Title: Putting children first: the role of psychology in applied youth mental health research The Incredibl
1Putting 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
2Overview
- 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
3Youth mental health why worry?
- Societyhas a choice whether or not to
acknowledge the importance of mental health of
its children and young people and invest in it
appropriately or notif 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
4The 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
5EBD 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(EBD)include - - withdrawn or disruptive behaviour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 -gt
unhappiness, low self-esteem, difficulty in
forming friendships
6- Conduct difficulties are detectable, preventable
and treatable but - Resistant to intervention if not treated early
75 treatment success rate for lt10s 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 -gt health,
education, social services and CJS - Preventing, reducing and halting aggressive
behaviour at school entryis a beneficial and
cost-effective means of interrupting the
progression from early conduct problems to later
delinquency and academic failure.
(Webster-Stratton Reid, 2004) -
7The 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
8Risk factors related to conduct problems
School and Peer Factors
Early Onset Conduct Problems
Child Factors
Contextual/ family Factors
9The 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
Webster-Stratton, 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, community-based prevention
programmes for families and teachers to promote
social, emotional and academic competence
10The Incredible Years Programmes
Teacher Programme
Child Dinosaur Programme Classroom
Child Dinosaur Programme Treatment
School Aged BASIC Parent Programme 6 8 yrs 9-12
yrs
ADVANCED Parent Programme
Infant Toddler Parent Programme 1-2 yrs
School Readiness Programme 2-4 yrs
BASIC Parent Programme 3-6 yrs
11The 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 -gt collaborative approach
and skill development through group discussion,
videotape/DVD modelling, role play, and
practice/rehearsal
12(No Transcript)
13Key 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
14The theoretical framework of the Incredible Years
- Based on the psychological principle that
behaviour is learned through social interaction - Underpinned by Banduras Social Learning Theory
(1978) -gt reciprocal determinism - P
- B E
15- 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 Webster-Stratton,
2004)
16The logic model of the Incredible Years
Leads to Poor Perform. In school
Leads to Lowered capacity to engage with
others Poor decision making
Leads to Anti-social Behaviour and Emotional
Difficulties
Parenting which is Harsh Inconsistent Coercive
TT Improved Classroom Management
PT Improved Parenting skills
CT Improved Social Skills
17Incredible Years the empirical context
- Based on approx.20 years of research and
development (mainly in the US) using rigorous
methodologies (eg. RCTs) and including
longer-term 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
18The 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
19- 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
20Supporting 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)
21Part Two
- The Incredible Years Ireland
- Research Study
22The Research Team
- NUI Maynooth
- Dr Sinead McGilloway (Psychology)
- Dr Anne Lodge (Education)
- Dr Catherine Comiskey (Maths)
- Dr Yvonne Barnes-Holmes (Psychology)
- Professor Donal ONeill (Economics)
- Bangor University, Wales
- Dr Tracey Bywater (Psychology and Incredible
Years Wales Centre) - Queens University Belfast
- Dr Michael Donnelly (Public Health
Epidemiology) - University of Washington
- Collaborative support from Professor Carolyn
Webster-Stratton
23Our 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
24Research objectives
- To assess the effectiveness of the parent
training programme on child and parent behaviour - To consider the impact of the teacher training
programme on child behaviour - To assess some combination of parent, teacher
and/or child training on behaviour - To examine the cost-effectiveness of the
programme - To monitor and appraise all aspects of
implementation fidelity
25Key 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?
26- 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?
27Research Design
- A largely experimental evaluation based on a
pragmatic Randomised Control Trial (RCT) design - 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) - A smaller implementation sub-study on the process
of implementing the Incredible Years programme
(including aspects of fidelity) - An economic evaluation based on a
cost-effectiveness analysis for each trial -
28Methodology
- 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
questionnaire-based assessments, some
observational work and interviews (11 or
group-based) with key stakeholders
29Principal 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)
30(2) Implementation study(2) Implementation
sub-study
- Stakeholder views
- Qualitative interviews and brief self-report
measures) (including parent and teacher
satisfaction) - Implementation fidelity (eg. quality of programme
delivery, participant responsiveness)
31(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 -gt incremental costs of
intervention relative to other interventions
32Developing 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
-
-
33 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 -gt transferability and effectiveness -
- Considerable potential to inform service delivery
and to provide best possible evidence to
influence policy and practice within an Irish
context
34Contact details and funding sources
- sinead.mcgilloway_at_nuim.ie
- This research is supported by Archways with
funding from the Atlantic Philanthropies and
Dormant Accounts Fund