UCD Geary Institute,
Institiúid Geary UCD,
University College Dublin,
An Coláiste Ollscoile, Baile Átha Cliath,
Belfield, Dublin 4, Ireland
Belfield, Baile Átha Cliath 4, Eire
T +353 1 716 4637
www.ucd.ie/geary
F +353 1 716 1108
E-mail: geary@ucd.ie
EVALUATION OF
THE OVERALL SUCCESS AND IMPACT OF
READY, STEADY, GROW
FOR
YOUNGBALLYMUN
Appendices
UCD GEARY INSTITUTE
&
UCD SCHOOL OF PSYCHOLOGY
July 2013
Contents
APPENDIX A:
READY, STEADY, GROW SERVICE DESIGN AND IMPLEMENTATION ............................................... 3
TIMELINES ............................................................................................................................................................. 3
A.1
A.2
KEY MILESTONES IN THE READY, STEADY, GROW SERVICE DESIGN...................................................................... 3
KEY READY, STEADY, GROW IMPLEMENTATION ACTIVITIES ............................................................................... 4
APPENDIX B:
READY, STEADY, GROW LOGIC MODEL ......................................................................................... 9
APPENDIX C:
READY, STEADY, GROW IMPLEMENTATION PLAN ....................................................................... 10
APPENDIX D:
FURTHER INFORMATION ON THE PCPS ....................................................................................... 22
D.1
D.2
PCPS VISITS........................................................................................................................................... 22
REFERRALS TO COMMUNITY-BASED SERVICES ................................................................................................ 22
APPENDIX E:
E.1
E.2
CRITERIA FOR IDENTIFYING SIMILAR PROGRAMMES ........................................................................................ 24
DESCRIPTIVE INFORMATION ON SIMILAR PROGRAMMES .................................................................................. 26
APPENDIX F:
F.1:
F.2
FURTHER INFORMATION ON SIMILAR PROGRAMMES ................................................................ 24
TECHNICAL AND STATISTICAL TERMINOLOGY ............................................................................. 28
PERMUTATION TESTING............................................................................................................................ 28
READING STATISTICAL TABLES .................................................................................................................... 29
APPENDIX G:
FURTHER INFORMATION ON ETHICAL APPROVAL AND CASE STUDY .......................................... 31
DESIGN ................................................................................................................................................................ 31
G.1
G.2
ETHICAL APPROVAL ................................................................................................................................. 31
CASE STUDIES ......................................................................................................................................... 31
APPENDIX H:
FURTHER METHODOLOGICAL INFORMATION ON STAKEHOLDER ............................................... 32
INTERVIEWS......................................................................................................................................................... 32
H.1
H.2
H.3
H.4
H.5
H.6
STAKEHOLDER INTERVIEWS METHOD .......................................................................................................... 32
DEVELOPMENT OF INTERVIEW SCHEDULES ................................................................................................... 32
SAMPLING ............................................................................................................................................. 32
PILOT STUDY .......................................................................................................................................... 33
STAKEHOLDER INTERVIEW PROTOCOL ......................................................................................................... 33
STAKEHOLDER INTERVIEW ANALYSIS PROCEDURE .......................................................................................... 33
APPENDIX I:
I.1
I.2
SCHEDULE FOR CAPACITY BUILDING INTERVIEWS ............................................................................................ 35
COLLABORATION INTERVIEW SCHEDULE ...................................................................................................... 38
APPENDIX J:
J.1
J.2
J.3
APPENDIX L
FURTHER METHODOLOGICAL INFORMATION ON STAKEHOLDER SURVEYS ................................ 42
STAKEHOLDER SURVEY METHOD ................................................................................................................ 42
STAKEHOLDER SURVEY SAMPLING .............................................................................................................. 42
SURVEY INSTRUMENT DEVELOPMENT ......................................................................................................... 42
APPENDIX K:
Part 5
STAKEHOLDER INTERVIEW SCHEDULES ....................................................................................... 35
SURVEY DESCRIPTION AND SOURCES ........................................................................................ 44
45
STAKEHOLDER SURVEYS ............................................................................................................ 47
i
L.1
L.2
SURVEY DISTRIBUTED FEBRUARY 2012........................................................................................................ 47
SURVEY DISTRIBUTED IN OCTOBER 2012 ..................................................................................................... 58
APPENDIX M:
STAKEHOLDER SURVEY RESULTS............................................................................................. 72
APPENDIX N:
PCPS INSTRUMENTS ............................................................................................................... 91
N.1
N.2
N.3
N.4
N.5
PARENTING STRESS INDEX ........................................................................................................................ 91
PARENTING SENSE OF COMPETENCE ........................................................................................................... 91
STRANGE SITUATION PROCEDURE .............................................................................................................. 92
EARLY CHILD MOTHER INTERACTION CODING SYSTEM (CITMI-R) ................................................................... 93
MANUAL OF DEVELOPMENTAL DIAGNOSIS – GESELL DEVELOPMENTAL SCHEDULES: ............................................ 93
APPENDIX O:
ANALYSIS OF PCPS OUTCOMES DATA ..................................................................................... 94
APPENDIX P:
PCPS OUTCOMES COMPARISON ANALYSIS ............................................................................. 95
APPENDIX Q :
BASELINE CHARACTERISTICS COMPARISON ............................................................................ 96
APPENDIX R:
PFL COMPARISON ANALYSES ................................................................................................... 97
APPENDIX S:
ADDITIONAL COMPARISON ANALYSES: PCPS TREATMENT GROUP VERSUS PCPS
COMPARISON GROUP ........................................................................................................................................ 100
APPENDIX T:
SURVEY WITH NON-PARTICIPANTS ........................................................................................ 106
APPENDIX U:
ENGAGEMENT AND ATTRITION ANALYSES VARIABLES ......................................................... 114
APPENDIX V:
ADDITIONAL TABLES FOR ANALYSES OF PSPCP OUTCOMES ................................................... 115
APPENDIX W:
ADDITIONAL ENGAGEMENT AND ATTRITION ANALYSES ...................................................... 129
APPENDIX X:
FICTIONAL CASE AND SOURCES ............................................................................................ 137
ii
Appendix A:
Timelines
A.1
2006
2007
Ready, Steady, Grow Service Design and Implementation
Key Milestones in the Ready, Steady, Grow Service Design
September
youngballymun formally launched
October
The Community Mothers Programme and a Prenatal Parent Support Programme
(based on Nurse Family Partnership model) recommended for implementation
in youngballymun’s Strategy Submission to OMCYA & AP
January
Community Mothers – opt not to go into partnership with youngballymun
youngballymun undertake a literature review to identify proven models of
antenatal and parent support for parents of 0 – 2 year olds
youngballymun undertakes a mapping exercise of existing services for parents of
0-2 year olds
September
The Antenatal and Parent Support Service Design Teams (SDT) established
DCU School of Nursing contracted to undertake a local needs and resource
assessment.
youngballymun carries out focus groups to inform service design
2008
November
DCU present the findings of an Audit and Needs Assessment to the SDT
December
SDT identified the Infant Mental Health Model as a possible approach
January
youngballymun representatives visit Infant Mental Health Specialists in Cork
HSE
Contact made with Michigan Association of Infant Mental Health & Dr. Deborah
Weatherston
March
Draft strategic plan developed and presented to the Board – amalgamating
Antenatal and Parent Support Services to form on service
April
Input from Tallaght PCPS staff at SDT
May
youngballymun representatives visits Tallaght PCPS site.
3
July
Contact made with Professor Cerezo PCPS programme developer
Negotiations commence with PHN Management to explore integration of PSPCP
with PHN service
2009
October
SDT meet to review Antenatal Stand of work
November
Service renamed Ready, Steady, Grow
January
Redevelopment of Ballymun East Community Centre (for location of PCPS)
commences
Contract with Professor Cerezo to deliver PCPS Training and provide ongoing
implementation support for PCPS
Professor Cerezo meeting with PHN team / presents of PCPS
2009
April
Initial contract signed with Ballymun Home Support to recruit & appoint RSG
Administrator & PCPS Coordinator
May
16 day Training of Ballymun Staff in PCPS commences (delivered by Professor
Cerezo)
June
RSG Administrator takes up post (via Ballymun Home Support)
August
PCPS Coordinator takes up post (via HSE)
SLT with the HSE, takes up position as Speech and Language therapist working
across the services for 0-5’s
July
A.2
2009
Ready, Steady, Grow Implementation Team (IT) established
Key Ready, Steady, Grow Implementation Activities
July
Ready, Steady, Grow Implementation Team (IT) established
October
Hanen You Make the Difference® (6 week staff training course for ECCE
practitioners)
November
Introduction to Infant Mental Health Workshop
4
December
PCPS opens in Ballymun
Formal launch of Ready Steady, Grow at youngballymun - A Child is Born
Conference
Infant Mental Health and Child Development Master Class 1
Enhanced Community Based Ante-Natal Service Working Group established by IT
2010
January
Infant Mental Health Master Classes by Dr Deborah Weatherston, for
practitioners/policy makers2 and parents
February
Ante-Natal Working Group meet
March
Integrated Team Building through Dialogue with RSG team
Ante-Natal Working Group Meet
June
Integrated Team Building through Dialogue with RSG team
August
Preparing for Parenthood Coordinator (PPC) takes up post
Advisory Group established to inform on the 1st 6 months of PPC work
Infant Mental Health Mentor takes up post
September
Hanen You Make the Difference® (6 week staff training course)3 commences
Follow-up Dialogue event with Ready, Steady, Grow
October
Hanen You Make the Difference® 9 week parent education programme4
commences
Ante-Natal Course commences (PPC & PCT) (4 sessions)
2011
December
Infant Mental Health Lunchtime Lecture : IMH Mentor
January
Infant Mental Health Training ‘A Safe Harbour from Stormy Seas; Supporting the
Master classes included presentations on ‘Developing reflection on Infant Mental Health Practice’ by Rochelle Matacz and
Catherine Maguire (Cork HSE), ‘Infant Brain Development’ by Professor Stuart Shanker, Distinguished Research Professor
, York University Candan, and ‘Social emotional development’ by Professor Cerezo.
2 Title –‘ Keeping the baby in mind in youngballymun. The importance of the early years: building a foundation for social
and emotional health’ topics covered include principles & practice of Infant Mental Health, and relationships matter to the
promotion of Infant Mental Health.
3 For staff members from across 3 agencies that provide home visiting to parents and young children as part of their service
(Ballymun Home Support Service, Lifestart, and Community Mothers).
4 At Geraldstown House. Participants are parents who either previously attended PCPSP or whose children are on the HSE
community SLT caseload. Programme delivered by RSG and HSE SLT.
1
5
Ballymun Home Support Team’ commences (4 sessions)
February
Pilot Baby Massage (PPC)
Ante-Natal Course commences (6 sessions)
Hanen You Make the Difference® parent programme commences
2011
March
Infant Mental Health Clinical Training :Supporting First Relationships (6 sessions)
Baby Massage (5 week course) commences
May
Antenatal Service Provider meeting convened
Ante-Natal Course commences (6 sessions)
June
0-3 Service Integration Coordinator (PHN role)
UCD awarded contract to evaluation RSG
youngballymun convenes Infant Mental Health Working Group
July
Baby Massage (5 week course) commences
September
Infant Mental Health Training: Foster Parent Training (2 sessions)5
Baby Ballymun6
Baby Massage (5 week course) commences
Ante-Natal course commences (5 sessions)
Hanen - You Make the Difference® parent programme commences
October
youngballymun hosts the 1st National Infant Mental Health Practice and Policy
Forum
Baby Massage (5 week course) commences
Hanen - You Make the Difference® parent programme commences
November
Pregnancy Yoga (PPC) commences
Marian O’Flynn & Bonnie Daligga
‘Baby Ballymun’ took place on Tuesday 20th September from 9.30 – 1pm in Axis, the morning included: information from
RSG; PHN’s; Community Mothers; 345 on choosing quality preschool; Oral Health; Citizens Advice; Primary Care Team.
There were a number of activities: developmental play ran by Lifestart; information workshops on nutrition and talking with
your baby; messy play; a parent and baby café; and photograph opportunity.
5
6
6
Baby Massage (5 week course) commences
2012
January
Baby Ballymun (Sleep workshop)
Baby First Aid Workshop
Baby Massage (5 week course) commences
Hanen - You Make the Difference® parent programme commences
Talk & Play (2 sessions)
Infant Mental Health Training: Supports for strengthening families (4 sessions)
February
Baby Ballymun: Feeding your baby/toddler Workshop
Talk & Play (4 sessions)
Ante-Natal course commences (5 sessions)
Hanen - You Make the Difference® parent programme commences
March
Baby Ballymun: Toddler behaviour workshop
Baby Massage (5 week course) commences
Talk & Play (3sessions)
2012
Infant Mental Health Training: Infant Toddler Emotional regulation
PCPS Coordination Post ends – she takes up Integrated Service Support post
IMH Working Group ends with finalisation of the document A Good Start is Half
the Work
April
Baby Ballymun: Baby Blues Workshop
Baby Massage (5 week course) commences
Hanen - You Make the Difference® parent programme commences
Infant Mental Health Workshop; Post natal depression7
Infant Mental Health Mentor post ends ongoing consultancy arrangement with
Mentor
May
Hanen - You Make the Difference® parent programme commences
June
Ante-Natal course in the RECO commences (5 sessions)
7
Understanding and working with babies and mums with postnatal depression Workshop co-delivered by HIM Mentor &
HSE Senior Psychologist
7
Baby Massage (5 week course) in Women’s Resource Centre commences
July
Baby Massage (5 week course) commences
August
Baby Massage (5 week course) commences
September
Baby Ballymun: Feeding your baby/ toddler Workshop
Hanen - You Make the Difference® parent programme commences
Pilot of Incredible Years Toddler Programme commences8
Externally facilitated review of PCPS9
PPC located in BRYR10
October
Baby Ballymun: Sleeping workshop
Ante-Natal Course commences (5 sessions)
RSG Infant Mental Health Strategy presented at Institute of Public Health Open
Conference, Belfast
November
Baby Ballymun: Toddler Behavour workshop
Infant Mental Health Workshop with Debbie Weatherston:
8
Expansion of follow on parent-child support services post PCPSP through the introduction of the Incredible Years Parent
and Toddler programme (IYTP). Fifteen parents recruited for the pilot ITYP starting mid September. The programme is codelivered by a CAFTA trained facilitator (part of the youngballymun Incredible Years team) and Mary Fanning in her role as
Integrated Service Support
9 Involved 5 members of the Public Health Nurse Team and Assistant Director of Public Health Nursing; youngballymun’s
RSG team and Programme Manager; and the PCPS Programme Developer. The review was very successful and reaffirmed
the joint commitment to the programme. Key areas for attention were identified: engaging with vulnerable families;
communication – both internal and external; promotion of the programme; and specific practice related areas.
10 Location of the Preparation for Parenthood Coordinator in Ballymun Regional Youth Resource (BRYR) to work
collaboratively with What’s Up? (youngballymun’s youth mental health strategy) and to strengthen the supports available to
young parents in the community.
8
Appendix B:
Ready, Steady, Grow Logic Model
9
Appendix C:
Ready, Steady, Grow Implementation Plan
10
11
12
13
14
15
16
17
18
19
20
21
Appendix D:
D.1
Further Information on the PCPS
PCPS visits
The PCPS visits occur when the infant is 3, 5, 7, 12, 15, and 18 months of age. Although these ages
are the optimum times for each visit, the programme design allows for boundaries around each age
within which the assigned visit can take place. These boundaries are displayed in Table D.1.
Table D.1 Age boundaries for PCPS visits
Month of visit
Age boundary in weeks
3 (13 wks)
10-19
5 (22 wks)
20-32
7 (30 wks)
33-42
12 (52 wks)
48-63
18 (78 wks)
74-86
If an infant starts the programme late (for example, he/she moves into the area at five months and
therefore misses the initial three month visit), he or she can still enter the programme at the next
visit that best suits his or her age.
D.2
Referrals to community-based services
RSG liaises with a number of community-based services and these are listed below.
1. Accord
2. Adult Read and Write Scheme
3. Assessment and Intervention Team
4. Assessment of Need
5. Audiology
6. Baby Massage
7. Ballymun Home Support
8. Ballymun Regional Youth Resource
9. Community and Family Training Agency
10. Community Counselling Service
22
11. Community Mental Health Nurse
12. Community Psychology
13. Creche
14. Dietician
15. Drop in Well Mother and Toddler Group
16. Drop in Well 0-12 Months Mother and Baby Group
17. General Community Information
18. Geraldstown House
19. GP
20. Incredible Years School Programme
21. Incredible Years Toddle Programmes
22. Job Centre
23. Mater Child and Adolescent Mental Health Service
24. Mediation Services
25. Mindfulness - HSE
26. Money Advice and Budgeting Service
27. Ophthalmology
28. Parent Programme
29. Parent Workshops (sleeping, feeding, toddler behaviour, baby blues, baby first aid)
30. Physiotherapy
31. Primary Care Adult Psychology
32. Primary Care Child Psychology Referral
33. Public Health Nurse
34. Social Work
35. Speech and Language Therapy
36. Stop Stress – HSE
37. Talk and Play
38. You Make the Difference
39. Young Mothers Group – Women’s Resource Centre
23
Appendix E:
E.1
Further Information on Similar Programmes
Criteria for identifying similar programmes
A literature review was conducted to identify and examine the effectiveness of programmes which
were similar to the PCPS. The main criteria for determining whether or not a programme was similar
to PCPS were:
•
Programme age range includes infants/toddlers aged 0-36 months
While the PCPS specifically targets children aged 0-18 months, many other programmes that
start at or shortly after birth continue until the child is 36 months old. Thus, we have
included these programmes in our review. We specifically examine their provision for
children up to the age of 18 months.
•
Programme targets both parents and children and examines similar outcomes to the PCPS
The PCPS targets child development and parenting outcomes, therefore it is important to
identify similar programmes with comparable outcomes. Early intervention programmes
which target both parents and children generally fall into three broad categories:
psychoanalytical, cognitive and socio-emotional developmental, and programmes for the
assessment and monitoring of mental/physical health. Programme which target parents
differ and can include basic parenting advice on nutrition, child health and discipline, as well
as providing direct support to the parents themselves. The psychoanalytical and
mental/physical health programmes are generally centre-based, while the cognitive and
socio-emotional developmental programmes tend to be either centre or home-based, or
both. The PCPS falls into both the second and third categories: it has both cognitive and
socio-emotional developmental and mental/physical health screening components. While it
is not a psychoanalytical programme, it does have a psychological support component, and
the D Station is often facilitated by a psychotherapist. Thus, the review includes programmes
which target all three dimensions.
•
Programme is suitable for use in an area of disadvantage, broadly comparable to Ballymun
The focus of PCPS is preventive rather than reactive. The PCPS’s sister programme in Spain
was initially designed to provide additional developmental support and assessments for
children who were at-risk of maltreatment. While all infants born within the Ballymun
catchment area are eligible to take part in the PCPS, it is particularly applicable to those in
low-income areas where the children are at increased risk of developmental delay compared
to their higher socio-economic status counterparts. One of the goals of the programme is to
identify any potential physical or emotional developmental difficulties the child may be
experiencing. These difficulties, if identified, are generally not addressed directly by the
programme, instead the children are referred to other services and, if required, receive
ongoing, intensive monitoring via the PCPS’s monthly meetings. In contrast, most centrebased early intervention programmes that target the same age-group as the PCPS are aimed
24
at children who have already been identified as having some form of developmental delay or
disadvantage. Thus, the review largely includes targeted programmes.
•
Programme is administered by trained professionals or para-professionals
The PCPS is delivered by professionals (nurses, speech and language therapists,
psychologists) who have been specially trained to administer the programme. Some widescale parent and child programmes, particularly those with a home-visiting component, are
delivered by trained para-professionals (e.g. the Parent-Child Home Programme). These may
be local people who have a wealth of knowledge about the community and its culture, but
no professional training. As these programmes are similar in design to the PCPS, we have
elected to include them in our review, but we highlight when para-professionals are used
instead of professionals.
•
Programme is either home-based, centre-based or a combination of both
Early intervention programmes are usually either centre-based, home-based or occasionally
both. Centre-based programmes are more likely to be delivered by professionals, yet tend to
target an older age-group. There are a plethora of home-visiting programmes which are
preventive in nature, target the 0-18 month age group, and work with both mother and
child. Therefore we have chosen to include home visiting programmes in our review of the
literature.
Note: Researchers are frequently interested in the long-term effects of early intervention
programmes, and as a result, programmes which operated several decades ago continue to
be studied today such that the long-term outcomes can be monitored. The Nurse-Family
Partnership is one such example. Therefore, some of the programmes presented included in
the review may have operated a number of years ago, or may have only been implemented
in pilot form, but are still considered relevant to the present evaluation.
25
E.2
Descriptive information on similar programmes
Programmes comparable to PCPS
Programme/
Intervention
Early Head
Start
Target
Population
Low-income
families
Age of
Children
0-36 months
Delivery Type
Florida Infant
Mental Health
Pilot
Children at
risk of out of
home
placement
because of
abuse and/or
neglect
0-36 months
Centre based
with some
home visits
Brookline
Early
Education
Project
All families in
the
community
3 months
before birth Kindergarten
Centre based
with home
visits
Health, educational, and
social services for parents
and children including home
visits, parent groups,
playgroup and prekindergarten, and health
and developmental
monitoring.
Infant Health
Premature
0-36 months
Centre based
Educational and family
Centre based,
home visiting
and
combination
of both
Intervention Components
and Duration
Home visiting programmes:
Home visits to support child
development and parentchild relationship. Bimonthly group sessions to
provide opportunities for
learning, discussion and
social activity
Centre programmes:
Care and education and
home visits twice per year
25 sessions of dyadic
therapy including referral to
additional services where
necessary
Outcomes
Evidence Base
References
Better child cognition, language,
and socio-emotional
development.
Parent provided more emotional
and learning support, less likely
to use negative parenting
strategies.
Randomised
control trial
Love et al., 2002.
Reduction in reports of
abuse/neglect. Improvement in
health and developmental status
of children and parent child
relationship. Improvement in
parental responsiveness and
decrease in intrusive behaviours.
Decrease in reports of caregiver
depression.
At elementary and second grade:
Dose related positive effects for
children’s social development
and learning skills and strategies.
Fewer children exhibiting social
or learning difficulties.
At 25 year follow up:
Superior educational attainment,
income, health and well-being.
Programme effects for cognition
Pre-post
design
Adams, Osofsky,
Hammer, & Graham,
2003.
Quasiexperimental
design
Hauser-Cram, Pierson,
Walker, & Tivnan, 1991
as cited in Palfrey et
al., 2005.
Pierson et al., 1983.
Bronson, Pierson, &
Tivnan, 1984.
Palfrey et al., 2005.
Randomised
Brooks-Gunn,
26
and
Development
Programme
infants
with home
visits
support services as well as
high quality paediatric
follow up and referral.
The Video
Feedback
Intervention
to Promote
Positive
Parenting
First-time
mothers with
insecure
attachment
styles
7-10 months
Home visits
First-time,
low-income
mothers
0-24 months
Home visits
High and low treatment
groups: Educational
feedback on mother-infant
interaction. Information on
sensitive parenting.
High treatment group only:
Discussions about early
attachment experiences.
Weekly or twice weekly
home visits by specially
trained nurses
Nurse Family
Partnership
Parent Child
Home
Program
Low-income
families
18-36 months
Home visits
Twice weekly visits by
trained para-professionals
and behaviour at 36 months.
Only heavier low birth weight
children showed sustained
cognitive gains at an 8 year follow
up.
Higher maternal sensitivity. No
differences in attachment
security.
control trial
Klebanov, Liaw, &
Spiker, 1993.
McCarton et al., 1997.
Randomised
control trial
Klein Velderman,
BakermansKranenburg, Juffer, &
van IJzendoorn, 2006.
Reductions in child health and
developmental problems,
including accidents/injuries. Long
term gains in both child and
maternal outcomes including
maternal employment and school
readiness.
Increased school readiness,
including IQ scores and receptive
language and a reduction in the
need for special education classes
in programme graduates. Higher
rates of graduation amongst 2
year program graduates, which
were comparable with middle
class peers and higher than socioeconomic peers
Randomised
control trial
Kitzman, et al., 1997;.
Olds, Henderson,
Tatelbaum &
Chamberlin, 1986.
Olds et al., 2002.
Randomised
control trial
Levenstein, 1970.
Lazar & Darlington,
1982.
Levenstein, Levenstein,
Shiminski, & Stolzberg,
1998.
27
Appendix F:
F.1:
Technical and Statistical Terminology
Permutation testing
Permutation tests (with 1,000 replications) were used to test for significant differences in
characteristics between the two groups. Classical statistical tests rely on the assumption that sample
sizes are large, and produce inferences based on p-values that are only valid for large samples. These
tests can be unreliable when the sample size is small. As the sample size of the PCPS evaluation is
relatively small, the analyses presented here used an alternative approach called permutation-based
hypothesis testing, which was developed by Heckman and colleagues (2010).
28
F.2
Reading statistical tables
A number of different statistical methods were used in the evaluation. This table provides
information on these tests which aid the interpretation of the tables provided in the report.
N
‘N’ indicates the number of people who are included in the analysis.
n
‘n’ indicates the number of people in individual groups.
M
‘M’ indicates the mean. It is the arithmetic average of all values.
SD
‘SD’ indicates the standard deviation. It represents the average distance of a set
of scores from the mean or average score.
Md
‘Md’ indicates the median. The middle value is in a ranked distribution of values,
calculated by seeing which value has an equal number of cases above and below
it.
IQR
‘IQR’ is the interquartile range and represents the range for the middle 50% of
values in a rank-ordered distribution.
t
‘t’ is the test statistic which compares the mean differences between two groups
on an interval- or ratio-level dependent variable.
p
‘p’ indicates the significance level of the p-value. A p-value represents the
probability that a test statistic is significantly different from the null hypothesis. It
shows how likely it is that a treatment group is significantly different from a
control group.
p<.01, p<.05
‘p<.01’ and ‘p<.05’ indicate that the test is statistically significant at the 1%, and
5% level respectively.
ns
‘ns’ indicates the variable is not statistically significant. Statistical significance is
given when the probability that the null hypothesis is true is low enough to reject
the null hypothesis as a plausible explanation for the relationship observed in a
sample.
Z
‘Z’ indicates the test statistic for the Wilcoxon signed-rank test. The Z-Store
represents how many standard deviation intervals a value falls above or below
the mean.
χ2
‘χ2’ indicates the test statistic for the Friedman test. It assesses the probability
that sampling error explains the relationships you observe between nominallevel variables displayed in cross-tabulation tables.
Q
‘Q’ indicates the test statistic for the Cochran test.
Friedman χ2
The ‘Friedman’-Test is a non-parametric test for comparing more than two
related samples.
29
Cochran Q
F
‘Cochran Q’ Test is a nonparametric test examining change in a dichotomous
variable across more than two observations.
The ‘F’-value is a continuous probability distribution of the ratio of two
independent random variables.
2
Eta squared
) is a measure of the magnitude of effect. It can be defined as
the proportion of variance associated with or accounted for by each of the main
effects, interactions, and error in an ANOVA study.
DQ
‘DQ’ defines the development quotient and represents the numeric expression of
a child's developmental level as measured by dividing the developmental age by
the chronologic age and multiplying by 100.
30
Appendix G:
Design
G.1
Further Information on Ethical Approval and Case Study
Ethical approval
A detailed ethical submission to conduct this study was compiled by the research team and
approved by the UCD Human Research Ethics Committee: Humanities Subcommittee in May 2011
(Research Ethics Reference Number [RERN]: HS-12-33-Doyle). The requirements of the UCD Human
Research Ethics Committee, the Data Protection Acts (1988 and 2003) and the Statistics Act (1993)
were fully met in the process evaluation study. Ethical approval was sought and obtained for each
individual element of the study as required (RERN: HS-E-11-135-Guerin: professionals’ interviews;
HS-E-12-07-Guerin: professionals’ survey; HS-12-122-Guerin, case studies). Ethical approval was also
sought for the non-participants’ survey of the programme evaluation (HS-12-33 Doyle). An
exemption from ethics approval was received for the evaluation of the PCPS (RERN: HS-E-11-131-
Doyle-Guerin). Separate ethical approval was not required for the other elements of the
programme evaluation.
G.2
Case studies
A detailed case study was designed to facilitate a more in-depth understanding of how RSG
promotes IMH principles and practices into the existing service structures in Ballymun. The aim of
the case study was to further inform our understanding of capacity building, collaboration and early
identification and intervention in RSG through the lens of four families by exploring their experiences
of RSG and its links with local service organisations. Findings from the stakeholder interviews and
surveys suggested that organisations differed in their level of engagement with RSG, and the case
studies were designed to investigate this variability, and its potential effects on capacity building,
collaboration and early identification. The case studies were designed to draw on multiple
stakeholders’ perspectives as well as referral records, incorporating the experiences of each family,
the relevant key RSG staff member and the key referral organisation staff member. A number of
families were randomly selected through a complex sampling process and were invited to participate
in the case studies, however the response rate was unfortunately very low, and to proceed with the
study could potentially have compromised the anonymity of the case families. Therefore the
research team, guided by the ethical guidelines set out by UCD’s Human Research Ethics Committee
and in agreement with youngballymun, elected not to proceed with the case studies.
31
Appendix H:
Interviews
H.1
Further Methodological Information on Stakeholder
Stakeholder Interviews Method
Two separate semi-structured interview schedules were developed for the process evaluation. They
were based on the literature reviews and examined the areas of capacity building and collaboration
respectively. Both schedules also contained a question about early identification and intervention.
The aim of the interviews was to conduct an initial investigation into these areas with a small group
of service delivery staff in Ballymun, using open-ended research techniques to allow for the
emergence of new themes, while also targeting the specific issues identified in the literature on
capacity building and collaboration. Once the interview transcripts had been analysed, the findings
were used to inform the development of a self-completed survey, to be administered at two time
points to professionals working in the Ballymun area.
H.2
Development of Interview Schedules
The interview schedules were developed using the models from contemporary literature on capacity
building (Brown et al., 2001; Crisp et al., 2000) and collaboration (Ahgren, et al., 2009) described in
the literature reviews. Capacity building was examined through a systems framework at individual,
personnel and organisational level (Brown et al., 2001). There is an element of conceptual overlap
between the areas of capacity building and collaboration, but in order to ensure that as much
information as possible was gathered from the qualitative interviews, the research team designed
two separate interview schedules, one to measure capacity building, thus addressing research
question a, and one to measure collaboration, addressing research question b. Questions on early
identification and intervention were included in both interview schedules so that research question
c) was addressed with both the capacity building and the collaboration interview participants.
H.3
Sampling
The sample of 30 potential interview participants was drawn from a group of 48 local stakeholders
who had attended the IMH training programme provided by youngballymun. The list comprised 10
professionals who were not regularly engaged in local direct service delivery with infants (e.g.
programme co-ordinators, adult mental health professionals), 11 professional direct service delivery
practitioners working regularly with infants (e.g. public health nurses, speech therapists), and 27
paraprofessional service delivery personnel (all local home support workers). Ten participants were
selected randomly from the latter two groups to minimise the potential for bias. Within each of the
three groups of ten, participants were then randomly allocated to either the capacity building or
collaboration interview. This resulted in a final, invited sample of 15 capacity building and 15
collaboration interviews.
Once the sampling frame had been developed, the researchers made initial contact with each
potential participant via email, introducing them to the research and explaining that they had been
selected to take part in an interview for the evaluation, and that they would be contacted about
their participation in the near future. Once this initial contact had been made, the researchers began
scheduling the interviews with those who had not opted-out. Each participant was contacted via
32
telephone to schedule an interview and to obtain informed verbal consent. After this, an interview
pack was sent via post to each participant. Each pack contained a detailed letter explaining the study
and its rationale, an interview topic sheet and consent form. Participants were asked to read this
information in advance and bring the consent form to the interview.
H.4
Pilot Study
The research team conducted pre-pilot interviews with each other to ensure congruence of
interviewing styles before formally piloting the research instruments. Interview schedules were then
piloted with two participants, both of whom had a strong interest in IMH and a good understanding
of the RSG programme. These participants took part in both the capacity building and collaboration
interviews. Their comments, observations, and reactions to the interviews were noted, and minor
changes were made to each interview schedule as a result. Once the interview schedules had been
finalised, the main body of interviews commenced. These interviews took place over the course of
two months from October to December 2011.
H.5
Stakeholder Interview Protocol
Participants were given the option of completing the interviews in their place of work or in a
meeting room provided by RSG in the Axis Centre in Ballymun. In cases where neither was possible,
the option of a telephone interview was offered. Interviewees were asked to read the information
sheet and to read and sign the consent form in advance of the interviews. Upon arrival at the
interview venue, the researchers had a brief discussion with each participant to ensure that they had
read and understood the information sheet, and invited participants to share any queries or
concerns they may have had about the interviews. Once the researcher was satisfied that the
participant was fully informed and had signed the consent sheet, the interview commenced.
Interviews were recorded on a digital voice recorder and typically lasted approximately 45 minutes,
but ranged from 20 minutes to 90 minutes. During the interview process, researchers used
techniques to ensure that participants’ views were being accurately captured. Participants’
responses were summarised and reflected back to the participant ensure that they had been
correctly understood by the researcher, and a summary of main points was checked at the end
providing an opportunity for the interviewee to clarify any points. Participants were systematically
debriefed after each interview: each participant received a debriefing sheet which included the
project co-ordinator’s contact details should they have any questions or suggestions afterwards. Two
participants requested a transcript from their interview and were provided with a fully anonymised
document via email.
H.6
Stakeholder Interview Analysis Procedure
All interviews were transcribed and anonymised using the Irish Qualitative Data Archive
anonymisation guidelines (2008) before being uploaded to the Nvivo 9 qualitative data analysis
package for analysis. Each transcript was analysed thematically using a combination of inductive and
deductive techniques, which allowed for the generation of new themes from each interview as well
as the identification of themes present in the research literature. As there is a strong degree of
overlap between the areas of capacity building and collaboration, the deductive analysis of each
interview was informed by the literature review of both of these areas to ensure that all relevant
data was highlighted, regardless of which interview schedule generated the data.
33
Data analysis was conducted initially by two researchers, who divided up the 23 transcripts and
began analysing them separately using one developing coding framework. Using the first transcript
as a template (Smith & Dunworth, 2003), the researchers examined this transcript and assigned
“codes” to the topics under discussion as they arose in the course of the typed interview. Each code
represented a small chunk of the transcript which was seen to have meaning to the topics under
examination (Boyatzis, 1998, cited in Braun & Clarke, 2006). Once the initial transcript had been
coded in this way, the researchers proceeded to code the other transcripts using the first transcript
as a template. To ensure quality and rigour of coding, inter-rater reliability was assessed during this
initial coding stage. Both researchers analysed one transcript. There was a high level of agreement
between the coders, and when researchers disagreed on coding, this was discussed until agreement
was reached. After initial coding stage, one researcher then worked towards completing the
thematic analysis. In keeping with Braun and Clarke’s method of thematic analysis, as more
transcripts were coded, they had an influence on the codes themselves, which were edited and
refined accordingly. Wider themes began to emerge at this stage, and the researchers began to
house each code within a more structured and defined framework of meaningful themes. As the
database of analysed transcripts grew, the themes began to take on a more specific shape. For
example, some codes, initially deemed important in their own right, were removed and recategorised under different themed headings. Others were discarded, and others which had initially
seemed of little relevance began to assume more meaning in the context of other codes and themes
as the analytical process progressed. Once all data had been coded and the framework of themes
had been created, the researchers re-examined all of the transcripts, codes and themes in order to
further “define and refine” (Braun & Clarke, 2006: p.92) the data and themes into a more
meaningful, coherent pattern which gave a fair and comprehensive overall view of the full dataset.
34
Appendix I:
I.1
Stakeholder Interview Schedules
Schedule for capacity building interviews
Part 1: Individual Role



What is your current role in relation to the infant mental health aspect of RSG?
How long have you been in this role?
Can you give a brief overview of your day to day work?
o What direct service skills are necessary to do your job?
o What personal skills are necessary to do your job?
o Do you work alone or as part of a team?
 If part of a team, how does that team typically operate? (common office,
regular meetings, phone contact, etc)
Part 2: RSG


Are you aware of RSG having a defined strategy in relation to IMH?
Do you feel that you have been given the resources required to carry out your role
effectively in relation to the IMH function of RSG (skills, opportunities, local and systemic
knowledge, funding) ?
o If not, what would help you to improve?
 Do you feel that the IMH needs of the end users of your service are being met?
o How is this being done? Can you give examples?
o How do you think the service could be improved?
o Are you aware of any quality control measures monitoring the effectiveness of
service delivery re IMH in RSG?
 What are they?
o Do you meet many end users from different cultures within your role?
 Is there any facility within your role for dealing with issues which may arise
as a result of cultural differences among service users?
 How do you think your role fits within the overall IMH function of RSG?
 Do you feel you have an influence on the way in which RSG is operated?
 Do you feel that there is adequate funding in place in order for RSG to build IMH capacity?
Part 3: Capacity Building




What is your understanding of the term “capacity building” in reference to IMH?
Are you aware of any capacity building function of RSG?
o Can you tell us about it?
o How often does it arise in your day to day work (LS)?
o Do you think it’s working (LS)?
 Why/why not?
Do you actively seek to develop IMH capacity in Ballymun within your role (LS)?
o How do you do this?
o If you don’t, is something preventing you from doing this?
How do you interact with other service providers in RSG:
o At the organisational level (meetings, regular updates, etc?)
 Do you ever specifically address IMH issues with these organisations (at
organisational level)?
35


Do you take any steps to work with these providers to build IMH capacity?
If not, is anything specific preventing you from doing this? (resources, local
politics, lack of information, lack of support)
o On an individual level?
 Is there much interaction?
 Do you feel you have an open relationship with them? Are there any
difficulties?
 Do you ever specifically address IMH issues with these individuals?
 Do you take any steps to work with these people at an individual level to
build IMH capacity?
 How is this done?
 If not, is anything specific preventing you from doing this?
(resources, local politics, lack of information, lack of support?)
 Do you feel that RSG have adequate access to the following resources needed for building
IMH capacity?
 Human resources
 Financial Resources
 What do you feel would improve RSG’s ability in this regards?
Skills / Competencies

Do you feel that you have the skills and competencies necessary to carry out the work
needed in order to build IMH?
o Do you feel other people you work with have these skills needed?
Organisational Learning






Are you aware of any plans in place to assess training needs and plan to address these needs
in RSG?
To what extent do you get the opportunity to continuously learn and build upon your skills?
To what extent do you feel you get to apply new skills to the work of building IMH capacity?
Do you feel that you are encouraged and rewarded to ‘ask why’ and put forward new
improved ways of doing things?
Do you feel that suggestions and ideas are implemented when you suggest them?
Policies: What government / local council policies do you feel impact / inform the work of
RSG and IMH capacity building?
Part 4: The Wider Community


How do you feel Ballymun-based community groups are working together re IMH (LS)?
o Is there a sense of working towards a common goal?
 If not, what’s preventing this from happening?
How do you interact with local groups?
o Do you work with local group leaders?
o Are there clear roles for partnership and community leaders?
o What is the nature of your interaction with them?
o How often do you meet them or talk to them?
o Do you ever specifically address IMH issues with these leaders?
o Do you have a role in helping these leaders to develop capacity for IMH in Ballymun?
 How do you do this?
 If not, is anything specific preventing you from doing this? (resources, local
politics, lack of information, lack of support)
o In your opinion, have RSG involved disadvantaged groups in their capacity building
activities?
36
o
To what extent do you feel cultural differences are taken into account when building
capacity?
Do you think RSG contribute to a sense of community in the area?
Outcomes

To what extent do you feel the community are changing from being passive to active
participants in building IMH capacity?
 To what extent do you feel RSG are addressing the root causes of issues affecting IMH in
Ballymun?
Part 5: Prior to RSG Implementation

How were referrals in relation to IMH identified prior to RSG implementation?
o How were referrals handled?
o How were referrals recorded?
 How and to what extent have processes / ways of working changed since RSG
implementation?
Part 6: Wrapping Up
o

o
o
Do you think RSG is succeeding in its capacity building function around IMH?
o What factors could help it to improve?
What supports have been put in place, in relation to the implementation of IMH principles in
the RSG programme?
What have been the barriers to IMH principle implementation?
Is there anything else you’d like to add?
37
I.2
Collaboration Interview Schedule
Part 1: Individual Role

What is your current role in relation to the infant mental health aspect of Ready
Steady Grow?
 How long have you been in this role?
 Can you give a brief overview of your day to day work?
o What direct service skills are necessary to do your job?
o What personal skills are necessary to do your job?
o Do you work alone or as part of a team?
 If part of a team, how does that team typically operate?
(common office, regular meetings, phone contact, etc)
Part 2: RSG

What is your understanding of the term “Collaboration”?
o If interviewee is confused, offer a definition of collaboration?

Are you aware of RSG having a defined strategy in relation to Collaboration and
Integration of services in Ballymun?
 What do you believe the nature of collaborative working in relation to Ready,
Steady, Grow to be?
o How is this being done? Can you give examples?
o How do you think collaboration / integration could be improved?
o Do you think it’s working (LS)?
 What in your opinion, have Young Ballymun done to promote collaboration with
partners, services and families in the community?
 One of the aims of RSG is the provision of ante- and post-natal services for
expectant mothers. This is provided via a number of organisations working in
collaboration with each other. In your opinion, has RSG fostered the
development of partnerships between these organistions, enabling them to
work together?
o If so, how has this been done?
Part 3: Collaboration
3(a) - Inputs to Collaboration
Resources



RSG aims to promote IMH organisations in Ballymun to work together in
partnership, what extent do you feel the community partnership has
sufficient skills and expertise to fulfill its role in the community?
Is the community partnership connected to its target populations?
o If so, how?
o If not, why do you think this is?
To what extent do you feel the partnership has the ability to bring people
together for meetings and activities?
Leadership

Is leadership defined in the community partnership?
38



How would you rate the strength of leadership in the community
partnership?
How would you rate the relationship between partnership members and
leaders in relation to the following:
o respect,
o trust,
o inclusiveness
o openness
Are there opportunities for Partnership members to take leadership
roles?
Participation of Community



Do community residents participate in collaborative activities?
o Who initiates their participation? (residents, organisations, both?)
o How does it work?
How diverse is the level of participation of the community? Is it reaching a
wide variety of people in terms of ethnic/socio-economic background?
o If not, why do you think this is?
To what extent do you think the partnership makes efforts to secure
funding for community programs?
3(b) - Processes of Collaboration
Planning and Implementation


In your opinion, has RSG promoted collaborative and integrated working
in the Ballymun Community?
o If so, how have they worked with you to build collaboration?
o Have any activities taken place to track the progress of
collaboration?
 If so, what form did they take? (eg. Meetings,
communications)
 Were they successful?
In your opinion, do RSG have a clear vision and objectives for where the
community partnership is going?
Communication (External)



In your opinion, does the Partnership communicate its actions and results
with the wider community?
o To what extent does the partnership communicate how its actions
will address problems that are important to the community?
Does the partnership include the views and priorities of the people
affected by its work? If so, how?
To what extent does the Partnership use media to promote awareness of
partnerships goals / accomplishments to a wider audience?
Communication (Internal)

How would you rate communication between members of the
partnership? (LS?)
o Do you get the opportunity to express your views / opinions?
39

To what extent do you feel listened to and heard within the partnership?

For each question, can you give examples of forms of communication
used?
o What works / doesn’t work?
Learning Organisation



To what extent do you get to learn from other partnership members and
exchange ideas?
To what extent do you get the opportunity to network and chat to
members informally before/after/between meetings?
How well does the partnership identify new and creative ways of solving
problems?
Partnership Roles / Ways of working

Do you feel that both professionals and non professionals get the
opportunity for similar responsibility and decision making power within
the partnership?
 Do partnership members get the opportunity to choose the roles they
play in the partnership?
 To what extent are members aware of each others’ roles and role
boundaries?
 To what extent are individuals flexible in their approach to problem
solving?
 Does the partnership make use of the skills / knowledge of its members
to make an impact in the local community?
If so, how is this done?
Conflict

Can you think of any conflicts you have seen between individuals /
organisations as part of the collaboration process?
o How was this handled?
o What worked well?
o What did you learn?
3(c) - Intermediate Outcomes of Collaboration
Impact on Members




Do you feel the community partnership has had an impact on your work
in the community?
o If so, how has it changed?
To what extent do you feel the partnership has allowed you to advocate
more effectively?
What do you feel are the benefits to you / your organisaiton of being
involved in the community partnership?
What do you feel are the costs to you / your organisation of being
involved in the community partnership?
40

How happy are you overall with being a member of the partnership?
Impact on Community

To what extent has the community partnership given help to community
groups to address and resolve their problems?
Impact on Officials

How would you rate working relationships between elected officials and
the partnership?
Sustainability


How has the partnership identified strengths and opportunities within its
members and provided opportunities for these to be used?
To what extent do you feel ownership of the community partnership?
Overall Impact

In your opinion, how has the partnership made progress in meeting its
objectives?
o What more could be done?
Part 4: Prior to RSG Implementation


How were referrals in relation to IMH identified prior to RSG
implementation?
o How were referrals handled?
o How were referrals recorded?
How and to what extent have processes / ways of working changed since
RSG implementation?
Part 5: Wrapping Up
o
Do you think RSG is succeeding in its collaboration function around RSG (LS)?
o What factors could help it to improve?
o What do you feel are the major barriers to collaboration within the
partnership?
o
Is there anything else you’d like to add?
41
Appendix J:
J.1
Further Methodological Information on Stakeholder Surveys
Stakeholder Survey Method
The stakeholder survey was developed to examine how Ready, Steady, Grow (RSG) is building the
capacity of the service community around the prevention of young children’s health and
developmental risk, and how RSG is working in a collaborative and integrated way with partners,
services and families in the community. The stakeholder interviews investigated the perceptions of a
smaller group of professionals and service delivery staff working in the Ballymun area. The survey
was designed to examine issues which were identified as salient in the interviews, and the literature,
in a more targeted way with a larger sample. The survey was administered at two time points, in
February and October 2012.
J.2
Stakeholder Survey Sampling
The survey sampling frame was devised by youngballymun and advised on by the research team, in
accordance with the data protection guidelines set out by the UCD Human Research Ethics
Committee. The sample consisted of 118 individuals, drawn from the areas of health and social care,
who worked with parents and children in the Ballymun ABCD electoral region. In keeping with the
recommendations of Crisp, Swerissen and Duckett (2000), these participants were purposively
selected to ensure that they were representative of different organisational levels, from senior
management to frontline staff. Table J2 presents a breakdown of the target sample by profession.
Once the sample had been developed, youngballymun contacted each individual, inviting them to
opt-out of participation if they so desired. youngballymun then sent the surveys to participants who
had not opted out.
Table J2. Breakdown of target survey sample by profession
Role
N
Frontline / Support Workers
38
%
32
Supervisors / Management
12
10
Speech & Language Therapy
3
3
Social Work
6
5
Psychology
5
4
Nursing
26
22
J.3
Survey Instrument Development
The aim of the semi-structured interviews described in appendix I was to create an index of topics
which could be further investigated via the quantitative surveys. Accordingly, some of the survey
42
questions were developed to accurately reflect the most salient themes which arose during the
course of the interviews. The remaining questions were based on the themes outlined in the
literature around capacity building and collaboration and their inclusion was justified by the
interviewees as they generated a good amount of discussion and feedback. A breakdown of the
survey sections and their sources is detailed in Appendix K. Where the term “interviews” is listed as
the source, it indicates that the question was developed to address a theme that emerged from the
semi-structured interviews. Where “literature” is listed, this indicates that the question was based
on the literature review.
43
Appendix K:
K.1
Survey Description and Sources
Part 1
Part 1 of the survey explored perceptions of RSG (Source: interviews). The purpose of this
introductory section was to target participants’ understanding of RSG and its target group. It
emerged during the course of the interviews that the terms RSG, PCPS and youngballymun were
sometimes used interchangeably by some of the participants, therefore was is important when
analysing the results of the survey to ensure that all people involved with RSG were aware of how it
differed from youngballymun and from the PCPS. The third question provided an indication of the
level of involvement that the participant had with youngballymun. These questions were developed
from the themes which emerged during the interviews, namely “Confidence in youngballymun” and
“Varying levels of engagement”.
K.2
Part 2
Part 2 related to participants’ opinions on “infant mental health” (Source: interviews and literature).
This section sought to capture whether the participant learned about infant mental health before or
after youngballymun began promoting its principles via training sessions. This was based on
emergent themes from the interviews, namely “frustration about resources”, “concern about
sustainability” and “enthusiasm about infant mental health”. In the course of the interviews it
emerged that a number of people had a personal interest in infant mental health and chose to bring
it to their roles, despite the lack of any formal requirement to advance infant mental health within
the remit of their own position. Questions (e) and (f) were based on the literature around capacity
building which highlighted the importance of communication and responsive structures (Saskatoon
District Health & Labonte, 1999). The response set for (e) and (f) was derived from the
‘Responsibility Assignment Matrix’; a tool often used in organizations to determine roles and
responsibilities for groups of employees (Project Management Institute, 2010).
K.3
Part 3
Part 3 sought to examine capacity building by RSG in relation to infant mental health (IMH). It will be
outlined on a question-by-question basis:


Question 7: (Source: interviews). During the course of the interviews it emerged that
participants felt there were a number of different factors which contributed to capacity
building. In this section, the essence of those factors outlined by participants was captured in
phrases which represented the emergent themes from these interviews.
Question 8: (Source: interviews and literature). Some of the phrases used here represented
elements of the interviews, but they were also grounded in the literature. Question 8 (a)
referred directly to capacity building by RSG, examining whether participants felt that the
training provided by RSG was given to the appropriate people (Hall & Best, 1997), while (b)
refers to IMH principles as outlined by Weatherston (2000) and examines whether, on a basic
level, practitioners were working in agreement with these principles.
44



K.4
Question 9: (Source: interviews and literature). This question examined possible barriers to
capacity building, which MacLellan-Wright and colleagues (2007) claimed was an important
factor to measure in any study on capacity building. The suggested barriers were developed
from emergent themes in the interviews, namely “frustration about resources”, “concern about
sustainability”, “varying levels of engagement” “effective collaboration depends on key factors”
and “enthusiasm about infant mental health”.
Questions 10 and 11: (Source: interviews and literature). These questions examined
participants’ thoughts on and participation in specific training and events provided by RSG in
relation to IMH. This was informed by some of the emergent themes in the interviews, namely
“enthusiasm about infant mental health” and “confidence in youngballymun”, as well as the
literature around learning and training for capacity building purposes (Hall & Best, 1997; Senge,
1990; Seligman, 1990).
Questions 12 and 13: (Source: interviews and literature). Questions 12 and 13 were mostly
informed by the literature. They investigated leadership, (Goodman et al., 1998)
communication (Saskatoon District Health & Labonte, 1999) and strategising (e.g. LaFond, 1995)
by RSG from the participants’ perspective. In examining the participants’ perspectives on
aspects of how RSG operated, these questions also addressed the wider issue of participation,
as outlined by Goodman and colleagues (1998).
Part 4
 Questions 14 – 18: (Source: interviews and literature). These questions sought to investigate
whether and how RSG was targeting and engaging the appropriate community members to
participate in their programmes. This was in keeping with the research outlined in the literature
review (e.g. Bopp et al., 1999; Goodman et al., 1998; Saskatoon District Health & Labonte,
1999), which suggested that leadership and effective community engagement were key
capacity building factors. These questions were also strongly informed by the themes which
arose from the interview analysis including “confidence in youngballymun”, and “varying levels
of engagement.”
 Question 19: (Source: interviews and literature). This question examined communication
between RSG and its service users. Communication was identified as an important factor in
capacity building (e.g. Goodman et al., 1998; Hawe et al., 2000; Jackson et al., 1999; SDH &
Labonte, 1999). The points outlined in Question 19 related to forms of communication
identified by participants in the interviews, which were linked to the “varying levels of
engagement” theme.
K.5
Part 5
Part 5 investigated collaboration between RSG and partners, services and families in Ballymun.
 Question 20: (Source: interviews and literature). These questions were largely based on the
literature, as some of the finer details of collaboration which emerged in the interviews were
already covered in the previous questions on capacity building. Question 20 investigates aspects
of the collaborative process through looking at physical and conceptual resources, which were
key elements of the collaboration models outlined by D’Amour et al. (2005). As such Question
20 covered the areas of identifying need in the community and how to address this need
45

(Chrislip & Larson, 1994); establishing trust (D’Amour et al., 2005; Lind, 2001); examining levels
of engagement including meetings, knowledge sharing and general communication (Hicks et al.,
2008; Stichler, 1995), as well as participants’ thoughts on sustainability (e.g. Larson et al., 2002)
and conflict (Scott, 2005). The emergent themes from the interviews also mapped well onto
these areas: namely “concern about sustainability” and “effective collaboration depends on key
factors”. Question 20 (e) was adapted from the ‘Community Capacity Building Tool’ (MacLellanWright et al., 2007) and aimed to track location on the journey towards a sustainable system of
infant mental health practice in the community.
Question 21: (Source: interviews and literature). This question related to the area of conflict.
The presence of conflict (Scott, 2005) and how it is handled (Assael, 1969) were identified as
key factors in effective collaboration.
46
Appendix L
L.1
Stakeholder Surveys
Survey distributed February 2012
47
48
49
50
51
52
53
54
55
56
57
L.2
Survey distributed in October 2012
58
59
60
61
62
63
64
65
66
67
68
69
70
71
Appendix M:
Stakeholder Survey Results
Table M.1 Respondents’ understanding of the term RSG
Response
Another name for the Parent-Child Psychological
Support Programme
Another name for youngballymun
Umbrella Term for YB's 0-3 Years Service
Missing
%
(n)
35.0
(14)
%
(n)
33.3
(6)
12.5
(5)
47.5
(19)
5.0
(2)
0.0
(0)
66.7
(12)
0.0
(0)
Table M.2 Respondents’ knowledge of community members’ eligibility for RSG
Response
RSG is available to all babies living within a defined
catchment area
RSG is available only to babies living within a defined
catchment area who have been identified as “at risk”
RSG is available to babies living anywhere in North Dublin,
once their parents want them to take part
Time 1
%
(n)
90.0
(36)
2.5
(1)
7.5
(3)
Time 2
%
(n)
94.4
(17)
5.6
(1)
0.0
(0)
Table M.3 Respondents’ contact with RSG staff
Response
Daily/Weekly
Monthly
Regular, Infrequent
Fewer than 3 occasions
Time 1
Time 2
%
(n)
42.5
(17)
20.0
(8)
25.0
(10)
%
(n)
55.5
(10)
11.1
(2)
22.2
(4)
12.5
(5)
11.11
(2)
72
Table M.4 Respondents’ contact with RSG since February 2012
Response
No change
Greater level of contact
Less contact
Missing
%
(n)
44.4
(8)
38.9
(7)
11.1
(2)
5.6
(1)
Table M.5 Respondents’ first encounter with the term ‘Infant Mental Health’
Time 1
Time 2
Response
%
(n)
%
(n)
I have never heard this term
2.5
(1)
15.0
(6)
17.5
(7)
30.0
(12)
35.0
(14)
5.6
(1)
5.6
(1)
11.1
(2)
44.4
(8)
33.3
(6)
In the last month
In the last year
In the last 3 years
Over 3 years ago
Table M.6 The occasion when respondents reported last hearing the team ‘Infant Mental
Health’
Response
%
I have never heard of this terma
(n)
5.6
(1)
In the past week
77.8
(14)
In the past month
11.1
(2)
0.0
(0)
5.6
(1)
0.0
(0)
In the past six months
In the past year
Over a year ago
Note. a This question was only asked at Time 2.
73
Table M.7 The reported relevance of IMH to respondents’ current roles
Time 1
Time 2
Response
%
%
Very Relevant
(n)
52.5
(21)
32.5
(13)
2.5
(1)
0.0
(0)
5.0
(2)
7.5
(3)
(n)
61.1
(11)
27.8
(5)
0.0
(0)
0.0
(0)
11.1
(2)
0.0
(0)
Relevant
Neither
Irrelevant
Very Irrelevant
Missing
Table M.8 Respondents’ level of agreement with statements relating to IMH
Time 1
Time 2
Statement
Disagree
Neither
Agree
Disagree
Neither
Agree
a)
“I feel Infant Mental Health is an
important issue for the Ballymun
community as a whole”
2.5%
0.0%
92.5%
0.0%
5.6%
88.9%
(n=1)
(n=0)
(n=37)
(n=0)
(n=1)
(n=16)
b)
“I am committed to the concept
of IMH and to raising awareness
of it in Ballymun”
0.0%
0.0%
92.5 %
0.0%
11.1%
83.3%
(n=0)
(n=0)
(n=37)
(n=0)
(n=2)
(n=15)
c)
“I feel that I can make the time
needed to identify and address
IMH needs in Ballymun with my
current work demands”
25.0%
12.5%
55.0%
27.8%
11.1%
51.1%
(n=10)
(n=5)
(n=22)
(n=5)
(n=2)
(n=9)
d)
“I want to identify and address
IMH needs in Ballymun but
simply don’t have the resources
right now”
20.0%
27.5%
50.0%
33.3%
16.7%
33.3%
(n=8)
(n=11)
(n=20)
(n=6)
(n=3)
(n=6)
74
Table M.9 Respondents’ reported actual and desired level of involvement in key decisions
related to IMH activities
To what extent are you involved in
key decisions in relation to IMH
activities in the community?
Not at all
Informed
Consulted
Responsible
Missing
To what extent do you believe you
should be involved in these
decisions?
Time 1
Time 2
Time 1
Time 2
%
%
%
%
(n)
25.0
22.2
(n)
(n)
5.0
(n)
(10)
(4)
(2)
(1)
40.0
22.2
45.0
16.7
(16)
(4)
(18)
(3)
12.5
16.7
22.5
44.4
(5)
(3)
(9)
(8)
22.5
33.3
27.5
27.8
(9)
(6)
(11)
(5)
0.0
5.6
0.0
5.6
(0)
(1)
(0)
5.9
(1)
75
Table M.10 Mean and cumulative ranks for respondents’ ratings of factors contributing to
successful capacity building in order of importance
Time 1
Time 2
Factors contributing to successful capacity
building
Mean
Rank
Cumulative
Rank
Direct training by RSG of frontline staff in Infant
Mental Health issues
2.9
1
Rank
3.2
Formal Infant Mental Health knowledge sharing
between frontline staff members, both within and
between organisations (e.g. through meetings,
mailing lists, discussion forums)
3.2
2
3.1
2
Correct identification, targeting and engagement
of the service users who are in most need of
support
4.0
3a
3.6
4
All stakeholders believing that the changes they
make to build capacity will lead to improved
outcomes for the service users
4.0
3a
2.9
1
Individuals taking the initiative to form
relationships with frontline staff from other
organisations and sharing knowledge on a one-toone basis
Individuals having a personal interest in infant
mental health issues which they choose to pursue
within their roles, regardless of training or
resources
4.3
4
4.5
5a
4.4
5
4.8
6
RSG being receptive and responsive to feedback
from frontline staff in other organisations about
issues relevant to IMH
4.5
6
4.5
5a
Mean
Cumulative
Rank
3
Note. a The ranks are tied
76
Table M.11 Respondents’ level of agreement with statements relating to capacity building
and IMH
Time 1
Time 2
Statement
Disagree
Neither
Agree
Disagree
Neither
Agree
a) RSG are building capacity in the right
10.0%
(n=4)
10.0%
(n=4)
72.5%
(n=29)
16.7%
(n=3)
11.1%
(n=2)
66.6%
(n=12)
places: they are giving the relevant
staff appropriate training to deal
with the circumstances they
encounter
b) When working with service users
referred to me by RSG:
I.
I try to put the baby at the
centre of everything and work
from there
2.5%
(n=1)
10.0%
(n=4)
72.5%
(n=29)
11.1%
(n=2)
5.6%
(n=1)
72.2%
(n=13)
II.
My role is to nurture and
support the parents, so they
can in turn support the baby
2.5%
(n=1)
12.5%
(n=5)
77.5%
(n=31)
5.6%
(n=1)
16.7%
(n=3)
72.2%
(n=13)
III.
My role is to attend to the
parent child relationship
2.5%
(n=1)
12.5%
(n=5)
75.0%
(n=30)
5.6%
(n=1)
27.8%
(n=5)
66.7%
(n=12)
IV.
I feel that the parent is the
expert on the baby
7.5%
(n=3)
15.0%
(n=6)
75.0%
(n=30)
5.6%
(n=1)
5.6%
(n=1)
83.4%
(n=15)
V.
I feel that I am the expert on
the baby
57.5%
(n=23)
27.5%
(n=11)
10.0%
(n=4)
72.3%
(n=13)
22.2%
(n=4)
5.6%
(n=1)
VI.
The parent is the expert but
under certain circumstances I
know more than the parent
about their baby
22.5%
(n=9)
20.0%
(n=8)
50.0%
(n=20)
33.3%
(n=6)
11.1%
(n=2)
55.5%
(n=10)
VII.
I am the expert, but under
certain circumstances the
parent knows more than I do
about their baby
27.5%
(n=11)
22.5%
(n=9)
42.5%
(n=17)
50.0%
(n=9)
22.2%
(n=4)
27.8%
(n=5)
77
Table M.12 Mean and cumulative ranks for respondents’ ratings of barriers to capacity
building in order of impact
Time 1
Barriers
Mean
Rank
Time 2
Cumulative
Rank
Mean
Rank
Cumulative
Rank
A lack of financial resources for issues which might
assist with capacity building
2.9
1
3.5
3
A lack of interest in collaboration between
organisations
3.7
2
3.4
2
A disconnect between RSG trying to build capacity
and organisations embracing of that idea
3.9
3
3.1
1
Difficulty putting theory into practice
4.2
4
4.4
5
Difficulties in individual relationships between
service providers at different agencies
4.3
5
3.9
4
A lack of motivation among frontline staff
4.5
6a
4.6
6
A lack of interest in training and up-skilling among
frontline staff
4.5
6a
4.7
7
Note. a The ranks are tied
78
Table M.13 Respondents’ attendance at and ratings of RSG meetings/events.
Time 1
Time 2
%
%
(n)
(n)
72.5
66.7
(29)
(12)
25.0
27.8
(10)
(5)
2.5
5.6
(1)
(1)
0
0
(0)
(0)
0
0
(0)
(0)
13.8
8.3
(4)
(1)
48.3
41.7
(14)
(5)
37.9
50
(11)
(6)
Attendance at meetings/events
Yes
No
Missing
Success of meetings/events attended a
Poor
Weak
Average
Good
Excellent
Note a Percentages are based only on participants who reported that they had attended meetings/events
79
Table M.14 Professionals’ perceptions of IMH training and their current skill level
Time 1
Statement
Time 2
Disagree
Neither
Agree
Disagree
Neither
Agree
a) IMH training was relevant and has
benefited me in my day to day worka
0.0%
11.8%
88.2%
0.0%
0.0%
100%
(n=0)
(n=2)
(n=15)
(n=0)
(n=0)
(n=10)
b) IMH training delivery and style was
effective
0.0%
5.9%
94.1%
10.0%
0.0%
90.0%
(n=0)
(n=1)
(n=16)
(n=1)
(n=0)
(n=9)
c) I have had the opportunity to apply the
skills I have learned in IMH training
0.0%
5.9%
94.1%
0.0%
0.0%
100%
(n=0)
(n=1)
(n=16)
(n=0)
(n=0)
(n=10)
d) I have been given the opportunity to
reflect upon and discuss how I am
applying the skills I have learned
11.8%
0.0%
88.2%
10.0%
10.0%
80.0%
(n=2)
(n=0)
(n=15)
(n=1)
(n=1)
(n=8)
e) I don’t need any further training from
RSG, I feel confident that I have the
skills necessary to work with them
70.5%
11.8%
17.7%
90.0%
10.0%
0.0%
(n=12)
(n=2)
(n=3)
(n=9)
(n=1)
(n=0)
f) I don’t feel confident in my skills – I
would like to receive further training
for my work with RSG
35.3%
11.8%
53.0%
60.0%
10.0%
30.0%
(n=6)
(n=2)
(n=9)
(n=6)
(n=1)
(n=3)
g) I feel confident in my skills but would
like further training from RSG
5.9%
11.8%
82.4%
10.0%
10.0%
80.0%
(n=1)
(n=2)
(n=14)
(n=1)
(n=1)
(n=8)
a
Note. Percentages are based only on respondents who answered this question
80
Table M.15 Respondents’ perceptions of collaborative activities between RSG and
professionals
Time 1
Statement
Time 2
Disagree
Neither
Agree
Disagree
Neither
Agree
7.5%
10.0%
70.0%
5.6%
11.1%
83.3%
(n=3)
(n=4)
(n=26)
(n=1)
(n=2)
(n=15)
b) RSG are failing to engage the most
appropriate service delivery groups
in the area
c) The leadership from RSG around
IMH issues is clearly defined
62.5%
17.5%
10.0%
44.5%
22.2%
16.7%
(n=25)
(n=7)
(n=4)
(n=8)
(n=4)
(n=3)
17.5%
7.5%
65.0%
5.6%
16.7%
77.8%
(n=7)
(n=3)
(n=26)
(n=1)
(n=3)
(n=14)
d) RSG has a clearly defined strategy
2.5%
7.5%
80.0%
0.0%
11.1%
88.9%
(n=1)
(n=3)
(n=32)
(n=0)
(n=2)
(n=16)
(n=14)
(n=5)
(n=17)
(n=8)
(n=6)
(n=4)
RSG have a clear vision of what
they want to achieve in Ballymun
0.0%
2.5%
85.0%
0.0%
0.0%
100%
(n=0)
(n=1)
(n=34)
(n=0)
(n=0)
(n=18)
I am aware of efforts being made
by RSG to lobby local political
figures in relation to IMH issue
17.5%
17.5%
55.0%
16.7%
33.3%
50.0%
(n=7)
(n=7)
(n=22)
(n=3)
(n=6)
(n=9)
h) I have been linked to other service
providers through RSG
12.5%
15.0%
65.0%
27.8%
16.7%
55.6%
(n=5)
(n=6)
(n=26)
(n=5)
(n=3)
(n=10)
i)
12.5%
12.5%
65.0%
16.7%
22.2%
61.1%
(n=5)
(n=5)
(n=26)
(n=3)
(n=4)
(n=11)
a)
e)
f)
g)
RSG are targeting the right partners
in terms of service delivery groups
RSG’s success is the direct result of
the work of a few committed
individuals
35.0%
RSG has encouraged me to build
upon pre-existing links with other
service providers
12.5%
42.5%
44.5%
33.3%
22.2%
Table M. 16 Respondents’ ratings of RSG’s influence on their interactions with other
service providers
Time 1
Time 2
Response
%
%
Positively
(n)
70.0
(n)
77.8
(28)
(14)
0.0
0.0
(0)
(0)
25.0
16.7
(10)
(3)
5.0
5.6
(2)
(1)
Negatively
Had no impact
Missing
Table M.17 Respondents’ perceptions of local parents’ knowledge about RSG
81
Level of Knowledge
None
Know the name
Know it’s related to babies
Know it’s related to babies’ development
Know it is related to babies’ development and
the relationship between caregiver and baby
Missing
Time 1
Time 2
%
%
(n)
(n)
5.0
5.6
(2)
(1)
15.0
11.1
(6)
(2)
20.0
11.1
(8)
(2)
40.0
44.4
(16)
(8)
20.0
16.7
(8)
(3)
0.0
11.1
(0)
(2)
Table M.18 Level of Reach of RSG services
Time 1
Time 2
%
%
(n)
(n)
I feel RSG is reaching all of the people who need
it most
2.5
0.0
(1)
(0)
I feel RSG is reaching the majority of the people
who need it most
22.5
27.8
(9)
(5)
I feel RSG is reaching some, but not all of the
people who need it most
62.5
61.1
(25)
(11)
I feel RSG is reaching few of the people who
need it most
12.5
0.0
(5)
(0)
Missing
0.0
11.1
(0)
(2)
Reaching the people who need it most
82
Table M.19 Mean and cumulative ranks for respondents’ ratings of barriers to parental
engagement in order of impact
Time 1
Time 2
Barriers to parental engagement
Mean
Rank
Cumulative
Rank
Mean
Rank
Cumulative
Rank
There is a culture of non-engagement in families (so
people are influenced by negative attitudes of their
own parents/siblings)
3.1
1
2.7
1
Parents forget appointments - they need individual
reminders and encouragement to attend
3.3
2
3.7
4
Logistical issues (e.g. difficulty arranging babysitters for
other children so they can attend a programme,
difficulty getting time off work, difficulty getting to the
programme site)
3.4
3
4.1
5
There is a culture of mistrust of organisations among
parents
3.6
4
3.2
3
Lack of belief among parents about what programmes
offered by RSG can actually achieve
3.8
5
4.3
6
There is a culture of non-engagement in the area (so
people are influenced by negative attitudes of their
neighbours and friends)
3.9
6
3.1
2
Over-representation of similar programmes in the area
6.2
7
6.3
7
83
Table M.20 Respondents’ perceptions of RSG’s engagement diverse groups
Time 1
Statement
Time 2
Disagree
Neither
Agree
Disagree
Neither
Agree
RSG are facilitating the Early
Identification of children’s
needsa
n/a
n/a
n/a
0.0%
0.0%
88.9%
(n=0)
(n=0)
(n=16)
b) RSG contribute positively to
the Early Identification of
children’s needsa
n/a
0.0%
0.0%
94.4%
(n=0)
(n=0)
(n=17)
c)
32.5%
40.0%
20.0%
11.1%
55.6%
22.2%
(n=13)
(n=16)
(n=8)
(n=2)
(n=10)
(n=4)
d) RSG are actively attempting to
engage members of the
Travelling communitya
n/a
n/a
n/a
0.0%
38.9%
50.0%
(n=0)
(n=7)
(n=9)
e)
RSG have successfully
engaged people from
international backgrounds
0.0%
25.0%
75.0%
0.0%
11,1%
72.2%
(n=0)
(n=10)
(n=30)
(n=0)
(n=2)
(n=13)
RSG are actively attempting to
engage people from
international backgroundsa
n/a
n/a
n/a
5.6%
22.2%
61.1%
(n=1)
(n=4)
(n=11)
RSG have successfully
engaged young parentsa
n/a
5.6%
11.1%
66.7%
(n=1)
(n=2)
(n=12)
0.0%
0.0%
100%
(n=0)
(n=0)
(n=18)
a)
f)
g)
RSG have successfully
engaged members of the
Travelling community
h) RSG are actively attempting to
engage young parentsa
n/a
n/a
n/a
n/a
n/a
n/a
n/a
a
Note. Questions a, b, d, f, g and h were only included in the second survey.
84
Table M.21 Respondents’ perceptions of RSG’s work with parents and other services in the
community
Time 1
Statement
Time 2
Disagree
Neither
Agree
Disagree
Neither
Agree
12.5%
12.5%
75.0%
16.7%
5.6%
72.2%
(n=5)
(n=5)
(n=30)
(n=3)
(n=1)
(n=13)
b) RSG clearly communicates to the
people in the community about
how it and other service providers
will address problems that are
important to them
c) RSG and other community services
provide adequate support to
parents in order to help them
attend appointments related to
IMH
7.5%
25.0%
62.5%
11.1%
27.8%
55.6%
(n=3)
(n=10)
(n=25)
(n=2)
(n=5)
(n=10)
10.0%
12.5%
75.0%
5.6%
22.2%
66.7%
(n=4)
(n=5)
(n=30)
(n=1)
(n=4)
(n=12)
d) Parents who attend RSG-related
services have a sense of trust and
feel that they are in good hands
e) I have noticed parents in the
community becoming more proactive in relation to addressing IMH
issues
f) Current RSG service users are
engaging sufficiently with services
in relation to IMH
g) RSG works effectively with partners
to be able to respond to the IMH
needs of the community
0.0%
17.5%
80.0%
0.0%
11.1%
83.3%
(n=0)
(n=7)
(n=32)
(n=0)
(n=2)
(n=15)
15.0%
37.5%
45.0%
16.7%
33.3%
44.5%
(n=6)
(n=15)
(n=18)
(n=3)
(n=6)
(n=8)
10.0%
30.0%
55.0%
16.7%
38.9%
33.3%
(n=4)
(n=12)
(n=22)
(n=3)
(n=7)
(n=6)
5.0%
22.5%
70.0%
5.6%
16.7%
66.7%
(n=2)
(n=9)
(n=28)
(n=1)
(n=3)
(n=12)
h) RSG works together with service
providers to maintain relationships
with parents in relation to IMH
10.0%
10.0%
77.5%
0.0%
22.2%
72.2%
(n=4)
(n=4)
(n=31)
(n=0)
(n=4)
(n=13)
a)
RSG promotes its services
effectively to parents in the
community
85
Table M.22 Mean and cumulative ranks for respondents’ ratings of communication
methods used to promote IMH services in order of effectiveness
Time 1
Barriers
Mean Rank
Time 2
Cumulative
Rank
Mean
Rank
Cumulative
Rank
Word of mouth
1.8
1
1.7
1
Scheduled home visits by frontline staff
3.0
2
3.3
3
Informal door to door visits by frontline staff
3.8
3
3.9
4
Text messages
4.0
4
3.1
2
Letters
4.2
5a
4.5
5
Posters / Flyers
4.2
5a
4.6
6
Emails
6.1
6
6.2
7
Note. a The ranks are tied
86
Table M.23 Respondents perceptions of RSG’s collaboration with partners, services, and
families in Ballymun
Time 1
Statement
Time 2
Disagree
Neither
Agree
Disagree
Neither
Agree
I feel that the number of common
goals and objectives outweighs the
number of conflicting goals and
objectives between RSG and my
organisation
12.5%
12.5%
62.5%
5.6%
22.2%
55.6%
(n=5)
(n=5)
(n=25)
(n=1)
(n=4)
(n=10)
b) As a service community, we have
identified what we need to achieve
in relation to IMH in the
community
15.0%
17.5%
65.0%
11.1%
27.8%
61.1%
(n=6)
(n=7)
(n=26)
(n=2)
(n=5)
(n=11)
c)
12.5%
2.5%
82.5%
5.6%
16.7%
77.8%
(n=5)
(n=1)
(n=33)
(n=1)
(n=3)
(n=14)
d) RSG has been able to correctly
identify how different programmes
in the community relate to the
problems the partnership is trying
to address
7.5%
27.5%
62.5%
5.6%
44.4%
44.4%
(n=3)
(n=11)
(n=25)
(n=1)
(n=8)
(n=8)
e)
RSG works with a diverse range of
professionals and organisations in
relation to IMH
0.0%
5.0%
92.5%
5.6%
0.0%
94.4%
(n=0)
(n=2)
(n=37)
(n=1)
(n=0)
(n=17)
I have sufficient linkages with RSG
to facilitate engagement,
assessment, support and
intervention with parents in
relation to IMH
17.5%
17.5%
57.5%
11.1%
22.2%
50.0%
(n=7)
(n=7)
(n=23)
(n=2)
(n=4)
(n=9)
a)
f)
Service providers working together
in the community generally trust
one another
87
Table M.23 (Continued)
Time 1
Time 2
Statement
Disagree
Neither
Agree
Disagree
Neither
Agree
g)
5.0%
10.0%
82.5%
0.0%
22.2%
77.8%
(n=2)
(n=4)
(n=33)
(n=0)
(n=4)
(n=14)
h) I feel communicated to and
informed in relation to IMH
activities in the community
20.0%
7.5%
70.0%
0.0%
11.1%
83.3%
(n=8)
(n=3)
(n=28)
(n=0)
(n=2)
(n=15)
i)
I feel that my organisation is on the
outside when it comes to
initiatives, activities and supports
in relation to IMH
47.5%
20.0%
25.0%
66.7%
11.1%
16.7%
(n=19)
(n=8)
(n=10)
(n=12)
(n=2)
(n=3)
Organisations communicate with
one another about IMH
independently of RSG
27.5%
32.5%
37.5%
33.3%
33.3%
33.3%
(n=11)
(n=13)
(n=15)
(n=6)
(n=6)
(n=6)
I feel that service providers share
knowledge effectively in relation to
IMH in the community
22.5%
27.5%
40.0%
27.8%
27.8%
33.3%
(n=9)
(n=11)
(n=16)
(n=5)
(n=5)
(n=6)
The work that RSG is currently
doing in the community is
sustainable in the long term
12.5%
12.5%
70.0%
0.0%
22.2%
66.7%
(n=5)
(n=5)
(n=28)
(n=0)
(n=4)
(n=12)
m) RSG has effective methods for
handling conflict between service
providers when working together
towards promoting IMH in the
community
10.0%
40.0%
45.0%
5.6%
50.0%
44.4%
(n=4)
(n=16)
(n=18)
(n=1)
(n=9)
(n=8)
j)
k)
l)
I feel that meetings and events in
relation to IMH are addressing
pressing issues and are worthwhile
Table M.24 Respondents’ perceptions of RSG’s progress in embedding a system of IMH
risk identification into the service community.
Just started
On the road
Nearly there
We’re there
Missing
Time 1
Time 2
%
%
(n)
(n)
22.5
5.6
(9)
(1)
47.5
72.2
(19)
(13)
25.0
16.7
(10)
(3)
5.0
0.0
(2)
(0)
0.0
5.6
(0)
(0)
88
Table M.25 Mean and cumulative ranks for respondents’ ratings of causes of conflict
between organisations in order of relevance
Time 1
Conflicts
Mean Rank
Time 2
Cumulative
Rank
Mean Rank
Cumulative
Rank
Resources
1.9
1
2.0
1
Responsibilities / Referrals
2.4
2
2.7
3
Individuals’ fear of losing power
/autonomy regarding their roles
2.8
3
2.5
2
Personality clashes
3.7
4
4.3
5
A historic of conflict
3.8
5
3.3
4
Open ended questions. The second survey also offered respondents the opportunity to provide
additional comments relating to capacity building, collaboration, and early identification of IMH
problems.
Seven professionals offered responses on capacity building. Two respondents referred positively to
the work of RSG, in raising awareness around IMH (n =1), and being valued by stakeholders (n =1).
Another professional described RSG’s work as a “work in progress”. The remaining respondents
alluded to the need for specific changes including: expanding the catchment area (n = 1), reaching
out more to early years practitioners (n =1), helping organisations to revaluate and change their
working practices (n =1), and linking with and focusing on young mothers as young people as well as
parents (n =1).
In relation to collaborative working, three respondents referred to the positive contribution of RSG
in this area, with the work of the integration facilitator and PCPS/PHN teams receiving particular
mention. Another professional identified the role of the IMH study group in enhancing collaborative
working. Also, while one respondent linked collaboration to a significant change in service provision
for 0-3s, another respondent indicated that case loads and low staffing resources were inhibiting her
organisation’s ability to work collaboratively with RSG.
Four participants offered additional comments on early identification. One respondent provided a
negative appraisal by stating that RSG was still missing the most vulnerable families. Two
participants commented on positive impacts, with one participant noting changes on PHN early
identification practice, and the other describing RSG’s assessment and intervention work as
“groundbreaking and essential”. The fourth respondent pointed to improvements that could be
made by RSG by tailoring its work to other organisations’ needs and skills in promoting parental
engagement.
89
Four professionals identified changes/developments in the RSG service. Changes included RSG’s
development into an area-based IMH strategy (n =3), changes in organisational roles (n =1), and the
development of programmes, training, capacity building, and services’ impact on policy makers (n
=1). For one respondent the changes she identified had not had impacted on her practice. However,
another participant noted that the clearer IMH framework had allowed her to audit progress and
make plans for addressing outstanding gaps. In relation to changes outside of RSG four professionals
described increased work demands (e.g. reductions in staffing and higher case loads), with two of
these professionals detailing the negative impact of these changes on their work. In contrast, two
professionals noted changes in work practices that had links to IMH (e.g. introducing continuity of
care in early years setting) with both indicating that these changes allowed for greater collaboration
with RSG. One practitioner also stated that the IMH study group had become more focused.
90
Appendix N:
PCPS Instruments
The following instruments are collected by the PCPS during the course of programme delivery.
N.1
Parenting Stress Index
The Parenting Stress Index Short Form (PSI/SF; Abidin, 1995) is administered at the introductory visit
(IV) and the 15 month visit. It provides a total score (36 items, α = .93) and three subscales
measuring potential factors related to Parenting Stress – parental distress, parent-child dysfunctional
interaction and difficult child. It provides an overall parenting stress score in addition to scores for
each of the three subscales, each containing 12 items. The Parental distress subscale measures
parents’ level of distress regarding her perception of her parenting role. The Parent-child
Dysfunctional Interaction subscale considers the mother’s perception of the quality of her
interactions with the child. The Difficult Child subscale measures the behavioural characteristics of
the child, as perceived by the mother. The PSI-SF also contains a measure of defensive responding
(Abidin, 1995).
The parent is presented with each of the 36 items and asked to indicate his/her level of agreement
with each item across a 5 point Likert scale. A response of ‘strongly agree’ is scored as 1 and strongly
disagree is scored 5, with possible scoring range of 36 to 180. A lower overall score is indicative of
higher levels of self reported stress. Subscales are calculated by summing the responses to items
that comprise each subscale. The overall PSI score is a summation of all subscales: difficult child (12
items, α = .87), parenting distress (12 items, α = .87), and parent-child dysfunctional interactions (12
items, α = .89). The test–retest, and internal consistency reliability of the PSI on various scales ranges
from 0.68 to 0.84.
N.2
Parenting Sense of Competence
The Parenting Sense of Competence Scale (Adapted) (PSOC; Gibaud-Wallston & Wandersman, 1978)
is administered at the IV and at the 15 month visit. It is a 17-item questionnaire which measures
overall parenting sense of competence and includes two subscales : feelings of satisfaction and
efficacy in the parenting role. Scores from six-item likert scales are summed to give a total score for
Parenting Sense of Competence. Parental satisfaction is measured by nine of the items and parental
self-efficacy is measured by eight items which are reverse-scored. The authors (Gibaud-Wallston &
Wandersman, 1978) report six week test-retest correlations of .46 to .82. Acceptable levels of
internal consistency have been reported for the total, Satisfaction, and Efficacy scales (α = .79, .75,
and .76 respectively; Johnston & Mash, 1989).
91
The reliability of the PSI/SF and the PSOC at each time point is listed in table N.1:
Table N.1
Cronbach alphas for PSI/SF and PSOC scales
PSI/SF Scale
N
Alpha
Total PSI/SF (3 months)
298
0.91
Parental Distress (3 months)
298
0.83
Parent Child Dysfunctional Interaction (3 months)
298
0.86
Difficult Child (3 months)
298
0.86
Total PSI/SF (15 months)
183
0.93
Parental Distress (15 months)
183
0.90
Parent Child Dysfunctional Interaction (15 months)
183
0.85
Difficult Child (15 months)
183
0.87
Total PSOC (3 months)
301
0.75
Efficacy (3 months)
301
0.66
Satisfaction (3 months)
301
0.69
Total PSOC (15 months)
182
0.85
Efficacy (15 months)
182
0.79
Satisfaction (15 months)
182
0.81
PSI/SF
PSOC
N.3
Strange Situation Procedure
Children’s attachment is measured at the 15 month visit, using the Strange Situation Procedure
(Ainsworth et al., 1978). This test consists of assessing the infant’s reaction over the course of a
number of short separations from and subsequent reunions with its parent, while a stranger also
comes and goes from the room. There are 8 specific episodes over a course of twenty minutes which
involve a combination of the parent and stranger interacting with or not interacting with the infant,
and the infant being left alone briefly. The test is based on the assumption that the child’s reactions
are an indication of the infant’s expectations of the parent’s availability and responsiveness to
him/her, and whether or not these anticipated parental reactions give the baby a sense of security
and trust. Coders analyse a recording of the infant’s behaviour at set times during the test and assign
a score on four different behaviours: proximity seeking, contact seeking and maintenance, resistance
and avoidance. An overall attachment type is then given to the child. A secure classification indicates
that the child can trust the mother during and after times of adversity, i.e. when separated and then
reunited. An insecure classification, such as insecure-ambivalent or insecure-avoidant suggests that
92
the child may be unsure of whether or not to trust the parent. Coding on this instrument was
managed by Profession M. Angeles Cerezo and was conducted by an offsite team. Only the final
scores of secure or insecure were available to the research team.
N.4
Early Child Mother Interaction Coding System (CITMI-R)
For this assessment, the parent is invited to engage in four minutes of uninterrupted, sequential free
play with the child when the nurse leaves the station temporarily. Their interaction is visually
recorded and is subsequently analysed on a number of different dimensions in order to examine the
quality and nature of the parent’s response to the child during this time is coded. Coders analyse
parent and child interaction in two categories – “interaction” when the child chooses to engage the
parent in play, and “non-interaction” when the child is playing alone and does not attempt to
directly engage the parent. The parent’s incidences of sensitive, intrusive, protective or disengaged
behaviour towards their child are recorded for “interaction”. When measuring the incidence of noninteraction, the same measures are used however the disengaged measure is omitted. Sensitive
behaviours correspond to parental attunement with the child and are desirable. Behaviours which
are intrusive, protective or disengaged are undesirable and may indicate parents who are less
attuned to their baby’s needs (Cerezo et al. 1986: in Cerezo, 2000). Coders undergo 18 hours of
training where the coder’s level of reliability with a pre-scored key is calculated using kappa
coefficient (Cerezo, 1991, as cited by M. A. Cerezo, personal communication, July 20, 2012). The
scale has been shown to have good content validity and criterion validity (Trenado, Pons-Salvador, &
Cerezo, 2001, as cited by M. A. Cerezo, personal communication, July 20, 2012).
N.5
Manual of Developmental Diagnosis – Gesell Developmental Schedules:
The child’s development is assessed through the administration of the Revised Gesell Developmental
Schedules at Station C at each programme visits except 15 months. The Gesell Developmental
Schedules were developed by Dr. Arnold Gesell in 1925 in the USA. They were revised in 1974 by
Knoblock and Pasamanick and again in 1980 by Knobloch, Stevens and Malone – this is the version
employed by the current programme. The scales list target behaviours grouped under five main
developmental fields: adaptive (alertness, intelligence, constructive exploration), gross motor
(balance, sitting, locomotion, postural reactions), fine motor (manual dexterity), language (facial
expression, gestures, vocalisations) and personal-social (feeding, playing, toilet training). An overall
global development age is also obtained which is based on an average of the five developmental
fields. Each behaviour is marked (+ or -) as either observed (seen by the assessor) or history (parent
has observed the behaviour in the past). Scores are determined by the presence or absence of
specific behaviours characteristic of children of a certain chronological age (CA). The presence or
absence of behaviours form the basis for a developmental age (DA) which can then be expressed as
a Developmental Quotient (DA/CA x 100).
93
Appendix O:
Analysis of PCPS Outcomes Data
Initially, the data were examined to determine its accuracy and whether the variables were normally
distributed. First, to ensure accuracy, the original data were proofread against the PASW data
file. In addition, the plausibility of the data was inspected by examining the minimum and
maximum values of all variables. The means and standard deviations of continuous variables
were also inspected. It was ensured that all values were within the plausible range. Second,
missing data were considered. Individual mean imputation was used for scales where one or
two items were missing. Missing values were replaced by the average of the completed items of
the scale. This method was chosen over other methods such as Multiple Imputation (MI) since it
has been found to produce high correlation coefficients with real data, and to perform
comparably as accurately as other methods (Tabachnick & Fidell, 2007). It also has the
advantage of ease of interpretability (Shrive, Stuart, Quan, & Ghali, 2006). Missing data in scales
were assessed and where one or two items were missing, individual mean imputation was
performed. The reliability of the scales were examined by calculating the Cronbach alpha (α) of
each scale, the most frequently used indicator of internal consistency. All scales had coefficients
of greater than 0.7, and were therefore considered to be reliable. Third, in order to assess
whether variables were normally distributed, frequency histograms and Q-Q plots of each
variable were visually inspected. In addition, z-scores for skew and kurtosis were calculated.
Skewness relates to the degree and direction of symmetry of a distribution and kurtosis relates
to the peakedness of a distribution. Variables with a skew or kurtosis z-score greater than an
absolute value of 3.29 were considered non-normal, as recommended by Tabachnick and Fidell
(2007) and Field (2009).
94
Appendix P:
PCPS Outcomes Comparison Analysis
As the sample size of the PCPS and PFL comparison groups was relatively small, all the analyses comparing the baseline characteristics and the outcomes of the
two groups used permutation-based hypothesis testing. This approach has been found to be appropriate for small samples and was used to analyse data for a
similar evaluation of the Perry Preschool Program by Heckman and colleagues (Heckman, Moon, Pinto, Savelyev, & Yatiz 2010). A permutation test gives
accurate p-values even when the sample sizes are small and sampling distribution is skewed as they do not rely on parametric assumptions (Marozzi, 2002). A
permutation test is a method whereby the outcome of interest is tested for significance by comparing the original sample to multiple, random permutations of
the data. In practice, the permutation testing procedure compares a test statistic computed on the original (pre-permutation) data with a distribution of test
statistics computed on re-samplings of that data. First, the relationship between measures is observed and a test statistic is calculated. Then, the data are
shuffled multiple times (i.e., 10,000) to examine whether the observed relationship is likely to occur by chance. The p-value for a permutation test is computed
as the fraction of re-sampled data which yield a test statistic greater (or less, depending on the direction of the test) than that yielded by the original data. If
the fraction is small, we know that the original statistic is an unlikely outcome.
The differences between the two groups were tested using both unconditional and conditional permutation analysis. Conditional permutation analysis controls
for differences in underlying characteristics between the two groups. For additional robustness, the propensity score matching technique was also employed
when comparing the outcomes of the two groups. The radius method with a caliper set at 0.01 was used to match individuals in the PCPS group to those in the
comparison group. This method was preferred over nearest neighbour matching as it was most successful at reducing bias in the comparison. The idea is to get
as close a match as possible on underlying characteristics before examining any differences between the groups on the two instruments of interest.
Finally, multiple hypothesis testing was used which allows us to test for the joint significance of multiple outcomes at the same time, thus minimising the
likelihood of finding treatment effects that are false. The multiple hypothesis method that we use is called the stepdown procedure. To illustrate the stepdown
procedure, consider the null hypothesis of no treatment effect for a set of, say, K outcomes jointly. The complement of the joint null hypothesis is the
hypothesis that there exists at least one hypothesis out of K that we reject. We applied the analysis of Romano and Wolf (2005) and its extension by Heckman
et al. (2010). Their methods control for overall error rates for vectors of hypotheses using the family-wise error rate (FWER), the probability of yielding one or
more false positives out of a set of hypotheses tests, as a criterion.
95
Appendix Q :
Baseline Characteristics Comparison
Table Q.1: Comparisons of PCPS baseline characteristics with PFL Control (CT), PFL Low Treatment, and Combined PFL Control + Low Treatment
baseline characteristics
PCPS
CT
P*
PFL Low Treatment
P*
Low + CT
P*
M
(SD)
M
(SD)
PCPS/CT
M
(SD)
PCPS/PFL Low
M
(SD)
PCPS/Low+CT
Economic Problems
0.49
(0.50)
0.48
(0.50)
ns
0.55
(0.50)
ns
0.51
(0.50)
ns
Planned Pregnancy
0.56
(0.5)
0.48
(0.50)
ns
0.30
(0.46)
<.01
0.39
(0.49)
<.01
No. of Other Children
0.95
(1.21)
1.11
(1.35)
ns
0.91
(1.15)
ns
1.01
(1.25)
ns
Mother’s Age
29.17
(6.22)
27.28
(6.20)
<.01
25.30
(5.99)
<.01
26.28
(6.16)
<.01
Mother Low Education
0.29
(0.45)
0.25
(0.44)
ns
0.40
(0.49)
<.05
0.33
(0.47)
ns
Mother Unemployed
0.42
(0.50)
0.37
(0.49)
ns
0.41
(0.49)
ns
0.39
(0.49)
ns
Mother Breastfed
0.24
(0.43)
0.32
(0.47)
ns
0.22
(0.42)
ns
0.27
(0.45)
ns
Irish Mother
0.74
(0.44)
0.95
(0.22)
<.01
0.99
(0.10)
<.01
0.97
(0.17)
<.01
Parenting Stress (Mother) 65.64 (15.52)
63.98
(16.99)
ns
64.3
(16.18)
ns
64.14
(16.53)
ns
Father’s Age
31.2
(6.43)
29.45
(7.28)
<.05
27.58
(7.33)
<.01
28.50
(7.35)
<.01
Father Low Education
0.35
(0.48)
0.38
(0.49)
ns
0.48
(0.50)
<.05
0.43
(0.50)
ns
Father Unemployed
0.39
(0.49)
0.31
(0.47)
ns
0.31
(0.47)
ns
0.31
(0.46)
ns
Low BW
0.10
(0.30)
0.06
(0.23)
ns
0.10
(0.30)
ns
0.08
(0.27)
ns
Male
0.50
(0.50)
0.51
(0.50)
ns
0.36
(0.48)
<.05
0.43
(0.50)
ns
Note. *P’ indicates the p value. ‘p<.01’ and ‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively. ‘ns’ indicates the variable is not statistically
significant.
96
Appendix R:
PFL Comparison Analyses
Table R.1 PCPS versus PFL Comparison Group
Controls for: mother’s age, father’s age, nationality
N
(ntreatment
/ ncontrol)a
Treatment
M
(SD)
Control
M
P
(SD)
Communication
6 Months
297
(213/84)
100.01
15.05
98.98
13.61
ns
12 Months
266
(184/82)
99.83
14.38
101.80
14.04
ns
18 Months
279
(208/71)
99.90
15.03
99.39
14.22
ns
Gross Motor
6 Months
297
(213/84)
99.92
15.08
100.04
15.48
ns
12 Months
266
(184/82)
101.28
13.23
101.29
13.70
ns
18 Months
279
(208/71)
99.98
15.08
102.50
13.09
ns
Fine Motor
6 Months
297
(213/84)
99.97
15.06
100.16
14.77
ns
12 Months
266
(184/82)
99.73
15.38
101.03
13.37
ns
18 Months
279
(208/71)
99.89
14.98
101.69
12.98
ns
Problem Solving
6 Months
297
(213/84)
99.92
15.08
100.43
13.69
ns
12 Months
266
(184/82)
100.14
14.76
101.57
13.82
ns
18 Months
279
(208/71)
99.99
15.02
100.12
13.65
ns
Personal & Social
6 Months
297
(213/84)
100.01
15.10
101.64
14.00
ns
12 Months
266
(184/82)
99.56
15.33
100.76
14.63
ns
18 Months
279
(208/71)
100.08
15.08
100.65
14.18
ns
Global
6 Months
297
(213/84)
100.00
15.00
102.00
16.57
ns
12 Months
266
(184/82)
99.89
15.08
101.85
13.83
ns
279
(208/71)
100.00
15.00
101.32
12.45
ns
18 Months
a
Note. treatment’ denotes the PCPS sample and ‘control’ denotes the PFL comparison group.
97
Table R.2 PCPS versus PFL Low Treatment Group
Controls for: mother’s age, father’s age, planned pregnancy, nationality, mother’s education,
father’s education
N
(ntreatment
/ ncontrol)a
Treatment
M
(SD)
Control
M
P
(SD)
Communication
6 Months
303
(213/90)
100.01
15.05
99.31
16.23
ns
12 Months
267
(184/83)
99.83
14.38
99.32
15.32
ns
18 Months
281
(208/73)
99.90
15.03
100.18
15.92
ns
Gross Motor
6 Months
303
(213/90)
99.92
15.08
98.69
15.37
ns
12 Months
267
(184/83)
101.28
13.13
98.78
15.61
ns
18 Months
281
(208/73)
99.98
15.08
96.52
20.33
ns
Fine Motor
6 Months
303
(213/90)
99.97
15.05
100.37
15.70
ns
12 Months
267
(184/83)
99.73
15.38
97.47
16.98
ns
18 Months
281
(208/73)
99.89
14.98
98.41
15.94
ns
Problem Solving
6 Months
303
(213/90)
99.92
15.08
100.33
16.07
ns
12 Months
267
(184/83)
100.14
14.76
99.17
16.40
ns
18 Months
281
(208/73)
99.99
15.02
99.63
14.93
ns
Personal & Social
6 Months
303
(213/90)
100.01
15.10
98.77
16.30
ns
12 Months
267
(184/83)
99.56
15.33
98.59
16.45
ns
18 Months
281
(208/73)
100.08
15.08
98.54
16.58
ns
Global
6 Months
303
(213/90)
100.00
15.00
99.26
15.74
ns
12 Months
267
(184/83)
99.89
15.08
98.09
16.60
ns
281
(208/73)
100
15
97.95
17.67
ns
18 Months
a
Note. treatment’ denotes the PCPS sample and ‘control’ denotes the PFL low treatment group.
98
Table R.3. PCPS versus PFL Comparison & Low Treatment Groups
Controls for: Mother’s age, father’s age, nationality, planned pregnancy
N
(ntreatment
/ ncontrol)a
Treatment
M
(SD)
Control
M
P
(SD)
Communication
6 Months
387
(213/174)
100.01
15.05
99.15
14.98
ns
12 Months
349
(184/165)
99.83
14.38
100.55
14.71
ns
18 Months
352
(208/144)
99.90
15.03
99.79
15.06
ns
Gross Motor
6 Months
387
(213/174)
99.92
15.08
99.34
15.40
ns
12 Months
349
(184/165)
101.28
13.13
100.03
14.70
ns
18 Months
352
(208/144)
99.98
15.08
99.47
17.35
ns
Fine Motor
6 Months
387
(213/174)
99.97
15.05
100.27
15.21
ns
12 Months
349
(184/165)
99.73
15.38
99.24
15.35
ns
18 Months
352
(208/144)
99.89
14.98
100.02
14.60
ns
Problem Solving
6 Months
387
(213/174)
99.92
15.08
100.38
14.93
ns
12 Months
349
(184/165)
100.14
14.76
100.36
15.18
ns
18 Months
352
(208/144)
99.99
15.02
99.87
14.27
ns
Personal & Social
6 Months
387
(213/174)
100.01
15.10
100.16
15.26
ns
12 Months
349
(184/165)
99.56
15.33
99.67
15.56
ns
18 Months
352
(208/144)
100.08
15.08
99.58
15.42
ns
Global
6 Months
387
(213/174)
100.00
15.00
100.58
16.16
ns
12 Months
349
(184/165)
99.89
15.08
99.96
15.36
ns
18 Months
352
(208/144)
100
15
99.62
15.36
ns
Note. a treatment’ denotes the PCPS sample and ‘control’ denotes the PFL comparison and low treatment
groups.
99
Appendix S:
Additional comparison analyses: PCPS treatment group
versus PCPS Comparison group
Introduction & Methodology
Previous analyses on the impact of the PCPS examined changes in the outcomes of the PCPS
participants over time and a comparison of the outcomes of the PCPS participants to the outcomes
of a group of socio-demographically similar families from another community who did not receive
PCPS. The first set of findings may not be causally attributed to the programme as there may have
been other factors affecting the outcomes over time that were unrelated to the programme, and the
second set of findings may be limited by their reliance one equivalent measures across both groups child development.
The present analysis compared the outcomes of PCPS participants who joined the programme at the
3 month visit and completed the 18 month visit to the outcomes of PCPS participants who joined the
programme between the 15 and 18 month visit. When PCPS first began, parents of all children
under the age of 18 months were invited to join the programme regardless of their infant’s age. For
example, if an infant was 16 months old when the programme started operating in November 2009,
they were eligible to join the programme and receive the 18 month visit. We identified 24 such
participants who were eligible for the 15 and 18 month visit, or the 18 month visit only. These
participants had the initial introductory visit (known as the “IV”) where baseline measures of family
circumstances and parental well-being were recorded. All of these participants then received at least
1 programme visit. Thirteen participants received 1 programme visit, two received 2 programme
visits, eight received 1 programme visit and 1 additional visit, and one received 1 programme visit
and 1 additional visit. As this group did not self-select into a less intensive version of PCPS, it serves
as a useful comparison for participants who were eligible for all six programme visits.
For the purposes of this analysis we refer to the participants who joined the programme when their
infants were 3 months old and were still in the programme when their infants were 18 months old
as the ‘PCPS treatment group’. We refer to those who joined the programme when their infants
were between 15 and 18 months as the ‘PCPS comparison group’. The analysis proceeded in two
steps. First, as baseline data from the IV were available for both groups, two-tailed permutation
tests were used to test for statistically significant differences between the PCPS treatment and PCPS
comparison groups in terms of standard socio-demographic and health measures. Second, onetailed permutation tests were used to compare the 15 and 18 month outcomes of the PCPS
treatment and the PCPS comparison groups to determine programme impact. Parent outcomes
were measured at 15 months (Parental Stress Index/Short Form (PSI/SF); Parental Sense of
Competence (PSOC)) and child outcomes were measured at 18 months (Gesell Developmental
Schedules). We hypothesised that the parent and child outcomes of the treatment group who were
eligible for all programme visits would be better than the outcomes of the comparison group who
joined the programme at the latter stages.
100
Results
Comparison of Baseline Characteristics
Table S.1 compared the baseline characteristics of the PCPS treatment group and PCPS comparison
group. It shows that there were no statistical differences across the two groups on any of the
demographic, economic, and health outcomes considered. This indicated that the groups were
equivalent regarding their baseline characteristics before they started receiving the programme,
thus any observed differences between the two groups at 15 and 18 months may be attributed to
PCPS rather than any underlying characteristics of the families.
Table S.1 PCPS Treatment group versus PCPS Comparison group results: Baseline
Demographics and Health Indicators
Baseline
Age of mother
Age of father
Teenage mother
More than 3 children
Single parent
Irish family
Mother 3rd level education
Father 3rd level education
Mother unemployed
Father unemployed
Economic problems
Mother health problems
affecting parenting
Father health problems
affecting parenting
Low birth weight baby
Premature baby
Normal delivery
Breastfed
nPCPS/
ncomp
PCPS treatment
group
PCPCP
P value
comparison
M
SD
M
211/24
211/21
211/23
211/24
211/24
211/21
208/24
181/20
210/24
177/21
211/24
209/24
29.45
27.73
-0.07
-0.10
-0.36
0.74
0.33
0.33
-0.39
-0.36
-0.45
-0.26
6.27
11.73
0.26
0.31
0.48
0.44
0.47
0.47
0.49
0.48
0.50
0.44
28.38
29.76
-0.04
-0.08
-0.29
0.62
0.42
0.45
-0.58
-0.48
-0.42
-0.29
5.16
4.94
0.21
0.28
0.46
0.50
0.50
0.51
0.50
0.51
0.50
0.46
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
ns
181/20
-0.18
0.38
-0.15
0.37
ns
211/23
211/23
211/23
205/24
-0.10
-0.06
0.70
0.28
0.30
0.24
0.46
0.45
-0.22
0.00
0.74
0.25
0.42
0.00
0.45
0.44
group
SD
ns
ns
ns
ns
Note: N = sample size; M = mean; SD = standard deviation; p = p value indicating statistical significance from a two -tailed
permutation test with 10,000 replications. ‘ns’ indicates the variable is not statistically significant. ‘p<.01’ and
‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively.
Comparison of Parent Outcomes
Tables S.2-4 compares the parent outcomes of the PCPS treatment group and the PCPS
comparison group. When these outcomes were measured at 15 months for participants in
both groups, the comparison group had not yet received any of the PCPS, while the
treatment group had been in the programme since 3 months.
101
As evident in Table S.2, the treatment group had significantly lower parenting stress levels,
as measured by the Parenting Stress Index (PSI), compared to the comparison group
(p<0.05). This result was primarily driven by a lower score on the Difficult Child subscale
which assesses how easy a parent finds managing their child’s behaviour.
Table S.2 PCPS Treatment group versus PCPS Comparison group results: Parenting Stress
Index (PSI) - Defensive Responding Included
15 Months
nPCPS/
ncomp
PCPS treatment
group
M
SD
PCPCP
P value
comparison
M
Total Stress
Parental Distress
Parent-Child Dysfunctional
Interaction
176/18
176/18
61.18
23.15
15.16
7.01
SD
group
68.56
16.60
25.67
10.03
176/18
16.76
4.73
18.28
4.94
p<.05
ns
ns
Difficult Child
176/18
21.28
6.54
24.61
5.45
p<.05
Note: N = sample size; M = mean; SD = standard deviation; p = p value indicating statistical significance from a one-tailed
permutation test with 10,000 replications. ‘ns’ indicates the variable is not statistically significant. ‘p<.01’ and
‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively.
The PSI/SF also includes a scale to measure defensive responding, which is used to identify parents
who may be trying to respond to a question in a way that makes them look more favourable to the
researcher. Parents who score high on this scale may be trying to minimise any problems, stress, or
negativity in their relationship with their child. Therefore the analysis was repeated by omitting
these participants and the results are reported in Table S.3. In the repeated analysis, the significant
change in the overall levels of parenting stress and the Difficult Child subscale were no longer
observed.
Table S.3 PCPS Treatment group versus PCPS Comparison group results: Parenting Stress
index (PSI) - Defensive Responding Excluded
15 Months
nPCPS/
ncomp
PCPS treatment
group
PCPCP
P value
comparison
M
SD
M
Total Stress
Parental Distress
Parent-Child Dysfunctional
Interaction
124/14
124/14
68.02
26.44
12.20
5.56
SD
group
73.57
15.13
28.79
9.02
124/14
18.26
4.76
19.71
4.63
ns
Difficult Child
124/14
23.32
6.32
25.07
5.82
ns
ns
ns
Note: N = sample size; M = mean; SD = standard deviation; p = p value indicating statistical significance from a one-tailed
permutation test with 10,000 replications. ‘ns’ indicates the variable is not statistically significant. ‘p<.01’ and
‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively.
102
Parenting self-esteem was measured using the Parental Sense of Competence Scale (PSOC). Table
S.4 demonstrates that there were no significant differences between participants in the PCPS
treatment group and the PCPS comparison group on either the total score or the two subscales.
Table S.4 PCPS Treatment group versus PCPS Comparison group results: Parental Sense of
Competence Scale (PSOC)
15 Months
nPCPS/
ncomp
PCPS treatment
group
PCPCP
P value
comparison
Total PSOC
Parental Efficacy
Parental Satisfaction
174/18
174/18
174/18
M
SD
73.45
31.27
42.18
10.19
5.21
6.61
M
SD
group
70.44
10.53
30.44
5.62
40.00
6.15
ns
ns
ns
Note: N = sample size; M = mean; SD = standard deviation; p = p value indicating statistical significance from a one-tailed
permutation test with 10,000 replications. ‘ns’ indicates the variable is not statistically significant. ‘p<.01’ and
‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively.
Comparison of Child Outcomes
Tables S.5-6 compare the child outcomes of the PCPS treatment group and the PCPS
comparison group which were measured when the children were 18 months of age. At this
stage the comparison group had received at least one programme visit, while the treatment
group had been in the programme since 3 months.
Child development was assessed through the administration of the Gesell Developmental Schedules
at the 18 month programme visit. A development quotient (DQ) was obtained for each child using
the following developmental fields: global (overall), adaptive (alertness, intelligence, constructive
exploration), gross motor (balance, sitting, locomotion, postural reactions), fine motor (manual
dexterity), language (facial expression, gestures, vocalisations) and personal-social (feeding, playing,
toilet training). The DQ expresses the norm of the child’s development with a DQ of 100 indicating
that the child is exactly on target for their age and a DQ of 85 and above indicating normal
development. A DQ below 85 indicates a developmental delay.
Table S.5 shows that there were no differences in the PCPS treatment and comparison group DQ
scores at 18 months. Table 6 shows that children in the PCPS treatment group were less at risk of
non-normal development regarding gross motor skills (p<.05) compared to children in the
comparison group. No other differences were observed.
103
Table S.5 PCPS Treatment group versus PCPS Comparison group results: Developmental
Quotient Scores
18 Months
nPCPS/
ncomp
PCPS treatment
group
PCPCP
P value
comparison
Global DQ
Adaptive DQ
Gross Motor DQ
Fine Motor DQ
Language DQ
Personal & Social DQ
208/23
211/24
211/24
211/24
202/24
211/24
M
SD
94.55
92.68
96.91
93.73
0.35
93.67
9.41
11.03
11.22
12.02
0.48
10.20
M
SD
group
94.60
13.60
92.55
14.07
95.36
15.32
94.47
13.45
0.25
0.44
94.03
13.35
ns
ns
ns
ns
ns
ns
Note: N = sample size; M = mean; SD = standard deviation; p = p value indicating statistical significance from a one-tailed
permutation test with 10,000 replications. ‘ns’ indicates the variable is not statistically significant. ‘p<.01’ and
‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively.
Table S.6 PCPS Treatment group versus PCPS Comparison group results: Developmental
Quotient Cutoff Scores (<85)
18 Months
Global cutoff
Adaptive cutoff
Gross Motor cutoff
Fine Motor cutoff
Language cutoff
Personal & Social cutoff
nPCPS/
ncomp
202/23
205/24
210/24
207/24
202/24
204/24
PCPS treatment
group
PCPCP
P value
comparison
M
SD
M
0.12
0.20
0.10
0.17
0.35
0.14
0.32
0.40
0.31
0.38
0.48
0.35
0.17
0.25
0.25
0.13
0.25
0.13
group
SD
0.39
0.44
0.44
0.34
0.44
0.34
ns
ns
p<.05
ns
ns
ns
Note: N = sample size; M = mean; SD = standard deviation; p = p value indicating statistical significance from a one-tailed
permutation test with 10,000 replications. ‘ns’ indicates the variable is not statistically significant. ‘p<.01’ and
‘p<.05’ indicate that the test is statistically significant at the 1% and 5% level respectively.
Summary
The aim of this additional analysis was to assess the impact of the full PCPS to a less
intensive version of the programme which focused on the last one or two programme visits.
There was little evidence that the full PCPS had an impact on improving parenting stress and
parental self-competence. While there was some evidence that parents who received the
programme up to 15 months found it easier to manage their child’s behaviour than those
who just joined the programme at 15 months, this result did not remain when parents who
responded defensively were removed from the analysis. Similarly, there is little evidence
that the full PCPS had an impact on improving child development. While the programme
had limited impact on overall adaptive, fine motor, language, and personal-social
104
development, children who received the full programme were less at risk of delayed gross
motor skills. Thus overall, the more intensive programme did not improve parental wellbeing or child development compared to the less intensive version. A significant caveat to
this additional analysis is that it is based on a comparison of a large treatment group (>200)
and a relatively small comparison group (~24), thus caution must be applied when
interpreting the results from this analysis.
105
Appendix T:
Survey with Non-Participants
106
107
108
109
110
111
112
113
Appendix U:
Engagement and Attrition Analyses Variables
Table U.1 Characteristics examined as potentially influencing engagement and attrition
Variable
Family
Single Parent
Economic Problems
Planned pregnancy
Number of other children the mother has
Irish Family
Mother
Age of Mother
Mother is unemployed
Mother 3rd Level qualification
Breastfed
Health problems (Mother)
PSI Raw Score
PSOC Raw Score
Father
Age of Father
Father 3rd Level qualification
Health problems (Father)
Description
As described
Programme staff assess whether participants
have economic problems or not by considering
their occupation / employment status
Indicates whether or not the pregnancy was
planned
The number of children the mother has,
excluding the child in the programme
Indicates whether or not both parents are Irish
Mother’s chronological age
As described
Mother has at least a 3rd Level qualification
Indicates if the mother has ever breastfed the
child
Indicates if any health problems which may affect
parenting were reported by the mother during
the initial interview
PSI refers to parents’ self-reported level of stress
as per the Parenting Stress Index (PSI)
PSOC refers to parents’ self-reported level of
competence as per the Parenting Sense of
Competence Scale (PSOC).
As described
Father has at least a 3rd Level qualification
Indicates if any health problems which may affect
parenting were reported by the father during the
initial interview
Father Unemployed
Child
As described
Low Birth Weight (< 3%ile)
A child is considered low birth weight if they are
lighter than 95% of their cohort at birth
Child is Male
As described
114
Appendix V:
Additional tables for analyses of PSPCP outcomes
Table V.2 Changes in CITMI-R interaction and non-interaction scores between 3 and 12 months
Parent-child Interaction
N
Wilcoxon T
p
Interaction - Sensitivity
57
5.59
n.s.
Interaction - Protective
56
27.70
<0.001
Interaction - Disengaged
52
2.11
n.s.
Interaction - Intrusive
56
18.98
<0.001
Non Interaction - Sensitivity
57
34.76
<0.001
Non Interaction- Protective
55
8.46
<0.05
Non Interaction - Intrusive
55
5.75
n.s.
115
Table V.3 Wilcoxon signed ranks tests comparing CITMI-R interaction scores between 3 and 12
months.
Parent-child Interaction
Z
P (2-tailed)
Interaction - Sensitivity
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Interaction – Protective
-2.545
-1.689
-.881
-1.142
-1.856
-.873
.011
.091
.378
.253
.063
.383
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Interaction – Disengaged
-1.399
-2.854
-4.113
-1.735
-3.506
-1.641
.162
.004*
.000*
.083
.000*
.101
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Interaction – Intrusive
-.556
-.556
-1.131
.000
-.577
-.577
.579
.579
.258
1.000
.564
.564
-.883
-1.633
-4.096
-1.356
-3.830
-3.248
.377
.102
.000*
.175
.000*
.001*
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Note. Bonferroni-adjusted significance level = 0.008
116
Table V.4 Post-hoc Wilcoxon signed ranks tests comparing CITMI-R non-interaction scores
between 3 and 12 months.
Parent-child Interaction
Z
P (2-tailed)
Non-Interaction - Sensitivity
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Non-Interaction – Protective
-2.227
-4.095
-4.813
-2.749
-3.328
-1.011
.026
.000**
.000**
.006*
.001*
.312
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Non-Interaction – Intrusive
-1.844
-.700
-.713
-.774
-1.800
-1.756
.065
.484
.476
.439
.072
.079
-.775
-.659
-.928
-.768
-1.722
-1.806
.439
.510
.354
.443
.085
.071
3 – 5 months
3 - 7 months
3 - 12 months
5 - 7 months
5 – 12 months
7 – 12 months
Note. Bonferroni-adjusted significance level = 0.008
117
Table V.5 Changes in CITMI-R interaction and non-interaction scores between 5 and 18 months
Parent-child Interaction
N
Wilcoxon T
p
Interaction - Sensitivity
158
5.59
n.s.
Interaction - Protective
154
27.70
<0.001
Interaction - Disengaged
151
2.11
n.s.
Interaction - Intrusive
158
18.98
<0.001
Non Interaction - Sensitivity
158
65.21
<0.001
Non Interaction- Protective
156
7.94
<0.05
Non Interaction - Intrusive
157
18.23
<0.001
Table V.6 Post-hoc Wilcoxon signed ranks tests comparing CITMI-R interaction scores between 5
and 12 months.
Parent-child Interaction
Z
P (2-tailed)
Interaction - Sensitivity
5 - 7 months
5 – 12 months
7 – 12 months
Interaction – Protective
-1.270
-1.860
-.676
.204
.063
.499
5 - 7 months
5 – 12 months
7 – 12 months
Interaction – Disengaged
-3.907
-6.122
-3.066
.000**
.000**
.002*
5 - 7 months
5 – 12 months
7 – 12 months
Interaction – Intrusive
-.172
-.742
-.687
.863
.458
.492
5 - 7 months
-4.126
.000**
5 – 12 months
-8.433
.000**
7 – 12 months
-6.164
.000**
Note. Bonferroni-adjusted significance level = 0.017
118
Table V.7 Post-hoc Wilcoxon signed ranks tests comparing CITMI-R non-interaction scores
between 5 and 12 months.
Parent-child Interaction
Z
P (2-tailed)
Non-interaction - Sensitivity
5 - 7 months
5 – 12 months
7 – 12 months
Non-interaction – Protective
-5.059
-7.558
-3.687
.000**
.000**
.000**
5 - 7 months
5 – 12 months
7 – 12 months
Non-interaction – Intrusive
-1.721
-3.206
-1.955
.085
.001*
.051
5 - 7 months
-1.191
.234
5 – 12 months
-3.332
.001**
7 – 12 months
-2.538
.011*
Note. Bonferroni-adjusted significance level = 0.017
Table V.8 Post-hoc Wilcoxon signed ranks tests comparing global DQs between 3 and 18 months.
Global DQ
Z
P (2-tailed)
3 - 5 months
-1.378
.168
3 - 7 months
-1.931
.053
3 - 12 months
-.661
.508
3 - 18 months
-.469
.639
5 – 7 months
-.544
.587
5 - 12 months
-1.209
.227
5 - 18 months
-1.575
.115
7 - 12 months
-2.325
.020
7 – 18 months
-1.987
.047
12 - 18 months
-.591
.555
Note. Bonferroni-adjusted significance level = 0.005
Table V.9 Post-hoc Wilcoxon signed ranks tests comparing global DQs between 5 and 18 months.
Global DQ
Z
P (2-tailed)
5 – 7 months
-.374
.708
5 - 12 months
-3.995
.000**
5 - 18 months
-3.380
.001*
7 - 12 months
-4.949
.000**
7 – 18 months
-3.347
.001*
12 - 18 months
-.301
.763
Note. Bonferroni-adjusted significance level = 0.008
119
Table V.10 Post-hoc Wilcoxon signed ranks tests comparing adaptive DQs between 3 and 18
months.
Adaptive DQ
Z
P (2-tailed)
3 - 5 months
-.975
.330
3 - 7 months
-2.282
.022
3 - 12 months
-1.154
.249
3 - 18 months
-.731
.465
5 – 7 months
-1.397
.163
5 - 12 months
-.047
.963
5 - 18 months
-.572
.567
7 - 12 months
-2.512
.012
7 – 18 months
-1.997
.046
12 - 18 months
-.581
.561
Note. Bonferroni-adjusted significance level = 0.005
Table V.11 Post-hoc Wilcoxon signed ranks tests comparing adaptive DQs between 5 and 18
months.
Adaptive DQ
Z
P (2-tailed)
5 – 7 months
-.770
.441
5 - 12 months
-3.057
.002*
5 - 18 months
-2.463
.014
7 - 12 months
-4.706
.000**
7 – 18 months
-3.190
.001*
12 - 18 months
-.204
.839
Note. Bonferroni-adjusted significance level = 0.008
Table V.12 Post-hoc Wilcoxon signed ranks tests comparing gross motor DQs between 3 and 18
months.
Gross motor DQ
Z
P (2-tailed)
3 - 5 months
-1.075
.283
3 - 7 months
-.546
.585
3 - 12 months
-1.466
.143
3 - 18 months
-1.457
.145
5 – 7 months
-.173
.863
5 - 12 months
-.738
.461
5 - 18 months
-2.167
.030
7 - 12 months
-1.494
.135
7 – 18 months
-2.614
.009
12 - 18 months
-3.634
.000*
Note. Bonferroni-adjusted significance level = 0.005
120
Table V.13 Post-hoc Wilcoxon signed ranks tests comparing gross motor DQs between 5 and 18
months.
Gross motor DQ
Z
P (2-tailed)
5 – 7 months
-1.748
.080
5 - 12 months
-1.621
.105
5 - 18 months
-2.612
.009
7 - 12 months
-.147
.883
7 – 18 months
-4.507
.000*
12 - 18 months
-5.114
.000*
Note. Bonferroni-adjusted significance level = 0.008
Table V.14 Post-hoc Wilcoxon signed ranks tests comparing fine motor DQs between 3 and 18
months.
Fine motor DQ
Z
P (2-tailed)
3 - 5 months
-2.636
.008
3 - 7 months
-3.646
.000*
3 - 12 months
-3.242
.001*
3 - 18 months
-1.994
.046
5 – 7 months
-1.621
.105
5 - 12 months
-.028
.978
5 - 18 months
-.619
.536
7 - 12 months
-2.231
.026
7 – 18 months
-1.967
.049
12 - 18 months
-1.020
.308
Note. Bonferroni-adjusted significance level = 0.005
Table V.15 Post-hoc Wilcoxon signed ranks tests comparing fine motor DQs between 5 and 18
months.
Fine motor DQ
Z
P (2-tailed)
5 – 7 months
-2.334
.020
5 - 12 months
-.907
.364
5 - 18 months
-1.087
.277
7 - 12 months
-4.646
.000*
7 – 18 months
-2.916
.004*
12 - 18 months
-.143
.886
Note. Bonferroni-adjusted significance level = 0.008
121
Table V.16 Post-hoc Wilcoxon signed ranks tests comparing language DQs between 3 and 18
months.
Language DQ
Z
P (2-tailed)
3 - 5 months
-1.279
.201
3 - 7 months
-.656
.512
3 - 12 months
-.082
.935
3 - 18 months
-2.750
.006
5 – 7 months
-1.181
.238
5 - 12 months
-2.067
.039
5 - 18 months
-4.071
.000*
7 - 12 months
-1.466
.143
7 – 18 months
-4.517
.000*
12 - 18 months
-3.907
.000*
Note. Bonferroni-adjusted significance level = 0.005
Table V.17 Post-hoc Wilcoxon signed ranks tests comparing language DQs between 5 and 18
months.
Language DQ
Z
P (2-tailed)
5 – 7 months
-2.763
.006*
5 - 12 months
-5.798
.000*
5 - 18 months
-7.674
.000*
7 - 12 months
-4.070
.000*
7 – 18 months
-7.793
.000*
12 - 18 months
-5.898
.000*
Note. Bonferroni-adjusted significance level = 0.008
Table V.18 Post-hoc Wilcoxon signed ranks tests comparing personal and social DQs between 3
and 18 months.
Personal and social DQ
Z
P (2-tailed)
3 - 5 months
-2.477
.013
3 - 7 months
-2.147
.032
3 - 12 months
-1.703
.089
3 - 18 months
-.018
.985
5 – 7 months
-.965
.334
5 - 12 months
-.974
.330
5 - 18 months
-2.577
.010
7 - 12 months
-.146
.884
7 – 18 months
-2.386
.017
12 - 18 months
-2.623
.009
Note. Bonferroni-adjusted significance level = 0.005
122
Table V.19 Post-hoc Wilcoxon signed ranks tests comparing personal and social DQs between 5
and 18 months.
Personal and social DQ
Z
P (2-tailed)
5 – 7 months
-2.842
.004*
5 - 12 months
-2.150
.032
5 - 18 months
-5.292
.000*
7 - 12 months
-.854
.393
7 – 18 months
-3.736
.000*
12 - 18 months
-4.153
.000*
Note. Bonferroni-adjusted significance level = 0.008
123
Table V.20: Dosage effects and child development and parent-child interaction
Control for 3month scores
Control for 5month scores
p
N
Beta
Control for 5month scores,
mother’s education
& number of other
children
N
Beta
p
N
Beta
p
Global DQ
65
0.12
.210 163
0.15 0.044 161
0.15 0.062
Adaptive DQ
65
0.17
.186 167
0.19
0.009 165
0.18 0.016
Gross motor DQ
66
-0.05 .716 167
0.06 0.393 165
0.05 0.492
Fine motor DQ
66
0.19
.128 167
0.09
0.235 165
0.08 0.308
Language DQ
66
0.02
.897 166
0.18 0.013 164
0.17 0.028
Personal & social DQ
66
-0.04 .751 169 -0.10
0.178 167
-0.12 0.096
Interaction – sensitive (s)
65
-.07
.595 164
.02
.809 162
.03
.725
Interaction – intrusive (t)
64
-.63
.000 164
-.33
.000 162
-.31
.000
Interaction – protective (p)
65
-.45
.000 164
-.22
.004 162
-.23
.003
Interaction – disengaged (f)
60
-.51
.000 159
-.16
.042 157
-.16
.047
Non-interaction – sensitive
65
-.12
.341 164
-.06
.412 162
-.03
.702
Non-interaction – intrusive (t)
63
-.53
.000 163
-.31
.000 161
-.30
.000
Non-interaction – protective (p) 63
-.43
.000 164
-.17
.023 162
-.19
.018
Child development
Parent-child interaction
124
Table V.21: Average number of visits for attachment types
Average number
of visits
N
Insecureavoidant
Insecureambivalent
Secure
P
200
4.75
5.09
4.88
ns
Table V.22: Dosage effects and attachment
Control for 5-month scores,
mother’s education & number
of other children
No controls
N
Beta
p
N
Beta
p
Secure vs insecure avoidant
200
-.15
0.455
198
-.09
0.685
Secure vs insecure
ambivalent
200
.29
0.315
198
.32
0.273
Attachment
125
Table V.23 Association between gender, mother’s education, nationality of family and PSI/SF
scores
Male/Female
High/Low mother’s
education
Irish/Non-Irish
family
N
β
p
N
β
p
N
β
p
Total PSI
174
0.01
n.s.
172
0.01
n.s.
174
-0.05
n.s.
Parental Distress
179
-0.03
n.s.
177
-0.04
n.s.
179
0.01
n.s.
Parent child
dysfunctional
interaction
178
0.02
n.s.
176
0.07
n.s.
178
-0.18
.007**
Difficult child
180
0.06
n.s.
178
0.02
n.s.
180
-0.02
n.s.
Table V.24 Association between gender, mother’s education, nationality of family and PSOC scores
Male/Female
High/Low mother’s
education
Irish/Non-Irish
family
N
β
p
N
β
p
N
β
p
Total PSOC
178
-0.10
n.s.
176
0.09
n.s.
178
-0.06
n.s.
Efficacy
178
-0.10
n.s.
176
0.06
n.s.
178
-0.05
n.s.
Satisfaction
178
-0.07
n.s.
176
0.08
n.s.
178
-0.05
n.s.
126
Table V.25 Association between gender, mother’s education, nationality of family and changes in
CITMI-R scores between 3 and 15 months
High/Low mother’s
education
Male/Female
Irish/Non-Irish family
F
p
η2
F
p
η2
F
p
η2
Interaction - Sensitivity
4.83
<0.05
0.08
0.89
n.s.
0.02
1.18
n.s.
0.02
Interaction - Protective
0.50
n.s.
0.01
0.78
n.s.
0.02
0.30
n.s.
0.01
Interaction - Disengaged
0.75
n.s.
0.02
1.67
n.s.
0.03
1.42
n.s.
0.03
Interaction - Intrusive
1.00
n.s.
0.02
0.47
n.s.
0.01
0.53
n.s.
0.01
Non Interaction - Sensitivity
0.07
n.s.
0.00
0.89
n.s.
0.02
0.15
n.s.
0.00
Non Interaction- Protective
1.53
n.s.
0.03
0.29
n.s.
0.01
0.66
n.s.
0.01
Non Interaction - Intrusive
0.43
n.s.
0.01
0.78
n.s.
0.02
0.02
n.s.
0.00
Table V.26 Association between gender, mother’s education, nationality of family and changes in
CITMI-R scores between 5 and 15 months
High/Low mother’s
education
Male/Female
Irish/Non-Irish family
F
p
η2
F
p
η2
F
p
η2
Interaction - Sensitivity
0.81
n.s.
0.01
2.04
n.s.
0.01
3.76
n.s.
0.02
Interaction - Protective
0.83
n.s.
0.01
1.70
n.s.
0.01
0.28
n.s.
0.00
Interaction - Disengaged
0.35
n.s.
0.00
2.20
n.s.
0.02
0.52
n.s.
0.00
Interaction - Intrusive
0.54
n.s.
0.00
3.95
<0.05
0.03
1.66
n.s.
0.01
Non Interaction - Sensitivity
3.34
n.s.
0.02
0.01
n.s.
0.00
0.01
n.s.
0.00
Non Interaction- Protective
5.28
<0.05
0.03
0.68
n.s.
0.00
0.16
n.s.
0.00
Non Interaction - Intrusive
0.66
n.s.
0.00
2.41
n.s.
0.02
0.16
n.s.
0.00
127
Table V.27 Association between gender, mother’s education, nationality of family and changes in
developmental quotients (DQs) between 3 and 18 months
High/Low mother’s
education
Male/Female
Irish/Non-Irish family
F
p
η2
F
p
η2
F
p
η2
Global DQ
1.24
n.s.
0.03
0.00
n.s.
0.00
0.29
n.s.
0.01
Adaptive DQ
1.37
n.s.
0.03
0.05
n.s.
0.00
0.10
n.s.
0.00
Gross motor DQ
0.01
n.s.
0.00
0.23
n.s.
0.01
0.44
n.s.
0.01
Fine motor DQ
0.71
n.s.
0.01
0.04
n.s.
0.00
0.33
n.s.
0.01
Language DQ
0.28
n.s.
0.01
0.13
n.s.
0.00
0.07
n.s.
0.00
Personal & social DQ
0.25
n.s.
0.01
0.07
n.s.
0.00
0.03
n.s.
0.00
Developmental Quotient (DQ)
Table V.28 Association between gender, mother’s education, nationality of family and changes in
DQs between 5 and 18 months
High/Low mother’s
education
Male/Female
Irish/Non-Irish family
F
p
η2
F
p
η2
F
p
η2
Global DQ
0.00
n.s.
0.00
0.15
n.s.
0.00
0.70
n.s.
0.01
Adaptive DQ
0.18
n.s.
0.00
0.13
n.s.
0.00
1.96
n.s.
0.01
Gross motor DQ
1.17
n.s.
0.01
0.24
n.s.
0.00
0.46
n.s.
0.00
Fine motor DQ
0.00
n.s.
0.00
0.11
n.s.
0.00
1.47
n.s.
0.01
Language DQ
0.28
n.s.
0.00
0.92
n.s.
0.01
2.61
n.s.
0.02
Personal & social DQ
0.00
n.s.
0.00
0.04
n.s.
0.00
1.15
n.s.
0.01
Developmental Quotient (DQ)
128
Appendix W:
Additional engagement and attrition analyses
Engagement and attrition can be calculated a number of different ways. In the final report, the level
of engagement in PCPS was examined by assessing programme attendance, looking at how many
participants attended the introductory visit only, one visit, two visits and so on. Meanwhile attrition
was investigated by comparing those who had attended 3 or more visits (defined by Cerezo (2003)
as programme completers with those who had attended less than 3 visits. Alternative analyses of
engagement and attrition were also carried out and are presented below.
Total Number of Missed Visits:
Table W.1 reports the mean number of missed visits for each of the mother, father, family and child
binary characteristics. This is an alternative method of calculating programme engagement. T tests
were conducted to test for statistically significant differences in levels of engagement between each
category. The table also reports the relationship between the continuous family, parent and child
characteristics and the total number of visits missed. Parents with economic problems missed more
visits on average (p<.05) - the average number of missed visits for those who reported economic
problems was 2.12 missed visits, compared to 1.62 missed visits for those who did not report
economic problems. Parents missed more visits on average if the pregnancy had been unplanned
(p<.01), missing an average of 2.18 visits compared with 1.63 missed visits when the pregnancy had
been planned. Participants who reported maternal unemployment missed more visits on average
(p<.05), reporting an average of 2.17 missed visits, compared to 1.63 when the mother was in
employment. Higher-level maternal education (p<.01) and breastfeeding (p<.01) were both
associated with fewer missed visits. On the paternal side, reported health problems were associated
with fewer visits (p<.01).
The bivariate regressions indicated that the number of other children in the family was significantly
positively related to the number of missed visits (p<.05). In other words, children with siblings were
more likely to miss visits than those without siblings. There were no significant differences for the
other characteristics.
When looking at the multivariate analysis, only one variable – number of other siblings – had an
independent impact on the number of missed visits.
129
Table W.1: Associations between binary and continuous family, parental and child characteristics
and total number of missed visits
N
Yes
(nyes / nno)
M
No
(SD)
P
M
(SD)
Family Characteristics
Single Parent
333
(123/210)
1.95
(1.90)
1.81
(1.85)
ns
Economic Problems
333
(162/171)
2.12
(1.92)
1.62
(1.79)
<.05
Planned Pregnancy
332
(187/145)
1.63
(1.73)
2.18
(2.0)
<.01
Irish Family
332
(239/93)
1.87
(1.89)
1.84
(1.82)
ns
Mother's Characteristics
Health Problems Mother
329
(89/240)
1.92
(1.81)
1.83
(1.89)
ns
rd
Mother 3 level Education
327
(93/234)
1.39
(1.64)
2.04
(1.93)
<.01
Mother Unemployed
330
(139/191)
2.17
(1.97)
1.63
(1.75)
<.05
Breastfed
324
(79/245)
1.37
(1.63)
2.04
(1.91)
<.01
Father's Characteristics
rd
Father 3 Level Education
283
(87/196)
1.67
(1.71)
1.92
(1.95)
ns
Unemployed Father
282
(110/172)
2.1
(1.89)
1.76
(1.87)
ns
Health Problems Father
289
(46/243)
1.33
(1.51)
2.00
(1.94)
<.01
Child Characteristics
Male Child
333
(165/168)
1.83
(1.79)
1.9
(1.95)
ns
Low Birth Weight
333
(32/301)
2.03
(1.96)
1.84
(1.86)
ns
Continuous measures
N
Relationship
M (SD)
P
Mother’s Age
331
-
29.17 (6.21)
ns
Number of other children
mother has
333
+
0.95 (1.21)
<.01
Father’s Age
293
-
31.2 (6.43)
ns
PSI Total
298
+
65.64 (15.52)
ns
Parent Sense of Competence
301
-
71.98 (8.95)
ns
Note. ‘N’ indicates the sample size. ‘n’ indicates size individual groupings within the overall sample. ‘M’
indicates the mean. ‘SD’ indicates the standard deviation. ‘P’ indicates the p value. ‘p<.01’ and ‘p<.05’ indicate
that the test is statistically significant at the 1% and 5% level respectively. ‘ns’ indicates the variable is not
statistically significant
130
Participants who attended all visits versus those who did not attend all visits:
Another way of calculating programme engagement was to compare attendance at all visits to
attendance at less than all visits. A binary variable was created to indicate participants who attended
all visits versus those who did not attend all visits. Permutation tests (with 1,000 replications) were
used to test for significant differences in characteristics between the two groups. Table W.2 shows
that people who attended all visits reported significantly less economic problems than those who did
not attend all visits (p<.05), and families with fewer children were more likely to attend all visits on
average than those with more children (p<.01). There were no significant differences for the
remaining characteristics.
131
Table W.2: Permutation tests comparing the characteristics of children, parents and families who attended all visits versus those who did
not
Variables
Attended all Visits
Did not attend all Visits
P
N
Mean
(SD)
N
Mean
(SD)
Single Parent
98
0.35
(0.48)
235
0.38
(0.49)
ns
Economic Problems
98
0.39
(0.49)
235
0.53
(0.5)
<.05
Planned pregnancy
97
0.61
(0.49)
235
0.55
(0.5)
ns
Irish Family
98
0.71
(0.45)
234
0.72
(0.49)
ns
Age of Mother
97
29.01
(5.85)
234
29.24
(6.38)
ns
Health problems of parent which may affect parenting (Mother)
97
0.21
(0.41)
232
0.30
(0.46)
ns
Mother has at least 3rd Level or Postgrad. qualification
96
0.37
(0.48)
231
0.25
(0.44)
ns
Mother Unemployed
97
0.35
(0.48)
233
0.45
(0.5)
ns
Does the mother breastfeed
93
0.31
(0.47)
231
0.22
(0.41)
ns
Number of other children the mother has
98
0.65
(0.92)
235
1.08
(1.3)
<.01
PSI Total
90
65.89
(16.28)
208
65.53
(15.21)
ns
PSOC Total
92
71.40
(8.53)
209
72.23
(9.13)
ns
Age of Father
88
31.31
(6.27)
205
31.16
(6.51)
ns
Health problems of parent which may affect parenting (Father)
86
0.2
(0.4)
203
0.14
(0.35)
ns
Father has at least 3rd Level or Postgrad. qualification
87
0.29
(0.46)
196
0.32
(0.47)
ns
Father Unemployed
83
0.33
(0.47)
199
0.42
(0.49)
ns
Child is Male
98
0.47
(0.5)
235
0.51
(0.5)
ns
Low Birth Weight (< 3%ile)
98
0.08
(0.28)
235
0.10
(0.30)
ns
Family Characteristics
Mother Characteristics
Father Characteristics
Notes:
‘N’ indicates
the sample size.
‘M’ indicates
the mean. ‘SD’
indicates the
standard
deviation. ‘P’
indicates the p
value from a
permutation
test with 1000
replications. ‘ns’
indicates the
variable is not
statistically
significant.
‘p<.01’ and
‘p<.05’ indicate
that the test is
statistically
significant at
the 1%, and 5%
level
respectively.
Child Characteristics
132
Attrition Analyses:
Attrition was examined using three different variables. The results of the statistical tests comparing
the characteristics of the attrition and non-attrition groups using Permutation tests are presented in
Tables W.3, W.4 and W.5.
In Table W.3 attrition is defined as missing the 18 month visit. Statistical differences were found
between the two groups on two measures. Families who missed the 18 month visit were more likely
to have had an unplanned pregnancy (p<.05) and to have mothers with less than third-level
education (p<.05) than those who attended the 18 month visit. None of the remaining
characteristics predicted attrition.
In Table W.4 attrition is defined as missing two consecutive visits. Families who missed two
consecutive visits statistically differed from those who did not miss two consecutive visits in several
ways. Firstly, the pregnancy was less likely to have been planned (p<.01) and the family were more
likely to experience economic problems (p<.05). Secondly, maternal characteristics were associated
with missing consecutive visits; third-level education (p<.05) and breastfeeding (p<.01) were
negatively associated while maternal unemployment (p<.05), number of other children (p<.01) and
the parental stress score (p<.05) were positively associated with missing consecutive visits. Finally,
on the paternal side, only unemployment was positively associated with missing consecutive visits
(p<.05).
Table W.5 compares characteristics of completers and non-completers, where completion is defined
as attending 3 or more visits (Cerezo, 2003). Families who were deemed completers differed
statistically from non-completers in a number of ways. Completers had fewer economic problems
(p<.05) and were more likely to have planned pregnancies (p<.01). Unemployed mothers (p<.01) and
fathers (p<.05) were significantly less likely to complete. Nursing mothers (p<.01) and mothers with
third level education (p<.01) were more likely to be completers. And finally, mothers who completed
the programme had significantly lower Parenting Stress scores than non-completers (p<.01).
Our multivariate analysis shows the importance of maternal education as an indicator of attrition.
Those with third level education were less like to miss the final visit (p<0.1) and more likely to attend
at least three visits (p<0.1). Breastfeeding is also shown to be a predictor of attending three or more
visits (p<0.5) and finally, Parental Stress is associated with a lower likelihood of attending three or
more visits (p<0.5).
133
Table W.3: Association between Attrition and Participant Characteristics: Missed 18 month visit
Variables
Non-Attrition
Attrition
P
N
Mean
SD
N
Mean
SD
Single Parent
213
0.36
(0.48)
120
0.39
(0.49)
ns
Economic Problems
213
0.45
(0.5)
120
0.55
(0.5)
ns
Planned pregnancy
212
0.61
(0.49)
120
0.48
(0.5)
<.05
Irish Family
213
0.74
(0.44)
119
0.69
(0.47)
ns
Age of Mother
212
29.56
(6.1)
119
28.49
(6.39)
ns
Health problems of parent which may affect parenting (Mother)
211
0.27
(0.44)
118
0.28
(0.45)
ns
Mother has at least 3rd Level or Postgrad. qualification
210
0.33
(0.47)
117
0.2
(0.4)
<.05
Mother Unemployed
212
0.39
(0.49)
118
0.48
(0.5)
ns
Does the mother breastfeed
207
0.29
(0.45)
117
0.17
(0.38)
ns
Number of other children the mother has
213
0.9
(1.12)
120
1.05
(1.37)
ns
PSI Total
197
64.73
(15.86)
101
67.42
(14.75)
ns
PSOC Total
198
72.09
(8.7)
103
71.77
(9.43)
ns
Age of Father
188
31.5
(6.16)
105
30.88
(6.88)
ns
Father has at least 3rd Level or Postgrad. qualification
183
0.33
(0.47)
100
0.27
(0.45)
ns
Health problems of parent which may affect parenting (Father)
183
0.18
(0.39)
106
0.12
(0.33)
ns
Father Unemployed
179
0.36
(0.48)
103
0.44
(0.5)
ns
Child is Male
102
0.46
(0.5)
231
0.51
(0.5)
ns
Low Birth Weight (< 3%ile)
213
0.1
(0.3)
120
0.09
(0.29)
ns
Family Characteristics
Mother Characteristics
Notes:
‘N’ indicates
the sample size.
‘M’ indicates
the mean. ‘SD’
indicates the
standard
deviation. ‘P’
indicates the p
value from a
permutation
test with 1000
replications. ‘ns’
indicates the
variable is not
statistically
significant.
‘p<.01’ and
‘p<.05’ indicate
that the test is
statistically
significant at
the 1%, and 5%
level
respectively.
Father Characteristics
Child Characteristics
134
Table W.4: Association between Attrition and Participant Characteristics: Missed 2 consecutive visits
Variables
Non-Attrition
Attrition
P
N
Mean
SD
N
Mean
SD
Single Parent
189
0.36
0.48
144
0.39
0.49
ns
Economic Problems
189
0.42
(0.5)
144
0.57
(.5)
<.05
Planned Pregnancy
188
0.63
(0.49)
144
0.48
(0.5)
<.01
Irish Family
189
0.75
(0.44)
143
0.69
(0.47)
ns
Age of Mother
188
29.19
(6.08)
143
29.15
(6.41)
ns
Health problems of parent which may affect parenting (Mother)
187
0.25
(0.43)
142
0.3
(0.46)
ns
Mother has at least 3rd Level or Postgrad. qualification
187
0.33
(0.47)
140
0.22
(0.42)
<.05
Mother Unemployed
188
0.37
(0.49)
142
0.49
(0.5)
<.05
Does the mother breastfeed
183
0.31
(0.46)
141
0.16
(0.37)
<.01
Number of other children the mother has
189
0.76
(1.01)
144
1.2
(1.4)
<.01
PSI Total
175
64.12
(15.51)
123
67.8
(15.33)
<.05
PSOC Total
176
72.54
(8.61)
125
71.18
(9.38)
ns
Age of Father
168
30.89
(6.19)
125
31.62
(6.74)
ns
Father has at least 3rd Level or Postgrad. qualification
163
0.31
(0.46)
120
0.31
(0.46)
ns
Health problems of parent which may affect parenting (Father)
164
0.19
(0.39)
125
0.12
(0.33)
ns
Father Unemployed
161
0.33
(0.47)
121
0.47
(0.5)
<.05
Child is Male
189
0.51
(0.5)
144
0.48
(0.5)
ns
Low Birth Weight (< 3%ile)
189
0.08
(0.27)
144
.12
(.32)
ns
Family Characteristics
Mother Characteristics
Notes:
‘N’ indicates
the sample size.
‘M’ indicates
the mean. ‘SD’
indicates the
standard
deviation. ‘P’
indicates the p
value from a
permutation
test with 1000
replications. ‘ns’
indicates the
variable is not
statistically
significant.
‘p<.01’ and
‘p<.05’ indicate
that the test is
statistically
significant at
the 1%, and 5%
level
respectively.
Father Characteristics
Child Characteristics
135
Table W.5: Association between Programme Completion and Participant Characteristics: Completed 3 or more visits
Variables
Non-Completed
Completed
P
N
Mean
SD
N
Mean
SD
Single Parent
102
0.42
(0.5)
231
.35
(0.48)
ns
Economic Problems
102
0.58
(0.5)
231
0.44
(0.5)
<.05
Planned pregnancy
102
0.45
(0.5)
230
0.61
(0.49)
<.01
Irish Family
101
0.73
(0.44)
231
0.71
(0.45)
ns
Age of Mother
101
28.47
(6.65)
230
29.48
(6.0)
ns
Health problems of parent which may affect parenting (Mother)
100
0.27
(0.45)
229
0.27
(0.45)
ns
Mother has at least 3rd Level or Postgrad. qualification
99
0.17
(0.38)
228
0.33
(0.47)
<.01
Mother Unemployed
100
0.54
(0.50)
230
0.37
(0.48)
<.01
Does the mother breastfeed
99
0.12
(0.39)
225
0.30
(0.33)
<.01
Number of other children the mother has
102
1.08
(1.45)
231
0.90
(1.09)
ns
PSI Total
88
69.33
(15.84)
210
64.1
(15.16)
<.01
PSOC Total
89
70.65
(9.6)
212
72.53
(8.61)
)
ns
Age of Father
90
30.63
(7.02)
203
31.45
(6.15)
ns
Father has at least 3rd Level or Postgrad. qualification
85
0.26
(0.44)
198
0.33
(0.47)
ns
Health problems of parent which may affect parenting (Father)
91
0.11
(0.31)
198
0.18
(0.39)
ns
Father Unemployed
88
0.48
(0.50)
194
0.35
(0.48)
<.05
Child is Male
102
0.46
(0.50)
231
0.51
(0.50)
ns
Low Birth Weight (< 3%ile)
102
0.11
(0.31)
231
0.09
(0.29)
ns
Family Characteristics
Mother Characteristics
Father Characteristics
Notes:
‘N’ indicates
the sample size.
‘M’ indicates
the mean. ‘SD’
indicates the
standard
deviation. ‘P’
indicates the p
value from a
permutation
test with 1000
replications. ‘ns’
indicates the
variable is not
statistically
significant.
‘p<.01’ and
‘p<.05’ indicate
that the test is
statistically
significant at
the 1%, and 5%
level
respectively.
Child Characteristics
136
Appendix X:
Fictional Case and Sources
This appendix contains the composite case created from combining some of the findings from the
evaluation to create a fictional account of the typical RSG child. The table below the account illustrates
the source of each facet of the story.
Sophie’s Story
Sophie is a little girl from Ballymun. Her mother, Ciara, is 29 and was born in Ireland. Ciara completed
her Leaving Cert and is now in paid employment, and she has another child, Sophie’s 5-year old brother.
Ciara had a normal delivery with Sophie, who was a healthy birth weight.
Sophie was 4 months old when her mam brought her to her first visit at the PCPS centre. Ciara had
received a letter about the PCPS from Ready, Steady, Grow, and had also heard about it from her local
public health nurse. There were a few things about the PCPS that Ciara was unsure of from reading the
letter, such as why they wanted to video herself and Sophie playing together. However, when she
arrived at her introductory visit the reason for this was fully explained and she decided that she would
like herself and Sophie to take part in the programme.
At Ciara’s introductory visit, the co-ordinator who works on the programme told her about the PCPS and
explained that Ciara and Sophie would see three different people at each of the six programme visits.
She asked Ciara a little bit about herself, Sophie, and their family and completed some questionnaires to
measure Ciara’s stress and how she felt about being a parent. She noted that Ciara had normal levels of
stress related to her parenting role at this time.
Over the course of the next year and a half, Sophie attended 4 of the 6 scheduled programme visits.
Unfortunately she had to miss two visits as Ciara could not find a babysitter for Sophie’s brother. At each
visit, the nurse conducted developmental checks on Sophie to monitor her growth, height, weight and
general physical health, and assess her developmental progress to make sure they identified any
problems with her development as soon as possible. Ciara was delighted to hear that Sophie’s gross
motor skills were improving over time. The nurse told Ciara that, while they were still within the normal
range, Sophie’s global, adaptive, fine motor, personal and social, and language skills were decreasing
over time in relation to expected levels of development. She gave Ciara some tips about what she could
do to help Sophie’s development in these areas.
As well as the developmental checks, the nurse also asked Ciara to play with Sophie at each visit. The
nurse videotaped them playing, and used the recording to give Ciara encouragement and tips on how
she and Sophie could get the most out of their playtime. From this Ciara learned to give Sophie space to
explore and play, while following Sophie’s lead. The nurse also checked in with Ciara on how things were
going for her and how she felt about being a parent.
137
Sophie’s second last visit was a little different from the previous visits as the nurse did a special
assessment to check Sophie’s attachment to her mother. The assessment showed that Sophie was
securely attached to her mother, which highlighted that she had a sense of trust and security in her
relationship with Ciara and knew her mother was there if she needed her.
At her final visit, a member of the PCPS staff noticed that Sophie’s speech and language skills were still
not developing as they should be, and suggested that Sophie should be referred to a speech and
language therapist to make sure everything was ok. Ciara agreed to this and the nurse made the referral
for her.
The speech and language therapist, Lucy, got in touch with Ciara after talking to the PCPS nurse and
scheduled an appointment to meet Sophie. Lucy was very busy as she had a heavy caseload and
resources were a problem for her. She was in regular contact with RSG about referrals, and had
attended one of their training sessions but she could not go to the next one as she had too much work
to do. She was disappointed about this as she wants to establish relationships with the other service
providers in Ballymun, and felt that the training arranged by RSG would provide a good opportunity for
her to collaborate with people working in the area. Lucy was interested in IMH and had a basic
understanding of it, so she wanted to do more IMH training in the future and perhaps join the IMH study
group.
After assessing Sophie, Lucy reassured Ciara that Sophie’s difficulties with language were minor and
developed a simple programme to address them, which involved returning to her for a follow-up
appointment. Ciara was relieved. By the last programme visit, Ciara felt in control of her parenting skills
and was less stressed about her role as a parent than she had been when she came for her initial
introductory visit over a year ago. She felt good about herself as a mam. Ciara was really satisfied with
the programme. She really liked the regular developmental check-ups that Sophie was getting, and she
was already recommending the programme to her friends and family. She was allowed to take home a
copy of the video of herself and Sophie playing, and was delighted to see how Sophie had grown up over
the course of the last 18 months. The reason for this was fully explained and she decided that she would
like herself and Sophie to take part in the programme.
138
Statement:
Rationale for inclusion11:
Sophie is a little girl from
Ballymun.
Her mother, Ciara, is 29 and was
born in Ireland. Ciara completed
her Leaving Cert and is now in
paid employment, and she has
another child, Sophie’s 5-year old
brother.
Ciara had a normal delivery with
Sophie, who was a healthy birth
weight.
Sophie was 4 months old when
her mam brought her to her first
visit at the PCPS centre.
The male/female ratio of PCPS infants is 49.55%/50.45%
Ciara had received a letter about
the PCPS from Ready, Steady,
Grow, and had also heard about
it from her local public health
nurse.
There were a few things about
the PCPS that Ciara was unsure
of from reading the letter, such
as why they wanted to video
herself and Sophie playing
together.
Ciara and Sophie would see three
different people at each of the
six programme visits. The nurse
asked Ciara a little bit about
herself, Sophie and their family
and
completed
some
questionnaires with Ciara to
measure her stress and how she
felt about being a parent.
The nurse noted that Ciara had
normal levels of stress related to
her parenting role at this time.
Over the course of the next year
and a half, Sophie attended 4 of
The average age of PCPS12 mothers is 29 years old
73.49% of mothers are Irish
42.8% of mothers had Leaving Cert only (this is the highest
proportion for any given category)
53.92% of mothers are in paid employment
53% of mothers had at least one other child
69.4% of deliveries listed as normal
9.6% of PCPS children were specifically highlighted as being Low
Birth Weight
The average age of an infant’s first attendance at PCPS is 4
months (3.7 months).
Most infants are brought to their first PCPS visit by their
mothers only; fathers attended the first visit in 47/333 cases.
RSG send a letter of invitation to parents of all babies born
within the catchment area.
The local PHN is also asked to inform parents about PSPCP.
From the non-participating parents survey the majority (59.1%)
of respondents indicated that they first heard of the PCPS from
the Public Health Nurse followed by letter of invitation (36.4%).
Video recording was highlighted as a concern about the
programme by two non-participating parents13.
Each programme visit involves visits to 3 separate stations, run
by 3 different people.
Some questionnaires are administered at the IV, including the
PSI/SF and the PSOC.
90% of mothers have stress levels within the normal range at
the IV (this includes defensively responding parents).
The programme runs for approximately 18 months from the IV
(shortly after birth) to the final programme visit, at 18 months
11
All data refer to the present sample of 333.
All references to “mothers” refer to PCPSP mothers in the present sample of 333.
13
Although this was not the leading reason for non-participation, it was seen as being a good example of a
question/concern that parents might have about the programme.
12
139
the 6 scheduled programme
visits.
Unfortunately she had to miss
two visits because Ciara could
not find a babysitter for Sophie’s
brother.
Ciara was delighted to hear that
Sophie’s gross motor skills were
improving over time.
The nurse told Ciara that, while
they were still within the normal
range, Sophie’s global, adaptive,
fine motor, personal and social,
and language skills were
decreasing over time in relation
to expected levels of
development.
The assessment showed that
Sophie was securely attached to
her mother which indicated that
she had a sense of trust and
security in her relationship with
Ciara and knew her mother was
there if she needed her.
At her final visit, the nurse
noticed that Sophie’s speech and
language skills still were not
developing as they should be,
and suggested that Sophie
should be referred to a speech
and language therapist to make
sure everything was ok. Ciara
agreed to this and the nurse
made the referral for her
Lucy was very busy as she had a
heavy caseload and resources
were a problem for her.
She was in regular contact with
RSG about referrals, and had
attended one of their training
of age.
The average programme attendance is 3.59 visits (engagement
analysis, section 5.5).
The number of other children in the family is an independent
predictor of engagement
Significant improvements over the course of the Programme
were observed for gross motor (p<0.001) development.
There were significant decreases in global (p<0.001), adaptive
(p<0.01), language (p<0.001), fine motor (p<0.01) development.
and personal and social development (p<0.001) over the course
of the programme.
At the 15 month visit, 73.5% of children in the programme were
classified as being securely attached through the Strange
Situation procedure
12.6% of families were referred to monthly meetings14. At the
final programme visit, developmental delays were most
frequent for language development (35%). Language
developmental delays is also a predictor of referral to a monthly
meeting (p<.01). Ratings of organisations’ engagement with
RSG, carried out for the case study, identified SLT as a highly
engaged organisation. Fifteen children from the evaluation
sample were referred to SLT services.
Stakeholder Interviews: Relevant theme: Frustration about
resources
Stakeholder Surveys: A considerable proportion of participants
indicated that they wanted to identify and address IMH needs in
Ballymun, but they simply did not have the resources (Time 1:
50%; Time 2: 33%).
Stakeholder Interviews: Relevant theme: Infant mental health
training is well received; frustration about resources.
Stakeholder Surveys: Resources are also rated as the top barrier
14
Although this does not represent the majority of PCPSP children, monthly meetings were included to
illustrate this aspect of the programme and to give the reader a sense of RSG’s relationship with the wider
service community.
140
sessions but she could not go to
the next one as she had too
much work to do.
She was disappointed about this
as she would like to establish
relationships with the other
service providers in Ballymun,
and felt that the training
arranged by RSG would provide a
good opportunity for her to meet
people working in the area.
Lucy was interested in IMH and
had a basic understanding of it,
so she wanted to do more IMH
training in the future and
perhaps join the IMH study
group.
By the last programme visit, Ciara
felt in control of her parenting
skills and was less stressed about
her role as a parent than she had
been when she came for her
initial interview over a year ago.
She felt good about herself as a
mam.
Ciara was really satisfied with the
programme. She really liked the
regular developmental check-ups
that Sophie was getting, and she
was already recommending the
programme to her friends and
family.
to capacity building.
Stakeholder Interviews: Relevant theme: effective collaboration
depends on key factors; specific sub- theme: having the
opportunity to meet at events
Stakeholder Surveys: Only one third of respondents agreed that
organisations communicate with one another outside of RSG.
Stakeholder Interviews: Relevant themes: Enthusiasm about
IMH; people want to learn more; IMH study group
Stakeholder Surveys: The majority of respondents indicated that
they were committed to the concept of IMH and that it was an
important issue for Ballymun.
PSI/SF sub-scales show decreased parental distress and parentchild dysfunctional interaction over the course of the
programme.
PSOC scores slightly increased over time (p<0.05), indicating a
higher level of parenting self-esteem upon completion of the
programme.
Scores on the subscales ‘Efficacy’ and ‘Satisfaction’ also
increased (p<0.05), which signifies greater feelings of parental
efficacy and satisfaction.
Anonymous self-report User Satisfaction Survey Findings:
94% of respondents very satisfied with the regular
developmental check-up that PCPS conducted with their babies.
99% of respondents would recommend the programme to other
mothers.
141