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

Update on the activities of the Centre for Evidence Based Early Evidence. Supporting Evidence Based Early Intervention Programmes across Wales and beyond . Bangor University 6 th March 2013 Professor Judy Hutchings, OBE Centre for Evidence Based Early Intervention, Bangor University.

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

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  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 6th March 2013 Professor Judy Hutchings, OBE Centre for Evidence Based Early Intervention, Bangor University

  2. Summary of presentation • Early work developing evidencebhasedprogrammes • 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 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)

  4. 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

  5. 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 5 5

  6. 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

  7. 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

  8. 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

  9. 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 For sibling nearest in age to index child: ECBI problem, ECBI intensity

  10. 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)

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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

  19. 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)

  20. Conclusions • Gwyneddrecognised 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

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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)

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

  28. Small Group Dina project Parent characteristics

  29. Small Group Dina project Teacher characteristics

  30. Small Group Dina project Next steps Finish data inputting & checking Conduct data analysis Write-up results

  31. 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

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

  33. 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

  34. Gwynedd evaluation of Gydai’nGilydd 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

  35. 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

  36. The plan • Two days trainingin 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

  37. 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

  38. 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..

  39. SINOVUYO CARING FAMILIES PROJECT Development and Evaluation of an Evidence-Based Early Childhood Development Parenting Programme for Vulnerable Families in South Africa

  40. 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

  41. 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

  42. 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 parentingby 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

  43. First meeting Zurich Dec 2012 Two further priority projects identified: • Identify the core principles/essential ingredients that make programmes effective and synthesize resultsto 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;

  44. 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

  45. 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

  46. Thank you For further information please visit our website http://www.centreforearlyinterventionwales.co.uk Email j.hutchings@bangor.ac.uk

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