lessons from the iy toddler trial in flying start services across wales
DESCRIPTION
Lessons from the IY Toddler trial in Flying Start services across Wales. Nia Griffith. Presentation Content. Flying Start WAG funded RCT Sample recruited Sure Start comparison Short-term findings and implications Long-term findings and implications Lessons learnt. Flying Start. - PowerPoint PPT PresentationTRANSCRIPT
Lessons from the IY Toddler trial in Flying Start services across Wales
Nia Griffith
January 2012
Presentation Content
• Flying Start• WAG funded RCT• Sample recruited• Sure Start comparison• Short-term findings and implications• Long-term findings and implications• Lessons learnt
Flying Start
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
Evaluation of the IY parenting intervention
Trial • Trial of new programme• 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
The IY Toddler Parenting programme.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
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
• 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 OUTCOMES
Follow-up one at 6-months post baseline
Additional Services Available:
Extra health visitor supportFree childcareBasic skills(Parenting courses – intervention only)
Positive Impacts of living in a Flying Start area?
Measure Baseline Score
6-month FU Score
Significance Level
SOGS DQ 96.98 101.82 P < .05
BDI II 10.82 7.93 P < .05
WEMWBS 47.85 49.93 P < .05
PSI-SF 76.01 68.61 P < .05
IT-HOME 34.77 37.37 P < .05
Significant improvements on main outcome measures for sample as a whole over 6-month period.
Main Measures
Added benefits of IY Toddler Parenting Programme for
Intervention Families living in Flying Start areas?
Analysis of WEMWBS
A significant improvement at 6-months for the INTERVENTION group compared to the CONTROL group (p= .01) using ANCOVA
Baseline Follow-up 145
46
47
48
49
50
51
52
47.37
50.95
48.87
47.33
Intervention Control
Time Figure: Mean mental wellbeing score for intervention and control group at baseline and follow-up 1
Mean mental w
ellbeing score
Analysis of Negative Parenting
Baseline Follow-up 15.0
7.0
9.0
11.0
13.0
15.0
17.0
19.0
21.0
23.0
Intervention Control
Time Figure: Mean observed negative parenting score for intervention and control group at baseline and
follow-up 1
A significant improvement at 6-months for the INTERVENTION group(p=.01)
A non significant change for the CONTROL group (p= .13)
Analysis of Child Deviance
Baseline Follow-up 10.0
5.0
10.0
15.0
20.0
25.0
Intervention Control
Time Figure: Mean observed negative parenting score for intervention and control group at baseline and
follow-up 1
A significant improvement at 6-months for the INTERVENTION group(p=.007)
A non significant change for the CONTROL group (p= .16)
Other short-term findings• Non-significant changes for INTERVENTION
when compared with CONTROLS on the following measures:– SOGS– BDI II– PSI-SF– PSOC– IT-HOME– Positive Parenting – Language Promotion
• Trend for improvement on all measures
LONG-TERM OUTCOMES
Baseline to 12-month follow-upTrial completers assigned to intervention only
n=42
Long-term changesBaseline 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
Significant improvements on all measures from baseline to 12-month follow-up
Child Development
Baseline Follow-up 1 Follow-up 285.0
90.0
95.0
100.0
105.0
110.0
115.0
Intervention Typical Devel
TimeChange in child DQ from Baseline to 12-month follow-up for 42 trial completers
A significant improvement at 12-months post INTERVENTION for trial completers (p=<.001)
What happened to the high-risk…?
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
• 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 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.
• Need for targeting• Evaluating intervention within service
setting• Evaluating intervention with a sample
with variable levels of risk• Differential effects for high-risk
participants
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