Incredible Years in Wales: Research update

1. Incredible Years in Wales: Research update Professor Judy Hutchings Centre for Evidence Based Early Intervention, Bangor University March 2011

2. Overview • Recently completed studies • Current evaluations

3. Mediator and Moderator analysis of Sure Start Do children who have higher levels of risk factors for conduct problems at baseline benefit less or more from intervention? • Intervention produced better outcomes for boys relative to girls • Depression was a significant moderator of intervention effects, therefore children of depressed parents fared better following intervention than control • Childs age was a significant moderator, with younger children faring better than older children • No moderator effect of baseline level of observed deviance, so more and less difficult children had equally good outcomes Does change in parenting behaviour mediate change in child conduct problem outcome? • Change in positive parenting skills after Parent Training (PT) acts as a partial mediator of change in child behaviour.

4. Sure Start Depression outcomes • Maternal depression improved significantly for the Sure Start sample but does change in maternal depression mediate change in child conduct problem outcome? • Sample consisted of 133 families who provided baseline and follow up (6 months later) data from the Sure Start Study; 86 Intervention & 47 Controls. • Results showed that a change in depression is a mediator of change in both child behaviour and self reported parenting behaviour 4

5. intervention - 48% above clinical cut-off at baseline 20% at f/u (p<.001)control – 34.0% above clinical cut-off at baseline 24% at f/u (p=.274)both ECBI problem scale and Arnold-O’leary parenting scale are significantly mediated by change in maternal depression (BDI).

6. Pathfinder parenting research with parents of 8 – 13 year olds Aim: To investigate the effectiveness of the extended 17 session school aged parenting programme Participants: 280 parents of children aged 8-13 years old Outcome Measures: BDI, Arnold O’Leary & ECBI Results: Improvement for child behaviour problems & parenting skills & a decrease in parental depression Parenting skills mediated a change in child behaviour. Family history of crime moderated effects on child behaviour

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8. Nursery Programme: Outcomes Aim: To evaluate the effectiveness of the Toddler Parenting Programme with a group of Nursery Workers on: Children’s behaviour in the nursery Levels of stress experienced by Nursery Workers Nursery Workers Sense of Competence Participants: 13 Nursery Workers and 30 children in their care Results: Reduced self-reported stress levels for Nursery Worker, reduced problematic behaviour for children in the nursery setting, & an increase in NW competence.

9. Behavioural Difficulties • Data obtained for the TSDQ and TSI, during the TCM large-scale RCT was used for this study. • Of the 248 participating children (mean age 4.88 years), 12.5% were viewed by their teachers as having significant behavioural problems, as rated on the TSDQ. • The mean total difficulties score of 7.2 was marginally above the the national mean of 6.6 reported by Goodman (1997). • 23.4% of children were above abnormal cut off for the impact supplement subscale on which teachers reported the effect that the child has on their daily functioning. • Gender analysis also confirmed national figures, with boys having three times more problems above the clinical cutoff than girls and four times more girls than boys demonstrating good pro-social skills.

10. Findings suggest that teachers are reporting significant and growing levels of problems in young children in Gwynedd. Results confirm previous studies demonstrating boys have higher levels of problems than girls. Results also suggest that teachers are finding these difficulties challenging.

11. Bro Lleu pilot project • Aim: To evaluate the effectiveness of the Small-group Therapeutic DINA with a group of high-risk children • Participants: 24 children (mean age = 7.07 years) identified by head-teacher. 7 Intervention and 5 Control identified by scores on TSDQ as ‘high-risk’ • Outcome Measures: Teacher Strengths and Difficulties Questionnaire (TSDQ), Wally Problem Solving Task & Direct Observation via TPOT

12. Results: A significant reduction of scores across all subscales of the TSDQ. A strong relationship between child and teacher positives in the classroom. Significant increases of positive, pro-social and total response to all problems, and a significant reduction of agonistic response using the Wally problem solving task • Concl • Conclusion: The small-group pull-out DINA programme is effective at reducing problematic behaviours, improving teacher-pupil relationships and increasing problem solving skills in children considered ‘high-risk’

13. Observational Coding:live or from video-tape? • Issues for researchers to consider: Cost, time, availability of coding scheme and triened coders at time of data collection. • Aim: To investigate the level of agreement between live and video methods when coding parent-child interactions. • Participants: 40 videos, from Welsh Toddler RCT, randomly selected from larger sample (N=193) children aged 1–3 years. • Results Although the two methods correlated significantly greater number of number of non-verbal behaviour events were captured in live observation and of verbal behaviour events in video observation. • Inter-observer rating of videocoded material yielded greater reliability (98%) by comparison with live coding (73%). • Conclusions: The differences suggest that the two modes should not be used interchangeably. Further investigation needed to validate findings across other populations and coding systems.

14. What can we learn from the Schedule of Growing Skills (WAG chosen instrument for Flying Start outcomes) • Aim: To validate the original and a new DQ method of scoring the Schedule of Growing Skills (SOGS) – a developmental screening tool - to increase its sensitivity • Participants: Data from two studies were used, the RCT of the IY Toddler programme and an MRes project comparing the SOGS to the standardised Griffiths Mental Development Scales (GMDS). • Outcome Measures: The SOGS, GMDS, and Ages and Stages Questionnaire (ASQ). • Results: The new DQ scoring method showed greater concurrent validity than the original scoring method when compared to both a standardised developmental assessment (GMDS) and a screening tool (ASQ). • The data suggested that the new scoring method reliably identifies children whose development suggests the need for more detailed assessment whereas the published scoring method does not. 14

15. Current Studies Dino School School Readiness Programme Baby Programme

16. IY Small Group Therapeutic Dina School Research Project Building social and emotional competence in young school children in North Wales: a pragmatic randomised controlled trial of a school based intervention Lottery funded – 3 year project April 2010 – March 2013 IY Cymru charity are the grant holders with partners in Gwynedd Education & Bangor University Aim: To evaluate the effectiveness of the IY Small-Group Therapeutic DINA programme with young school children who may benefit from more intensive exposure to the Dina school curriculum (in schools already delivering classroom Dina and whose teachers have also been trained in the IY Teacher classroom management principles). 16

17. Rationale for the project Parenting interventions work but some high-risk children may need additional direct work. It is not possible to engage all parents. Interventions for children must strengthen social and emotional competencies and problem solving skills in order to reduce behaviour problems and achieve desired academic outcomes and school success. High risk children may need a targeted intervention in addition to universally delivered school based programmes of social and problem solving skills and emotional regulation in order to increase the child’s opportunities to learn by discovery and experience.

18. Dinosaur School Curriculum • How to do your best in school • How to become a feelings detective • How to solve problems • How to manage anger • How to make and keep friends

19. Background to the trial • Was developed and researched in Seattle as both a clinical therapeutic and a preventive classroom programme • The therapeutic programme has been run successfully with CAMHS referred Welsh children (Hutchings et al 2007a) • Children already have the IY Classroom Dina curriculum and teachers have received training in the IY teacher classroom management principles, both of which have shown good outcomes (Hutchings et al 2004, Hutchings et al., 2007b) • A pilot study demonstrated improved problem solving, reduced behavioural problems and increased positive behaviour towards teachers (Hutchings et al, in press) • This additional therapeutic programme now needs to be researched in a larger randomised controlled trial

20. What makes this trial important? • The first rigorous trial of the Small Group Dina Programme for young children who are already receiving the classroom Dina curriculum and have been taught IY TCM principles • Made possible by lottery funding because of the innovative approach in Gwynedd to establish classroom Dina county-wide • The plan • 20 schools, 9 in phase 1 20010/11, 11 in Phase 2 2011/12 • 40 teachers/classroom assistants to deliver the programme • 240 children and their parents • 120 intervention, 120 wait-list control • Teachers of participating children

21. School-Readiness Programme • Rationale • Starting school is a transition point when parents can build a strong relationship with their child’s teachers and learn to support their child’s education • Programme content: Four sessions delivered to parents through schools Two sessions on child-directed play Two sessions on interactive reading (reading with CARE – Commenting, Asking questions, Responding with praise, Expanding what the child says) • Aims: To evaluate the effectiveness of the new School Readiness programme To establish a battery of measures to assess school readiness • Participants: Phase 1: 5 schools, Phase 2: 7 schools Each school to recruit 6 - 12 parents C A R E

22. Parents and babies programme • Aim: to evaluate the effectiveness of the new eight session parents and babies programme • Programme: content covers parental concerns about health and development – sleeping, weaning and crying, safety alerts, getting to know your baby, and activities to strengthen parent-child attachment and how to encourage babies brain development • Participants: 75 families with babies under 6 months of age at start of programme. Nine groups north- and mid-Wales (2 - Autumn 2010, 7 - Spring 2011) 50 Intervention, 25 Control children (from same areas). Baseline assessments November 2010 - February 2011. Follow-up assessments at 6 & 12 months after baseline between February- August 2011. Control families offered Toddler Programme after 6 months

23. Diolch yn Fawr For further information please visit our research website www.incredible-years-wales-research.bangor.ac.uk or Email j.hutchings@bangor.ac.uk