Parenting support for school readiness:

1. Parenting support for school readiness: Enhancing Social-Emotional Health and Wellbeing in the Early Years (The E-SEE Project) April 2018 Dr Sarah Blower Family Wellbeing Team Department of Health Sciences University of York

2. School readiness includes cognitive (e.g., academic skills, language development) and social-emotional (e.g., self-control, peer competence) dimensions amongst others Family environments and parenting behaviours have a strong influence on children’s development and their readiness for school

3. Social and emotional wellbeing provides the building block for healthy behaviours and educational attainment and positive life outcomes emotional wellbeing – this includes being happy and confident and not anxious or depressed psychological wellbeing – this includes the ability to be autonomous, problem-solve, manage emotions, experience empathy, be resilient and attentive social wellbeing – has good relationships with others and does not have behavioural problems, that is, they are not disruptive, violent or a bully.

4. Low social and emotional competency

5. Barlow & Coren (2018) reviewed 6 systematic reviews: ‘parenting programmes are effective in improving child emotional and behavioural adjustment in addition to enhancing the psychosocial wellbeing of parents’. http://guidebook.eif.org.uk/ Early Intervention Foundation Guidebook for programme evidence level/effectiveness/cost and if in UK Effective intervention

6. Features of effective parenting programmes Parenting quality and parent-child relationships improve by: Changing parenting behaviours Changing parents’ beliefs and feelings Skills training Collaborative play Selective attention and praise Exploring parent views + general principles and support Structured sequence of sessions to increase competencies Manualised (skilled facilitators tailor to parents’ needs) Groupformat orone‐to‐one, in variety of settings, for various levels of need

8. Reducing health inequalities: Theoretical representation of the health gradient and levelling up

9. Theoretical representation of the effect of different approaches to reduce inequalities Reproduced from: NHS Kensington and Chelsea (2011), National Collaborating Centre for Determinants of Health (2013)

10. NIHR Public Health Research Call 13/93 What are the effective and cost-effective interventions to promote social and emotional well-being among children aged under 2 years? For more info and our protocol see:http://www.nets.nihr.ac.uk/projects/phr/139310

11. Enhancing Social-Emotional Health and Wellbeing in the Early Years (The E-SEE Project) This project was funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 13/93/10).

12. Intervention (non-NHS): Proportionate universal interventions to support social and emotional wellbeing. We are particularly interested in interventions which investigate the most effective ways that fathers, grandparents and others who informally care for children, can promote social and emotional wellbeing • Comparator: Services as usual • Outcomes: Social and emotional wellbeing of children <2 yrs • Duration of follow up: how medium-long term impact can be assessed • Impact on inequalities: impact of intervention on health inequalities • Setting: Community settings (not home based due to ongoing research) • Public engagement: incorporate a mechanism for public involvement

13. Incredible Years

16. Nationwide and International E-SEE Partnerships • Trial funded 2015 to 2020 • (2015-17 external pilot; 2017-20 main trial) • Expertise from a variety of Universities • Universities of York, Sheffield, Exeter, UCLAN, Maynooth in Ireland • Carolyn Webster-Stratton and IY Seattle are advisers • BUT this is an independent evaluation • Five delivery sites and associated partners: • North Yorkshire County Council and Harrogate and District NHS Foundation Trust • Harrogate, Knaresborough, Ripon, Selby (and rural), Tadcaster and Sherburn • Devon Virgin Care and Action for Children • Blackburn with DarwenCouncil and Lancashire Care NHS Foundation Trust • Solent NHS Trust • Suffolk County Council

17. What the E-SEE trial involves • Test the effectiveness of Incredible Years (IY) parenting support programmes (infant and toddler versions) when delivered at different levels according to need (reflecting the principle of providing a universal proportionate service) • Universal and targeted elements for those with ‘at risk’ score on the depression screener & child social and emotional development screener Offer three different Incredible Years elements • Incredible Babies book - the universal element of the programme which will be offered to all IY allocated families. • Incredible Babies group programme - a targeted element • Incredible Toddlers group programme – a second targeted element. • Dyads recruited when infant is ≤8 weeks old – remain in the study for 18-months and are visited by the research team in the family home at four time points

19. Measures Baseline, 2 & 9 month follow-up

20. Outcome evaluation • Main research question: • To what extent does the proportionate delivery model of IY enhance child social emotional wellbeing at age 20 months of age, and adult wellbeing, compared to SAU, and how effective is each dose as assessed ’post-dose? • Does IY lead to enhanced child cognitive development compared to SAU? • Does IY strengthen parent-child relationships? • For whom is the cumulative/individual IY programmes most effective? • Process evaluation • Can a multi-agency service deliver IY in a proportionate universalism model, and what are the organisational, or systems-level, barriers and facilitators to delivering in this way with fidelity? • How acceptable and feasible is delivery of IY-I and IY-T for key intervention stakeholders, i.e. parents/co-parents, facilitators, heath facilitators, service managers? • Economic appraisal/cost analyses • Is IY and the proposed delivery model cost-effective? • Does IY influence patterns of health and social service use in children and parent/s? • Can we assess the likely long-term cost and benefits of the IY programmes?

22. Further impact • In addition to informing on evidence of ESEE steps model we aim to inform NICE on the highlighted gap of available attachment measures for children under 1 year • The Public Health Framework for child development includes the Ages and Stages Questionnaire, which is currently routinely collected at 2-2.5 years of age. However, currently social and emotional wellbeing is not routinely collected • We are interested in validity, reliability, accessibility and acceptability of measures and their practice/research use…. • As part of the E-SEE study we have conducted a systematic review of measures used to evaluate the outcomes of parent programmes for 0-5s

23. www.ukimplementation.org.uk In the morning the focus will be on work undertaken in Scotland led by Dr Melissa Van Dyke, International Expert Adviser in Implementation (CELCIS, University of Strathclyde) and Fiona Mitchell, Strategy and Alignment Lead (CELCIS, University of Strathclyde).The afternoon will focus on ongoing work in the city of Bradford with speakers involved in the Better Start Bradford Initiative, to include Michaela Howell, Director Bradford Trident, and DrJosie Dickerson, Programme Manager for the Better Start Bradford Innovation Hub.

24. Acknowledgements • A huge thank you to….. • Funders: • NIHR PHR • The extended research teams • All research partners and stakeholders, and especially the participating families and service staff

25. Thank you for listening Any questions? Enhancing Social-Emotional Health and Wellbeing in the Early Years (The E-SEE Project) Sarah Blower: sarah.blower@york.ac.uk @sarah_blower The views and opinions expressed are those of the presenters and do not necessarily reflect those of the NIHR PHR Programme or the Department of Health. This project was funded by the National Institute for Health Research Public Health Research (NIHR PHR) Programme (project number 13/93/10).