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Evaluation of the T2U-early years early parenting service: What works and how, for parents, children and families in the regional context?
Thesis   Open access

Evaluation of the T2U-early years early parenting service: What works and how, for parents, children and families in the regional context?

Sherryn Bailey
Southern Cross University
Doctor of Philosophy (PhD), Southern Cross University
2025
DOI:
https://doi.org/10.25918/thesis.557
Appears in  Recent Southern Cross PhD Theses
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Bailey SN PhD 20257.52 MBDownloadView
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Abstract

Realist evaluation Specialist early parenting support Rural healthcare parenting difficulties Implementation science
Early parenting interventions for parents with children aged 0–3 years are supported by evidence demonstrating improvements in parent knowledge and skills, parent–child relationships, and child outcomes. Although early childhood investment is prioritised in Australian and international policy, inequities persist in access to specialist early parenting services for families living in rural and remote communities. To address this gap, a novel mobile specialist early parenting service, Tresillian To You (T2U), was implemented in 2018 for five disadvantaged rural communities on the Mid North Coast of New South Wales. The service, based on Tresillian’s evidence-based metropolitan service model, was adapted for delivery in low population-density settings. The adaptation and delivery of this service for rural parents has not been previously evaluated. This thesis reports a realist evaluation designed to address this evidence gap by examining how, for whom and under which circumstances the T2U early parenting service works for rural families experiencing early parenting difficulty. Realist evaluation is a theory-driven approach that seeks to explain outcomes by identifying interactions between contexts, mechanisms and outcomes, supporting the development of explanatory program theories. The research design consisted of three phases: developing, testing, and refining program theories. A mixed methods approach included interviews with key stakeholders (n=8), and semi-structured interviews with T2U service providers (n=5) and pre- and post-intervention interviews with T2U parents (n=36). As the study progressed, a second cohort of post-intervention parents (n=17) was interviewed to explore contexts, mechanisms and outcomes for parents identified at risk of postnatal depression and/or anxiety. Program theories were refined and synthesised with substantive evidence. Two primary outcomes were identified. First, T2U improved access to specialist early parenting support for rural families both within and beyond target communities, with access shaped by contextual factors and mechanisms of community engagement. Second improvements were observed in parent outcomes. Given the highly contextualised nature of early parenting difficulties for rural parents, multiple mechanisms were activated, depending on service resources and family circumstances. Flexible, relational approaches to care triggered mechanisms of trust, reassurance, and validation in the context of early parenting difficulty, and for many parents, in the presence of mental health challenges. This research demonstrates how a small-scale specialist early parenting service administers context-dependent interventions. Findings inform continued T2U upscaling and support the broader development of early parenting services for rural families in Australia and internationally.

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