Dr Lucy Thompson NHS Greater Glasgow and Clyde

1. Glasgow Parenting Support Framework Evaluation: school readiness and longitudinal trajectories using the Strengths and Difficulties Questionnaire (SDQ) and linked health data Dr Lucy Thompson NHS Greater Glasgow and Clyde

2. Glasgow Parenting Support Evaluation • Collaboration between NHS GGC, Glasgow City Council Education Services and University of Glasgow • Funded by Scottish Government • Involves whole population assessments of social and emotional development at ages 30 months, 5 years, 7 years and 10 years • Prime aim is service evaluation rather than research

3. Key factors • Collaborative project • Local academic expertise • NHS input from a range of levels • Multidisciplinary / multiagency evaluation steering group • Evaluation administrative office • Coordination and communication • Regular meetings of admin staff • Regular contact with parenting coordinators

4. Glasgow Evaluation Principles • Focus on measurable child-centred outcomes • Use standardised tools • Data should be useful for 4 purposes: • Professional decision making • Needs assessment • Performance management • External evaluation

5. Research Questions (1) • What is the reach of /engagement with the Triple P programme (compared to projected population figures)? • In those families engaging with Triple P interventions, what is the short term impact in terms of reducing risk factors and increasing protective factors associated with poor or favourable developmental outcomes in children and young people? • Can we achieve our aim of 90% completion of pre- and post-intervention evaluation measures?

6. Research Questions (2) • What is the pattern of emotional and behavioural difficulties in the population at 2.5, 5, 7 and 10 years? • What is the pattern of emotional and behavioural difficulties in a sample of the population at 12 to 16 years? • How do these patterns compare with national and international normative data? • Does this overall pattern change over time? • To what extent do difficulties experienced by individual children persist or change over time? • Do socio-demographic factors such as geographical area, relative deprivation and school influence trajectories of emotional and behavioural functioning?

7. Research Questions (3) • To what extent are offers, uptake and completion of Triple-P and other interventions matched to the level of emotional and behavioural difficulties? • Are offers, uptake and completion of interventions influenced by socio-demographic factors, parents’ perceptions, belief systems, etc? • To what extent do offers, uptake and completion of interventions influence the persistence of difficulties? • What are the predictors of resolution of difficulties both among participants in parenting support interventions and more broadly?

8. Research Questions (4) • To what extent is the population of parents aware of Triple P and other sources of parenting support? • What are the key lessons regarding the implementation process? • Do rates of child injury change over time? • Do numbers of children subject to child protection case conferences and looked after away from home change over time?

9. Types of data • Routinely-gathered data on all children in Glasgow through: • the Child Health Surveillance System including data collected at the new universal contact at 30 months; • social work systems re. child protection, child placement, etc; and • Scottish Morbidity Record (SMR) data on child injury held centrally by NHS Scotland’s Information and Statistics Division (ISD) • Recently-instigated routinely-gathered data on emotional and behavioural wellbeing for children in the education system; • Process data – referral, uptake, completion information, as well as pre- and post-intervention questionnaire data and qualitative feedback from practitioners, stakeholders and parents.

10. The Strengths and Difficulties Questionnaire – www.sdqinfo.org • A brief behavioural screening questionnaire for 3-16 year olds. • 3 versions – parent, teacher, self-complete • Originally developed as a screening tool for psychological problems in children • but can be used to assess change after interventions • and can be used to compare the wellbeing of populations

11. The SDQ • 25 questions used to measure five aspects of the child’s development: • emotional symptoms • conduct problems • hyperactivity/inattention • peer relationship problems • pro-social behaviour • Responses: “Not True”, “Somewhat True”, “Certainly True” • Questions scores in each domain totalled and classified: unlikely to have problems / possibly has problems / likely to have problems • Along with questions about impact of problems, if relevant

13. SDQ data collection • At a new routine 30 month health check by health visitors – SDQ (parent version) and language • Before school entry (completed by nursery staff) • At primary 3 (age 7) (teacher complete) • At primary 6 (age 10) (self complete)

14. x – data collection point Solid lines indicate cohorts within the life of this project Dashed lines project to future data collection (beyond this project) 2010: SDQ data at school entry only (cross-sectional time-specific only). 2011: SDQ data at school entry PLUS at 2.5 years (as above PLUS cross-sectional time-series). 2012: SDQ data at school entry PLUS at 2.5 years PLUS at 7 and 10 years (as above PLUS longitudinal cohort).

15. Single child trajectory – potential data Demographic info questionnaires SIMD routine records GROS CHS-PS SEEMIS SEEMIS? SEEMIS? SDQ@30m SDQ@ preschool SDQ@7 yrs SDQ@ 10 yrs birth teens Triple P interventions: offer  referral  uptake  completion Local admin systems… Social work involvement Social work data systems

16. SDQ at school entry • For all children entering primary school in Glasgow, started in 2010 • Completed by Child Development Officers as part of routine Transition Documentation • Now available as a SEEMIS module • Data will be linkable to NHS and GROS data • A way to measure how all preschool services are performing?

17. Response rates – 2010 “pilot phase” • Nursery-based data only so far • Data available for about 70% of Glasgow school entrants – about 3,300 in total • Good questionnaire completion rates • Some nurseries did not return data • Expect about 97% completion in 2011

19. SIMD09 using within-Glasgow ranksData source: Bruce Whyte at GCPH

20. Factors related to total SDQ score at school entry Scores adjusted for establishment and neighbourhood SIMD = Scottish Index of Multiple Deprivation (1=most deprived, 5=most affluent)

21. Deprivation and SDQ subscales

28. Analysis – future plans • Refining the maps – disentangling the impact of neighbourhood, deprivation and service use • Linkage of health and education data: plotting trajectories from 2 to 10 years • Identify effects of area, nursery, school, family on these trajectories • Design trials of interventions aiming to reduce inequalities

29. Further evaluation of SDQ use • User perspectives • Child Development Officers • Heads of preschool establishments • P1 teachers • Primary head teachers • Checking against parental scores

30. Interviews with nursery staff • Preliminary findings: • Helps to think about children’s social and emotional readiness for school, rather than just academic preparedness • Consistent with Curriculum for Excellence – looking at the ‘whole child’. • Concerns about parental consent & informing parents confidently • Concerns about committing any negative information about a child to ‘paper’ • Concerns the data wouldn’t be used

31. Acknowledgements • Phil Wilson • Carolyn Wilson and the SG Child and Maternal Health Division • Amanda Kerr, John Butcher and Morag Gunion and City of Glasgow Education Services • Kim Jones & Kelly Chung • Bruce Whyte at Glasgow Centre for Population Health • Sarah Barry at Robertson Centre for Biostatistics • Scottish Government produced the socio-economic data and Scottish Neighbourhood Statistics provided the datazone information.

32. lucy.thompson@ggc.scot.nhs.uk