Researching the Incredible Years Toddler
Parenting Programme in Wales
Professor Judy Hutchings
Nia Griffith
Bangor University
March 2011
Poverty in Wales
• 200,000 children in Wales live in
poverty
• ‘living in poverty’ defined as weekly
income after housing costs falling below
60% of the median income for families
of this type (WAG, 2010)
Negative Outcomes..
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Poor physical health
Poor mental health
Delayed child development
Abuse
Behavioural and emotional difficulties
Poor academic achievement
Poor employment prospects
Adolescent and adult delinquency
Why Early Intervention?
Compelling evidence for the benefits of
early intervention
• More Effective
• More Cost-effective
• Key component of the Child Poverty
Strategy for Wales
• Continuation of IY centre tradition for Early
Intervention
Flying Start
Flying start initiative aims to fund high quality services for children aged
0 - 3 years in disadvantaged areas in Wales
Estimated 25,000 children aged 0 - 3 living within FS catchment areas
Families targeted by area of residence, with investment of £2,000 per child
per annum in the form of:
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Extra health visitor visits from dedicated Flying Start Heath Visitor
Free childcare
Basic skills courses, language and play
Parenting courses
Evaluation of the IY parenting
intervention
Trial
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Trial of new programme
Randomised Control Trial
Small numbers
Participants
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Parents of children aged between 12 and 36 months
Targeted families living in Flying Start areas
No other inclusion criteria
Recruitment
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Families recruited by group leaders in each area
Randomisation
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Random allocation by NWORTH (North Wales Organization for Randomised
Trials in Health)
Stratified for age and sex and allocated on 2:1 ratio Intervention: Waiting list
control
Control families wait 6 months for Intervention
RCT Research locations
North Wales Sites
•Blaenau Ffestiniog
•Caernarfon (Maesincla)
•Bangor (Maesgeirchen)
•Holyhead
Mid Wales Sites
•Welshpool
South Wales Sites
•Rhondda Cynon Taf (Porth)
•Blaenau Gwent (Llanhilleth)
•Neath (Britton Ferry)
Sample Characteristics
• 89 families
• Parent age at Baseline (M= 29.97, SD= 6.72) range 16-48 years.
• 24% Welsh first language.
• 54% <20 Years at birth of 1st child.
Sample Characteristics cont.
•53% living in council/housing association houses.
•20% had concerns about their child’s development
•26% reported having felt low/helpless or depressed at some point since the birth
of their child
•15% had an immediate family member with a drugs/alcohol problem,
•14% had an immediate family member who had been involved in some form of
criminal activity.
•36% left school without any qualifications
Comparison of FS and National Average
Characteristic
Flying Start
Sample (103
dyads)
Social Trends
2007*
Lone Parent Families
31%
24%
Age of parent at birth of 1st
Child
22.1 years
27.3 years
Living below recognised
poverty indicator WAG
(2010)
53% Actual
17%
16% Probable
Information sourced from:
Social Trends No.37 (2007). London: Office for National Statistics
Measures
• Developmental Measures
- Schedule of growing skills (SOGS)
• Measure of Home Environment
- HOME
• Parent Measures:
- Parenting Stress Inventory (PSI)
- Beck Depression Inventory (BDI)
- Warwick-Edinburgh Mental Wellbeing Scale
• Direct Observation:
- Dyadic Parent-Child Interaction Coding Scheme (DPICS)
Positive Impacts of living in a
Flying Start area?
Additional Services Available:
Extra health visitor support
Free childcare
Basic skills
(Parenting courses – intervention only)
Main Measures
Measure
Baseline Score
6-month FU
Score
Significance
Level
SOGS DQ
96.98
101.82
P < .05
BDI II
10.82
7.93
P < .05
PSI-SF
76.01
68.61
P < .05
IT-HOME
34.77
37.37
P < .05
Significant improvements on main outcome measures for
sample as a whole over 6-month period.
Added benefits of IY Toddler
Parenting Programme for
Intervention Families living in
Flying Start areas?
The IY Toddler Parenting
programme.
STRUCTURE
• Twelve sessions
• Delivered weekly in 2 – 2 ½ hour sessions by two leaders
• Collaborative learning process using discussion and ideas drawn
from watching video-clips of other parents
• Brainstorming/role-play/home activities
• Group structure providing for group problem solving and peer
support
• CONTENT
• Relationship building through child led play, coaching children’s
academic, social and emotional skills, praise and spontaneous
incentives, handling separations and reunions, establishing
routines, learning how to give clear instructions and how to ignore,
distract and redirect children
• Learning to understand children’s development and safety
awareness are themes that run throughout the programme
SHORT TERM DATA
Follow-up two at 6-months post baseline
Preliminary Analysis WEMWBS
53
Mean mental wellbeing score
52
51.7
51
50
49
50.1
48.9
48
47
Intervention
47.2
Control
46
45
44
Baseline
Follow-up 1
Time
Figure: Mean mental wellbeing score for intervention and control group at
baseline and follow-up 1
Significant improvement for intervention sample relative to control group
demonstrated in parent report mental well-being at 6 month follow-up (Warwick
Edinburgh Mental Well Being Scale, NHS Health Scotland, 2006), (p = .014).
Preliminary Analysis of DPICS
Mean no. of critical parenting statements
18.0
16.0
14.0
15.3
12.0
10.0
12.0
10.3
8.0
8.2
6.0
Intervention
Control
4.0
2.0
0.0
Baseline
Follow-up 1
Time
Figure: Mean score for the critical parenting subcategory of the DPICS at
BL and FU1
Significant improvement in observed critical parenting statements directed towards the target
child at 6 month follow-up, measured by DPICS (Eyberg & Robinson, 2000), (p = .001)
No significant changes were observed for the control group. (p = .258)
Preliminary Analysis of DPICS
1.8
1.7
Mean no. of physical negatives
1.6
1.4
1.2
1.5
1.4
1.0
0.8
Intervention
0.6
Control
0.4
0.5
0.2
0.0
Baseline
Follow-up 1
Time
Figure: Mean score of the physical negative subcategory of the DPICS from
BL to FU1
Significant improvement in observed physical negatives directed towards the
target child at 6 month follow-up, measured by DPICS (Eyberg & Robinson,
2000). (p = .009)
No significant changes were observed for the control group. (p = .730)
LONGER TERM OUTCMES
Follow-up two at 12-months post baseline
Further Analysis of BDI
14
13
Mean Depression Score
12
12.24
11
10
10.13
9.69
Intervention
9
Control
8
Cut-off
7.08
7
6
5.39
5
4
Baseline
FU1
FU2
Time-point
No significant improvements at 6-months for the two subgroups, although
significant for the whole sample at FU1.
A significant reduction in total BDI for intervention families at 12-months, (p = <.01)
Further Analysis of IT HOME
No significant improvements for the either group at 6-months.
A significant improvement in total HOME score for intervention families at 12months, (p = .003)
Further Analysis of SOGS
Developmental Quotient
No significant improvements for either group at 6-months 9p= .892)
although significant for the whole sample at FU1, (p = .04)
A significant improvement in DQ for intervention families at 12-months, (p = .021).
Relative Deprivation
How at-risk were our sample?
Income level
100%
90%
80%
Percentage
70%
60%
50%
Above
40%
Below
30%
20%
10%
0%
Sure Start
Flying Start
National Average
% of people living below the recognised poverty index
Multiple Risks- SED6
Risk Factor
FS Sample
SS Sample
Unemployed/Benefit Dependant
49%
76%
Single Parent
37%
42%
Large Family
31%
45%
Parent Low-educational Attainment
39%
39%
Poor Quality Housing
18%
10%
CONSIDERED AT-RISK (>2 Risks)
70%
80%
Compiled from questions in PDHQ, Hutchings (1998)
Depression and Stress
Measure
FS M
(SD)
SS M
(SD)
P value
FS Clinical
Significant
SS Clinical
Significant
BDI
10.82
(9.44)
16.48
(10.39)
<0.001
16%
37%
PSI-SF
76.01
(20.54)
100.36
(23.47)
<0.001
21%
67%
Comparison of FS and SS on outcome measures for parent stress and
depression at baseline
Conclusions
• There are significant benefits from living in a Flying
Start area for the whole sample in terms of
improvements in child developmental status,
reductions in maternal depression and stress an level
and stimulation in the home environment
• There are added short-term benefits from attending
the IY Toddler programme in terms of significantly
reduced negative parenting and improved parental
mental wellbeing relative to the control families
• There are continued longer-term improvements for
intervention families in terms of maintenance of
improvements in mental wellbeing and a significant
long term benefit for child development (SOGS)
Conclusions Cont.
• Data indicates that targeting by area
alone is not the most effective way of
finding the most at-risk families. It is
necessary to find some mechanism of
distributing resources to families in
need, but using a simple targeting
measure of child deviance resulted in
the recruitment of a much higher risk
sample.
Additional Projects
• Evaluating the cost-effectiveness of the
Incredible Years Toddler Parenting
Programme- Jo Charles
• Validating the SOGS- Margiad Williams
• Comparing Live and Video ObservationNic Gridley
• Differential genetic susceptibility in the
Incredible Years toddler parenting
programme: Pilot study- Collaboration with
Birkbeck University
Thank you for listening!
Diolch am wrando!