Tracey Bywater

1
An Evaluation of the Incredible Years Parent
Programme in Wales

• Tracey Bywater
• t.bywater_at_bangor.ac.uk
• University of Wales Bangor
• Project funded by The Health Foundation

2

• Overview
• Current project
• The intervention
• Why are we doing it?
• Evaluation questions
• Method Results
• Conclusions future research

3
The Intervention

• Was developed by Professor Webster-Stratton at
  the University of Washington, Seattle. It focuses
  on strengthening parenting skills, with the
  intention of preventing, reducing and treating
  conduct problems among children aged 2 - 8 years
  and increasing their social competence
• It consists of 12-14 weekly sessions that
  emphasise the importance of play, ways to help
  children learn, effective praise, use of
  incentives, limit setting and ways to deal
  effectively with misbehaviour. A collaborative
  approach is emphasised with skills developed
  through group discussion, videotape modeling and
  rehearsal

4

• Why the Current Evaluation of the BASIC Parent
  Programme?
• Evidence from the UK with a clinical population
• No UK evaluation of the programme within an early
  intervention/preventive community setting
• Sure Start services in North Mid Wales have
  been trained and are implementing the programme
• Implementation of the programme in Wales poses
  special challenges due to the bi-lingual, rural
  population

5
Evaluation Questions

• Can we deliver the programme in the same way as
  researched and developed by Webster-Stratton in a
  Welsh setting with health, social services and
  voluntary sector staff?
• Is the programme effective in improving parental
  skills and reducing child behaviour problems in
  identified high risk 3- 4-year-olds?
• How do participants and leaders respond to the
  programme and what, if any, difficulties are
  experienced in using the programme?

6

• Method - Participants
• Potential families approached by local health
  visitors, yielding 240 names, 153 were eligible
  and consented
• intervention 104, waiting list control 49.
• Criteria
• Low income/dependent on benefits
• Living in a Sure Start area
• Index child aged between 36 58 months
• Index child to score above the clinical cut-off
  on the Eyberg Child Behaviour Inventory (ECBI)

7

• Measures
• Two visits at each data collection point
• To collect questionnaire and interview data
• to assess family risk factors, parenting
  competencies, child social competencies child
  conduct problems
• 2) Observational coding of parent-child
  interaction
• to assess parent-child interaction, parenting
  practice child behaviour

8

• List of Measures
• Personal Data and Health Questionnaire (PDHQ,
  Hutchings, 1996a)
• Socio-economic disadvantage (SED 6 Hutchings,
  1996a)
• Index of Major Life Events (Oxford University)
• Beck Depression Inventory (BDI Beck, Ward,
  Mendelson, Mock, Erbaugh, 1961)
• Parenting Stress Index/Short Form (PSI/SF
  Abidin, 1990)
• Eyberg Child Behavior Inventory (ECBI Eyberg
  Ross, 1978 Eyberg, 1980)
• Strengths and Difficulties Questionnaire (SDQ
  Goodman, 1997)
• Conners Abbreviated Parent/Teacher Rating Scale
  (Conners, 1994)
• Kendall Self Control Rating Scale (SCRS Kendall
  Wilcox, 1979)
• Social Competence Scale Parent (Fast Track
  Project)
• British Picture Vocabulary Scale (BPVS-II Dunn,
  Dunn, Whetton, Burley, 1997)
• The Parenting Scale (Arnold, OLeary, Wolff
  Acker, 1993)
• Service Utilisation Questionnaire (Chisholm et
  al., 2000 Beecham, 1995)
• EQ-5D Health-Related Quality of Life
  Questionnaire (Kind, Hardman, Macran,1995)
• Dyadic Parent-Child Interaction Coding System
  (DPICS Eyberg Robinson, 2000)

9

• Short-Term Results
• No significant difference was found between the
  intervention and control groups at baseline on
  socio-economic status or number of risk factors
• No difference on scores at baseline on any
  outcome measures between conditions
• At follow-up 1 significant differences were found
  on all measures between conditions

10

• 1) Observation using the Dyadic Parent-Child
  Interaction Coding System
• 30 minute observation
• a checklist of 35 parent child behaviour
  categories
• Observers blind to the experimental condition

11
DPICS
12

• 2) The Eyberg Child Behaviour Inventory
• 36 items, ages 2-16 years
• Problem score has a minimum of 0, maximum of 36
  (yes/no answers, problem or not)
• Intensity scale - minimum score of 36, maximum
  252 (scale of 1 7, where 1 never and 7
  always)
• Clinical cut-off scores, 127 intensity, or 11
  problem

13
ECBI
14

• Long-Term Results
• At follow-up 3 improvements in parent skills
  competencies had been maintained
• At follow-up 3 reductions in negative child
  behaviour had been maintained
• At follow-up 3 reductions in parental stress
  depression had been maintained

15

• DPICS

Figure 3. Observed positive parenting behaviours
in 30 minutes
16

• DPICS

Figure 4. Observed critical parenting behaviours
in 30 minutes
17

• DPICS

Figure 5. Observed child deviance in 30 minutes
18

• ECBI

Figure 6. Eyberg problem scale, clinical cut off
is 11
19

• Summary of Findings
• Observational findings
• Intervention parents use more positive parenting,
  less critical parenting
• Children are better behaved
• ECBI findings
• Parents perceive their child as having fewer
  problem behaviours
• Child behaviours are less intense
• Other measures
• Reduction in parental depression stress,
  improved parent skills
• Reduction in child hyperactivity, conduct
  problems, increased social competence and self
  control

20

• Implementation fidelity
• All leaders had basic three day leader training
  and had run IY groups
• All leaders attended a weekly three hour
  supervision session
• All sessions were video-taped and randomly
  selected tapes sent for assessment of programme
  fidelity
• Materials for running the group were provided
  from the research office, parent handouts, books,
  magnets, tapes, CDs, raffle prizes, set of
  videos, etc.
• All parent and group leader evaluations,
  registers etc. were completed
• Every parent who missed a session was contacted
  and provided with the session handouts etc. and,
  where possible, a make-up session
• All parents were phoned by a group leader between
  sessions

21

• Conclusions
• There are plenty of high risk children in North
  Wales Sure Start areas
• These children can be identified by health
  visitors and their parents can be recruited and
  retained into the programme
• We can deliver the programme with fidelity
• Comparable results to Seattle - transportable
• To achieve the best outcomes for our children
  families need evidence based programmes with
  demonstrated long term outcomes and delivered
  with fidelity

22

• Other research linked to this project
• Health Economics bolt-on study showed that the
  Programme was cost-effective
• Ph.D The programme works for children who were
  the most hyperactive and with many negative child
  behaviours
• Ph.D Investigating leader styles and impact on
  outcome measures
• Ph.D Evaluating the Teacher Classroom Management
  IY Programme
• M.Sc looking at sibling behaviour - siblings
  behaviour improved
• M.Sc Environmental stressors and programme
  attendance - did not predict attendance
• M.Sc Parent Programme shown to work, regardless
  of differing crime rates

23

• Possible future research
• Evaluating the Parent Programme with foster
  carers
• Evaluating Service implementation and support for
  IY Parent Programme
• Gender differences
• Pathfinders