Early results for the “Pathfinder” Project
This is a Westminster Government funded project to evaluate the roll out of three evidence-based programmes in England, Incredible Years, Triple-P and Strenghtening Families. Incredible Years groups were run in six English local authorities and group leaders collected pre- and post-group data and forwarded it to the research team in Bangor for analysis. The project used an 18-session Parent Programme that combined elements of the School-Aged Parenting Programme with parts of the Advanced adult problem solving curriculum. The children were mainly aged from 8-13 years old, the mean age for the sample was 9 years and 8 months old. Parenting competences, parental depression and child behaviour were assessed using a variety of measures, and differences between baseline and follow-up data were analysed. We also looked at feedback from teachers, including an assessment of the chidrens' general performance in class.
Complete data (both baseline and follow-up) was provided by N=223 parents and N=181 teachers. The results were encouraging, we found a significant reduction (p=.001) in dysfunctional behaviours displayed by the child as percieved by the main caregiver, measured using the Eyberg Child Behaviour Inventory (ECBI; Eyberg & Ross, 1978. Eyberg, 1980). Self-rated parental depression scores reduced significantly (p=.001) from mild/moderate depression to approaching the clinical cut-off (10-18) as measured by the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock & Erbaugh, 1961). An increase in positive behaviours was also observed in the children by caregivers and teachers using the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). The improvements noted by the teachers was also encouraging showing the programme may have altered children's behaviour in school. In particular we noted a consitent reduction in hyperactive behaviours.
Given the size of the changes demonstrated and the sample size, it is likely we can attribute these changes to the effect of the parenting programme on the parents, as the children were not seen at all. This study did not employ a control group, however other studies have shown that no change occurs for contrls for the positive and negative behaviour sometimes increases The data is being further analysed and a report is currently being written for publication. It was encouraging to establish that the positive findings were achieved across all authorities, so congratulations to all who participated and to the mentors and trainers from across the UK that supported them and helped to ensure that the programmes were delivered with fidelity. Prof. J. Hutchings supported the mentors, Dr. T. Bywater and Kate Shakespeare analysed the data, all were invloved in the write up of the report.
Archways, the evaluation of the Incredible Years Programme in Ireland.
Archways three-year commitment to implement and evaluate the Incredible Years BASIC Parenting Programme, TCM, and combination trial with children experiencing emotional and behavioural difficulties has also progressed. Working in collaboration with Dr. S McGilloway at the National University of Ireland, Maynooth. This research project, funded by Atlantic Philanthropies, recently concluded the first phase of a study with 53 parents, from 3 local authorities and the second phase is currently under way. Follow-ups are being conducted as are baseline visits for the second block of 93 parents. The research team has been trained in the DPICS observation method for the assessment of parent-child interactions and will observe all families in the second block. Archways are also undertaking the first rigorous evaluation of the Incredible Years Teacher Classroom Management (TCM) in Ireland. Preparatory work in twelve schools in Limerick, a highly disadvantaged area of the country, has been completed and the full evaluation commenced in October. Training will be delivered from Jan – May 09. Prof. J. Hutchings was on the EAC commitee and Dr. T. Bywater was a consultant. Dr. T. Bywater, Dr. K. Jones and P. Martin trained the research team in the observational measures. To find out more information about Archways visit www.archways.ie
British Council
The comparative study is underway in Portugal, funded by the British Council. An outline for the paper comparing our Sure Start outcomes with Portugal’s has been agreed. Our partners at Coimbra University, Assoc Profs Maria Filomena Gasper and Maria Joao Seabroe are undertaking the following research projects. Both projects will employ the use of the observation DPICS method. The research team was trained in this method in June and July this year by Dr. T. Bywater and Dr. K. Jones.
1. An evaluation of the IY BASIC programme in three areas in Portugal using a RCT design with three arms to the trial: intervention, control, and normal family support group for parents of children with significant behavioural difficulties. Follow-ups will be at 6 and 12 months after baseline. Approx 140 families will participate.
2. The second is a study of children with ADHD and CD type problems (3-6 yrs of age).
The team in Portugal has a blog containing information about their work with IY and the ADHD project visit it at, www.projectopaismaesincriveis.blogspot.com
Birmingham City Council
Birmingham City Council have funded Dartington Social Research Unit to undertake an evaluation of three interventions, IY, Triple-P, and PATHS. Dr. T. Bywater will act as Principal Investigator from Bangor. Prof. D. Perkins (on secondment for 12 months from Penn State University, USA) will be the Principal Investigator from Dartington. Prof. J. Hutchings will train leaders in the delivery of IY and will also supervise group leaders throughout the running of theIY Parent Programme with parents of 3 and 4 year old chldren.
Cochrane Review; Behavioural group-based parent training interventions for children aged 3-8 with early onset conduct problems.
M. Furlong at Maynooth University, Ireland, has been awarded funds to carry out this review with co-authors Dr. S. McGilloway, Dr. T. Bywater, Prof. J. Hutchings, Dr. M. Donnelly, and Dr. S. Smith. The principal aim of this review is to determine which behavioural, group-based parenting interventions, are most effective in alleviating conduct problems in children during the important developmental-transitional phase in childhood. A secondary aim of the review is to ascertain whether or not some programmes/interventions work better than others and especially with children in high risk, multiply disadvantaged families. The question of what works best, for whom and under what circumstances is one that is often ignored in reviews of psychosocial (as opposed to medical) interventions and it is important, therefore, in so far as possible, to make like-with-like comparisons
4 Year Sure Start Follow-Up
The Welsh Sure Start study funded by Health Foundation (Hutchings et al., 2007) demonstrated significant statistical and clinical effects in reducing child behaviour problems, but it is of vital importance to establish whether these outcomes are maintained long-term and for whom. This proposed study will contribute to the sparse evidence base on the longer-term effectiveness of early intervention for CD and could provide the basis for a new larger RCT based longitudinal study of the IY programme to explore the effect of the provision of additional ongoing support to some families.
153 families took part in the North-Wales study, (104 intervention and 49 waiting-list control families). At 6-month follow-up 86 intervention and 47 control families participated and at 18-month follow-up there were 79 intervention families. Control families were offered the intervention after the 6-month follow-up and no further measures collected from them.
There were no differences between control and intervention condition families on any measure of child or family characteristics at baseline. All children lived in disadvantaged Sure Start areas with clinical levels of conduct problems as measured by the ECBI parent report. A significant difference between the two conditions was found at 6-month follow-up (attendance on the parent programme occurred between baseline and 6-month follow-up) on multiple measures of child and parenting behaviour and parental stress and mental health measures (Hutchings et al., 2007). The programme was shown to have a positive affect on the intervention families across all Sure Start areas, regardless of level of area crime and social disadvantage (Hutchings, Bywater, Davies, & Whitaker, 2006). The positive outcomes for the intervention condition were maintained at 12 and 18-month follow-up (Bywater, et al., submitted).
This is possibly the most significant pragmatic randomised controlled trial of early prevention of CD in the UK. Its importance lies primarily in having demonstrated that, given the right training, supervision and support, existing Sure Start staff in eleven centres across North- and Mid-Wales could deliver the evidence based IY programme effectively and achieve excellent outcomes (Hutchings et al., 2007). By comparison the National Evaluation of Sure Start in England (Belsky et al., 2006) failed to demonstrate any benefits for children at high-risk of CD. In addition to excellent behavioural outcomes in the Welsh study The Centre for Economics and Policy in Health at Bangor University carried out economic analyses and found the programme to be good value for money (Edwards et al., 2007).
A four-year follow-up of the Welsh Sure Start families has been funded by North West Wales NHS Trust and is due to start in January 2009.
This would clarify for which children the success of this preventive early intervention is maintained. Identification of the characteristics of children/families for whom a one-off ‘dose’ is insufficient and who need additional support to maintain good outcomes, would contribute to decisions about the structure of early preventive services and provide the preliminary evidence for a study to compare brief and longer-term interventions for such families.
To view a broader description of measures mentioned in the above research visit our measures page.
T Bywater as Principal Investigator and lead Applicant, J Hutchings as Co-applicant and K. Shakespeare as Research Assistant.