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Evaluating the Enhancing Parenting Skills (EPaS) 2014 programme

This study evaluates the effectiveness of the Enhancing Parenting Skills (EPaS) 2014 programme in addressing behaviour problems in children. The programme, individually delivered with three core components, aims to improve parenting skills through structured assessment, case analysis, and intervention strategies. The trial involved health visitors working with disadvantaged families, and promising results were found, suggesting that EPaS could be a useful tool in working with challenging families.

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Evaluating the Enhancing Parenting Skills (EPaS) 2014 programme

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  1. Evaluating the Enhancing Parenting Skills (EPaS) 2014 programme Margiad Elen Williams

  2. Behaviour Problems • Most common childhood mental health disorder (Polanczyk et al., 2015) • Increasing levels over the last decade (BMA, 2013; Hutchings et al., 2011) • Most common reason for referral to CAMHS (NCCMH, 2013) • Predict poor outcomes into adolescence and adulthood (Colman et al., 2009; Reef et al., 2009)

  3. Parenting Programmes • Most effective interventions (NCCMH, 2013) • Different formats of delivery • Group programmes highly effective (Furlong et al., 2012) • Barriers to access for disadvantaged families

  4. Individually Delivered • May be more appropriate (Lundahl et al., 2006) • Eliminate barriers • Tailored to family needs (Fettig & Ostrosky, 2011)

  5. Enhancing Parenting Skills • Developed in 1990s • Individually delivered • Three core components

  6. What do we know about the family? Why does the behaviour occur? What strategies can be used? What types of behaviour problems are evident? What are the possible triggers?

  7. Previous Research Intensive Treatment trial (Hutchings et al., 2002, 2004) • Significant improvements compared to standard CAMHS, maintained at 4-years Health visitor trial (Lane & Hutchings, 2002) • Significant improvements but small sample and no randomisation Waterloo trial (Hutchings & Williams, 2013) • Significant improvements but small sample and no control group

  8. EPaS 2014 trial • Aim to address limitations • Course re-designed • Day 1 – Structured Assessment • Day 2 – Case Analysis • Day 3 – Intervention Strategies • Tailored to support health visitors • See Williams & Hutchings (2015)

  9. EPaS 2014 trial design • Multi-centre pragmatic randomised controlled trial • North West Wales • Central North Wales • North East Wales • Shropshire

  10. EPaS 2014 trial design • Health visitors recruit 2 families • Families randomised to intervention or TAU • Weekly visits for for up to 12 weeks • Data collection at baseline and 6-months • Child behaviour • Parenting skills • Parental depression • Observation of parent-child interaction

  11. Health visitors • 37 attended training

  12. Families

  13. Baseline Scores

  14. HV Satisfaction “This has been an excellent course to give me and the parents a framework to tackle behavioural problems” “I would have liked more 1:1 sessions …throughout the intervention phase as this was the most difficult period of the intervention to manage”

  15. Parent Satisfaction

  16. Analyses • Two types of analyses: • Complete case – families with baseline and follow-up data (Intervention n = 19; control n = 17) • Per-protocol – families who completed all 3 stages of EPaS (Intervention n = 13; control n = 17)

  17. Complete Case F (1, 33) = 5.22, p = .029, d = 0.88

  18. Per-protocol F (1, 27) = 5.21, p = .031, d = 1.53 F (1, 27) = 6.83, p = .014, d = 1.30

  19. Conclusions • Health visitors working with highly challenged families • High levels of satisfaction (HV and parents) • Promising results • Potentially useful tool for working with disadvantaged families

  20. References • British Medical Association [BMA] Board of Science (2013). Growing up in the UK: ensuring a healthy future for our children. Retrieved from: http://www.bma.org.uk/working-for-change/improving-and-protecting-health/child-health/growing-up-in-the-uk • Colman, I., Murray, J., Abbott, R.A., Maughan, B., Kuh, D., Croudace, T.J., & Jones, P.B. (2009). Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort. British Medical Journal, 338, a2981-a2989. • Fettig, A., & Ostrosky, M.M. (2011). Collaborating with parents in reducing children’s challenging behaviors: Linking functional assessment to intervention. Child Development Research, doi: 10.1155/2011/835941 • Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S.M., & Donnelly, M. (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Cochrane review). Cochrane Database for Systematic Reviews, 2, 1-362. doi: 10.1002/14651858.CD008225.pub2 • Hutchings, J., & Williams, M.E. (2013). Report on the staff training project to support children with developmental challenges funded by the Waterloo Foundation. Bangor University: Children’s Early Intervention Trust • Hutchings, J., Lane, E., & Kelly, J. (2004). Comparison of two treatments for children with severely disruptive behaviours: A four-year follow-up. Behavioural and Cognitive Psychotherapy, 32, 15-30. doi:10.1017/S1352465804001018 • Hutchings, J., Williams, M. E., Martin, P., & Pritchard, R. O. (2011). Levels of behavioural difficulties in young welsh school children. Welsh Journal of Education, 15(1), 103-115. • Hutchings, J., Appleton, P., Smith, M., Lane, E., & Nash, S. (2002). Evaluation of two treatments for children with severe behaviour problems: Child behaviour and maternal mental health outcomes. Behavioural and Cognitive Psychotherapy, 30, 279-295. doi:10.1017/S1352465802003041 • Lane, E., & Hutchings, J. (2002). Benefits of a course in behavioural analysis for health visitors. British Journal of Nursing, 11, 702-714 • Lundahl, B., Risser, H.J., & Lovejoy, M.C. (2006). A meta-analysis of parent training: Moderators and follow-up effects. Clinical Psychology Review, 26, 86-104. • National Collaborating Centre for Mental Health (2013). Antisocial behaviour and conduct disorders in children and young people: The NICE guideline on recognition, intervention, and management (No. 158). Leicester, UK: RCPsych Publications • Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry. Advance online publication. doi:10.1111/jcpp.12381 • Reef, J., Diamantopoulou, S., van Meurs, I., Verhulst, F., & van der Ende, J. (2009). Child to adult continuities of psychopathology: a 24-year follow-up. Acta Psychiatrica Scandinavica, 120, 230-238. doi:10.1111/j.1600-0447.2009.01422.x • Williams, M. E., & Hutchings, J. (2015). A pilot effectiveness study of the Enhancing Parenting Skills (EPaS) 2014 programme for parents of children with behaviour problems: Study protocol for a randomised controlled trial. Trials, 16, 221-229. doi:10.1186/s13063-015-0741-y

  21. Thank you for listening Diolch am wrando

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