Post on 11-Jan-2016
description
Lessons from the IY Toddler trial in Flying Start services across
Wales
Nia Griffith
March 2012
Flying Start WAG funded RCT Sample recruited Sure Start comparison Short-term findings and implications Long-term findings and implications Lessons learnt
Presentation Content
Background to the study
Flying start initiative aims to fund high quality services for children aged
0 - 3 years in disadvantaged areas in Wales
Estimated 25,000 children aged 0 - 3 living within FS catchment areas
Families targeted by area of residence, with investment of £2,000 per child per annum in the form of:
• Extra health visitor visits from dedicated Flying Start Heath Visitor
• Free childcare• Basic skills courses, language and play• Parenting courses
Flying Start
Evaluation of the IY parenting intervention
Trial • Trial of new programme (preventative)• Randomised Control Trial• Small numbers
Participants• Parents of children aged between 12 and 36 months• Targeted families living in Flying Start areas • No other inclusion criteria
Randomisation• Random allocation by NWORTH (North Wales
Organization for Randomised Trials in Health)• Stratified for age and sex and allocated on 2:1 ratio
Intervention: Waiting list control• Control families wait 6 months for Intervention
STRUCTURE• Twelve sessions• Delivered weekly in 2 – 2 ½ hour sessions by two leaders• Collaborative learning process using discussion and ideas
drawn from watching video-clips of other parents• Brainstorming/role-play/home activities• Group structure providing for group problem solving and
peer support
CONTENT• Relationship building through child led play, coaching
children’s academic, social and emotional skills, praise and spontaneous incentives, handling separations and reunions, establishing routines, learning how to give clear instructions and how to ignore, distract and redirect children
• Learning to understand children’s development and safety awareness are themes that run throughout the programme
The IY Toddler Parenting Programme
Measures
• Developmental Measures
- Schedule of growing skills (SOGS)
• Measure of Home Environment
- IT- HOME
• Parent Measures
- Parenting Stress Inventory (PSI)
- Beck Depression Inventory (BDI)
- Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS)
-Parent Competence (PSOC)
• Direct Observation
- Dyadic Parent-Child Interaction Coding Scheme (DPICS)
BASELINE DATA
Sample Characteristics
•89 families •Parent age at Baseline (M= 29.97, SD= 6.72) range 16-48 years•38% Single parents•54% <20 Years at birth of 1st child•36% left school without any qualifications•61% living below recognised poverty indicator
Comparison with Sure Start Measure
FS M (SD)
SS M (SD)
P value FS ClinicalSignificant
SS ClinicalSignificant
BDI 10.82 (9.44)
16.48 (10.39)
<0.001 16% 37%
PSI-SF 76.01 (20.54)
100.36 (23.47)
<0.001 21% 67%
SED6 1.99 (1.60)
2.88 (1.48)
<0.001 55% 80%
Comparison of FS and SS on outcome measures for parent stress and depression at baseline
SHORT-TERM OUTCOMESFollow-up one at 6-months post baseline
Analysis of WEMWBS
A significant improvement at 6-months for the INTERVENTION group compared to the CONTROL group (p= .01) using ANCOVA
Analysis of Negative Parenting
A significant improvement at 6-months for the INTERVENTION group when compared with the CONTROL group (p=.055)
Non-significant changes for INTERVENTION when compared with CONTROLS on the following measures: SOGS BDI II PSI-SF PSOC IT-HOME Positive Parenting
Trend for improvement on all measures
Other short-term findings
LONG-TERM OUTCOMESBaseline to 12-month follow-upTrial completers assigned to intervention only (n=42)
Baseline 12-month FU
Measure M (SD) M (SD) P-Value Effect Size
SGS II 94.98 (13.68) 111.81 (16.59) <.001 0.72
BDI II 11.31 (9.28) 5.07 (7.03) <.001 0.56
WEMWBS 47.02 (10.05) 51.69 (7.86) <.001 0.49
PSI-SF 77.10 (21.73) 67.81 (17.13) .01 0.39
PSOC 59.55 (9.54) 64.21 (8.20) .002 0.48
IT-HOME 35.60 (6.91) 40.79 (4.26) <.001 0.66
Long-term changes
Significant improvements on all measures from baseline to 12-month follow-up
Child Development
A significant improvement at 12-months post INTERVENTION for trial completers (p=<.001)
Sample split by indicators of risk to explore differential effect for high versus low-risk families:
Poverty Indicator (WAG) Child Developmental Delay (SGS II DQ < 85) Multiple Environmental Risks (SED5) Clinical Levels of Depression (BDI II) Clinical Levels of Stress (PSI-SF)
Explored magnitude of Effect Size for High versus Low-risk families on a range of outcome measures
What happened to the high-risk…?
Findings…..
A greater proportion of the families identified as high-risk in terms of poverty, multiple environmental risk, early signs of child developmental delay and clinical levels of depression and stress were experiencing medium and large effects.
What happened to the high-risk…?
What does this mean…….
The families with the greatest level of need for intervention were the families who have BENEFITED THE MOST.
What happened to the high-risk…?
Study Implications and Lessons Learnt
Recruitment Many families have a need for intervention Several families despite their circumstances are
functioning well Resulted in the recruitment of families with a
range of needs Use of additional targeting measures identifies
families with a greater need of intervention
Study Implications and Lessons Learnt
Short-term benefits to parental well-being and negative parenting Preventative trial Varying level of need Ceiling effect on several measures
…..Yet significant improvements were seen on both measures of parental well-being and
negative parenting
Study Implications and Lessons Learnt
When evaluating an intervention within service setting it is important to gather information
about what other services families are accessing
real world research can be messy Lots of services being offered
Lessons from the IYTPP trial
Families in greatest need improve the most..
Implications for service deliveryHighlighting the need to find those
families at greatest risk, particularly when resources are scarce
Implications for evaluationHave greater room to move on
measurement scales
Lessons from the IYTPP trial
Thank you for listening!
Diolch am wrando!
n.griffith@bangor.ac.uk