Transcript PowerPoint Template

‘Putting children first’: the role of psychology in
applied youth mental health research – The
‘Incredible Years Ireland’ Study
Dr Sinéad McGilloway, Department of Psychology , NUI Maynooth
Overview
PART ONE
• Background/context: youth mental health and emotional and
behavioural difficulties
• The Incredible Years program: theory, practice and research
• Supporting ‘at-risk’ families: the international policy context
------------------------PART TWO
• The NUIM-led National Evaluation of Incredible Years:
- the research team
- research objectives
- research design and methodology
• Conclusion
Youth mental health: why worry?
• “Society…has a choice whether or not to acknowledge the
importance of mental health of its children [and young people]
and invest in it appropriately or not…if we are to change things,
action is needed now.” (Mental Health Foundation, 1999)
• Mental health problems amongst young people have increased
substantially in almost all developed countries since World War
II
• Approximately one in five children and adolescents have
mental ill health but….the majority rarely reach specialist
services
• Problems range from: *emotional and conduct disorders;
anxiety; depression; substance abuse; self harm; eating
disorders; and psychotic illnesses
The Irish context: a legacy of vulnerability
• Increase in juvenile offending (typically high levels of mental ill
health and EBD amongst offenders)
continuing high school drop-out rates
• Increasing numbers of 15 to 17 yr-olds detained in adult prisons
• Increase in the use of adult inpatient care by teenagers (and the
lack of appropriate facilities)
• Suicide: more young people (15-34yrs) in Ireland die from suicide
than in any other EU member state
• Impact of bullying on school children
EBD: a source of growing concern
• Emotional and behavioural difficulties
(EBD)include:
- withdrawn or disruptive behaviour
- marked and persistent concentration difficulties
- poor social interaction
- poorly developed life/social skills
• Approximately 10% of children in UK and US
(higher in boys); as many as 35% in areas of high
social deprivation
• Children with EBD often rejected by peers ->
unhappiness, low self-esteem, difficulty in
forming friendships
• Conduct difficulties are detectable, preventable and treatable
but…
• Resistant to intervention if not treated early; 75% treatment
success rate for <10s; 25% for adolescents
• Predictive of: juvenile delinquency; low levels of educational
attainment; school drop-out; entry into the Criminal Justice
System; and adult mental health problems
• Considerable long-term costs -> health, education, social
services and CJS
• “Preventing, reducing and halting aggressive behaviour at school
entry…is a beneficial and cost-effective means of interrupting the
progression from early conduct problems to later delinquency and
academic failure.” (Webster-Stratton & Reid, 2004)
The good news…
• Behaviourally based (early)interventions have
been shown to be very effective in addressing
problem parenting and promoting social
competence
• Behavioural disorders can be detected at an
early age due to well known risk factors:
- low income/poor living conditions
- disadvantaged neighbourhoods
- young and/or lone parent households
- parental mental health problems
- low parental educational levels/criminal
history
- large families
Risk factors related to conduct problems
Parenting
Factors
Child
Factors
Contextual/
family
Factors
School and
Peer
Factors
Early
Onset
Conduct
Problem
s
The Incredible Years Parent,Teacher and
Child Training Series
• The Incredible Years program comprises three linked
programmes aimed at addressing parent and child
behaviours whilst also helping teachers to better manage
problem behaviour
• Developed and refined by Professor Carolyn WebsterStratton, University of Washington, Seattle over a 30-year
period
• Two long-term goals: (1) to develop comprehensive
treatment programmes for young children with early onset
conduct problems;(2) to develop cost-effective, communitybased prevention programmes for families and teachers to
promote social, emotional and academic competence
The Incredible Years Programmes
Teacher
Programme
Child Dinosaur
Programme
Treatment
Infant
Toddler
Parent
Programme
1-2 yrs
School
Readiness
Child
Dinosaur
Programme
Classroom
BASIC
Parent
Programme
Programme
2-4 yrs
3-6 yrs
School Aged
BASIC Parent
Programme
6 – 8 yrs
9-12 yrs
ADVANCED
Parent
Programme
The BASIC Parent Training
Intervention
• Focuses on strengthening
parenting skills to prevent,
reduce and treat conduct
problems among children aged 3
- 6 years and to increase their
social competence
• 12-14 weekly sessions ->
collaborative approach and skill
development through group
discussion, videotape/DVD
modelling, role play, and
practice/rehearsal
Key components of IY parent training
• New parenting skills must be modelled and
rehearsed
• Sanctions (non-violent) for negative behaviour,
relationship building, praise and rewards
• Home based ‘practice’ or homework
• Collaborative ethos – emphasising principles
rather than prescribing techniques
• Address difficulties in adult relationships/other
family problems
• Must be delivered early
The theoretical framework of the
Incredible Years
• Based on the psychological principle that
behaviour is learned through social
interaction
• Underpinned by Bandura’s Social
Learning Theory (1978) -> reciprocal
determinism
P
B
E
• Social interaction reinforces ways of thinking and behaving
• Bandura emphasised the process of learning through
observation (ie. most human behaviour is learned by
following a model)
• Modelling influenced by: (1) characteristics of the model; (2)
observer attributes; and (3) reward consequences
• Aim of Incredible Years: “…to increase positive behaviours
through a variety of rewards whilst reducing unwanted
behaviours through response cost or other strategies,
resulting in their disappearance.” (Hutchings and WebsterStratton, 2004)
The logic model of the
Incredible Years
Parenting
which is:
Harsh
Inconsistent
Coercive
PT
Improved
Parenting
skills
Leads to:
Lowered
capacity to
engage
with others &
Poor decision
making
CT
Improved
Social
Skills
Leads to:
Anti-social
Behaviour
and
Emotional
Difficulties
Leads to:
Poor
Perform.
In
school
TT
Improved
Classroom
Management
Incredible Years: the empirical context
• Based on approx.20 years of research and
development (mainly in the US) using rigorous
methodologies (eg. RCTs) and including longerterm follow-ups
• The findings have shown Incredible Years to be
highly effective in reducing child aggression and
other behaviour problems whilst increasing
social competence at home and at school
• For example, BASIC PT programme has been
strongly supported through 9 published RCTs
•
- based on parent reports and direct
observation of child behaviour and parenting
style
The Welsh Surestart Study
• Three RCTs of the parent (PT) and teacher (TT)
programmes
Parent Training
• 46% reduction in conduct problems and negative child
behaviour in the intervention group versus 7% in the control
group
• Reduction in violent incidents and significant improvements
in parenting skills and parental mental health
• Longer term findings show maintenance of all gains in the
intervention group
Teacher Training
• Intervention teachers gave clearer instructions to children
than in the control group and allowed more time for
compliance before repeating instructions;
• Pupils in intervention classes more compliant with more
socially positive behaviour
• Teachers reported satisfaction with the programme and
believed that the strategies taught were effective and
improved pupils’ behaviour
Supporting high risk families:
the policy context
• Several recent UK government initiatives:
- Surestart program in England (2001)
- Welsh Assembly Government Parenting Action Plan (2005)
- ‘Reaching Out’: the Action Plan on Social Exclusion (2006)
- National Academy for Parenting Practitioners (NAPP) (2007)
- NICE guidelines
• Norway: – extensive government funding to implement the
Incredible Years programme on a national basis
(The programme has also been implemented in Canada, Australia, New
Zealand, Scandinavia, Germany, Portugal)
• US: – “blueprint” and “model” programme for violence and
substance abuse prevention (US Office of Juvenile Justice and
Delinquency Prevention; the Centre for Substance Abuse Prevention)
Part Two
The Incredible Years Ireland
Research Study
The Research Team
NUI Maynooth
•
•
•
•
•
Dr Sinead McGilloway (Psychology)
Dr Anne Lodge (Education)
Dr Catherine Comiskey (Maths)
Dr Yvonne Barnes-Holmes (Psychology)
Professor Donal O’Neill (Economics)
Bangor University, Wales
•
Dr Tracey Bywater (Psychology and Incredible Years Wales Centre)
Queen’s University Belfast
•
Dr Michael Donnelly (Public Health & Epidemiology)
University of Washington
•
Collaborative support from Professor Carolyn Webster-Stratton
Our role?
• To undertake and complete to the highest possible
standards, a three-year national evaluation of the
Incredible Years programme in Ireland
• To act as the objective, honest ‘broker’ when
conducting the research and when disseminating
findings
• To work collaboratively with Archways and others
(eg. schools/teachers) in executing the research
and to promote a sense of ownership amongst all
key stakeholders
Research objectives
1. To assess the effectiveness of the parent training
programme on child and parent behaviour
2. To consider the impact of the teacher training
programme on child behaviour
3. To assess some combination of parent, teacher
and/or child training on behaviour
4. To examine the cost-effectiveness of the
programme
5. To monitor and appraise all aspects of
implementation fidelity
Key research questions
• To what extent does the Incredible Years
programme lead to improvements in the behaviour
of young Irish children(2-7yrs)?
• How effective is the programme in improving
parental well being and parental and teacher skills
and competencies?
• Are improvements maintained over time?
• Do some programme elements work better than
others?
• How cost-effective is the programme?
• How do the results compare with work undertaken
elsewhere?
• What are the experiences of key stakeholders and
what factors facilitate or inhibit the effective
implementation of the programme?
• Are there any problems or issues in delivering the
programme that are peculiar to an Irish context?
Research Design
•
A largely experimental evaluation based on a
pragmatic Randomised Control Trial (RCT)
design
1. Multi-site longitudinal follow-up study involving
three RCTS on: (a) parent training (PT); (b)
teacher training(TT); and (3) a combination of
parent, teacher and child training(PT/TT/CT)
2. A smaller implementation sub-study on the
process of implementing the Incredible Years
programme (including aspects of fidelity)
3. An economic evaluation based on a costeffectiveness analysis for each trial
Methodology
•
Participants randomly allocated to intervention or waiting
list control group on basis of inclusion criteria
•
Six sites: four in Dublin (PT); one in Limerick (TT) and one
in Cork (PT/TT/CT)
•
Participants in the RCTs will be assessed at baseline and
6 and 12 months later (approx. 2 visits at each data
collection point)
•
Study based on mixed methods including questionnairebased assessments, some observational work and
interviews (1:1 or group-based) with key stakeholders
Principal outcomes: (1) RCTs
•
•
•
•
•
•
Child conduct problems
Child social and problem solving skills
Parent competencies
Parent psychological well being/mental health
Teacher competencies (classroom management)
Changes in parent-child and teacher-child
interaction (behavioural observation)
(2) Implementation sub-study
• Stakeholder views
• Qualitative interviews and brief selfreport measures) (including parent and
teacher satisfaction)
• Implementation fidelity (eg. quality of
programme delivery, participant
responsiveness)
(3) Economic Evaluation
• Routinely available costs (eg. materials, training)
• Costs of health, education and social services
used by parents, children and teachers during
study period
• Incredible Years Group Leader cost diaries
• Overall outcome -> incremental costs of
intervention relative to other interventions
Developing the evidence base
• Increasing recognition that health and social care
policies and practices need to be informed by
robust evidence derived from high quality research
• Such research informs process of service delivery
and the formulation of key government policies
• Evidence-based programmes are more likely to
have an impact because they tend:
- to be taken more seriously
- to be more likely to influence service providers
and policy makers
- to receive funding
- to make a difference
Conclusion
• The need to address emotional and behavioural
problems in our children is a social and political
imperative
• Incredible Years Ireland Study (IYIS) – will be one of
the largest evaluations outside the US
• One of only a very few studies undertaken in a
community setting and targeting parents, teachers
and children
• Will attempt to build upon and develop existing
research -> transferability and effectiveness
• Considerable potential to inform service delivery and
to provide best possible evidence to influence policy
and practice within an Irish context
Contact details and funding sources
[email protected]
This research is supported by Archways with funding from
the Atlantic Philanthropies and Dormant Accounts Fund