Department of Social Work



Department of Social Work International Master of Science in Social WorkParenting: The Challenging Task of Modern WorldA Critical Review of COPE (Community Parent Education Program)Strengths and Weaknesses of COPE from the Point of View of Parents and EducatorsDegree report 15 higher education creditsSpring 2008Author: Sahar Kaleibari NotashSupervisor: Anita Kihlstr?mAbstractCOPE is one of the state-based public parent education programs carried on in Sweden with an aim to prevent the behavioral problems of young children. This study is a qualitative research to examine the strengths and weaknesses of COPE from the point of view of parents and educators. The study has an intercultural perspective and intends to assess if the cognitive-behavioral education can lead to the empowerment of parents. Semi-structured interviews are used to gather information. Empowerment and Cognitive-behavioral theories are used to analyze the findings of this study. According to the findings, meeting other parents with the same problems and learning the behavioral means to create the desired behavior and extinguish the undesired ones are the first strong points of the program according to parents and educators. They also mentioned that gaining self confidence, self control and anger control, as well as learning to behave rationally and according to the correct models are the results of this education.The most important barrier for the application of COPE is a cultural aspect. The Swedish society is not comfortable with the usage of material means of encouragement and punishment according to my informants. Low participation of parents both in the sessions and discussions is another problem.Individual empowerment both for parents and educators are achieved in COPE according to the interviews. Parents reported being more secure and in control in relation to children after taking part in COPE. Despite my earlier experiences of family education programs in Iran, reports about social empowerment is lacking in the Swedish context. Meanwhile, parents and educators had some suggestions to improve the program most importantly about social empowerment of parents.Key words: parent education, empowerment, parent views, educator views, cognitive-behavioral education, COPE.AcknowledgmentI would like to thank the Department of Social Work in G?teborg University which prepared a rich ground for my study, and my supervisor Anita Kihlstr?m who helped me in this degree report. Also, I am grateful to the kind cooperation of Astrid Tun?s who helped me in gathering information for this report. I would like to thank my dear friends Reyhaneh and Arezou for their kind support and help. Finally, I thank all the informants who participated in my interviews and expressed their views. Sahar Kaleibari NotashContents TOC \o "1-3" \h \z \u Abstract PAGEREF _Toc278832762 \h 2Acknowledgment PAGEREF _Toc278832763 \h 31. Introduction PAGEREF _Toc278832764 \h 61.1. The research subject: COPE PAGEREF _Toc278832765 \h 61.2 Problem Area and aim of the study PAGEREF _Toc278832766 \h 81.3. Research Questions. PAGEREF _Toc278832767 \h 81.4 Definitions PAGEREF _Toc278832768 \h 82. COPE PAGEREF _Toc278832769 \h 82.1 Background PAGEREF _Toc278832770 \h 82.2 The purpose of COPE PAGEREF _Toc278832771 \h 92.3 How COPE is implemented PAGEREF _Toc278832772 \h 103. Earlier researches about behavioral parent educational programs PAGEREF _Toc278832773 \h 123.1. Researches about the Behavioral Parent Education PAGEREF _Toc278832774 \h 123.2. Earlier Researches about empowerment of families PAGEREF _Toc278832775 \h 144. Theoretical framework PAGEREF _Toc278832776 \h 164.1. Empowerment PAGEREF _Toc278832777 \h 164.2. Cognitive-behavioral social work PAGEREF _Toc278832778 \h 185. Method PAGEREF _Toc278832779 \h 205.1 Design PAGEREF _Toc278832780 \h 205.2 Data collection PAGEREF _Toc278832781 \h 205.3 Data processing PAGEREF _Toc278832782 \h 225.4. Validity, Reliability and Generalizability PAGEREF _Toc278832783 \h 225.5. Ethical consideration. PAGEREF _Toc278832784 \h 236. Results and Analysis PAGEREF _Toc278832785 \h 246.1.Why parents need this program PAGEREF _Toc278832786 \h 246.2. Benefits and aims of the program: PAGEREF _Toc278832787 \h 256.3.Strengths of the program PAGEREF _Toc278832788 \h 276.4. Weaknesses of the program PAGEREF _Toc278832789 \h 276.5. Improvement of the program PAGEREF _Toc278832790 \h 296.6. Effects of cope on parents PAGEREF _Toc278832791 \h 306.7. Practical problems in implementation of program PAGEREF _Toc278832792 \h 326.8. Integration of the program to Swedish context PAGEREF _Toc278832793 \h 337. Discussion PAGEREF _Toc278832794 \h 33References PAGEREF _Toc278832795 \h 36Appendixs PAGEREF _Toc278832796 \h 391-Interview guide of “study of weakness and strength of COPE “ PAGEREF _Toc278832797 \h 39Educators’ version PAGEREF _Toc278832798 \h 39Parents’ version PAGEREF _Toc278832799 \h 402-Informed Consent PAGEREF _Toc278832800 \h 411. Introduction1.1. The research subject: COPESocial Work with children and families is a specialized area of work in Sweden. The state began to have a stronger role in the family life by introducing new laws about children and women, providing public childcare facilities and emphasizing on dual earner model during the last century. Nuclear family is still the predominant form of family in Sweden, but there are many indicators which show that the situation of the nuclear families is moving towards instability. Facts like high divorce rate and reduction of fertility as well as introduction of other family patterns are changing the family system in Sweden (Therborn, 2004). There are several different reasons for the importance of family education in Sweden which makes parent education one of the important areas of social work with families. One reason is that for most people, parenting can be a challenging task of adulthood. They may face a difficult situation in fulfilling this responsibility while this task is an opportunity for learning, growth, and development of them (Marienau C. and Segal J., 2006). Secondly, providing secure and favorable conditions during childhood and adolescence is one of the national public health policies of Sweden. Lastly, mental ill-health is one of the three most important public health issues in Sweden (Bremberg, S. 2003). General family education programs can prevent mental ill health in children. A study done in Canada shows that a significant number of children with behavior disorders do not get support. Ironically, children at greatest risk are more deprived from professional support. This is because they come from the poor socioeconomic strata, and their parents recognize their behavior problems late, and feel stigmatized if they seek assistance (Cunningham, Bremner and, Boyle, 1995). A general family education can cover all social strata including the neediest. For children of families with disabilities, single parents, or those otherwise receiving long-term social assistance there is a higher risk of unfavourable development in many aspects including mental health. These parents might be at greater risk of early retirement for medical reasons or hospital care for mental problems. According to the Swedish medical authorities single parents with seriously impaired children are especially vulnerable when it comes to financial resources and health (The National Board of Health and Welfare, 2006). One of the prevalent mental health problems is BMP (Behavior Management Problems). According to Axberg et al (2007), in Sweden BMP is common among children (4-12%). This problem is increasing and in long-term will result in poor psychosocial adjustment. Barlow and Stewart-Brown (2000) believes that behavior problems in children are an important social, educational, and health issue. They mention that the prevalence of these problems, their stability over time, their poor prognosis, and their costs to both individuals and the society, all point to the need for primary prevention and early effective interventions.As a result of mentioned reasons, the Swedish government decided to use the parental support programs for prevention of mental illnesses based on the findings of one hundred different high quality studies which proved the effectiveness of parent education. The parliament and government provide facilities for family education to help with the prevention of mental ill-health by appropriate regulations (Bremberg, S., 2003). Researching about the implemented programs and their effectiveness is one essential part of the program in order to correct the directions, content and methods of education. A lot of studies are done to assess the effect of the program on the behavior of the children and parents. It is also important to study and research the views of the partners who are participating in the programs and hear their voices and their assessments about their experience of participating in the program. Since COPE is a new program in Sweden, there is no research about its implementation. The only available sources are some reports of educators. So there is a need to study the program in the Swedish society. Also there is little information about the views of parents and educators about the program, and most of the researchers studied the effectiveness of the program on child behavior and parent-child relation according to the positivist ideas of reality. According to Gilbert(2003) individuals and groups construct their own version of reality. Therefore I want to examine the experiences of parents and educators who are participating in the program.I have been engaged in family education in Iran for some years. Due to my previous studies in early childhood education, and my working experience in this field, I was interested to observe a similar program in Sweden. As an educator, back home, I observed that all kind of family education has a great influence on parents, mostly mothers. They came to our center to know about their children and how to treat them. As soon as they get education about the family systems, child rights and other related subject, they start to seek their own rights. It seems parent education is a little sparkle which helps them to go ahead. They initiate their own study groups and try to help and support each other in a very patriarchal society. The knowledge and the skills they learn give them power in the family. The social network they participate in, on the other hand make the basis of their individual and social empowerment. Also, my field placement period in the international master program gave me this opportunity to be in contact with the families and the educators of COPE (Community Parent Education Program). Social department office of Fr?lunda renders family education program since 2004. I participated in the program and obtained the educational material during my field placement. I decided to perform a study about COPE after being in contact with the families and the educators. I was more convinced about the importance of this study because all the previous studies were concentrated on the effectiveness of the program and views of the participants were generally ignored. There was a need to study the program from the point of view of parents and educators. 1.2 Problem Area and aim of the studyAs mentioned the family education is a tool to enhance mental health. Many researchers studied the effectiveness of these programs, and most of them concluded that these programs are highly effective. There are a few researches about the point of view of parents and educators about the content, method and aims of these programs. The subjective role of the participants is ignored in the most of the studies. This research is going to achieve a deeper understanding about the implementation of these cognitive- behavioral programs. In other words, this study wants to look at the effectiveness of the program from the point of view of the practitioners and service users. Every educational program has some weaknesses and strengths, whose recognition is a way to enrich them and bring in new possibilities to educate target group better. In this research the weaknesses and strengths of the program will be considered from the point of view of educators and parents to achieve a thorough understanding of the program characteristics. Empowerment theory will be used alongside the cognitive-behavioral theory to interpret the subjects’ ideas about the program and to find a new definition of effectiveness of the program.1.3. Research Questions.What are the strengths of the COPE program from the point of view of the parents and the educators?What are the weaknesses of the COPE program from the point of view of the parents and educators?Can the behavioral education of COPE result in parents’ empowerment?1.4 DefinitionsThe phrase "parent education program" is used here to refer to group-based programs with a standardized format aimed at enhancing parenting skills (Barlow and Stewart-Brown, 2000).Attention-deficit/hyperactivity disorder (ADHD) is the most recent diagnostic label for children presenting with significant problems with attention, impulsiveness and over activity which is one of the most prevalent childhood psychiatric disorders (Barkley, 1998).2. COPE 2.1 Background In Sweden, family education programs implemented by the government are known as “Interaction programs”. They are the instruments of the government to support parents in two main areas: providing emotional development and creating boundaries for their children. These programs emphasize on collected experience of all the parents in the group. The programs are divided according to different age groups. In the age group of 2-9 years, the goal of programs is to reduce the risk of developing behavior problems. There are three main programs for this age group (2-9): De otroliga ?ren [The Incredible Years], Community Parent Education Program (COPE) and KOMET [COMET] (Bremberg, S., 2003). The programs include watching of movies, discussing problems, providing solutions for them and practicing the solutions.COPE (Community Parent Education Program) is a family education program which is designed by Professor Charles E. Cunningham in McMaster University Faculty of Health Sciences in Canada. It is a large group version of individual family programs for families of children with ADHA which later have been implemented in mental health clinics (Barkley, 1998, p. 396). The program was introduced to Sweden as of year 2004 (Swedish COPE site). In Sweden, COPE is implemented by National Institute of Public Health free of charge for all parents of children between 3-12 years old. It has facilities for free child care during the sessions of program. This program is implemented with some changes in content, order of the subjects and movies, and is used as a general family education program in different cities and different centers (National Institute of Public Health website). Most of the educators or leaders are social workers, preschool or school teachers and are educated directly by Charles E. Cunningham, the author of the program, or the private center of ‘Svenska COPE- Foreningen’ under the supervision of Agneta Hellstrom.2.2 The purpose of COPE According to Barkley (1998), parents of children with ADHD suffer from low self-esteem, a sense of lack of control over the child’s difficulties, and higher depression. Low regulated behavior of their children causes more controlling and less positive approach to child management. There are some groups pf parents for whom the rate of participation in intervention programs is lower. Younger, economically disadvantaged, socially isolated, depressed, immigrant parents, parents whom the official language of the country is their second language and are culturally different are least likely to enroll in and complete intervention programs. The same is true for parents of children with the most severe problems. On the other hand, studies shows that these groups come to community-based parenting courses more regularly. Barkley (1998) showed that parent training improves child management skills, enhances parental confidence, reduces stress and improves family relationships. He believes that “Improving parenting skills is accompanied with less behavioral difficulties of children” (p. 394). COPE family education can be a good response to the needs of families who are in trouble or are at risk to be in trouble because of ADHD of the children. Also, COPE teaches self-control strategies, and the group provides a sense of universal parenting experiences with common problems. The group encourages supportive contacts and exchange of knowledge between the parents (Barkley, 1998). These are achieved with a low cost, single-leader program which uses community utilizations to help families.When the parents find solutions by themselves in the groups, they show more commitment to the findings. They feel they own the solutions and alternative suggestions. This fact reduces their resistant for change, and helps them to implement the findings. Finding solutions is a life skill. This practice helps them to find individual solutions for their own special situations in the future. They also build skills for cooperative problem solving process (Barkley, 1998).Providing group education for parents which are facing less severe problems gives more opportunity to help children with more severe problems. The fact that their families use clinical and professional help more frequently is a practical evidence for effectiveness of the program. COPE is an educational program which is based on social learning-based parenting programs, social-cognitive psychology, family systems theory, small-group interventions and larger-support-group models (Barkley, 1998). This is followed with a coping-modeling problem- solving approach.According to Barkley(1998), leaders use modeling, role playing, goal setting, and self-monitored homework strategies to introduce new skills. ‘Social-Cognitive psychology’ tries to use attitude change models and it is assumed that optimal shifts in attitudes and behavior will be obtained when parents devise their own solutions and rationales. 2.3 How COPE is implementedIn order to increase the chances of parents’ participation in COPE, the program has predicted the possible causes for parents’ evasion from educational programs. According to Cunningham (1998), some barriers which may stop parents to go to parent education programs are difficulties for day-time attendance, extracurricular activities, travel time or transportation costs, and child care problems. These problems are solved in COPE by different hours for course, using neighborhood schools and facilities, free education and free child care facilities. The whole average 25 member of the group will be divided to five to seven sub-groups who can work together. Each group has a leader who is responsible for keeping members concentrated on tasks and writes the discussion of group and shares them with the large group. Each member must take the responsibilities of the leader in the subgroup.To have a COPE education in an area these steps is followed:Advertising in different places including schools, pre-schools and mental health clinics Informing parents about the program and its goals; its format, benefits and advantages for parents in an informative sessionParent training in a course which is included of 8-16 two hours weekly sessionsFollow up in monthly discussion for the parents educated in COPE According to Cunningham (1998) and the leaders which I interviewed, the structure of each session is as follows: The session starts with informal social activities including taking sandwiches and coffee and talking to each other. Then leader outlines session plan by describing what will be done during the session. Subgroups review homework to build self-efficacy and focus on small gains which the results of revision will be presented in large-group. Then the new subject will be presented to parents by watching the videotapes which simplifies complex problems by a vignettes depicting, exaggerated version of common child management errors. Parents in participant subgroups identify errors, discuss their consequences, develop alternative strategies, and formulate supporting rationales instead of the problematic behavior. In the large group proposed solutions are discussed by subgroups and leaders demonstrate the solutions by modeling. Subgroups brainstorm about applications and make a list of the situations which the strategies are applicable. Pairs of parents rehear strategies to strengthen skills, build confidence and prepare for applying the strategies. Leaders plan homework and close the session.The most important aims of the program are encouraging positive behavior and improving child-parent relationship. Parents learn how to pay attention to the child in a positive way and to identify and encourage or reinforce the child’s good behavior which can improve child’s behavior and make the relationship of parent-child friendly and help to development of language, conversational skills and social competence. Balancing family relationships is another aim which is achieved by education of time management, allocation and attention between siblings, spouse and self. Parents should learn to avoid conflicts by disengaging from escalating conflicts and controlling thoughts which intensify anger.Another aim is to help parents facilitate managing transitions. That is transition from non-obeying child to cooperative child by using when-then strategies which encourage compliance via the application of the rewarding principles. In this line Point system is introduced in which parents learn how to give points for god behavior and delete points for bad behavior. Collecting of a certain number of points results in a reward. This can help to form a new behavior. Self-regulation strategies are improved by using planning ahead strategies in which parents identify problematic situation and try to help child to develop a plan for that situation and negotiate incentives. Parents should ignore minor errors, reward follow through and review the plans as necessary. Parents are educated to deal with more serious problems by showing some effective responses to aggressive behavior. This can be time-out from positive reinforcement. This includes firm emotionally neutral commands, a quick neutral warning and application of an effective consequence.Finally, problem-solving is educated using PASTE strategy which implies picking one soluble problem, analyzing the advantages and disadvantages of alternative solutions, selecting the most promising alternative, trying it out and evaluating outcomes. This is a summary of the COPE program which is outlined by Cunningham and is copied, translated and adjusted to the Swedish needs and was implemented during my observation period. 3. Earlier researches about behavioral parent educational programsWith the help of librarians in the Gothenburg University’s library and Research Methods course I started my research by searching the recourses in the university library. I started by searching library catalogues like Gunda and Libris and search the following databases: Illumina; Science Direct and Eric. I tried to find books and essays in journals according the following keywords: Family education, parent education, behavioral education, empowerment, Cope, family social work, Swedish social work, family in Sweden, cognitive-behavioral theory, ADHD, Family Empowerment. Also I used Google advanced search to find some information about Dr Cunningham’s works and researches. I found some research according to the keywords but none of them had both aspects of BPT and empowerment of families. Therefore I selected some of the more relevant works from each aspect. Most of the researches which are related to the subject of parent education use quantitative methods to study the effectiveness of program on the behavior of parents or children. I did not find qualitative research, studying behavioral parent education (BPT). But there are some works about the empowerment of families and the mental health of their children. I mentioned first the BPT researches and then empowerment researches according to the date from recent to later researches.3.1. Researches about the Behavioral Parent Education One of the aims of the study of Axberg, U. (2007) is to evaluate the effectiveness of the parent training program “Incredible Years Series” (IYS) in diverse clinical settings in Sweden. The parents answered various questionnaires before and after participating in the parent-training groups. The results show significant reduction of BMP in the children on all relevant measures. A significant increase in the self-rated well-being of the mothers was also found.Hoofdakker, B.J. et al (2007) investigated the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC). They compared a group of 5 months RCC with other group which had 5 months RCC plus 12 educational sessions in group format. Results show that adjunctive BPT enhances the effectiveness of routine treatment of children with ADHD, particularly in decreasing behavioral and internalizing problems, but not in reducing ADHD symptoms or parenting stress. Reyno, S. M. and McGrath, P. J. examined the parent training literature to distinguish the child, parent, and family factors which can predict the effectiveness of parent education in child behavioral problems. This literature review included from 1980 to 2004 the studies which were about the prevention and treatment of child behavioral problems. Socioeconomic status and maternal mental health are particularly important factors. Corkum, Penny V. et al (2005) evaluated a 10-week behavior training program for parents of children with ADHD and also examined whether the inclusion of an intervention provided to children's classroom teachers would result in additional behavioral benefits. Two groups are compared: parent training and parent plus teacher training groups. Results indicate that the program is effective in improving of home behavior of children. Also, greater reduction in children's ADHD symptoms was observed in the second group which shows the importance of teacher education alongside of parent training programs.Rooke et al (2004) mentioned that many parents of children with conduct problems do not seek professional help. In this research, they studied the relevance of the beliefs of parents about the problem behavior and their attendance in parent education programs. The parents who showed a stronger believe in potential change, and the effect of child’s behavior on parents’ behavior, attended more often. These findings shows the importance of routine open access group parent training offered at schools so that parents feel less stigmatized, and the turnouts would increase.Bunting (2004) studied a number of systematic reviews of parenting programs effectiveness that summaries the impact of these programs on a range of parental and child outcomes. The findings show that parenting programs can have a positive impact on a range of outcomes, including improved child behavior, increased maternal self-esteem and relationship adjustment, improved mother- child interaction and knowledge and decreased maternal depression and stress. These positive results are maintained over time, with group-based, behaviorally orientated programs. But high drop-out rates may show the limited effectiveness for a minority of parents. Andrea M. Chronis et al (2004) reviewed the parameters of BPT including, parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD. Different longitudinal studies show that BPT has improved both child ADHD behavior and maladaptive parenting behavior. Also there are other improvements like reducing parenting stress and child classroom behavior. Group-based interventions which are more cost-effective, efficient, may be less stigmatizing for some families. Also, researchers emphasis on importance of videotaped modeling and coping modeling problem solving techniques in BPT skills education. Community based programs which are more accessible for low-SES families and those from diverse backgrounds are recommended. Also, parents of children with ADHD may need parent focused interventions like parental psychopathology, marital problems, father involvement, and issues relevant for single parents and parents from disadvantaged backgrounds.The study of Hartman et al (2003) showed that all of the families don’t benefit from PBT programs and one third of children need clinical help after the intervention. Mothers of boys, exhibiting conduct problems attended a parent training program (The Incredible Years). Treatment effectiveness was assessed. Results indicated significant decreases in mothers' negative parenting interactions with their children and in children’s conduct problems. Boys with elevated ratings of attention problems showed similar benefits from the parent training program. A systematic review by Barlow and Stewart-Brown (2000) examined the effectiveness of group parent education programs that aimed to improve behavior problems in children. Critical appraisal of these studies revealed considerable heterogeneity in the interventions, the populations studied, and the outcome measures used. Nevertheless, these studies suggest that structured parent education programs can be effective in producing positive change in both parental perceptions and objective measures of children's behavior and that these changes are maintained over time. Cunningham et al (1995) compared a large group community-based parent training program to a clinic-based individual parent training (FT) program. All families of junior kindergartners with above the 90th percentile reported behavioral problems randomly assigned to: (1) a 12–week clinic-based individual parent training (Clinic/Individual), (2) a 12–week community-based large group parent training (Community/Group), or (3) a waiting list control condition. Immigrant families, those using English as a second language and parents of children with severe behavior problems were significantly more likely to enroll in Community/Groups than Clinic/Individual FT. Parents in Community/Groups reported greater improvements in behavior problems at home and better maintenance of these gains at 6-month follow-up. A cost analysis showed that, with groups of 18 families, Community/Groups are more than six times as cost effective as Clinic/Individual programs. With a look to these researches, I conclude that the BPT is effective for the improvement of the behavioral problems in children and behavior of their parents. Also, it is helpful for improvement of mental situation of parents and children. Group based interventions have better results than individual methods generally and are most cost effective. They attract disadvantaged and marginalized families.3.2. Earlier Researches about empowerment of familiesIn their article Parents as developing adult learner, Marienau and Segal (2006) presented that parents as continuous learners whose critical reflections on their experiences with parenting can be a rich fodder for their growth and development. Theories and models are highlighted that may suggest a wider repertoire of approaches for helping professionals who are facilitating parents in their learning and growth.Johnson et al (2003) explored the extent to which a national random sample of National Assoc of Social Workers members holds beliefs and attitudes congruent with the parent empowerment perspective. Two profiles emerged from the data. Respondents who disagree with statements attributing blame to parents agree with sharing information openly with parents; believe that parents are doing their best, are credible reporters, and are experts about their own children; agree that workers need research knowledge; and disagree that the child is usually the identified patient in a dysfunctional family. In contrast, respondents who believe parents cause their children's emotional and behavioral problems disagree with open information sharing; disagree that parents are doing their best or are experts about their own children; agree that the child is an identified patient in a dysfunctional family; and agree that parents' ideas are important mostly to give the worker clues about family dynamics. Taub, Tighe, and Burchard (2001) examined the relations between family empowerment, children's mental health, and longitudinal changes in family empowerment. Family empowerment increased significantly over time while a child was receiving mental health services. There was also a trend for an increase in parent-reported community empowerment. Parents' reports of children's adjustment were found to correlate significantly with both family and service system empowerment at follow-up. Change in family empowerment over time was found to be a significant predictor of change in children's externalizing problems while in services. Canning and Fantuzzo (2000) mentioned that a brief empowered parent education strategy was developed and evaluated on African American parents who participated in Head Start (a family support program implemented in US). This was compared with a conventional parent education approach. Parents who participated in this unique approach to parent education critisized the content and process of a conventional parent education strategy and collaborated with professionals to design and conduct their own culturally relevant parent workshop. Engagement for parents who participated in the empowered strategy was significantly greater than parents who participated in the conventional one. Content was judged as more relevant and presenter behavior was judged as more respectful than in the conventional approach. Ninety percent of participants queried preferred empowered parent education when asked which workshop they would attend if given the choice.Bickman et al (1998), in Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy. Scheel and Rieckmann (1998) mentioned that parents of clinic-referred preschool children are particularly vulnerable to less self-efficacious judgments of their ability to effectively parent their child. It is vital that these parents demonstrate empowerment through proactive involvement in treatment. Parent internal perceptions of stress, family functioning, stress due to child condition, and extra familial influences were considered in separate predictive models of parent self-efficacy and parent empowerment. Stepwise regression revealed parent stress and family functioning as significant predictors of parent self-efficacy, while a broader range of variables that also included parent employment and education constituted the parent empowerment model. These findings support a multiple-level perspective of empowerment that includes self-efficacy. Vincent (1996) examined contrasting perspectives to the 'empowerment' of parents, which have informed developments at a national and local level. The first approach is exemplified by social democratic initiatives which define 'empowerment' as a strengthening of the role of parent-as-citizen, through mechanisms designed to encourage the closer involvement of parents in the planning and delivery of local education services. The second definition of empowerment is contained within the Conservative Party's emphasis on promoting the role of the parent-as-consumer, especially through policies claiming to enhance parental choice of school. A third approach, supported by the 'new centrists', emphasizes the responsibility of the individual to empower him/herself, by taking advantage of opportunities to participate. Discourses around 'empowerment' are understood by differently situated groups and individuals. 4. Theoretical frameworkTo analyze my results I used two different theories: Empowerment and Cognitive- behavioral theory. The empowerment theory is applied for two different reasons which will be explained bellow. The cognitive-behavioral theory is used because COPE program is based on it.As mentioned in the earlier research part parents of children with behavioral problems are not only isolated and marginalized but also feel guilty and blame themselves continually because of the problems of their children. This situation makes them feel powerless. I used empowerment theory to assess effectiveness of the PBT programs to empower parents. On the other COPE is based on Cognitive-behavioral theory. The aim of behavioral education is to change from undesired behavior to desired behavior. Empowerment also seeks change of the views about the problems and their roots. By ‘conscious-raising’, empowerment tries to change the understanding of social context of the problems and developing ways of addressing them. It helps people to avoid self-blaming and accept personal responsibilities to achieve change and work on their effectiveness to make change (Payne, 2005). In particular, I would like to examine if the behavioral programs can lead to empowerment of the parents. That is if the behavior change can lead into changing of views and feeling empowered in child-raising. 4.1. EmpowermentAlthough empowerment came late to social work literature but has achieved prominence in social work. Some social workers think empowerment is the keystone of social work and is the fundamental part of it. The empowerment can be used in several ranges of activities from consulting to involvement in service planning. The purpose of empowerment is to help people resist in front of labeling process which wants to put them down, marginalize and dismiss them (Adams, 2003). It helps people gain collective control to manage their lives to achieve the power of decision and action to get their own goals, influence policies, get a subjective role instead of being object of intervention of society (Payne,2005). Empowerment is based on self-directed group-work in an educational process (Adams, 2003).Empowerment help people feel self-worthier by reducing their isolation and connecting them to social relations. It tries to improve self-concept and self-confidence. By sharing experience of stigmatization in collective networks, people can move from dependence to interdependence (Payne, 2005). COPE program tries to improve self confidence in parents by encouraging them to share their problems and find solutions in a peer group. Empowerment seeks different things for different people. It is searching social justice by bringing equality through equal social right for allocating of resources (Adams, 2003). COPE also, tries to share the resources of society among all people and give them equal opportunities to gain their different needs during a collective action.There are different interrelated domains of empowerment which can cover different areas of life. Empowerment includes self, individual, group, organization and community domains. Self, individual and group empowerment which are related to this research will be explained.The empowered person is more motivated and able to empower other people. So, before empowering other people, social workers need to consider their thoughts, feelings and situation and empower themselves. They need to develop a democratic way of working towards the goal of self-empowerment and empowerment of service-users. For service users, empowerment is to overcome their disempowerment and gain more control over their lives (Adams, 2003).Empowering individuals is an essential prerequisite for group empowerment. Individual empowerment makes clients more self-directive and assertive, creates positive attitudes toward working with others. Dialogue is center of work and is linked to education and criticality. Without dialogue there is no communication, and without communication there can be no true education. Again, true dialogue cannot exist unless it involves critical thinking. (Adams, 2003, p. 66) Similarly, COPE uses dialogue as a central part of its work. Subgroups discuss subjects and present it in the main group. Dialogue takes place among individuals, in small groups, in the big group, among leaders, and between leaders and the group members.Most of the empowerment is done in group work because of its democratic, participative and humanistic values (Payne, 2005). Adams (2003) believes groups can provide support, reduce the risk of isolation, offer a context in which personal skills can be developed and practiced. Characteristics of group empowerment are: equality of members, independent decision-making, common problems, confidentiality, free participation, voluntary activity, mutual help and support, sharing the roles of helper and helped, and sharing common experiences (Adams, 2003). The same regulations of group work govern COPE program. As a result of all of the similarities in content and process of COPE and empowerment, I will analyze my findings in the light of empowerment theory in order to assess how much COPE can contribute in empowering parents. 4.2. Cognitive-behavioral social workCognitive-behavioral theories are two separate but related groups of ideas. Their origins are psychological learning and psychological theories of perception and information-processing. Behaviorists think that the only thing that we can study is the behavior. Therefore, the only thing we can change is behavior, if it makes trouble for person. Behavioral work by using a linear model of explanation of behavior (one thing leads to another thing) focuses on specific behaviors. It relies on behavioral principles and learning theory and its intervention is based on research evidenced of effectiveness. Workers help clients to use changed behaviors in many situations and generalize the desired behavior (Payne, 2005).As Payne (2005) stated the main aim of behavioral social work is increasing desired behaviors and reducing undesired behavior. Some social workers work with the parents of children who have behavior problems. They teach them being consistent and use social skills approach to educate parents. What they learn can be practiced at home. Rewarding is taught alongside time out, fines and penalties. There are practice and homework which will be reviewed in next sessions. Both the process of education and what is educated use cognitive- behavioral rules. COPE is designed to change undesired behavior of children to the desired behavior by changing behavior of parents. It is an educational program to teach parents how they can change their children’s behavior by using encouragement and punishment. Base of work is cognitive-behavioral theory. Cognitive-behavioral methods are therapeutic procedures which focus on changing thoughts and feelings alongside, instead of or as a precursor to, changing behaviors. (Payne, 2005, p.122)This kind of social work uses psychological change of individuals instead of social changes and emphasis on scientific methods .This branch of social work has a limited use and is specially used in some special psychological problems like school phobia, childhood problems and in psychiatric settings, particularly, in the case of cognitive methods, with mild anxiety and depression. These approaches can be used successfully in group work where people have common problems or backgrounds (Payne, 2005). Some of the important ideas underlying behavioral work which are applicable in COPE are explained below:Operant conditioning is one of the concepts used in this program. Social workers try to control the contingencies which influence behavior and consequence by positive or negative reinforcement and punishment. Encouraging (positive reinforcement) of useful behavior makes the process easier.Another concept is assertiveness training. It is one of the treating techniques used for lack of confidence. People can practice desired behavior in a safe and supportive situation, so they can use it in the real life. Cognitive factors such as disorders of perception or attribution (the meaning attached to events and experiences) are the focus of attention in behavioral work. Since the behavior is under the influence of perception or interpretation of the events, undesired behavior is related to misunderstanding. Therefore cognitive work tries to correct the perceptions and interpretation. The other concept is social learning and modeling. In social learning, social worker focuses on the social situation which can help to learn desired behavior. Modeling is the main idea which people learn especially from the successful behaviors of other people. Most people do not learn by reading books or being told what to do; getting a demonstration of what to do, experimenting while in a supportive environment and getting feedback and encouragement are important.(Payne, 2005, p.125).According to Payne (2005), the following steps are taken in social skills training programs:Specify problems where there are gaps in existent behavior and the desired oneDivide the problems into small stagesCognitive work to identify the misunderstandingsDemonstration of the desired behavior and practicing itConnecting changed behaviors together to make more complex onesTeaching the application of the learned behavior As mentioned during the description of COPE program in second part, the same procedure is applied in COPE.5. Method5.1 Design According to Gilbert (2003) classification this research is a policy-oriented applied research. It is an evaluation research which is focused on collecting data to study the effects of some form of planned change. The primary aim of evaluation research is to determine if a particular policy or intervention is working and the purpose of this kind of research is enlightenment. This research is directed in a qualitative method to grasp the views of the participants of program and approach to their point of view and interpretation of the reality of the program. According to Adams (2003), service users’ views and experiences are dismally under-represented in research, theorizing and practice-based material. Thus, their views beside the educators' views are used to evaluate the program. Therefore, I decided to use interviews as the main method of data collection in order to access to service users views.As May (2001) stated interviews yield rich insights into people’s biographies, experiences, opinions, values, aspirations, attitudes and feelings. Kvale (1996) defines interview as a conversation which has a structure and a purpose, which is to obtain descriptions of the life world of the interviewee with respect to interpreting the meaning of the described phenomena. Therefore interview is used as a method of data collection in order to include attitudes of educators and parents. I decided to use semi-structured interview because this method uses techniques from both focused and structured of interview. The interviewer asks specified questions but also is free to probe beyond the answers. The interviewer can record qualitative information about the topic and this enables the interviewer to inter into dialogue with interviewee (May, 2001).A semi-structured interview was used to collect data. Besides the questions of interview guide, follow up questions used to clarify especially the influence of empowerment theory on the weaknesses and strengths of the program. Three kind of questions (what, why and how) are answered by the interviewees about the program. 5.1.1 Preparing for InterviewsIn performing the interviews I was interested about the following questions:What are the aims of the program?Who can participate in the program?What are the content and the method of the work?What evaluation systems are used?Number, gender and nationality of clientsDuration and the process of each session These questions were formed in my mind after I observed the reporting process made by the Health Manger of Fr?lunda district to political members of the district council about the implementation of COPE. To have more background about the program, I studied further information about the program in the study plans made by educators. The questions of interview guide were prepared according to the views of parents and educators which I collected from the evaluation papers which are regularly filled by participants after each period, observations and the views of educators. The interview guide is available in appendix. The questions are based three main parts: advantages, weaknesses and the ways to improve COPE. Later I participated in four educational sessions in order to get familiar with the context of the program. This helped me to get to know the participants. I could contact some of them later and ask them to participate in research.To get a deep understanding of the advantages and difficulties of the program I needed to be familiar with the views of both parents and educators about the program. Along with the informal meetings with the educators, four set of evaluation papers of the previous COPE programs were gathered and translated by two educators.5.2 Data collectionI performed semi-structured interviews with four people (two parents and two educators) in English. The sample is a non-probable sample with volunteer interviewees. In most of the cases researchers redefine their qualitative study population to conform to the available lists. When the goal of a research is to understand the social processes, the researcher uses purposive or non-probability sampling. In this method the chance of selection for each element in a population is unknown and for some elements is zero (May, 2001).I invited all the participants in different groups to take part in the interviews for this study. Five people volunteered to participate in this study. Three female educators in two different center of Fr?lunda district and two mothers from two different groups in one center were volunteered to participate in the research. I had met them during the observation phase. Five interviews were planned, according to the number of volunteers. One interview was canceled by one of the educators because of the difficulties of language and no more people were found to replace. One of the mothers had a non-Swedish background but has been grown up in Sweden. The rest of the interviewees were native Swedes. The interviews were conducted in English because I did not speak Swedish. This proved to be a constraint to the study because many parents were not comfortable to participate in the study due to the language limitations. Only the people who were able to speak in English volunteered to participate in the interviews. Nevertheless, some of them had problems in expressing themselves in English. In one case the interviewee used Swedish language to answer to two questions which are translated by someone else for the researcher with the permission of the interviewee. Therefore, I believe the language barrier did not affect the research in general.The interviews were conducted and recorded in a calm place. One of the educators was interviewed in her office in preschool and the other in the group study room in the social work department in the G?teborg University. The parents preferred their houses for the interviews because they have young children. In interview sessions, I first thanked the interviewees for their participation. Then I informed them about their rights, and I told them they could ask me about the research after the interview. The interviews were done according to the interview guide and took at least 40 minutes and maximum around 75 minutes. Two interviews were stopped several times because of the needs of the children who were present at the interview place. The children made sound and wanted their parents’ attention. Therefore the parents were not fully concentrated.5.3 Data processing All interviews were recorded. Transcriptions were prepared according to the recorded speech. They included the whole conversations. I sent them later to the interviewees and asked them to read the text and inform me if they found some mistakes or wanted to withdraw their interviews. But they did not ask me to cut any part of the interview. The categorization method was used to analyze the interviews. The transcriptions were categorized according to different themes in the interviews in order to facilitate the analysis of the interviews. The categorization method is used to analyze the experience that is shared by a group of people and compare all references to the selected phenomenon in one interview or across several interviews (Gilbert, 2008). The categorization is done according to the themes of the interview guide. The followings themes are discussed: Why parents need this program, Aims and benefits of program, the weakness and strengths of it, proposals to improve the program, effects of COPE, problems of leaders, problems of application, integrability of the program to the Swedish cultureThe interviews were analyzed according to the empowerment theory, cognitive-behavioral theory and research questions.5.4. Validity, Reliability and GeneralizabilitySocial sciences use reliability, validity and generalizability for verifying of knowledge. Against positivist view which tries to generalize the laws of behavior, a contrasting humanistic view assumes that situations are unique and each phenomenon has its own intrinsic structure and logic (Kvale, 1996). Therefore, the emphasis in this view is on the heterogeneity and conceptuality of knowledge, with a shift from generalization to contextualization. Analytical generalization is a logical conclusion in which the researcher indicates why (according to similarities and differences and using theory based logical statements) one finding can be used in another situation. In other word, it must be cleared in the process of generalization what is, what may be and what could be in a situation (Kvale, 1996). The interviews and observations were used to answer the question what is, and I used empowerment theory and the results to get a logical statement to predict what may be and what could be in next parent education programs.My sample was somehow biased especially about parents because they were volunteered from people who were interested and were able to speak English. Therefore, they might be more educated and self-confident. It is the same about educators. Also, they accept to have an interview with a non-Swedish student which may show some especial political or social interests. Therefore they might not be a representative sample of the population in question.Reliability means the consistency of the research findings. Validity, which is the degree that a method investigates what it is intended to investigate, is changed from a product investigation to the quality control process during the knowledge construction. By emphasizing on pragmatic truth, validity determination in this view seeks for abstractions from a unity, where a comprehensive verification of qualitative research findings will involve observation, conversation and interaction (Kvale, 1996).As a result of my professional background as a family educator in Iran, I was much dedicated to empowerment theory as a meaningful and necessary tool for family education. I was much interested to assess if the collective family education programs lead to empowerment of parents in Sweden. Therefore, during my interviews, I focused on questions directed to feeling more powerful and getting support from the group. Thus, some of my follow up questions might be somehow leading in this context. In the same way, the transcription of the tape records might be influenced by my personal interests and attitudes when the voice was not clear. The program is new. Therefore, according to educators, they are not so skillful and practiced about the program to see the weaknesses and the strengths of it. They think they need more time to understand the weaknesses and strengths of the program. It can limit the validity of the research. Also, the language is an important issue. Since it is not the language which researcher and interviewees speak conveniently some meanings might be missed by both partners. Since I tried to make rapport with the interviewees to encourage them to participate, it is possible that they answered the questions according to what they assumed about my interests and hide some parts of their beliefs.5.5. Ethical consideration.According to Kvale (1996) the ethical issues should be considered in seven stages of the research which will be discussed below. I ensured that the aim of research is not against the society or some groups of it. Since the results can help the improvement of the program, the purpose of the research is in the behalf of the service users and educators.The voluntariness of participation in the research was ensued. All of the interviewees were volunteers. They were informed about the purpose of the research and they could ask about the research in the end of interview. Moreover, they were informed that they can refuse to answer a question if they didn’t want, and they could withdraw their statements in the later stage if they choose to. They were advised that if there is a part or some special points in the interview that they don’t want be mentioned they can inform the researcher. The transcriptions of the interviews were sent to the interviewees later.The confidentiality of the information was also guaranteed by the researcher. Nobody would have access to their personal information. Only the researcher and supervisor and examiner will have access to the tape records and transcriptions. The personal information that may result in their recognition will be eliminated.To prevent a stressful situation it was mentioned that language problems are common between the interviewee and interviewer. Therefore, they could feel comfortable for thinking about the wording and structuring of the sentences during the interview. The statements of the interviewees were clarified by follow up questions during the interviews to avoid the wrong interpretations.The interviews were conducted without any stranger. The researcher did not enter in the subjects which interviewees avoided them obviously. Nevertheless, the interviewees seemed stressed because they were not accustomed to speaking English. Also, those whose young children were present during the interview were more uncomfortable. The analysis is done according to the interviews and theoretical framework. Since the results are not against the interests of special group or person, they can be published. After the completion of grade report, the thesis will be sent to all participants.6. Results and Analysis In this part, first the results of interviews will be presented using categorization approach as a qualitative method. Then the results will be discussed according to the theoretical frameworks. The categorization is according to the themes of the interview guide. The followings themes are discussed: Why parents need this program, Aims and benefits of program, the weakness and strengths of it, proposals to improve the program, effects of COPE, problems of leaders, problems of application, integrability of the program to the Swedish culture. I will describe the results for each theme in the following. 6.1.Why parents need this program Parents participated in the program because of the following reasons. They heard about the parent education programs from friends. Besides they felt that they have not enough parenting experiences and skills. They felt a need for getting advice and meeting other parents. One of them felt more need for communication with other parents because she is a single mother. Educators mentioned another set of the reasons which is categorized in four sections. The first category is behavioral problems of children. They think parents participate in programs because children disobey them and always argue. They think parents don’t have good relationship with their children. That the child doesn’t listen to them and the parents feel that they are just screaming and arguing don’t have a nice relationship with the child. (Educator 1)The second category is socio-economical situation of the parents. They stated that most of the time both parents work excessive and are in a stressful economical situation. As a result, they feel guilty that they don’t have enough time for their children and want to be nice with them. They think if they don’t put limitation for children they will compensate for their absence .In this category also we see single parents which are alone and are not able to do their parental responsibilities. Because I am a single parent and I don’t have anybody to ask for advice I have only rely on myself when there is tow parents you can communicate and come up with the solutions and see the problems easier so for me that is the most being single makes it hard. So that is why I choose to go to COPE. (Parent 1)There is a cultural aspect for this issue in Sweden as mentioned by the educators. Parents think if they put limitation or are strict with their children other people will think they are not good parent so they feel uncomfortable to do their parental responsibilities. They participate in educational program to overcome this problem. The last point as mentioned by educators is the lack of parenting skills. They don’t know the best way for putting limitations and giving consequences for bad behavior of their children. The educators stated that the parents are unable to spend a meaningful time with their children in a structured way. It means that even if they find a time to spend with their children, they don’t know how to plan it so that they can construct a good relationship with their children. One educator mentioned that parents give extra importance for domestic works like cleaning and tidying up and can’t dedicate enough time to their children. Besides, the parents don’t know what is the definition and responsibilities of a good parent. As we can see there are different reasons which attract parents to the program. Some of them can be answered by a behavioral program. They gain skills and tolls to overcome in a difficult situation. On the other hand they empower themselves by meeting the peers and sharing the problem. Problems can be social, economical, cultural, or problems relating to their parenting skills. 6.2. Benefits and aims of the program:Parents mentioned several benefits which they gained during the implementation of COPE. These benefits can be categorized into three parts. The first category includes the advantages which are usually aimed by the most of the parent educational programs. In this category parents stated that COPE reminded them the essential rules of parenting and taught them to be patient. It helped them to see the situations with different eyes and don’t get confused by different parenting theories. They mentioned that the teachers gave them useful advices. The second group is the benefits which is obviously related to the cognitive behavioral theory and shows how they learned from a behavioral program. In this category, they mentioned that COPE gave them an organized way of thinking about parenting and improved their strategies for reinforcement and problem solving strategies. It helped them to learn to react in the problematic situation rationally instead of emotionally. You don’t react with your brain you react with your feelings. You need to be reminded all the time about all the things. (Parent 2) They think they found a path to follow in parenting and learned how to teach children the rules of prioritizing most important tasks. They learned how to apply different disciplinary methods in different situations. As a last point, they stated that they gained more confidence to be more firm and apply rules.The third category is the benefits which can be related to self and individual empowerment. Parents stated that COPE helped them to gain strengths in parental role and feel more secure. It helped them to hear the views and experiences of the other parents. This resulted in a shared experience for them, not to feel alone and feel in the same boat with other parents. ‘I got to meet the parents and I got to be a part of their stories’. (parent 1) It seems that they improved self confidence and self control and improved parenting styles in the different type of dialogues. Educators gave similar answers to the question of what are the aims of the COPE. Their answers also are categorized in three main parts. As a usual result of parent education they stated that COPE can help parents to be happy. They can enjoy shared time with children without conflicts and anger. They can meet other parents and give good tips for parenting to each other.They mentioned that parents can learn the parenting skills together which is obviously related to social learning theory. Also, they stated that parents can find new ways to distinguish and solve problems. Some of the aims of COPE related to empowerment theory according o the educators are the following. COPE helps parents not to feel alone and teach them to support each other. It makes them stronger parents and improves their self confidence and self control. They can feel more powerful through making their own community and controlling the undesirable situation.In short, we can see that parents and educators share the understanding about the purposes of the program. It shows that the program is well-implemented according to the predefined aims. The statements of the parents implicate that they feel more individually empowered. As a result of the education of behavioral tools they gained more control on themselves and their situations. They feel that they are not alone and their situation is not a unique one. 6.3.Strengths of the programThe most important strength point of the program as mentioned by parents is what they learn in the first session. They learn how to pay attention to their children and encourage them. The other important part of the program is planning ahead which helps them learn how to plan their activities and how to help children understand and cooperate with them. Parents mentioned that it is easy for them to learn and apply the planning. The other point which parents think is a new idea and helps them a lot is ignoring bad behavior.Also educators believe that the most important part of the program is to learn how to pay attention to children and encourage them. The strategies for ignoring bad behavior come later. They think if parents learn the when-and-then strategies, which help them to plan a prioritized plan for children, they will have fewer conflicts with their children. Also, they will be able to use their time in a useful way. Educators mentioned that improving self control of children can help parents be calmer and teach their children to be independent. Educators think that the program tries to encourage parents in several ways: positive feedback of the educators or peers, as well as the reinforcing results they gain after changing their own behavior with children. This improves the self images of the parents that is parents gain better images of their own parenting skills which encourages them into acting even better. They have a feeling of mutual gain and give. During the group interactions since they think they bring something into the group, it is easier for them to accept the conclusions in the group. The other advantage of the program as put forth by educators is giving rational thinking abilities in the parenting issues. They learn to think about their own behavior and its consequences. Also, parents can adjust the program according to their needs.It can be concluded that parents mentioned cognitive-behavioral aspects of the program as strengthens of it. They have mentioned several points about the behavior control strategies. Educators also put the cognitive benefits of the program in first place. They mentioned that the behavioral education and behavioral methods improve the behavior of parents beside the behavior of the children. Also they have mentioned some points which can be related to empowerment theory. The benefits of group work and mutual aid of parents can lead to individual empowerment. 6.4. Weaknesses of the program The first point which is mentioned by parents relates to the novelty of the program. Since the program is newly introduced, they did not reflect about the weaknesses of the program. One of the parents was not satisfied with the level of interactions within the group. I would probably get more if we had longer opportunities and more opportunities to interact with each other. (Parent1)The other weakness which is mentioned by parents is related to the applying of the method. They mentioned that they had difficulties in understanding the exercises. Also, the amount of practice before moving to the next skill is not enough. Homework is difficult to understand and apply and there is a need for more examples. Some believe that strategies in cope are applicable for older children with more communicative abilities. One of the parents stated that it is difficult for her to change her behavior to apply the methods. She thinks that parents need more self control skills.As mentioned by one of the educators before, punishment is viewed very negatively in Swedish culture. One parent confirmed it by stating that she disapproves the usage of punishment in any form for example time out. She stated that instead of punishing she prefers to model the desired behavior in a way her child can learn it. It seems some behavioral methods which are not favorable in Swedish culture can be replaced by other behavioral methods which are gentler and are acceptable culturally. The other weakness refers to the educational material. One of the mothers think that the nature of videos is theatrical which did not show a real situation of parent-child interaction and focuses on parents’ bad behavior. She thinks the bad behavior of children is missed in these videos. As a result parents can’t recognize it and relate it to their life situation. One of the blames themselves when she said: We are the weaknesses. The course itself is very good and the methods are very good but putting them into practice means different thing for each parent and each family.(Parent1)Educators also mentioned some weaknesses which can be categorized to different groups. The first is the applicability of the program. They think that it takes time for parents to feel comfortable in group and to open up. In first sessions they are shy to participate in discussions. Some educational tools like brainstorming and role play are difficult for parents. Educators think if the parent’s discussions don’t go in the right direction the group will miss the educational goals. Also, some methods are very difficult to be applied by parents. Planning a head and problem solving between the parents are the most difficult parts. The last point about the application of program is that some of the homework are not clear for parents and they had to explain it for parents several times.Educators also confirmed that parents prefer not to use punishment as a disciplinary tool. They mentioned that parents don’t like time-out and parents are concerned about the usage of giving the consequences. It is not clear if parents use punishment as a parental tool later in their normal life.The other weakness from the point of view of educators is that parents don’t have much information about COPE and thus the rate of participation is low. Sometimes there are not enough parents to have a complete group.The last weakness mentioned by educators is about the educational material. They also, confirmed that the videos do not have a good quality but they stated that they would be improved. ‘Some of them are not so good’ as expressed by Educator 2.As can be seen most weaknesses are about the application of methods. Also the cultural concerns and avoidance of Swedish society of usage of punishment and rewarding is clearly one of the obstacles of the program. The program is based on the usage of behaviorism methods and if parents avoid using the tools they may not achieve some aims. 6.5. Improvement of the programParents put forth some suggestions to improve COPE which is categorized to three parts. First part is related to the participation of parents .One of them thinks that the program needs people who are more vocal and participate in discussions.The parents should have been as open as I am and share more about their difficulties. (Parent 1) it was more or less the same people how were talking.( Parent 2)Parents also, suggested introducing a financial incentive to increase the rate of participation of parents and continuing the program. In order to increase the participation of parents one of the parents suggested that there should be two versions of program, one small group and one big group and parents have the choice between them according to their needs and abilities for participation in group work.The second category is about the application of the methods. Parents have some suggestions for improving the usage and quality of application of methods. One of them thinks that if they practice the skills more in group the program can be more effective. Also, one of them believes that using home visits and individual home based services for practicing the new skills can help parents to apply what they learn in a correct way. She thinks showing the practical aspects of being patient, gives more hints about the self control and anger control. The third group of the suggestions is related to the social empowerment. One of the parents believes that making small networks with long-term friendly relations will help parents to feel more secure and support each other. I think smaller groups when the children are born the hospital arranges some form of parenting information for six or seven session that the same group of parents go to and give the child birth almost in the same period of time I don’t think they should followed up but they should cooperate so this continues from those things taking in that group and make tight connections between parents and support each other. So they can have a group to be comfortable… A group with the history, a group that we had met before. People know each other. People may have children in the same daycare. ( Parent1)Educators also mentioned some points to improve the COPE which is categorized to different parts. First of all they have some suggestions about their situation as a leader. One of them thinks that there should be a continual educational program for the teachers. The second point is that they think as educators they need more professional help from colleagues and the course educator. They think they need more feedback and help in difficult situations. The last point is related to the leader’s manual. One of the leaders thinks that they should produce an individual manual alongside using cope manual. It can help educators to follow the program in a right track.The second group is somehow related to the same thing which is stated by the parents. They think there should be a session for parents to learn how to make connection with educational structure and open up more. The other part is about the educational material. Educators like the parents think that there should be a demonstration of appropriate behavior in the movies and showing the inappropriate behavior dose not suffice.The last part is related to the parents which are sent to program by social services. One educator thinks these parents need some follow ups to help them use the program more effectively and change the situation which is considered harmful for children by social services office. It seems that parents and educators suggested appropriate and relevant points to improve the weaknesses they stated earlier. 6.6. Effects of cope on parents I categorized the effects of the program in three parts: knowledge, attitude, and behavior. First the interviewees did not mention any change due to the participation in the program. One of them said that she does not feel an internal change.Then I suggested them to think about the three possible different areas of change which might have happened for them after participating in the program. They think that they have access to books, magazines and friends which can provide the knowledge which is offered in the program. Therefore they think the program does not have a big effect on changing of their knowledge level. ‘I had the knowledge just wonder how put it into the practice’ (Parent 2)But they think their attitudes are changed. One of them described the changing of attitude like this:New ways to do things and think about the situation.(Parent2)My attitude is changed, I can look at her [my child] without getting emotionally involved. (parent1)Also she explained that her attitude is changed about prioritization of activities.I had to change my attitude, maybe let go some of it to be able to prioritize better. Maybe some days the dishes are not as important as actually cooking is. And maybe some days making the house clean is not as important as going outside with my child. So it is another attitude which in fact changes our behaviors.(Parent1)They stated they feel more calm and in control. It seems that the parents have a better view that how they can prioritize their activities and plan their lives and it helps them to have more control on their lives as well as their feelings which results in the peace of their minds. Educators also, mentioned some changes in knowledge, behavior of parents and specially their attitudes toward their childrenI am so glad that I could see in some parents a huge different. I can see a big difference like in the attitude about the children and they don’t think in a negative way about their children.(Educator2)Also, they emphasized a lot about the self confidence gained by parents. It seems that self confidence is created during the active group work. Empowerment takes place when they feel they are the active agents who can change their situation and are not subject of education.They can feel more confidence like I am a good parent. Educator 1And they come to us and they find the knowledge they had inside of themselves. They came up with the ideas they came from themselves that give them a lot of confidence… I think the whole problem is like to get I am in control, I am in charge. And that makes them safer. Because then you know how to control the situation.(Educator2 ) Another educator described the effect of program as below: I think that they think more like a parent. So it may be the whole. Everything you said, the behavior and the knowledge and attitude. I think the most important effect of program is to see other ways to go and other rules to take. (Educator 1 ) The other effect which educators observed is related to the solidarity as also stated by an educator: And they feel better because they know they are not alone.( Educator1)As mentioned above, I conclude the biggest change in first step happens in attitudes. The interviews are done some days after finishing of the course. Therefore the long term changes cannot be observed and reported by parents. They emphasize on the attitude change. Educators on the other hand reported some changes in behavior of parents. The reason might be that the educators have more experience of working with different groups and see the parents’ situation from a wider view 6.7. Practical problems in implementation of programLeaders reported some practical problems which can be categorized to two groups. In first group mostly there are problems related to participation and interrelation of parents. One of educators reported that some parents think if they go to parent education programs they are bad parents. Therefore educators have to work initially on their attitudes toward participating in program. The other educator confirms this problem. She says some parents think they will expose themselves if they talk about their families and want to hide and ignore the problems. The other problem in this group is the rate of participation. One educator thinks that when there are fewer people it is harder for them to speak up because they feel like everybody listens so much to them. There are some cultural issues which can decrease the participation of fathers. In this part of the city we have many parents from different countries and may be they think it is the mothers’ duty to come to parent education. (Educator1)The other problem which educators face is about the parents who are sent to the program by social services office in line with the child protection programs. Educators think that they need more work, lot of encouragement and attention. They seem intimidated and shy to participate.The second group of educators’ practical problems is related to application of program. They think that following the manual is not easy because parents sometimes get out of the subject and you have to bring them back. It takes time and sometimes the main subject is not discussed enough to reach the main goals of educators. The other problem which is similar to the first one happens when everybody are quiet. It is really hard to be a team leader when all are reluctant to make a statement or share their views. Parents also mentioned some points which are related to the practical problems of implementation. One of them stated that we were different people from different backgrounds without common problems. Also the cases were not open enough and some people feel insecure to share them. The other one pointed that shyness and language problem of some parents make them avoid from full participation. Besides, some people were more dominant especially those who were more vocal. This made it difficult for everybody to participate in group discussions. Sometimes it could result on limitation of different ideas and views of parents.6.8. Integration of the program to Swedish contextAs mentioned before, COPE was originally designed in Canada. The program later was replicated and adjusted in Sweden. To see if the program matches the Swedish culture I asked them if they find something unfamiliar in the program. It seems that the behavioral way of reinforcement and punishment is not culturally familiar and favorable in Sweden. One of the parents answered rewarding is a modern concept in Swedish society. The other answered that I can’t say because I am not originally from Sweden and my parents used the parenting culture of our home country for my upbringing. Similarly one of the educators said time out and rewarding system is not the way we use in Swedish family. It is not so common to give stars for good behavior and getting them back because of bad behavior in Sweden.It seems that other parts of program fits well in the Swedish society. It seems that the socio-economical and educational level of the parents is not so different in the Canada and Sweden. It makes it easy to use the program with small changes.6.9 Cognitive-behavioral education of COPE and empowermentTo determine the relation between cognitive-behavioral education of COPE and empowerment, I will firstly examine how much COPE is successful to reach its behavioral aims. Then I shall analyze if the empowerment takes place or not and how.According to the findings in first two questions which are described in the above eight parts under result section , parents and educators confirmed the positive results of COPE education. COPE could fulfill most of its educational aims. Educators activate the cognitive process of parents to find the problems and produce the solutions for their common problems. Role play as a modeling instrument is used in several parts of the program. Using encouragement and giving feedback to initiate new behavior or reinforce desired behavior is used in this program. Also the educators help parents to use this method and rules in their relation with the child to get control of the child and produce desired behavior and eliminate the undesired behavior. So there is a unity of method and content in this sense in the program which can result in a high efficient program. According to the interviewees, COPE has good effects on the change of knowledge, attitude, and behavior of parents. It is really good to see and I am so glad that I could see in some parents a huge different. (Educator2)It shows that COPE is successful to fulfill its behavioral aims. To adjust COPE to Swedish context there was a need to change some parts relating to punishment and reinforcement to be able to come to the practice of everyday life of Swedish parents.It seems that the program has really contributed to the empowerment of the parents. Group work increases parents’ self-management skills and helps them to act as a member of a group to achieve shared goals. Gaining power, feeling more secure, feeling more in control in difficult situations and other factors of empowerment work is reported by parents and educators during the interviews. They even go further and suggest initiating a local supportive group of parents to seek social empowerment beside the individual empowerment. Also, educators reported that they have reached individual and social empowerment by working in the group of educators before and after the course. They emphasize that they need more help of peers and seek group work and shared work with other leaders. It shows that the program is empowering and can help both parents and educator to gain more self and social empowerment.7. DiscussionIn this study the point of view of parents and educators about the COPE program is examined in a qualitative manner. COPE is an evidence- based parent education program which is originally from Canada but is adjusted to the needs of Swedish families. COPE is based on cognitive-behavioral theories and uses social learning and modeling theories for behavior modification. In most of the earlier related researches, the quantitative methods are used to evaluate the effectiveness of the program according to the positivist idea of truth. The researchers measured some predesigned factors of behavior of child or parent before and after the intervention with or without the evidence group. So, the views and experiences of the parents and educators who are the participants of the program were ignored and some important part of reality of the implementation of the program was missed. But this research uses a qualitative method with the semi-structured interview of volunteer samples to go further than effectiveness factors of previous researches. I used interview results to find answers to my three research questions. First question asks the point of view of parents and educators about the strengths of the program. According to my results it seems that both participants and educators believe that COPE is a very helpful educational program to change the unwanted behavior of parents and children and establishes desired behaviors. It helps parents to find and resolve their children’s problems in a systematic manner and feel calm and in control. As to the second question about the weakness of the program, it seems that there are some cultural barriers in applying certain behavioral methods like punishment which are programmed in the original form of COPE education in Canada. Physical forms of punishment and reinforcement of children as prescribed in the behavioral methods are alien to the Swedish culture and parents find it difficult to practice. Also, participation of parents is low due to perceived stigmatization for participation in the program. On the other hand, parents find it very difficult to open up and talk about their internal family problems in groups. The third research question is the main subject of discussion in this part. I was interested to know if the cognitive-behavioral education of parents leads into their empowerment. From the empirical data it seems that some aspects of COPE education can help individual empowerment of parents and educators. The informants talked about some important elements of empowerment like feeling secure, in control. They also expressed their willingness to work in group to achieve shared goals. They were no more helpless or powerless in difficult moments of their lives.Educators use the cognitive- behavioral social work to change parents’ behavior which can lead to better adjustment and less behavioral problems of their children. As mentioned in earlier research part, many researches show the efficiency of the BPT (Behavioral Parent Training) programs in reducing the behavioral problems of children and increasing families’ different well-being factors. In a similar program, Incredible Years, there is significant reduction of behavioral problems in the children on all relevant measures (Axberg, 2007). Another study shows significant decrease in mothers' negative parenting interactions with their children and in children’s conduct problems (Hartman, 2003). Earlier research in this area is mostly focused on behavioral changes and ignores the relation of changing of behavior with empowerment. The only relevant works I found is done by Marienau and Segal (2006) which mentioned that experiencing parenting can be a help for development and strengthen of parents and Taub, Tighe, and Burchard (2001) mentioned the positive relation between the family empowerment and increasing of mental health of children. In my research I mainly focused on the relation of cognitive-behavioral education and empowerment. From a theoretical perspective, it is possible that the cognitive behavioral education results in empowerment of participants. According to Payne (2005) empowerment is a rationalistic theory and applies self-knowledge and self control. It assumes that people can control their lives by rational, cognitive means. They can do it by changing ways of perception and interpretation of information and removing false perceptions and beliefs. On the other hand, cognitive-behavioral methods can help people to feel in control and change the situation of feeling powerless (Adams, 2003). Also, according to Barkley (1998) Social-Cognitive psychology tries to use attitude change models while parents devise their own solutions and rationales. It can be seen that cognitive-behavioral methods theoretically can lead to some aspects of empowerment. The other point is about the morality of usage of behavioral programs. They use the methods of client control. According to Payne (2005) some may say that all methods can be misused and the most important morality is that the method can work and help the clients. Behavioral methods can validate it by measuring the affectivity of their programs. Also, it is claimed that cognitive –behavioral methods doesn’t label clients since emphasize on special behaviors. Still there are many doubts about the usage of these methods and some social workers use the technique only when the client decides to change the behavior or just use some aspects of work instead of using whole of perspective in their work.The results of the research seem to be valid since a semi-structured interview method is used to grasp the research questions. The general line of interview guide is based on the research questions which were designed to gather data and the questions and were adapted to the interviewees. The reliability of the results is ensured by research method. The interview guide questions the social structure in a systematic manner. The answers are based on general trends in the society and cultural structures which may not be changed easily by time. Since the general Swedish culture and family structure was the base of analysis, the results can be generalized in the Swedish context. One important thing which I found affecting my direction in research is my background as a social worker from a developing country. In my context all of social works which are done for children and families are empowering for them especially for women. Lack of legal support and traditional context of the country limits the power of women. So, any kind of social work which brings the notion of citizenship, human right even child rights give a kind of turning on their engine to get their missed persona , social, and human rights in the society, family and group. Although, some aspects of empowerment can be seen in the Swedish context, it is much different in level and amount when I compare it with my home country. These differences can be due to different socio-economical situation of women in these countries. Cultural and political differences might be crucial. In Sweden, equality of men and women is one of the main aims and targets of government. In the society, the rights and freedom of women are accepted in wider aspects when I compare it with Iran. Women have enough situations to show their power or try to gain it through a systematic way and don’t need to use any educational or social situation to empower themselves.This research can be done as a comparative pattern in a developing country versus Sweden to study the differences of the same intervention in different socio-economical contexts. It can reveal the effects of the social structures on the individual and group empowerment and help to design appropriate interventions for families in different contexts. References:Adams, R., 2003. Social Work and Empowerment. 3rd ed. New York: Palgrave Macmillan.Axberg , U., HYPERLINK ""Hansson, K., HYPERLINK ""Broberg, A.G., 2007. Evaluation of the Incredible Years Series - An open study of its effects when first introduced in Sweden. Nordic Journal of Psychiatry, 61(2), pp.143 – 151Barkley, R. A., 1998. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, 2nd ed. , New York: Guilford press.Barlow, J. D., Stewart-Brown,S., 2000. Behavior Problems and Group-Based Parent Education Programs. Journal of Developmental and Behavioral Pediatrics, 21(5):356-370Barth, R.P., Landsverk, J., Chamberlain, P., Reid, J. B., Rolls, J. A., Hurlburt, M. S., Farmer, E. M. Z., James, S., McCabe, K. M., Kohl, P.L., 2005. Parent-Training Programs in Child Welfare Services: Planning for a More Evidence-Based Approach to Serving Biological Parents. Research on Social Work Practice, 15(5), pp. 353-371Bickman, L., Heflinger, C. A., Northrup, D., Sonnichsen, S., Sonnichsen, S.,1998. Long Term Outcomes to Family Caregiver Empowerment. Journal of Child and Family Studies, 7(3), pp. 262-289Bor, W., HYPERLINK ""Sanders, M.R., Markie-Dadds, C., 2002. The Effects of the Triple P-Positive Parenting Program on Preschool Children With Co-Occurring Disruptive Behavior and Attentional/Hyperactive Difficulties, Journal of Abnormal Child Psychology,30(6), pp. 571–587. Bremberg, S., 2003. New tools for parents: Proposals for new forms of parent support, Swedish National Institute of Public Health, [online]. Available at < ; [Accessed May 2008].Bunting, L., 2004. Parenting Programmes: The Best Available Evidence. Child Care in Practice, 10 (4), pp.327 – 343Canning, S. S.,?Fantuzzo, J. W., 2000. Competent Families, Collaborative Professionals: Empowered Parent Education for Low Income, African American Families. Journal of Prevention and Intervention in the Community,20(1-2), pp. 179-196.Chronis, A. M., Chacko, A., Fabiano, G.A., Wymbs, B.T., Pelham, W.E. Jr., 2004. Enhancements to the Behavioral Parent Training Paradigm for Families of Children With ADHD: Review and Future Directions. Clinical Child and Family Psychology Review, 7(1), pp. 1-27.Corkum, P.?V., McKinnon, M.M., Mullane, J.C., 2005. The Effect of Involving Classroom Teachers in a Parent Training Program for Families of Children with ADHD. Child and Family Behavior Therapy, 27(4), pp.29-49.Cunningham, C. E., Bremner, R., Boyle, M., 1995. Large Group Community-Based Parenting Programs for Families of Preschoolers at Risk for Disruptive Behaviour Disorders: Utilization, Cost Effectiveness, and Outcome. Journal of Child Psychology and Psychiatry, 36 (7), pp. 1141-1159.Cunningham, C.E., Boyle, M.H., 2002. Preschoolers at Risk for Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Family, Parenting, and Behavioral Correlates. Journal of Abnormal Child Psychology, 30(6), pp. 555–569.Gilbert, N., 2003. Researching Social Life. 2nd ed. London: Sage.Gilbert, N., 2008. Researching Social Life. 3RDed. London: Sage.Hartman, R.R., Stage, S.A., Webster-Stratton, C., 2003. A growth curve analysis of parent training outcomes: examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors. Journal of Child Psychology and Psychiatry and Allied Disciplines, 44(3) pp. 388-398.Johnson, H. C., Cournoyer, D. E., Filiri, J., Flynn, M., Grant, A. M., Lant, M. A., Parasco, S., Stanek, E. J., 2003. Are We Parent-Friendly? Views of Parents of Children with Emotional and Behavioral Disabilities. Families in Society, [online]. Available at: < ; [Accessed on may 2008].Kvale, S.,1996. Interviews: An Introduction to Qualitative Research Interviewing. London: Sage.Marienau, C., Segal. J., (2006), Parents as developing adult learners, Child Welfare, 85(5), pp.767-784. May, T., 2001. Social Research: Issues, Methods and Process.3rd ed . London: Open university Press.Payne, M.,2005. Modern Social Work Theory. 3rd ed. New York: Palgrave Macmillan.Petersson, C., Petersson, K., H?kansson, A.,2003. General parental education in Sweden: participants and non-participants. Scandinavian Journal of? Primary Health Care, [online]. Available at: [Accessed May2008].Reyno, S.M.,?McGrath, P. J., 2006. Predictors of parent training efficacy for child externalizing behavior problems – a meta-analytic review. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47(1), pp. 99-111(13), Rooke, O., Thompson, M., Day, C., 2004. School-Based Open Access Parenting Programmes: Factors Relating to Uptake. Child and Adolescent Mental Health, 9(3), pp. 130–138Scheel, M. J., Rieckmann, T.,1998. An empirically derived description of self-efficacy and empowerment for parents of children identified as psychologically disordered. The American Journal of Family Therapy, 26 (1), pp. 15-27.Taub, J., Tighe, T. A., Burchard, J., 2001. The Effects of Parent Empowerment on Adjustment for Children Receiving Comprehensive Mental Health Services. Children's Services, 4(3), pp. 103 – 122.Therborn,G., 2004. Between Sex and Power, London: Routledge.van den Hoofdakker, B.J., van der Veen-Mulders, L., HYPERLINK ""Sytema, S., HYPERLINK ""Emmelkamp, P.M., Minderaa, R.B., Nauta, M.H.,2007. Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: a randomized controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, [online]. Available at: <; [Accessed May2008].Vincent, C., 1996. Parent empowerment? Collective action and inaction in education. Oxford Review of Education, 22(4), pp. 465-482.National public health objectives for Sweden: Swedish COPE: National Board of Health and Welfare: Institute of Public Health website: guide of “study of weakness and strength of COPE “Educators’ versionDear … thank you very much for participating in this research. As you know I am going to ask you about your experiences of cope as a leader. This data will be used for the research of “study of weakness and strength of COPE”. All the things that you tell me will be used just for research purposes and your name and personal information will be confidential. We can discuss about the research and its goals after the interview more.1-As first question please tell me what do you think is purpose of cope?2- Why do you think Swedish families need this program? Or what are the benefits of cope for Swedish families?3- Which parts are more useable for Swedish families? Why?4- What are the unnecessary parts of cope for Swedish families? Why?5- What do you think is missed in this program according to the needs of Swedish families?6- How do you think cope gains its goals? (What are the best parts of it to gain the goals: content, method?)7- What are the weaknesses of cope? Why?8- How do you think cope can be better?9- Do you think this course have practical effect on parents? (Which part of parenting do you think change more by participation in cope: knowledge, attitude or behavior?) How?10- Which parts are easier to understand and apply? Why?11- Which parts are more difficult to understand and apply? Why?12- Which difficulties do you have as a leader? Why?13-I don’t have more questions. If there is something about cope which you think is important please tell me.Thank you again for participating. I will send you the transcription of the interview as soon as I prepare it. If you have some question about research please ask me now.Parents’ versionDear … thank you very much for participating in this research. As you know I am going to ask you about your experiences of cope as a parent. This data will be used for the research of “study of weakness and strength of COPE”. All the things that you tell me will be used just for research purposes and your name and personal information will be confidential. We can discuss about the research and its goals after the interview more. 1-As first question please tell me what do you think get from cope?2- Why do you think you need this program? Or what are the benefits of cope for your family?3- Which parts are more useable for you? Why?4- What are the unnecessary parts of cope for you? Why?5- What do you think is missed in this program according to the needs of your family?6- How do you think cope gains its goals? (What are the best parts of it to gain the goals: content, method?) How?7- What are the weaknesses of cope? Why?8- How do you think cope can be better?9- Do you think this course have practical effect on you? (Which part of parenting do you think change more by participation in cope: knowledge, attitude or behavior?) how?10- Which parts are easier to understand and apply? Why?11- Which parts are more difficult to understand and apply? Why?12-I don’t have more questions. If there is something about cope which you think is important please tell me.Thank you again for participating. I will send you the transcription of the interview as soon as I prepare it. If you have some question about research please ask me now.2-Informed ConsentThe following is a presentation of how we will use the data collected in the interview.The research project is a part of our education in the International Masters program in Social Work at the University of Gothenburg, Sweden. In order to insure that our project meets the ethical requirements for good research we promise to adhere to the following principles:Interviewees in the project will be given information about the purpose of the project.Interviewees have the right to decide whether he or she will participate in the project, even after the interview has been concluded.The collected data will be handled confidentially and will be kept in such a way that no unauthorized person can view or access it.The interview will be recorded as this makes it easier for us to document what is said during the interview and also helps us in the continuing work with the project. In our analyze some data may be changed so that no interviewee will be recognized. After finishing the project the data will be destroyed. The data we collect will only be used in this project.You have the right to decline answering any questions, or terminate the interview without giving an explanation.You are welcome to contact us or our supervisor in case you have any questions (e-mail addresses below).Student name & e-mail Supervisor name & e-mail ................
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