Researching the Incredible Years Toddler Parenting Programme in Wales

1. Researching the Incredible Years Toddler Parenting Programme in Wales Professor Judy Hutchings Nia Griffith Bangor University

2. Poverty in Wales • 200,000 children in Wales live in poverty • ‘living in poverty’ defined as weekly income after housing costs falling below 60% of the median income for families of this type (WAG, 2010)

3. Negative Outcomes.. • Poor physical health • Poor mental health • Delayed child development • Abuse • Behavioural and emotional difficulties • Poor academic achievement • Poor employment prospects • Adolescent and adult delinquency

4. Why Early Intervention? Compelling evidence for the benefits of early intervention • More Effective • More Cost-effective • Key component of the Child Poverty Strategy for Wales • Continuation of IY centre tradition for Early Intervention

5. Flying Start Flying start initiative aims to fund high quality services for children aged 0 - 3 years in disadvantaged areas in Wales Estimated 25,000 children aged 0 - 3 living within FS catchment areas Families targeted by area of residence, with investment of £2,000 per child per annum in the form of: • Extra health visitor visits from dedicated Flying Start Heath Visitor • Free childcare • Basic skills courses, language and play • Parenting courses

6. Trial • Trial of new programme • Randomised Control Trial • Small numbers • Participants • Parents of children aged between 12 and 36 months • Targeted families living in Flying Start areas • No other inclusion criteria • Recruitment • Families recruited by group leaders in each area • Randomisation • Random allocation by NWORTH (North Wales Organization for Randomised Trials in Health) • Stratified for age and sex and allocated on 2:1 ratio Intervention: Waiting list control • Control families wait 6 months for Intervention Evaluation of the IY parenting intervention

7. RCT Research locations • North Wales Sites • Blaenau Ffestiniog • Caernarfon (Maesincla) • Bangor (Maesgeirchen) • Holyhead • Mid Wales Sites • Welshpool • South Wales Sites • Rhondda Cynon Taf (Porth) • Blaenau Gwent (Llanhilleth) • Neath (Britton Ferry)

8. Sample Characteristics • 89 families • Parent age at Baseline (M= 29.97, SD= 6.72) range 16-48 years. • 24% Welsh first language. • 54% <20 Years at birth of 1st child.

9. Sample Characteristics cont. • 53% living in council/housing association houses. • 20% had concerns about their child’s development • 26% reported having felt low/helpless or depressed at some point since the birth of their child • 15% had an immediate family member with a drugs/alcohol problem, • 14% had an immediate family member who had been involved in some form of criminal activity. • 36% left school without any qualifications

10. Comparison of FS and National Average Information sourced from: Social Trends No.37 (2007). London: Office for National Statistics

11. Measures • Developmental Measures • - Schedule of growing skills (SOGS) • Measure of Home Environment • - HOME • Parent Measures: • Parenting Stress Inventory (PSI) • Beck Depression Inventory (BDI) • Warwick-Edinburgh Mental Wellbeing Scale • Direct Observation: • - Dyadic Parent-Child Interaction Coding Scheme (DPICS)

12. Additional Services Available:Extra health visitor supportFree childcareBasic skills(Parenting courses – intervention only) Positive Impacts of living in a Flying Start area?

13. Main Measures Significant improvements on main outcome measures for sample as a whole over 6-month period.

14. Added benefits of IY Toddler Parenting Programme for Intervention Families living in Flying Start areas?

15. The IY Toddler Parenting programme. STRUCTURE • Twelve sessions • Delivered weekly in 2 – 2 ½ hour sessions by two leaders • Collaborative learning process using discussion and ideas drawn from watching video-clips of other parents • Brainstorming/role-play/home activities • Group structure providing for group problem solving and peer support • CONTENT • Relationship building through child led play, coaching children’s academic, social and emotional skills, praise and spontaneous incentives, handling separations and reunions, establishing routines, learning how to give clear instructions and how to ignore, distract and redirect children • Learning to understand children’s development and safety awareness are themes that run throughout the programme

16. SHORT TERM DATA Follow-up two at 6-months post baseline

17. Preliminary Analysis WEMWBS Significant improvement for intervention sample relative to control group demonstrated in parent report mental well-being at 6 month follow-up (Warwick Edinburgh Mental Well Being Scale, NHS Health Scotland, 2006), (p = .014).

18. Preliminary Analysis of DPICS Significant improvement in observed critical parenting statements directed towards the target child at 6 month follow-up, measured by DPICS (Eyberg & Robinson, 2000), (p = .001) No significant changes were observed for the control group. (p = .258)

19. Preliminary Analysis of DPICS Significant improvement in observed physical negatives directed towards the target child at 6 month follow-up, measured by DPICS (Eyberg & Robinson, 2000). (p = .009) No significant changes were observed for the control group. (p = .730)

20. LONGER TERM OUTCMES Follow-up two at 12-months post baseline

21. Further Analysis of BDI No significant improvements at 6-months for the two subgroups, although significant for the whole sample at FU1. A significant reduction in total BDI for intervention families at 12-months, (p = <.01)

22. Further Analysis of IT HOME No significant improvements for the either group at 6-months. A significant improvement in total HOME score for intervention families at 12-months, (p = .003)

23. Further Analysis of SOGS Developmental Quotient No significant improvements for either group at 6-months 9p= .892) although significant for the whole sample at FU1, (p = .04) A significant improvement in DQ for intervention families at 12-months, (p = .021).

24. Relative DeprivationHow at-risk were our sample?

25. Income level

26. Multiple Risks- SED6 Compiled from questions in PDHQ, Hutchings (1998)

27. Depression and Stress Comparison of FS and SS on outcome measures for parent stress and depression at baseline

28. Conclusions • There are significant benefits from living in a Flying Start area for the whole sample in terms of improvements in child developmental status, reductions in maternal depression and stress an level and stimulation in the home environment • There are added short-term benefits from attending the IY Toddler programme in terms of significantly reduced negative parenting and improved parental mental wellbeing relative to the control families • There are continued longer-term improvements for intervention families in terms of maintenance of improvements in mental wellbeing and a significant long term benefit for child development (SOGS)

29. Conclusions Cont. • Data indicates that targeting by area alone is not the most effective way of finding the most at-risk families. It is necessary to find some mechanism of distributing resources to families in need, but using a simple targeting measure of child deviance resulted in the recruitment of a much higher risk sample.

30. Additional Projects • Evaluating the cost-effectiveness of the Incredible Years Toddler Parenting Programme- Jo Charles • Validating the SOGS- Margiad Williams • Comparing Live and Video Observation- Nic Gridley • Differential genetic susceptibility in the Incredible Years toddler parenting programme: Pilot study- Collaboration with Birkbeck University

31. Thank you for listening!Diolch am wrando!