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Title: Putting children first: the role of psychology in applied youth mental health research The Incredibl


1
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

2
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

3
Youth 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

4
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

5

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  • - withdrawn or disruptive behaviour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 -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)

7
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

8
Risk factors related to conduct problems
  • Parenting
  • Factors

School and Peer Factors
Early Onset Conduct Problems
Child Factors
Contextual/ family Factors
9
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
    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

10
The 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
11
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 -gt collaborative approach
    and skill development through group discussion,
    videotape/DVD modelling, role play, and
    practice/rehearsal

12
(No Transcript)
13
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

14
The 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)

16
The 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
17
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
    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

18
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

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

20
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)

21
Part Two
  • The Incredible Years Ireland
  • Research Study

22
The 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

23
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

24
Research 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

25
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?

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?

27

Research 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

28
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
    questionnaire-based assessments, some
    observational work and interviews (11 or
    group-based) with key stakeholders

29
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)

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

32
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

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

34
Contact 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
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