. Investing in evaluative capacity building would allow for ongoing process evaluations with supported playgroups to be conducted that address questions as “Who attends and how often?”, “Does the program work better for some participants than for others?” or “Are some outcomes easier to achieve than others?”

This paper has reported on a systematic review of studies of supported playgroups, an important approach to low intensity, low cost, early parenting intervention. While some studies had strong research designs on which effectiveness of the supported playgroup model could be established, the majority employed weak designs that provided little insight into program effectiveness. Studies commonly reported that supported playgroup programs were highly valued by parents and stakeholders, and descriptive data indicated that parents gained new knowledge about children’s development, experienced reduced social isolation, and were better connected to other services. For supported playgroups with specific interventions that employed experimental designs, there was evidence of some benefits to child language, social, and behavioral development and positive parenting behaviors.

In light of considerable government investment and strong community support in Australia, there is an urgent need to establish a stronger evidence base, guided by the adoption of an explicit theory of change for the supported playgroup approach. This will require governments and service providers to invest in more rigorous research designs, use established measures of key parenting and child constructs to enable comparability across studies that may involve different populations of participants, and build training models and evaluative capacities of playgroup facilitators who are the key personnel contributing to the success of supported playgroups. Through these directions, the effectiveness and efficiency of program delivery can be established to realize improved outcomes for families.

Disclaimer

The views expressed here are those of the authors alone and should not be attributed to the funding body.

Notes

Author Contributions

K.W.: co-designed the study, conducted study selection, data extraction and analysis, led writing of final report. D.B.: co-designed the study, conducted study selection and data extraction, and co-wrote the final report. M.V.: conducted search and led study selection process, data extraction. J.N.: co-design of study and final report writing.

Funding

This study was funded by the Queensland Government Department of Education as part of a competitively awarded tender (Supported Playgroup Evaluation).

Compliance with Ethical Standards

This study is a systematic literature review of published and grey literature. No new data collection or human research participants were involved. All aspects of ethical methodological approaches aligned with the systematic review methodology have been adhered to.

Conflict of Interest

K.W., D.B., and J.N. declare a potential perceived conflict of interest in that four of the final 34 research papers included in this review are authored by one of more of these authors. However, these papers were found through the search strategies identified and met the review inclusion criteria as specified in the article.

Supplementary material

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Supplementary Materials

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbaneAustralia
  2. 2.School of Early Childhood and Inclusive EducationQueensland University of TechnologyBrisbaneAustralia
  3. 3.Universidad de los AndesSantiagoChile
  4. 4.Judith Lumley CentreLa Trobe UniversityMelbourneAustralia

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