Researching the Incredible Years Toddler Parenting Programme in Wales

March 2011March 2011

Researching the Incredible Years Toddler Parenting Programme in

Wales

Researching the Incredible Years Toddler Parenting Programme in

Wales

Professor Judy Hutchings Nia Griffith

Bangor University

Professor Judy Hutchings Nia Griffith

Bangor University

Poverty in WalesPoverty 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)

• 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)

Negative Outcomes..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

• Poor physical health• Poor mental health• Delayed child development• Abuse• Behavioural and emotional difficulties

• Poor academic achievement• Poor employment prospects• Adolescent and adult delinquency

Why Early Intervention?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

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

Flying StartFlying 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

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

Evaluation of the IY parenting interventionEvaluation of the IY

parenting interventionTrial • 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

RCT Research locationsRCT Research locationsNorth 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)

Sample CharacteristicsSample 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.

Sample Characteristics cont.

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

Comparison of FS and National AverageComparison of FS and National Average

Characteristic Flying Start Sample (103 dyads)

Social Trends 2007*

Lone Parent Families 31% 24%

Age of parent at birth of 1st Child

22.1 years 27.3 years

Living below recognised poverty indicator WAG (2010)

53% Actual

16% Probable

17%

Information sourced from:Social Trends No.37 (2007). London: Office for National Statistics

MeasuresMeasures• 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)

Additional Services Available:

Extra health visitor supportFree childcareBasic skills(Parenting courses – intervention only)

Additional Services Available:

Extra health visitor supportFree childcareBasic skills(Parenting courses – intervention only)

Positive Impacts of living in a Flying Start area?

Measure Baseline Score

6-month FU Score

Significance Level

SOGS DQ 96.98 101.82 P < .05

BDI II 10.82 7.93 P < .05

PSI-SF 76.01 68.61 P < .05

IT-HOME 34.77 37.37 P < .05

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

Main MeasuresMain Measures

Added benefits of IY Toddler Parenting

Programme for Intervention Families living in Flying Start

areas?

Added benefits of IY Toddler Parenting

Programme for Intervention Families living in Flying Start

areas?

The IY Toddler Parenting programme.

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

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

SHORT TERM DATASHORT TERM DATA

Follow-up two at 6-months post baseline

Preliminary Analysis WEMWBSPreliminary 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).

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).

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)



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)

LONGER TERM OUTCMESLONGER TERM OUTCMES



Further Analysis of BDI

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)

Further Analysis of IT HOME

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)

Further Analysis of SOGS Developmental

Quotient

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).

Relative Deprivation

How at-risk were our sample?

Relative Deprivation

How at-risk were our sample?

Income levelIncome level

Multiple Risks- SED6Multiple Risks- SED6Risk Factor FS Sample SS Sample

Unemployed/Benefit Dependant 49% 76%

Single Parent 37% 42%

Large Family 31% 45%

Parent Low-educational Attainment

39% 39%

Poor Quality Housing 18% 10%

CONSIDERED AT-RISK (>2 Risks)

70% 80%

Compiled from questions in PDHQ, Hutchings (1998)

Depression and StressDepression and Stress

Measure FS M (SD)

SS M (SD)

P value FS ClinicalSignificant

SS ClinicalSignificant

BDI 10.82 (9.44)

16.48 (10.39)

<0.001 16% 37%

PSI-SF 76.01 (20.54)

100.36 (23.47)

<0.001 21% 67%

Comparison of FS and SS on outcome measures for parent stress and depression at baseline

ConclusionsConclusions• 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)

• 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)

Conclusions Cont.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.

• 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.

Additional ProjectsAdditional 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

• 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

Thank you for listening!

Diolch am wrando!

Thank you for listening!

Diolch am wrando!

Researching the Incredible Years Toddler Parenting Programme in Wales

Documents