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Update on the activities of the Centre for Evidence Based Early Evidence

Supporting Evidence Based Early Intervention Programmes across Wales and

beyond.Bangor University

6th March 2013

Professor Judy Hutchings, OBECentre for Evidence Based Early Intervention,

Bangor University

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Summary of presentation• Early work developing evidencebhased programmes• Completed research activity – - Wales, - Birmingham, - Pathfinder, - Gwynedd, ESCAPE, parenting programme- Literature review on programmes for parents of teenagers

• Current research projects Wales –- Small group Dina,- IY Baby, - IY School readiness, - KiVa bullying prevention programme, - PREPARE – web based parenting support,- Gwynedd LA evaluation of early intervention services- Waterloo grant – two day training across Wales to support professionals working with children

with developmental challenges

• Current research projects elsewhere – • England ADHD trial with Southampton, • Parenting trial with Oxford and Cape Town Universities

• Other activities – • WHO Violence Prevention Alliance – parenting subgroup

Current team Judy – Centre Director Helen – Centre Co-Director CEBEI, bringing her expertise in work in

Jamaica, University PI for the Small Group Dina Project Eleanor managing the Dina lottery project and centre finances Margiad leading on Dina lottery project data input and analysis Steff (RPSO on lottery project and MSc student) Karen (RPSO on Gwynedd evaluation and MSc student) Nic (PhD student on maternal language) Laura (PhD student on children’s peer relationships, Lottery project) Stefanos (PREPARE PhD student commencing 1st April 2013) Elin – Admin for the Children’s Early Intervention Trust Charity (CEIT) Suzy (Master’s student researching the KiVa bullying prevention

programme) Dilys and Kath – Admin for CEBEI Bridget and Sue IY trainers working for CEIT (Catrin – IY Baby, Kirstie IY School readiness, just completing PhDs ) Tracey (Honorary Research Fellow now Reader at University of York)

CEBEI activities An ongoing research programme Training, supervision and support for

evidence based practice and service development

Staff surveys on fidelity issues Service manager fidelity workshops Evaluation workshops Annual conferences Newsletters Publications

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Why the Centre: USA and UK – 1990s

USA few publicly funded services but lots of high quality research

UK publicly funded health and education services but little demand for outcome evaluation and little quality research

My goal to bring evidence based services to Wales and beyond

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Developing and researching the Intensive Treatment

programme 1990s A parenting programme for parents of CAMHS

referred children with conduct disorder Coaching, video feedback and goal setting

compared with standard CAMHS support Coaching programme worked best on all

measures, child behaviour, parental mental health

Long term, four year outcomes still successful but standard CAMHS children reverted to original levels of problems

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Intensive treatment programme developed into a

programme for health visitors Health visitors trained in observation,

case analysis, key parenting skills They each identified a child and

worked with them using the programme Results again demonstrated significant

improvements in child behaviour and maternal mental health

Significant improvements in HV knowledge of behavioural principles 7

IY Parenting Programme: research

completed•Welsh Sure Start study: short- and long-term

outcomes, outcomes for children at risk of adhd, mediators and moderators of change,

maternal depression outcomes, key group leader behaviours

•Pathfinder project: parenting 8 – 13 year olds outcomes

•Toddler Programme: 1 – 2 yos, outcomes•Nursery Staff Programme: outcomes

•Foster carer study

Sure Start research project; short and longer term outcomes

Short term significant effects occurred relative to controls on all measures:

For parents:Reduced maternal depression maintained to 18 monthsReduced observed negative parenting and increased

positive parenting maintained to 18 monthPSI - parental stress levels BDI - depression levels (clinical

effect size = .59)For target children:ECBI intensity and total problem scores showed significant

reductions at 6, 12 and 18 months and 3 and 4 yearsKendall SCRS - self-control Conners – hyperactivity For sibling nearest in age to index child:ECBI problem, ECBI intensity

Other outcomes from the Sure Start study

Significant improvements in inattentive and hyperactive behaviour for the 60+% of children in the clinical range for these problems (Jones)

Leader skills, praise and reflective statements are mirrored in parents behaviour (Eames)

Changes in parenting behaviour mediate changes in child behaviour (Gardner)

All parents, young, single, depressed, level of child problems all did equally well (Gardner)

Improvements in depression mediate child behaviour improvements (Hutchings and Williams)

Toddler projectNia Griffith PhD

RCT of the IY Toddler programme in Flying Start areas across Wales

Significant improvements at 6 month FU for parental mental well-being, and reductions in observed negative parenting

Significant improvements at 12 month FU for child development, parental mental health, parental stress, and parental competence

Nursery project Effectiveness of the IY Toddler programme

for Nursery workers – workers targeted and worked with one child

Significant improvements child problematic behaviour in nursery, staff levels of stress, and staff sense of competence

Programme effective in out-of-home setting

IY Foster Carer project More children in foster care and more with

challenging behaviour Children’s behaviour problems contribute to

foster placement breakdown 46 foster carers in three counties in Wales

participated (2:1 intervention to control) Results: significant reductions in child

behaviour problems and carer stress and depression

Subsequent publication of issues to considered in working with carers using the IY parent programme

Teacher Classroom Management project

RCT of the IY TCM programme in 12 classrooms

Observations of classrooms and target children (high and low problems identified using TSDQ)

Significant reductions in children’s classroom off-task behaviour

Significant reductions in teacher negatives to target children, and reductions in target children’s negatives to teacher and off-task behaviour

Birmingham Brighter Futures project

Birmingham: biggest local authority in Europe RCT of three programmes (IY, TripleP, PATHS)

done by Dartington Social Research Unit IY - a replication of Welsh Sure Start Study (161

three and four year olds at risk of emotional and behavioural problems)

CEBEI provided training and supervision for the IY leaders (Judy, Bridget, Sue)

Results - significant improvements in child behaviour on the SDQ and ECBI and a strong and significant improvement in self-reported parenting skills on the O’Leary Parenting Scale

Current situation in Birmingham

An IY administrator for the City We still provide training and supervision, 15

new staff trained this year 12 certified leaders, 5 people proceeding to

peer coach training, mentor plans to bring programme in-house

A 16 area locality model, either 2 or 3 groups per locality per year dependent upon level of need

Currently 20 groups running the 14 week basic programme.

Pathfinder Early Intervention project

Six Authorities in England delivering IY School Aged programme with 8-13 yr olds

First trial of programme with high-challenge children in this older age range

Training and supervision co-ordinated by CEBEI (Judy, Bridget, Sue)

18 session programme (IY School Age Basic + Advanced adult relationship programmes)

Significant improvements in child behaviour, parental depression, parenting skills at 6-month FU

Additional analyses Mediator – improvements in parenting skills

mediated improvements in child behaviour

Moderator – all of the normal risk factors, teenage parent, family history of drug/alcohol use, parental depression, single parenthood or poverty moderated outcome, did equally well

Only family history of crime moderated outcome with these families demonstrating poorer outcomes

Gwynedd ESCAPE evaluationCeri Ellis

Escape: a six-session programme for parents of conduct problem teenagers (10-18 yrs)

Programme aims: to increase school attendance and reduce offending behaviour

No previous good evidence of efficacy Gwynedd funded evaluation but after

commencement of the programme Evaluation of outcomes from 3 groups, 2 in

Bangor, 1 in Porthmadog (N=21)

Conclusions Gwynedd recognised the need for evaluation Difficult to generalise findings, pre-post measures

collected by leaders and a small sample Significant improvements but still in clinical range

so prospects of maintenance of gains limited Leaders were highly skilled with additional training

(e.g. IY) and made additions to programme Effective programmes with this target population

are longer and involve both parents and adolescents

Should be emphasis on providing families with effective interventions that yield sustained results

Literature review of programmes for parents of teenagers with challenging behaviour

Gwynedd Council commissioned a review of evidence-based parent programmes for parents of high challenge teenagers

Undertaken by Suzy Clarkson

Ten programmes reviewed, Multi-systemic Therapy*, Functional Family Therapy*Strengthening Families Programme 10-14*, Parents Plus Adolescents Programme, Incredible Years (8 -13 years), Standard Teen Triple P, Take 3, STOP, Living with Teenagers, ESCAPE* Blueprint programmes with evidence for this population

Conclusions Parenting programmes for conduct disorder

show greatest impact as compared to other interventions but results decrease with increasing child age

Effective programmes for this age range (MST; FFT; SPT 10-14) are all Blueprints for Violence Prevention and work with the whole family, parents and adolescents, are more sustained and have significant impact on adolescent emotion regulation and behaviour

Fidelity has a significant impact on positive outcomes

Current Studies•IY Therapeutic Dino School for high risk young children – extra coaching for high risk children already receiving classroom Dina and with TCM trained teachers

•IY School Readiness Programme for parents of children as they enrol in school delivered by school staff to build the home-school link

•IY Baby Programme for parents and babies during their first year of life delivered by health care staff

•KiVa bullying prevention programme

Small Group Dina project

• BIG Lottery funded project

• RCT of the 18-session IY Small Group Dina programme • 22 schools in Gwynedd, Powys, and Anglesey

Phase 1 (2010/11) – 9 schools Phase 2 (2011/12) – 13 schools

Small Group Dina project

• Children identified using the teacher version of the Strengths and Difficulties questionnaire (Goodman 1997)

• Participants randomised on a 1:1 basis to intervention or wait-list control

• Final sample N = 224 children

Small Group Dina project

• Measures include :-

Demographics (parent & teacher) Child behaviour (parent & teacher) Parental mental health Parenting skills Wally problem solving task Lego task (observation) Classroom observation (phase 2 only)

Small Group Dina project

• Child characteristics

•SDQ total difficulties borderline 14 and 17 Abnormal

Child demographics Control (n=109) Intervention (n=115)Mean age, months (SD) 65.24 (10.84) 65.57 (12.01)

% male 60.6 63.5

% Welsh 36.7 36.5

Mean no. SGD sessions (SD) attended

/ 14.63 (3.80)

Mean TSDQ total score* (SD)

18.39 (4.71) 18.24 (4.46)

Small Group Dina project

• Parent characteristics

Parent demographics Control (n=109) Intervention (n=115)Mean age, years (SD) 33.44 (6.41) 33.21 (8.04)

% female 89.0 92.2

% single parents 29.4 39.1

% below poverty threshold

66.7 70.2

% left school at 16 yrs 45.0 41.7

Small Group Dina project

• Teacher characteristics

Teacher demographics All (N=54)Mean age, years (SD) 39.44 (10.51)

% female 96.4

Mean no. yrs teaching 15.43 (9.91)

Mean no. yrs current school 11.42 (8.56)

Mean no. schools taught 2.09 (1.11)

% teaching multi-year class 42.9

Small Group Dina project

• Next steps Finish data inputting & checking Conduct data analysis Write-up results

PREPARE A new study funded by a former

Bangor student To develop a web based parent

programme using evidence based principles to support children’s school readiness

Funding for a PhD student, Stefanos, and for web consultancy and associated costs to trial the programme

Commencing 1st April 2013

Possible PREPARE components

Play Read Encourage Praise Attend Reward Educate

Gwynedd evaluation of early intervention services

• A collaborative project between CEBEI, the Children’s Early Intervention Trust, and Gwynedd Council

• Builds on the Escape and Literature review partnership

• 1st Feb 2013 – 31st March 2014

• Karen Jones, CEBEI appointed as RPSO to undertake this work

Gwynedd evaluation of Gydai’n Gilydd early

intervention services • Project involves :-

Developing a ‘Distance Travelled Toolkit’ to be used by Gwynedd’s Team Around the Family to measure/monitor impact of its work on improving outcomes for families Developing appropriate measures to evaluate/monitor impact of four, newly commissioned, early intervention services working with families Undertaking independent evaluation with a sample of families receiving interventions/services through the programme

Waterloo foundation grant Grant to deliver training in one to one work

with families with children with developmental problems across Wales

To deal with the problems/behaviours that might be amenable to change

Builds on the earlier evidence from the Intensive Treatment Programme and the Enhancing Parenting Skills programme for HVs

Support from Children in Wales

The plan Two days training in each of five locations in Wales:

Bangor, Flintshire, Cardiff, Swansea and Newtown 12 - 15 participants in each Centre Day one completed – introduced a structured

assessment and case formulation process Day two - building intervention strategies A manual developed to support assessment, case

analysis and intervention A parenting booklet to teach parenting skills and

principles of reinforcement being published Participants work with one familyto implement the

programme and collect data for evaluation

The ADHD trial in England• Partnered with Southampton University who hold the grant for a head to head trial of IY and New Forest parenting programme with young children aged 2 – 5 at risk of ADHD- Locations: Nottingham, Stoke and Southampton

•CEBEI trained IY group leaders and are supporting through supervision (Judy, Sue, Bridget, Linda - Poole)

•Plan was for each Centre to run one trial group and 5 research groups Jan 2012 – Dec 2013•Results 2014

•Challenges so far include loss of group leaders and significant recruitment and retention difficulties

Parenting trial with Oxford & Cape Town Universities

• Urgent need for affordable parenting programmes in low/middle income countries•The core components of effective parent programmes are known• Sinovuyo is a programme that incorporates- african values –respect for families, elders - african culture, stories and songs • recognises the many challenges facing in severely disadvantaged circumstances, families, bereavement, intimate partner violence, HIV and aids etc..

SINOVUYO CARING FAMILIES PROJECT

Development and Evaluation of an Evidence-Based Early Childhood Development Parenting Programme

for Vulnerable Families in South Africa

YEAR 1: INTEVENTION DEVELOPMENT

- Community-based participatory approach with stakeholders- Parents, Service Providers, Expert Consultations- Policy meetings with relevant government agencies

- Qualitative research in community: May – June 2012- Focus groups and In-depth Interviews

- 97 Parents, 24 Service providers- Experiences of parenting children with behavior problems- Applicability of acceptability of evidence-based parenting progs- Feasibility of implementing parenting programmes

- Programme develop and manualization- Illustrated story vignettes, role-play, storytelling- Home practice

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YEAR TWO: PILOT EVALUATION STUDY- Randomised controlled trial: Feb to May 2013

- N = 60 parents in Khayelitsha (a township outside Cape Town- Wait-list control (3 months)- Parents/caregivers of children ages 3 to 8

- Assessments at baseline and post-intervention

- Outcome Evaluation- Child Behavior (parent-report and observation)- Parenting Behavior (self-report and observational)- Parental Mental Health (self report depression and parenting

stress)

- Process Evaluation- Programme fidelity, Exposure/Adherence, Participant

satisfaction

WHO Violence Prevention Alliance

dedicated to the prevention of interpersonal violence through the implementation of evidence-informed strategies.

Parenting project sub-group – to reduce violence against children through increasing effective parenting by increasing the evidence-base for parenting programmes applicable to low- and middle-income countries (LMIC) given the dearth of evidence of effectiveness in such countries.

Developing a guidance document on conducting outcome evaluations of parenting programmes to prevent violence in LMIC. funded by the UBS Optimus Foundation, work began in 2012 and will be completed in June 2013

First meeting Zurich Dec 2012

Two further priority projects identified:

Identify the core principles/essential ingredients that make programmes effective and synthesize results to provide guidance on how to choose a good parenting programme;

- Judy Hutchings and Chris Mikton (WHO) co-lead on seeking funds for this project

Review the evidence for mass media campaigns and edutainment interventions;

Development of the IY programmes in Wales

• Welsh Government funded support for training across Wales for the programmes from 2006 – 2013

• 10 Authorities have partnered us in RCTs

• 3 Authorities have mentors, six have peer coaches,

• 30 certified or part certified leaders across Wales

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Welsh Government continued to fund training across Wales in parent programmes for a seventh year, until March 2013

All 22 Authorities in Wales are delivering or have delivered the parent programme

Baby and toddler parent programmes seen as highly relevant to early intervention projects

School readiness parent programme becoming established

Thank youFor further information please visit our website

 http://www.centreforearlyinterventionwales.co.uk

Emailj.hutchings@bangor.ac.uk