IT Tallaght 11th March 2015

Overview of establishment of CDI; Overview of CDI programmes; Programme evaluations and link to policy; What works; Challenges; Questions.

Consortium of 23 people established; One of three Prevention and Early Intervention

Programmes funded by Government and The Atlantic Philanthropies;

Needs Analysis “How Are Our Kids?” (2004); 15 million granted for the design, implementation

and evaluation of programmes; “How Are Our Families”, 2012 indicates ongoing

disadvantage and social issues; CDI now funded under the Government’s Area

Based Childhood Programme (ABC) – co-funded by AP.

Identifying need; Developing a coherent, community informed,

integrated response; Implementing and overseeing the quality delivery of

evidence-based programmes; Supporting inter-agency collaboration and outcomes

focused approaches; Evaluating evidence-informed programmes, to

identify what works and what doesn’t; Sharing the learning regarding programmes and

processes in order to inform future policy and practice.

Children’s Services

Committee (CSC)

Children’s Services

Committee (CSC)

The Atlantic Philanthropies

(AP)

The Atlantic Philanthropies

(AP)

Department of Children and Youth

Affairs (DCYA)

Department of Children and Youth

Affairs (DCYA)CDI BoardCDI Board

Restorative Practice

Management Committee (RPC)

Restorative Practice

Management Committee (RPC)

CDI Implementation Support Group

(ISG)

CDI Implementation Support Group

(ISG)

CDI TeamCDI Team

RP National Strategic

Forum

RP National Strategic

Forum

Human Resources Sub-Committee

Human Resources Sub-Committee

Finance and Risk Sub-Committee

Finance and Risk Sub-Committee

Communications Sub-Committee

Communications Sub-Committee

Pobal/CESPobal/CES

Indicates an advisory/supportive relationship

Indicates lines of accountability

Expert Advisory

Committee (EAC)

Expert Advisory

Committee (EAC)

Local Community Development

Committee (LCDC)

Local Community Development

Committee (LCDC)

CDI Governance Chart 2015:

Early Years Service; Speech and Language Service; Doodle Den: Literacy; Mate-Tricks: Pro-Social Behaviour; Healthy Schools Programme; Community Safety Initiative; Restorative Practice Programme.

Research design; Logic modelling; Manualised approach; Delivery through local agencies; Supporting quality.

A logic model is a tool for programme planning, implementation and evaluation;

It provides a rationale for delivering specific programmes;

It clearly describes a programme’s goals, tasks, activities and anticipated outcomes, and links to evidence and best practice.

Why use a manualised approach?

To ensure the programme is: Delivered with consistency Delivered as intended Adheres to the Logic Model

The role of fidelity and dosage• Evidence-based programmes are most effective when they

are implemented with fidelity;• Fidelity helps us to attribute positive outcomes to the

programme;• The greater the fidelity, the more likely positive outcomes

will be replicated;• Dosage – where participants receive the intended amount

of programme/ core intervention.

Fidelity (i.e. where practitioners use all

the core intervention components skillfully)

3 Randomised Controlled Trials

Quasi-Experimental Study

Healthy School’s Programme – (TCD)

3 Process Evaluations

Retrospective Impact Study

Speech & Language Therapy

Dedicated Quality Specialist role; Training; Communities of Practice (COP’s); Site / practice visits; Fidelity checks; Progress meetings; Programmatic / thematic steering committees.

2 year programme 2½-3 year olds; HighScope Curriculum; 1:5 staff:child ratio; Staff qualifications; Key worker system; Home visits; Parent/Carer Facilitator (PCF); Speech and Language Therapy (SLT); Communities of Practice (CoP); Manager meetings; Onsite support.

Measures Findings

Child cognitive & language scores:

Overall - no statistically significant difference.

Control groups scored higher on a Rhyme & Lower case recognition. Within intervention groups – between group differences on: rhyme; block building and vocabulary.

Child Attendance:

No great difference. However, Int. services had a better minimum attendance rate = better at supporting children prone to lower attendance.

ECCE Environment:

Int. services engaged significantly more often in some music/movement; nature/science and maths.

Int. services had better planning and curricular quality.

Int. services had a higher quality literacy environment.

Int. staff maintained similar levels of sensitivity throughout evaluation.

Home learning environment:

Int. parents had a an improved home learning environment.

Measures Findings

Home Learning Environment:

Int. parents had a an improved home learning environment.

Process:HighScope training:“revolutionised their practice” e.g. conflict resolution: end of year two, children were able to solve problems and conflicts without adult intervention.

Speech and Language training: better understanding of language development and how to support children with SL needs, e.g. greater awareness of the print rich environment.

Communities of Practice (CoP): opportunity to share ideas, information and ideas - impacted on their daily practice and would like to see them continued.

High staff:child ratios – as evident in children’s behaviour; Non–contact time to allow for planning and training – as

evident in improved curricular and planning quality; Advisable to have training structures in place prior to

programme implementation; Importance of a very specific and clear curriculum; In light of bedding-down effects, a longitudinal study/follow-

up of parents, children and preschools would help to determine if these effects persist and strengthen over time;

Delivery of parent training as part of a pre-school programme.

Collaboration with HSE; 2 therapists employed; Three pronged approach; Onsite delivery; 11 early years services & 5 primary

schools; Staff training – formal and informal.

18% discharged within normal limits following intervention – TW has an over-representation of families at risk of experiencing multiple disadvantages (CDI, 2004 and 2005);

55-66% not ‘picked up’ by HSE service – early identification and intervention;

25% referred to other specialist services - promotion of access to health services.

Changes in practice related to the support of speech and language development within the Early Years services and schools;

Parents reported easier access and less stigmatisation - highlights the need for other SLT and specialist services to give consideration to location and accessibility issues;

Improved Therapists’ Wellbeing:◦ Therapists fulfilled by working in an intensive manner with

children. Made possible by short waiting lists and on-site therapy over the course of the school/Early Years service term;

◦ HSE counterparts reported frustration at having to deal with long waiting lists and block therapy delivery.

Manualised whole school approach – based on the WHO model of health promotion;

Two Healthy Schools Coordinators (HSC) based in 5 schools;

Supported schools to implement health and well being activities, both in and out of school;

Supported schools to review and update school policies;

Supported families to attend specialist appointments;

Strengthened links with school and health services, through establishment of Care Teams.

Intervention schools showed significant difference in overweight and obesity: Increased from baseline.

Children (older cohort) in intervention schools self reported a reduction in bullying from baseline.

Health and Wellbeing: Both intervention and comparison were on average within international range from baseline through to final year.

Autonomy + parent relations improved into year 2 (both groups).

Child Depression: Intervention and comparison: baseline – within international range, improvements in year 2.

However: schools have begun the process of change that is required to become a WHO defined ‘health promoting school.

BMI: Higher percentages of Control school children were underweight, overweight and obese compared to Int. schools;

Int. schools showed significant improvement in social support and peer relations compared to C schools;

No significant differences between I and C schools on breakfast uptake, children’s perception of weight and incidences of reported bullying;

No significant differences between I and C schools on emotional and behavioural outcomes;

No significant differences between I and C schools on the depression scale.

An assessment of the readiness of a school or organisation for an intervention needs to be undertaken prior to the implementation;

An expansion of the culture of joint working and collaboration is required from the Department of Education and Skills and the Department of Health in order to continue the development of children’s wellbeing in educational settings;

A National Framework for Health Promoting Schools involving the Departments of Education and Health should be developed;

The establishment of a Health Promoting Committee, with health and local authority participation, building on local inter-agency models of working;

Health promotion and mechanisms to support inter-agency collaboration should be included in training for teachers and related professionals, and as part of continuous professional development;

CDI recommends that all Government Departments commit to using evidence to inform planning and service delivery and that the implications are taken on board.

Parents were: Positive about library session; Feeling informed about what their child was doing; and Had good relationships with everyone involved.

Facilitators: Support from CDI and positive communication; Improved relationships with schools and parents; Improved parental involvement; Improved delivery over time, greater confidence and knowledge of the manual.

No change in majority of the 21 outcomes investigated -16 showed no impact

Two statistically significant adverse effects:◦ Anti-social Behaviour (PSB Questionnaire)◦ Authoritarian Parenting (APQ)

Three effects approaching significance:◦ Liberal parenting (adverse effect)◦ Conflict tactics (positive effect)◦ Improvement in relationships with mothers (positive effect)

Views and observations of the programme from the various stakeholders were generally very positive;

Combined findings from the process evaluation and the outcomes data, provided by engaged parents and their children were more favourable towards the Mate-Tricks programme than the findings from the full sample of parents and children;

The model of change or tools provided to facilitators (i.e. the Mate-Tricks programme) was not effective.

After-school programmes focused on behavioural change should be rigorously piloted before roll out;

All services for children should be evaluated. Programmes which have shown no demonstrable impact on outcomes should be incrementally removed and replaced with EBPs;

All Government Departments commit to using evidence to inform planning;

Serious consideration should be given to the implications of the MT evaluation for professional training, service planning and integration;

Managers in all state funded organisations working with children receive training in logic modelling, utilising evidence to inform planning and assessing outcomes;

Pre-service training involves mandatory modules on engaging parents.

Support for parents of young children; On site, early intervention speech and language – 3

pronged approach; Ongoing professional development, focus on reflective

practice, quality promotion; Afterschool, literacy rich, high activity curriculum; Collaboration to improve referrals and service

gateways; Creating and supporting structures, systems and

relationships which promote collaboration.

Impacting on children’s behaviour through after school settings;

Evaluating programmes without a ‘bedding down’ period;

Process driven programmes (i.e. cultural change) is slow;

Unanticipated training and support needs were identified, necessary for the delivery of quality services with fidelity.

The tension between being “community-led” and “evidence-based”.

Web-site: www.twcdi.ie

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