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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 25th January 2013

Professor Judy Hutchings, OBE

Centre for Evidence Based Early Intervention, Bangor University

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Summary of presentation• 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 Margiad leading on Dina lottery project data input and analysis Steff (RPSO on lottery project and Master’s student) Karen (RPSO on Gwynedd evaluation and Masters 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)

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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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CEBEI strategies An ongoing research programme Annual conferences Staff surveys Service manager fidelity workshops Evaluation workshops Newsletters and conferences Publications Supervision and support for evidence

based practice and service development

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 months

Reduced observed negative parenting and increased positive parenting maintained to 18 month

PSI - 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 years

Kendall SCRS - self-control Conners – hyperactivity Social competence

For sibling nearest in age to index child:

ECBI problem, ECBI intensity

Other outcomes from the Sure Start study

Signifcant improvements in inattentive and hyperactive behaviour for the 60+% of children in the clinical range for these problems

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

Improvements in depression mediate child behaviour improvements

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, observed negative parenting, and observed child deviance

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

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 needing to be 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

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 week 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 England delivering IY School Aged programme with 8-13 yr olds

First trial of programme with children in 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, they all did equally well

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

Gwynedd ESCAPE evaluationundertaken by Ceri Ellis

Escape is: A six-session parent programme for parents of

conduct problem teenagers (10-18 yrs)

Programme aims: to increase school attendance and reduce offending behaviour

One topic each session :- empathy; current issues at home; division of parental control and responsibilities; how to approach situations; how to be positive; how to empower their child

Gwynedd evaluation Gwynedd Families First Deliveries Plan

included multi-agency support for parents of high challenge teenagers

Escape programme selected

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)

Sample and measures 32 referred 21 recruited (66%) Retention (pre-post data from 14

parents (67%), qualitative interviews with 11 parents (53%)

fathers represented one third of parents 71% of teenagers were male 38% of parents were single Measures of child behaviour, parental

mental health, ‘Family Grid’, parent (11) and leader (4) qualitative feedback

results Significant improvements in conduct and pro-

social scores on SDQ but remained within clinical range

Significant improvement in parent self-esteem and an unvalidated measure

Data for parental mental health was incomplete at post-group

Parents enjoyed the programme but too short and did not address specific issues/needs

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

collected by leaders and a small sample, etc. 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

In general, across the age range, parenting programmes for conduct disorder show greatest impact compared to other interventions but results decrease with child age

Limited number of evidence-based programmes with this age range

Effective programmes for this age range (MST; FFT; SPT 10-14) are all Blueprints for Violence Prevention

Effective programmes work with the whole family (both parents and teenagers) – more sustainable and have significant impact on adolescent emotion regulation and behaviour

Conclusions Effective programmes are longer

Effective programmes include parents and adolescents and are Blueprints

Fidelity has a significant relationship with positive outcomes

Barriers to attendance require addressing (transport, childcare, etc.) to ensure retention

Although costly in the short-term, costs are minimal in the long-term when considering the cost of antisocial behaviour for society

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

• We hope to have results to report by the conference in Cardiff

KiVa Anti-bullying programme

• Developed by Prof Christina Salmivalli University of Turku, Finland• Funded by Finnish Government• RCT trial 2006-2009• National roll out since 2009• Approved for WG funding

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defenders of the victim

outsiders

assistants of the bully

victim

reinforcers of the bully

12%

8%

20%

7%

17%

24%bully

Participant roles in bullying (Salmivalli et al., 1996)

Background of KiVa: The social architecture of bullying

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In order to reduce bullying...

We do not necessarily need to change the victims, making them ”less vulnerable”

UNIVERSAL Influencing the behavior of classmates can reduce the

rewards gained by the bullies and consequently, their motivation to bully in the first place

INDICATEDHowever, the victims need to feel that they are heard and helped by the adults at schoolThe bullies need to be confronted for their unacceptable behavior

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Repeating & testing of what has been learnt – ”I KNOW”

Learning to take action – ”I CAN”

Motivation – ”I DO”

KiVa games and KiVa Street are closely connected to student lessons

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RCT: Success of the indicated actions

The proportion of cases handled by the school team in which bullying... Stopped completely 79.4% Decreased 18.5% Remained the same 1.9% Increased 0.3%

Garandeau et al., Tackling acute cases of bullying: Comparison of two methods in the context of the KiVa antibullying program.

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Scaling up

2009: 1450 schools 2010: + 810 schools 2011: + 200 schools + Åland Island

82% of comprehensive schools in the country have adopted KIVa

About 7500-8000 teachers and other school personnel trained face-to-face

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Main conclusions (broad rollout) Effects weaker than in RCT, but still

significant (for victimization, OR= 1.21, 95% CI=1.12-1.31), with much variation across grade levels

Again, strongest effects in grade 4 and weakest in secondary school (grades 7-9)

Generalized to Finnish population of 500,000 students, the effects of this size would mean a reduction of 12000 victims and 8000 bullies after nine months of KiVa implementation

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Current pilot in Wales Small scale KESS funded evaluation,

CEBEI – Suzy Clarkson Mres 7 schools in North Wales, 3 schools in

Cheshire, 7 schools in South Wales Trained by Christina in May 2012, Unit 2

curriculum in English 9 – 11 yos The 17 schools completed baseline survey

and are implementing programme, now on lessons 3 to 4 of Unit 2 and very enthusiastic about the lessons

Only one bullying incident so far 40

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RCT funding from March 2013• Welsh Big Lottery Funding 2013 - 2015Project Partners, Dartington social Research Unit & CEBEI• 20 primary schools (from across Wales)• To implement and evaluate the entire KiVa primary school curriculum (Units 1 and 2) (all of KS2, years 3 - 6)

• Randomised allocation of schools• 10 schools to implement 2013 and 20 schools to implement in 2014

• Meetings in March to identify interested schools 41

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Aims and outcomes

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• Reduce bullying, measured by pupil self-report – online survey

• Reduce victimisation, measured by pupil self-report – online survey

• Improved mental well-being, measured by Teacher Strengths and Difficulties Questionnaire

• Improved school attendance, measured in terms of half day sessions missed

PREPARE A newly funded study Funded by a former student at Bangor 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

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 early intervention services

• Project will involve :- Developing ‘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 sample of families receiving interventions/services through the programme

Waterloo foundation grant £10,000 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 Intensive Treatment Programme research and the Enhancing Parenting Skills programme

Support from Children in Wales

The plan Two days training, February and April Five locations in Wales: Bangor, Flint, Cardiff,

Swansea and Newtown 15 participants in each Centre Day one – introducing a structured assessment and

case formulation process Day two focused on intervention A manual developed to support assessment, case

analysis and intervention skills A parenting booklet to teach parenting skills and

principles of reinforcement being published Participants collect data for evaluation

The ADHD trial in England

• Partnered with Southampton University in 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)

•Each Centre running one trial group and 5 research groups Jan 2012 – Dec 2013•Results 2014

•Challenges so far include loss of group leaders, 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 severly 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

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-study

- Outcome Evaluation- Child Behavior Problems (self-report and observational)- Parenting Behavior (self-report and observational)- Parental Mental Health (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 progs 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 in our RCTs

• 3 Authorities have mentors, six have peer coaches,

• 30 certified or part certified leaders across Wales

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

All 22 Authorities in Wales delivering the parent programme

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

School readiness parent programme becoming established

Thank you

For further information please visit our websites http://www.centreforearlyinterventionwales.co.uk

Research website: http://incredible-years-wales research.bangor.ac.uk

Email

j.hutchings@bangor.ac.uk