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

1. 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

2. 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

3. 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)

4. 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 4

5. 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

6. 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 IY Parenting Programme: research completed

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. Gwynedd evaluation • GwyneddFamilies 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)

19. 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

20. 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

21. conclusions • Gwyneddrecognised 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

22. 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 programmesreviewed, 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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)

29. Small Group Dina project Child characteristics SDQ total difficulties borderline 14 and 17 Abnormal

30. Small Group Dina project Parent characteristics

31. Small Group Dina project Teacher characteristics

32. 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

33. 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

34. Background of KiVa: The social architecture of bullying • Participant roles in bullying (Salmivalli et al., 1996) 20% reinforcers of the bully 24% 8% bully outsiders 12% victim 17% assistants of the bully defenders of the victim 7% 34 34

35. In order to reduce bullying... • Wedonotnecessarilyneed to change the victims, makingthem”lessvulnerable” UNIVERSAL • Influencing the behavior ofclassmatescanreduce the rewardsgainedby the bullies and consequently, theirmotivation to bully in the firstplace However, the victims need to feel that they are heard and helped by the adults at school The bullies need to be confronted for their unacceptable behavior INDICATED 35

36. KiVa games and KiVa Street are closely connected to student lessons • Repeating & testing of what has been learnt – ”I KNOW” • Learning to take action – ”I CAN” • Motivation – ”I DO” 36

37. 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. 37

38. Scaling up • 2009: 1450 schools • 2010: + 810 schools • 2011: + 200 schools + Åland Island • 82% of comprehensiveschools in the country haveadoptedKIVa • About 7500-8000 teachers and otherschoolpersonneltrainedface-to-face 38

39. 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 39

40. Currentpilot in Wales • Small scale KESS fundedevaluation, CEBEI – SuzyClarksonMres • 7schools in North Wales, 3 schools in Cheshire, 7 schools in South Wales • Trainedby Christina in May 2012, Unit 2 curriculum in English 9 – 11 yos • The 17 schoolscompletedbaselinesurvey and areimplementingprogramme, now on lessons 3 to 4 of Unit 2 and veryenthusiasticabout the lessons • Onlyonebullyingincidentsofar 40

41. RCT fundingfromMarch 2013 • Welsh Big Lottery Funding 2013 - 2015 • Project 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

42. Aims and outcomes • 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 42

43. 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

44. Possible PREPARE components • Play • Read • Encourage • Praise • Attend • Reward • Educate

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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..