CYP(3)-PAP 31

Children and Young People Committee

Inquiry into Parenting Action Plan

Response from Professor Judy Hutchingson and Dr Tracey Bywater Bangor University

We are unable to publish all of this document due to its size.However, a full report of this document can be requested.

Information about our organisation

We write on behalf of the Incredible Years (IY) Wales team based in Bangor University. Incredible Years Cymru is a recently formed registered charity based within the University that developed from the research and dissemination work carried out at the IY Wales Centre over the last 10 years (see Appendix A for charitable objectives of Incredible Years Cymru). Our main activities are co-ordinating training and consultation for staff using the Incredible Years parent, child and teacher programmes across Wales and undertaking funded service evaluation and research mainly, but not entirely, focusing on the IY parent programmes (Appendix B contains the background to the programmes in Seattle where they were developed and to their development in Wales. Appendix C contains our publications list demonstrating positive outcomes for all of the programmes in Wales).

Our work for the Welsh Assembly Government as part of the Parenting Action Plan for Wales

Our study evaluating the effectiveness of the IY basic parent programme for children living in Wales, and at high risk of conduct disorder, produced excellent results (Hutchings et al 2007 a and b, see copies in appendix D). As a result the Welsh Assembly Government (WAG) funded training of leaders in the Incredible Years parent programme for staff from each Children and Young Peoples Partnership from April 2006, as part of the Parenting Action Plan for Wales. Appendix E has the report on the initial year of funding in which staff from 15 Authorities received parent programme leader training. It also contains a report of a survey, undertaken in July 2007, which established that all but one of the 15 Authorities that had received training during the first year of the scheme were delivering the programme. Funding continued through 2007/8 to provide training places for the remaining seven Authorities and additional supervision and consultation to staff that had received training (see appendix F). A further survey of uptake of programme delivery across Wales is currently being undertaken. This will be completed by September 2008.

In 2008/9 funding has been continued to provide additional training in the newer programmes for the parents of older (9 - 12 year old) and younger (babies and toddlers) children and for the first time WAG has included funding for people to train to deliver the IY Teacher Classroom Management programme due to a randomised controlled trail in North Wales which demonstrated its effectiveness (Appendix G). It is well received by teachers, produces good outcomes, and fits well with the collaborative philosophy of the Foundation Phase. There has also been additional funding from WAG, to research the new toddler programme with parents of one and two year olds (see appendix H for a summary), and the Wales Office for Research and Development in Health and Social Care (WORD) to research the IY basic parent programme with foster carers (see summary in Appendix I).

Our response describes the work of the IY Wales Centre undertaken as part of the Parenting Action Plan (2005) and suggests strategies for the next phase of the Action Plan and issues for further consideration.

The proposal to fund training across Wales in the IY parent programme was set out in Paragraphs  4.15 - 4.20 of the Plan and the references to it from the Plan are included in Appendix J along with references to other topics within the Plan on which we wish to comment.

Delivery of the Parenting Action Plan

How effective do you consider the implementation of the Parenting Action Plan (PAP) to have been?

The case for early intervention with parents has been demonstrated numerous times (both nationally and internationally (Sutton et al; 2004) and is clearly accepted in Wales at both local and national level. By providing training for staff to deliver the IY parent programmes, and through its subsequent guidance around the use of evidence based programmes, WAG has given an excellent lead in encouraging the delivery of effective programmes across Wales.

In terms of the work using the IY programmes an excellent start has been made. During the first two years of funding 240 group leaders were trained with WAG funds, and an additional 214 trained by services in Wales using their own resources. There have also been 281 attendances at supervision days during the first two years of funding. There was great enthusiasm from services across Wales to receive the training and resources funded by WAG. Resources included leader materials and copies of the translation of the IY parent book in Welsh.

The survey of leaders trained in the first year (2006/7) was extremely encouraging in that it showed that 1/3^rd of leaders who responded had already delivered the programme and a further 1/3^rd were planning to do so. Moreover all of those who had delivered the programme were enthusiastic about the changes they had seen in parents and intended to deliver it again despite, in many cases, having been given insufficient resources, particularly in relation to time. Experience of delivering the programme also confirmed for leaders the complexity of the support needs of high-risk families and the benefits of supervision. The survey also identified supervision issues which adds further weight to WAG’s decision to increase the provision in year two for supporting trained people in delivering the programme. The challenge that still remains is to ensure effective services on the ground with sufficient resources and appropriate supervision to ensure high quality service delivery, being accessible to all parents whose children are at risk regardless of where they live.  This does not translate so far into an effective Wales-wide provision.

From the IY Centre we made clear from the start that if WAG wanted to target parents whose children were at greatest risk of developing conduct disorder then skilled staff and adequate resources were required in order to enable effective engagement of these families (Hutchings et al 2004a, Hutchings et al 2007b). During the second year of funding increasing numbers of leaders attended supervision to develop their leader skills and to gain support around effective strategies to recruit and retain high-risk families.

We were aware from our North Wales research with staff from Sure Start Centres across North and Mid Wales that the programme can be delivered effectively in these services but that to do so required a high level of both supervision and staff time and resources. We also made clear that it was our long-term goal to develop the skills of staff from each Authority towards the establishment of in-house mentors who would be responsible for local training and consultation. This strategic step ensures high quality affordable programme delivery because training and supervision costs come in-house. Like Professor Webster-Stratton (the programme developer) we see this development of in-house resources to support the programme as the essential link that ensures effective service provision at a local level. This is, however, a slow process whereby leaders develop their own skills through running groups and then submit themselves for leader accreditation. Accreditation involves both submission of a two-hour videotape of a group session and of materials from running the programme (Appendix K contains details of the leader accreditation process and copies of the detailed leader skills checklists that are used to assess this). This process can often take a year or two to achieve. Further steps involve training as a peer coach and subsequently a Mentor who can deliver in-house training and supervision. It is important that the PAP strategy incorporates the need for continuing funding to develop a cadre of accredited programme leaders and mentors across Wales. This will require continuing current levels of funding for at least a further two years from April 2009.

• Has the amount of support available to parents increased?

The response from the CYPs should determine this but it is apparent to us that as a result of the IY training the quality of parenting support in high-risk communities has improved and it seems likely that there has also been an increase in provision.

• Is support accessible for all parents?

The focus in most CYPs is the delivery of programmes in high-risk Sure Start/Flying Start areas. Whilst these are areas in which there are likely to be great proportions of children/young people experiencing difficulties there is still an enormous task ahead in ensuring that such programmes are available to all families that would benefit from them. This will require the training of regular staff such as health visitors and school nurses but also ensuring that their jobs include delivery of parenting programmes in ring-fenced time.

• Is support getting through to the parents who need it most?

Progressive universalism describes the concept that universal services alone will not be effective in helping very high risk families and that there needs to be targeted support alongside universal access services. It seems likely that the poor results achieved in the English Sure Start study (Belsky et al., 2006) were a result of two problems; i) services were left to their own devices without guidance as to what might be effective and ii) that the universal services within the Sure Start areas were disproportionately used by the less disadvantaged families resulting in the more disadvantaged families having even poorer outcomes than similar families living in areas that were still awaiting Sure Start funding.

The IY parent programme is one of the few that have evidence with both prevention and treatment populations (Webster-Stratton 1994; Webster-Stratton 1996; Webster-Stratton & Hammond 1997; Scott et al 2001). It is also equally effective with high risk, as well as less stressed families. This has been shown to be the case in both Seattle and in our own work in Wales (Hartman et al, 2003; Webster-Stratton 1998a & b; Hutchings et al 2007a, Gardner et al submitted). In our study none of the child or family characteristics that generally predict less positive outcomes, i.e. young parents, single parents, depressed mothers, unemployment, poverty, were associated with poorer outcomes.

In terms of developing effective services across Wales, part of our role is to help staff to become effective in engaging and retaining the challenging high-risk families. The evidence from 40 years of parenting research is that whilst almost all parenting programmes improve child behaviour only some manage to do this with the higher risk children. Those that do are programmes that not only have a core curriculum based on social learning theory but are collaborative in delivery style and also ensure accessibility of the programme through the provision of transport and crèches.

The IY programme has an excellent efficacy track record with these highest risk families but this takes high levels of leader skill and resources. Within the programme there are a number of important components from self-evaluation checklists, supervision and consultation and the rigorous leader accreditation process previously mentioned (see appendix K).  Our goal for Wales is to develop a local mentor in each CYP who can train and support people in their locality.

Continued work on parenting

• What do you consider to be the key parenting issues still needing to be addressed by the Welsh Assembly Government?

In terms of IY there is a need to continue to support those staff across Wales to deliver a high quality programme and work towards leader accreditation and mentorship.

There will also be a need to provide supervision for the education service staff that train to deliver the Teacher Classroom Management programme in their localities (something that is funded in the current year).

What has worked, and what hasn’t?

• Are you aware of any examples of good practice in supporting parents?

Can you detail these, and explain why these examples have been successful?

There are now many Authorities across Wales delivering high quality services but particularly across North West Wales where we have a number of accredited leaders and a parent programme mentor. Staff in North Wales have been involved in evaluating all of the programmes

The Barnardo’s project in Cardiff has been delivering the IY parent programme to a group of very high-risk families and providing additional wrap around support.

Powys made a strategic appointment of Dr. Sue Evans, Consultant Child Psychologist, whose role is to develop the IY programmes across Powys. Sue has succeeded in establishing the parent child and teacher programmes across the County. So the lesson here seems to be that if this is the responsibility of one person it works.

Every school in Gwynedd now has teachers trained in the Teacher Classroom Management programme and in delivering the Classroom Dinosaur School social and emotional curriculum. They have also trained teachers to deliver school based parent programmes. Gwynedd had an Assistant Director who gave a strategic lead. Having a key person who makes the commitment to seeing a project implemented seems to be important (Appendix L contains a published article on the implementation of the Classroom Dinosaur School programme in Gwynedd, Hutchings et al 2004b).

• Can you identify any areas of the Parenting Action Plan which you consider to have been successfully implemented, and any that have not? Why have these areas been successfully implemented, or not?

The provision of training in the IY programmes has been successful and gone according to plan. Furthermore it has been recognised as effective by the CYPs who in many cases have purchased additional training places above their allocation. WAG has been willing to fund continuing supervision and consultation in recognition of the challenging nature of this work.

WAG made reference in the Plan to the work using the IY programmes in the classroom and have continued to monitor our work in evaluating the Teacher Classroom Management programme. Appendix M contains a diagram showing the range of parent, child and teacher programmes and also their curricula.

Having recognised the effectiveness of the teacher programme and how its collaborative philosophy fits with the goals of the foundation phase of education the third year of funding of IY programmes in Wales includes making places available to education staff across Wales to train to deliver this programme.

We have recently undertaken an exercise in mapping the IY programmes to levels of service need, covering the first 12 years of a child’s life. We feel that this could form the basis of a comprehensive service for Wales based on similar work in Norway. In this we identify three levels of service, universal, indicated and referred. An evidence base exists or these programmes at all of these levels. Suggested uses of the various programmes and possible staff to deliver them are set out in Table 1. This should be looked at alongside the diagram of programmes and summaries of their curricula in appendix M.

Table 1 Suggested Incredible Years programme strategy for Wales

LAC children are identified specifically as a tier 3 service need as funded across Wales but access to services for all LAC is implied at all other levels

Additional comments

Looked after children

Following the good results from the trial platform study of the IY parent programme with foster carers (see Appendix I) we recommend that the use of the programme is extended in this area.

CAMHS services

The NICE guidance (see summary in Appendix N) recommended group based parenting programmes as the treatment for conduct disorder and the IY programme was one of the only two named programmes. It is not acceptable for CAMHS services to leave parenting support to front line services. CAMHS referred children can be very challenging and it is important that group leaders are experienced in working with such children in order that they can guide parents towards realistic goals.

Work in schools to promote children’s mental health

The Gwynedd project is exceptional (Appendices G and L) and continues to develop. There is a case for exploring more widespread delivery of the IY Classroom Dinosaur School social skills and problem-solving curriculum across Wales with linked provision of parenting support within schools.

Young parents

In our research we have found the IY parent programme to be equally effective with the younger parents in our sample but there is a place for using the parent programme in targeted interventions for young parents, using the new infant programme for the first year of life which has just been trialled in Caernarfon, and the toddler programme for parents of one to three year olds (currently being researched across Wales, Appendix H).

Socio-economic disadvantage

Whilst our targeted Sure Start sample families were by definition disadvantaged we also found that within the sample those with the greatest number of disadvantaging circumstances did as well as the relatively less disadvantaged families. This was achieved because of the high level of fidelity of programme delivery (See Appendix D)

Conclusion

We commend WAG for having led the way in ensuring that families receive evidence-based programmes (see Agenda article Appendix O - Hutchings 2007). There will be an on-going need to provide supervision and consultation over the next three years to create a group of certified parent programme leaders from whom local mentors will emerge. Supervision should also be extended to include support for those training teachers using the IY classroom management programme.

Authorities need further support to develop plans for the highest risk families and this is helped where there is an identified individual who has responsibility for establishing a programme and ensuring its fidelity.

Further targeted support using the IY parent programmes should be considered particularly for young parents, foster-carers, and parents of children headed out of foster care and back home to their biological families.

It would be useful to build on the Teacher initiative by following the example of Gwynedd in developing use of the Dinosaur School curriculum (Hutchings et al 2004b; Hutchings et al 2007c).

We would be happy to be involved in further discussion on the potential role of the IY programmes in supporting parents and children in Wales at all levels, universal, targeted preventive, clinically referred and looked after children.

References

Belsky, J, Melhuish E, Barnes, J, Leyland AH, Romaniuk H, (2006) National Evaluation of Sure Start Research Team. Effects of Sure Start local programmes on children and families: early findings from a quasi-experimental, cross sectional study. British Medical Journal 332 1476.

Gardner F., Hutchings, J. and Bywater, T. (submitted) Who benefits and how does it work?

Moderators and mediators of outcome in a randomised trial of parenting interventions in multiple 'Sure Start’ services

Hartman R, Stage S & Webster-Stratton C (2003) A growth curve analysis of parent training outcomes: examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors. Journal of

Child Psychology and Psychiatry 44 (3) 388-398.

Hutchings, J. Gardner, F., & Lane, E. (2004a). Making evidence based interventions work in clinical settings: common and specific therapy factors and implementation fidelity. In Carole Sutton David Utting and David Farrington (Eds): Support from the start: Working with young children and their Families to reduce the risks of crime and antisocial behaviour. Research Report 524. ISBN: 1 84478 203 4. London: Department for Education and Skills.

Hutchings, J., Lane, E., Ellis Owen, R. & Gwyn, R. (2004b). The introduction of the Webster-Stratton Classroom Dinosaur School Programme in Gwynedd, North Wales. Education and Child Psychology, 21 (4)  4-15.

Hutchings, J. (2007). Incredible Years: How Wales has led the UK in ensuring effectiveness of Sure Start children’s programme, Agenda: Journal of the Institute of Welsh Affairs 55-56.

Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., Jones, K., Eames, C., & Edwards, R.T. (2007a). Parenting Intervention in Sure Start Services for Children at Risk of Developing Conduct Disorder: Pragmatic Randomised Controlled Trial. British Medical Journal, doi:10.1136/bmj.39126.620799.55

Hutchings, J., Bywater, T., & Daley, D. (2007b) A Pragmatic Randomised Controlled Trial of a Parenting Intervention in Sure Start Services for Pre-School Children at Risk of Developing Conduct Disorder: How and why did it work? Journal of Children’s Services 2, 2, 4-14.

Hutchings, J., Daley, D., Jones, K., Martin, P., Bywater, T., & Gwyn, R., (2007c) Early results from developing and researching the Webster-Stratton Incredible Years Teacher Classroom Management Training Programme in North West Wales. Journal of Children’s Services, 2 (3), 15-26.

Sutton, C., Utting, D. and Farrington, D. (2004): Support from the start: Working with young children and their Families to reduce the risks of crime and antisocial behaviour. Research Report 524. ISBN: 1 84478 203 4, London: Department for Education and Skills.

Scott S, Spender Q, Doolan M, Jacobs B, Aspland H. (2001) Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice. British Medical Journal 2001;323:194-203.

Webster-Stratton, C., (1994). Advancing Videotape Parent Training: A Comparison Study. Journal of Consulting and Clinical Psychology, 62(3), 583-593. The American Psychological Association, Inc. 

Webster-Stratton, C. (1996). Early Intervention with Videotape modeling: programs for families of children with Oppositional Defiant Disorder or Conduct Disorder Follow-Up of Children Who Received the Incredible Years Intervention for Oppositional-Defiant Disorder: Maintenance and Prediction of 2-year follow-up. In M. J. Guralnick (Ed.) The effectiveness of early intervention: Second generation research. 429-454. Baltimore, MD. Paul Brookes. 

Webster-Stratton, C. & Hammond, M. A. (1997). Treating Children with Early-Onset Conduct Problems: A Comparison of Child and Parent Training Interventions Journal of Consulting and Clinical Psychology, 65(1), 93-109. 

Webster-Stratton, C. (1998a) Parent training with low income families. In: Lutzker (Ed) Handbook of Child Abuse Research. New York: Plenum Press.

Webster-Stratton, C. (1998b) Preventing conduct problems in Head Start children: Strengthening parenting competencies. Journal of Consulting and Clinical Psychology 66 (5) 715-730.

Index to appendices

Appendix A Charitable Objectives - Incredible Years Cymru
Appendix B Background to the programmes in Seattle and Wales
Appendix C Incredible Years Wales publications list
Appendix D North Wales Sure Start outcomes

Hutchings, J., Bywater, T., Daley, D., Gardner, F., Whitaker, C., Jones, K., Eames, C., & Edwards, R.T. (2007). Parenting Intervention in Sure Start Services for Children at Risk of Developing Conduct Disorder: Pragmatic Randomised Controlled Trial. BMJ, doi:10.1136/bmj.39126.620799.55

Hutchings, J., Bywater, T., & Daley, D. (2007) A Pragmatic Randomised Controlled Trial of a Parenting

Intervention in Sure Start Services for Pre-School Children at Risk of Developing Conduct Disorder: How and why did it work? Journal of Children’s Services 2, 2, 4-14.

Bywater, T., Hutchings, J., Daley, D., Whitaker, C., Yeo, S. T., Jones, K., Eames, C. and Tudor-Edwards, R.. (submitted) Long-term effectiveness of a parenting intervention in Sure Start services in Wales for children at risk of developing conduct disorder.

Gardner, F., Hutchings, J. & Bywater, T. (submitted) Who benefits and how does it work? Moderators and mediators of outcome in a randomised trial of parenting interventions in multiple 'Sure Start’ services.

Appendix E Report in the initial year of WAG funding 2006/7 and survey of programme use by staff trained in 2006/7
Appendix F Report on 2007/8 funding and details of funded work for 2008/9
Appendix G Paper on preliminary outcomes from teacher classroom management trial
Hutchings, J., Daley, D., Jones, K., Martin, P., Bywater, T., & Gwyn, R., (2007) Early results from developing and researching the Webster-Stratton Incredible Years Teacher Classroom

Management Training Programme in North West Wales. Journal of Children’s Services Vol 2 (3), 15-26.

Appendix H Summary of the WAG funded trial of the IY toddler programme
Appendix I Summary of outcomes from the WORD funded looked after children research project.
Appendix J References to the IY programme in the Parenting Action Plan for Wales 2005
Appendix K Leader accreditation information
Appendix L Article on Dinosaur School programme in Gwynedd schools

Hutchings, J., Lane, E., Ellis Owen, R. & Gwyn, R. (2004). The introduction of the Webster

Stratton Classroom Dinosaur School Programme in Gwynedd, North Wales. Education and Child

Psychology, 21 (4)  4-15.

Appendix M Diagram showing the range of IY programmes and details of their curricula
Appendix N Summary of NICE guidance on parenting interventions for the treatment of conduct disorder in children
Appendix O Article on developments in Wales published in Agenda the Journal of the Institute of Welsh Affairs in Winter 2007